In Brief: 医院领导正在开发能力指挥中心,以解决大量常见的能力和操作问题.
The term “command center” might conjure images of a dim, secure room, lit by the ambient glow of wall-size monitors, 一群头戴式耳机的专家向焦虑的导演传递实时数据,而这位导演来回踱步, 做出生死攸关的草率决定——这是悬疑惊悚片里的东西, not healthcare.
Hospital command centers are a bit less dramatic. But while they may lack the high profile of, say, NASA Mission Control or a counterintelligence operation, 他们的核心目标是使用相同用途的技术,以便在正确的时间将适当的资源送到正确的地方. And the decisions made within them can indeed be highly consequential.
What Is a Hospital Capacity Command Center?
医院容量指挥中心(CCCs)是用于管理患者吞吐量的集中式枢纽. They combine existing, traditionally siloed services or departments such as transfers, bed management, transport, and patient access, and put them under one roof—either physically, virtually, or in hybrid form. CCCs actively manage patient flow and supporting services, using real-time data and analytics to make decisions. They can have either a single-hospital, multihospital, or health system–wide scope, depending on the organization.
The past decade has seen the rapid expansion of CCCs. A 2022 national survey 确定至少有25个bet8网站备用(在31个答复者中)目前在运行核心承诺, with an additional 5 actively planning to launch one.
Motivation for Starting CCCs
医院领导制定核心承诺,以解决大量常见的能力和运营问题.
ED Boarding
Mitigating lengthy ED boarding time is the most common reason to build a CCC. 监控急诊科登机包括跟踪在急诊科等待住院床位的病人人数和平均等待时间. ED boarders occupy treatment spaces needed for triaging incoming ED patients. Long boarding times can result in ED overcrowding, pose safety risks, and are associated with poor patient outcomes and longer length of stay (LOS). The Joint Commission consequently recommends aiming for a boarding time of four hours or less.
CCCs使医院管理人员能够采取动态方法来管理住院患者的数量, discerning the clinical service(s) with the highest demand, and minimizing the wait time of patients with the most acute needs. CCCs可以激活高占用操作协议,其中可能包括救护车分流, provider call, and requesting timely discharges from inpatient units.
Excessive LOS
Patients hospitalized for longer than expected based on their diagnosis 占用床位,限制吞吐量,经历更糟糕的结果,并构成拒绝保险的风险. bet8网站备用领导者正在使用CCCs通过优化患者旅程来减少LOS, from admission to discharge and every step in between. 减少总体LOS还可以改善急诊科的登机时间,并使患者能够更快地进入可以开始治疗的住院bet8娱乐.
CCCs使医院运营商能够通过优化床位安置过程来缩短处理时间, 例如通过病床管理和环境bet8娱乐之间的密切协调. 一些CCCs让病例管理和其他临床bet8网站备用参与打破出院障碍.g., interfacing across hospital departments to address waits for meds, DME, or tests) to reduce LOS of otherwise medically ready patients. These changes are possible because the central CCC:
- Has a view of the entire patient journey.
- Is empowered to make decisions to optimize patient flow.
- Has aligned incentives among support services to reduce LOS.
Suboptimal Bed Utilization
Health systems face varying capacity challenges across network hospitals. Frequently at tertiary or quaternary care facilities (i.e., hub hospitals or academic medical centers [AMCs]), the demand for beds exceeds the supply, creating constraints on patient flow. 然而,并不是所有进入这些医院的病人都需要三级护理能力. 较小的社区医院可能有床位,也有能力照顾这些病人.
运营共同承诺中心的管理者了解其bet8网站备用的长期床位分布以及不同医院的能力. 这有助于在不同护理级别之间更快地转移,减少患者在“错误的床”上等待的时间.” With a global view of capacity, CCC administrators can pinpoint specific needs for beds—for example, prompting ICUs to proactively identify patients ready for downgrade. 一些医院可能会向CCC的bet8网站备用收费,让他们监督ICU的容量,并平衡来自多个来源的ICU入院情况(如转院和手术后病例),以最好地满足请求并最大限度地减少延误.
Transfer Declines
由于床位不足,医院常常被迫拒绝或推迟转诊. This disrupts the continuity of patient care, causes frustration for referring providers, and risks revenue integrity.
CCCs平衡内部系统容量和外部转移需求,并专注于接受和优先考虑医院最能bet8娱乐的患者(符合正确的护理水平), service offerings unique to hospital, and centers of excellence). Furthermore, CCC监测排放和协调入院的其他努力增加了系统容量, leading to the ability to accept more transfers. 通过优化转移接受途径的数量来简化转移接受过程也有助于管理和最大限度地减少转移下降.
OR and PACU Boarding
手术室和麻醉后护理单元(PACU)入住是一个能力挑战,特别是amc经常将其作为启动ccc的动机. PACU登机发生在患者在PACU等待住院床位(通常是ICU级别)时。, 当患者由于缺乏可用的PACU床位而在手术室等待时,就会发生手术室滞留.
Like suboptimal bed utilization, OR and PACU boarding results from mismatched time-of-bed availability. 外科病人经常与急诊科的病人“竞争”同一张病床, 研究发现,多达70%的ICU转移是由于手术量 variability. These delays are costly to hospitals and disrupt on-time start of subsequent cases.
CCCs监控实时和趋势延迟,以应对反复出现和可预测的挑战, adjust block scheduling or release, and request downgrades from ICUs to address upstream delays. CCCbet8网站备用还可以监督不同icu (MICU)之间的患者分诊, SICU, cardiac ICU, neuro ICU), as appropriate, to utilize excess capacity.
Staffing Challenges
Healthcare staffing shortages were a problem before the pandemic, and COVID-19 only exacerbated the issue. CCCs can’t fill vacancies, but through real-time monitoring of an entire hospital, they are positioned to deploy staff when and where they are needed most.
CCCs普遍监测床位的可用性和人员配备,以确保医院床位的供应, and staff matches the current and predicted demand for beds as closely as possible. CCCs审查运输和电动汽车等bet8娱乐需求的数据,并可以部署现有的工作人员,以最大限度地发挥其影响.g., aligning shifts with timing of discharges). CCCs often incorporate nursing float pool administration, further streamlining the deployment of staff across the system where needed.
Need for Central Patient Monitoring
CCCs可以为小型社区医院提供一种更经济的方式来整合集中患者监测(例如.g., 通过集中的企业bet8娱乐,通过视频进行跌倒监测或通过临床信息的实时馈送进行败血症监测. 正在纳入一些核心承诺的其他中央病人监测bet8娱乐包括远程看护bet8娱乐, virtual ICUs, and hospital at home. 这些一对多方法提供了可伸缩性、成本效率和增加的患者访问. CCC的系统级视图提高了它在最需要这些bet8娱乐的地方部署这些bet8娱乐的能力.
How to Build or Grow a CCC
CCCs与刺激其发展的各种驱动因素一样多样和复杂. While there are common reasons for why health systems develop CCCs, the departments differ in function, governance, and scope (e.g., hospital or health system).
If your hospital or health system is considering a new or expanded CCC, check out our recent article in the Joint Commission Journal on Quality and Patient Safety, written in conjunction with the Hospital Capacity Management Consortium, 一个容量管理行业工作组,目标是提高急症护理容量管理的效率. Finally, ECG’s team of capacity management experts can help your system navigate starting, evaluating, or expanding your CCC.
It’s time to improve the efficiency of acute care and
capacity management.
Is your hospital or health system considering a new or expanded CCC?
Contact UsEdited by: Matt Maslin
Published June 22, 2023