Designing a Hospital Command Center for Success
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1 1 Designing a Hospital Command Center for Success Ramin Yazdanfar, MD Medical Director, UPMC Pinnacle Transfer Center & Patient Placement Operations Center (PPOC) Staff Hospitalist, UPMC Pinnacle Hospitalist Program
Transcript of Designing a Hospital Command Center for Success
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Designing a Hospital Command Center for SuccessRamin Yazdanfar, MD
Medical Director, UPMC Pinnacle Transfer Center & Patient Placement Operations Center (PPOC)Staff Hospitalist, UPMC Pinnacle Hospitalist Program
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Agenda
• PART 1:– Key elements in developing a command center– Structure/design/integration
• PART 2:– Putting it all together - UPMC Pinnacle– COVID-19 success
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PART 1: KEY ELEMENTS IN DEVELOPING & DESIGNING A COMMAND CENTER
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Evolution to an Integrated Command Center
Traditional Call Center (P3)
Integrated Command Center (UPMC Pinnacle 7)
• Move pt from AàB • Real-time Analytics and Decision Support
• Non-clinical • Pre-emptive clinical decision making
• Simple to implement • Multi-purpose center
• Less integration with IT • Cross-functional resources
• Imbalance of resources • Load balancing for the system (understand status of system)
• Poor clinical efficiency • Only avenue for patient flow
• Hospital centric • Patient centric
• Focused solely on input • Focused on input/throughput/output
• Optimize access/affordability/convenience/outcomes
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Benefits of an Integrated Command Center
• System standardization• Process education, execution, and verification• Improved patient experience
– Care transitions – Flow efficiency
• Real-time demand capacity management– Right patient, right bed, right time
• Optimized staffing• Transparency• Increased system revenue
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Thoughts to consider…
• What is the vision?– Traditional call center?– Integrated command center?
• What is needed to get there?– Space– Time– Resources– $$$
• Think ahead– Expect and plan for growth
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Key Elements
• Physical Location– Space– Layout– Amenities
• Technology– Phones– Computers and Software– Accessible Data/Information
• Integration– Co-location
• Leadership
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Selecting a Space
• On-site vs off-campus• Open-concept vs individual rooms• Attached meeting/conference room– Staff meetings– Bed huddle
• Secure access– Badge or code entry
• Room for growth
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Layout/Amenities
• Ergonomic design– Sit/stand desks
• Proper monitor placement– Ergonomic chairs
• Lumbar support• Appropriate seat depth and chair height• Arm rests• Reclinable
– Foot rests– Keyboard wrist supports
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Layout/Amenities
• Desk layout– Proximity with privacy– Lighting– Ample space for monitors & phones– Desk supplies & storage– Dashboard visibility– Easy access to reference material
• Online• Desk reference/Flip books/Cork boards
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Layout/Amenities
• Noise cancellation– Noise-friendly flooring
• Carpets & rugs• Vinyl flooring – more absorptive
– Plants– Acoustic wall panels– Cubicles– Wireless headsets– Internal messaging
• Air handling• Temperature control
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Layout/Amenities
• Lockers– 1 per employee
• Break room– Table/chairs– TV or radio– Kitchenette
• Microwave/Fridge/Toaster• Coffee machine• Water cooler or dispenser
• Bathroom• Supply Closet
– Pens, paper, printer ink, etc.
