Bed-der than ever

HEADNOTE

WORKFLOW MANAGEMENT: CASE HISTORY

HEADNOTE

Pittsburgh hospital uses automated bed tracking and control to speed efficiency in its ED.

In 1999, UPMC McKeesport, a 243-bed teaching hospital outside

of Pittsburgh, found itself in a double dilemma shared by many hospitals nationwide. Not only was its emergency department (ED) often overloaded, but it also was difficult to find beds for patients who needed to be admitted. As a result, patients waited in the ED, sometimes for hours, while overworked ED staff tried to find an empty bed.

The hospital had built a new ED in 1999, but to solve its efficiency problem, it needed a new technology approach. Hospital administrators engaged a consulting company to help the hospital determine exactly what problems existed and how to solve them.

Analyzing Needs

Together, hospital administrators, clinical staff and consultants discovered that the hospital ED delays were higher than national averages. The wait time that patients endured in the ED was 34 percent higher than national averages, and the elapsed time from "door to bed" was nearly three times the national average.

Since 83 percent of all UPMC McKeesport's patients were admitted via the ED, versus 41 percent nationally, something had to be done-and fast.

According to T. Michael White, M.D., chairman of the hospital's quality improvement committee, "When our employees were surveyed and asked what things prevented them from providing the best patient care, the number one response was `bed delays.'"

To locate a bed, ED staff, nurses or physicians called various nursing units to see if that unit had a bed available. Unit nurses then had to physically go and look at any empty rooms to see if they were clean and ready for the next patient. Often, because both the ED and the nursing units were very busy, calls were not returned and multiple calls were placed. Meanwhile, patients waited.

ED Strategy

Hospitals administrators, clinicians and the consultants identified three goals for UPMC McKeesport ED's revised strategy, and all were fixed on efficiency: 1) expedite time to the physician; 2) expedite time to diagnosis; 3) expedite time to admission. To do this, the hospital developed a five-point plan that included:

1. A revised triage form to shorten the triage process and direct patients to the right program of care sooner;

2. Implementation of bedside registration with registration staff who come to the patient's bedside;

3. Implementation of a centralized bed control;

4. Implementation of an automated bed-tracking system;

5. Creation of a new "administrative resident" position within the ED, whereby a resident physician works with each patient personally, taking medical histories and answering questions while that patient waits for a bed assignment.

At the core of UPMC McKeesport's new approach to bed control is an automated workflow system that utilizes a centralized bed control coordinator with a bed-tracking system. UPMC McKeesport chose the bed-tracking system developed by Tele-Tracking Technologies of Pittsburgh because of its comprehensiveness and user-friendliness for a variety of hospital users.

The system uses the telephone as its key "user component," according to Robin Lane, R.N., the organization's bed control coordinator. Use of the telephone makes the tracking system user-friendly and appealing to staff. "It's not just easy for the bed control coordinator to use, it's also easy for our housekeeping and nursing staffs to use. That's why it has been successful here. Implementation took only a few days, and using it is now part of the organization's daily routine."

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Coded Calls

The bed-tracking system works this way. First, when a patient is discharged, the nursing unit places a coded call to a special bed control phone number. The code tells which room and bed needs to be cleaned and also which housekeeper is assigned to that room. Then, the automated system sends a pager message to the housekeeper assigned, telling him or her what bed or room needs to be cleaned.

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The electronic bedboard from Tele-Tracking's Bed Management Suite.

If the housekeeper doesn't reach the room within 30 minutes, another call is automatically sent to the supervisor, alerting him or her of the situation. When the housekeeper gets to the room, he or she, too, places a coded call, alerting the system that cleaning is in progress. A final call is placed when cleaning is done, alerting the system that the room is ready, or alerting the system if the room first needs repairs before it can become available.

When each phone call is placed, the information is automatically entered into the centralized bed control system and can be accessed immediately by keying the bed board on a computer. TeleTracking also offers a 50-inch "bed board" wall panel, which shows the same information in a significantly larger format. The bed control coordinator sees in real time which beds are available, what types of beds they are and which rooms are in repair or are being cleaned.

Measurable Improvements

The new ED and bed-tracking programs at UPMC McKeesport have resulted in measurable improvements. First, the door-to-bed time has improved by nearly 30 percent. Similarly, what the hospital calls the "hold time"-the span of time the patient spends in the ED prior to admission-was reduced by nearly 30 percent, putting the hospital slightly below the national average, after being more than 40 percent above it. Finally, patients rating the ED services as "very good" improved from 42.5 percent in 1999 to 52.9 percent in 2001.

Along with shorter wait times for patients, the system has boosted employee morale by reducing unnecessary stress. It has also lengthened the time clinicians can spend with patients instead of trying to locate a bed.

The system has helped the hospital realign staffing patterns to reflect true peak times. Traditional staffing included the assumption that most patients were discharged around 11 a.m., so the volume of housekeeping and nursing staff was higher at that time. The bed-tracking system proved that real peak discharge occurred from 2 p.m. to 7 p.m., so staff hours have been adjusted to reflect peak discharge times.

A final result has been improved morale among housekeeping staff-a key component in the bed-tracking system-who have received renewed recognition for the important role they play in hospital operations.

Now, with the help of technology, UPMC McKeesport is back on the fast track to efficiency.

AUTHOR_AFFILIATION

For more information on bed-tracking systems from Tele-Tracking Technologies, www.rsleads.com/303ht-210