University of Alabama Medicine, a 1,157-bed academic medical center, manages 50,000 annual admissions and 300 daily emergency department visits. It has 57 operating room suites, with 130 surgeries per day.
UAB, the only American College of Surgeons-designated Level 1 Trauma and Burn Center in Alabama, also serves as a safety net hospital for the Birmingham community, since some 35 percent of the patients who come through the door are uninsured.
Given these demographics, high patient volume was creating significant challenges for the hospital, such as being on diversion 60 percent of the time; an average wait time for an inpatient bed up to 210 minutes; only 15 percent of discharges occurring before noon; more than 45 percent of transfer requests denied; midnight occupancy averaging 94 percent, and 6,000 clinic encounters a day.
UAB knew it needed to take an enterprisewide approach to throughput efforts, working simultaneously across primary care and ambulatory clinics, perioperative services and inpatient areas, said Brittany Lindsey, director of patient throughput at UAB Medicine.
“A cultural shift also needed to occur with a heightened focus on throughput as a daily priority and a commitment to centralize responsibility, accountability and authority for decision making within the new Center for Patient Flow,” she explained.
To address those capacity issues, a strategic patient flow plan was developed that included a centralized patient placement center, the Center for Patient Flow. UAB implemented patient flow systems from vendor TeleTracking, Lindsey explained, to:
- Coordinate all critical activities that impact patient throughput, wait times, emergency department overcrowding by automating workflows and providing visibility to those in the ED, patient placement, nursing, environmental services, and patient transport.
- Seamlessly coordinate the transfer of critically ill patients to a higher level of care for a holistic approach to improving access and also increasing market share.
- Generate data for comparative purposes and promote continuous improvement at an enterprise level.
- Help hospital leadership monitor the real-time status of enterprise-wide flow operations.
“To support the technology, it was determined that staffing changes were needed and included a patient flow supervisor responsible for oversight of the daily operations, a patient placement coordinator and specialist, a nursing coordinator to act as an administrator, a stat nurse to handle clinical needs, and a Lean analyst to provide data analysis and project management,” she added.
Patient flow technology can be a great asset for healthcare provider organizations. There are a variety of patient flow technology vendors, including Allscripts, Central Logic, Cerner, Change Healthcare, Epic and Hospital IQ.
“Patient flow technology provides a tremendous amount of actionable data that wouldn’t otherwise be available”
Brittany Lindsey, UAB Medicine
At UAB Medicine, structural/operational changes included adding a director for patient flow at the nursing leadership and hospital leadership tables, along with developing a cross-departmental Patient Flow Governance Council.
It also created a team to leverage TeleTracking data for a hospital operations scorecard and leveraging senior leadership sponsorship. And finally, UAB added environmental services and transport within the Center for Patient Flow.
Process changes included creating a hospital leadership data dashboard with care progression indicators to leverage senior leadership to establish a data-driven patient flow program, she said. And by using data that that was generated for external partnerships, the hospital was able to boost internal and external marketing to create access and improve market share, she added.
That’s a lot of work, but it resulted in some very positive outcomes.
According to Lindsey, monthly patient transfer requests increased from 922 in October 2015 to 1,266 in August 2017, patient transfer declines due to capacity dropped from 249 per month to 35 per month, discharge orders increased to 35 percent by 10 a.m. and the average discharge time is now closer to noon – freeing up capacity earlier in the day for waiting patients. Medical/surgery and critical care diversions, meanwhile, dropped from 60 percent to 19 percent.
Further, environmental services SWAT teams reduced response time to clean a vacated room by 20 minutes and off-service placement decreased from 20 percent to 7 percent. And the length of stay has been reduced by 0.5 days.
“Patient flow technology provides a tremendous amount of actionable data that wouldn’t otherwise be available,” Lindsey said. “Information is available on emergency department admits, surgery admits, internal transfers and clinic admits. This information made it possible then to manage care coordination delays, transport operations and environmental services operations.”
This data also helped determine three core best practices that drive and sustain organizational change, she added.
“Access – managing capacity in order to open up beds to new patients,” she explained. “Efficient and effective placement – the visibility that the technology provides helps ensure that patients are placed in the right bed and receive the right care in a timely manner. And identifying throughput barriers – again the visibility that the technology provides makes it possible to identify the daily throughput barriers and find solutions by partnering with other departments.”
Specifically, UAB started using the data from the previous day to improve planning for the next day. The data is used to support real-time communication and decision making, and it’s incorporated into daily huddle meetings to help prioritize work for the day.