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Technology
• Telephony– 1 per employee– Conference call capability– Recordability– Call intake structure
• Phone tree• Engage caller while on hold• Call back features
– Desktop directory– Headsets
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Technology
• Computers/monitors– Multi-monitor setup– Optimal CPU specifications
• Printer/fax/scanner• Transfer center software
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Technology
• Dashboards – Display vs control– Team-based vs system-based– Minimum 2 large wall-mounted LCD monitors– Real time capacity display– Pending transfers by campus– ED/inpatient/surgical volumes
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Integration
• Strategic co-location of resources– Bed Placement– House Supervisors– Outcomes Management– Environmental Services/Housekeeping– Emergency Medical Services
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Leadership
• Leadership on site– Medical Director– Director of Capacity Management– Director of Operations– Nurse Manager of Transfer Center
• Defined reporting structure• Transfer center steering committee• Standard operating procedures
– “Source of truth” for the system
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PART 2: PUTTING IT ALL TOGETHER –DESIGNING OUR COMMAND CENTER FOR SUCCESS
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UPMC Pinnacle Market
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Scope of Practice
• Serve a 10-county area in Central Pennsylvania– >1.2 million area residents
• 7 acute care hospitals– 1,160 licensed beds
• >160 outpatient clinics & ancillary facilities• >2,900 physicians & allied health professionals• >11,000 employees
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Scope of Practice
• Annual Data:– 285,000 ED Visits– 60,000 Admissions– 20,000 Observation Cases– 71,000 Surgical Cases– 6,000 Babies Delivered– 1.5 Million Outpatient Visits
• 690,000 Primary Care Visits
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About UPMC Pinnacle
• Urgent Care & Emergency Services• Maternity Care & Level III NICU• Joint Ventures in Ambulatory Surgery, Acute & Outpatient Rehab, Home
Infusion & Home Care, Occupational Medicine, Behavioral Health• Transplant Program• Comprehensive Spine, Bone, Joint, Ortho & Sports Medicine services • Hillman Cancer Institute• PinnacleHealth Cardiovascular Institute• Osteopathic & Allopathic Accredited Residency Programs
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About UPMC Pinnacle
• Joint Commission Certification in 6 areas:– Advanced Heart Failure– Advanced Inpatient Diabetes– Advanced Stroke (Primary Stroke Center)– Knee Surgery– Hip Surgery– Spine Surgery
• “A” for Patient Safety by Leapfrog Group • Magnet Designated Hospital for Nursing Excellence (P3)• HealthGrades Distinguished Hospital for Clinical Excellence• Becker’s Hospital Review: 150 Top Places to Work in Healthcare
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History
1873 •Harrisburg Hospital is created
1951 •Community General Osteopathic Hospital (CGOH) opens
1998 •CGOH joins PinnacleHealth
2014 •PinnacleHealth West Shore Hospital opens – Formalizes “P3” (Pinnacle 3)
2017 •PinnacleHealth purchases 5 local CHS hospitals, closing 1 for a total of 7 PinnacleHealth Hospitals
2017 •PinnacleHealth becomes part of UPMC health system (35+ acute care hospitals), becoming “UPMC Pinnacle”
2018 •UPMC Pinnacle Transfer Center is created
2019 •Central Logic Go-Live (December 4)
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Where We Started
• Patient Placement Operations Center (PPOC)– Central control center for PinnacleHealth
• On-site call center– Services:
• Patient bed assignment• Provider notification of inpatient consults• Scheduling of outpatient services in ED OBS unit• Supplemental registration activity• Manage nursing department central call-off line• Coordinate nursing department staffing allocation• Call intake for direct admission/transfer requests
– Hours of Operation: 24/7/365
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Where We Started
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Where We Started
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Where We Are Going
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Challenges
• Internal• Lack of standardized approach to transfers• Lack of contemporary system for managing transfers• Lack of data • Recruitment/retention• “Legacy” culture/behaviors• Lack of trust in PPOC• Lack of space
• External• Difficult to change established regional referral patterns• Highly competitive local market
• Streamlined transfer center processes• Broad clinical capabilities
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Steps to Success
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Define Organizational Structure
• Leadership– Nurse/Physician dyad model
• Connie Lauffer, RN, MS – Director of Capacity Management• Ramin Yazdanfar, MD – Medical Director, Transfer Center and PPOC
– Report to: Transfer Center Steering Committee• Staff
