University of Alabama Patient Progression Initiative
Challenge
In an era of decreasing revenue reimbursement and rising human labor costs that often result in decreased capital funds it is critical for healthcare organizations to identify opportunities which would enhance processes and technology, as well as improve the effectiveness of current operations to increase capacity without a significant drain on capital. The University of Alabama at Birmingham Hospital (UABH), Birmingham, Alabama, an internationally renowned academic medical center in the southeast United States, recognized and heeded the urgent call to improve daily operations directly related to patient throughput to yield increased capacity.
In collaboration with Stockamp and Associates, Inc., an assessment of operations and capacity statistics was completed as part of the Patient Progression initiative and a proposal submitted that UABH could increase patient capacity by four percent (4%) without submitting a Certificate of Need (CON) application for additional beds. It was determined, fairly quickly, that the most benefit to be gained existed in the processes surrounding patient flow through the system, beginning with the management of one of our most valued assets, inpatient beds. The initiative comprised of the creative implementation of technology, an electronic bed board, coupled with enhanced processes and team collaboration from physicians, nursing services, environmental services, patient accommodations, and patient escort that would aid in more efficient management of the current complement of 908 licensed beds.
LEVERAGING TECHNOLOGY The bed assignment processes prior to the project initiatives consisted of
- a paper “bedboard” utilized to manage 779 acute medical-surgical, psychiatric and inpatient rehabilitation beds and assist with patient placement of 129 intensive care units (ICU) beds,
- multiple telephone calls to and from nursing units to inquire about bed status and request beds for admissions and notification of dirty-bed status to Environmental Services (EVS) and Unit Support Specialists (USS) via phone or paging;
- each resulting in untimely patient placements and poor coordination of resources which ultimately led to an average of 3,140 diversion hours per year.
To improve the bed assignment processes, the organization needed to obtain automated technology that could eliminate the manual notification, decrease phone call queries, and allow end-users to have a real-time view of patient capacity. In addition, the technology selected would have to be implemented with process redesigns spanning from patient accommodations to each nursing unit, and would require user buy-in at all levels, administrative support, and an organizational culture shift for success.
Solution
PRODUCT SELECTION In the process of determining what technology would be right for the organization, based on existing Information System (IS) infrastructure, organizational culture, and ability to implement, a multi-disciplinary team comprised of representatives from nursing services, environmental services, patient accommodations, patient escort, IS and administration assessed bed management products available in the current market. The group developed criteria for evaluating the products by starting with an aggregate list of “required fields” that each product would have to offer. In addition, the group identified a list of technology features (bells and whistles) that were preferred by the end-users. Examples of the criteria used to evaluate potential products included the following:
- Ability to identify capacity statistics and patient information such as admissions, discharges, room information and basic patient demographics through Admission/Discharge/Transfer (ADT) interface capability
- Ability to support multiple users logged in concurrently at multiple sites
- Ability to dispatch patient escort
- User-friendly interface
- Real-time notification to EVS/USS regarding bed status
- EVS/USS workdriver system
- Multi-level performance tracking report package
- View of house capacity in one-screen/scroll view
- Ability to view, track and provide through client workstations:
- Current bed status
- Pending admissions
- Transfer requests
- Off-service placement
Once the selection committee narrowed the products to two potential options, vendor demonstrations were scheduled for hands-on trials for the intended end-users to make final recommendations. Based on the criteria assessments and product trials, a final product marketed by TeleTracking™ with two separate modules; BedTracking® for environmental services and Transport Tracking™, and PreAdmit Tracking™ for Patient Accommodations was recommended as the product of choice.
The selection committee then presented final recommendations to the Executive Leadership and Clinical Advisory Groups responsible for oversight for the Patient Progression initiative. With the approval of the recommendation and the commitment to provide the necessary funding for the technology, the Executive Leadership set forth a very aggressive implementation timeline to ensure that return on investment would begin at least half way through the planned project engagement of eleven months. The vendor reported that the proposed installation timeframe was one of the most aggressive of any of the installations (more than 800 facilities) to date, but agreed to the timeline. Given such an aggressive timeline, to ensure project success, the Executive Leadership team allocated IS resources that included a project manager, as well as the necessary support to interface with the vendor to complete the product installation within the established timeframe. In addition to the IS resources, the installation team consisted of the Patient Accommodations Manager serving as team leader and the Administrative Director of Patient Progression serving as team administrator responsible for escalating technical issues and process barriers that required administrative or clinical intervention. With the product approved, expressed vendor consent, and a signed contract it became clear that constant, effective communication with follow through would be the most beneficial attribute of the installation team.
