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LISTEN TIME | 18:31


On Part 2 of the two-part episode, we continue our conversation with Dr. Olusegun Ishmael (Dr. Ish), Vice President, Clinical Operations/System Associate Chief Medical Officer for Sinai Chicago. The state of Illinois has 40 safety net hospitals - representing 19.1% of the state's hospitals. Dr. Ishmael tells TeleTracking's Maria Romano how Sinai Chicago works to help serve vulnerable populations.

What you'll learn on this episode:

  • The roadblocks are safety net hospitals facing today(1:54)
  • The efficiencies and value of partnering with TeleTracking (7:18)
  • Launching a Command Center at Sinai Chicago (11:30)
  • The future of safety net hospitals (14:33)

Video: Watch the Conversation

Listen: Patient Flow Podcast

 

More about this episode

View Transcript

Maria Romano:

So Illinois, they have 40 Safety Net hospitals currently and they represent 19.1% of all the hospitals in Illinois. And they're a major source of medical care for low income, uninsured, and vulnerable populations. Can you explain, Dr. Ismail how you believe the Safety Net hospitals in Illinois are driving safe efficient care for these vulnerable populations?

Dr. Ismail:

So the interesting thing about Safety Net hospitals, we tend to be concentrated in specific areas. So either large, big cities, like you just said, underrepresented areas, poorer populations, rural settings. So areas where typically there would be maybe primary care sometimes, definitely very reduced number of access to specialty care. So those kind of situations then put the population at risk of not accessing care.

So for example, a patient who may be next to a super university hospital who has your neurobiology services, your pulmonology service down the stream, you'll be your Safety Nets who don't have access to those kind of specialties. So from my perspective, that's where the disproportionate services are there or aren't there.

Maria Romano:

Absolutely. Can you explain what you see as roadblocks that your experiencing right now in Safety Net hospitals that are preventing people to get access to care in your hospital right now? Can you just explain what you're seeing?

Dr. Ismail:

So I think we can divide it up into multiple factors. There's a national shortage of healthcare professionals. Nursing alone, there's a shortage of nurses in the country. I think as a nation we haven't prepared ourselves and the pandemic kind of exacerbated it. We haven't trained enough healthcare professionals. So for example, nurses have decided to work as we call agency or travel nurses and make two, three times as much as they would make if they were on staff at a hospital. It's simple supply and demand and we live in a capitalist society. So if I have an opportunity to make double what I'm making, why wouldn't I take that up? So one, is the nursing shortage is going to make it worse and it's harder for me as a Safety Net hospital to compete with a hospital that has deeper pockets. So if I'm paying premium nursing rates and another hospital can pay higher than me, guess where the nurses are going, they're going to shift to the higher paying facility.

It's human nature. I don't fault anybody for that. So that's huge. Competing against other hospitals in terms of nursing, now take the provider setting. A lot of people have chosen not to go into becoming a physician. So there are lots of specialties out there right now, which it's hard to recruit for. I have been trying to recruit for psychiatry for at least the last six months and getting perpetual roadblocks. And when you work in a Safety Net hospital, so I may be concerned about your hypertension, your diabetes, but if I am not treating your psychosocial issues at the same time and you have some behavioral health diagnosis that compounds your medical. So now we're trying to balance two issues, both your behavioral psychiatric issues with your medical, and if you're considering how do I even pay for my medication?

Where do I live? Am I living in a food desert? So those are kind of issues that I need to be able to address with having psychiatry on board. And if I can't even recruit psychiatry and I can't recruit cardiology and all these other specialties, and there's a wait list at other hospitals. So once again, delayed care and those other hospitals are not even accepting your insurance or if you have no insurance, which is ironical because behind me are two pictures of the Obama's.

Maria Romano:

Right? Right.

Dr. Ismail:

It's interesting, we're talking about access to care and that's one of his key cardinal legacies that he's left behind. So those are two areas. It's nursing shortage physician short. Then you take on top of it, we're living in a society now and where the economy is terrible all over the world, not just in the United States.

So people have resources that are being stretched to the limit. Just a few months ago people were talking about how do I put gas in my car? So people have to make a decision, Do I get to work? Do I come to the doctor's office? So that exacerbates it. So there's lots of multiple factorial issues. And then we now throw in how do you get reimbursed? And I know from a payer perspective, if you send in a claim and I feel like it's not a claim claim, I send it back to you to readjust the claim and every time it goes back, that's dollars that are being delayed in payments and there's a time factor to money.

