North Montreal deploys SHREWD solution to monitor patient flow

One of the five Montreal’s integrated university health and social services networks has partnered with VitalHub Corp. to pilot an operational visibility solution that will streamline patient flow across the network’s 26 healthcare services.

This network, the Centre intégré universitaire de santé et services sociaux du nord-de-l’île-de-Montreal (CIUSSS-NIM), will be the first integrated health-care network in Canada to deploy the SHREWD Resilience and Action modules from VitalHub’s recently acquired UK subsidiary, Transforming Systems.

The CIUSSS includes three acute care hospitals, two mental health hospitals and 11 long-term care and rehab institutions, with a total of approximately 3,000 beds. It’s also responsible for six primary care centres for a population of 450,000 people and provides home care to 9,000 people every week.

Established in 2015 as a result of a major healthcare reorganization in Quebec, the CIUSSS currently has no network-wide visibility of patient flow and bed occupancy, depriving it of an opportunity to anticipate bottlenecks and make adjustments in a timely manner.

Frédéric Abergel, CEO of the North Island Montreal CIUSSS, had been thinking about the need for an operational visibility solution for several years, but it was COVID-19 that motivated him to take action.

“At the beginning of the pandemic we had major problems managing what was happening in our long-term care institutions,” he said. “The COVID-19 virus hit us very hard and we had trouble knowing what was happening with our beds in real-time. The manager of each site knew, but on a CIUSSS level, it was really difficult.”

At the same time, Abergel learned that VitalHub had acquired Transforming Systems, whose SHREWD solution is deployed in 30 percent of the National Health Services’s Integrated Care Systems in the UK.

“I knew that if there was one healthcare system close to ours in Quebec, it was the UK system,” said Abergel.

VitalHub, a Toronto-based software company that focuses on patient flow, with customers in Canada, the UK, the Middle East and Australia, supported a demo and a decision was made to pilot SHREWD.

“We are working in silos now,” noted Abergel. “Every hospital has its own visibility, but we want patients to flow through the system. If someone comes to one of our ERs and we have no beds in that hospital, but we have beds in our other two acute care hospitals, we would like to redirect the patient. Today, it’s really cumbersome and most of the process is manual.”

Abergel also offers the example of an elderly hospital patient who has no social support at home and is about to be discharged. “We know this patient will have to be discharged to a long-term care bed, but right now, it takes many people talking to each other from the hospital and long-term care, back and forth.

“We waste hours, if not days, co-ordinating the transfer of patients. It’s the same thing for rehab beds. It takes a long time to have a grasp of everything going on. With SHREWD, we’ll know right away if a bed is available.”

The SHREWD Resilience module presents users with an overview of patient flow through a pie-shaped, colour-coded graphical user interface conveying capacity utilization for every health service in the network, including ERs, hospitals, long-term care and rehab.

Clicking on a pie segment allows the user to drill down to see the number of patients in an ER and the number of hospital and long-term care beds available. Colour coding from green to amber, red and black based on pre-set user-defined thresholds reveals pressure points and allows healthcare staff to anticipate the impact on other services.

Abergel, for example, notes that “every January in Canada, we have an increase in demand for rehab because seniors fall during the winter. They break their bones, go to surgery and then to rehab. SHREWD will provide exact number of patients requiring rehabilitation, in real-time, giving us advanced notice of who’s coming in,” giving CIUSSS staff time to free up the required number of beds.

The SHREWD Action module will go one step further and automate the necessary communication and co-ordination required when a pre-determined threshold is reached.

“Let’s say we have 10 patients waiting more than two days for a rehab bed,” said Abergel. “Based on that threshold, we could have an alert go out automatically to designated staff to do something to admit those patients without delay so they don’t pile up in the hospital.

“This module will allow us to define the rules and actions required. Today, when we get to this threshold, we convene a meeting of 10 or 15 people. They sit around and gather information on occupancy of rehab beds. Then we’ll make a decision. We want to automate this process.”

He added that, “Every time a patient spends a day in hospital, the patient has more chances of getting an infection. It’s also blocking a bed for someone in ER who needs it. There are a lot of impacts of having patients waiting for no reason.”

Abergel isn’t sold on the need for a single command centre with key staff monitoring network-wide metrics on overhead monitors. In fact, Niels Tofting, VitalHub’s executive vice-president of business development and marketing, claims SHREWD is designed to support a decentralized model.

“You don’t have to invest in a dedicated space,” he said. “SHREWD sources key analytical information from existing databases and brings it together in a way that it can be consumed by front line staff, managers and executives in an organization, so everyone is on the same page with regard to what is happening across the system.”

Implementing SHREWD in an integrated healthcare network isn’t as difficult as some may think, said Lisa Riley, VitalHub’s vice-president of strategy.

“People overestimate how much effort it takes to do this. We simply take data from existing systems and bring it into the SHREWD data lake. It’s a very straightforward process. In the UK, we’ve implemented it in as little as four weeks. It doesn’t have to be onerous.

“Some people in Canada have said it’s too advanced, that they’re not ready for it, but it’s not advanced at all. It’s simple. You don’t need to worry about how complex your data is. We simplify it for you.”

VitalHub is also talking to potential customers in Ontario and sees opportunity for additional interest in SHREWD given the trend toward integrated healthcare networks across Canada.