Sustain the Gain

Nov. 1, 2006

Midwest healthcare system achieves demonstrated efficiency and quality improvements with an automated bed management system coupled with wholly redesigned internal processes for using it.

Oftentimes, a phrase like, “…and patient care improved dramatically” is sandwiched into the recounting of a healthcare organization’s positive experience with information technology, but without much to justify its presence. Making a real dent in the quality of healthcare delivered to patients is, most often, not the result of simply deploying IT. Rather, it results from larger scale organizational changes in strategic planning, process improvement and training coupled with IT—and none of those occur without a lot of forethought and elbow grease.

Midwest healthcare system achieves demonstrated efficiency and quality improvements with an automated bed management system coupled with wholly redesigned internal processes for using it.

Oftentimes, a phrase like, “…and patient care improved dramatically” is sandwiched into the recounting of a healthcare organization’s positive experience with information technology, but without much to justify its presence. Making a real dent in the quality of healthcare delivered to patients is, most often, not the result of simply deploying IT. Rather, it results from larger scale organizational changes in strategic planning, process improvement and training coupled with IT—and none of those occur without a lot of forethought and elbow grease.

In Peoria, Ill., OSF Saint Francis Medical Center knows that firsthand. OSF Saint Francis is a 710-bed tertiary referral center and teaching hospital, and is the flagship of the six-hospital Order of Saint Francis (OSF) HealthCare System. It is also a Level-1 trauma center with more than 62,000 emergency visits per year. Like in many other hospitals, patient backlogs due to inpatient bed availability forced medical staff to divert emergency patients to other emergency rooms. On the best of days, getting a patient into the right room at the right time in a way that maximized all existing resources—beds, rooms, emergency facilities, nursing staff, transport staff and specialized intensive care units, to name a handful—was a challenge.

Today, it is different: OSF Saint Francis uses an electronic medical record for clinical charting and automated capacity management for patient flow and bed management. Today the organization plans for beds that will be needed tomorrow and the next day, not just in the next hour. Today, no full-time nurse roams the halls looking for available rooms and no one person sits on the phone all day, managing incoming requests for patient beds. Now, everyone involved in getting patients into the right rooms at the right times is on the same page because they share electronic and real-time data.

Getting to that point, however, required both process improvement and automation.

Starting With Six Sigma
Six Sigma was the approach OSF Saint Francis chose to analyze and tackle numerous issues, dating back to 2002. In fact, OSF HealthCare adopted Six Sigma enterprisewide just this year.

“Like many hospitals,” says Hoa Cooper, R.N., operations manager, adult hospitalist service, “OSF Saint Francis has challenges of constraint and restraint. Our physical facilities are limited to what they are. Staffing is always a hurdle. Reimbursements are shrinking, and patients come into the hospital far more educated about healthcare than in the past. Healthcare changes rapidly, yet most facilities are bound by their physical, financial and even philosophical limitations. We all want to provide better care, but we all experience constraints.”

Any organization can attempt changes, and some can even generate improvements, but how to “sustain the gain” over the long term was OSF Saint Francis’ underlying goal. In 2002, the organization adopted a Six Sigma approach, identifying at the outset five burning-platform issues to be addressed. Staffing was a critical one; bed management was another among the five; so was overcrowding in the ED. In fact, during one 12-month period at OSF Saint Francis, ambulances had been diverted to other hospitals 149 times.

Cooper says, “We were new at Six Sigma, so we brought it first to the ED to address overcrowding. We soon realized, though, it’s not just an ED problem. Even if we fixed overcrowding in the ED, we would still lack hospital beds for patients who needed them.” Next, the Six Sigma team focused on the hospital’s discharge-by-noon initiative, designed to discharge patients earlier in the day to make more beds more available by early afternoon, but that initiative only led the team deeper into process analysis, and into admissions, where they identified myriad problems.

OSF Saint Francis collected a lot of patient data, but didn’t have one proven way to communicate it to everyone. No one seemed to know, at a given time, exactly how many patients were in the hospital, how many were expected and if beds were or would be available. “We had multiple processes in place; as a result, no one was dealing with the same information at the same time,” says Cooper. “The admissions process was inconsistent, and often depended on where a patient entered into the system.” Those charged with transporting patients also had efficiency hurdles; they used a manual system, picking up a paper transport order, transporting the patient and then having to return the paper order to the transport station, signed as completed.

Deliberate Due Diligence
Overall, the group identified five major problems with its mission to better manage patient flow, largely focusing on admissions-related issues:

  • Communication regarding available beds was fragmented;
  • New technology was needed to predict and plan admissions;
  • The admission process was inconsistent across the enterprise;
  • The time gap between bed assignment and occupancy was too great;
  • Patient transport was too decentralized.

In deciding to pursue an IT-based solution for managing patient flow and bed availability, the Six Sigma group knew that OSF Saint Francis needed redesigned internal processes to support the technology, and also that adding software to the equation couldn’t put any more work on anyone’s plate.

Cooper says the group researched products from several vendors and favored most the Bed Management Suite from Tele-Tracking Technologies Inc. But before any contract was signed, hospital representatives performed aggressive due diligence with on-site visits to two different hospitals using the software to see it in action. They also conducted a cost-benefit analysis of the technology to accompany their recommendation to hospital administration to purchase it. The admissions analysis project began in December 2003, and OSF Saint Francis signed a contract with Tele-Tracking Technologies in December 2004 for the Bed Management Suite and the company’s TransportTracking for dispatcher-less transport management.

