The HHC Care Logistics Center
The right care at the right time and in the right place
November 15, 2017
By Dr. Rocco Orlando III
One of the biggest trends in U.S. health care is consolidation.
Building integrated networks has allowed many health care organizations to provide more comprehensive services to their communities. But as systems expand, growth can create new complexities.
Radiology professionals understand this issue well. As providers consolidate, imaging resources expand. However, that does not always lead to parallel improvements in referral management, patient wait times and physician access to images and reports.
My colleagues and I have given a lot of thought to the challenges and opportunities of consolidation. Over the last 10 years, Hartford HealthCare has grown to include five acute care hospitals (and a continuum of non-acute organizations) serving 2 million people in Connecticut.
Our network has improved the community’s access to top-level tertiary and quaternary care. However, the network sometimes has been the victim of its own success.
On one hand, Hartford Hospital — our academic medical center — was often at capacity, particularly in the neurosciences ICU. On the other hand, we had excess capacity in our community hospitals. This is despite the fact that several of our community facilities provide very high-end critical care services.
We knew that better patient flow was the answer, but simply focusing on our academic medical center wasn’t enough. We needed to optimize patient logistics across our entire health network.
In 2016, we began working on several care-logistics strategies — all with the goal of getting the right patients to the right location promptly, so we could provide them with the highest quality care as close to home as possible. To date, we have achieved significant progress by focusing on three key initiatives in collaboration with GE Healthcare.
A systemwide ‘command center’ for patient logistics
In September, Hartford HealthCare launched the Care Logistics Center, a central unit that consolidates the patient logistics functions of all five of our acute care hospitals. Designed and implemented with the help of GE Healthcare Partners, the unit serves as a command center for managing patient flow and resource utilization across our entire network.
The Care Logistics Center has significantly improved the way we move patients throughout our system. One key to its effectiveness is colocation. Previously, it was difficult for logistics staff at different hospitals to coordinate their efforts. Now, a single team of logistics managers literally sit elbow to elbow in the Care Logistics Center. That facilitates real-time communication, allowing staff to make quick and appropriate patient movement decisions. Only Hartford Hospital had dedicated logistics staff in the past. Bringing all logistics functions into one unit has allowed us to identify inefficiencies and create standardized processes.
Technology is also an essential part of this solution. The Care Logistics Center has implemented a single information system to manage patient flow — Epic’s patient transfer module. The system allows the team to manage all the resources available at each facility. Staff members also use dashboards to monitor key patient flow metrics in near real time, including transfers, boarding times and ED and OR queues. Staff even track air medical arrivals with a helipad video monitor.
To illustrate how the Care Logistics Center works, consider this “before and after” scenario. In the past, most patients at our smaller community hospitals who needed critical care services were transferred to Hartford Hospital. However, other facilities in our network have very strong ICU teams. Today, thanks to centralized management through the Care Logistics Center, patients with moderate-complexity illnesses are often transferred to other community facilities. This typically keeps those patients closer to home. It also helps us optimize capacity across our system, leveraging community hospital assets while freeing up Hartford Hospital beds for the most complex patients.
Currently, the Care Logistics Center focuses on bed management. In the near future, it will also take over patient transport and environmental services for all five acute facilities. That will enable us to coordinate not just bed assignment, but patient movement and room turnover as well.
A ‘digital twin’ to model logistical impacts
Improving the flow of patients across our system was only half the challenge. To make the best use of our resources, Hartford HealthCare also needed to maximize the utility of our tertiary referral center.
GE Healthcare Partners helped us address this challenge with data analytics. The GE team used 18 months of patient data to create a digital model of patient movement at Hartford Hospital. The result was a “digital twin” of our academic medical center.
This tool has enabled us to do two things. First, it allowed us to identify common areas of breakdown within patient flow and zero in on the processes most in need of improvement. Second, it lets us model various patient flow solutions. We are using our digital twin to test potential solutions in a virtual environment before we invest time and money in any changes.
