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Team manages admissions, patient flow

by Cindy Abole
Public Relations
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.
MUSC 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 Johnson.
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 nurse manager.

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 (HICS).

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

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