Tampa General Hospital faced high occupancy levels, increasing patient volumes and higher acuities – beds were filled with more patients who were also sicker.

THE PROBLEM

To meet the needs of the community, the organization needed to transform its operations to increase access to the health system, including emergency department, inpatient and procedural services.

This was an initiative that could not wait, said Ronetta Lambert, senior director of CareComm operations at Tampa General Hospital.

"While Tampa General is undertaking a master facility plan to grow physical space, that is not an immediate solution," she explained. "We needed to be able to safely treat more patients within our existing footprint.

"We looked for a solution that could address the patient flow issues that were impacting both the cost and quality of care delivery," she continued. "Constrained access to our services was leading to increased patient waiting times. Inefficient coordination of services resulted in extended hospital stays. Overutilization of resources was driving an increase in costs."

The ability to address these issues was limited because the health system lacked the situational awareness tools that could provide transparency into the current situation and the ability to anticipate future bottlenecks, she added.

"These patient access and flow issues were happening against the backdrop of challenges facing all healthcare organizations – reimbursements are declining, costs are rising, and the industry is shifting from volume to value," she noted.

PROPOSAL

To Lambert, it seemed like the health system was seeking the impossible – it needed a technology that would help streamline care delivery and improve patient throughput without having a negative impact on quality of care or staff morale.

"We looked for technology and a partner that could provide our clinicians and operations teams with actionable insights, thus enabling Tampa General to improve patient flow, increase access to care and elevate care quality," she said.

"GE Healthcare offered a complete solution that puts innovative technology into the hands of our operational and clinical team members," she continued. "The technology and the deployment strategy support both a physical central Command Center and improved daily operating system on the units."

"The Command Center technology is integrated into our care teams' daily operations, helping them to manage and streamline patient care delivery and driving our clinical, financial and operational outcomes."

Ronetta Lambert, Tampa General Hospital

The combination of powerful technology and implementation strategy, along with a deliberate focus on change management, have helped Tampa General achieve what seemed nearly impossible, she added.

Integral technology design features that drive outcomes, she reported, include:

• Real-time technology. "We have situational awareness that provides us with clear information about where to put our resources, time and energy in the moment."

• Alert-based workflows. "We define the alerts that each user sees, which helps us pinpoint risks and barriers across patient flow. We've also been able to reimagine roles to find the best ways to support the local care teams. As a result, both care and operational teams know what actions to take in the moment to prevent delays and bottlenecks."

• Synergy with the Epic electronic health record. "The GE Healthcare Command Center technology pulls information from Epic, leveraging what our clinicians are already documenting to reveal real-time insights into our current operations and risk points."

Equally important, the implementation approach is based on the premise that the technology is useless unless it is put into practice across the enterprise, Lambert said.

"The implementation allows for customization within the software tailored to our needs and aligned with our operations and clinical workflows," she said. "As partners, GE Healthcare has been with us from the initial software design, process change and implementation, helping to hardwire the process improvements into our standard practice.

"Because staff engagement was essential to this initiative, we appreciate that the technology deployment is designed with people and actions in mind," she continued. "The people who will use the system are designing it alongside the GE Healthcare and Tampa General deployment team."

In addition, the team focused on re-engineering processes in parallel with the technology deployment.

"We rely on the technology to reveal underlying issues that need resolution," Lambert explained. "On Day One of turning on an alert, we might have one hundred alerts come into the Command Center. Instead of focusing solely on chasing down fixes for each of those alerts, we also need to address the root cause of the problem.

"Then our teams can focus their attention on the alerts and exceptions that require additional attention," she added.

In addition to the build of both the physical Command Center space and program, re-engineering processes related to surgical access and patient flow, and the build of 20 Tiles, the project scope also includes the use of a Hospital of the Future simulation model. (Tiles are web apps that draw information from a real-time data model inside the Command Center platform.)

"The Hospital of the Future is critical to helping us align our capacity strategy," Lambert said. "The simulation model allows us to ask 'what if' questions to target the right strategies before we expend time, energy and resources on a project."

The team can explore the impact of scenarios, such as:

• What happens if patients are routed differently?

• What is the upstream and downstream impact of eliminating bottlenecks in procedural areas?

• How will patient flow process changes impact length of stay?

•  How are capacity, waiting times and access impacted if length of stay is reduced by a half-day?

MEETING THE CHALLENGE

At Tampa General, technology innovation has evolved in three phases. Phase 1 was creating situational awareness.

"This initial phase involved the deployment of three GE Command Center Tiles – Capacity Snapshot, Boarders and Surgical Tube Map – that provide visibility into what is happening now in our procedural, emergency department and inpatient/observation bed enterprises," Lambert explained.

"The Tiles allow operations and caregiving staff to see how many patients are waiting and provide a clear line of sight to their needs," she continued. "The Tiles surface key insights about which areas are under pressure, allowing us to effectively redirect resources. These Tiles are leveraged by hospital clinical and operational leadership as well as Command Center intake teams coordinating the admissions process."

Phase 2 is optimizing patient flow.

