Post on 12-Nov-2021
11
Designing a Hospital Command Center for SuccessRamin Yazdanfar, MD
Medical Director, UPMC Pinnacle Transfer Center & Patient Placement Operations Center (PPOC)Staff Hospitalist, UPMC Pinnacle Hospitalist Program
2
Agenda
• PART 1:– Key elements in developing a command center– Structure/design/integration
• PART 2:– Putting it all together - UPMC Pinnacle– COVID-19 success
2
3
PART 1: KEY ELEMENTS IN DEVELOPING & DESIGNING A COMMAND CENTER
3
4
Evolution to an Integrated Command Center
Traditional Call Center (P3)
Integrated Command Center (UPMC Pinnacle 7)
• Move pt from AàB • Real-time Analytics and Decision Support
• Non-clinical • Pre-emptive clinical decision making
• Simple to implement • Multi-purpose center
• Less integration with IT • Cross-functional resources
• Imbalance of resources • Load balancing for the system (understand status of system)
• Poor clinical efficiency • Only avenue for patient flow
• Hospital centric • Patient centric
• Focused solely on input • Focused on input/throughput/output
• Optimize access/affordability/convenience/outcomes
4
5
Benefits of an Integrated Command Center
• System standardization• Process education, execution, and verification• Improved patient experience
– Care transitions – Flow efficiency
• Real-time demand capacity management– Right patient, right bed, right time
• Optimized staffing• Transparency• Increased system revenue
6
Thoughts to consider…
• What is the vision?– Traditional call center?– Integrated command center?
• What is needed to get there?– Space– Time– Resources– $$$
• Think ahead– Expect and plan for growth
6
7
Key Elements
• Physical Location– Space– Layout– Amenities
• Technology– Phones– Computers and Software– Accessible Data/Information
• Integration– Co-location
• Leadership
7
8
Selecting a Space
• On-site vs off-campus• Open-concept vs individual rooms• Attached meeting/conference room– Staff meetings– Bed huddle
• Secure access– Badge or code entry
• Room for growth
8
9
Layout/Amenities
• Ergonomic design– Sit/stand desks
• Proper monitor placement– Ergonomic chairs
• Lumbar support• Appropriate seat depth and chair height• Arm rests• Reclinable
– Foot rests– Keyboard wrist supports
9
1010
11
Layout/Amenities
• Desk layout– Proximity with privacy– Lighting– Ample space for monitors & phones– Desk supplies & storage– Dashboard visibility– Easy access to reference material
• Online• Desk reference/Flip books/Cork boards
11
12
Layout/Amenities
• Noise cancellation– Noise-friendly flooring
• Carpets & rugs• Vinyl flooring – more absorptive
– Plants– Acoustic wall panels– Cubicles– Wireless headsets– Internal messaging
• Air handling• Temperature control
12
13
Layout/Amenities
• Lockers– 1 per employee
• Break room– Table/chairs– TV or radio– Kitchenette
• Microwave/Fridge/Toaster• Coffee machine• Water cooler or dispenser
• Bathroom• Supply Closet
– Pens, paper, printer ink, etc.
