Team manages admissions, patient flow
by Cindy Abole
Although waiting, delays and cancellations are more often synonymous
with people and air travel, the same issues also are challenges in
health care, especially in hospitals where facilities chronically run
short of beds. Every day, the Bed Management & Admit-Transfer
Center (ATC) team stays busy managing a complicated dance between
patient admissions, transfers and discharges.
Bed Management & Admit-Transfer Center team is Marilyn Willis, from
left, Nancy Hendry, Georgia Hicks, Leslie Folsom, Lisa McCormick, Marie
Herrin, Sue Redfield-Jones, Rhonda Moore, Colleen Lehrke and Dr. Sarah
To help manage growth and a steady influx of patients, MUSC medical
center replaced its manual bed management system and tracking board
with a more efficient electronic bed board tool. The program allows
staff to track patients and beds in real time, manage bed occupancy
status and check on the availability of beds for patients coming from
emergency services, outpatient clinics, referring hospitals and
physicians' offices throughout the Tri-county area and beyond. MUSC’s
current in-patient bed capacity is 689, which include beds at the
Institute of Psychiatry. The system manages beds within the University
Hospital, Children’s Hospital and Ashley River Tower facilities. The
success of the new system is the result of a collaborative,
multi-phased project that assists people who make decisions about bed
placement, use of new, efficient technology and staff training. The
program’s efficiency with clinical staff and related departments
contribute to improvements in patient satisfaction and outcomes for
good patient care.
The Bed Management & ATC group is led by Nancy Hendry, R.N., and
her 15-member admit nursing team. With an average of 20 years clinical
nursing experience, the group is constantly busy communicating with
nursing and physician staff in managing incoming patients and existing
patients, handling admit transfers and disaster preparedness for all
three medical center facilities.
“Our work affects so many people and areas throughout the
organization,” said Hendry, who was hired in 2006 to transition from
the cumbersome manual system to the new electronic dashboard program.
“Because of this, we’re able to see how things work and come together
on a larger, broader perspective. We’re a great team and we’re here to
help people and provide a valuable service working with both physicians
and clinical staff to adequately place and accommodate patients.”
When ART opened in February 2008, MUSC’s first phase of the new
replacement hospital expanded capacity and bed space to support
specialty services including the Heart & Vascular Center, Chest
Pain Center and relocation of the Digestive Disease Center. It also
allowed for the reorganization and consolidation of clinical services
and renovation of patient care areas in the University Hospital that
added beds to various units.
With the manual system, ATC staff were constantly on the phone with
staff, physicians and departments handling patient admissions and
scrambling to place patients in appropriate beds. The work was often
frantic and uncontrollable.
The department gained many benefits with the new electronic bed board
system. For example, many manual processes using the new systems have
decreased. All requests are managed electronically with information
sent directly to the charge nurse’s phone in each unit and assignment
details are sent to the patient’s files. So, there’s fewer phone calls
made regarding admissions and check-ups about bed requests.
The team works 8-10-12-hour rotating days and staggered shifts to
provide round-the-clock coverage. Two nurses primarily work weekends
(Friday to Sunday). Monday through Fridays, a nurse is assigned to
place patients in each hospital. ATC nurses can provide critical,
on-the-spot decision-making based on their experience and clinical
knowledge for patient care. When there are no available beds within a
primary unit, they must determine where’s the next best unit to place a
patient. Despite their workload and responsibilities, each nurse
possesses an appreciation, understanding and commitment to her job and
its related issues.
“Bed Management’s Lisa McCormick is an invaluable resource to the
Children’s Hospital. Having a bed management coordinator specifically
for the Children’s Hospital and an electronic system has really cut
down on the number of phone calls that are made to admit and transfer
patients,” said Melinda Biller, R.N., Pediatric Intensive Care Unit
Use of the electronic system also has improved the department’s
relationship with other support areas including hospital maintenance
and housekeeping services. The team needed to improve communications
when patient rooms were closed for construction/renovation as part of
the main hospital’s realignment plan. Room closures constantly affected
the hospital’s daily bed availability status. To resolve this, Hendry
worked with Dave Dement, director of Hospital Maintenance & the
Central Energy Plant, to receive e-mail updates alerting ATC staff when
rooms would be unavailable due to construction. She also worked with
Dick Smith, Environmental Services director, who works with
housekeeping staff. Smith experienced transitional challenges with his
employees following bed management’s move to the electronic system.
Within 18 months, they were able to make improvements after identifying
important needs. Smith reorganized work teams and instituted new goals
and additional training for his managers, which was supported by bed
management staff. Today, both departments share a good working
relationship and are supportive to their area’s goals.
“The electronic process has improved communication between the bed
management team and units making it easier for nurses in their job of
admitting patients,” said Sue Pletcher, director of Hospital Info
Services/Patient Access Services. “We’re seeing significant
improvements in staff documentation of tracking reports, phone logs and
other paperwork. The system autologs information regarding patient
flow. From a quality perspective, it has helped identify gaps in the
process so that we can make adjustments. Overall, it has improved
patient throughput throughout the medical center.”
Hendry stays on top of issues and reports to the hospital’s bed flow
committee and advisory board, which meet monthly, to identify and
discuss patient admissions and flow issues. She also meets with MUSC
executive medical director Pat Cawley, M.D., who chairs the group, to
discuss ideas and recommendations.
Another role of the ATC is to facilitate patient transfers from outside
facilities. Physicians, from outside facilities requesting to admit a
patient to MUSC, call ATC to be connected with an MUSC physician. An
ATC nurse gathers appropriate clinical and administrative information,
connects the physician and stays on the line. This one-stop shop effort
helps with efficiency and timeliness in the admit transfer process.
Admission nurses have a valuable role with the Bed Management & ATC
team. A dedicated nurse is stationed both in ART and the University
Hospital to support nursing staff for new admissions. They coordinate
information for patient histories in the system database and provide
follow up to patients and their needs.
For now, Hendry and her team are currently focused on building and
maintaining relationships among staff, patients and internal and
external customers. She especially wants to keep improving on the
department’s relationship with nurses.
“We do more than just place patients on a board and assign them a bed.
We work closely with families, whether it’s calming them on behalf of a
newly admitted family member, providing directions or managing call
backs and other patient issues. Our focus is to provide the best care
for our patients and their families,” said McCormick.
Admit-transfer team ready to respond Nurse veteran Marie
Herrin has been a nurse for 22 years and has worked in MUSC’s Bed
Management & Admit-Transfer Center for 10-plus years. Not only does
she help her colleagues manage placing patients throughout the medical
center, Herrin also assists anytime the medical center responds to a
community emergency and activates its Hospital Incident Command System
As players in the emergency operations response plan, Herrin
coordinates information regarding bed availability at MUSC. She works
with her counterparts at Roper St. Francis and Trident hospitals in
sharing similar information. According to Herrin, the ATC drills
continuously with MUSC’s HICS and quarterly with Tri-county disaster
drills. She believes participation with these drills prepare staff and
reminds them to review the hospital’s disaster and bad weather policies
that are posted in each unit/department.
Friday, Sept. 11, 2009