A majority of patients admitted at Good Shepherd Medical Center arrive through the hospital’s Emergency Department. Good Shepherd wanted to extend its Emergency Department Information System (EDIS) to enable communication of real-time patient data across the hospital to increase efficiency, improve patient safety, and enhance patient satisfaction.
Good Shepherd Medical Center is a 425-bed, regional-referral medical center and the only Level II Trauma Center in Longview, Texas, that provides inpatient and outpatient services in multiple disciplines. In 2005, as a part of the hospital’s ongoing efforts to advance its Emergency Department (ED) process management and flow, Good Shepherd implemented an Emergency Department Information System (EDIS) from medical software provider MEDHOST. The EDIS provides patient tracking, charting, and order placement functionality through an easy-to-use touch-screen interface.
After successfully implementing the EDIS, Good Shepherd executives turned their attention to maximizing patient flow and the efficient movement of patients across departments to avoid patient diversion— the process of directing incoming patient traffic to other hospitals when the ED no longer has capacity for additional patients. In 2008, Good Shepherd was forced to divert patients for more than 122 hours—an amount that was unacceptable to the hospital’s leadership team.
To assess bed levels and plan for patient flow, charge nurses held daily bed meetings. These meetings took nurses off the floor for 30 minutes and were not always effective. Further, staff shortages occasionally limited the hospital to using only 80 percent of available beds.
While Good Shepherd consistently ranks high in patient quality and safety ratings, the leadership team knew that improving enterprisewide access to patient flow information and the resulting staff collaboration would improve cross-discipline communication and minimize human errors. A misinterpreted admission order, for example, could result in sending a patient to the wrong location or assigning a single nurse a large percentage of high acuity patients, further overwhelming the staff member and impeding efficient flow.
Executives called for a technology solution that would quickly expose operational inefficiencies and specific areas for improvement. As more than 85 percent of admissions come through the ED, Good Shepherd executives turned to MEDHOST for help addressing its patient flow issues.Solution
Good Shepherd became a beta partner for a new solution from MEDHOST that addresses patient flow and bed management. “We were looking at patients who were stuck in the ED,” says Patricia Daiker, Vice President of Marketing at MEDHOST. “If we could move those patients out and into a bed, overall patient flow would improve.”
||The great thing about this tool is that visibility of information creates accountability. It allows the entire hospital to work together.
Vice President, Good Shepherd Medical Center
In March 2009, two architects from MEDHOST attended a one-day Architecture Design Session at the Microsoft Technology Center (MTC) in Dallas, Texas. “At the MTC, we had an in-depth strategy session with the Microsoft architects, confirming that Microsoft Silverlight and Windows Communication Foundation were the right technologies to deliver a high-performing Internet application with a very rich user experience,” says Eric Rock, Chief Technology Officer at MEDHOST.
The solution, called OpCenter, is a Microsoft .NET Framework–based application that pulls data from the MEDHOST EDIS and provides a web-based, at-a-glance view of patient flow throughout Good Shepherd. From a patient’s arrival at the ED, through admission, bed assignment, and pending discharge, the software communicates real-time data that hospital leadership can use to make informed decisions about patient flow. Good Shepherd went through a number of deployments for the solution, each time providing feedback and suggestions to MEDHOST.
“MEDHOST was very responsive in making adjustments,” says Ron Short, Vice President of Operations at Good Shepherd Medical Center. For instance, based on feedback from Good Shepherd, MEDHOST added a Bed-Ahead feature to signal the OpCenter main user screen when a new bed is needed, prior to receipt of the inpatient admission order. OpCenter also supplies Good Shepherd with easy-to-use use tools for modifying alert thresholds, notifications, and other parameters.
“The Microsoft platform was very nimble,” says Rock. “We were able to get input and feedback from Good Shepherd, and then rapidly complete change requests.” Benefits
Good Shepherd has improved patient flow and efficiency while enhancing patient safety and satisfaction through its use of OpCenter. “The great thing about this tool is that visibility of information creates accountability,” says Short. “It allows the entire hospital to work together.”
Improved Patient Flow
“The ED Saturation Meter shows us how saturated the ED and inpatient areas are so that we can react more quickly to move patients,” says Dancel Maxwell, Director of Clinical Patient Access and Patient Flow at Good Shepherd Medical Center. Hospital diversion hasn’t been necessary since OpCenter was implemented in 2009.
“Better visibility into patient flow across our medical center has allowed us to reduce bed assignment times by 20 minutes per admission,” says Short. “Our patients get settled more quickly, while our emergency caregivers are freed to tend to the next patient.”
Further, Good Shepherd is preparing to move to virtual bed meetings for charge nurses. Instead of daily, face-to-face meetings, charge nurses will enter bed assignment information into the OpCenter solution. The information will be shared instantly, allowing charge nurses to gain back roughly five nursing hours per week.Improved Patient Safety
With OpCenter, inpatient bed numbers are noted within the user interface, and admission orders are also scanned into the system. “We can compare the two to ensure that patients are appropriately placed in observation or inpatient status,” says Maxwell. “We have also reduced the variance that resulted from having to relocate patients to a higher level of care.” ED patients are assigned to nurses based on a feature called the Nurse Workload Monitor. This OpCenter bar-graph display shows which nurses have the highest number of acute-care patients so that managers can avoid overloading individual nurses.
Enhanced Patient Satisfaction
Each Good Shepherd patient receives a patient care survey after being discharged. “Our patient surveys indicate a 40 percent rise in patient satisfaction since the OpCenter deployment,” says Maxwell. “Such an increase was a wonderful, unanticipated surprise.”
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