#11 - Boarders Tile

Andy Day: Hello and welcome. This is Andy Day from the Command Center Team, here today to talk to you about the Boarders Tile.

We’re on Tile Viewer right now which is the landing page in our system. Whenever you log in, this is where you land. And you can see a variety of different Tiles that you can pick from depending on your installation. In this case we’re here to talk about Boarders, so I’ll click on that to dive into the Tile. Before I dive into the individual alerts on the Tile, let’s orient you to the overall functionality. In the upper left, you see the name of the Tile and the view. In this case, the Facility View that we’re on right now. Going across to the right, you’ll see the QuickNav button.

Right now we’re looking at Hospital 1. You can choose to look at a different hospital, let’s pick Hospital 2 in this case to zoom in.

Next to that is the little ‘i’ or Info Button. That’s where the Legend lives and so you can always see a definition of any symbol or icon that can appear on the Tile, so that you can not have to have a cheat sheet or a lookup guide with you. It’s always in the Tile and if anything ever changes, this is updated so you can go here to see what anything means. Next to that is the little gear or Settings button. This is where users can go to change the way the Tile appears to suit their preferences. And it can save that when they come back it’ll log in the same way and they don’t have to try to remember that.

And then lastly, in the bottom left corner of the Tile, the little flickering bars back and forth, that’s the Freshness Indicator. That says when the last data set was received by the Tile. It should come every 30 seconds. This way we know we have data that’s as fresh as possible and is connected to the real time systems in as real time, as near real time as possible. Now, the data we’re showing here is mock data to protect from PHI, but it’s very representative of what you would see in a real client installation or situation. So now let’s dive into the individual sections or types of Boarders.

You see here 5 different types of Boarders that were picked for this case out of about 9 categories that are available. In this case, you see ED Holds, you see ED Long Stay, you see Internal Transfers, PACU Holds, and Procedural Holds. Each of these is a type of Boarder, or patients that are queuing to get in or you’ve already decided ‘We’re going to admit this patient and we’re waiting to accommodate them’.

So, within each category, there’s a common pattern. Let’s dive into ED Holds, the top one there. The first column on the left is how long they’ve been in a boarding state. Not how long they’ve been there, but how long they’ve been boarding. You can sort from longest to shortest or different ways of sorting in the Settings button. There’s some flags there, we’ll come back to those in a minute.

The next is the Patient Information, their pseudonym, and their either MRN or FIN number depending on the hospital. Of course, you can tell this is de-identified data. Next to that is the bed type. This is the bed type and level of care that that patient is waiting for. That in combination with their service line or specialty determines what beds will be appropriate for that patient.

On the right then, you see Bed Status and you see there’s a ‘1’ there on the first patient. That means that we haven’t picked a bed for this patient yet, but we found one that matches the needs of that patient based on what we see in the system and we’re suggesting it as a possible choice.

Of course, the Bed Manager would use their clinical judgment and decide what bed they want to put the patient in. Below that, you see a bed that has been selected. Bed 2229-01, but that bed is currently occupied. You see the little ‘O’ next to the assigned bed symbol. That means that that bed has a patient in it that needs to be discharged before we can move this patient in. So that pattern, if you will, is consistent across the different categories. And you’ll also see like, on ED Holds, there’s a count of 7 at the top. That’s how many of ED Hold or ED Board there are right now. Below that, ED Long Stay. This is patients who don’t yet have a disposition, a decision to admit, but have been in the ED longer than a configurable time threshold, ya know, can be whatever number of hours you pick. And again, you can see the same pattern repeating itself here across to the right.

If you look at that Internal Transfers one, you’ll see that there’s 2 pages of them. It’s just paginated like the Hertz board at the airport. And that middle one has a red bed alert. That’s very interesting to us. That says that that bed’s been assigned, cleaned, and ready to go for more than X minutes.

Usually, most people pick 30 minutes. And so that means we have to get with patient transport or get nurses to take reports and we can move this patient and get on with it, and do a better job of accommodating patients promptly.

