As care delivery becomes more complex, health systems across the country are finding ways to effectively and efficiently coordinate patient care across the continuum. One of the main challenges they are seeking to address is reducing patient wait times.
Kettering Health Network in Dayton, Ohio, which serves a population of 800,000, is one such organization that was struggling with the movement of patients through its system. Within the not-for-profit network that includes nine hospitals, Kettering College and more than 120 outpatient facilities, it took an average of 16 phone calls by physicians, nurses and bed controllers throughout the health system to move one patient. For example, the ED would call patient placement to see if there was a clean, ready bed; then call the floor to confirm; then call environmental services to expedite the bed cleaning if the room was empty but not yet cleaned; then call to arrange transportation; and then call the floor again to let the nurse know the patient was arriving.
Clearly, this was not sustainable. The health system’s clinical and senior leadership teams knew they had to find a solution to break down departmental silos—such as patient access and placement, environmental services, case management and patient transport—unify around a timely, cohesive patient experience and create the operational foresight to drive long-term improvements.
Catalysts for Change
Several factors contributed to Kettering Health Network’s operational challenges related to patient wait times. These challenges, which provided a catalyst for change, included:
- Network growth and an increase in patient access points
- At-capacity tertiary facilities
- Inconsistencies in practices across system facilities
- The closing of a neighboring hospital, which had 400 beds and handled 70,000 ED visits annually
- A focus on decreasing length of stay, left without being seen, diversion and network leakage metrics
The concepts of centralization and achieving economies of scale became the goal and a way to solve these operational challenges. Direct benefits of these solutions would include:
- Decreasing lost transfers and out-of-network leakage
- Increasing out-of-network admissions
- Developing a one-call approach to speed up admissions
- Creating visibility across the network to better utilize beds and optimize available capacity
Secondary benefits of centralization would include:
- Improved physician, staff and patient satisfaction
- Standardization of processes leading to greater efficiencies
- Implementation of best practices and the ability to scale the system accordingly to ever-evolving circumstances
The senior management team determined, after a thorough research and due diligence process, that the most effective way to achieve these benefits would be to build and implement a health system command center—one that would take a patient-centered approach and provide real-time visibility into system capacity.
The Network Operations Command Center
Kettering Health Network named the health system command center the Network Operations Command Center. Launching the center involved patient-flow technology implementations to manage the path of the patient from admission through discharge at eight facilities in six months, and the NOCC opened Jan. 22, 2019. Some of the technology systems implemented included video monitoring of access points; dashboards with a system view of bedding, environmental services and pending hospitalizations; integrated phone systems; and a visual monitor/situational awareness tool.
A major reason for a smooth launch was new technology seamlessly integrated with all of Kettering Health Network’s other systems, including its EHR. This helped automate and increase the efficiency of processes such as placing patients and coordinating caregivers and support staff. It also provides an at-a-glance understanding of current and projected capacity in acute and post-acute settings—at the enterprise, facility, unit and individual bed levels. In addition, the technology provides integrated nursing views and mobile apps to prioritize and coordinate all key stakeholders’ work and facilitate care progression and discharge planning. This promotes system-level capacity, utilization, care coordination and quality.
As a result of this centralization and integration, everyone—at every level of the organization—now
has a key role to play in patient experience. This type of big picture view of the entire network allows for load-leveling census at the different campuses and prioritization of admissions and transfers. It also allows for economies of scale—eliminating overlapping roles between campuses, standardizing processes and eliminating situations such as blocking beds and diversions.
The core technology platform also provides systemwide situational awareness of operations, helps the health system understand workflow bottlenecks before they occur and helps leadership determine the resources needed to complement clinical activities. The platform includes analytics built to combine meaningful operational data with data from other systems.
Positive Results
This was an aggressive undertaking, and there were several concepts that the organization considered mission critical to its success, including:
- Distributed situational awareness across the health system
- Centralization of key teams, which includes transfer center nurses and dispatch and patient flow specialists
- An engaged medical director, who in turn engaged other clinicians
- NOCC team leads, which helped navigate cultural changes
- Centralized information systems
- The creation of patient movement algorithms
Some results to date include:
Increased new patient volume and revenue (exceeding budget by 755 inpatient/observation patients)
Decreased number of ED holds (average network decrease of 50 minutes per hold)
Decreased ICU length-of-stay and increased capacity (average 5 percent increase in acute unit capacity and an average length-of-stay reduction of two hours per patient, which equals 101,472 total hours and a direct cost reduction of $6.7 million)
Improved transparency thanks to the introduction of patient portal whiteboards (a nurse and physician satisfier)
Decreased bed assignment times (average reduction of 15 minutes across the network)
Reduced environmental services turnaround times (average reduction of 61minutes across the network)
The initial outcomes have been extremely positive. It’s quiet in the NOCC, and there’s no chaos, despite the fact that there are dozens of individuals in the same room. The culture change was hard at first, but overall the buy-in was there—because staff members know this is helping their friends, families and neighbors.
John Weimer, RN, FACHE, is vice president of network emergency, trauma and operational command center services at Kettering Health Network, Dayton, Ohio (john.weimer@ketteringhealth.org).