How a Data-Driven Command Center Can Improve ED Outcomes

November 08, 2022 - Emergency departments (EDs) serve as an integral front door in hospital systems, supporting numerous patients requiring acute care or inpatient admission on a daily basis. However, healthcare-wide challenges such as capacity management and staffing shortages have significantly impacted EDs recently, particularly as the COVID-19 pandemic exacerbated these issues.

According to a September study published in JAMA Network Open, hospital occupancy, defined as the percentage of occupied staffed inpatient beds in a facility, is associated with longer ED wait and boarding times, which can contribute to patient safety issues.

Another measure of ED function and hospital capacity, how often patients leave the ED without receiving care, is also correlated with higher risks of patient safety issues and adverse outcomes. In another study, researchers found that the median rate of patients leaving the ED without being seen significantly increased from 1.1 percent in January 2017 to 2.1 percent in December 2021.

Health systems are working to address these challenges in various ways, with some turning to artificial intelligence (AI) and real-time analytics.

Florida-based AdventHealth is one of those organizations. It has created and implemented a data-driven command center known as Mission Control to assist with ED capacity management and improve outcomes, explained Sanjay Pattani, MD, emergency medicine physician and associate chief medical officer of AdventHealth Mission Control, in a recent interview with HealthITAnalytics.

IDENTIFYING THE NEED FOR ADMISSION, LEVEL OF CARE, AND ACUITY

As one of a hospital system’s front doors, EDs play an essential role in both acute care and inpatient hospital medicine, according to Pattani. When a patient arrives in the ED, clinicians assess the patient’s condition, the type of care that they need, and whether that care requires the patient to be admitted to the hospital.

These first steps in the care coordination process are critical and must be completed in a timely manner to prevent adverse outcomes. However, Pattani noted that overcrowding of EDs and staffing issues in inpatient medicine could create stumbling blocks to timely care coordination.

“Post-pandemic, and even during the pandemic, as the workforce challenges continue on the inpatient side, the ER is actually feeling a little bit of tension with boarding patients for longer periods of time or finding a bed in a timely fashion for their patients that need care,” Pattani explained. “And oftentimes, in systems where there are multiple hospitals, the coordination of that appropriate care, if you will, with the appropriate bed, [relies on] manual processes, with multiple phone calls.”

This can lead to increased wait times, delays in care that a non-ED clinician can provide, and strain on the nursing staff, which all impact patient care, he continued.

ENSURING SEAMLESS CONTINUITY OF CARE

To minimize delays in care and manage bed capacity throughout the transition from acute care to inpatient medicine, AdventHealth turned to Mission Control. The command center enables the health system to match a patient’s acuity and level of care needs with the location of an appropriate bed in real time, Pattani stated.

If a bed isn’t readily available, Mission Control allows clinicians to support care continuity and manage the clinical progression of care. Patient handoffs, for instance, present multiple opportunities to create or perpetuate gaps in care and outcomes. Pattani noted that facilitating direct communication of patient care needs between care teams can help ensure smooth handoffs and continuity of care.

Prior to Mission Control, handoff processes had to be undertaken manually, which can lead to errors and potential weaknesses in capacity management. Further, Mission Control tracks 2,400 to 2,600 patients throughout their care journeys daily, making the manual nature of the process that much more of a challenge.

“It used to be where we would independently try to figure out how we could accommodate that patient in an overcrowded hospital or find a place somewhere else in our sister hospitals,” Pattani stated. “Now, Mission Control [connects and coordinates] the care for that patient at a physician level, at a nursing level, and at a patient level. So, to the patient, it's all seamless… Connecting that patient care at the point of care and continuing that communication stream is a vital component of Mission Control.”

Mission Control also acts as a safety net to prevent and address any barriers to the progression of care. For example, Pattani explained that if there are orders for a CAT scan of the abdomen in a patient’s chart, and that CAT scan was ordered 14 hours ago, but the patient hasn’t gotten the scan, Mission Control identifies that as a barrier to the progression of care.

From there, the command center sends out an alert according to AdventHealth’s service level expectation of when that CAT scan should have been done to ensure that the scan isn’t put off any longer.

These alerts are used for various care services, from CAT scans to prescriptions, to identify what is and is not happening with a patient once they are assigned to a bed. Tracking these data points can help with care escalation, oversight, and efficiency across the organization, according to Pattani.

MANAGING CAPACITY ACROSS HOSPITALS

Another way in which Mission Control helps support bed capacity management and care continuity is by facilitating the appropriate transfer of patients to other hospitals. These ‘lateral transfers’ allow health systems to decompress their Eds and prevent overcrowding by admitting patients through the hospital’s front door and then translocating them through a ‘side door’ into another facility in the network, Pattani stated.

By doing so, AdventHealth can engage in another concept related to capacity management — level loading across hospitals.

“So, a hospital down the road four or five miles, it's at 75 percent occupancy, versus [another] hospital at 50… [Mission Control] looks at part of that and identifies the availability of capacity somewhere else,” he said. “And so, we'll take patients from one ER where perhaps even that hospital is over capacity, but we'll find an available bed at another facility.”

Pattani noted that initially, staff and patients alike were skeptical about these lateral transfers but warmed up to the concept after seeing how they could positively impact operational efficiency, clinical quality, and outcomes by getting patients into an available bed more quickly.

These benefits, achieved through Mission Control, were particularly visible during the early stages of the COVID-19 pandemic, Pattani explained.

“We went from a centralized ICU model, and then when the volumes became too large, we decentralized,” he stated. “But as we decentralized, we also overflowed into other non-traditional ICU space, and Mission Control was able to, in real time, capture this overflow space. So, non-traditional ICU space, we really track that, but we were able to expand our ICUs with the tools that we had. And then we were still able to track people that needed to come, which were far sicker and needed quaternary area care. So, we were able to coordinate and blend patient needs based on acuity and the severity of illness.”

The ability to track disease states and severity was critical for ICU capacity planning during the first COVID-19 surge, allowing AdventHealth leadership to strategize and mobilize to meet demand, he continued.

Moving into 2023, AdventHealth plans to expand Mission Control further, continuing to leverage it to address staffing issues and clinician burnout.