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Predictive Modeling

Real-time analytics increase early discharges

Dashboard lowers cost per case, improves patient satisfaction and minimizes staff frustration. By Michael C. Lindberg, M.D.


artford Hospital was able to increase early, 11 a.m. discharge from 9.5 percent to 25.6 percent within seven months through the de- velopment of a multidisciplinary program that includes the use of a business intelligence (BI) dashboard that delivers real-time analytics on patient throughput. The dashboard has the potential to increase Hartford’s daily census, lower cost per case, improve patient satisfac- tion and minimize staff frustration over bottlenecks. Hartford Hospital is an 867-bed regional referral cen- ter with an annual inpatient volume of 57,000, outpatient volume of more than 2 million, 11,000 employees and $1.4 billion in total network revenue. In addition, we continue to gain market share, seeing 2 percent more patients in 2010 than we did in 2009.

Offl oading from the ED With the second-largest emergency department in Connecticut (95,267 annual visits), we needed a way to offl oad patients quickly from the ED to more appropriate levels of care while better managing length of stay and promoting earlier discharge. We also needed to access real-time data for a more structured approach to patient management, to manage clinical and fi nancial data more effi ciently, to monitor and track performance in multiple areas and to build a data warehouse. We envisioned a clinical, operational and fi nancial en- vironment where we could operate from quality metrics, benchmark performance against national standards, track internal performance gains against baseline and optimize patient care based on real-time data. Working with an implementation group of managers and staff from clinical care, decision support and infor- mation technology, the hospital evaluated three vendors on the criteria of size, current products and future enhancements; applicability to patient-care needs and fl ow; and ease of use, fl uidity and graphic presentation. After a six-month evaluation process, the hospital chose Carefx, which had acquired the rights to market and further develop a suite of six business intelligence tools from a Cleveland Clinic start-up in 2010. The patient throughput dashboard allows physician

24 May 2011

groups, units, unit clusters and individual healthcare professionals at Hartford Hospital to identify patient- fl ow trends and opportunities that would increase early discharge and reduce length of stay. Rather than dealing with multiple sources of information, report delays and text-based presentations, physicians, nurses and other professionals now view near-real-time information in graphic detail so they can quickly compare their perfor- mance to hospital and department baselines. The dashboard also facilitates communication between Hartford Hospital and its physicians. By identifying problem diagnoses, areas and fl oors, the hospital can quickly invest resources to enhance patient fl ow. By offering physicians immediate feedback on length of stay, readmissions and order entry, the hospital is able to comply with parts of the ongoing professional practice evaluation process for re-credentialing as mandated by the Joint Commission on Accreditation of Healthcare Organizations (JCAHO).

Benefi ts for physicians, nurses, CMO At Hartford Hospital, we pull both inpatient data from multiple systems, including patient billing, bed management and transport, and transfer it into the patient throughput dashboard via a weekly feed. The dashboard translates data into metrics, helping our professionals hone in patient-fl ow problems and identify best practices for application to lower-performing individuals, units and groups. After only nine months of using the new BI patient throughput dashboard, the 24 users were surveyed and: • 70 percent reported they were actively using dash- boards (weekly);

• 90 percent claimed improved ability to manage work- fl ow; and

• 100 percent claimed the dashboard saved them time on data gathering and report generation. We also generate group and individual report cards for our 26-member hospitalist group. If a physician under- performs on order entry, readmissions or length of stay, the department and division chiefs share relevant data in a one-on-one conversation. Quarterly reports seem to be


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