We had previously featured an article on this site on the Smart patient room innovation at the Univ. of Pittsburgh Medical Center. Since, then we have talked to David Sharbaugh(DS), the leader of the smart room project and,  a senior director at UPMC’s center for quality improvement and innovation and, Lucy Thompson(LT) one of the team members.

Today we bring you this exclusive interview.

What is the vision behind the smart room project ?

DS:  We believe this technology will enhance patient safety, allow clinicians to spend more time at the bedside, simplify the jobs of health care workers and improve overall patient satisfaction

Who are the people behind the smart room?

DS: The core development team consisted of 5 people. Working anywhere from part time to full time to complete most of the development. In addition, over the past six months a team of clinicians and medical technologists have worked on this.

Where does the ultrasound technology for Smart Rooms come from ?

DS: the system uses ultrasound tracking devices to identify the numerous caregivers whom a patient might encounter on any given day. UPMC used Sonitor technologies, as the vendor for buying the ultrasound tracking devices.

How much did it cost to build the smart room system?

DS/LT: Since it was internally developed, it mainly cost UPMC man-hours (or FTEs in health care parlance). But,  the total cost to the system would be approximately $2 per patient/day.

What clincal metrics does smart room system impact?

DS/LT: We are currently still compiling the metrics and observing the impact, but it is estimated that this system has reduced the time spent searching for allergies, demographics, since there is a visual cue provided to the care giver on the items that need to be completed. Medication safety is expected to impacted and patient safety, and, fall rate are some other metrics that are expected to improve. Currently, smart rooms are in the medical surgical floor.

How long did it take to train staff on this system?

LT/DS: There was minimal training for this, since the screen interfaces that staff and, physicians need to use are very intuitive.

Future enhancements to the Smart patient rooms system.

The Smart Room went live in early October and is being tested in six patient rooms at the UPMC Shadyside campus .They, told us that they are currently working on releasing the second version. The new version would include code information that will automatically display to the relevant care giver when a code is called.

In addition patient will be able schedule tests, get test results, and other information. Another possible enhancement is informative emails to patients!

We think this is innovative and will keep bringing you more information on future enhancements. So keep watching this space.

The benefits of improving patient flow go way beyond reducing wait times. While most healthcare administrators tend to focus on reduced diversions (in the ED), elopments, elective surgery cancellations, improving flow can positively impact quality of worklife for physicians, nurses and staff . This can in turn have a very positive impact on patient satisfaction and quality of care.

Here are top 5 tried and tested strategies used to improve flow.

1. Evaluate and monitor bed status in Med surg and Intermediate care units continuously – Don’t sweat the small stuff, the biggest bottleneck for patient flow is mainly in these units. In any acute care hospital, when you hear ‘we don’t have beds’ that usually means there are no monitored beds. So focussing on these units instead of the rest of the house helps. Also, these are the units where there are lots of activity during the day (usually not captured in midnight census which is used to measure occupancy usually). Increasing bed capacity in these units will help flow greatly.

2. Minimize transfers: Again this is counter intuitive but if you actually observe data you will see that transfer consume the most resources (beds, staff, environmental services etc). So do it right the first time and put patients in the right level of care. This can also reduce your insurance denials and impact finances positively.

3. Create an admissions unit to reduce stress on your ED: If your diversion hours in the Emergency Department and admission times are hitting the roof, you know you are in crisis. For quick relief create and admissions unit to keep the ED rooms/beds turning over quicker than usual. The admissions unit can focus on tracking and expedite flow to different units while the ED focuses on providing emergency care and evaluation.

4. Create a discharge lounge : Add a checkout lounge with a coffee bar and flat panel tvs to move patients waiting for a ride, so the valuable beds can be turned over to accomodate other patients. This will also impact patient satisfaction positively.

5. Airlines style surge staffing with demand: Use the airline model when it comes to staffing. Airlines tend to staff proactively during peak hours (and don’t worry about productivity in the short run).Also rememeber this does not only mean nursing staff. This applies to support staff as well. If you don’t have adequate environmental services staff for instance, there is not chance of beds opening up quickly on discharge. Moreover, support staff don’t cost much but are an asset in opening up beds.

