A Nurse's Perspective on Centralized Patient Logistics

Welcome to Patient Flow Podcast. On today's episode of the Patient Flow Podcast, we continue our conversation with Lisa Maples, Director of Centralized Patient Logistics at Health First in Rockledge, Florida. Given her ground up approach to starting a command center, Lisa shares with TeleTracking's Susan McLaughlin the essential keys to success. Let's listen in. 

Susan: Great, great. Lisa, based on your experience, if you had a completely blank slate and you could build a brand-new command center with anything, anything that you wanted, what are some things that you've learned that you would do differently, that you would do if you sort of had the blank slate?

Lisa Maples: Well, I kind of alluded to this earlier, but one of the big things that I would do when I first was looking at a new command center is make sure that I incorporated an educator for the logistics center from the beginning. We got about two years into our centralized command center before we realized we needed an educator and it has really caused some starts and stops where I think we could have been, I think, a much smoother moving forward process if we had had a educator in place. So that's one of the things I would have done is just really make sure from the get-go we had an educator in place that was familiar with TeleTracking, that was familiar with our patient flow processes, that could get everybody that was hiring in to us up and running quickly and moving forward. So that's one of the things that we didn't do that I wish, if I was starting all over again, I would certainly do. The other things is that I would ... You know, we kind of, as we've moved along with our command center, have added things to it here and there over the years. I think that as we did that we realized how important to have registration down here, how important it was to have utilization review here. If I had my chance to do it over again, I would sit down, really think about everything that affected patient flow through our facilities and try to from the get-go have all those areas in the centralized patient logistics area instead of having a few, then adding some, adding some, adding some. I think it would have just been an easier process to have everything in place to start with.

Susan: Lisa, you had mentioned previously the importance of relying on the frontline people, that they have the most experience and they know the most insight. Could you talk about the importance of physician integration into the command center?

Lisa Maples: I think having our physicians in our command center, we don't have them in our command center, but we have our vital watch EICU group right next to us also, here in our centralized area, which there's a physician in there. Having that physician in there just gives us that next level of being able to look at the big picture and determine where we should accept patients to, determine if we have the capability to care for patients to help us think through our processes and think through our patient placements on where we have people going and who needs this and who doesn't. It's just another level of being able to have that physician to run stuff by, to say, "Hey, here's what's going on. What do you think about this?" And having that physician insight has just been invaluable to us. So, having the vital watch EICU doctor there at night is, if we need to run some questions by him, if we need to run a scenario by him, they're happy to talk to us and happy to help us through that. And then one of the other things that they work through while they're there, too is that they have a great ability to look at the ICU patients, determine where they're at in their care, and determine whether or not those folks are ready to be downgraded, and we can work through that to free up ICU beds. They've also started working with us now to look at our PCU patients and see if they're ready to be downgraded from that PCU level of care to a med-surg level of care, again freeing up some PCU beds for us. So they are helping us on that end with patient flow on a daily basis, looking at where people are in their care continuum and if they're ready to be downgraded and then getting those people to the appropriate level of care so we open up beds for our patients coming into the ED.

Susan: Lisa, the past year we've seen, especially you in Florida, we've seen hurricanes, and this past winter with a really challenging flu season. How do you handle those type of emergency scenarios?

Lisa Maples: Well, we're very, very versed at handling hurricanes. Health First has four hospitals, and one of our hospitals actually sits out in the middle of the water on some reclaimed land. So when we're getting a hurricane that's going to come anywhere close to our coast, that's one of the hospitals that we actually have to evacuate. So, having this centralized patient logistics center makes it so much easier for us. We look at our tele tracking system. We can see where every patient is, where we have capacity to take patients that we're getting ready to evacuate, where we can move our moms and babies from our OB floor at this hospital that we need to evacuate. So it gives us the ability to be here in the centralized location and make the best decisions for how we're going to move our patients and keep them safe during the storm. We also work through the discharges, we work through all those things to try to get our volumes and censuses as low as we can, again utilizing our centralized view in the command center, we can see where our beds are starting to empty, yeah, we can see where we have capacity starting to grow so that we can move patients again. And then one of the other things is that when we do evacuate the hospital, we move that staff to the other areas to help us care for the patients in the other facilities. Again, being able to sit here in a centralized location and see where we have the highest volumes, where we have the most incoming patients, what floors are going to get multiple admits, we can then work with our staffing centralized resource team to know where we need to deploy staff to so that we're matching the amount of staff to the patients that we're moving ahead of this storm. And then our command centers, you know they love to call here and find out in Realtime what the situation is in any of our four facilities, what's the census, what kind of beds do we have left? Do we have ICU capacity? Do we have med-surg capacity? The command centers get so much information from us because we have that big global view of our organization as a whole. Instead of looking at each individual hospital, we now are looking across our organization at all 950 beds we have, and saying, "During this hurricane, this is how we can best utilize the beds that we have left."

Susan: Great, great. Well Lisa, thank you so much for joining us today. This is absolutely wonderful information, and I hope you'll join us again as you continue doing great work at Health First.