Moses Cone Health System automated new patient flow processes, instilled end-user accountability to reinforce culture change, and optimized operational performance by eliminating bottlenecks, reducing delays and increasing available beds.
By empowering stakeholders with real-time information, inappropriate admissions to the step-down unit reduced by 40 percent. The unit is better able to care for its patients, since it is no longer bogged down by unnecessary transfers. Also, ED wait times have decreased by half, which has greatly enhanced patient satisfaction.
Aided by Allscripts Patient Flow, Moses Cone Health System changed its organizational culture to make patient flow more seamless and efficient from arrival to discharge. For the ED, automation helped decrease bed request to patient placement time from 4.5 to 2.5 hours. Overall LOS decreased from 6.0 to 5.3 days, indicating more efficient patient care. Additionally, the system enabled Moses Cone Health System to create a centralized patient placement function infused with clinical expertise, the role of the patient progression nurse, and an improved nurse triage process for the Step-down unit. Combined, these changes have increased overall patient and employee satisfaction.
The use of Allscripts Patient Flow enabled Moses Cone Health System to rapidly achieve quantifiable results that have directly improved operational performance. Within the first 90 days, the number of early discharges was increased by 2.5 percent and late discharges were decreased by half. The combination of these benefits made available an additional 27 beds per day, which may be used to treat more patients.
Moses Cone Health System also improved its utilization of resources. For example, increased real-time visibility into bed status has eliminated the need for daily bed huddles. Based on nurse staffing formerly required for this 30 minute meeting, the annual cost reduction amounts to $324,000.
REINFORCING BEST PRACTICE THROUGH TECHNOLOGY
In 2006, Moses Cone formed a multidisciplinary patient flow committee, which mapped the ideal patient flow for key departments such as patient placement, ED, PACU and step-down. Leveraging lean principles and the Institute for Healthcare Improvement’s Idealized Design process, the team exposed the potential for inconsistent or untimely hand offs among these departments. To address the problems causing bottlenecks and delays, the committee redesigned processes and established standards for compliance. Implementing Allscripts Patient Flow provided the means to measure compliance through real-time reporting that enabled immediate remediation. With the new level of transparency and data analysis catalyzed by the automation, the team instituted several key process changes.
IMPROVING WORKFLOW COORDINATION
Moses Cone established measurable objectives to track and address problems identified with hand offs across departments. For example, the committee tracked objectives such as 90 percent bed turnover compliance and transfers within 30 minutes from ED and PACU. These compliance standards set the stage for automating workflow through technology.
With bed turnover, nurses were considered in compliance if they entered a “room empty/bed dirty” status into Allscripts Patient Flow as the discharged patient was being transported out of the room. If no status was entered at this point, the room would remain dirty until environmental services (EVS) discovered it needed cleaning. As status updates are communicated instantaneously with Allscripts Bed Turnover™, EVS managers monitor bed status and turnover activity in real time.
OPTIMIZING BED UTILIZATION
Moses Cone Health System linked the processes for patient placement and resource allocation through the use of Allscripts Bed Management™, which provides all stakeholders involved in patient flow with real-time information such as pending admissions, transfers, discharges and bed supply. The technology helps the Health System expedite the patient’s progression from admission to the right room without time-consuming manual work to identify the right bed for each patient.
Enabled with enterprise-wide visibility, Moses Cone Health System changed its organizational structure to institute a centralized patient placement function serving both Moses Cone Hospital and Wesley Long Community Hospital. The patient placement team, which previously reported to accounting, shifted to report to nursing so clinical experts became involved in monitoring patient placement needs. Automation helped enable proactive demand planning. Now patients are matched to the right bed the first time, based on clinical matching and accurate real-time availability.
To help resolve problems with inappropriate admissions to the step-down unit, the Health System created a nurse triage system that collaborates with patient placement. Bolstered by information from Allscripts Bed Management, the step-down unit gained the authority to push back should patients be placed in the wrong unit or if a patient’s acuity level didn’t warrant monitoring in the step-down unit.
The hospitals also created a new role — the progression nurse, who reviews reports from Allscripts Patient Flow, interacts with clinicians, and intervenes early to ensure a timely discharge. This new role represents a consistent staff presence dedicated to decreasing length of stay (LOS) and reducing delays on a case-specific basis.