PROCESS REDESIGN With the installation of TeleTracking™, the initiation of a complete redesign of patient placement operational processes was required to maximize the benefits of TeleTracking™ within the Patient Accommodations Department. Pre-implementation work teams were established to collect and collate the required, specific information about the organization’s bed capacity, nursing unit structure, end-user and bed attributes, etc. for data entry into the new system. Security access levels within departments, user templates, user identification, and training schedules were developed to ensure a smooth implementation. Additionally, an IS support model was developed to outline the responsibilities of various departments to maintain and update all aspects of the system - from creating new users to creating additional beds and modifying nursing unit complement.
Significant process changes occurred within the Patient Accommodations Department; key operational processes had to be completely redesigned to incorporate the use of TeleTracking™. Based on the ease of locating available beds and pending confirmed discharges/transfers by unit, staff allocation was revised to maximize productivity. The ability of TeleTracking™ to filter and sort by various views, has allowed the Patient Accommodation staff to individualize, streamline and organize their on-screen work assignments, which has greatly decreased staff frustration with spending valuable time sorting through stacks of paper to find information concerning complete/incomplete bed assignments and current bed status to answer questions from callers inquiring about bed status. The ability for each staff member to update/create pre-admissions, view other co-workers worklists and completed patient assignments has resulted in decreased reliance on verbal communication of pertinent information to appropriate co-workers and increased efficiency when interacting with customers concerning patient placement. As a result, communication within the Patient Accommodations Department has greatly been enhanced with the use of TeleTracking™.
The availability of real-time information provided by TeleTracking™ has positively impacted work performance. Prior to installation of TeleTracking™, multiple phone calls had to be made to the nursing units to check the bed status, verify discharge/transfer orders, and confirm if a patient had physically vacated a room before admitting a new patient. This process often involved messages being left for the appropriate nursing staff to call back, resulting in extremely long wait times. The implementation of an ADT system interface has provided automatic updates to the bedboard™ regarding patient discharges and transfers on the nursing units. As well, predicted discharges for each nursing unit (ICUs excluded) are now provided daily through a collaborative process involving the Care Managers, Social Workers and patient care team via the ADT interface. The predicted discharges are used by Patient Accommodations to proactively manage inpatient beds for pending admissions and next day scheduled surgeries by providing future potential census information.
Process redesigns for the departments of EVS and USS staff were key to success. Existing processes relied on manual communication via pagers that patients were discharged and being escorted from the room to the discharge area by USS or patient escort staff. The EVS/USS staff would then report to the room and begin cleaning. In the absence of automatic paging, the EVS/USS staff were reliant on communications from multiple sources that rooms were ready to clean; a system that was inherent to numerous delays. Without the technology to track time to respond to a room clean request or the time required to complete a room clean, the management teams did not have adequate outcome data to hold staff accountable and to make process improvements.
The dial-in module of BedTracking® allows patient escort or USS staff to dial in from the patient’s room at the time of departure. The dial-in automatically pages the EVS/USS staff zoned to that area to begin a room clean. Upon arrival to the dirty room, the dial-in process for the EVS/USS staff triggers the room to “In Progress”, which converts to clean status when staff dial-in at the completion of the room clean. Each step of the process – dirty, in progress and clean – are visible in real time on the bedboard that is viewed by Patient Accommodations and available to the nursing units and administration for viewing at all times. The data provided to the management teams has proved invaluable in improving staff productivity, response times, and total room turn-around time. The built in escalation pages to managers when staff fail to respond to a room request adds to the accountability. The total impact has been a significant reduction in room turn-around time and the provision of operational data to support an organizational decision regarding the staffing structure that will best support optimal room management.
Patient Escort’s processes were revised to include the dial-in steps to initiate the paging process for notification that a patient had vacated a room and the room required cleaning. The process change for the patient escort staff was minimal and initially considered to be needed primarily for the purposes of starting the paging notification process. However, the organization soon realized operational improvements for the Patient Escort department that proved beneficial to the entire patient flow through the system.
Results
PROJECT SUCCESS The current success that our organization is realizing from this initiative is attributable to multiple factors and players. One critical element, executive support, both, administrative and clinical, probably outweighs all other factors combined. UABH’s administrative and clinical leadership recognized the importance of increasing patient capacity without tapping the political CON process or further accessing capital for physical expansion. Every step of the process from technology assessment to post-implementation monitoring has been under the guidance and direction of two leadership oversight groups, the Executive Leadership and the Clinical Advisory Group. The Executive Leadership served to ensure that all decisions related to the project were financially sound and operationally feasible. The Clinical Advisory Group validated that decisions regarding processes and technology intended to enhance patient flow through the system would not negatively impact the quality of patient care or create patient safety issues.
Benefit
Reductions in bed assignment and room turn-around times, improved patient discharge transportation times and fewer cancelled trips, decreased incoming and outgoing call volumes for patient accommodations and decreased hours on diversion have yielded enhanced patient throughput, increased patient/family and employee satisfaction and enhanced financial performance from incremental capacity created.
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University of Alabama-Birmingham Hospital
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