"Through the build of five GE Command Center Tiles – Patient Manager, Care Progression, Imaging Expediter, Observation Management and ED Expediter – we improved our coordination of services and reduced the average length of stay," Lambert said. "All of these Tiles deliver patient-level alerts across the entire continuum.

"These alerts are resolved by a multidisciplinary team working across the enterprise – not just in the physical Command Center space," she continued.

The Patient Manager Tile is essential to the success of this phase, she added.

"It's a real-time list of all patients in an inpatient/observation bed, inclusive of all key patient information, such as dates of upcoming procedures, expected discharge date and expected disposition, such as to a skilled nursing facility or home," she said. "It reveals and highlights any barriers to flow or safety risk points, such as a delayed consult, delayed therapy or missing imaging so that timely, appropriate action can be taken.

"Used by nurses, case managers, social workers, and ancillary and support service leaders, the Patient Manager Tile is a single platform that keeps a multidisciplinary group aligned," she continued.

It provides the ability to:

• Foster communication and collaboration. "The full care team is aligned on current and future patient care needs and actions required. The Tile is leveraged in unit rounds, shift change hand-off and within the Command Center."

• Escalate issues. "It provides local care teams the option to escalate a barrier to the Command Center, where a Command Center Nurse Expediter can work toward fast resolution. This gives valuable time back to frontline nurses."

• Manage care progression. "Within the Tile, the team created an algorithm to assess a patient's readiness to step down to a lower level of care based on 90-plus clinical criteria prior to physician order. This is leveraged by ICU Nurses and Case Managers to coordinate with providers to safely progress care."

Phase 3 is creating a safety net for patients.

"Patient care is central to everything we do, and this phase focused specifically on care quality and patient safety," Lambert said.

It involved the deployment of three modules within the Patient Manager Tile:

• Perinatal. "Patient-level alerting related to the safety and flow of mom and baby."

• Zero Harm. "Patient-level alerting on central line, lab and medication care risk points. For example, a patient showing trends of declining hemoglobin over the last three days."

• Sepsis Management. "Recent addition that provides alerts about patients with a potential sepsis concern and highlights instances where the sepsis treatment is not compliant with our defined protocol. The Tile uses real-time information from Epic, and then rules-based logic based on a weighted algorithm with more than 14 clinical factors; it's based on algorithm logic we created specific to our organization."

RESULTS

In the first two years of the program, Tampa General reduced length of stay by half a day, cut out 20,000 excess days and saved $40 million by eliminating inefficiencies.

"The excess days is an accrual of patients who stayed past their expected length of stay based on diagnosis-related group," Lambert explained. "Because we're not paid for those excess days, cutting them significantly has contributed to substantial cost savings. In addition, it's the equivalent of adding 30 beds, allowing us to safely treat more patients.

"The Command Center technology is integrated into our care teams' daily operations, helping them to manage and streamline patient care delivery and driving our clinical, financial and operational outcomes," she continued. "The system provides actionable insights that reveal bottlenecks, establish priorities, and support optimization of time and resources across the enterprise."

The Command Center operational staff support local care teams, giving them more time for direct patient care. For example, the Command Center Nurse Expediter team resolves 96% of barriers that are escalated to them.

"Between October 2021 and March 2022, we reduced our Neuro ICU length of day by 8 hours," Lambert reported. "The creation of an ICU Downgrade Algorithm within the Patient Manager Tile allows us to assess a patient's readiness to step down to a lower level of care based on 90-plus clinical criteria prior to physician order with 96% accuracy.

"The nursing and case management teams use the Tile and algorithm in their daily rounds and charge nurse shift reports," she continued. "When they see the patient might be ready for a lower level of care, they partner with the intensivist to review and step the patient down when appropriate. These efforts also support ongoing bed planning and patient movement."

ADVICE FOR OTHERS

A successful Command Center development and deployment requires four major elements, Lambert advised.

"First is leadership support and buy-in," she said. "The technology will shine a light in dark corners, and you will see problems that you did not know existed.

"It's critical to have leaders who will lean into the transformation and see this as an opportunity for continuous improvement," she added. "There must be an organization-wide culture that doesn't assign blame, but instead focuses on work that solves the problem."

The second is commitment to addressing root causes.

"Often, the more you build, the more challenges you see," she noted. "Remember, that the goal is not to have the Command Center solve all the problems for the hospital or health system. Instead, provide the resources for parallel efforts that focus on process redesigns and fix any failure points."

The third is integration of strong change management processes.

"The Command Center is not a program that ends – it becomes the way you operate," she explained. "Those ongoing process improvements require strong communication and buy-in at all levels. Success depends on people seeing the value of doing things differently."

And the fourth is foster staff engagement.

"Keep in mind that Command Center technology is new to hospitals and health systems, so many people are seeing this for the first time in their careers," she noted. "The more they understand the technology, process and goals, the more they can contribute to the success.

"Engage the end users in the design of the technology," she concluded. "Commit to understanding their needs and challenges to ensure that the technology is going to solve real problems."

Twitter: @SiwickiHealthIT
Email the writer: bsiwicki@himss.org
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