Driven by Executive and Staff Engagement Broward Health’s Command Center has Created an Integrated Structure that Improves the Patient Experience

Part 1:

Welcome to the Patient Flow Podcast powered by TeleTracking. On today's episode, we meet Paul Taber, Director of the Centralized Patient Logistics Center at Broward Health in Broward County, Florida. Paul discusses the steps to success in implementing an effective patient flow plan. Let's listen in. 

Paul: A lot of our success at Broward Health has been related to our key administrators, the top leadership in the organization, having ... being the key stakeholders, and driving the force all the way down to myself and the rest of the organization, related to the key metrics. To keep the momentum going, they added some key performance metrics into our evaluations, and into our balance scorecards. So they hold every person involved in bed placement, bed cleaning, transportation, everything around the patient experience, they hold us accountable through the balance scorecard for the organization. They added certain measures to that to be able to track us and to perform.

Paul: Yes, yes. It started at the top and it's worked its way down. Management holds all their staff accountable. I hold my staff accountable, and the Patient Logistic Center to meeting the national metrics that you guys shared with us. We adopted the TeleTracking standard. It's working very well for us. Obviously, we continue to have challenges, little spots, pockets here and there. But as we analyze all the data, we focus on those pockets and try to drive towards improvement.

Amie: Can you talk about who's in your center? What does the floor plan look like? How is it staffed? Who's there?

Paul: Currently, we call the area the Patient Logistics Center. It's located in our corporate IS building. It's right across the street from our flagship hospital, Broward Health Medical Center. We have, currently, 20 employees, 20 FTEs working in the department. It's a mix of RNs for the transfer center and bed placement, as well as bed placement specialists. Those are some non-clinical individuals that do some of the bed placements.

We have case managers. We have registration. And we have, obviously, the manager and a director of the area running and overseeing the organization. Our top leadership, we have an AVP, you guys know him, Bill Griffith.

He's been excellent for our center since he started in late December. He's provided a lot of guidance for the entire organization. Our footprint is, we have eight large screen monitors up in the front showing the day-to-day metrics, and the day-to-day flow of the patients, and the beds availability. That's been working great.

Amie: Talking about case management's role within the command center, and whether it does or doesn't fit, and what their roles and responsibilities are, how was the decision made to fold them into your command center? Has that been successful for you?

Paul: Yes, the addition of the case management to our command center has been very beneficial. They're currently working on all ED utilization review, reviewing those before the patients actually make it to the hospital bed, the in-patient bed, making sure we have the patient at a right status based on InterQual criteria.

We are also utilizing them for transfers. They handle all the authorizations for the transfers coming in. So it's somebody in the shop, right there, as the transfer center nurse is working on it, she or he can pass that on and make sure any authorization is needed. Obviously, emergent ones, there's no authorization, EDDED. But the inter-facility ones that are coming from an in-patient area or need our in-patient area, we achieve the authorization before the patient leaves the sending organization. That's worked very well for us. We have it staffed 24, six. We're not staffed on Sundays because that's our lowest transfer volume. But our next fiscal year, we're hoping to get it staffed for 24, seven.

Amie: Are there any other departments that you're planning to fold into the command center?

Paul: Some of the long-term goals, or short-term goals, is EMS dispatch, meaning transportation to our hospital from other facilities and discharge transportation home or to a SNFF. That's actually going to start on June 3rd, so real soon. That's a short-term goal.

We're going to have staff using the TeleTracking system and the care performance indicators from the field, or from the sites, indicate what type of transport they need. Our staff is going to receive that request and dispatch one of the local contracted ambulance service providers to there. So we have full visibility and approval process, so we make sure we're not spending too many Broward Health taxpaying dollars on transportation that's not needed. Obviously, the insurance ones will be billed directly to the ambulance provider, but the tax-assisted ones and the uninsured, Broward Health is a county hospital, or tax-assisted hospital, so we would want to make sure we're a good steward of that money.

Susan: Paul, we understand that you recently engaged in disaster preparedness drills. Could you share how the ability to track staff and patients ... excuse me, provide information about their general condition, and the location of those patients, and track the overall capacity of your health system, has been enhanced with the launch of the command center?

Paul: Sure. As the command center went live in August, earlier in 2018, towards the end of the year and in January, your team came and helped us build the Disaster Management Module within TeleTracking. We played with it a little bit, tweaked it a little bit, gave feedback. They came back onsite, and/or remotely, made some changes for us in preparation for a drill. We performed a drill about three weeks ago for two of our medical centers, our largest and our smallest, a total of about 800 beds. The drill was related to a hurricane event. The hurricane hit south Florida, which hopefully doesn't happen anytime soon. Again, there was substantial flooding and power loss, so we had to eventually evacuate two of our hospitals. The total evacuations that we had to do was around 600 patients from those two hospitals.

We used the TeleTracking system in our test mode. We used the test system to do this, so we actually had real scrambled patients. So we didn't ... real scenario, real clinical-based solutions already loaded into TeleTracking. Their names were scrambled or de-identified. We were able to use the system with the command centers at both hospitals. The incident command centers, as they stood up, they were triaging the patients for us directly in the TeleTracking system, the red, yellow, green categories, as well as telling us what type of localization the patient needed, whether it's wheelchair, stretcher, or if they're ambulatory, and a few key requirements based on the equipment that they have or the scenarios. If they have ventilators, oxygen, and those types of things. So we're able to see that face-up in the TeleTracking system in our disaster management views.

Our staff was able to partner with seven local, and actually, throughout the state of Florida, hospitals to triage those patients too. We had the sites pre-populated. We just list them as generic sites one through seven. So that's our plan, in the future, to designate who those sites one through seven are. That's what we did during this drill. We evacuated, assimilated, obviously, evacuated all the patients across the state of Florida.

Amie: In the event of a real disaster, what kind of information do you have to share to regional, state officials? Now that you have technology in place, do you see that being a lot easier than previously, when you were doing it manually?

Paul: Our projected census, and the census buttons in TeleTracking proved invaluable during that drill. We had full visibility of all four of our medical centers at the click of a button. We didn't have to call anybody for bed availability. We didn't have to see which units were closed, we already knew that from the time the drill started. I was able to pull that up and see that we had capacity in our own organization for about 250 of those patients. So we were able to quickly triage them to our local facilities that were not evacuating a little further inland, and that was not a major issue. We were able to see that availability.

What would be great ... And we provided that bed census immediately to our ESF8 counterparts at the county level, and they provided up to this data level. So they can see immediately what our needs are, and what we can help with from the other regions.

You are listening to the Patient Flow Podcast powered by TeleTracking. We'll listen to Part 2 of this podcast with Paul Taber of Broward Health in our next episode. 

Part 2

Welcome to the Patient Flow Podcast powered by TeleTracking. On today's episode, we continue our conversation with Paul Taber, Director of the Centralized Patient Logistics Center at Broward Health in Broward County, Florida. In this segment, Paul discusses the culture shift in implementing an effective patient flow system. Let's listen in. 

Paul: The leadership from the top gave us our mission to implement this product, make sure it's successful to approve patient flow. That was their driving force. They wanted to improve the patient experience, to get them through the ERs through the inpatient areas. And that has really pushed across our entire organization.

All the staff at different levels are engaged. They're all engaged at different levels, of course, you always have your early adapters and your late adapters, just like any application that's in. And we are struggling with that at times. But overall, the biggest group of people have been successful with it, are adapting it. They see the change that it's making. They see the improvement in life without treatment (LWOTs) in ED. We had a higher rate. And almost immediately, at each one of our medical centers, those LWOTs dropped to almost zero. And that continues for the last nine months, six to nine months depending on which site went live at which time. But we're driving towards patient through, but less holes in the vacuum at most of our sites, unless ICU bottleneck as we're moving through patients through.

Amie: Have you had pushback from clinicians at each of your facilities? What we hear all the time is, how could that command center possibly know what's happening in my facility? They're located somewhere else. And just how have you bridged that gap? And really ... ensured that what you're doing in the command center is truly great for the patient, and that you do have visibility into what's happening at each of those facilities?

