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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.
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