A common struggle for many hospitals involves knowing exactly when a room is vacated, ready to be cleaned, and when it is clean and available for the next waiting patient. If it’s unclear when the previous patient was discharged, that means the waiting patient may have a longer stay in the emergency department or the post-surgical unit, for example.
Together, these types of delays lead to inefficiencies in overall patient flow and negatively affect capacity for the health system, reducing usable capacity.
CHRISTUS Santa Rosa Hospital-Westover Hills, a 150-bed hospital serving the fastest-growing area of San Antonio, faced this problem. With specialized care that includes orthopedic and surgical services, ICU, women’s services, a newborn nursery, comprehensive cardiovascular care, emergency services and more, it was critical for the facility to find ways to maximize capacity and effectively use every bed in order to meet the needs of the community.
CHRISTUS Health is one of the top Catholic health systems in the U.S., with more than 600 centers, including long-term care facilities, community hospitals, walk-in clinics and health ministries.
What is piloted and successful at one site can then be shared across the system. Because of its size, CHRISTUS Santa Rosa Hospital-Westover Hills often serves as a test site for new technology and processes that end up benefiting the system as a whole.
Real-time locating system technology, or RTLS, integrated with a patient-flow-technology platform and supporting workflows, helps ensure dirty bed notifications (when a patient is discharged) are expedited. The process in turn expedites bed-turn times by environmental services staff. So San Antonio hospital turned to TeleTracking, a vendor of RTLS and other technologies.
A patient, for example, is given a bracelet with an RTLS tag when they are admitted. When they meet the appropriate discharge milestones, the process continues with the discharge order entering the workflow.
“The RTLS technology notifies staff of open beds approximately 2 hours and 40 minutes sooner than manual entry into the electronic health record.”
James Pharr, CHRISTUS Santa Rosa Hospital-Westover Hills
When the patient with the completed discharge order is near one of the designated hospital exits, the bracelet is removed, and it is placed in a drop-box that sends an automatic alert to environmental services informing them that the bed is ready to be cleaned and prepared for the next patient.
By placing the focus on when the patient physically leaves the patient room, rather than waiting for documentation to be completed, beds are available sooner and hospital leadership can improve admission rates and increase revenue from existing capacity, said James Pharr, hospital transportation lead at CHRISTUS Santa Rosa Hospital-Westover Hills.
There are many vendors of real-time location system technology on the market today, such as CenTrak, GE Healthcare, Hewlett-Packard, Midmark RTLS, Mojix, Siemens, Skytron, Stanley Healthcare, TeleTracking, Vizzia Technologies and Zebra Manufacturing Solutions.
MEETING THE CHALLENGE
In February 2019, the team at CHRISTUS decided to implement RTLS technology to safely and efficiently expedite patients ready for discharge, making it possible to meet the challenge of opening up additional capacity for the hospital.
RTLS hardware was installed at seven entrances/exits, and patients were given bracelets at registration or when they came in through the emergency department. The RTLS technology seamlessly integrated with the core patient flow solution they were already using from TeleTracking for visibility.
“The team members who were part of the implementation represented a range of departments,” Pharr explained. “Patient registration and emergency department registration were trained on how to bracelet patients at admission. Patient transporters were trained on how to remove the bracelets upon discharge and place them in a designated drop-box. Nurses on each of the units were trained on using the whiteboards to monitor patients’ whereabouts and prioritize them for discharge.”
The combined result gives patient placement the ability to immediately see when a patient is discharged so they can then assign the next patient.
“The RTLS technology notifies staff of open beds approximately 2 hours and 40 minutes sooner than manual entry into the electronic health record and helps avoid what is often referred to as discharge batching,” Pharr said. “Batching is a situation where staff wait until the end of shift to enter a batch of patients into the electronic health record that were discharged earlier, so that new patients coming into the unit will be managed by the incoming shift.”
This type of technology and workflow prevents that from happening and literally “pulls” the next waiting patient from the ER onto the floor with the next open bed – reducing what’s known as “lost bedtime,” he added. The bottom line is that sick patients get to a bed and can begin treatment sooner.
From February 2019 to February 2020, patient-bracelet tagging, compliance and sustainability have remained at more than 90% – with more than 4,000 patients being discharged through this process over those 12 months.
“Gained insight into 2,339 hours to prepare and pull the next patient by not batching and wasting approximately two hours and 40 minutes gave caregivers time back at the bedside,” Pharr reported. “In addition, the increased capacity resulted in increased ROI, based on 117 bed gains being gained, with a $3,000 average daily patient contribution margin, leading to $351,000 in revenue gained in one year – a significant increase for a 150-bed community hospital,” Pharr said.
ADVICE FOR OTHERS
“Discharge efficiency is an important part of strong, overall health system operations, and a best practice that is focusing on when the patient physically leaves the patient room, rather than waiting for documentation to be completed,” Pharr advised.
“Automated workflows driven by RTLS maximize patient throughput, open up time for staff members and increase revenue. And like any major change, staff engagement is important – it needs to become a part of the culture with everyone understanding and complying with the process across units.”
It also is important for the environmental services and patient transport departments to understand how their workflows will be impacted – and improved – by knowing where patients were, when they are going to be discharged, and expediting the process of room turnover for the next patient, he concluded.
Email the writer: [email protected]
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