High-tech solution provides Aurora with real-time bed management system
IS went three steps beyond’ initial ideas, AM says
A new bed management system in place at Aurora Health Care’s Milwaukee-based hospitals is eliminating the need for daily meetings, saving untold numbers of phone calls, and "doing things we never even anticipated," says Marne Bonomo, PhD, regional director for patient access.
The Oracle database, built by Aurora’s information systems (IS) staff, is interfaced with the admission-discharge-transfer (ADT) system and provides real-time bed management capability, she adds. When patient volume is high, Bonomo says, "I can do a printout of the [bed status] summary and walk around with a piece of paper telling me the latest status of the hospital. No computerized bed management system I have worked with has even come close to this one. Every time we get in a room to discuss functionality, we think of something else that it can do."
No longer necessary, she says, are the daily 11 a.m. calls by nursing staff to get the status of the facility’s beds, and the daily 11:30 a.m. meeting with the charge nurse and bed placement staff to determine afternoon staffing. Instead, those involved simply can access an "e-board" on their computers to instantly see which beds are empty, which beds are occupied, and who is in them. Housekeeping can see which rooms need cleaning.
With the new system, Bonomo says, she no longer needs to scroll through computer screens or have a patient’s name to check the status of a particular bed. "I can hover the computer mouse over a particular cell and see who’s in that bed, or I can see a picture of the whole hospital on one screen, which is amazing."
Bonomo credits what she calls an incredible IS team for the success of the bed management system. "Every idea we’ve given them, they’ve taken three steps beyond," she says. "I think they have telepathy." Hours spent in programming, she notes, are the only real expense associated with the new system.
For admitting staff not actively managing beds, the system’s benefit is that it will show "the reality of the beds," Bonomo points out. "Once we start putting in pending patients — those waiting for a bed — it gives us a higher level of knowledge. We now have the ability to predict within a 5% variance how many patients to expect on any given day. We are using calculations based upon history, what we know is scheduled for today, what is pending from the ED [emergency department], and factoring in the number of current patients that have discharge orders."
A stoplight color system immediately informs staff of the hospital’s occupancy level, she says. "With a green light, we can take anything; with yellow we’re beginning to get full; and with orange, we are triaging admits and working very closely with the ED because we are down to 12 beds, of which only three are critical care."
When the status gets to red — or diversion — level, Bonomo adds, "We have nothing." The stoplight colors come on automatically, she notes. "The point of that is to alert the ancillary support departments. Housekeeping knows to go into the high-census plan and can approve overtime and extra shifts without going to regional management."
Aurora went live with the database in January at its largest hospital, St. Luke’s Medical Center, and at the hospital’s second campus, St. Luke’s South Shore, Bonomo notes. "The next two largest [facilities] are clamoring to go up."
It will not be long, she says, before the other Aurora hospitals are on board. "The executive vice president of nursing is very interested in having the same information from everywhere else that she now has from St. Luke’s."
A true picture
The system actually was put up in late December 2001, but staff realized some more tweaking was needed. "When you asked for a private room, for example, all of the critical care-beds popped up, so we qualified some of the searches," she says.
Once the database is in place across the 13-hospital system, Bonomo points out, personnel handling patient transfers can look at Aurora facilities across the state and see "where things are busy, and where they’re not, and where we can be more efficient."
This capability will eliminate multiple phone calls to bed placement staff regarding patient transfers, she says, as well as quell any skepticism about the number of beds actually available. "Now everybody has a picture of what is true."
With the confidentiality guidelines of the Health Insurance Portability and Accountability Act (HIPAA) in mind, Aurora has taken steps to ensure proper management of the e-portal that allows access to the bed management database, Bonomo says. Aurora’s e-portal already is HIPAA-compliant, she adds, and the organization is moving toward an intranet strategy to reduce the need for additional outside vendors, part of a corporate strategic goal.
