Information on bed control spurs ideas for change
Homework makes collaborative project easier
Before the meeting between the National Association of Children’s Hospitals and Related Institutions (NACHRI) members and Medical Management Planning (MMP) clients to try to solve the issue of bed control, prospective attendees had to fill out several forms and flowcharts that examined the bed-control issue in depth.
Among them were a matrix flowchart, a pediatric patient flow collection form, a copy of policies and procedures related to bed control from precertification to discharge, and any forms or tools that facilitate the bed-control process.
The matrix flowchart asked questions related to scheduled admissions, surgical transfers, unanticipated admissions from the ambulatory surgical unit, unplanned admissions from clinics, unplanned admissions from primary care physicians, emergency department (ED) admissions, and transfers from other institutions. For the last three categories, there were questions about those admissions for the day, evening, and night shifts.
During the meeting, participants looked at seven issues related to bed control:
- admission notification;
- determining patient placement;
- patient assessment, including labs and initial orders;
- financial screening and authorization;
- discharge planning;
- room preparation;
- discharge notification.
MMP and NACHRI also brought in experts from the hotel industry to talk about how they handle bed control. They shared how preregistration can ease guest flow. One executive shared how his hotel held twice daily meetings between registration and housekeeping staff to review issues and potential problems. He shared how supervisors and managers assist when there is a large influx of people and told about systems that let registration personnel know if a specific room is ready.
The participants also came up with 42 recommendations and suggestions for improving their systems and a "yes, but . . ." dictionary designed to help facilities overcome some specific problems. For instance, if there is no one to transport a patient to a unit, there is a list of potential solutions to the problem, such as finding out what other staff might be available to do the job.
The meeting was a chance to think in isolation about a problem, says Paul Ocón, RN, critical care administrator at Childrens Memorial Hospital in Chicago. "You can have the idea, and that’s great. But when I came back, I had to be ready to test out ideas, do analyses, and talk to the official and unofficial stakeholders."
Already, there have been changes at Ocón’s hospital. "We looked at the time of admission from the ED to when they got a bed and found an average of two hours. So we implemented a new program. Rather than calling a unit directly and dealing with some of the pediatric-specific issues like whether we need a bassinet, a crib, or a bed, we have implemented a centralized process."
A patient placement position was created. That person has a global view of what is available. When the ED calls, the employee asks if there are issues to consider, such as the type of bed needed. A fax is sent to the unit about the patient and treatment. The program started the last week in June, and since then, average wait time has fallen to an hour and 20 minutes.
"Of course, winter is really busy, so we don’t know if this will all fall apart," Ocón says.
Ocón has other goals for the program, too. "Because we are freestanding, at Childrens Memorial, what you see is what you get," he explains. "In other words, we are growing programs, but we are land-locked in an urban setting. On paper, we are full 66% of the time, but the sensation at the bedside is that we never have enough beds."
The problem is evident from parent, patient, and clinician comments. "Like a true academic institution, we do not have a problem gathering information," Ocón explains. "But we sometimes do act like rabbits on the proverbial highway, where we are frozen with indecision."
Ocón wants to decrease wait times and improve communication of bed availability. To measure if he is succeeding, Ocón will use patient and physician surveys, wait time data, and information on admission denials and reroutes.
He has assembled a multidisciplinary team of physicians, nurses, and administrators to change processes and analyze results on a quarterly basis.
Data from the hospital as a whole, as well as on a unit level, will be studied. Additionally, there will be formal and informal meetings with nursing leadership to evaluate how wait times and communications are doing on a daily basis.
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