Question

Managing the flow of patients and bed capacity is challenging for any hospital, especially for unscheduled admissions. For Zed Medical Center, a large regional referral center in the South and a member of the University HealthSystem Consortium, the challenge is even greater. As the flagship hospital for a multihospital system with more than 750 licensed beds and a Level 1 trauma center with 50-plus trauma beds, approximately 70% of annual admissions are unscheduled.

The Assistant Vice-President for Operations has a PhD in Nursing, is a Fellow of the Advisory Board Company, and has more than 20 years' tenure at Zed Medical Center. Three of the ten departments under her purview (Patient Care Coordinator, Bed Control, and Patient Transfers) are directly engaged in managing patient flow and bed capacity. The division is also responsible for systemwide care coordination for patients discharged to skilled nursing facilities, to home health, and to home without planned service delivery. Current operational goals include (1) decreasing the current length of stay by 0.3 days from 5.7 to 5.4 days and (2) “ED to 3”—a slogan incorporating the intention to place patients from the emergency department into a bed within 3 hours of the decision to admit. With the Centers for Medicare & Medicaid Services in the process of clarifying penalties for readmissions within 30 days, Zed Medical Center has begun to prepare by determining its baseline percentage of readmissions within 30 days.

The eight staff members assigned to Patient Transfers coordinate with hospitals within the region wanting to transfer patients to Zed Medical Center. They take calls, connect outside transfers with accepting physicians, and arrange transport. The accepting physician determines the patient's needed level of care, special care needs (e.g., diabetic), and the time frame for transfer. The Patient Transfer Department uses the software package CentralLogic (www.centrallogic.com/), specifically the ForeFront module (www.centrallogic.com/products/forefront), to manage the transfer and admission of patients. After a patient has been accepted for admission by the admitting physician, Bed Control makes the bed assignment. The staff members of Bed Control assign incoming patients to specific beds once the Patient Placement Facilitators from the Patient Care Coordinator Department identify the nursing unit to which patients should be assigned. This determination is made based on the level of care required, physician preferences in choice of nursing unit, and the scope of care supported by the nursing units. The Bed Control Department uses the Capacity Management Suite (www.teletracking.com/solutions/products/index.html) of TeleTracking software (www.teletracking.com/). The PreAdmitTracking module keeps track of bed status through the use of an “electric bedboard,” which provides a graphical user interface through which planned admissions, transfers, and discharges can be annotated. The status of a bed freed by patient discharge for which a cleaning request has been made is also noted (dirty, in progress, cleaned). The Bed Tracking module uses the medical center's paging network to notify the environmental services staff of a cleaning request and the head nurse of the unit that a patient is incoming. The TransportTracking module automatically dispatches patient transport requests via phone or pager.

1. How are patients prioritized for bed assignment?

2. Describe some of the advantages and disadvantages of this new software. Include the stated organizational goals in your answer.

3. Discuss how this software might share data with other institutional applications to provide a dashboard view of census-type activity.

Answer 1

1. The staff members of Bed Control assign incoming patients to specific beds once the Patient Placement Facilitators from the Patient Care Coordinator Department identify the nursing unit to which patients should be assigned. This determination is made based on the level of care required, physician preferences in choice of nursing unit, and the scope of care supported by the nursing units.

2. Advantages :

- keeps track of the bed status

- provides a graphical user interface through which planned admissions, transfers, and discharges can be annotated

- the status of a bed freed by patient discharge for which a cleaning request has been made is also noted

- uses the medical center's paging network to notify the environmental services staff of a cleaning request and the head nurse of the unit that a patient is incoming

- The TransportTracking module automatically dispatches patient transport requests via phone or pager

Disadvantages:

- Carshing of the Sysytem

- can't be delivered in emerngency cases

- easy data collection from the system

3. The software might share the data to other insititutional applications in-order to soothen the functions in the hospital. The data might be shared to the frontdesk via remote to better view of the rooms availabale in the hospital