For example, Hartford Hospital will soon open a dedicated inpatient rehabilitation unit. Before we committed to this initiative, we used the digital twin to understand the impact of converting a general medicine unit into an acute rehabilitation center. The simulation model gave us detailed insight into what we can expect in terms of occupancy rates in the new rehab unit, occupancy rates in other general medicine units as they absorb more volume, staffing efficiency and options for deploying hospitalists.
For health system leaders, the digital twin is a powerful decision-making tool. As we staff up and build out for our new rehabilitation unit, we have a high level of confidence that it will benefit our patients, our staff and our organization overall.
We are now in the process of using our digital twin to answer several questions: What will happen to boarding rates if we alter our ED triage process? Can we reduce length of stay by creating additional step-down capabilities? What is the best way to serve our inpatient infusion patients in an outpatient setting?
The entire effort ties back to our initiatives in the Care Logistics Center. The digital twin allows us to understand how different patient transfer protocols impact patient flow and volume throughout our integrated network.
A patient-centered imaging strategy
A key goal of all these initiatives is to improve patient care by reducing wait times. This is especially important in the field of radiology, where digital imaging services are becoming increasingly complex.
On the process side, we are developing ways to use our Care Logistics Center to improve patient access to imaging services across our system. On the technology side, we are leveraging our systems to build a patient-centered imaging strategy. Our working principle is: When the patient moves, his or her images move, too.
Through our “ImageConnect” initiative, we developed a centralized PACS system linked to Epic. The system indexes all digital images generated within our health network. As a result, clinicians can access all images, not just reports, through Epic. This capability supports our Care Logistics Center strategy. Prior to any patient transfer, patient imaging is immediately available to any future caregivers, which informs the decision-making process about the goals of the transfer. Images are immediately available to caregivers and radiologists prior to the transfer, allowing a determination of the treatment plan before the patient arrives. In some cases, image availability leads to a decision to avoid transfer and treat in the local facility.
Solutions support sustainability
The main driver of all our logistics initiatives is to improve care quality and patient safety. But our analyses show that improving patient movement is also economically advantageous.
Improved efficiency leads to lower costs, which can benefit both individual health networks and the U.S. health care system as a whole. As our industry continues to evolve, making better use of resources will be the key to long-term sustainability. It will also help us provide the right care at the right time and in the right place to as many patients as possible.
About the author: Rocco Orlando III, M.D., is senior vice president and chief medical officer for Hartford HealthCare, which has more than 18,000 employees and $2.4 billion in net revenue.
One of the biggest trends in U.S. health care is consolidation.
Building integrated networks has allowed many health care organizations to provide more comprehensive services to their communities. But as systems expand, growth can create new complexities.
Radiology professionals understand this issue well. As providers consolidate, imaging resources expand. However, that does not always lead to parallel improvements in referral management, patient wait times and physician access to images and reports.
My colleagues and I have given a lot of thought to the challenges and opportunities of consolidation. Over the last 10 years, Hartford HealthCare has grown to include five acute care hospitals (and a continuum of non-acute organizations) serving 2 million people in Connecticut.
Our network has improved the community’s access to top-level tertiary and quaternary care. However, the network sometimes has been the victim of its own success.
On one hand, Hartford Hospital — our academic medical center — was often at capacity, particularly in the neurosciences ICU. On the other hand, we had excess capacity in our community hospitals. This is despite the fact that several of our community facilities provide very high-end critical care services.
We knew that better patient flow was the answer, but simply focusing on our academic medical center wasn’t enough. We needed to optimize patient logistics across our entire health network.
In 2016, we began working on several care-logistics strategies — all with the goal of getting the right patients to the right location promptly, so we could provide them with the highest quality care as close to home as possible. To date, we have achieved significant progress by focusing on three key initiatives in collaboration with GE Healthcare.
