Novel tracking system improves patient flow and quality

A visual patient tracking system at the Southlake Regional Health Centre, in Newmarket, Ont., has had an astonishing impact on process improvement and quality at the 380-bed hospital. The system also gives managers a quick understanding of what’s happening at the busy centre – letting them know whether things are running smoothly, or if actions should be taken to move patients from one unit to another to eliminate bottlenecks and waits.

“In an instant, it gives you the pulse of the whole hospital,” commented Helena Hutton, chief operating officer at Southlake. “In minutes, we’re able to clear logjams. You can see which beds are empty, and you’re able to phone just those units instead of calling all over the hospital.”

Hutton and Susan Grills, project manager, gave an overview of how the system works during the eHealth 2014 conference, held in Vancouver in June.

The solution, called McKesson Performance Visibility (MPV), was supplied by McKesson Canada and installed in 2012. Southlake was the second site in Canada to use the system (the first was implemented in Montreal), and its success has led several others to acquire it. At Southlake, it has already:

• Reduced phone calls among nurses and other staff members by 960 minutes per day.
• Eliminated about 400 interruptions of the work of nurses and other staff members each day, the equivalent of about 12.2 hours daily.
• Reduced medication errors. (The reduction in interruptions is believed to be asso-ciated with a sizeable lowering of drug errors.)
• Reduced the number of falls by 50 percent.
• Reduced the number of patients waiting in the ED by 17 percent.

The MPV system enables everyone in the hospital to see whether a bed is occupied, what type of patient is in the bed, when he or she is expected to be discharged, and the special needs of that patient.

It’s all colour-coded, so staff can see at glance whether a patient who should have been discharged is still in a bed (red), if a bed is open but still needs housekeeping to get it ready (brown), or if it’s unoccupied and ready for a patient (white).

“It’s a geo-spatial map that works in real-time,” said Hutton. “Once you know the colour scheme, it’s quite easy to understand.”

This simple but pervasive system is displayed on large monitors throughout the hospital (where patient names are hidden, for privacy reasons), and on desktops, where patient identities are available to staff members.

It has resulted in a dramatic drop in phone calls between nurses, many of whom used to spend much of their days tracking down available beds. Before the arrival of MPV, they’d call around to various units to see whether they could move patients into them. Now, they can see in a moment when beds are available, and need only call a particular unit to give a report on the incoming patient.

Interestingly, many staff members were initially skeptical about the new system, and doubted whether it would be useful. “One charge nurse told me she didn’t have time for it,” said Grills. “But it turned out that she would spend most of her time calling other units to see when beds were ready.

“After the system went in, and she started using it, she could see the state of readiness of a bed in seconds, without calling to badger anyone else. The charge nurse found she loved the new system,” said Grills.

In addition, the reduced need to call other units resulted in better relations among units, as nurses felt less harassed.

Significantly, the visual system notes whether precautions should be taken with patients. It clearly indicates whether a patient requires infection control, has skin integrity issues, is at risk of falls, or may be violent.

“Staff members, including transporters, can immediately see if a patient has any special needs,” commented Grills.

That’s led to a tremendous reduction in falls – in a one year period, falls were reduced by 50 percent – and awareness of potentially violent patients was greatly enhanced.

Patient flow has also improved, as staff can quickly see which units have beds available. That has led to reduced waits in the emergency department.

And because the MPV system includes an estimated discharge date, staff are alerted to patients who are still in hospital after their expected discharge date – the lettering on the screen turns bright red. Staff are then prompted to find out why the patient hasn’t been discharged or to revise the discharge date.

Since the visual system lets staff know of impending discharges – 48 hours or less, with the lettering changing from green to yellow – they can take special efforts to ensure that tests and paperwork are completed beforehand.

Medication waste has been reduced, too, as pharmacy staff can see whether patients are still in hospital, and when they’re expected to leave. Before the MPV system was implemented, pharmacy staff sometimes prepared expensive medications, only to find that the patients had already left the hospital.

The location of patients in the hospital can also be tracked, as nurses can note when patients have gone to different units for tests. A timer lets staff know how long patients have been at a certain location, such as the radiology department or a cath lab, and enables them to estimate when patients should return to their rooms.

Ron Dunn, vice president of information solutions for McKesson Canada, noted: “Hospitals are facing capacity and resource constraints that are impacting operational and clinical performance. The results for Southlake clearly demonstrate that MPV has had a positive impact on their operational efficiency, particularly at a time when Ontario hospitals must improve their performance to support the quality-based procedure funding model. MPV is the ideal platform to do this.”

Grills pointed out that all staff members involved in patient flow have taken ownership of the system throughout the hospital. “They challenge each other to update the system, and to ask why certain tasks haven’t been completed,” she said.

In short order, the MPV has become an important management tool. In addition to the clinical staff members who make heavy use of the system, the hospital’s chief executive officer – Dr. Dave Williams – likes to take an occasional peek, to keep tabs on the organization. Hutton mentioned that Dr. Williams was miffed, not long ago, when he couldn’t use the system during a short period of product maintenance. “We’ve all come to rely on it,” said Hutton. “I use it three times a day, and I’ll often look [remotely] before I go to bed.”

Southlake accommodates more than 90,000 visits to its Emergency Department, 22,000 in-patient admissions, and 600,000 out-patient visits each year. It provides care to the more than 1 million people who reside in York Region, Simcoe County, and as far north as Muskoka.