A little earlier, I mentioned to you these flags. Let’s go back to the ED Holds section and look at those flags. You see the little map pin? What that is, is that’s a rerouting alert. That means that that patient - there might be a hospital closer to their home zip code than the hospital we’re in. We’re in Hospital 2 right now and Hospital 5 is actually a mile closer to their house.And so, if the Bed Manager was to look and say, “Oh, Hospital 5 is less congested than Hospital 2 right now.” We might choose to have a discussion with that patient of, “Hey, I know you’re here right now and we will admit you, but if you would like, we could consider admitting you to this other facility of ours where we can get you in right away and you don’t have to keep waiting”.

So, again, an opportunity for a dialogue to balance load across the system. Speaking of load across the system, if I’m a system executive, I might be interested in looking at the whole system.

So I’m gonna go to the view, and select the System View. And so what that does, is instead of giving me details of every patient, it gives me the count by category or arrival modality as well as the longest waiting patient in the ED. And that’s sort of the canary in the coal mine. How long are patients waiting? And we like to look at that across the system and compare. So at an executive level, you can see this and say, “Ah, I now which hospitals have more pressure or less pressure and I can appropriately reallocate resources”. So that’s the Boarders Tile. A very helpful Tile in looking at at-a-glance visibility of all the inbound pressure on the system to take patients for access. At-a-glance the ability to do it without having to click through many, many different subcomponents of the EMR.

hanks very much for your time. Andy: So with that, I’d like to ask Dr. Jessica Schlicher from CHI Franciscan to tell us a little bit about your experience with the use of the Boarder Tile. And first, if you wouldn’t mind introducing yourself and a little bit abut the CHI program. Dr. Schlicher?

Dr. Schlicher:

Sure. Sure, thanks for having me. I’m Jessica Schlicher, I’m the Medical Director for our Mission Control and Virtual Hospital in the Pacific Northwest.

Our program is about a year old. We have a number of centralized functions for our system which includes 8 hospitals. Here in Mission Control, we have a centralized bed placement for all of our hospitals and procedural areas.

We have a centralized staffing office for all those hospitals, as well as a transfer center and a physician on-duty program that incorporates both hospital’s ED and surgical colleagues. So we have a physician leader in our Mission Control every day.

In terms of our analytics that GE has built for us, the Boarders Tile is extremely useful to have at-a-glance an understanding of where our capacity challenges really are in that moment. I actually just got finished using this. I walked into Mission Control for the day and went over with our physician on duty exactly what our status was. The first things we did was looked at Boarders.

So we have 8 hospitals. 2 of them are some trouble capacity-wise today. We said, “Well, which hospitals are those and then why?”, right? So you might notice that right now one of our hospitals has 10 Boarders Some of them are there because they need psychiatric care. Some of them are there because they’re waiting for a specific service or type of bed. We can see that really easily. And then, the first thing we actually focus on, is there anybody who has a bed request that is critical care level of care that’s boarding? And we know that patients with delays, especially the sickest patients that we care for have an increased risk of mortality when they are waiting in the emergency department. So, we find that to be something that’s really helpful to be able to see at a glance.

We can then walk right over to bed placement and understand “Ok if those folks are boarding, what’s your plan for them? How are we doing?” We can figure out how we’re gonna address those issues, right? So if there’s a unit that’s closed perhaps need to bring in staff or need to expedite some discharges to make sure that there’s space for those patients. Boarders really helps us marry up what particular resource we need at that moment with patients who are waiting, which is why we find it really helpful.

Andy:

That’s super, thank you. Are there any particular metrics that you’ve been able to move since you started your program and used the Boarders Tile specifically?

Dr. Schlicher:

Yea, we’ve actually noticed that our total amount of boarding as counted by patients boarding at 5 am has gone down by about half. Even in seasons where all of the hospitals up and down the I-5 Corridor experience a lot of capacity issues, we still noticed that we have made an impact on that. And bringing visibility has been very engaging to our house supervisor staff as well as to our physician leaders throughout the system. It’s also helpful to be able to take a screenshot of the Boarders Tile and share that with our ED Director so that they can understand exactly where we are across the system, and where there’s capacity they can transfer patients into. So we have found it to be very helpful.

Even though you can get the information in your EMR, you can’t really get it in a digestible and easy to understand form. Or at least we haven’t been able to. So that’s been very helpful.

Andy:

Super. Thanks so much for your time, Jessica, and I really appreciate your feedback.

Dr. Schlicher:

Thanks so much!