By Kirstin Grace-Simons (Madigan Army Medical Center)January 2, 2020
MADIGAN ARMY MEDICAL CENTER, Joint Base Lewis-McChord, Wash. -- When a person is dealing with a serious illness or injury, the "door to doc" time they experience when they go to a clinic or hospital for care is paramount.
In healthcare the movement of patients from one point of care to another is called throughput or patient flow. It's a significant factor in efficiency and patient satisfaction.
"The Institute for Healthcare Improvement has published two white papers about patient flow that line out multiple tactics that hospitals should use to optimize patient flow," explained Mark Sanders, who is the nurse methods analyst bringing his extensive patient flow background to bear in streamlining Madigan's process.
The IHI has established that the standard should be 15 minutes or fewer to assign an inpatient bed when the decision to admit has occurred. Then, the goal is for the patient to physically be in the assigned bed within 60 minutes.
Madigan does not currently follow a singular methodology when it comes to assigning someone to an inpatient bed, thereby admitting people through multiple avenues. To standardize this task, Sanders is building a front door through which all patients will pass.
"If we use a single portal with scripted questions, a decision matrix, and the scope of service of each inpatient unit, we will achieve consistency and we will also be able to measure it," detailed Sanders.
His vision of a patient admitting logistics center to facilitate that movement is starting to take shape.
The plan for a patient logistics center includes a bank of monitors that display patient flow from entry into care through discharge, as well as bed and staffing availability, for the busiest units.
Sanders and the supportive team around this effort are approaching the finish line of the planning phase with walls about to be moved so the center can be constructed.
Experienced at building this model through years as a consultant, Sanders knows one of the biggest hurdles to process improvement is simply getting the word out about the changes.
"Part of that work was helping people adhere to recognized standards and metrics, and building the processes that go along with those. Part of that is basically raising situational awareness," he explained.
To that end, the "one bed -- one call" initiative has been started to let staff know that the process is changing and it is going to be easier than ever. The provider will simply need to call 968-1BED (968-1233) to have a bed assigned while they are on the phone with the nursing supervisor.
Sanders has been working on this for a while now. He started at Madigan just two weeks before MHS GENESIS did; they have been inseparable ever since.
"It's just all blossomed. I've done this before, just never with MHS GENESIS," he said.
At the Defense Health Information Technology Symposium this year, Sanders was the chief speaker on the subject of Clairvia, which is the engine within the new electronic health record that drives the data towards measurement and trending.
MHS GENESIS is part of the factors driving this change in process. The Defense Health Agency assumption of authority for all military treatment facilities as of Oct. 1, 2019, is also bringing standardization to military medicine. Add to those major influences a Joint Commission survey for reaccreditation in the coming year and the IHI's guidelines, and the time has never been more right for this process improvement effort.
While all these drivers are significant, the impact on care is expected to be substantial and applauded.
"The nursing staff should see smoother (patient) flow, fewer transitions of care, more lateral support, better communication and a more standardized approach at every admit and discharge," Sanders said.
The goal is to put patients where they can be best served by expert nurses who work within that level of care and scope of service right from the start. That will minimize the transfers and the transitions of care where vital information about a patient's condition and needs can get lost.
Lt. Col. Sherie Johnson, the nursing supervisor who is responsible for admitting and will be seated front and center to manage the flow of patients, echoed the expectation for a standardized approach smoothing the provision of care, especially for the nursing staff.
Having the providers make the call to the logistics center to secure a bed for the patient they have decided to admit cuts time and chances for errors. The nursing supervisor getting that call can ask all the pertinent questions about that patient directly of their provider instead of spending time tracking down that information through a chart review.
"If they contact us directly, then I'm able to answer those questions and make the appropriate placement," said Johnson.
Streamlining this process better enables the realization of the potential of the new EHR's ability to forecast staffing needs across the hospital, both maximizing efficiency and safety.
"If the nursing staff knows we're going to give them the right patient in the right bed at the right time with the right amount of staff to support the work that's being created, then they don't have to worry about those things," said Sanders.
The new bed assignment and admitting process starts Jan. 6. Construction on the logistics center will begin Feb. 11.
To read more about Clairvia and MHS GENESIS, visit: