#10 - Capacity Snapshot Tile

Jeff Terry: Hello, and welcome to today's webinar about the Capacity Snapshot Tile. I'm Jeff Terry.

This Tile is in use at more than 40 hospitals in the US, Canada, and the United Kingdom. It's really foundational to most of our Command Center programs and that it gives a sense of the status of bed capacity, both now and after we process the decisions that we've already made. And that's useful at the system level and all the way down to the unit level. Like with any Tile, we access it through the Tile Viewer. Each rectangle's a Tile here.

I'll go into Capacity Snapshot. Reminder that up in the right, if we ever forget what a symbol means or what a calculation is, you click on the "Info" button and then all that is explained. And to the right of that is a Settings button where I can do things like set the hospital that I want to look at, and I can save that setting so that every time I come back into it, I see the same thing. I'm not going to do that now. We'll navigate through it another way. And of course, in the bottom left of the Tile is the freshness indicator. That just tells me that the Tile has updated in the last 30 seconds as I would expect it to.

So if we look at the real estate of the Tile, let's start with that left most column where it says ‘system’. So that is the number of beds available in the system right now, or within 30 seconds. I have 1,041 beds available, 780 of which are nonspecialty, 261 of which are specialty. And then you can see the breakdowns in nonspecialty, 285 critical care beds available, 180 tele beds available, etc. I can click on those carets, by the way, to collapse and expand nonspecialty and specialty.

Every client that we work with has made different choices about how they want these rows organized. You know, is it level of care? Is it service line? Is it some mix? That's up to you, but you get the idea here. Out to the right, I then have information about the regions in my health system, Region 1, Region 2, Region 3. Let me walk you through Region 1 so you understand those numbers.

Looking at the overall line, the In, the 22 under In means that I have 22 patients that have an order to move into one of my beds, but haven't yet arrived. That can be a border in the ED, a border in the PACU, a patient that's been assigned to bed on the transfer center queue. And I have 8 patients with discharge orders to leave my system. My census, I have 547 physical patients in my inpatient beds. And my occupancy star is 70%. Now, we can put occupancy there if we want, which you're probably familiar with. Most people choose to put some version of occupancy star, which adds to that 547, those 22 inbound patients to give me an occupancy star of 70%, which is my effective capacity. Because while there may be an empty bed, it's already been assigned to someone.

To the right of that, you see I have 271 actual unoccupied beds. And then my total does the same thing I just mentioned. The total subtracts 22 from 271 to tell me that there are actually 249 beds available, which I could assign in Region 1. And you see that same pattern played out across the Tile where there's nothing like BMT in Region 2. That means I don't have any bone marrow transplant beds in Region 2.

So now, if I drill into Region 1 by clicking on the arrow there, I see the same pattern played out in Region 1, where Region 1 is now the left most column and the three hospitals of Region 1 are laid out to the right. Now, let's look at Hospital 1 and let's drill into the critical care beds in Hospital 1. I do that by clicking on the arrow there, and now I get a unit level breakdown. So you can see each row is a unit and I get quite a bit of detail about what's going on with the capacity there. So the first thing is I get the census. So in 3 MICU, the census is eight. If I click on that, there's the alias MRN and bed number of those eight patients.

Now, below that are two very useful numbers if I get to run out of capacity. An often method to create capacity is by looking at my downgrades. And so that one is telling me there's one patient on that unit right now that does not meet the level of care of the unit. Maybe I can consider accelerating that downgrade. Out to the right, I get my occupancy, which is traditional, and to the right of that occupancy star calculated in the way that I mentioned earlier. And then here, you see the breakdown of that, of the different elements of what's moving a little more clearly.

So how many beds are clean on each unit? How many beds are dirty on each unit? If I click on one of those dirty numbers, like on 5 MICU, it'll tell me... which of those beds are dirty, how long has it been in the cleaning process. Ignore the timestamp, this is fake data. But right now, how long has that bed been in the cleaning process? And then to the right of that, I get things like the first, the demand. So there's one patient that's been assigned to this unit who has not yet arrived. There's another patient who has been targeted to our unit, but not yet assigned a bed. But again, they're coming, so I need to process that, think about that and how I plan.

To the right of that, transfers that have been targeted to this unit. And then to the right of that, I get a forecast, which is based on the time of day and considering those admissions and transfers that are already targeted, how many more should I expect today? So adding those up, the assigned admits transfers expected, that's the demand of my unit. And then to the right of that, I get a sense of the outbound. How many patients will be moving out of my unit either because they have a discharge order or a transfer order?

And if I click on the one and see the ICU, I can be reminded of which patient that is that has a transfer order out and where they are. And then when I add all that up, the unoccupied minus the demand plus the outbound, I get something called net beds, which is a very useful single number to tell me, after I process all of the decisions that people have already made, how much capacity do I have left. A negative one is a very interesting number. And most of our Command Centers, whenever there's a negative, somebody is problem-solving that. A common way to problem-solve that is to look at the downgrades that I mentioned earlier. Another way is to look at the block beds. Maybe we can unblock a bed, and that's why you see that listed there. So if I click on any of those numbers, I find out how many beds are blocked on that unit and why are they blocked? In some cases, I can take an action to unblock a bed. So that's the unit level breakdown.

I want to show you one other thing, which is if I go into the upper left, I could click that up arrow to go back to the Region View, but I'm going to click the Attribute View to go down and look at beds a different way. So this is in Hospital 1, organized by some of these specialty or attributes that we may be looking for.

