Boost Communication to Improve Hospital Patient Throughput

To streamline the admissions process for emergency department patients, Tufts Medical Center is using a clinical communication and collaboration platform to improve teamwork between physicians and the hospital's Center of Patient Placement.

Tufts Medicine has focused on improving communication between clinicians and between care teams to increase hospital patient throughput.

Hospital patient throughput is a key metric for hospitals. Weak throughput can lead to boarding in emergency departments and patient safety concerns such as hospital-acquired infections when patient lengths of stay are extended beyond medical necessity.

Patient throughput is a major concern for chief medical officers and other clinical leaders, says Michael Davis, MD, associate chief medical information officer at Tufts Medicine and an internal medicine hospitalist at Tufts Medical Center.

"A big part of the chief medical officer's role is patient safety and quality care," he says. "So, when you have overcrowding of the ED or hospital units, you run the risk of compromising the quality of care you provide to patients, and you run the risk of patient safety events happening such as hospital-acquired infections. If we can streamline patient throughput across the hospital encounter, you are going to avoid the mismatch of supply and demand for beds. Ultimately, across the board, boosting patient throughput should have a beneficial effect on patient safety."

Tufts Medical Center has been concentrating on eliminating waste in the admissions process—specifically eliminating "phone tag" between essential players in the hospital, Davis says. The hospital has targeted an inefficient process for admitting patients from the emergency department.

"In the past, the ED physician was trying to call the medicine provider, the ED physician was trying to talk with the Center for Patient Placement, and the Center for Patient Placement was trying to reach out to the medicine provider," he says.

About a year ago, Tufts Medical Center started to use TigerConnect, a clinical communication and collaboration platform that provides communication on smartphones and desktop computers, to boost teamwork between ED physicians, the Center of Patient Placement, and the medicine physicians who are admitting patients, Davis says.

"Instead of trying to arrange separate conversations, the ED physicians can go into TigerConnect, activate the admissions team, then you have a group conversation on a single thread about the patient," he says. "That has streamlined communication for the admissions process. This is important for us because we are sensitive to overcrowding in the ED—we want to get our admitted patients out of the ED as quickly as possible and up to the medicine floors."

In addition to improving the efficiency of the admissions process, Tufts Medical Center has been using the clinical communication and collaboration platform to improve patient throughput in operating rooms.

The hospital analyzed the patient life cycle of going through the OR, where patients check in, go into preop, have the procedure, then go into postop. They found that process required many different phone calls to be made to all of the people needed to coordinate getting the OR ready and getting the physicians and anesthesiologists to come in to perform the procedure, Davis says.

"There was a lot of waste in that communication process, which contributed to decreased rates of the first case on-time starts for OR cases," he says. "We leveraged an integration between our electronic medical record and TigerConnect. When the OR staff is documenting in the EMR, there are automatic notifications that are sent to TigerConnect alerting the multidisciplinary OR staff about milestones that prompt them to come into the OR. We were able to eliminate wasteful phone calls, without adding any new work for the OR staff."

Combined with internal efforts by the hospital's perioperative team, including a staggered OR start time pilot, the first case on-time start rate has increased by about 70%, Davis says.

To make sure patient discharges are not delayed because of difficulties placing patients at post-acute facilities, Tufts Medical Center relies on case managers to work closely with the hospital's post-acute partners, Davis says.

"The case managers need to know from the medical team when the patient is medically ready for discharge," he says. "There is a lot of communication going on between the physicians and the case managers throughout a patient's entire hospital encounter. A physician may interact with several case managers on different floors, so you must rely on efficient, on-the-go digital communication."