By Dorothy Brooks
Children’s Mercy in Kansas City aims to leverage an impressive array of artificial intelligence (AI)-driven tools, predictive analytics, and other feats of engineering to hone patient flow to new heights of efficiency. That is just one goal of the new Patient Progression Hub, now situated on the hospital’s main floor.
Here, operations personnel from key departments have begun to monitor a steady stream of real-time data, arming them with the information they need to maximize resources and anticipate patient surges. This makes Mercy the first freestanding children’s hospital to partner with GE HealthCare to assemble all these high-tech tools into a centralized, mission control-like setting where decisions can be made quickly to accommodate current and anticipated patient care needs.
Jennifer Watts, MD, MPH, a pediatric emergency physician and the chief patient progression medical officer at the hospital, says administrators had been holding conversations around improving efficiency and throughput for years before they finally decided to move forward on the NASA-inspired project, which debuted in April. “When the technology came forward and was a little bit more available, and we were seeing what it was doing at some hospitals on the adult side around the country, then we knew the timing was right for us to venture into this space,” she explains.
Johns Hopkins Hospital partnered with GE HealthCare to launch its Capacity Command Center in 2016, and other adult hospitals have since partnered with GE to develop similar centers. Children’s Mercy fully intends to learn from and collaborate with these pioneers, but also establish some best practices of its own regarding pediatric care and children’s hospitals.
Watts notes emergency clinicians should benefit in multiple ways from the center’s analytic and operational capabilities. “The hub gives us visibility and transparency into the entire organization, from referral to discharge, and the ED is obviously a piece of that,” she says.
Perhaps the biggest positive impact in this setting is likely to be on boarding and efficiency regarding referrals.
“Our referral network consists of the majority of the western side of Missouri and all of Kansas, so we have quite a large range of referral patterns,” Watts observes. “When we know kids are coming, and what they’re coming in for, and we have that information all in one place, it gives us a better opportunity to plan for and predict [needed resources].”
For example, during times of high capacity, such as flu surges or mass casualty incidents, ED boarding can become a problem. However, Watts notes because of the hub’s visibility across the organization, administrators will have the tools and the data at their disposal to prioritize throughput and move patients through the system faster. In turn, this will open beds for incoming patients.
“We’re able to take the ED and plug that into the overall system so that we can better plan on the inpatient side for those admissions, and then decrease our boarding times in the ED,” Watts says.
To make this happen, a multidisciplinary team representing all the different facets of hospital operations is manning the hub at all times. “We have our house shift supervisors for the hospital, we have our flow administrator, we have a discharge expediter, and we have EVS [environmental services] for bed turnover,” Watts observes.
Also, there are care management staff from the ED housed in the hub as well as the hospital’s transfer center, including the dispatch function for the critical care transport team.
“Every day, this whole team is working on efficiency and moving kids through the system,” Watts reports. “At any given time, we have our operating rooms running, we have our ICUs transferring kids ... to the floors, and we have our referrals coming in.”
Stephanie Meyer, RN, MS-FNP, NEA-BC, senior vice president and chief nursing officer at Children’s Mercy, says the space is designed for teams to react to the data feeds.
“It allows groups in a hospital that want to work together to do so more seamlessly by actually taking down the walls and putting them in the same space,” she says. “Everyone is in one location and they’re all working together.”
Also, Meyer notes the hub is providing nursing staff with new perspectives and opportunities. “Our nurses have always excelled at connecting with our patients and our families, but now they are finding new ways to connect to [the hospital’s] broader goals,” she observes. “They’re getting a better idea of how their role fits into the big picture.”
Furthermore, the hub should be able to lift many administrative burdens off frontline providers so they can focus on patient care.
“Our bedside teams may be calling to see why a consult wasn’t completed or they may be looking ahead to try to help secure some things the patient is going to need in order to go home. Our bedside teams have had to take on more and more of that [type of work] over the last 10 years,” Meyer says. “Our goal here is to keep bedside care at the bedside.”
For instance, if there are three kids in the hospital, and the only thing keeping them from discharge is completing a test, the hub can prioritize those tests with radiology. “Then, the floor team members don’t have to necessarily be the ones coordinating that,” Watts says.
Similarly, when patients in the ED require referrals to other departments or outpatient care, that can take time and energy from bedside teams who are simultaneously trying to provide clinical care. “We’re able to get kids in [to referral providers], and prevent our bedside teams from having to be on the phone frequently,” Watts notes.
This kind of assistance will be well received by the nursing staff, according to Meyer. “They are excited to have this as a new resource and as an additional adjunct to help them provide care. It has actually reinvigorated our teams, and they are excited about its endless possibilities,” she says.
While the hub will assist with immediate- and near-term capacity planning, administrators also are looking forward to using the center’s sophisticated predictive capabilities in new ways. For example, investigators can use the hub’s mathematical and AI-driven tools to assess how a particular set of circumstances in one part of the health system is likely to affect other aspects of the system, making it possible to better prepare for different types of events or emergencies.
“The better prepared we are for an influx of patients, a significant case, or whatever [arises], the better we can take care of kids, and the more efficiently we can do it while still maintaining the highest quality,” Watts says. “The predictive analytics are critical in this. That may be one of the most exciting parts for me because it’s a [resource] that we haven’t had before.”
Maximizing the hub’s full potential will take some time. “Referrals that come into our hospital, whether they are direct admissions or coming through our ED, eventually will all be centralized in the hub; that is a work in progress,” Watts says. “We are not there today, but we are on a path to that point.”
While the current focus is on improving metrics pertaining to throughput and efficiency, Watts notes the hub can affect many other aspects of patient care. “We are adding in quality and risk of harm into our day-to-day operations,” she says. “We have a little bit more transparency, and we can be proactive about all of our quality metrics that the hospital has prioritized for the year.”
In addition, Watts notes administrators are considering using the hub to address health equity, ensuring everyone is treated equally and fairly, and that no one falls through the cracks. Further, there are plans to improve inpatient-to-outpatient transitions and take advantage of tools like remote monitoring and other telehealth capabilities.
With so many avenues to pursue, Watts has observed “a spark of interest and a spark of joy” among staff. This was a particularly welcome development considering the crucible of the pandemic years. “We are coming off the tails of COVID, we have a staffing crisis in healthcare across the board, and there are high levels of burnout,” Watts notes.
Consequently, seeing the hub’s positive effect on staff has been heartening. “We have seen all kinds of ideas for the hub [coming from staff],” Watts adds. “I think we will continue to see a lot of opportunities from this.”
Children’s Mercy in Kansas City aims to leverage an impressive array of artificial intelligence-driven tools, predictive analytics, and other feats of engineering to hone patient flow to new heights of efficiency.
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