THE REAL TIME HEALTHCARE PODCAST · Apr 8 · 13:05 min

#33 - Mary Martin, MPA, FACHE, and Chief Operating Officer and Matthew Rougeux, MHA, Assistant Vice President, Patient Flow of Duke University Health System

In this Episode:

In this podcast, Jeff Terry is joined by Mary Martin, MPA, FACHE, and Chief Operating Officer and Matthew Rougeux, MHA, Assistant Vice President, Patient Flow of Duke University Health System.

In this episode they talk about how Duke has handled the pandemic, about their investment into CAREhub for their community, and what GE Tiles are being used to make a difference in their hospital operations.

Jeff Terry:
Hello and welcome. I'm Jeff Terry. Very happy to be joined today by Mary Martin and Matt Rougeux Of Duke university health system. Hi Mary. Hi, Matt.

Matt Rougeux:
How are you?

Mary Martin:
Hello.

Jeff Terry:
Wonderful. Duke, obviously a leader in many things, including in COVID. I know great service to the community and also innovation that spread well beyond the community. Mary, starting with you. What are some of the things you're most proud of in the response to the pandemic?

Mary Martin:
Sure. I mean, first I'd start with our teams resiliency. And so the ability of the team to come together and really look at regulations that were coming out every day that were different and pivot on a dime to be able to meet the challenge of taking care of COVID patients was certainly instrumental in our success.

A few points of pride, first would be that Duke was one of the hospitals that came up with the guidelines to reprocess N95s. So if you recall, in the beginning of the pandemic, there was a big fear that we would not have proper PPE. And so through innovation with both folks on the medicine side, and then folks on the school side, we were able to come up with the guidelines there.

We were also one of the groups that worked with GE and others to stand up a COVID Tile. So we could understand where our patients were, what part of the process they were in and the total care component in caring for those COVID patients.

The last thing I'll mention is we had a building that was a year away from opening and because of COVID and anticipated surge, we pivoted the construction team to focus on the bottom four floors, and were able to open up two units in that building a year ahead of schedule. So just monumental efforts from everyone, both medical and nonmedical, to make sure we could care for our COVID patients.

Jeff Terry:
That's brilliant. Thank you for that. And congratulations. Next question. So clearly you're doing vaccinations now. Could you share what's the status of that and where the vaccines go next?

Mary Martin:
Sure. So I'm proud to say in the state of North Carolina, Duke, although not the biggest, has got the most shots in arms to date. So we're very excited about that. First we started with our healthcare workers. I'm proud to say there's been an uptick of 70% of healthcare workers that are eligible that have received the vaccine. We're now vaccinating those that are 65 and older. So we have seen several tens of thousands of those patients come through. We just received word that in a few weeks, we'll be able to move on to K through 12 educators. So really we're starting to get into more of the general population and are hopeful that we can continue.

There's still a vaccine shortage in terms of the number of vaccines that we are receiving. So we're working with the federal government and the state government to keep that supply open. There are a lot of people that want the vaccine. And so we are looking at, whether it's mass vaccination sites. We did a event in the Latinx community last night, complete with a DJ I'm told, where we were targeting very specific populations of underserved that may have been hit harder by COVID. So we're really trying to work in getting into those underserved areas as well.

Jeff Terry:
And then quick follow up on that. So clearly you're doing vaccinations on the campus, and then you're also pushing teams out to different places, potentially mass sites. Say more about that if you don't mind.

Mary Martin:
So we've been exploring, they've done some mass vaccination clinics in Charlotte. So we've been working with Durham County and Wake County to determine if we would do something here, a big arena style type, but also finding success in going into the community centers and those underserved areas as well. We have a 65 and older site here on campus. And one in Raleigh Southern High School in Durham is a site. So really trying to diversify our sites as well.

Jeff Terry:
That's brilliant. Thank you very much. Matt, turning to you. One of the great innovations of Duke is CAREhub, which you of course are the principal architect or among the principal architects and leader of, so I'd like to unpack that a little bit. So to start, why did you go with CAREhub?

Matt Rougeux:
So yeah, the, the investment into CAREhub was more of an investment into our community that Duke was making. When you look at some of the challenges that we were struggling with at the time, we were struggling with patients that were trying to transfer from outside hospitals, these community hospitals, that couldn't support these patients. And we weren't able to fit them into our beds at any of our hospitals. Our ED boarding times were going up and the number of patients that were boarding in our ED, as well as our OR times as well. And obviously those things combined were impacting the morale of our staff every day as well. So the amount of work it was taking to move patients both into our institution and around our institution was a struggle and something that our teams were having to do many phone calls, lots of meetings or emails going around trying to do this. And so we got a team together to assess and say, how can we do this better? How can we do this differently? To really make sure that we were investing in our community and making space to make sure we can care for everyone who needs our care, while also making sure that we were investing in our staff and making things easier for them as they provide care to our patients.

Jeff Terry:
Brilliant. I should clarify, that was pre COVID that you decided to invest in that. Maybe my next question is, what is CAREhub, but maybe you could also comment on its relevance through the pandemic, which I know you weren't thinking of when we started, but...

Matt Rougeux:
Absolutely, it was good timing, right? To have a pandemic in the middle of some of this work to happen. CAREhub for us, CARE stands for capacity access by real-time engagement. And that is both a program that we are doing, but it is also a team that meets together and is co located together. So as a program, it's the way that we're re-inventing the way that patients transitioned through our care delivery models and how we create greater efficiencies and effectiveness for our patients. As I mentioned before, also making sure that it's more streamlined for our caregivers as well, so that they are putting all of their focus on the process. Their focus is on our patients and their families as well.