Emerging trends in healthcare: Physician Ranking systems

A previous post, on this site briefly touched on ‘Zagat survey style’(for those not familiar, the Zagat survey rates restuarants in the US and around the world) physician ranking systems making their presence felt in the websphere. Believe it or not, this is not a flash in the pan. Infact, there are several establish sites that already rank physicians. Some others are extending this to hospitals, but more on that later.For this post we will stick to physicians and providers.

N.Y. leads the way

Late last year, New York’s attorney general  Andrew Cuomo announced  a first-of-its-kind agreement with Cigna Corp. The plan is to establish an industry standard for the doctor-rating systems that health insurers increasingly use to guide consumers. While health plans and insurers have been doing this for years, public will now have access to how health plans measure and rate doctors in terms of quality of care and cost efficiency.   

Sounds fair and square? So what is the caveat? If you are a health professional you will probably identify right away that there is a possibility that this might eventually steer patients to the cheapest, rather than the best doctors and services. UnitedHealth, for instance, gives doctors and hospitals that follow certain care guidelines and are cost-efficient a “UnitedHealth Premium” designation.

Quality or Cost ?

Jim Collins in his best selling book ‘Good to Great’ says that Good is the enemy of Great.  However the same logic can not be applied here. Meaning, “Quality is not the enemy of cost”. If you are not convinced all you have to do is look at other industries. In the auto industry for instance, they have realized that at some point there is a tradeoff between quality and cost and so good quality at a reasonable cost has become widely accepted. Quality guru, Walter Massing  states that the only viable policy is to concentrate on failure costs and to justify prevention measures for one problem at a time. 

What consumers need to know and health 2.0 sites need to publish?

So where does all this lead? Healthcare providers have a stake in this and so they will need to brace themselves, start looking at quality of care and efficiency a little more seriously. The serious Health 2.0 sites need to start publishing performance / rating on a host of information besides bedside manners and pleasantness of physician (which are important, but do not provide any insight to the physician’s chances of success in the treatment process). 

Here is a sample list of indicators that we need to look at to determine the best doctors/providers for our friends and family.

• Customer satisfaction metrics:Bedside manners
• Process metrics: Average wait times
• Clinical quality and outcomes: Hospitalization rate and risk-adjust mortality
• Other measures: Clinically integrated IT systems (known to influence medication and surgery risks)

Survey rage 

Measuring patient satisfaction and using surveys is getting increasingly popular in US healthcare. If you work for a hospital, physician practice or even a private clinic, you would have become familiar with some form of the patient satisfaction survey or another. If you are not then look online and chances are you are already being rated, ranked, scored and reported by someone online. Late last year America’s largest health benefits company(Well Point), engaged Zagat Survey to develop a new online survey tool. Even,  Google is supposedly working on an online rating app.

Making sense out of surveys

But how do you balance these scoring systems , with more meaningful assessments of care quality and competence? Patient safety guru Bob Watcher, who coined the term ‘hospitalist’ says that a balanced approach is more important than a single peephole. What he means by this is that, it’s important to look at a number of different factors(such as hospitalization rates, acuity etc) while determining patient satisfaction. We will save the discusssion on what such a survey might look like for another day.For now, let us focus on how to choose and use existing internal and external patient satisfaction systems.  Let us do that by asking a hypothetical question ….

“How would Toyota manage patient satisfaction ?”

Toyota management realizes the importance of accessing the “Voice of the Customer” . Its organizational structure has a  customer relations department that handles customer satisfaction (i.e., patient surveys in our case) and customer relations (i.e., employee training and incentives, patient assistance center, and dispute resolution).

• If you aren’t listening to your patients, you can’t have all the business attributes that provide them good care and value. However, if you aren’t using this information to create change, then don’t bother listening
• Toyota might establish a customer survey system that measures patient satisfaction with the process of care, the delivery experience, the service experience, and clinical quality. Based on the results of these surveys, they would develop your strategic plans to improve customer service.
•  Deparment/Service line Reporting- Summary evaluations and specific, but anonymous, customer comments would be shared with the departments. Departments/specialities would now monitor their own progress, which puts less pressure on the measures
• Elminitate inter department competition- Gaming occurs in nearly every system when two departments scores are compared. We all know how Inpatient units and Emergency departments often game the survey system to show inflated scores in hospitals. So Toyota would establish acceptable levels of performance and eliminate making distinctions of performance above that level.
• Telephone Surveys- Telephone surveys would be conducted to determine initial satisfaction with the care process. Standards for conducting the phone survey and processing the data would  also been established.