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When Barbara Wegner, CHAM, began making calls last spring in search of new technology to help out with her health system’s bed control function, she made an interesting discovery: A vendor with whom she already had worked was getting ready to beta-test just such a solution.
"I found out they were looking for sites to test the new product, so I contacted them and said we’d like to participate," says Wegner, regional director for access management at Providence Health System in Portland, OR.
The Electronic BedBoard, designed by Tele-Tracking Technologies in Pittsburgh, now is in place at Providence St. Vincent, the system’s largest hospital, and the results have been dramatic, she says.
"We are turning around beds more quickly, and it’s impossible to hide a bed now," Wegner says. "There is a 50-inch [flat-panel monitor] that gives the entire picture of the hospital [beds] at a glance."
The beta test — also taking place at three other locations throughout the country — began at Providence in December 2001 and was to be completed by the end of April 2002. Other locations are WakeMed in Raleigh, NC; Doylestown (PA) Hospital, and Winter Haven (FL) Hospital.
Through what the vendor calls PreAdmit Tracking — not to be confused with the process of registering patients in advance of admission — all of the bed requests flowing into the hospital are consolidated onto one computer screen, called the PreAdmit Window.
"Before," Wegner adds, "there were a bunch of little pieces of paper with notes written on them [regarding incoming patients]."
Those pieces of paper might include the surgery schedule, a handwritten direct-admit form, or a fax from the emergency department (ED) about a patient who needs a bed, explains Gene Nacey, MHA, founder and workflow consultant for Tele-Tracking Technologies. "There would also be a lot of ADT [admission/discharge/transfer] entries, and notes taken from physicians who’ve called to say they’re sending over a patient."
"Typically, there are 10-14 pieces of paper [bed control personnel] are dealing with," he adds. "So this paper is lying around, and they’re wondering where to put these patients."
What PreAdmit Tracking does is like data mining, Nacey says. "Except for the phone calls, all the information is in the hospital, but is in different systems. The catheterization lab might have its own scheduling system, admitting has the ADT system, and the ED usually has its own system for tracking patients.
"We have built a very flexible interface for all these systems," he says. "We get the bulk of all this information electronically onto one screen, so when [access employees] are determining what patients they need to place, they can look at one screen [on the PC] where all this information has flowed in. We have consolidated all those sources." (To see the Pre-Admit Window screen, click here.)
The next piece of the process, Nacey explains, was for bed control employees to have a good representation of which beds were available, which were dirty, which had patients who were about to be discharged, and so on. Most of that information was available from BedTracking, the telephone-based system Nacey’s company began marketing in 1991, he notes, but it wasn’t configured to look like a bed board.
"We created an electronic bed board that looks like a giant spreadsheet," Nacey says. "Each patient unit is a separate column, and each bed is represented by three cells." (To see the Electronic Bed-Board illustration, click here.) The first cell indicates the bed number and whether the occupant is male or female, the second gives the status of the bed — clean, dirty, or other options — and the third cell defines up to four other attributes.
One of the most common uses of the third cell, Nacey says, is to indicate a telemetry bed. One of his favorite uses, he adds, is one chosen by Providence, which notes in the third cell that the bed is close to the nurses’ station. Those beds are chosen if there is a combative patient or one who needs to be watched more closely for any reason.
Otherwise, Nacey points out, it would take a lot of phone calls to determine that placement "unless you have a geographic map in your brain."
The bed board will show 18 data elements without anyone touching a computer keyboard or mouse, he says. "The monitor shows virtually the whole hospital so you know the status of almost every bed. Some patient units might be very large, so you might have to scroll vertically to see the last 10 or 20 rooms."
Many options are available as to how the information is displayed, Nacey notes. "All the [beta sites] are sorted by status, with the occupied beds shown last, since these are the least interesting." Beds may be sorted alphabetically — in which case the occupied beds conveniently are last — or by number, he adds.
Bed control staff can look from the PC — where the incoming bed requests are consolidated — to the electronic bed board showing the big picture and then make the bed assignment, Nacey says. The bed board instantly is updated when the employee clicks on the patient, then on "assigned" and either selects or types in the bed number, he explains. An "A" in the middle cell shows the bed has been taken.
It’s possible, he notes, for employees in various hospital departments to see a mini bed board on their PCs. "The ED [staff] can see just their patients, or one of the units upstairs can see a version with just those patients," Nacey adds. "As long as they’re on the general hospital network, a bed board can be installed."
Wegner says she may or may not want to take advantage of this opportunity to share bed management information with other departments. "If we did make a decision to let one of the patient floors have it," she adds, "it would be view-only.’"
"Too much information could be a dangerous thing," Nacey agrees. "Folks might try to move patients into available beds without permission. These things must be centrally located or chaos can ensue."
"Each department can have PreAdmit Tracking installed on a workstation in their area," he adds, "but we have the ability to limit the units they see. We can limit them to see only the activities related to their patients and their beds."
In that case, Nacey says, any patients assigned to that unit or waiting for a bed on that unit will show up on that area’s PreAdmit Window. The mini bed board in those areas would show only one column, the one containing that unit’s beds, and the respective status of those beds, he notes.
At Providence St. Vincent, two people are on duty in the bed control area during the day and for periods in the evening, Wegner explains, with one person handling the job during part of the evening and at night.
"They are isolated in a room by themselves, where they manage the flow of patients and assign beds to patients being admitted from the ED and by physicians — the urgent call-ins and the electively scheduled admissions," she says. "Everybody is very excited about the technology.
"We’re trying to do some measurement [of time and effort saved]," Wegner notes, "but we know that we’re turning beds around more quickly."
"It’s a wonderful tool," adds Patricia Weygandt, manager of access services for Providence St. Vincent. "It has really helped us to more accurately place our patients and do that in a more timely manner. It’s great for both the bed control coordinators and the patient placement coordinators to have a clear picture of the house census at a glance."
The patient placement coordinators, she points out, are nurses who function as liaisons between access and nursing. "They help get the patient in the proper place and provide more clinical information when it is needed."
Providence Portland, another of the system’s three Portland-area facilities, wants the bed management technology as soon as possible, Wegner says. One of the things she’s interested in exploring, she says, is whether the technology could flow between facilities. The idea would be that if beds were tight at St. Vincent, Wegner adds, "we might try to get a patient in at Portland."
The company is working on such a concept, Nacey says. "Our plan is to allow multiple hospitals in one system to have a combined bed board, specifically targeting disaster response issues systemwide."
[For more information on products from Tele-Tracking Technologies, contact Gene Nacey at (724) 339-1424. Barbara Wegner can be reached via e-mail at firstname.lastname@example.org.]