Be proactive, expect patients. The route was well thought out by the event planners.  Along the route there were aid stations, first responders, ambulances, and at the finish a large medical tent.  Given the distance and the challenging course, it would be no surprise that some of the runners would need access to medical care.  Planners had caregivers proactively observing runners, looking for signs of distress.  Just beyond the finish line there were elevated observation platforms, and “rapid responders” were constantly looking for any sign of trouble, with AEDs ready and slung over their shoulder.  When it comes to patient flow, how can we become more proactive in expecting patients, and adapting to meet their needs right where they are?

Be visible, easy to access. Medical providers of all types were positioned across the course. I observed paramedics and EMTs, physicians and nurses, athletic trainers and sports medicine specialists, each clearly visible by the colored vests associated with their role. If a runner needed assistance, finding someone to help them was very easy.  Access to expert care was just a few steps away, at any moment.   When it comes to patient flow, care systems are hugely complex, how might we be easier to access?

Be coordinated, work together. A marathon is a major event, requiring many agencies, organizations, and months of planning. Hundreds of staff and volunteers converge to provide a seamless network of care along a winding course, in small teams of caregivers. It is unlikely that any of these unique teams worked together previously, and yet they operated synchronously.  Big signs guiding care protocols hung on the sides of the tent, for all to see. Just-in-time training, pre-event briefings at the start of the race, and through a systematic leadership structure it all came together perfectly.  When it comes to patient flow, achieving a focused mindset is a challenge, what can we do to bring our care teams together around shared goals?

Be organized, time matters. In the days leading up to the marathon, supplies and equipment were prepared and placed along the course for clinician use with patients. The goal was to provide immediate treatment, on location and resolve any issues  as completely as possible. In rare instances, patients needed to be moved to gain access to higher levels of care.  When clinicians are equipped, at the point of care, time to treatment is swift and further clinical decline prevented.  When it comes to patient flow, searching for equipment and supplies wastes valuable time, in what ways are we better able to deploy clinician tools?

Be prepared, many variables exist. A marathon is subject to many variables, the weather being one of the most impactful—with the least ability to control.  A few degrees either way can have significant impact on runner health.  Man-made variables also exist, and unfortunately we must also consider the need to respond to an event intended to inflict harm at a mass gathering.  I was given a brief introduction to the “mass casualty unit” truck that was positioned just footsteps away from my position.  Ability to scale up quickly is essential and during the event briefing, it was stated who was assigned to specific roles, in case of need.  When it comes to patient flow, what are the factors that impact our patients, and how can we be better ready to rapidly meet their needs?

Be informed, leverage technology. On large display monitors, one could immediately see where the first and last runners were positioned, along with the runners real-time progression along the course. Likewise, a medical tracking system allowed care teams across the course to see the status of the aid points, ambulances, and medical tents. Patients were tracked by their runner-bib numbers and categorized with a color-coded system.  Patients under medical care for 0-30 minutes were coded yellow, 30-60 minutes were coded red, and beyond 60 minutes were flashing red. The intent was to provide immediate visual cues to help caregivers make the decision to discharge or escalate care. In my observation most patients were cared for and discharged within 30 minutes. When it comes to patient flow, have we adopted the right technology that prompts us to make the highest value decisions to minimize patient wait times?

At the end of the event, I was thankful that myself and other members of the care team weren’t very busy.  Due to an unseasonably cool day, we had a very low number of patients needing the expertise and efficiency of the marathon’s care system.  The runners enjoyed a safe event, the planners enjoyed the satisfaction of providing a successful event with an ecosystem of support, and the care teams enjoyed time together serving their community…just as the care teams at healthcare systems do each and every day.

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About the Expert

Dr. Scott Newton has more than 30 years of experience in healthcare—working as an EMT, a nurse, an educator and a patient flow command center leader—he is also a trusted adviser and thought leader.

Scott has deep knowledge of the healthcare system and understands that success is tied to high reliability, just-in-time responses, and responsible solutions—that it’s about getting it right the first time for patients and clinicians.

A graduate of the Doctor of Nursing Practice program at Johns Hopkins School of Nursing, Scott built a Command Center as an output of his doctoral project and believes that as healthcare continues to evolve, patient flow will play an even more prominent role across the care continuum.

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