Parrish Medical Center Case Study—Driving Patient Flow Improvements in the midst of COVID-19

Health systems have been heroic in their response to the COVID-19 pandemic—caring for patients, keeping patients and families connected without in-person visitation, and keeping up the spirits of their teams during these difficult circumstances. And as elective surgeries resume, teams are also helping drive efficiency in the operating room.

Parrish Medical Center recently shared their five-year patient flow journey via webinar—and their phased approach to addressing critical issues along the care continuum is a recipe for success. It is also a testament to Parrish Medical Center’s commitment to People (PMC Care Partners), Process (Lean Six Sigma), and Technology (including TeleTracking and other critical solutions)—and the team’s ability to scale and deliver meaningful outcomes that matter.

The Launch of Mission Control

Parrish Medical Center, located on the Florida Space Coast, is a 210 bed, not-for-profit hospital, serving 100,000 residents. In 2015, a team was assembled, and a patient throughput project was launched, to address decentralized workflows, manual processes related to patient movement, and little to no visibility into bed capacity and equipment utilization. The team’s primary goal was to achieve zero preventable harm, become more efficient and ensure care in a timely manner. This meant a few things:

• centralizing the patient placement function
• leveraging interfaces to ensure information was flowing between systems and available to those who needed access to it
• automating manual workflows, such as notifying environmental services that a room is ready for cleaning
• centralizing patient clinical data
• having access to real-time, actionable, and meaningful data to see where opportunities for improvement existed

The team was so committed to the project that they created a mission statement that supports the organization’s mission of “Healing Experiences for Everyone all the Time.”

The purpose of Parrish “Mission Control” is to coordinate safe and efficient person-centered movement across the health care continuum, using the Five Rights of Patient Placement: Right Bed, Right Level of Care, Right Method, Right Time, Right Now.

The patient logistics center or “Mission Control” was also considered the foundation of an overall throughput improvement plan to coordinate that type of safe, efficient movement across the healthcare continuum—and so in September 2017, Parrish Mission Control opened just as Hurricane Irma was bearing down on the coast.

And, in 2018, the team set out to address two additional patient flow obstacles:

1. Automating and expediting notifications to environmental services and patient placement when a patient is discharged to eliminate what some refer to as ‘dead bed time’—accomplished with Real-Time Locating System (RTLS) technology and the badging of patients upon admission, and the removing of the badge upon discharge.
2. Addressing patient flow challenges by tracking patients, staff, and procedures in real-time. TeleTracking’s Clinical Workflow Suite solution went live on May 7, 2018—a day often referred to as “Cold Turkey Tuesday”—because the old-school whiteboards came down, and the digital whiteboards went live. With the launch of TeleTracking’s peri-operative solution, the team had complete transparency and visibility into the status of patients in the peri-operative suite—eliminating the need to make multiple phone calls and/or have people coming in and out of the operating rooms to provide updates.

For operational changes like this to be effective, cultural change is critical. And with any change, some were skeptical, while others were fully supportive of the new way. Once live, it only took a few hours for the team to become engaged with the technology—and confident in what it could do to help the perioperative area run more smoothly. 

Transparency, Visibility and Managing COVID-19

The transparency and visibility generated by Parrish’s “Mission Control,” along with the benefits of the RTLS technology and the solution in the perioperative space helped—and is helping—as Parrish manages the COVID-19 crisis. Like many health systems across the U.S., Parrish Medical Center started preparing for COVID-19 patients in January by establishing a multi-disciplinary planning team and an incident command center. The team activated their plan in mid-March—which included turning ICU rooms into negative pressure rooms, creating ICU beds in the perioperative and med-surg areas, and converting half of the ICU beds into a COVID-19 ICU.

Also like many health systems in the U.S., in March, all visitation and elective surgeries were cancelled. However, looking to the future, a multi-disciplinary group started looking at how to reopen elective surgeries. 

A key safety measure tied to the reopening involved testing every person coming into the facility.  And by utilizing custom patient attributes in TeleTracking for COVID testing, the team could quickly see pending, negative or positive patients.

Also tied to testing, is the normal, pre-admission process. Typically, 60-70% of patients have this assessment in person—but currently, to reduce risk, all testing is done via phone or virtually, with a few exceptions. In fact, the team came up with a risk stratification to help guide their reopening, broken down by healthcare service type:

• Telehealth/phone visits have no risk, and includes new patient visits, routine check-ins and activities where an in-person appointment or presence is not required.
• Social distance, in-person, non-surgical visits have low risk and includes activities that need to be done in a healthcare setting, yet do not require being within six feet of a patient.
• Non-social distance, in person, non-surgical visits have medium to high risk and includes activities that need to be done in a healthcare setting and requires being within six feet of the patient.
• Elective surgery, invasive or aerosol-generating procedures have the highest risk and include any surgical, invasive or aerosolizing activity that can be scheduled.

Rethinking Perioperative Processes

The objective of reducing the risks associated with COVID-19 also had the team rethinking their peri-operative processes. For example, pre- and post-operative areas previously had “pods,” which consisted of four bays. Historically, patients were placed in two or three pods, which meant three or four patients were located in one spot—making it convenient for the nurses and physicians to manage care.

Now, that type of closeness is not conducive to social distancing. So, the team redesigned the workflow of these areas, utilizing the full range of space. This provides the necessary social distancing—and because the same spaces are being utilized for pre- and post-operative care, one nurse can care for these patients pre- and postoperatively. This change offers multiple benefits, including less exposure, more effective staffing, improved transitions, and improved continuity in care. In addition, by using RTLS badges on patients, which are dropped in a box when the patient leaves, environmental services is automatically notified that the bed is ready to be cleaned, that a special clean may be necessary, and eliminating dead bed time [the time the patient actually leaves their bed to be discharged until the time EVS is notified to begin cleaning the bed]—saving 270 patient days to date.

In Conclusion

The team at Parrish Medical Center has been successfully managing multiple priorities—focusing on COVID-19, ensuring they have surge capacity and the appropriate care environment for those patients, and simultaneously managing and monitoring the population they typically serve. And they have been able to do this successfully with the combination of their centralized “Mission Control” and technology in the perioperative area—providing the best care for patients and the best working environment for caregivers.