– Central Bed Coordinator (RN)– Patient Placement Coordinator – Scheduling and Staffing Specialist – PPOC – Transfer Center Specialist– *cross-trained all staff to learn transfer center workflows/protocols
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Define Overall Vision
• Commit to development of an integrated command center
• Define our mission/vision/values– Over-communicate to team
• Development of our Transfer Center “Business Plan” – Include a description, timeline, resource investment,
projected financial costs and return, growth plan (including integration plans)
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Purchase Transfer Center Software
• Central Logic – Date of Implementation: 12/4/2019
• 12-18 month process– External site visits
• Vendor comparisons– On-site meetings– Organizational financial decisions– Implementation (3-4 months)
• Staff training, preparation, practice• Building organizational excitement
– Go live• Re-launching of our “new” command center
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Find a Suitable Location
• Asks:– On-site– Attached Conference room• Daily capacity huddle
– Secure access– Office space for leadership– Room to grow
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Find a Suitable Location
• Space planning committee– Design– Layout
• Supply Chain– Furniture– Dashboards– White boards– Amenities
• Information Technology– Computers/monitors– Printer/Fax/Scanner
• Telecommunications– Vanity phone number: 717-988-BEDS– Phone installation– Recording software
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Current Design
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Current Design
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Current Design
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Current Design
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Current Design
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Current Design
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Current Design
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Current Design
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Once Concept Proved…
• Outreach/Marketing Campaign– Physician Liaison– Flyers, pens, mousepads, postcards, magnets– “Roadshow”
• Developed UPMC Pinnacle intranet page • “Refer a patient” tab on www.upmcpinnacle.com
website
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Marketing
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If you build it, they will come…
• Integration– Outcomes Management– Environmental Services– Emergency Medical Services– Ongoing integration with UPMC MedCall• Shared protocols, resources, operations, data
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Integration
• UPMC Community Life Team– 2 dispatchers co-located in PPOC– Expansion plan• 4 dispatchers (7a-11p)• One-Call for all internal and external transport requests
– Including discharges
• Coordinate with EVS for bed clean upon depart
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Historical Data Comparison
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Jan-19 Feb-19 Mar-19 Apr-19 May-19 Jun-19 Jul-19 Aug-19 Sep-19 Oct-19 Nov-19 Dec-19 Jan-20 Feb-20 Mar-20 Apr-20 May-20 Jun-20 Jul-20 Aug-20
TOTAL Transfer and Direct Admit Referrals
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Historical Data Comparison
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Jan Feb March April May June July Aug Sept Oct Nov Dec
Completed Transfers (only)Month over Month Comparison
2015 2016 2017 2018 2019 2020
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Overall Transfer Call Type Volume
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Jan-20 Feb-20 Mar-20 Apr-20 May-20 Jun-20 Jul-20 Aug-20 TOTAL
Transfer Request 172 203 142 111 145 169 197 221 1360
Direct Admit 182 177 160 121 137 164 177 190 1308
Consult Request 10 4 5 3 9 7 10 15 63
Information Only 16 5 4 0 7 3 4 5 44
Transport Only 16 0 2 0 1 1 1 0 21
Total 396 389 313 235 299 344 389 431 2796
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Data Points
• Volume of Referrals– UPMC vs Non-UPMC– Direct Admit Referring Locations
• Volume of Accepted vs Declined Cases– By Provider, Service, Campus, Market– Declined Case review
• Agent Performance reports• Time Metrics for provider responsiveness• Service Line Reports• Hospital Site Reports
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Measures of Success
• Customer service satisfaction – Patients– Providers - referring and receiving
• Growth of referrals – Geographic– Specialty specific
• Decreased leakage• Improved patient outcomes• Reputation
– “trust mark” of the hospital
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COVID-19 RESPONSE:OUR TIME TO SHINE
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Principles/Definitions
• CAPACITY: ability to provide high-quality care for everyone who is or could become a patient in a defined unit (or hospital) on a given day
• ACUITY: severity of a hospitalized patient’s illness and/or the level of attention/service the patient will need
• CAPACITY STRAIN: when the cumulative needs of the patient population exceed the functional capacity or capability to continue care– May be associated with:
