Methodist Healthcare, a six-hospital, 1800-bed system in San Antonio, TX, made patient flow improvement its top priority for FY2010 with spectacular results, including sharp growth in transfer center volume and major reductions in lost bed time, bed assignment time and ED diversions.
The prospect of federal stimulus money has prompted many U.S. healthcare providers to build out the so-called “digital backbone” of their institutions to accommodate EMRs. But one Texas health system opted to shore up the “operational backbone” of its facilities — patient flow.
And the return on investment has been immediate.
The Methodist Healthcare System serves 22 rural counties around San Antonio, with six hospitals, including a children’s hospital and a free standing emergency department. MHS features the nation’s top live donor kidney transplant center and paired kidney exchange, four stroke programs, an accredited chest pain center, round-the-clock neurosurgical/neurology coverage.
In the early 2000s, the system was experiencing an increase in patient congestion, which was not surprising given the growing needs of its service area. But a closer look revealed that, for all concerned, congestion was more than a matter of inconvenience.
Emergency room diversions had reached 600 hours per month. Average patient placement time was seven hours and ED hold hours were on the increase. A home-grown electronic request system yielded no real-time data and patients’ isolation status was not being effectively communicated to hospital personnel. Departmental “silos” produced constant communication breakdowns. The slowdowns were delaying care to patients, costing the system business and leaving physicians, employees and families dissatisfied.
Making patient flow the priority
Methodist’s first step in correcting the problem was to institute an enterprise-wide multidisciplinary throughput steering committee to lead all patient throughput initiatives for MHS. Then it created an executive level office to direct each initiative. To underscore the enterprise importance of improving patient flow, MHS leadership adopted it as the No. 1 priority for fiscal 2010 and named Susan Sewell vice president of patient management.
MHS also engaged a consultant — Avanti Patient Flow Services — to review existing flow practices and identify improvement opportunities. During the engagement, Avanti worked closely with MHS leadership and staff to gather and examine data which would help to assess existing practices.
“Physicians are getting patients to the needed level of care quicker,” she says. “And surgeries are not being cancelled.”
Avanti assessed operations at Methodist Hospital (MH), Methodist Specialty & Transplant Hospital (MSTH), Metropolitan Methodist Hospital (Metro), Northeast Methodist Hospital (NEM), Methodist Stone Oak Hospital (MSOH), and Methodist Children’s Hospital (MCH). A gap analysis was also conducted to determine how Methodist patient flow processes matched industry Best Practices.
In addition, Avanti, a division of TeleTracking Technologies, Inc., assessed how MHS personnel were using the patient flow automation software recently installed by TeleTracking to replace its home-grown system. Their recommendations featured an initiative to manage all patient flow for the entire enterprise from a central hub, plus the creation of usage standards for TeleTracking’s Capacity Management Suite™ software.
In the fall of 2009, patient placement and transfer center services were centralized and staffed round the clock with experienced RNs who guide all internal and external patient movement throughout the MHS campuses. The center included call recording capabilities, multi-caller conferencing options, and physician specialty algorithms. This truly centralized approach, using best practice standards, made PPS the true ‘hub’ for all patient flow activities throughout the system.
MHS also invested in TransferCenter™, a TeleTracking application which automates the referral process and electronically links the center to the units system-wide. This link, through integration with TeleTracking’s enterprise-wide patient flow software, makes information about bed availability, transport, etc., accessible in real time to transfer center staff, who can then request the correct bed for a patient’s condition without a flurry of phone calls and negotiation. In addition, all data regarding the transfer is recorded, including referral source and timeliness of response, for future analysis.
According to Sewell, the move has already had a huge impact.
A bird’s eye view of the enterprise
“Centralization has allowed us to see all beds in the facility and be more efficient with placement,” she said. “Now we’re able to move patients from one hospital to another hospital, decreasing ED hold hours.”
“It also has allowed us to bring in transfers from outside of San Antonio and outside of our facility and even out assignments within the system so we aren’t bringing anyone into an overly crowded hospital. We have been able to reduce our ED hold hours about 50 percent.”
The streamlined flow of referral patients has been a great help to outlying referring physicians and has increased physician satisfaction both inside and outside of Methodist Healthcare.
“Physicians are getting patients to the needed level of care quicker,” she says. “And surgeries are not being cancelled.”
Transfer Center volume has risen by 90%. Overall income increased 7.9%
This centralized department also manages direct admissions for MHS affiliated physicians, plus all internal admit source areas. The model eliminates the “silo” problem in the placement process and maximizes the use of all existing capacity throughout the MHS enterprise because patient placement and transfer decisions are now made using real-time information in CMS at an all-encompassing enterprise level.
An immediate bed search is conducted with a bed confirmed at one of the health system campuses within 10 minutes of the request. The effect on flow of this streamlined process is dramatic.
Within the past year:
- Bed assignment time has decreased 68%.
- Lost bed time went from 76 minutes to 35 minutes.
- Time from bed request to bed occupation is down 45 percent.
- Monthly ED diversions dropped from 700 hours to just eight hours.
- Transfer Center volume has risen 65 percent.
- The transfer acceptance rate is now at 99 percent.
- The system gained 4.5 percent of the rural market share. Overall income increased 7.9 percent year-over-year.
And, because of the amount of useful data produced through the automation process, MHS is able to determine shifting trends in referrals and identify opportunities to deliver new services by region and demographics.
Infection fighting software
Methodist is also using features built into their patient flow system to fight the spread of hospital acquired infection. Sewell explained that no patient will be placed in a bed without the requester indicating if that patient currently or previously had HAI.
“TeleTracking allows us to select isolation attributes at the time a bed is requested for a patient, whether it’s MRSA, VRE or none…that applies to that patient,” she says. “That is a field that must be filled out in order for a bed to be assigned.
This is done via a pull down menu which lists as many as 50 such conditions. Once an infection attribute is selected, it stays with the patient’s record until the condition changes. The simple procedure helps to avoid communication breakdowns which can lead to exposure of housekeepers and transporters, the most widely travelled personnel in any hospital. Such exposure not only endangers these workers, but potentially aids in the spread of infection to other parts of the hospital.
“With every patient moved the attribute follows them, so now EVS and transport will know ahead of time that they’re walking into a room that possibly has an infection,” Sewell says. “If they don’t know and they go from patient to patient, it does increase the risk of spreading more infection throughout the hospital.”
While TeleTracking’s software already included the infection indicator, the ability to block bed assignments until the infection status field is completed was a special request by Sewell. She said the response was typical of her experience with TeleTracking.
“They’re very much invested in their hospitals,” she said. “They’re not a vendor who comes in, implements the software and then leaves. They’re very much committed to your success and fixing whatever issues that may arise, whether it’s because of your processes or because of an interface or technology issue.”.
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