Tracking patient bed flow at Oregon Health & Science University, the state’s only academic health center, has long been a challenge. Patients come from far and wide for unique health care services, some available only at OHSU.
Like other hospitals across the country, OHSU recognized that better ways to assess, guide and monitor patient care were needed.
In 2016, the hospital was unable to accommodate 568 transfer patients — a number OHSU leaders knew would continue to grow if a solution was not found.
“When we can’t accommodate a patient, that really hurts. It’s part of our commitment to the community to be able to take care of the patients who need us and our specialized services,” said Carl Eriksson, M.D., M.P.H., medical capacity officer for OHSU Doernbecher Children’s Hospital and associate professor of pediatrics (critical care) in the OHSU School of Medicine.
In early 2017, a dedicated team set to work. They looked at how the current system was structured, how information was communicated, how patient flow was tracked, and at admission and discharge trends. They consulted with other health systems, realizing that individual hospitals may have different core problems but all hospitals struggle with similar issues.
They identified technology solutions that could be helpful and formulated a plan.
Like an air traffic control tower
In 2017, OHSU opened Mission Control, a modern command center that uses predictive analytics and a real-time data display to coordinate patient care from the time the patient enters the hospital until they are discharged.
The system monitors patient flow across a four-hospital system, including OHSU Hospital and Doernbecher Children’s Hospital on Marquam Hill, as well as partner hospitals Tuality Healthcare and Adventist Health Portland.
Matthias Merkel, M.D., Ph.D., was part of the team who helped bring the program online.
He likens patient care operations at a hospital to those of an air traffic control tower.
Patients enter OHSU every day in various ways and from different directions, explains Merkel, chief medical capacity officer at OHSU and a professor of anesthesiology and perioperative medicine in the OHSU School of Medicine.
They arrive via ambulance, helicopter, car, taxi or bus; from home, community hospitals around the state or between OHSU clinics and units, such as the emergency department or operating rooms.
They hail from the Portland-metro area and all points beyond. And they discharge to home, skilled nursing homes and rehabilitation centers. Together, this represents a highly complex flow of patients.
Air traffic control towers rely on technology to help manage all those daily flights through a centralized command center. By comparison, most hospitals, are still coordinating patient bed flow by hand, and decisions are made at the unit level.
Prior to implementing Mission Control, nurse leaders would meet every six hours or so to compare current bed counts and anticipated discharges. Between meet-ups, bed flow managers had to rely on a combination of in-person rounds, phone calls, pages and text messages to determine how many patients could be admitted.
“Before Mission Control, when a transfer request came in, the patient either came to OHSU, or, unfortunately, if we were not able to place them, they remained in the referring hospital,” said Jennifer Packer, M.S.N., RN, CENP, CEN, chief nursing officer for Tuality Healthcare.
The right treatment at the right time
Hidden away in an unassuming quiet office, a small team hunches over computers — the human and technological heart of patient flow at OHSU.
This crew focuses on getting patients to the right place for the treatment they require, using up-to-the-minute data from all four hospitals. This helps them function as a health system, allowing the more complex cases to be sent to the OHSU.
The command center, which includes the OHSU Transfer Center, is staffed 24-7 by a team of nurses, physicians, transport coordinators and patient placement officers. When a patient needs care, the team references current data to find the best location — at the OHSU or a partner hospital — to match the patient’s needs with resources across the system.
Mission Control is about helping improve a patient’s experience, reducing delays in care, and getting the right care at hospitals that are closer to their homes, says James Heilman, M.D., M.B.A., chief medical transfer officer at OHSU and assistant professor of emergency medicine in the OHSU School of Medicine.
“At OHSU Mission Control, our goal is to place more patients more efficiently in order to provide more access to more patients across our state,” he says.
The GE Healthcare partnership
The technological wizardry that makes Mission Control possible was created through a partnership with GE Healthcare. OHSU is the second hospital in the U.S. to bring modern technology and analytics into daily hospital operations, and the first to coordinate care between separate partner hospitals, using the GE platform.
GE worked with OHSU to create a customized program that pulls patient data from every department in all four hospitals – OHSU Hospital, OHSU Doernbecher Children’s Hospital, Tuality Healthcare and Adventist Health Portland -- two with different software and electronic medical record systems. The data is organized into “tiles” which are displayed in Mission Control.
The team can easily see and monitor where beds are available, when patients are waiting to be admitted or transferred, and when beds need to be cleaned. This helps the health care team move patients as quickly and safely as possible.
Another added benefit of Mission Control technology is predictive analysis, using historical trends, which can help improve patient experience and optimize care coordination. OHSU data scientist Peter Graven, Ph.D., developed a forecasting tool that allows the Mission Control team to anticipate inpatient capacity constraints in all areas, up to one week in advance. This increased situational awareness allows the team to be more forward-thinking and take action sooner.
OHSU also is the first hospital to add GE Healthcare’s new sepsis tile and algorithm, which are designed to give hospital teams a head start in catching and managing patients with sepsis symptoms.
Susan Yoder, R.N, B.S.N., patient care operations and nursing director says: “The use of GE Health technology has increased visibility and transparency, allowing us to identify opportunities across the OHSU health system. Maintaining access to high-quality health care is now accepted as a shared responsibility throughout our system. We all work together to accept the next patient, thereby meeting our mission of improving the health of all Oregonians.”
Bringing the air traffic control concept to the OHSU has resulted in significant improvements. In fiscal year 2017, the hospital placed more than 500 patients with its partner hospitals, increasing access to the Oregon’s academic health center for patients across the state, many from rural hospitals across the region. By fiscal year 2019, that number had more than doubled to 1,200.
“We also were able to operate at a higher occupancy level in the hospital which allowed us to serve more patients,” adds Heilman.
There are more ways the analytics can help mainstream operations in the future, but for some in Mission Control, the most straightforward results are the most meaningful.
“It’s having a real impact for our patients, and we are able to serve more patients. And that’s real exciting,” says Packer.
FY 2018 v. FY 2017
- Accepted 554 more transfer patients
- Declined 92 fewer transfer patients
- 519 transfers accepted to partner hospitals
- Created 8.5 beds per day on OHSU Marquam Hill Campus
FY 2019 v. FY 2018
- Accepted 615 more transfer patients
- Declined 277 fewer transfer patients
- 1,222 transfers accepted to our partner hospitals
- Created 18.4 beds/day at OHSU Marquam Hill Campus