So my dollar today, getting it two, three months down the line or even six months down the line, there's a time factor that I'm losing of, I still have to pay the staff, I'm paying premium to recruit nurses. I'm having to pay premium to maintain the staff that I have. So that factors all into it. So there are multiple layers and then we now have to pay some Covid monies back. That was helped to support a lot of our Safety Net hospitals and other hospitals. So it becomes a domino effect like you and I have said earlier. So then multifactorial issues at hand are in play right now.

Maria Romano:

So going back to the efficiency, that is really the first initiative that you have within hospital operations or absence of care, is efficiency with the turnover, with the turnover of the beds. And that really segues into the next question I wanted to ask you. How with the partnership with TeleTracking, right, that we did start working with your hospital organization, your entire system about a year and a half ago, two years. And can you describe how you feel that this partnership is very valuable in gaining more efficiency to ensure that the patients aren't waiting for the care that they need?

Dr. Ismail:

So it is interesting, our relationship started right in the middle of the pandemic. So it's kind of like speed dating, reintroduce each other. I say, Okay, let's try this again.

Maria Romano:

Yes, exactly.

Dr. Ismail:

But one of the interesting things, and I love analogies and I've given you this analogy, but to the audience, this is the analogy I use, is that I'm a mom-and-pop shop. I have a mom-and-pop restaurant. So comparing that to a bigger chain restaurant where I have 10 tables that I have to turn over and another restaurant which has more deeper pockets, nicer room, has 20 tables. I have to be able to turn around my tables quicker and faster than my competitor has. But I also have to maintain the service level. The food has to be good. My staff has to smile, but they still have to turn those tables over because while I have 10 and they have 20, I have to turn my tables over twice as many times as they have to maybe be able to maintain the 20:20 ratio.

And so that's an analogy I give everybody. I said, so using a tool like TeleTracking for us is my opportunity to make those beds turn over more efficiently. I need to know when patients are in, how do I get them into the bed quicker? And then when we've treated them, how do I get them home quicker? So every little step, So I use analogy also of when you get out of bed, tell me how you get out bed. When I used to teach residents and they said, "Well, I just get up". I said, "No, you sit up, you flip your feet off of the bed". I said, So there're little steps that you don't think about in the process of doing things. That's why I think a tool like TeleTracking helps us to do, so from the moment the patient enters the emergency room, I can track it.

How long do they stay in the emergency room? How long does it take for me to clean the room upstairs? How long does it take for somebody to take the patient from the ER to that bed? How long do they spend in that bed? And from each step of the way and the patient progression of care, I can track it and then begin to identify what is hindering that movement through the hospital. Is it environmental services? Is it not cleaning the room in a timely manner, Is it the nurses on the floor are not accepting the patients in a timely manner? Then I can work on those individual steps and then be able to go back to those individual leaders and say, Here's where we are today. Here's our goal and this is what we need to do to get to those goals. So that's where TeleTracking for me is helpful and especially since I come from a family of, my mom is a nurse, but my dad is an industrial engineer.

So it's all about processes and that's the way my mind work is, okay, how do we break down this process into its own individual steps? Being able to track that and from my healthcare perspective is being able to, it's like any other data, it's what are the vital signs of the patient? Blood pressure, heart rate, respiratory rate, and then being able to track it. So we have to be able to track the processes, the individual steps and the process. So that's where I look at TeleTracking being a very important tool in being the efficient, making our beds efficient or making the whole system efficient.

Maria Romano:

Well it's really been an honor to be able to partner with you throughout this time and especially watching the engagement from all of your leaders that are there. They want to improve this access of care. And I would love for you to talk about your command center that is led by the best person. I think I know, Sean [inaudible 00:11:05], right? And she holds people accountable. So can you just give us that insight for your command center?

Dr. Ismail:

So how command center, and we were at another hospital in the north on the East coast, Carilion. So compared to them, we're still in our infancy stage in terms of growth. But what it has done, I'll give you an example of how efficient. So I got a phone call on Saturday morning at 1:00 AM So we had accepted a case, an orthopedic case at 1:00 PM the previous day from another Safety Net hospital. And by 1:00 AM the patient has still not arrived. So our transfer center calls me saying, "Hey doc, what are we doing?" So then I had to reach out to that Safety Net hospital and escalate it up to their CEO to say, "Come on, well you need to move this patient."

 

But this is part of the issues in healthcare. They could not find an ambulance service to bring the patient over. So 12 hours later we're still waiting for the patient.

