Christiana Care Health System

The vision of Christiana Care Health System (CCHS) is to be a coordinated, patient-focused healthcare system, but managing and coordinating patient flow across two high-capacity hospitals had become increasingly challenging. The health system had what Rick Olivere, director of environmental services, called a "broken bed turnover process," which made it difficult to proactively manage the hospitals’ surges in capacity. CCHS had a legacy bed tracking system that was not meeting the hospitals’ demands.

"The process for cleaning beds was irreparably broken," states Olivere, indicating that beds could sit dirty for hours. "We were in a reactionary mode; we would get the bed ready for the next patient when we needed it." Olivere indicates that spikes in bed cleaning requests would begin around 2:00 p.m., and environmental services staff would not recover until nearly midnight.

As a result, patients were often boarded in the ED and the OR, causing lengthy delays, bottlenecks and an overall decrease in productivity and efficiency.

From the nurses’ perspective, the floor nurse had no control of bed turnover. As many as 12 calls and pages would transpire before a bed was ready for the next patient. "It was a mad dash for both nursing and environmental services," describes Olivere.

“We wanted to follow the example of other industries and solve our process problems through a complete redesign,” states Chris Konen, project manager. “While we saw back-up in the OR and ED, we knew they weren’t the only departments that needed new processes. Patient flow is a hospital-wide issue.” To that end, a committee of nurses, executives, staff and physicians overhauled CCHS’ patient flow processes and developed a proactive, efficient “best practices” model.

To enable this new patient flow model, CCHS selected Allscripts patient flow solutions. “The Allscripts team really understands the area of business they’re automating,” says Konen. “Their products are very intuitive; they facilitate the ideal patient flow process.”

CCHS set the following patient flow goals:

• Response time: 10-minute maximum interval from “bed dirty” request to housekeeper’s arrival
• Clean time: 30-minute maximum for housekeepers to complete cleaning
• Turnaround time: 80 percent of all beds were to be cleaned in 40 minutes or less

Sunrise Bed Management™ and Sunrise Bed Turnover™ solutions facilitated CCHS’ aggressive goals through instant communication, prompts and customized views that gave staff a perspective of what was happening, as well as what needed to happen next. In addition, CCHS realized the value of providing mobility for supervisory staff in nursing, environmental services and other areas. Key staff received Fujitsu ultra-portable “clamshell” laptops with wireless connectivity hospital-wide. The laptops fit comfortably in a lab coat or suit pocket and enable staff to roam the halls while checking status and receiving alerts in real time. CCHS implemented at Wilmington Hospital, the smaller of its two facilities, in the fourth quarter of 2005. After realizing success, CCHS implemented the patient flow solutions at Christiana Hospital in February 2006.

"Our average time for bed turnover is now 30-minutes," states Konen. "That’s got to be among the best in the country." Ten to 12 phone calls per case have been reduced to just one, which greatly enhances efficiency while enabling nurses and staff to focus more on patient care.

Under the new patient flow model, nurses are required to call for bed cleaning within 15 minutes of the patient’s departure — a process that has worked particularly well. "It was a great trade-off for the nurses," says Konen, "They make one phone call rather than constantly chase down people and resources." Konen indicates that CCHS had nurse acceptance within 24 hours of implementation. Olivere, on the environmental services side, also indicates that "we had a high degree of compliance within a couple of days of being live." He points out that while they conducted unanticipated checks and balances to help drive compliance, he was nonetheless amazed at how quickly staff adapted to and supported the new system.