If I'm hunting for a negative pressure bed or bariatric capable bed, those are all rolled up here with where are they? How long have they been clean, etc? So the same sorts of columns, but organized for those types of beds. And if I don't have capacity in my hospital, out to the right, it's telling me, "Do any of my neighboring hospitals have capacity for those specialty or those special attribute types of beds?" That's attribute view. I'm just going to navigate to the top to show you how easy that is.

So I click the up arrow, I go back to the unit view. Click it again, I go to the hospital view. Click it again, I'll go to the system view where I see my regions. And again, all of that is real time state of what's my census, and how much capacity do I really have available after I process all the decisions I've made. And in many cases, this is a tool to help us find capacity, expedite activity, focus activity, so we can create capacity and get patients the capacity that they need when they need it. With that, I want to turn to a user to hear their experience.

Please go ahead.

Scott Jahnke:

Hello everyone, my name is Scott Jahnke, the Manager of CareComm Operations at Tampa General Hospital in Tampa Florida.

CareComm is our Command Center that opened in August of 2019. We’re here today to talk about Capacity Snapshot, the building block to any Command Center. But first, for those of you that do not know, let me tell you a little bit about Tampa General Hospital. We’re a 1,007 bed not-for-profit academic medical center, associated with the University of South Florida Morsani College of Medicine.

We deliver world class care as the region’s only level 1 trauma burn center. We’re one of the busiest transplant centers in the nation. We’re also home to an 82 bed, level 4 NICU, and a 32 bed, neuroscience ICU, which is the largest on the west coast of Florida. I’ve had the privilege of working with Tampa General Hospital for the past 11 years. 9 of which have been with patient flow. So without further ado, let’s get talking about Capacity Management.

So the question of the day is how do we use Capacity Snapshot at Tampa General Hospital, and what are the benefits? Capacity Snapshot is used to provide organizational alignment. To get everybody rowing the same boat. To get everybody focused on the same goals as it relates to patient flow. We start by having an 8 am huddle within our own team. Some hospitals call it ‘Commander Rounds’, others call call it ‘walking the wall’. Ours is just our CareComm AM Huddle.

Each team member within CareComm reports on their division and they inform the rest of the team members what they need or what kind of barriers that they may have to patient flow. As we get to the bed control portion, we utilize Capacity Snapshot to highlight the areas in need.

So looking at the Capacity Snapshot Tile for this morning, we can see that our neuroscience service line is at 100% occupancy. To get further information, we can click on the chevron. It’ll show that we have zero available ICU beds currently. And we have 1 dirty bed on our neuro acute care unit. We can see that there’s 1 patient to go to our neuro ICU and we have 2 patients that have transfer orders to move out.

From here I can also see that 1 of my patients in neuro ICU has a clean and ready bed on another unit. So from a flow perspective, we can then expedite that move to get this patient up to the neuro ICU. Each of these buttons is clickable. When you click on them, it’ll provide further information as to what’s populating that confirm transfer or discharge area.

Going back to the main screen, we can see other areas that may be under pressure. So our CVT service line which is our cardiac service line, both surgery and medical cardiology. I can see that our CCU our 3H cardiovascular tele, which primarily deals with cardiothoracic post surgical patients when they no longer need ICU, and our medical cardiology unit are all at 100% capacity. Looking at 5A2, I can see they only have 1 discharge order at this time. 3H, the same.

The one special thing about 3H is they have 2 unassigned patients to come to their unit. Likely from an ICU downgrade, but with only 1 confirmed discharge. They have a net negative beds of 1. So I’ll pay close attention to helping 3H free up capacity, so their net beds become at least zero. As a real time example, back on May 26th, 2020, we started the day with zero ICU beds in the entire organization.

As Dr. Chang gave the say of the house, he made known that there were zero ICU beds by filtering on the level of care. From there, he also showed that from a medsurge capacity level, we did have space. Within 10 minutes of safety huddle concluding, there were 3 patients with transfer orders to move to a lower level of care. We were able to quickly place those patients and then work as a team to expedite those movements. Thankfully we did that because we quickly needed those ICU beds for patients that arrived in the emergency department. We were able to quickly place them up in the ICU beds and provide the care that the patients deserve.

The greatest benefit of Capacity Snapshot is to provide organizational alignment. Most people within an organization have never looked at a bed board. They have not taken the time to understand the complexities of patient placement. Capacity Snapshot removes all of those complexities. It provides one area where people can get the information in a clear, concise manner. By doing that, they understand the global needs of the hospital, not just their one area. But at the same time, they can also understand how their one area impacts the entire organization. As your Command Center evolves, you will find new and exciting ways to use the Capacity Snapshot Tile.

Currently at TGH, we’re rewriting our entire capacity management plan, and Capacity Snapshot is at the center of that plan. We’re utilizing the net bed feature to be able to trigger different actions that people in the organization need to use. So while on the surface, Capacity Snapshot may seem like a little bit of a vanilla Tile, the more you utilize it and the more you understand it, the more you can harness the power that the information provides.

So hopefully you got a better understanding of the Capacity Snapshot Tile and how it’s benefited us at Tampa General Hospital. I thank you for your time and have a wonderful day.

Jeff Terry:

Wonderful! Thank you for that, and thank you very much to our audience for joining. That concludes today's webinar.