A Process to Support Software
Implementation began in January 2005 and took three months. Essentially, says Cooper, implementation went very smoothly. The only problem was a little leftover skepticism from clinical staff based on an earlier IT roll out.

Six months prior to implementation of Tele-Tracking’s capacity management system, OSF Saint Francis had implemented an electronic medical record (EMR) throughout the hospital and that project, as EMR implementations can be, was a multifaceted challenge for doctors and nurses. Clinical staff had barely returned their work lives to normal when the Six Sigma group introduced another IT implementation, this time for patient flow and bed management. Some staff thought, “Oh, no, not again.”

The roll out, however, went just as planned; new software and new internal processes worked together like hand-in-glove. As part of its redesigned processes, OSF Saint Francis established a new patient logistics department to consolidate bed management and patient placement. The department’s primary function is to monitor bed status across 26 separate nursing units throughout the hospital via use of the electronic bed board displays and to address throughput issues before a patient is discharged. Noting a pending or confirmed discharge of a patient on a color-coded electronic bed board lets a patient logistics coordinator plan to reoccupy that bed even before it is vacated or the room is cleaned.

The entire logistics process is monitored in real-time on strategically located flat screen video displays, so staff in ED, intensive care and other units are constantly updated on bed availability. At any point in the day, a patient logistics coordinator knows the exact status of each hospital bed and can anticipate when beds will become available.

Since throughput involves a continuous critical path of patient transfers between the emergency department, PACU (post-anesthesia care unit), ICU (intensive care unit) and step-down units, backlogs at any point can cascade, causing the whole system to bog down, without the right IT in place to support the process. The centralized concept permits better monitoring of ICU cases, for example, that could be moved to a step-down unit, allows prompts for timely discharge, transport, cleaning and all other capacity management functions.

Technology provides a seamless flow of communication among many disparate departments so that each step in the process is addressed. This data stream makes the information transparent to each individual who is involved, allowing individuals to be more accountable for their separate roles and simultaneously allowing all the players in the process to perform their roles in sequence without delay or disruption.

Conquering Implementation
A successful marriage of new software and new process, says Cooper, depends on blending the two with a right combination of factors. “We trained our staff on the new processes first,” she says, before introducing them to the software. After everyone understood the new process, Tele-Tracking sent in training experts to work with staff and stay on-site during the go-live week.

“Tele-Tracking has its own best practices in place for use of the technology,” says Cooper, “but we customized them specifically for OSF Saint Francis, and then Tele-Tracking customized the technology to wrap around our new processes. They came on-site to train, and we had scheduled conference calls with them once a week, too.”

Today, streamlined processes for patient logistics have one FTE per shift managing all the bed placement. The Tele-Tracking system is interfaced with the hospital’s EMR. All preregistrations come through the system so staff can review planned admissions and anticipated discharges and can project capacity for at least tomorrow and often beyond.

Cooper says that awhile back, OSF Saint Francis had to take the Tele-Tracking system offline for about six hours while IT staff upgraded the system, and she heard complaints. “Everyone wanted the automated bed management back right away.”

Measures of Success
Atlanta-based management consulting firm Maestro Strategies LLC, which specializes in technology-driven change, conducted an independent third-party analysis to evaluate the medical center’s return on investment and notable gains achieved that could be sustained.

The analysis revealed that redesigning and automating the fragmented processes of patient throughput allowed OSF Saint Francis to project an internal rate of return of 180 percent during the 12-month period.

Diversions to other hospitals have been dramatically reduced by 75 percent, says Cooper, giving more patients access to the skilled expertise of a Level-1 trauma center. The resulting admissions have added more than $287,000 in contribution margin (net revenues less direct expenses) in the first year. In addition, Cooper says OSF Saint Francis does not divert any ambulances now. It may occasionally divert planned and future admissions, but that, she says, is a matter of instructing a patient not to arrive; it is not turning away an ambulance patient.

OSF Saint Francis has saved more than $300,000 in personnel costs by reducing (through redeployment) the number of staff needed to identify available rooms and manage their readiness. Today, one patient logistics coordinator at a time handles the function via automation.

The hospital has improved its discharge-by-noon rates by nearly 30 percent, vacating more rooms earlier in the day for reoccupation by afternoon; like most facilities, OSF Saint Francis continues to work on facilitating early discharges. Cooper says that intrahospital phone calls related to patient flow have just about stopped, since everyone who needs patient-flow data uses the electronic bed board. The need for daily bed placement meetings between charge nurses and clinical managers has been eliminated. The average turnover time for a patient room is now less than one hour.

The Institute for Healthcare Improvement has concluded that improper placement of patients has a significant impact on mortality rates. For the first seven months following installation of the Tele-Tracking’s system, the medical center’s ICU mortality rates dropped from 8.84 percent to 5.84 percent from the same period the previous year.

With Maestro’s assistance, the hospital also measured staff satisfaction by conducting a written survey of 26 charge nurses who play a critical role in patient flow on the units as well as the ED and PACU. The results showed that 93 percent believed the new bed management process made admitting easier; 88 percent believed placement times had dropped, and the same number agreed that rooms were being turned over more quickly. Finally, all 26 nurses agreed that the new system gives everyone more accountability and assures more timely placements.

For more information about the Bed Management Suite and other solutions from Tele-Tracking Technologies,
www.rsleads.com/611ht-205

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