By Rodney Moore
As hospitals and clinicians settle in to the relatively new world of electronic medical records, many are beginning to look for ways to benefit from all of the data that gets collected.
On their own, EMRs don’t offer logistics and optimization since their primary function is data collection and documentation. While several EMRs have added a basic bed management option to identify where patients can be placed, it is only a small step toward driving efficiency in the hospital.
Mitch Berg, senior director and regional executive with the Texas Hospital Association’s HealthShare, said part of the challenge is that EMRs were not built to solve for efficiency. “None of the hospitals we talk with expect EMRs to help reduce their length of stay, for example,” Berg said. “They don't have any illusions that’s what an EMR is going to do. That's where the utility of putting as much of this data to use as possible, in real time, and in an effective way, comes in.
“At Blessing Health System, an integrated health system based in Quincy, Illinois, Chief Executive Officer Maureen Kahn saw the system’s chosen EMR’s limitations when it came to driving efficiency. “We saw growth in the inpatient setting while most other hospitals saw a decline,” Kahn said. “We knew we needed to be able to take on more volume while having consistent and sustainable performance, which meant we needed something bigger and bolder than the throughput projects we had done in the past.”
Four Best Practices to Optimize Efficiency
According to Samantha Platzke, senior vice president of system performance and chief financial officer at Care Logistics, there are four best practices hospitals can implement to build upon their EMR platforms and improve efficiency.
First, Platzke recommends identifying patient status as soon as the patient enters the hospital. “Getting patient status right and removing variability in how you establish it is really the key first step because the whole care team is aligned for the type of patient they're caring for,” Platzke said.
Second, Platzke noted the importance of setting a target length of stay and having the care team driving toward that goal. “It’s vital to establish a target length of stay and a progression plan with specific times and milestones for every patient,” said Platzke. “This must occur at time of admission.”
The third key for optimizing efficiency is ensuring adequate resources based on demand. “The best practice is to be able to forecast for demand on the staffing in the hospital at least four to six hours in advance while understanding that demand needs must go beyond simply measuring patient census,” Platzke said. “It should be measured based on the actual care that a nurse must provide during those hours.”
Platzke said a final key factor is to create a system where every department and all leadership are working collaboratively. “To really optimize, you’ve got to create a system (in which) all the departments are together working simultaneously to implement and sustain all of those best practices,” Platzke said.
Achieving this sustainability has been important at Blessing Health as well. “In the past,” Kahn said, “we did smaller, focused efforts such as an ED throughput project, but we found that the improvements were not sustainable. Sustainability must be built in, and you must have the right tools to automate it. With our Care Logistics project, we started by putting the process improvements in place first and followed it with the technology to sustain our improvements.”
Best practices around logistics such as testing and bed management include developing standard operating procedures, workflows and technology to support simultaneous scheduling to meet the demand for each hospital.
“The bottom line for both inpatients and outpatients is how do you utilize your resources within the hospital to maximize patient throughput and give patients a high-quality care experience,” Berg said. “With just an EMR, the providers and other clinical staff usually will need to drill down into that EMR data to find information they're looking for, but Care Logistics pulls it all up to the surface.”
Kahn agrees and said achieving real-time communication among its care teams is saving time and impacting patient satisfaction. “Our physicians can walk onto any unit and immediately know where a patient is and what tests they are receiving. In the past, tests ordered today often were not completed until the following day,” Kahn said. “Most of those tests are now done the same day, and attending physicians are getting the information they need to make decisions sooner than they ever did before.”
Sizable Returns Often Achieved
Hospitals that partner with Care Logistics also say that physicians and staff are much happier because there is a very clear understanding of what must be done to successfully progress the care of patients and what the real-time status of each patient is in his or her own progression of care. In addition, the financial opportunities are significant. On average, hospitals working with Care Logistics see a return of $19 million. “Depending on the size of the hospital, the improvement could range from $6 million to as high as $55 million per year,” Platzke said.
By implementing best practices such as those mentioned by Platzke, hospitals can build upon their own EMR platforms to optimize efficiency and achieve similar results. At Blessing Health System, adoption of best practices has resulted in the capacity to accommodate a 9.5 percent growth in admissions while simultaneously reducing the utilization of nursing overtime and agency labor. Total improvements have had an annual financial impact of $11.6 million.