13
14
Technology
• Telephony– 1 per employee– Conference call capability– Recordability– Call intake structure
• Phone tree• Engage caller while on hold• Call back features
– Desktop directory– Headsets
14
15
Technology
• Computers/monitors– Multi-monitor setup– Optimal CPU specifications
• Printer/fax/scanner• Transfer center software
15
16
Technology
• Dashboards – Display vs control– Team-based vs system-based– Minimum 2 large wall-mounted LCD monitors– Real time capacity display– Pending transfers by campus– ED/inpatient/surgical volumes
16
17
Integration
• Strategic co-location of resources– Bed Placement– House Supervisors– Outcomes Management– Environmental Services/Housekeeping– Emergency Medical Services
17
18
Leadership
• Leadership on site– Medical Director– Director of Capacity Management– Director of Operations– Nurse Manager of Transfer Center
• Defined reporting structure• Transfer center steering committee• Standard operating procedures
– “Source of truth” for the system
18
19
PART 2: PUTTING IT ALL TOGETHER –DESIGNING OUR COMMAND CENTER FOR SUCCESS
19
20
21
UPMC Pinnacle Market
22
Scope of Practice
• Serve a 10-county area in Central Pennsylvania– >1.2 million area residents
• 7 acute care hospitals– 1,160 licensed beds
• >160 outpatient clinics & ancillary facilities• >2,900 physicians & allied health professionals• >11,000 employees
22
23
Scope of Practice
• Annual Data:– 285,000 ED Visits– 60,000 Admissions– 20,000 Observation Cases– 71,000 Surgical Cases– 6,000 Babies Delivered– 1.5 Million Outpatient Visits
• 690,000 Primary Care Visits
23
24
About UPMC Pinnacle
• Urgent Care & Emergency Services• Maternity Care & Level III NICU• Joint Ventures in Ambulatory Surgery, Acute & Outpatient Rehab, Home
Infusion & Home Care, Occupational Medicine, Behavioral Health• Transplant Program• Comprehensive Spine, Bone, Joint, Ortho & Sports Medicine services • Hillman Cancer Institute• PinnacleHealth Cardiovascular Institute• Osteopathic & Allopathic Accredited Residency Programs
24
25
About UPMC Pinnacle
• Joint Commission Certification in 6 areas:– Advanced Heart Failure– Advanced Inpatient Diabetes– Advanced Stroke (Primary Stroke Center)– Knee Surgery– Hip Surgery– Spine Surgery
• “A” for Patient Safety by Leapfrog Group • Magnet Designated Hospital for Nursing Excellence (P3)• HealthGrades Distinguished Hospital for Clinical Excellence• Becker’s Hospital Review: 150 Top Places to Work in Healthcare
26
History
1873 •Harrisburg Hospital is created
1951 •Community General Osteopathic Hospital (CGOH) opens
1998 •CGOH joins PinnacleHealth
2014 •PinnacleHealth West Shore Hospital opens – Formalizes “P3” (Pinnacle 3)
2017 •PinnacleHealth purchases 5 local CHS hospitals, closing 1 for a total of 7 PinnacleHealth Hospitals
2017 •PinnacleHealth becomes part of UPMC health system (35+ acute care hospitals), becoming “UPMC Pinnacle”
2018 •UPMC Pinnacle Transfer Center is created
2019 •Central Logic Go-Live (December 4)
27
Where We Started
• Patient Placement Operations Center (PPOC)– Central control center for PinnacleHealth
• On-site call center– Services:
• Patient bed assignment• Provider notification of inpatient consults• Scheduling of outpatient services in ED OBS unit• Supplemental registration activity• Manage nursing department central call-off line• Coordinate nursing department staffing allocation• Call intake for direct admission/transfer requests
– Hours of Operation: 24/7/365
27
28
Where We Started
28
29
Where We Started
29
30
Where We Are Going
30
31
Challenges
• Internal• Lack of standardized approach to transfers• Lack of contemporary system for managing transfers• Lack of data • Recruitment/retention• “Legacy” culture/behaviors• Lack of trust in PPOC• Lack of space
• External• Difficult to change established regional referral patterns• Highly competitive local market
• Streamlined transfer center processes• Broad clinical capabilities
31
32
Steps to Success
32
33
Define Organizational Structure
• Leadership– Nurse/Physician dyad model
• Connie Lauffer, RN, MS – Director of Capacity Management• Ramin Yazdanfar, MD – Medical Director, Transfer Center and PPOC
