A new tool: Hospital command centres
Having the capability to anticipate, detect, and mitigate risk in real time, command centres complement other performance improvement tools. Command centres are multi-purpose and scalable; they evolve over time like smartphones building on the cultural and technology infrastructure.
They create value by:
- Supporting front-line care teams
- Focusing decision makers, empowering them to take action, and equipping them with predictive information to act in real-time
- Providing a centre of gravity for culture, learning, and continuous improvement
- Offering wide-ranging scope that can span complex care management, delays in care, continuum patient flow, scheduling, clinical deterioration, patient safety, eICU, virtual care, and more.
Leading providers with legacy transfer centres, bed management centres and resource centres are replacing them with command centres because of several key advantages. The new centres:
- Offer multi-purpose flexibility and scalability
- Manage patients into, through and out of the hospital
- Manage patient safety and experience, not just bed management or transfers
- Include care management and strategy, not just housekeeping and transport
- Incorporate predictive and prescriptive decision support tools, not just dashboards from IT systems
Proof of concept
The Johns Hopkins Hospital opened the Judy Reitz Command Center (JRCC), the first of its kind globally, in February 2016. GE designed, implemented, and activated the JRCCC as part of an overall transformation program that has delivered step-function improvements in ED boarding, OR holds, and declined transfers despite the hospital routinely operating above 95 percent occupancy.
Humber River Hospital opened a Command Centre (HRCC) in November 2017. GE designed, implemented, and activated the HRCC as part of an overall transformation program focused on improving quality of care, throughput, access, and cost. Evidence from this proof of concept suggests that healthcare command centres can have significant impact as the centerpiece of an overall efficiency agenda. In addition to real-time action, the JRCC has become a highly visible centre of gravity enabling overall efficiency.
GE Healthcare’s approach
Typically, command centres are the centerpiece of an overall transformation. Transformation starts with discovery and then proceeds in two work-streams: first, reengineer the system using a digital twin to target process improvements and second, design the command centre for real-time, all-the-time optimization. GE “tiles” trigger command centre staff to act with finely-tuned decision support based on a cross-system data model outside the Electronic Medical Record. A typical command centre has 10-20 tiles that stream information within the command centre and to staff across the hospital via smartphones, PCs, tablets, and other devices.
Command centre design begins by crystallizing problems during the discovery phase. The GE team then leads clients through a problem-back design process to develop functional requirements, which may include functions, staff, location and floor plan, source systems, actions, analytics, and a multi-generational plan.
Once the design is approved, GE works with the client-selected architect to fully specify and build the space. In parallel, GE builds the Wall of Analytics™ which delivers tiles to users and integrates with the video wall in the command centre. GE also works extensively with staff to socialize the concept, plan actions, rehearse, and ultimately activate the command centre to deliver impact. GE Healthcare drives the overall program from inception to sustainable outcomes.
The program at Johns Hopkins delivered a step-function improvement in key indicators that has been sustained, including:
- Patient transfers from other hospitals – Johns Hopkins has seen a 60 percent improvement in the ability to accept patients with complex medical
conditions from other hospitals.
- Ambulance pickup – Johns Hopkins’ critical care team is now dispatched 63 minutes sooner to pick up patients from outside hospitals.
- Emergency Department – Once a decision is made to admit a patient from the Emergency Department, the bed is assigned 30 percent faster.Patients are transferred 26
percent faster after they are assigned a bed.
- Operating room – Transfer delays from the operating room after a procedure have been reduced by 70 percent.
- Patient discharges – 21 percent more patients are now discharged before noon,compared to the previous year.
Like every command centre, the JRCC is expanding to tackle new problems for patients, families and caregivers. The scope has already expanded to throughput and the team is planning to address clinical outcomes and cost.
The command centres described here are different from the many existing transfer centres, bed management centres and resource centres. Leading providers with these legacy smaller centres are already replacing them with command centres. These new centres are multi-purpose and scalable. They manage patients into, through and out of the hospital. They manage patient safety and experience, not just bed management or transfers. They include care management and strategy not just housekeeping and transport. They also incorporate predictive and prescriptive decision support tools, not just dashboards from IT systems