Paul: Yes, we have been challenged with that from some of the leadership, and some of the medical and nursing staff as well. What we do to bridge that gap is, they are our eyes and ears on the field. They are in the hospital. If they see something going on, we give them the authority to, or we give them the ability to move the patients as needed for critical situations, a patient coding, a raptor response, something major going on at their floor right then. It's always patient safety first, to take of the patient, we'll catch up the system in a few minutes. But that is very far and few between. Those types of incidents don't happen a lot in the hospitals, thankfully.

So, what we do is, we partner with them. We own the bed control process, we own the transfer process. We actually own the acceptance process along with the physician that's receiving the call ... or the omitting physician, or ED accepting physician. But we work directly with them. And anything they see through the nursing supervisors, the nurse's supervisors are a key role in this. They changed their job role, they're no longer really the bed czar. It opened them up to do other things with patient flow management. Deal with the bottlenecks that are happening, that are still going on, or the confusion of moving patients around. They can deal with EVS, they can help deal with transportation to make sure the patients move, and have a destination to go when EVS is finished.

Amie: How have you been able to market the command center to your referring physicians and hospitals that need to bring patients into Broward Health?

Paul: Early on, we worked with TeleTracking. We took some of your models that you provided with us. We blasted out, a few weeks before going live, or about a month before going live, to all the medical executive committees. We also attended all the medical executive committees. And I gave a presentation at each one of those, about a month before going live, to let them know what's coming. And they passed that information down. Our marketing team developed screensavers based on a picture from our command center that you guys have used for your publications as well. And we did the screensavers across the entire organization. Word of mouth has been a lot of it, and rounding at the physician meetings has been very important.

One of our latest thing is, our marketing department is starting to go out to the referring hospitals, and referring physician offices to help gain support for the system. One of the things that we've improved upon for the referring physicians for direct admits, they no longer have to wait for things. They call our center, one number to call, no matter which one of the four hospitals they are going to, they can call any information, then alert their staff. And we can give them a financial number right then, so they can go on and put the electronic orders as the patient's in their office, or en route to the hospital. So everything is ready when the patient arrives. Hopefully, they don't have to wait. That's the goal. Getting them into a bed as they arrive, and finish their registration.

Susan: Also related to throughput, but have you seen impact on your discharge planning process?

Paul: We started some additional multi-disciplinary rounds at the hospitals, using TeleTracking resources as sort of the guide for that. So that has gone well at our four medical centers. We are still working to improve our discharge times, they are still very high. And we understand that that's a complete culture change at our organization, as it is at many others. So we are still not meeting our goal of the four hours at this time, but we're working towards that. The goal is four hours, right? Or is it two hours? Just want to make sure, sorry ... DC window, two hours. So, the goal is under two hours. We're typically right around the four hour timeframe. Some of our hospitals are up at the six, so we continue to work through that.

A lot of that is education related to, is it a pending discharge, or confirmed discharge? And all the consultants that have to sign off on the case. Or a discharge order is written because a physician is making rounds in the morning, then he or she is ordering a test that's not going to get done until three or four in that afternoon. And then a decision to truly discharge a patient might not be made that same day. So that's elevating some of our hours. So, we're working on those whole processes. But overall, I think we've seen a slight decrease of our discharge window time, but nothing drastic.

Susan: What is your one major piece of advice that you would give to somebody who's just getting ready to start this process?

Paul: Main thing is to ensure you have high level executive leadership that supports the process. Without that, you will not success. I participated in many other IT projects, I was an IT manager before I came over to the transfer center. And other projects have failed or been delayed because you did not have the administrative support. And fortunately, in our organization, the top executives supported it. And they filtered it down to the regional executives, and everybody supported. So that's the main one.

The other one I would recommend, and maybe TeleTracking could help with this, and I mentioned it the other day, possibly a partner organize. Make a buddy system. So as sites are going live, get one of your partner sites that have been live and experienced for a little while, and share their information with the new hospital. So they can kind of buddy up, they can share the lessons learned. We all love everybody that comes to help us build these systems, but there's nothing more valuable than personal references from sites that have been doing it, because you hear the standard bill talk, and then you hear the reality. And you want to, somewhere, get in the middle of that, because you want the project to go live. If you customize it too much, you're never going to go live. But you need to have some kind of middle ground to know where to focus on. Sometimes that provides a little bit more value than the vendor directly telling us.

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