Catawba Valley Medical Center in Hickory, North Carolina, is a 258-bed facility with 15 family practices and numerous other ambulatory facilities.
The medical center wanted to reduce the time patients spend in the emergency department while waiting for an open bed in the hospital so they can be admitted. Prolonged wait times can cause discomfort for patients and delay treatment.
Catawba Valley Medical Center has earned the Magnet Award for nursing excellence five years in a row, and it is recognized in the region for medical excellence, so this was an issue the hospital was committed to improving.
“At the medical center, the administrators on duty are responsible for finding beds for newly admitted patients,” said Christy Hoke, director of health informatics at Catawba Valley Medical Center. “But because administrators on duty are usually moving around the hospital, it can be difficult for them to receive prompt alerts of a new patient admission, which can cause a delay of a bed assignment.”
“When considering similar technology, your organization must determine the expectation of staff regarding personal versus organization-provided devices.”
Christy Hoke, Catawba Valley Medical Center
Traditional means of communications – via paper, pagers and phones – were not efficient enough to help reduce ED-to-bed wait times, she added.
The medical center’s ED-to-Bed Wait Reduction initiative had three objectives:
- Timely notification to the administrators on duty when a patient is to be admitted.
- Tie to the ADT feed so that charge nurses get admission requests for their business groups only.
- Streamline workflow for various types of admissions to reduce ED wait times.
Earlier this year, Catawba Valley Medical Center implemented the Bed Management desktop module to the Admission section of its Meditech 6.0 EHR as the first step toward resolving ED-to-bed wait times for patients.
“With this tool, an administrator on duty can log into a computer and see bed requests, as well as available beds, in their units,” Hoke explained. “Then, the administrator on duty can match the request to the bed and facilitate transferring the patient to a room.”
The Bed Management tool solved part of the problem – matching a new patient admission to a bed – but the core issue remained: How to alert the administrators on duty in a timely fashion as they move about the facility throughout the day.
There are a variety of care collaboration platforms on the health IT market today. Vendors include Carestream, Careteam, DrFirst, eXo Platform, PerfectServe and Wipro.
MEETING THE CHALLENGE
To resolve the problem of alerting administrators on duty, the medical center began using DrFirst’s Backline care collaboration tool to enable physicians and advance practice providers to chat with each other securely throughout the day.
“With the Meditech 6.0 EHR and Backline, charge nurses can use their own smartphones for communication, and that is efficient, timely and HIPAA-compliant,” Hoke said. “Backline can be used to alert the administrators on duty no matter where they are in the hospital. Once notified, administrators on duty can quickly respond with a bed match and transition the patient to an inpatient room.”
To make it easy for the ED staff to request a bed for a newly admitted patient, Catawba added an “admit request” button within the Emergency Department module of its EHR. Now, with one click, staff can send a request for a bed to the Bed Management module, which immediately notifies via Backline the administrators on duty of the need.
“The most challenging part of the Backline implementation turned out to be splitting admission requests to the appropriate clinical unit at the medical center in real time,” Hoke remarked. “Catawba Valley Medical Center has eight clinical units, each one managed by a charge nurse. For instance, a cardiac unit should only receive bed requests for the cardiology unit, and so forth. Collaborating with DrFirst, the medical center created a ‘virtual printer’ to separate and send Backline notifications to the correct units.”
Room requests specific to other units were removed from their Backline feeds to save the charge nurses time filtering through requests that were unrelated to their units. Now, each unit’s charge nurse receives only his or her admission notifications in real time.
“Catawba Valley Medical Center looked at the devices the hospital staff were currently using, including the charge phones,” Hoke recalled. “With its HIPAA security, the decision to begin enabling Backline on the personal mobile devices of select staff was clear. Now, Backline is implemented on Catawba Valley Medical Center inpatient units’ and administrators on duty’s smartphones.”
Catawba Valley Medical Center has significantly reduced ED-to-bed wait times. And clinicians and nurses have noted substantial improvements in workflow efficiencies.
“Within two months of implementing Backline for the ED-to-Bed Wait Reduction initiative, the time from ED arrival to departure to a room decreased by nearly 97 minutes per patient,” Hoke reported. “Calls to the administrators on duty decreased from 274 before electronic notifications to 149 since implementation, eliminating approximately 125 calls per day to the administrators on duty.”
That’s a huge improvement with significant impact on the administrator on duty’s ability to do his or her job with fewer distractions while improving the patient experience, she added.
ADVICE FOR OTHERS
“When considering similar technology, your organization must determine the expectation of staff regarding personal versus organization-provided devices,” Hoke advised. “For non-exempt staff, our organization chose to provide a device. Exempt staff would provide their own devices. In addition to HIPPA-compliant texting, it is important to see what additional services the vendor can provide that would improve workflows in your organization.”