Oakwood Boosts Core Measure Compliance While Improving Patient Flow By Monica Donofrio, RN, BS, CPHQ Senior Director of Care Management and Patient Access Oakwood Hospital and Medical Center Thanks for the Memories, But "Shelve" the Manual Bed Board Two years ago, Oakwood Hospital and Medical Center (Oakwood) set out to replace our original 1953 bed board. The board was a 632-slot shelving system that held color-coded cards with dog ears, symbols and clips denoting patient types. We were looking to do more than expel an eyesore. What we didn't know was how much our new system would ultimately improve not only patient flow, but also regulatory compliance and quality of care. Since opening, Oakwood had relied on the same manual patient placement system. Yet by 2006, as a teaching hospital and hub of a four-hospital system, we were seeing more than 88,000 ED patients a year. Close to 150 patients a month waited more than four hours for a bed. A typical patient placement required five phone calls. Dedicated staff members did nothing but walk the halls looking for empty beds. And care team members had no way of identifying the day's probable discharges, making it difficult to prepare those patients for timely departures. Our Enterprise At-a-Glance In June 2007, we finally left the mid-20th century behind and went live on McKesson's Horizon Enterprise Visibility™ solution. Information from our clinical, ADT, housekeeping, RFID and other systems is intuitively displayed against the hospital's floor plan so everyone shares the same up-to-date information. The addition of this enterprise tracking board provides our staff with real-time, at-a-glance views of patient status and location that put everyone involved in the care process on the same page.       Nurse managers huddle in the "war room" and rely on          seven electronic whiteboards (plasma screens) to see          what's going on throughout our large campus while          reviewing shift-end reports and making staffing decisions.       In the patient placement center, bed managers can view          the hospital at-a-glance or toggle quickly among the          hospital's 28 units to expedite transfers to the          appropriate level of care.       In the physician lounge, specialists can quickly find their          patients, see if they are in their rooms and check room          availability on their units.       Patient charts are now monitored by radio frequency          identification (RFID) tags, which enable physicians and          others to quickly note on the board where their patients          are so they can round more efficiently.       On patient floors, nurses no longer have to continually          log into a computer to see if lab results are back, or          medications or blood products are ready — intuitive          icons on the board let them know at a glance.       Timed icons count down time remaining until scheduled          ambulance transfers so care team members can make          sure patients are ready when the ambulance arrives.       Icons identify core measure patients and prompt          clinicians to administer all interventions within required          timeframes and provide the proper patient education          and discharge instructions. Getting Time Back for Direct Patient Care Within just three months of automating patient placement, we have seen impressive results:       Oakwood improved bed assignment timeliness by 33%,          which helped reduce excessive ED wait times by 25%.       Staff members who formerly hunted for hidden beds          have been redeployed.       Each day's probable discharges are now identified and          broadcast by 9:00 a.m. over 85% of the time, helping to          mobilize everyone involved in the care process.       With real-time census and other key information readily          available, staffing decisions are more accurate and fewer          bed meetings are needed. This has given at least an          hour a day back to RNs for direct care and nursing          leadership for managing that care. Since implementing our 21st-century whiteboard, we have moved into the Center for Medicaid & Medicare Services' top decile for core measure compliance, excelling in 13 out of 19 indicators. While not directly attributable to any one initiative or technology, this improved performance has qualified the organization for an incentive bonus of more than $4 million from Blue Cross/Blue Shield. That's something our dear old bed board just couldn't provide. Monica Donofrio, BS, RN, CPHQ, is the senior director of care management and patient access at Oakwood Hospital and Medical Center, the hub of Oakwood Health System, a four acute-care hospital system in Dearborn, Mich. She oversees case management, social work and palliative care services as well as direct admissions, medical necessity screening and bed management for the 632-bed teaching hospital. Ms. Donofrio is a Six Sigma Black Belt. In 2007 Oakwood Health System won a Michigan Quality Leadership Award.		Oakwood: A Room with a View Berwick Book: Leadership for Smooth Patient Flow N.E. Georgia MC: Hospital Room Service Addressing Capacity without Physical Expansion A solution designed to smooth daily patient flow proves invaluable during recent capacity surges during disaster responses at Providence Holy Cross. A centralized operations center manages bed availability enterprisewide, reducing patient wait times and improving satisfaction. A Joint Commission expert recommends measuring "head to bed, foot to door" to establish goals and eliminate the bottlenecks that threaten patient safety. Broadcasting real-time information about patient status on an enterprise tracking board puts everyone involved in the care process on the same page. 5995 Windward Parkway Alpharetta, GA 30005