A small room just off the admissions area at Tufts Medical Center in Boston contains what many in the facility describe as the nerve center of the hospital. It looks like the bridge of the Starship Enterprise. Multiple plasma screen monitors blink with yellow, green, and blue squares.
Employees sit seated in front of the monitors, analyze the colors and icons as they enter new data into the computers below, and relay information to callers.
To the outside observer, the screens look like a bunch of flashing lights, but these screens are actually a snapshot of the entire facility. They are a part of Tufts' RapidView system, powered by McKesson's Horizon Enterprise Visibility™ solution.
RapidView isn't a tool that benefits just one department. The system helps improve every aspect of the facility, from housekeeping to employees to physicians.
"RapidView allows us to access timely, correct information so we can better align patient needs with our resources," says Terry Hudson-Jinks RN, MSN, vice president of patient care services at Tufts Medical Center.
Reading the board
This is where June Stark, RN, BSN, MEd, director of case management and quality support services at Tufts Medical Center starts her day—in the admission discharge transfer (ADT) center. With just a three- to five-minute scan of the screens, Stark can tell whether Tufts has enough discharges to meet the scheduled admissions.
"There is an art to it," Stark says. "After a while you can just look at the screens and know if it's going to be a busy day."
Each screen in the ADT center represents a floor of the hospital and each square represents a room. The color of a room is based on what type of patient is occupying the bed—a green room means the patient is an inpatient, blue means the patient is receiving observation services, etc.
This morning Stark notices the squares on one floor are almost all solid green, which means discharge orders have not been written for those patients. She sends a page to the nurses and case managers on that floor telling them to make sure the latest data are in the system and to promote additional discharges.
When Stark checks the boards later in the day she hopes to see a few green and white striped squares where green squares appeared in the morning. Green and white striped squares mean a physician wrote a discharge order and a discharge is pending.
A striped square also displays how many minutes have passed since the physician wrote the order. This makes it easy to track how quickly patients are discharged after the physician writes the order.
Improving patient flow
RapidView system is partly a response to the Massachusetts mandate that EDs can no longer divert patients, says Melissa Culkins Bair, RN, MS, nursing director of the ADT Center at Tufts Medical Center.
"One of the reasons we came up with the bed board [RapidView] was so that we could improve patient flow because we couldn't have the ED closing the door," Culkins Bair says.
RapidView improves patient flow by providing up-to-the-minute information for healthcare professionals, admitting staff members, and housekeeping staff members. Before RapidView, there was no mechanism to track such information.
"We worked in silos before centralizing patient access with RapidView. We didn't always have up-to-date information on unit-based throughput, leaving us uninformed on the clinical priorities," Culkins Bair says.
Electronic timers within the RapidView system keep track of everything.
For example, when staff members discharge a patient, this is communicated automatically by messages fed from clinical information systems to all employees by turning the green and white square brown, which means the room is dirty.
The housekeeping staff members and all other hospital employees on that floor see the brown square on one of the many LCD screens mounted in the common areas. Housekeeping goes to the brown room and signs in that he or she has begun cleaning. This turns the square brown and white and also starts the clock. Once finished, the crew member signs off that the room is clean and moves on to the next brown square.
This time-keeping feature makes staff members more accountable because it allows administrators to see how the patient moves along the continuum in real time. If it took three hours longer than expected to clean the room, managers can investigate the reason for the delay and take steps to improve the process.