We also though co-located our teams together. So we brought together teams who traditionally have had to use chat messaging services, phone calls, pagers, and putting them in the room together so that they can have better conversations around the movement of patients around our institution.

As you mentioned, coincidentally, we had COVID started in the middle of this and we had to find a new way to do this. As we talked about trying to space people out six feet apart, which was different than we had originally anticipated doing, but also kind of a new problem that we needed to be able to flex, not just looking at an annual basis or a seasonal basis as hospitals have traditionally done, but looking at that at a daily and a weekly basis as well, to understand how we can flex our care spaces to make sure we were providing that care to these patients who were infected with COVID, but also making sure we weren't losing our eyesight on all the other patients in our community that needed our care as well.

Jeff Terry:
And so, if you don't mind me asking, I know some of the GE Tiles are in the in CAREhub, but can you remind me which those are for the audience?

Matt Rougeux:
So we have the capacity snapshot Tile, our hospital infectious disease or COVID Tile, our patient placement prioritize Tile and our discharge barrier Tile.

Jeff Terry:
Right. And that's probably a good place to end pack a little further. Obviously there's many dimensions to that work, but discharge is a popular one, obviously. So can you share a bit about how it helps to impact discharge?

Matt Rougeux:
Absolutely. So, as we mentioned before CAREhub being both a program and it's our team, it took both components of that to start working on our discharging challenges that we had. Specifically looking at our length of stay challenges in conjunction with our standardization of processes. As we went around our institution, we found out that all of our rounding teams, all of our different care units had different processes by which they rounded on our patients and were focused on different aspects of a patient's care. And so we went and did some PTSA learning cycles and we brought teams together and pilots to understand what was working well and what didn't work well within our culture and created a pathway to standardize the way that we do discharge rounds at all three of our hospitals.

In conjunction, we brought along this Tile as well to give us greater visualization. One of the challenges we had is that what one provider may see is not what our PT team would see or our nursing team saw within our EMR. And so bringing all those things together ensures that we're all seeing the same information and we can see where a patient has a barrier towards that transition towards discharge. And it helps us in prioritizing our work as well.

It also tremendously helped us as we talk about COVID planning and the number of beds that we were going to have available to us to make sure we understood how many patients we're discharging every day. That let us know how many OR cases I can afford to do the next day and so it was a constant balance of conversation with our peri-op platform in conjunction with all the new information we had that we did not have in the past, where we can make good sound decisions to say, we are confident that we can do this many cases tomorrow and not impact the care that our patients are receiving,

Jeff Terry:
Which is, I know we were chatting before the filming, I know that is a constant sort of battle. It continues even today, right? How do we balance it all? Brilliant. Thank you. So Matt, final question for you. So CAREhub, COVID, progress work, what's your vision for where this goes next? What's the next generation of CAREhub?

Matt Rougeux:
As we get more into this work, we learn new things that we want to focus on and we want to innovate on. And so one of the things that we're focused on right now is on census forecasting and complementing that with our nursing staffing. We're working on projecting on our census 14 days in advance, but marrying that with our nursing staffing on each of those units. So we can see well in advance, whether I have one of our most precious resources in the hospital, which is our staff. Do we have enough of them? Do we have them in the right locations for the patients we're expecting to be serving on those days? So we can begin making decisions in advance of how we might change schedules around.

But it also helps us on the day of the day before, as we look at our float pool and how we allocate our nurses within our health system as well. And so COVID, that was one of the things that taught us is that we really needed to put some focus on there and to make sure we have great transparency. And so that's one of the exciting things that we're working on as well as we've moved more into a patient's transition throughout their stay here. And we're looking at, through our care progression Tile, looking at the risks patient space. Both as a risk of harm and a risk of a longer length of stay to understand how we might intervene earlier in a patient's stay, rather than looking at data on the backend.

Jeff Terry:
Brilliant. Brilliant. Thank you very much. And Mary, my final question to bring you in, obviously another principal architect of CAREhub, what's your vision for the next generation of that work?

Mary Martin:
Yeah, so like Matt, I am extremely excited for the forecasting. I had it at a prior institution and I am flying a bit blind without it. It really is game changing to be able to have that information at your fingertips.

I also hope we start to get into some of the OR throughput and efficiency. So right now we're having a 6:00 AM call. We're having a 5:15 PM call where we're trying to troubleshoot for the next day. And I think with some of the additional information we can gather through the use of forecasting or other OR information, we can hopefully cut back on those calls to have more intelligence.

The last thing I'll say is, even this morning, we had a meeting in terms of our care progression Tile of how we could use that Tile to help us flag when a patient needs a care conference. So we have a number of patients, particularly in this COVID world that are having difficult time getting placements at Smith and other facilities that are needed. And so when is the time when we pulled together senior leaders to say, I need you to make this phone call, or I need you to make this contact because we have to make a decision on this patient before they're stuck here for days, weeks, months, so...

Mary Martin:
Exactly. Right now, we'll hear about them a month later and think, gosh, if I would've known about that three weeks ago, we may have avoided 21 days in a stay here. So really looking forward to that.

Jeff Terry:
Brilliant. Well, thank you very much for joining today, Matt and Mary both. And thank you also for letting us be on this journey with you. We love working for you and with you, so thank you very much.

Mary Martin:
Thank you. It's been a great experience,

Jeff Terry:
Brilliant. With that, I will close the podcast.

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