Guelph General Hospital

Report
Telephony
Bidirectional Interface to
Meditech Bed Board
Sue MacNeil
Director, Food and Environmental Services
Jean Ferguson
Manager, Informatics
Presentation Outline
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Profile – Guelph General Hospital
Organizational drivers
Identifying an opportunity
GGH Solution – telephony interface
Benefits/Outcomes
Next steps
GUELPH GENERAL HOSPITAL
VISION
WE WILL ACHIEVE EXCELLENCE IN EVERYTHING WE DO
MISSION
TOGETHER WITH OUR COMMUNITY
AND GUIDED BY OUR VALUES,
WE PROVIDE QUALITY,
PATIENT-CENTERED
HEALTH CARE
VALUES
COMPASSION
ACCOUNTABILITY
RESPECT
TEAMWORK
Information about GGH
• GGH is a dynamic, comprehensive acute care facility providing a
full range of services to the 180,000 residents of Guelph and
Wellington County
• GGH is governed by a volunteer Board of Directors
• The hospital employs over 1,200 staff
• More than 200 Hospital volunteers contribute 1,500 hours of
work per month
• There are approximately 300 professional staff at GGH including
physicians, midwives and dentists
Number of Beds
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22
65
60
14
8
Critical Care and Step Down
Surgery
Medicine
Obstetrics
Paediatrics
Total: 169 beds
Picture
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Ontario Healthcare Landscape
• The Ministry of Health and Long-Term Care (MoHLT) is working
to establish a patient-focused, results-driven, integrated and
sustainable publicly funded health system for Ontario based on
helping people stay healthy, delivering good care when people
need it, and protecting the health system for future generations
MoHLTC Mission and Mandate
• Stewardship
• Establishing overall strategic direction and provincial priorities
• Developing legislation, regulations, standards, policies, and
directives to support those strategic directions
• Monitoring and reporting on the performance of the health
system and the health of Ontarians
• Planning for and establishing funding models and levels of
funding for the health care system
• Ensuring that ministry and system strategic directions and
expectations are fulfilled
What is a LHIN?
• Local Health Integrated Network
• Not-for-profit corporations
• Work with local health providers and community members to
determine the health service priorities of the region
• Plan, integrate and fund local health services, including:
 Hospitals
 Community Care Access Centres
 Mental Health and Addictions Services
 Community Support Services
 Long-term care
 Community Health Centres
WWLHIN Accountability
• Bound by the Local Health System Integration Act 2006
• Accountable to residents Waterloo-Wellington and MoHLTC
• Guided by Ministry/LHIN Performance Agreement (MLPA) which
defines obligations and responsibilities of the LHIN and MoHLTC
• Accountability Agreements between WWLHIN and health
service providers of Waterloo Wellington identify:
 Responsibilities
 Accountabilities
 Performance delivery targets
Pay for Results Program (P4R)
• Implemented in July 2010 by MoHLTC
• Ontario's Pay for Results Program helps hospitals meet specific
emergency room (ER) wait time reduction targets
• In the first two years overall wait times showed decrease of
– 4.7 hours (28%) for patients who require complex medical
care or admission to hospital
– 1.4 hours (22%) for patients with minor conditions
• Hospitals use the funding to ensure more patients are treated
within the targets
P4R Indicators
• Emergency Room Length of Stay
• Date/time of registration or triage to date/time patient left ED
• ER LOS Admitted
• ER LOS Non-Admitted Complex
• ER LOS Non-Admitted Minor
• Time to Physician Initial Assessment
• Date/time from registration or triage to date/time patient is initially
assessed by physician
• Time to Inpatient Bed
• Date/time from decision to admit to date/time patient left ED
P4R Success Factors
GGH has consistently placed in the top ten performers
for P4R in Ontario over the past two years
 P4R Steering Committee with Senior Team and
Physician support and involvement
 Recognize impact of inpatient bed availability on
Emergency Department
 Identify opportunities for improvement
 Alignment with LEAN and PIP initiatives
 Every Minute Matters Campaign to engage staff
Organizational Drivers
• P4R Funding – need to continually improve TAT
for patients being admitted from ER to inpatient
units to meet targets
• Smaller process improvement initiatives
identified as a result of broader ED PIP project
• “Every Minute Matters” Campaign
Housekeeping Department
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65 staff
