Re-Visioning Bed Management at South Florida’s Memorial Healthcare System
Late last year, leaders at the six-facility, 2,200-bed, Hollywood, Florida-based Memorial Healthcare System developed and implemented a forward-looking strategy centered around a system-wide care coordination center. The health system’s leaders unveiled its Care Coordination Center, an actual command location that is coordinating interfacility transfers, managing bed capacity, and floating pool staffing needs in real time, while also implementing virtual care models. The $1.7 million, 3,000 sq. ft. facility incorporates Epic EHR technology for patient flow and the AI-driven Virtual Nursing solution from the Chicago-based ArtSight, among other innovations, and is already becoming a gamechanger not just for patients and families, but Memorial’s clinical staff as well.
Among the key features of the initiative:
• Transfer Center Coordination: The CCC streamlines inbound and outbound interfacility transfers, optimizing patient placement and flow. Patients from emergency departments will be efficiently transferred to Memorial facilities with available beds to accelerate patient care.
• Centralized Bed Placement & Capacity Management: Dedicated patient flow expediters oversee bed assignments, maximizing capacity and improving patient transitions.
• Centralized Staffing: By creating a centralized resource pool for all staffing needs, the health system’s leaders have improved management, fostering collaboration across departments, and allowing nurses and other healthcare professionals to be assigned based on acuity and need.
• Virtual Patient Observation: A dedicated team assigned to designated adult patient rooms is using advanced technology to virtually monitor patients who are at high risk for falls, ensuring immediate intervention and reducing incidents.
• Virtual Nursing Initiative: The Virtual Nursing program that launched late last autumn at Memorial Hospital West is enhancing operations by allowing nurses to virtually handle admissions, discharges, and patient education, freeing bedside nurses to focus on direct patient care.
Enhanced Operations and Real-Time Monitoring: The CCC employs a centralized methodology of capacity management across Memorial’s six acute care facilities. By utilizing people, technology, and standardized processes, the CCC ensures timely access to care for our community. Dashboards in the center provide an at-a-glance view of real-time capacity and patient flow operations, assisting staff in identifying and removing barriers to patient care, such as discharge delays and bed turnover.
Per this ambitious initiative, Healthcare Innovation Editor-in-Chief Mark Hagland spoke recently with Jeffrey Sturman, Memorial’s chief digital and information officer for the Memorial Healthcare System and for the associated South Broward Hospital District. Below are excerpts from their interview.
How long have you been CIO, and when was “digital” added to your title?
I’ve been CIO for nearly seven years now; and the “digital” element was added to my title about four years ago. Altogether, across two stints, I’ve been a part of the organization for 18 years.
How big is your IT team?
About 420 staff members.
And you have a slightly complex organization, correct?
Yes, we are a community-based public, safety-net health system with a seven-person board appointed by the governor.
What was the origin of this current initiative?
We’ve always had an efficiency in our ability to manage patients across six hospitals. We’re six hospitals in a fairly tight geography. We have five acute-care hospitals and one children’s hospital. But the five acute-care hospitals working collaboratively as a healthcare system, has only really been fully so for the past several years. Historically, those acute-care hospitals really acted somewhat independently from one another. So in order to triage patients across the system and operate more efficiently, we needed some kind of command center. And a combination of people—clinical, operational, and technical—all came up with this. And as a consultant, I had led teams across the country to implement command centers.
What’s been the timeframe for the development of the initiative?
I conceived it in 2019-2020, just before the entire country shifted because of COVID. So it was put on hold. In the summer of 2022, we went back and moved forward actively with this. And I went back and looked at command centers across the country—Johns Hopkins, Tampa General, I had a conversation with Yale Health System. And Judy Frum, and other clinical leaders. I said, oh, I’ve had that experience before as a consultant. And in the summer of 2022, we started to lay the foundation with our executive team as to the value we could achieve, and why it was important to achieve system-ness, put together a budget, and find space. So I freed up space in my data center. And that’s where we started and have gone live. It’s very innovative, and leveraging space. This is offsite at my data center location in Pembroke Pines.
How many individuals are working in that data center?
About 25-30 people. And that’s a combination of jobs and functions. Historically, the biggest part of this group has been the Transfer Center, which we’ve had at Memorial for a number of years, helping to transfer patients out of acute care to post-acute care or home. That transfer center was not run in a great way previously; now, all those resources are run together in a coordinated way, and they’re the biggest group in the command center.
We also manage bed capacity. And historically, all six of our hospitals had bed placement done by a small group of managers in each hospital. They’re now all together, about eight team members, working out of the Care Coordination Center.
So you’ve gone from non-managed to fully managed bed capacity, then?
That’s exactly right. It’s no more post-its on people’s computer screens any longer. We have huge dashboards in front of everybody; we have three big screens on our managers’ desks, so they really can get a better sense of how and where things are; things are color-coded; it looks like a NASA command center. We use Epic for bed placement, management, and capacity management. But the bias was, I cared about my own facility; now, I care about the entire system. I’ll get stats for you.
The other big group is a very clinically focused group, and that is the people actually monitoring on video screens, virtual patient observation and virtual nursing, and they’re watching inpatient rooms to see how patients are cutting down on sitters—health systems use a lot of sitters. We have these virtual patient observation managers, nurses. Twelve patients are being monitored by these nurses.
And they can say, “Mr. Jones, please don’t get out of bed right now,” and can call a nurse onsite to avert a patient fall, for example. And the AI functionality can identify based on movement of a patient in a bed, red, yellow, or green, whether a patient’s movement suggests a patient trying to get out of bed, and they can notify the nurse on the floor immediately. So it’s a combination of a real nurse on the floor, a virtual nurse in our care coordination center, and AI. The AI activated a few weeks ago. But since the implementation of those virtual observers, we’ve had not one fall. You know how costly, both clinically a patient fall can be, but costly from a wellness perspective.
Have there been any challenges?
The biggest challenge has been that this represented a change in workflow, so just getting the workflow down between the care coordination center and the hospitals, was a challenge. The hospital people are learning and the care coordination center are learning the people in the hospitals. And then the communication process has changed. It’s far more efficient. We’re already seeing the turnover of beds happening much more quickly. Patients moving from the ED to the inpatient bed, we’ve already seen a gain there. Discharge delays and bed turnover, all of those things from a capacity and a patient flow perspectives, that’s the why behind the whole care coordination center.
It sounds like a win-win for everyone, because you’re moving patients to discharge, who are ready, correct?
Yes, if we can achieve better throughput, that’s great.
What have been the biggest lessons learned so far on this journey?
These are complex processes that we’re pulling together, and it really does take a team of people. This may have been in some small part my vision as the CIO; but I always say, you have to get your clinical leadership involved early. I was very conscious of this. When we had the ribbon-cutting a month ago, I was there as support. I want the clinical operations leaders out in front and owning it. I don’t want this to be seen as an IT project; it has to have ownership on the part of the clinician leaders as sponsors.
Is there anything you’d like to add?
The investment here is not small. And we will outgrow our space in our data center. We have plans to leverage this at a future level of additional use cases. So we need to invest further in this; and if you don’t invest at the right level, these initiatives won’t be successful. Some people will be tempted to do this on the cheap, but to be successful, this requires a pretty big investment. But I really do think this is a competitive differentiator for our market.
