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Tracking Patients, Tracking Quality

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Managing bed flow is important for all hospitals—but for critical-access hospitals that cannot exceed 25 acute-care beds and must maintain an average length of stay of 96 hours or less, keeping track of available beds is particularly critical. For Prowers Medical Center, managing bed flow with the traditional “white board” proved ineffective. Staff members at the 25-bed CAH in Lamar, CO, did not have a clear picture of what was happening on the floor, says Chief Executive Officer Greg Gerard. Emergency department staff would be informed that the hospital was full and unable to accept new patients, but two hours later patients would be discharged and beds would open up, he says. It was also not uncommon for observation patients to be in the hospital longer than 24 hours. “We would admit an observation patient, and they would be here 30 to 35 hours. They would be over the 24-hour rule, and a lot of time that would be a denial for us,” Gerard says.

To better manage the facility’s bed flow, Gerard implemented Birmingham, AL-based Awarix Inc.’s patient-care visibility system last fall. The hospital now has large screen displays in the ED and on the med-surg unit that have a color-coded map of the floor. The technology shows which rooms are occupied by an acute patient, an observation patient or a swing-bed patient, Gerard explains. The system also shows which rooms are waiting to be cleaned and how long an observation patient has been in the room. The technology can be accessed from desktop computers at the hospital, as well. “I am looking at my desktop in my office and I can see how many beds are occupied. I can scroll over the room, see who the patient is, how long they have been here, their age, their admitting physician and their insurance,” he says.

But the feature that Gerard most appreciates is the system’s ability to keep Prowers on track with the Centers for Medicare & Medicaid Services’ core quality measures. For example, if a heart failure patient is admitted, the system automatically triggers the different core measures for heart failure, which visually pop up on the screen for that room and show which assessment is due, Gerard says. When that assessment is complete, staff members can remove it—then the next measure will pop up, he says. “The bed management system is obviously important, but I realized it improves the quality of care more than you initially believe. It should help us to be 100 percent compliant with every core measure. That is something that you cannot put a value on.”

For Gerard, the benefits of the system, which costs about $15,000 for the hardware and a monthly subscription of a little more than $2,000, seem endless. For example, a safety indicator will appear on the screen for patients at risk for falls; pending and completed lab results show up on the screen, so nurses can avoid repeated phone calls to check on test results; physicians on rounds can see if a patient has been taken for tests and when he or she left; scheduled discharges can be highlighted; if the hospital does need to go onto bypass, the system has different alert statuses so everyone knows. “As far as I am concerned it is pretty reasonable,” Gerard says. “Our net revenue per admission is approximately $5,000. We avoided two to three transfers this past winter because of our ability to manage our beds better. That’s at least $10,000 to $15,000 in net revenue saved by not having to deny an admission.”

As with any new technology, however, staff members needed time to adjust and kinks with the system needed to be worked out. “We were up and running within a week or so. It is easy to roll out. The challenge for us was building the interface, because it interfaces to your information system,” says Gerard, adding that getting the interfaces functioning reliably took about a month.

The hospital is already looking to the future. The technology does have the ability to interface with a radio frequency identification tracking system, Gerard says, “so eventually we can have a little chip in the patient bracelet and a lot of this stuff—when patients are moved out of the room—will be automatic; we won’t have to manually do it. About half of the stuff we do is still manual.”

Employees at Prowers are starting to see the benefits, as well. For instance, there were no patients in the hospital’s birth center recently, but the ED was full. Nurses from OB went down to the ED and asked if they could help because they noticed that they were busy, Gerard say. “In a couple months from now we probably couldn’t live without it.”

—Carrie Vaughan