May 2021Spotlight feature

Patient “traffic” is flowing more smoothly, thanks to new digital Command Centre

Real-time data helps reduce waiting time for admission or discharge at JGH

Getting assigned to a hospital bed can be a lot like driving on a highway at rush hour: Even if traffic is heavy, everything can still move smoothly, as long as bottlenecks don’t suddenly materialize on the on‑ramps, the off-ramps or anywhere in between.

If patients are on track with their course of treatment (highway cruising) and are efficiently discharged at the proper time (off-ramps), new patients can be admitted (on-ramps) and then seamlessly join the flow.

Unfortunately, the real world doesn’t always live up to our expectations. In a busy hospital like the JGH, numerous factors are constantly at play, any of which can cause significant delays, serious slow-downs or even total gridlock.

Why should this matter? Because if patients don’t move through and out of the JGH at the right time, beds won’t be available for newcomers who urgently need hospitalization. This is all the more concerning if beds are needed quickly to treat individuals with COVID-19.

The importance of efficient bedflow has long been acknowledged. But only recently have major strides been made at the JGH, thanks to a project that takes full advantage of the digital power of the new Command Centre established by CIUSSS West-Central Montreal.

The many benefits of the Command Centre

In addition to improving the process of getting certain patients admitted to the JGH and assigned to a bed with minimal delay, the C4 Command Centre has been instrumental in making vaccination a largely hassle-free procedure.

When patients are ready to be discharged from the hospital, C4 has also been of key importance in enabling them to go home—or to be transferred to rehabilitation or long-term care—more quickly.

“The Command Centre serves as a focal point,” says Dr. Shannon Fraser, the Centre’s Medical Director. “It’s where we can meet in person or virtually on a daily basis—or sometimes even hourly, if necessary—to prevent potential problems or, at the very least, to minimize their effects.”

Developed with substantial financial support from the JGH Foundation, the Command Centre is also known as C4, because its activities enable the hospital and the CIUSSS to be better able to Care, Communicate, Collaborate and Create.

The efforts are paying off, judging from the numbers of NSAs (niveau soins actifs) at the hospital. The term refers to patients who have finished their hospital treatment, but continue to occupy their acute-care beds until they can be sent home or transferred to another facility, such as a long-term care centre.

The Command Centre on the second floor of Pavilion B at the JGH.

The Command Centre on the second floor of Pavilion B at the JGH.

Last year, it was not uncommon for there to be at least 60 NSA patients at the JGH at any given time. Then the Command Centre shifted into high gear: During the first 3½ months of 2021, the number of NSAs plunged as far as the low 20s and is now in the low 30s.

This has made CIUSSS West-Central Montreal one of the very few healthcare networks in Quebec—perhaps even the only one—to regularly meet and sometimes even improve upon the target number of NSAs that the Ministry of Health has set.

To keep moving forward, the CIUSSS has been relying on the expertise of the Digital Health Information Management team. For more than 10 years, a team of analysts—currently consisting of Maria Veres, Coralie Lafontant and Thanh Truc Nguyen—has been providing support to the JGH and the CIUSSS in analytics and the development of applications.

A highlight of their work is the creation of a dynamic dashboard for the Command Centre, containing updates about the flow of patients in and out of the hospital, as well as COVID-19 information for clinicians. The dashboard took fifth place among 120 submissions in a major competition by Desjardins in innovation in health care.

Before the Command Centre existed, senior managers often had to base their decisions on outdated information, explains Dr. Fraser, who also serves as JGH Chief of General Surgery.

“On top of that,” she says, “some of us were still working in silos. If a problem came up, it wasn’t always clear whom we needed to talk to or who was in charge of what. Often, this left us open to some uncomfortable surprises.

“We can be much more proactive about anticipating problems and dealing with them before they get out of hand.”

“But now we can make more effective decisions, because we’re grouped together in a single location. Fresh, useful data about the JGH and the other CIUSSS sites is also available to us, appearing on our screens every half-hour.”

The focus of all of this activity is a spacious room on the second floor of Pavilion B. On the walls are large video screens that display the latest information about the condition and status of patients and other healthcare users at the JGH and elsewhere in the CIUSSS.

Representatives of several CIUSSS directorates—such as Nursing, Long-Term Care, Rehabilitation and the Support Program for the Autonomy of Seniors—sit at terminals in the Command Centre, where they work with managers to oversee the daily ebb and flow of patients.

“We’ve got real synergy happening here,” enthuses André Poitras, the Command Centre’s Clinical Administrative Coordinator and senior nursing manager, who meets twice a day to discuss the movement of patients with Dr. Fraser and with Bedflow Coordinator Carol Viegas.

“Before the Command Centre, we would usually gather only when there was a serious emergency to react to,” Mr. Poitras says. “Those situations still come up—for instance, there was a power outage not long ago and we were able to get all of the updates we needed and respond quickly.

“But now, because we also meet during routine, non-urgent times, we can be much more proactive about anticipating problems and dealing with them before they get out of hand.”

“It’s all about communication and being able to reach out for help,” agrees Ms. Viegas. “It’s also incredibly helpful to have a global view of our CIUSSS on the screens. I no longer have to wait to be told how many admissions we have or how fast we have to move to accommodate them. Everything I need to know is right there.

“It’s already making a difference in the lives of patients in the JGH and across our CIUSSS. Forget about ‘reactive.’ ‘Preventive’ is our new goal.”

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