– Report to: Transfer Center Steering Committee• Staff
– Central Bed Coordinator (RN)– Patient Placement Coordinator – Scheduling and Staffing Specialist – PPOC – Transfer Center Specialist– *cross-trained all staff to learn transfer center workflows/protocols
33
34
Define Overall Vision
• Commit to development of an integrated command center
• Define our mission/vision/values– Over-communicate to team
• Development of our Transfer Center “Business Plan” – Include a description, timeline, resource investment,
projected financial costs and return, growth plan (including integration plans)
34
35
Purchase Transfer Center Software
• Central Logic – Date of Implementation: 12/4/2019
• 12-18 month process– External site visits
• Vendor comparisons– On-site meetings– Organizational financial decisions– Implementation (3-4 months)
• Staff training, preparation, practice• Building organizational excitement
– Go live• Re-launching of our “new” command center
35
36
Find a Suitable Location
• Asks:– On-site– Attached Conference room• Daily capacity huddle
– Secure access– Office space for leadership– Room to grow
36
37
Find a Suitable Location
• Space planning committee– Design– Layout
• Supply Chain– Furniture– Dashboards– White boards– Amenities
• Information Technology– Computers/monitors– Printer/Fax/Scanner
• Telecommunications– Vanity phone number: 717-988-BEDS– Phone installation– Recording software
37
38
Current Design
38
39
Current Design
39
40
Current Design
40
41
Current Design
41
42
Current Design
42
43
Current Design
43
44
Current Design
44
45
Current Design
45
46
Once Concept Proved…
• Outreach/Marketing Campaign– Physician Liaison– Flyers, pens, mousepads, postcards, magnets– “Roadshow”
• Developed UPMC Pinnacle intranet page • “Refer a patient” tab on www.upmcpinnacle.com
website
46
47
Marketing
47
48
If you build it, they will come…
• Integration– Outcomes Management– Environmental Services– Emergency Medical Services– Ongoing integration with UPMC MedCall• Shared protocols, resources, operations, data
48
49
Integration
• UPMC Community Life Team– 2 dispatchers co-located in PPOC– Expansion plan• 4 dispatchers (7a-11p)• One-Call for all internal and external transport requests
– Including discharges
• Coordinate with EVS for bed clean upon depart
49
50
Historical Data Comparison
50
0
50
100
150
200
250
300
350
400
450
Jan-19 Feb-19 Mar-19 Apr-19 May-19 Jun-19 Jul-19 Aug-19 Sep-19 Oct-19 Nov-19 Dec-19 Jan-20 Feb-20 Mar-20 Apr-20 May-20 Jun-20 Jul-20 Aug-20
TOTAL Transfer and Direct Admit Referrals
51
Historical Data Comparison
51
0
50
100
150
200
250
Jan Feb March April May June July Aug Sept Oct Nov Dec
Completed Transfers (only)Month over Month Comparison
2015 2016 2017 2018 2019 2020
52
Overall Transfer Call Type Volume
52
Jan-20 Feb-20 Mar-20 Apr-20 May-20 Jun-20 Jul-20 Aug-20 TOTAL
Transfer Request 172 203 142 111 145 169 197 221 1360
Direct Admit 182 177 160 121 137 164 177 190 1308
Consult Request 10 4 5 3 9 7 10 15 63
Information Only 16 5 4 0 7 3 4 5 44
Transport Only 16 0 2 0 1 1 1 0 21
Total 396 389 313 235 299 344 389 431 2796
53
Data Points
• Volume of Referrals– UPMC vs Non-UPMC– Direct Admit Referring Locations
• Volume of Accepted vs Declined Cases– By Provider, Service, Campus, Market– Declined Case review
• Agent Performance reports• Time Metrics for provider responsiveness• Service Line Reports• Hospital Site Reports
53
54
Measures of Success
• Customer service satisfaction – Patients– Providers - referring and receiving
• Growth of referrals – Geographic– Specialty specific
• Decreased leakage• Improved patient outcomes• Reputation
– “trust mark” of the hospital
55
COVID-19 RESPONSE:OUR TIME TO SHINE
55
56
Principles/Definitions
• CAPACITY: ability to provide high-quality care for everyone who is or could become a patient in a defined unit (or hospital) on a given day
• ACUITY: severity of a hospitalized patient’s illness and/or the level of attention/service the patient will need
• CAPACITY STRAIN: when the cumulative needs of the patient population exceed the functional capacity or capability to continue care– May be associated with:
• Increased morbidity/mortality• Decreased patient and provider experience• Potential lost hospital revenue
