How NASA-like mission control centers can lead to system-wide patient flow efficiencies
Everything we do comes back to what is best for our patient. Delivering the right care, at the right place, at the right time — is the goal of an effective, efficient patient flow strategy. And the best way to achieve that goal is through an operational command center.
Carilion Clinic is a seven-hospital, 1,100 bed health system in Roanoke, Va., that implemented a NASA-like mission control center, known as the CTaC, in 2012 to allow for the seamless entry of patients into the health system and coordination of the safest, most appropriate care throughout their length of stay. We created a physical space that facilitates collaboration between various departments, and we implemented state-of-the-art technology and a patient flow software system, TeleTracking, that provides real-time capacity updates.
This level of integration is critical because there are several points of entry into a health system — from coming in through the emergency department, via helicopter or ambulance, or being referred through a doctor’s office. In the example of being life-flighted, we might have to make three moves behind the scenes to open up that specialty bed.
How We Got Started
I’m proud to have been an RN for more than 22 years. I started my career in the hospital inpatient environment, worked as a flight nurse and then transitioned into a marketing/business development role in Carilion Clinic’s transportation department.
A few years ago, a team at Carilion decided to reevaluate how patients were transferred into the system. I became involved in the task force because in my business development role, I was on the front lines talking to customers; I knew the areas we were strong in, and at the same time, I also knew where there were opportunities for improvement.
When we started the planning process, one of the first decisions was to move the transfer center under the emergency services wing of the hospital. The decision came with an EMS mindset, including clear protocols and consistent processes at the center that helped to ensure that no matter what the situation — many of them stressful — people have an algorithmic approach to rely on and guide them to success.
Next we needed to design the physical space and determined that it made sense to put EMS dispatch and transfer center nurses in the same room, as it just simplified things. That was just the first part of the puzzle; we also needed dispatchers to help get the discharges out and the new patients in a bed. So we established processes that allowed for better prioritization and a more natural progression. This methodical approach has resulted in our center being recognized for its best practices three years after implementation.
Barriers to Patient Access, Throughput
The main barrier was simple. From a transfer perspective, we simply had more patients than beds. So first we needed to address the length of stay issues; part of that involved determining what services could be administered on an outpatient basis versus an inpatient basis.
We consider it our responsibility to our patients to always maximize efficiencies, and we take that very seriously. Previously, there were several portals of entry, and when a hospital is running at 95-98% capacity that can be challenging, especially with time sensitive issues. It literally can mean the difference between life and death.
With our move to a centralized system, people knew what to expect and knew how to facilitate things so that the right patients were sent to the right facility — whether it was our main facility or one of our six community hospitals. The result was a 40-60% increase in transfer admissions to one of our main secondary campuses and improved efficiencies for the system as a whole.
Creating Synergies, Managing Cultural Change
Physical space is important to creating the right synergies between the command center employees, and we were very blessed to get the physical space that we have. Our center is arranged in a semi-circle layout — which works perfectly from a collaboration standpoint. We worked closely with a wonderful space manager, as well as a project manager who helped us maximize the floor area and make it easy for nurses and dispatchers to communicate, all while allowing ample space for monitors and dashboards. Since the center’s go-live, we have also incorporated the inpatient clinical transport and environmental services dispatchers into our model. It was a logical fit with our throughput work.
It was a big cultural change to have different departments working together so closely, so making sure everyone felt invested and that they could communicate openly with each other was essential. We brought everyone who was going to be involved to the table and we wanted to know what they liked, what we needed to work on and what was on their wish lists. We also worked closely with everyone on a robust training program to ensure they would be comfortable and compliant with the software systems.
And these efforts have paid off. Really strong relationships were established in the department, with both EMS and nursing staff feeling like they were part of the bigger picture and that the entire health system was operating as a cohesive unit. Plus, once everyone saw the level and timeliness of data that the software provided, and the fact that operational decisions could be made based on that data and used for future planning decisions, they fully embraced the new way of doing things.
Impact, Lessons learned
With a single point of entry into the health system, patient transfer acceptance, bed assignments, provider consultations and patient transportation times have improved. Specifically, accepted transfer referral volumes have increased 11%, and we saw a 5% increase in the number of patients who were moved to a clean bed once it was assigned within one hour.
These numbers also show that we have been able to make things as transparent, seamless and full-service as possible — a transfer call is never let go until that patient is accepted at some location — even if that location is at a competing organization. There should never be any unanswered questions at the end of a call, because at the end of the day it’s about taking care of patients. We strongly believe this strategy has really helped facilitate trust — that physicians and nurses will reach out to us in the future if they know they can count on us to help them in each and every situation. And that also means reduced patient diversions, decreased patient wait times, timely discharges, effective nursing ratios, etc.