5 shifts (days, evenings, nights + support staff, 1000-1800 and 12002000)
Dedicated housekeeping staff in ER 24/7, including breaks
Strategic goal = support patient flow by timely TAT on beds
Trends affecting demands on housekeeping resources:
• Increasing # patients requiring isolation – additional cleaning
time, additional moves to meet private accommodation and
cohorting requirements
• Surges in ER creating demands on resources in off-hours
• Discharge times fluctuate with changes in surgical programs (ie
bariatric program) – need to adjust staffing accordingly
• Increase of 9.2% inpatient admissions (2010-2012)
Previous Model
Notification To Housekeeping Of
A Dirty Bed
Staff Used:
Bed sheets
Verbal Notification
Phone calls
Pagers
Notification To Housekeeping
Of A Dirty Room
Previous Model
Notification To Unit Staff/BA Of
A Clean Bed
Staff Used:
Bed sheets
Verbal Notification
Phone calls
Notification To Unit
Staff/BA Of A Clean Room
Issues/Problems
Multiple Processes
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Staff confusion, training issues- each unit had their
own preferences for communicating when beds were
dirty or clean
Wasted time, multiple phone calls/interactions to
notify both dirty and clean rooms
Some staff not notified at all – staff notify one person,
not the other
Delays In Communication
Dirty Bed
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Unit staff document on bed sheet; rely on
Housekeeper to “see it”
Delays between Bed Allocation being notified and
Housekeeping being notified
Clean Bed
•
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Housekeeping record time bed cleaned on bed sheet;
rely on Unit staff to “see it”
Delays between Bed Allocation being notified and
Housekeeping being notified
Trust Issues
•
Unit staff not reporting discharges = perception that bed
is being held to prevent an admission
•
Unit staff back-timing discharge time on bed sheets 
appears as though Housekeeper didn’t see or do the bed
 Animosity between Housekeepers on multiple shifts
regarding workload
 Issues between Housekeeping, unit staff, ER and BA
when beds are considered to be hidden or held
Fluctuations In Patient Flow
• Discharges & transfers batched, often around
unit staff shift changes
 Multiple beds become available at Housekeeping shift
times
 Stat beds needed as a result of extended holds
 Peaks and valleys in patient flow make it harder to
balance/staff the workload
 Back-ups in ER followed by ++ admissions  difficult to
meet TAT’s, P4R targets
Identifying An
Opportunity
GGH Solution - Telephony Interface
Telephony Requirements
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Connexall Software / Licensing
Server (Virtual)
Wireless connectivity
Compatible phones for all Housekeeping staff
dedicated to inpatient units + 1 RP (Spectralink)
 Meditech bidirectional interface
 Interface Engine (MDI Solutions)
Step 1 – Entry Of Patient
Discharge/Transfer in Room
414-1 On Bed Board
• Discharge/transfer of
patient in Rm 414-1
activates DIRTY bed
status on Bed Board
• Discharge/transfer entry
on screen includes
isolation status, stat bed
and whether cleaning
required
Step 2 – HL7 Message From Meditech
To Spectralink Phone
• Message and ring come
through on phone
indicating Bed 414-1
needs to be cleaned
• Stat beds can be
identified in message
• Isolation status noted,
indicating type of
cleaning required
Step 3 – Housekeeper acknowledges
bed to be cleaned
• Housekeeper
acknowledges message by
pressing green button on
left
• Bed board updated to
“Cleaning In Progress”
• Option also to escalate bed
to RP by pressing green
button on right
Step 4 – Housekeeper
cleans bed
• Bed added to work assignment; Housekeeper can review bed log on phone
• Housekeeper may assign bed verbally to staff who are supporting their unit
with discharges; staff let Housekeeper know when they are done
• Beds cleaned in order of priority
• Bed Board shows Cleaning In Progress
Step 5 – Bed Clean HL7 Message
Entered By Housekeeper
• Housekeeper chooses bed
from list and then chooses
custom option on phone
to send clean message
back to Bed Board
Step 6 – Message Confirmation Of
Clean Bed
• Message appears
on phone
confirming status
update on Bed
Board
Step 7 – Bed Board Updated To Clean
Status
• Bed Board now
shows 414-1 as
CLEAN, ready for
new admission
Operationalizing The Concept
Key Steps/Decisions
Mapping Beds To Phones
Days:
 Messages directed to companion
phones carried by staff on each
unit from 0800-1600 daily
 Unit staff responsible for
assigning and completing clean
