Command centre in Montreal monitors an entire region

A new Command Centre at Montreal’s Jewish General Hospital (JGH) is likely the first facility of its kind in Canada – and possibly in North America – to gather and display data about an integrated healthcare network.

Hospital staff in the Command Centre, or C4 as it’s called, are able to oversee and expedite patient flows and transfers within West-Central Montreal’s Centre Integré universitaire de santé et de service sociaux (CIUSSS).

One of five integrated healthcare networks in the city, the West-Central Montreal CIUSSS encompasses a total of 34 healthcare facilities and services, including the JGH, five long-term care homes, three rehab hospitals, community clinics, outpatient services and home care.

“Before we had the Command Centre, decisions were made in silos, and if you didn’t have the right information, you had to call somebody or send an email and wait for a response,” said Dr. Shannon Fraser, medical director of the Command Centre and chief of General Surgery.

“The Command Centre is now the hub that brings together the people with the right information to make decisions much more efficiently and much quicker, and where we’re able to address any barriers or issues that come up. That didn’t exist before. We were working in our own little space and when we hit a wall, we’d have to call each other. Now, we can make decisions in minutes and hours, not weeks and days.”

“The concept of the Command Centre is well known in other industries, including the military, NASA and airport flight control,” noted Amanda Babbit of Maisha Labs, a health tech company with offices in Montreal and Tel Aviv that provides the JGH with technical expertise.

“It has proven effective in critical situations, especially where decisions have significant outcomes and where the environment is changing rapidly. Healthcare is one of them, so our goal is to allow the team in the room to receive and react to information quickly to facilitate efficiencies where we might not have been able to before.”

Screens within the Command Centre display bed board information and allow staff to drill down to individual patient data “if, for example, we’re trying to direct a patient at the end of their care phase to an appropriate spot for their next phase of care,” said Dr. Fraser.

Command Centre staff are able to see the number of patients waiting in the Emergency Department for acute care beds, alternative level of care (ALC) patients waiting for transfer out of acute care, patient length of stay data, and capacity information in the long-term care and rehab facilities.

Before the COVID-19 pandemic, the JGH had more than 60 ALC patients at any given time. By February 15, with the Command Centre in operation, the hospital had only 22 ALC patients taking up acute care beds.

In addition to inpatient rehab and long-term care, Command Centre staff are able to direct patients to virtual rehab at home, said Mary Lattas, associate director of Rehabilitation and Multidisciplinary Services.

With key people from different departments in the same room with all the information at their fingertips, it’s much easier to match demand and capacity.

An artificial intelligence (AI) algorithm developed by Maisha Labs predicts the volume of COVID-19 patients showing up in the Emergency Department and whether they’ll be admitted or discharged.

“Predictive analytics can help prevent glitches by giving healthcare teams warning of what’s coming,” said Babbit. “If the teams are aware in advance that they’re looking at higher numbers of COVID patients, they can make preparations ahead of time.

“Another tool that predicts the flow of admitted COVID patients is based on epidemiological data. It predicts which patients are going to need elevated levels of care.”

The JGH has made a special effort to sell the concept of the Command Centre to hospital staff “because when we introduce these kinds of changes, there’s naturally a little bit of pushback,” said Babbit.

“People are proud of what they do and aren’t always that excited about change. In healthcare, everything we do really matters. It’s not like working in a bank or a real estate office. The work we do literally changes peoples’ lives.

“You can help someone get healthy, or not, so whenever we come in and say, ‘Hey, we have a fancy new tool, we want to change everything,’ it’s normal for there to be pushback. By bringing them into the Command Centre and saying, ‘We have some ideas, what do you think?’ That’s how we drive holistic change.”

Clinicians who might be uncomfortable with patient transfer decisions are able to see the big picture.

“We can explain that a patient can still rehab on an outpatient basis,” said Lattas. “We don’t need to keep them as an inpatient because we have patients waiting in acute care, including stroke patients who shouldn’t be waiting for more than two days for their stroke care. We have to be mindful of that and ensure access for everybody. When it’s presented in that manner, they understand better and accept the change.”

To help free up beds, the JGH is also operating a virtual ward pilot project for cardiology patients. Using smartwatches and patches from Biobeat, an Israeli health tech company, the hospital is able to remotely monitor patients who may be at high risk for complications.

The devices measure blood pressure, oxygen saturation, heart rate, respiratory rate, temperature and stroke volume, allowing staff in the Command Centre to keep an eye on patients beyond the walls of the hospital.

If there is an issue, clinicians can intervene to prevent an Emergency Department visit or hospitalization.

The Command Centre, or C4 as it’s called, initially operated in the hospital’s boardroom, but relocated to a permanent space in early April. Funding was provided by the Jewish General Hospital Foundation.