Adventist Health is a large, multi-hospital health system with acute facilities located across three states. With the onset of COVID-19, Adventist Health, like most healthcare organizations, set up a central crisis command center to manage the response to the disaster.
As the step-down units and ICUs in the center of the crisis closed in on capacity, it became clear that the ability to have a cross-facility view for beds within the organization was a necessity. Several of the hospitals already were connected with a tracking solution, but this was not visible to other facilities or the command center.
“As the crisis command center started to explore the topic, other needs also surfaced,” said Dr. Dana Zanone, vice president and health informatics officer at Adventist Health.
“These included the need to easily identify our COVID-19 patients, the need to manage clean room and turnaround times, the need to manage and flex staffing, the need to understand the number of negative pressure rooms and to visualize COVID wings, and the need to track ventilators, Bipap, and CPAP capacity.”
This combined list was used as the scope of work document and included the command center, as well as the “boots on the ground” in the facilities deep in the crisis.
Adventist Health turned to its EHR vendor, Cerner, to solve the problem with the vendor’s CareAware Capacity Management technology.
“We decided to extend the capacity management that already was in one of our sites, St. Helena, to the other sites and did a head-to-head comparison with another tool being used in four of our hospitals,” Zanone explained. “After viewing the wish list from our staff, Cerner came up with a two-phased approach and worked with us to identify the immediate-need items versus our wish list items.”
"Using the information developed for capacity management, we were able to track daily all of the metrics for our facilities and overall for the health system for COVID-19."
Dr. Dana Zanone, Adventist Health
The project was quickly chartered, and the project management offices at Cerner and Adventist Health began working together to implement it quickly.
There are many vendors with electronic health records systems on the health IT market today, including Allscripts, athenahealth, Cerner, DrChrono, eClinicalWorks, Epic, Greenway Health, HCS, Meditech and NextGen Healthcare.
MEETING THE CHALLENGE
Phase 1 was implemented in five business days within the command center, and a large monitor was set up with ancillary screens adjacent to show other important and relevant information. It also was deployed within all of the facilities for the local command centers to use.
Both the central command center and the local command centers used this information to track where COVID-19 patients were, to transfer patients to other facilities, and to plan for ventilator deployments from one site to another or from central supply.
“We also used this information to begin tracking COVID-19 testing rates, positivity rates and overall COVID-19 patient loads,” Zanone explained. “We were able to easily see the percentage of patients who were intubated, versus CPAP/BiPAP, versus supportive care, and compare the care to other organizations as information began to come out around the care of these critically ill patients.”
The provider organization also integrated a couple of other vendors into this system. One was GE Tiles, and this information was pulled from capacity management into a real-time dashboard view that allowed the system to see the overall trends of COVID-19 at a glance.
This information then was distributed daily to all leaders so they could easily see where they were, as an organization and at the different sites.
“We also used this information to determine who could be sent to our hospital-at-home system by our ED providers and hospitalists, which helped us keep some of our non-COVID-19 patients out of the facilities and at home with their families,” Zanone added.
For Phase 2, Cerner worked with Adventist Health to add many of the items needed. The phase was complete within 30 days.
“This involved the creation of some de novo fields based on our new COVID-19 paradigm,” Zanone said. “After Phase 2, other needs were recognized as needed for some additional views in the central command center. These new views were designed and implemented by Cerner as a delayed Phase 3.”
One of the positive results of the project was a decrease in patient transfers to other facilities.
“In the past, transferring a patient was a very manual process and involved a lot of coordination from the provider to contact another provider, [a] nurse supervisor to nurse call, arranging transportation,” Zanone explained. “Also, in the past, you could not see who had capacity. It was necessary at times to call multiple facilities to find one with capacity.”
Use of capacity management allowed the health system to easily see who had capacity. As a fortunate consequence, a system process was developed that encompassed who was on call at each facility for transfer and transportation contracts, enabling the quick movement of patients. Average transfer went down from 6-8 hours to 2 hours.
Another positive result was a decrease in room turnaround time. In many of the facilities, turnaround time for rooms was dependent on the nurse calling housekeeping and notifying them which room was ready. With the capacity-management tool, the local command center was able to see who was discharged and immediately call and get the room cleaned. This was especially useful in facilities where staff was holding COVID-19 patients in the ED.
“Using the information developed for capacity management, we were able to track daily all of the metrics for our facilities, and overall for the health system for COVID-19,” Zanone said. “This enabled those individuals tasked with reporting to the CDC or government an easy view into the information needed. This has saved us hundreds of hours of staff time over the course of the pandemic.”
ADVICE FOR OTHERS
When vetting a patient-tracking application, Zanone advised, here are the things to consider:
- Who needs the solution, and where are they located? Consider the physical space and the hardware needs for the space.
- Engage leaders and end users, and document the necessary requirements. Don’t be afraid to start the conversation with advice from other healthcare systems or the vendor to generate a starting place. It is sometimes hard for end users to think of everything, but giving them a template to build on is easier and more useful. Engaging end users takes time, but the reward is the adoption of the technology and the word-of-mouth that one has considered their needs.
- Consider the timeline: Does one have all the time in the world to build an elephant? Or does one have a short turnaround time? For a short turnaround time, negotiate a phased approach, so that one can get the essential function out and work on perfection afterwards. If one does this, make sure that one holds the vendor accountable for all milestones with the contract and payment structure. With all the time in the world, one can build a full approach and spend time piloting and testing.
- Because the organization is implementing a new technology, take the time to systematize the process of patient transfer. Who gets contacted and who contacts them? Arrange a normal transportation mechanism. Consider how one does the hand-off and what information needs to be sent with patients.