message entries for beds on their
unit
 Option to escalate beds to RP
under special circumstances (stat
beds, off the unit) during the day
 Escalate any beds not yet cleaned
at end of shift
Evenings/Nights:
 Messages directed to one phone
from 1600 – 0800 daily
 RP (lead) responsible for
assigning and completing clean
message entries for beds on
their shift
 Messages (ie dirty beds) stay on
phone at shift change times
(2400 hrs, 0800)
Key Steps/Decisions
Mapping escalation steps in event of no response
(ie phone failure, dead zones, misplaced phone)
•Housekeeper
•RP
•ER Housekeeper
- if no response (ie ACK) after 5 min 
- one repeat alert/message 
- still no response after 5 min 
- escalate to RP
- no response after 5 min 
- one repeat alert/message 
- still no response after 5 min 
- escalate to ER Housekeeping phone
- no response after 5 min 
- retry indefinitely every 5 min
* RP = responsible person (lead)
Key Steps/Decisions
Delays In Entering CLEAN Message
• Potential for delay in cleaning due to volume,
2 step-cleaning and not requesting support
• Housekeeper may forget to enter CLEAN
message
If bed not cleaned within 2 hours
 message/alert escalates to RP to further
assess situation
Key Steps/Decisions
Message Details
• Unit & bed #
• Isolation status
• Stat
• SWAP bed
Isolation Status
C
CP
D
DC
A
AC
Contact
Contact Plus
Droplet
Droplet Contact
Airborne
Airborne
Key Steps/Decisions
Coordination With Bed
Support Staff
• Support staff must
coordinate cleaning
completion with primary
Housekeeper (or RP on
evenings)
• Challenge during shift
changes when beds being
escalated to RP yet may be
in progress of being cleaned
Managing Breaks &
Meetings
• Decision made that staff not
required to respond to calls
during breaks but most do
as only acknowledgement
required (unless stat bed, in
which case cleaning would
be escalated to RP)
Key Steps/Decisions
Downtime
• Manual system (old process) utilized if
interface down (ie phone calls, pagers,
bed sheets)
• Pagers used if phones down
Benefits & Outcomes
 TAT’s from ER to admission improved
Eliminated all
delays between
discharge/transfer
of patient in
system 
Housekeeping
notification
Supported P4R funding
Benefits & Outcomes
 Process improvements – clear/automated
process for communication between Unit
Staff, Bed Allocation & Housekeeper
 Improved staff relationships – trust,
accountability
 Better tracking method for beds needing to
be cleaned on a shift
 Ability to accurately identify isolation status
and therefore type of cleaning at time of
notification
Benefits & Outcomes
Opportunity to identify other processes
that affect patient flow, patient safety
• Infection control risks identified related to bed
transfers occurring without cleaning
• Manual daily updates of Bed Board unrelated
to discharges/transfers  risk of errors
• Entering “No Clean” when in fact cleaning
required
Benefits & Outcomes
 Improved workflow, less batching
 Fewer stat calls
Graph correlates with actual Housekeeping telephony notifications  able to plan/adjust
staffing accordingly
Reports
Reports provide statistics regarding
number and type of cleanings, TAT’s for
cleaning
Reports provide ability to investigate
concerns regarding delays in admissions
Next Steps
Patient
discharged
or
transferred
Manual
Process
Transfer
or
discharge
entered
into
Meditech
Notification By
Telephony To
Housekeeping
Notification
To Bed
Allocation &
Unit Staff that
bed is clean
Automate process through 2-way
Telephony Interface
Reduce delays in discharge/transfer entries into Meditech
= human factor
Ongoing Staff Education
• Unit staff – appropriate, timely entries
• Housekeeping staff – CLEAN entries to
consistently be made 5 minutes before bed is
cleaned
• Appropriate escalation relative to workload
• Continue to review reports to identify patient
safety issues requiring education and follow-up
Future Enhancements
• Bed Board access on units
• Potential applications in outpatient locations
• Ability to escalate beds to support staff
(requires additional phones and updates to
software)
Acknowledgement to Key Resources
 Sponsorship of Senior Team (CIO/CFO, and CNO)
Planning Team
Implementation Team
 PIP Leaders
 Connexall Project Management
 Housekeeping
 Connexall Technical Resources
 Bed Allocation
 Connexall Programming Resources
 Ward Clerks
 Informatics Analyst (Project Lead)
 Nursing staff
 Housekeeping Resources
 Telecommunications
 Network Analyst
 Information Management
 Interface Analyst
GGH & Connexall
Partnership
Connexall
Questions ?
Thank you

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