• July 2008 FEATURE ARTICLES •
EDIS: Case History
Clean Beds, Less-Crowded
State-of-the-art bed tracking leads to shorter ED waits and faster turn-arounds.
New York Methodist Hospital, Brooklyn, N.Y.
At New York Methodist Hospital (NYM), an
uncoordinated system for bed turnover at patient discharge
caused overcrowding in the emergency department (ED) and became
a serious issue. As many as 25 patients might be kept waiting in
the ED during high-volume periods, which created numerous
challenges for the Brooklyn, N.Y.-based hospital. The ED
received 65,295 patients in 2007; however, the ED was at risk of
losing revenue from turning patients away because it was at
operating capacity. Hospital administrators often overstaffed
their environmental and patient-transport teams because they
couldn’t accurately predict their needs. And, due to the
overcrowded conditions and long waits, patient satisfaction also
suffered.
NYM has a deep-rooted tradition of providing
excellent and compassionate care to the people of Brooklyn. A
member of the New York-Presbyterian Healthcare System and an
affiliate of Weill Cornell Medical College, NYM recently
celebrated the 125th anniversary of receiving its charter and
the completion of its newest building — a state-of-the-art
patient-care pavilion. The seven-story, 100,000-square foot
structure houses the renovated and greatly expanded ED, which
includes 45 adult beds, a 10-bed pediatric unit and a separate
OB/GYN section, as well as adult and pediatric triage rooms.
Insufficient Data
Hospital leadership quickly identified the
root causes for the prolonged bed-turnover times: "There was
minimal accountability," says Kathleen Mazza, assistant vice
president of nursing. The bed-turnover process required members
of different teams within the organization to perform many
sequential tasks. However, the system to communicate the
discharge orders, patient transport and room cleaning requests
was paper-based and labor intensive.
The time between when unit clerks enter discharge orders to when beds are turned over for new patients has been reduced. Ninety-five percent of discharges that used to take up to several hours are completed within five to 15 minutes.
Damian Zambrana, NYM operations coordinator,
spent more than an hour each day gathering the data necessary
for bed turnover. "I had to go floor-by-floor,
patient-by-patient looking for pending discharges," says
Zambrana. "The old process was very time-consuming." In
addition, the process couldn’t provide hospital leadership with
the information they needed to make data-driven decisions
because they had no data to hold their staff members
accountable, only anecdotal information, which didn’t show the
entire picture.
Administrators believed that an electronic
bed-tracking system would help solve many of these challenges.
NYM’s IT team met with key members of the administration,
nursing, admissions, transportation, environmental services and
revenue cycle departments to discuss solutions that would best
fit everyone’s needs. After researching a number of
possibilities, the majority of users favored implementing an
electronic bed-tracking board that featured a beeper system that
alerted staff when tasks were assigned.
An Outside-the-Box Solution
Several of the systems being considered cost
nearly $500,000 and presented systems integration issues. If the
organization adopted a separate bed tracking application, it
would have to be interfaced with the other hospital systems and
users trained to operate it.
The IT department was worried it might face
user adoption issues. "We challenged them to look outside of the
box," says Robert Dulak, NYM’s IT director. "We needed to think
about what we were really trying to do, which was to improve
patient throughput and manage the bed-tracking process."
Senior management tasked the IT team to use
its existing order entry capabilities to notify of bed
availability. NYM had been using the Cerner Millennium
PowerChart, PowerOrders and computerized physician order entry
solutions in its ED since 2003. "We realized we had a lot of
what we needed already in place," says Dulak. "It’s about what
you’re trying to accomplish rather than the bells and whistles
[of a new application]," he says. "Since we already had these
systems in place, and they were widely accepted, the Cerner
solution had the advantage. We didn’t want to have to go back
and forth between two systems."
The IT department designed a set of orders
within the Millennium system that automates the bed-turnover
process. This set enables teams to monitor waiting tasks and
informs the next team when tasks are completed. The
transportation team created a designated dispatcher who notifies
the teams when orders are completed and new tasks can begin.
Once a patient is ready to be discharged, the
unit clerk places an order for transportation. The admitting
team then places an order to discharge the patient. Upon
completion of that order, the environmental team receives an
order to clean the bed. All teams can access the same task list
to see pending transportation, discharge and cleaning orders.
The IT department also developed custom management reports to
evaluate the success of new processes.
Since the IT team developed the new order sets themselves,
the hospital incurred no additional software or support
expenses. The team created one order set called "Bed Tracking"
that included a transport order. It also created two
nested-order sets called "Patient Discharge" and "In-House
Transfer." These new order sets were created using new code
sets. Task lists and requisitions also were created to print to
admitting, environmental services and transport departments. The
overall time to create these orders took less than a day, but
the IT department spent about 45 days testing and refining its
design.
The hospital purchased new computer terminals
and printers for the environmental and transport teams who now
needed access to the new system. The organization also trained
600 nurses and more than 100 full- and part-time staff members.
Better Accountability, Fewer Complaints
NYM has been happy with the results it has
seen since implementing the system in January 2008. The time
between when unit clerks enter discharge orders to when beds are
turned over for new patients has been reduced. Ninety-five
percent of discharges that used to take up to several hours are
completed within five to 15 minutes. The hospital also has seen
a 25 percent improvement in the time it takes for a discharged
patient to receive transportation away from the hospital
facility.
Zambrana says that instead of going
floor-to-floor to various departments to gather patient
discharge data he can now access all of that information
electronically. "The patient task list allows me to see any
pending required transport or cleaning," he says. "I used to
have to go to the department and look over their shoulders. Now,
I don’t even have to bother them with a phone call. I don’t have
to wait in line for them to give me this information — I can get
it all in one click." Zambrana says that the pending discharge
list is his favorite part of the new system. It enables him to
avoid overloading floors that have a lot of dirty beds, and
better manage patient flow into the hospital.
Patient relations also is seeing fewer
complaints from patients related to crowding and wait times. End
users report being very satisfied with the system, saying they
would not want to return to the manual process. Communication,
accountability and teamwork also have all markedly improved.
Because the data comes in electronically, focus on workflow
and bed-turnover processes has improved. The IT team considers
the project a success as well, especially considering they were
able to derive more value from the existing system. As one
manager of the IT department stated: "Every time we simplify the
IT world of our organization, it’s a success for us."