Anticlue

Electronic Bed Boards

As a part of yesteday’s Himss conference, I took full advantage of attending the session on realizing Quantitative and Qualiative Benefits using New Patient Flow Technology.

The session was obviously on implementing an electronic bed board, which I think after attending the session is a great idea. Nationally, patients are getting sicker and staying longer. Increasing patient float and decreasing available beds. Admission issues and available bed issues have already started.

Wonder if you have a patient flow problem, just look around. Are the admitting waiting and ED areas standing room only? Is there a long wait and an inability to admit patients? Is it hard to accommodate add-on surgery cases? Are patients ever placed in the wrong unit just because there is an available bed? Does the ED divert? How often does the ED divert?

So if you have answered yes, more than likely you are also suffering capacity issues. This is why a bed board is helpful. Length of stay is normally taken off of the midnight census, although there may be a 30 – 40 % variance during the day, the best way to determine where a patient has been through out the day, is to look at all of the transfers throughout the stay. Patient flow management defines and tracks any number of relevant transfers over time.

A couple of questions to ask during the implementation are:

• How many ways can we admit a patient, what are our entrances?
• How long does it take to transport a patient, how do particular segments work?
• How do we align the peaks with the staffing patterns?
• On average how many times does a patient move during a 1 day LOS, 2 day LOS, 3 day LOS?

Once you realize there is a capacity issue, there are a couple of ways to handle it

1. Shorten unnecessary patient time in rooms
2. Shorten vacant room time between patients, (what is the OR turnover time? Actually just have what is the {insert location} turn over time?)
3. Get more licensed beds, and expand size to accommodate the new beds.

The important item when examining capacity is to address the bottlenecks. Remember, patients only flow at the rate of the bottle necks. It doesn’t do any good to have all the non-bottlenecks occupied. Also once you work according to your constraint, bottleneck, another one will pop up, so be sure to look for it, and review the process again.

In implementing an Electronic Bed, lessons learned were:

• Patient Flow becomes better understood
• A manager of patient flow needs to be identified
• Housekeeping needs to know where to go next, so send housekeeping where they are needed.
• Time in surgery has many benefits, such as the nurses looking to see who is coming up from surgery.
• Don’t use an interface for the transfers, place buttons were needed.
  Hitting the button is much more effective mechanism for tracking.

To quickly summarize, patient flow changes:

Quantitative Change

• Increase utilization & capacity (volume)
• Increase direct labor productivity
• Reduce overtime & agency premiums

Qualitative Change

• Improve clinical outcomes /reduce errors
• Improve patient and family and satisfaction
• Improve physician and staff satisfaction /retention

Strategic Change

• Enables compliance with new JCAHO standard
• Leverage data (asset) for process improvement
• Seek competitive advantage in marketplace

Technology as an enabler

• Configurable tool to meet unique process needs
• Not tied to CIS/AMR platform
• Intra and inter-departmental platform
• Public display increases accountability, wide distribution of real-time info
• Personal accountability, in recording data and issuing events.

Commitment to improve processes

• Senior management leads multi-disciplinary team/nurses engaged
• Low cost. Non-disruptive data collection process
• Data mining and analysis to support process improvement
• Taking the leap of faith and then keep going.