And so what we needed to implement now that we're implementing is that for our transfer center is to reach back out to them and say, if you are having issues getting the patient over, tell us what your issues are. Maybe we can't solve it because for example, in this case we had relationship with an ambulance service, we could have sent that ambulance service to go pick them up. So that's where our navigation center, our transfer center is really playing a key piece in helping those other Safety Net hospitals traverse the land mines that are being placed in their way in terms of getting quality access to care. So I have nothing but kudos to say to all transfers because she's like the patient that hasn't arrived, what am I supposed to do now?

Maria Romano:

Man, I could have drove from New York.

Dr. Ismail:

Exactly. 

Maria Romano:

But again, that's really scary because that's a landscape what's going on right across the country with transportation, with getting the patients out of the hospital. Level of care.

So this is a constant work in progress that you are doing with an entire team of people at Sinai Chicago that are so engaged with improving that access of care. So I'd like to kind of end our conversation for this podcast today on how the next step, I know you have thirty, sixty, ninety, a hundred twenty day goals. It's endless your goals that you have, but one of the goals as you talked about was making sure that you could partner with other Safety Net hospitals and you've agreed to have a talk with one in the area and possibly start to share data moving forward so you can load balance in real time using TeleTracking. So kind of just give us, as we're closing out here, what the vision is of what you want to see to ensure that patients in a Safety Net hospital are getting that access of care.

Dr. Ismail:

So my vision, high level vision is we all need to be interconnected in terms of knowing where all the beds are within our systems and in a way we're competing, but in a way we all have the same mission of providing quality access to care in a timely manner. So if we all know where all the beds are and we also know what the TeleTracking terminology that attributes of those beds, so can that bed take a certain patient at a certain time? And then also know the attributes of the hospital. What are the specialties you have? What are the specialties you don't have? So that way we can do something called an auto accept. So I just, the CEO that I escalated that case that I just brought up, him and I just sent him a text message. I say, Hey, we need to get to a point where we can auto accept cases.

I know you don't have orthopedics, but if you know I have a bed and I know you need an Ortho case, then my doctors will auto accept. So it's no longer a need for them to just get on the phone and start arguing back and forth for hours. It's simply, we've auto accepted the case, the criteria set, you will know from your command center and my command center where all the beds are, you know I have an Ortho bed that meets the patient's criteria. I have my doctors who already auto accepted, so we're not delaying care. So the minute that patient hits your emergency room, hip fracture is going to Sinai Chicago because it meets the attributes. You know on your monitor that I have orthopedic beds available. So the minute the vital signs are taken, baseline labs are ordered. You call my transfer center and say, Hey, I know you got a bed on two North, that's an orthopedic bed. We're sending this patient over to you guys, notify your orthopedic surgeon.

Maria Romano:

Perfect. Yep.

Dr. Ismail:

Perfect scenario.

Maria Romano:

Well the patient right, is not going through hoops?

Dr. Ismail:

Exactly.

Maria Romano:

To the care that they need to have and TeleTracking and partnership with your Safety Net hospitals can produce this and it's all about the patient.

Dr. Ismail:

And you hit on the nail on the head. So it's not only just a quality issue, but it's a patient satisfaction. So can you imagine, so the last patient we were talking about 80 year old female who was laying in an ER in the inner city of Chicago for over 12 hours. Can you imagine if she was in that ER for under an hour and in my O.R. within a two three hour period, had her surgery, then she's in rehab within the next day, how happy she would be.

Maria Romano:

Yes, with any type of incidences occurring, you're reducing that risk from that quality of care issue, but also you're decreasing your length of stay immediately.

Dr. Ismail:

Exactly.

Maria Romano:

The appropriate placement without having to wait. So the burden, right, and the financial obligation, it will decrease.

Dr. Ismail:

Exactly.

Maria Romano:

Because that length of stay is decreasing, but more importantly it's about the quality of care. Quality of care produces less time needed in a hospital stay. Right?

Dr. Ismail:

Right. Yeah, we all know that the longer you stay in the hospital, the more risk for infections , all the hospital acquired conditions. So it's just overall better patient care. And I'm going to use a term, customer satisfaction.

Maria Romano:

This has been the Patient Flow podcast powered by TeleTracking, your source in insightful conversation with industry leaders making a difference with patient flow today.

 

More information about this resource

Categories
COVID-19, Client Success, Patient Throughput, Patient Discharge, Disaster Readiness
Media Type
Podcast
Roles
Clinician, Executive, Administration

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