• Increased morbidity/mortality• Decreased patient and provider experience• Potential lost hospital revenue
• DEMAND-CAPACITY MANAGEMENT: predict capacity and demand, and plan for mismatch
• LOAD BALANCING: relative equalization of patient loads between individual facilities (according to respective capacities and/or acuities)– Ensure no facility gets overwhelmed
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Load Balancing
• Pre-Hospital• Inter-Facility• Intra-UPMC
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Pre-Hospital Load Balancing via Transfer Center
• Transfer Center– Mandated screening questions for all Transfers/Direct Admits
• Does the patient have a pending or positive COVID-19 test?• Do you suspect the patient may have COVID-19?• Does the patient have a fever or respiratory symptoms without a
known cause?• Does the patient live in a nursing home or have they resided in a
nursing home in the last 14 days?– If yes to ANY of these questions, case escalated
• Reviewed for clinical appropriateness and bed placement
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Pre-Hospital Load Balancing via Transfer Center
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Pre-Hospital Load Balancing via Our EMS Resources
• Early observations:– Facilities quick to call “911”– Perception of “Too sick” for direct admit to floor– P3 ICU capacity strain
• Particularly HH
• Can we leverage co-location of EMS dispatch with bed placement/transfer center to direct patients to hospitals with capacity?– Limitations: EMS protocols, patient preference, culture
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Pre-Hospital Load Balancing via Our EMS Resources
• Spring Creek (SNF) Pre-COVID-19:– 73.1% to HH
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Q1 2019 Q2 2019 Q3 2019 Q4 2019 Q1 2020 TOTAL
Holy Spirit Hospital 1 1 4 8 3 17
Penn State Milton S. Hershey Medical Center
17 25 24 21 19 106
UPMC Pinnacle Community Osteopathic 5 7 5 5 3 25
UPMC Pinnacle West Shore 0 0 0 0 0 0
UPMC Pinnacle Harrisburg 74 75 79 81 94 403
TOTAL 97 108 112 115 119 551
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Pre-Hospital Load Balancing via Our EMS Resources
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• EMS screens patients for COVID-19 prior to transport• Target population: COVID-19 POSITIVE/PUI• Info dispersed to 4 major South Central PA EMS companies
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Pre-Hospital Load Balancing via Our EMS Resources
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• Spring Creek COVID-19:– 41.3% overall to HH (previously 73.1%)– 14.4% COVID-19 POSITIVE and PUI to HH
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Inter-Facility Load Balancing
• Questions:– Can we move patients from one campus to another for capacity?– What patient population?
• ICU vs med/surg?• Current in-house vs ED patients?
– What is the capacity/acuity trigger?– What does the process look like?
• Who initiates?• When to start?• When to stop?
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Inter-Facility Load Balancing
• “Standard Operating Procedure (SOP) for ICU Capacity Management at P3”– Centralized approach to include:
• Daily review of ICU capacity and acuity• Management strategies for capacity strain
– Standard daily operations– Mitigation steps
• Patient transfer protocol– Internal process– Patient selection– Target facilities
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Inter-Facility Load Balancing
• As the inpatient milieu evolves, so too does the SOP– Expand to include med/surg patients– Expand outside of P3– Flu season?– New standard practice?
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Inter-Facility Load Balancing
• 50+ successful transfers (last 2-3 months)– ≈80% med/surg– ≈20% ICU
• Utilized scripting/defined talking points• Service recovery and follow-up with >25 patients – Overwhelmingly positive patient experience
• Utilized command center resources to drive operational change
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Intra-UPMC Load Balancing
• 35+ hospital health system• Built relationships with our colleagues across
the state
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What Worked?
• What key design elements allowed this process to succeed?– Dashboards
• Data monitoring• Capacity transparency
– Attached conference room• Dauphin and Cumberland County Incident Command
– Integration– Embedded leadership– Standard operating procedures– Coffee Maker!
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Design Checklist
q Overall visionq Physical location
q Spaceq Locationq Conceptq Meeting roomq Secure accessq Room for growth
q Layoutq Ergonomic designq Desk features
q Amenitiesq Noise cancellingq Lockersq Break room
q Bathroomq Supply closet
q Technologyq Phonesq Computersq Transfer Center Softwareq Printer/Fax/Scannerq Dashboards
q Integrationq Strategic co-location of resources
q Leadership q On site
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THANK YOU!
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