• DEMAND-CAPACITY MANAGEMENT: predict capacity and demand, and plan for mismatch
• LOAD BALANCING: relative equalization of patient loads between individual facilities (according to respective capacities and/or acuities)– Ensure no facility gets overwhelmed
56
5757
58
Load Balancing
• Pre-Hospital• Inter-Facility• Intra-UPMC
58
59
Pre-Hospital Load Balancing via Transfer Center
• Transfer Center– Mandated screening questions for all Transfers/Direct Admits
• Does the patient have a pending or positive COVID-19 test?• Do you suspect the patient may have COVID-19?• Does the patient have a fever or respiratory symptoms without a
known cause?• Does the patient live in a nursing home or have they resided in a
nursing home in the last 14 days?– If yes to ANY of these questions, case escalated
• Reviewed for clinical appropriateness and bed placement
59
60
Pre-Hospital Load Balancing via Transfer Center
60
61
Pre-Hospital Load Balancing via Our EMS Resources
• Early observations:– Facilities quick to call “911”– Perception of “Too sick” for direct admit to floor– P3 ICU capacity strain
• Particularly HH
• Can we leverage co-location of EMS dispatch with bed placement/transfer center to direct patients to hospitals with capacity?– Limitations: EMS protocols, patient preference, culture
61
62
Pre-Hospital Load Balancing via Our EMS Resources
• Spring Creek (SNF) Pre-COVID-19:– 73.1% to HH
62
Q1 2019 Q2 2019 Q3 2019 Q4 2019 Q1 2020 TOTAL
Holy Spirit Hospital 1 1 4 8 3 17
Penn State Milton S. Hershey Medical Center
17 25 24 21 19 106
UPMC Pinnacle Community Osteopathic 5 7 5 5 3 25
UPMC Pinnacle West Shore 0 0 0 0 0 0
UPMC Pinnacle Harrisburg 74 75 79 81 94 403
TOTAL 97 108 112 115 119 551
63
Pre-Hospital Load Balancing via Our EMS Resources
63
• EMS screens patients for COVID-19 prior to transport• Target population: COVID-19 POSITIVE/PUI• Info dispersed to 4 major South Central PA EMS companies
64
Pre-Hospital Load Balancing via Our EMS Resources
64
• Spring Creek COVID-19:– 41.3% overall to HH (previously 73.1%)– 14.4% COVID-19 POSITIVE and PUI to HH
65
Inter-Facility Load Balancing
• Questions:– Can we move patients from one campus to another for capacity?– What patient population?
• ICU vs med/surg?• Current in-house vs ED patients?
– What is the capacity/acuity trigger?– What does the process look like?
• Who initiates?• When to start?• When to stop?
65
66
Inter-Facility Load Balancing
• “Standard Operating Procedure (SOP) for ICU Capacity Management at P3”– Centralized approach to include:
• Daily review of ICU capacity and acuity• Management strategies for capacity strain
– Standard daily operations– Mitigation steps
• Patient transfer protocol– Internal process– Patient selection– Target facilities
66
67
Inter-Facility Load Balancing
• As the inpatient milieu evolves, so too does the SOP– Expand to include med/surg patients– Expand outside of P3– Flu season?– New standard practice?
67
68
Inter-Facility Load Balancing
• 50+ successful transfers (last 2-3 months)– ≈80% med/surg– ≈20% ICU
• Utilized scripting/defined talking points• Service recovery and follow-up with >25 patients – Overwhelmingly positive patient experience
• Utilized command center resources to drive operational change
68
69
Intra-UPMC Load Balancing
• 35+ hospital health system• Built relationships with our colleagues across
the state
69
70
What Worked?
• What key design elements allowed this process to succeed?– Dashboards
• Data monitoring• Capacity transparency
– Attached conference room• Dauphin and Cumberland County Incident Command
– Integration– Embedded leadership– Standard operating procedures– Coffee Maker!
70
71
Design Checklist
q Overall visionq Physical location
q Spaceq Locationq Conceptq Meeting roomq Secure accessq Room for growth
q Layoutq Ergonomic designq Desk features
q Amenitiesq Noise cancellingq Lockersq Break room
q Bathroomq Supply closet
q Technologyq Phonesq Computersq Transfer Center Softwareq Printer/Fax/Scannerq Dashboards
q Integrationq Strategic co-location of resources
q Leadership q On site
71
72
QUESTIONS?
AVAILABLE VIA EMAIL: YAZDANFARR@UPMC.EDU
72
73
THANK YOU!
73