Five different access levels were created, Bonomo says, including levels for patient placement, housekeeping, patient care management, and ancillary departments, which only need to see how full the units are. An administrative level allows more in-depth access for system management and setting up access privileges, she explains.
"Those who have access can dial in from any PC anywhere," Bonomo says. "At first, we only had three levels of access for the e-board, but then we decided we needed more. The housekeeping staff didn’t need to know who was in that bed, so their access allows them only to see all the beds and to know to change them from dirty to clean. Patient care management needs to know who’s in the bed, but shouldn’t be changing any of the information."
At the administrative level, very few people can make changes to the database and change the level of those who access it, she notes. "There’s a detailed level for the placement staff so they can change the status of virtually any room or equipment, but can’t change the board itself or give other people access."
The planning for the bed management system is being done by an administrative team that includes the head of the hospital, key physician leaders, and the director of nursing, in addition to Bonomo. That team is busy developing policies and protocols, she adds, with strong support from a quality management representative. That person provides the team with statistical analyses and is instrumental in disseminating information such as average discharge time and diversion rate. The quality management rep also worked with the statisticians to develop the historical reports that are used for evidence-based predictions, she adds.
John Whitcomb, MD, the hospital’s medical director of emergency services, has been instrumental in garnering support for what needed to be done, she says. "He has been our advocate with every medical service and every medical leader, taking the time to present this new philosophy to countless medical sections and quality leadership meetings." Historically, Bonomo notes, all the hospital diversion activity was blamed on the ED, when the real problem was a lack of information and of coordinated effort across the facility.
Whitcomb points out that hospitals with diversion problems need to address what he calls the "life cycle of a bed," looking at elements that are precise and that can be measured. (See "With diversions, ED is just a symptom of inefficiency," in this issue.) Some physicians tend to focus on the fact that "they have medical judgment and you don’t," he cautions. "Don’t get into that with them — just keep it about the [data]."
Some physicians are still trying to do things "the old way," Bonomo says, by calling the nursing units directly to place their patients. "The policy now is that all patients are placed through patient access." However, when a physician calls the unit, the nurse typically will take the information and simply get the access department on another line without making an issue of it, Bonomo adds.
Meanwhile, she says, "the confidence level [among physicians and others] is building. We are installing monitors in key physician lounges that display the summary screen. It’s set up to show the beds that are functional, those that are blocked, and the percentage of occupancy. Those who are savvy enough can go looking through [the system] to get more detail, such as how many patients are on telemetry."
Aurora’s initial idea for the Oracle database and the leadership team came from Vanderbilt University Medical Center in Nashville, TN, Bonomo notes. "I had read a white paper presented to the American College of Health Care Executives by Barbara Walczyk, Vanderbilt’s director of performance management and improvement, outlining how they significantly reduced diversions with their bed management initiative. They developed a database based on the Sheraton hotel system and new procedures initially that reduced their diversion rate something like 96%."
Vanderbilt personnel were asked to come to Aurora in August and present their project, she says. From that initial inservice, Bonomo adds, a healthy competitive partnership was born, with information and wins shared for mutual benefit.
While Vanderbilt’s bed management database was not integrated with its ADT system, she says, Aurora’s now has that functionality. "We even have the ability to integrate our e-board with any ADT system. This was almost too good to be true."
Aurora has a homegrown system called ADZ across several hospitals. It uses a product from Atlanta-based McKesson-HBOC at one hospital, and is in the process of migrating systemwide to software from Kansas City, MO-based Cerner Corp.
"With our system," Bonomo points out, "wherever the patient is seen first, it shows up on the e-board. I can fly over a cell, see who is in a bed, the diagnosis, the physician, and the patient’s date of birth, because this information is in the registration system."
However, she adds, "we would never have gotten started had we not seen the information from Vanderbilt. We knew that predictive management was possible, but the difficult part was where to begin. Vanderbilt opened that door for us."
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