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Breaking the Bottleneck

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It's not just having the right technology to improve bed management, it's also knowing how to use it.

Technology can help make hospitals more efficient, improve quality, and reduce patient flow bottlenecks—but only if the technology is used effectively. Many organizations will buy some new technology and not use it to its full capability, says Lynette Wheeler, service leader for cardiopulmonary and vascular services at Heartland Health in St. Joseph, MO. "It happens more than administrators would like to think," she says.

Challenges include capturing good and timely data and effective utilization of data in the system. For example, two of the biggest roadblocks to optimizing bed management technology are behavioral issues: staff members batching admissions or discharge orders rather than entering them into the system in a timely fashion, and employees bypassing the system and reverting to manual processes because the technology is too cumbersome for the existing workflow.

As with any technology, the system is only as good as the data going in, says Mary Ann Holt, RN, a partner with IMA Consulting in Chadds Ford, PA. "If a person is not entering data in an accurate and timely manner, then you are not getting that information communicated back to the right people so that they can use it," she says.

Here's what two health systems did to optimize their use of technology.

Train, train, train. Heartland Health consistently ranked in the top percentile for various quality metrics in cardiology. But it has also ranked in the top quartile for cost, says Wheeler. So the health system launched a cardiovascular services project to improve care and eliminate waste. "We have a lot of competition only 40 minutes away, and consumers, especially baby boomers, want to shop, so we couldn't just tout our quality. We knew we'd have to get costs in line," says Wheeler.

The health system, which already owned a number of Premier Healthcare Alliance tools, such as ClinicalAdvisor, which offers clinical efficiency and quality performance benchmarking, partnered with Premier's consultants to help meet its goals. The tools can be complex, and determining what data to take out and how to interpret it can be difficult, so the consultants helped show staff members additional tricks to using the system, Wheeler says.

When Moses Cone Health System in Greensboro, NC, implemented a patient flow solution from Farmington, CT-based Premise (now part of Eclipsys Corp.), it enlisted the help of leaders in the patient placement and information systems departments to work with the vendor during the installation and test phases to resolve any workflow issues. Then it trained charge nurses and inpatient department leadership to the highest level, since they use the system the most.

Capture the right data. One of the first challenges Heartland Health faced was determining where the bottlenecks from its cardiac catheterization labs were coming from. So it used technology and flow charts of its processes to identify the hot spots.

"We had to get all of the staff involved, because it crosses more than one department," says Wheeler. The health system determined that the bottlenecks weren't from the day of the surgery to discharge, she says. "It was presurgery that was our delay and biggest opportunity—not postsurgery."

To date, the project has saved the hospital, which was a recipient of the 2009 Malcolm Baldrige National Quality Award, more than $3.3 million in its cardiovascular service line from labor, supplies, length of stay, and throughput.

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