A systemwide ‘command center’ for patient logistics
In September, Hartford HealthCare launched the Care Logistics Center, a central unit that consolidates the patient logistics functions of all five of our acute care hospitals. Designed and implemented with the help of GE Healthcare Partners, the unit serves as a command center for managing patient flow and resource utilization across our entire network.
The Care Logistics Center has significantly improved the way we move patients throughout our system. One key to its effectiveness is colocation. Previously, it was difficult for logistics staff at different hospitals to coordinate their efforts. Now, a single team of logistics managers literally sit elbow to elbow in the Care Logistics Center. That facilitates real-time communication, allowing staff to make quick and appropriate patient movement decisions. Only Hartford Hospital had dedicated logistics staff in the past. Bringing all logistics functions into one unit has allowed us to identify inefficiencies and create standardized processes.
Technology is also an essential part of this solution. The Care Logistics Center has implemented a single information system to manage patient flow — Epic’s patient transfer module. The system allows the team to manage all the resources available at each facility. Staff members also use dashboards to monitor key patient flow metrics in near real time, including transfers, boarding times and ED and OR queues. Staff even track air medical arrivals with a helipad video monitor.
To illustrate how the Care Logistics Center works, consider this “before and after” scenario. In the past, most patients at our smaller community hospitals who needed critical care services were transferred to Hartford Hospital. However, other facilities in our network have very strong ICU teams. Today, thanks to centralized management through the Care Logistics Center, patients with moderate-complexity illnesses are often transferred to other community facilities. This typically keeps those patients closer to home. It also helps us optimize capacity across our system, leveraging community hospital assets while freeing up Hartford Hospital beds for the most complex patients.
Currently, the Care Logistics Center focuses on bed management. In the near future, it will also take over patient transport and environmental services for all five acute facilities. That will enable us to coordinate not just bed assignment, but patient movement and room turnover as well.
A ‘digital twin’ to model logistical impacts
Improving the flow of patients across our system was only half the challenge. To make the best use of our resources, Hartford HealthCare also needed to maximize the utility of our tertiary referral center.
GE Healthcare Partners helped us address this challenge with data analytics. The GE team used 18 months of patient data to create a digital model of patient movement at Hartford Hospital. The result was a “digital twin” of our academic medical center.
This tool has enabled us to do two things. First, it allowed us to identify common areas of breakdown within patient flow and zero in on the processes most in need of improvement. Second, it lets us model various patient flow solutions. We are using our digital twin to test potential solutions in a virtual environment before we invest time and money in any changes.
For example, Hartford Hospital will soon open a dedicated inpatient rehabilitation unit. Before we committed to this initiative, we used the digital twin to understand the impact of converting a general medicine unit into an acute rehabilitation center. The simulation model gave us detailed insight into what we can expect in terms of occupancy rates in the new rehab unit, occupancy rates in other general medicine units as they absorb more volume, staffing efficiency and options for deploying hospitalists.
For health system leaders, the digital twin is a powerful decision-making tool. As we staff up and build out for our new rehabilitation unit, we have a high level of confidence that it will benefit our patients, our staff and our organization overall.
We are now in the process of using our digital twin to answer several questions: What will happen to boarding rates if we alter our ED triage process? Can we reduce length of stay by creating additional step-down capabilities? What is the best way to serve our inpatient infusion patients in an outpatient setting?
The entire effort ties back to our initiatives in the Care Logistics Center. The digital twin allows us to understand how different patient transfer protocols impact patient flow and volume throughout our integrated network.
A patient-centered imaging strategy
A key goal of all these initiatives is to improve patient care by reducing wait times. This is especially important in the field of radiology, where digital imaging services are becoming increasingly complex.
On the process side, we are developing ways to use our Care Logistics Center to improve patient access to imaging services across our system. On the technology side, we are leveraging our systems to build a patient-centered imaging strategy. Our working principle is: When the patient moves, his or her images move, too.
Through our “ImageConnect” initiative, we developed a centralized PACS system linked to Epic. The system indexes all digital images generated within our health network. As a result, clinicians can access all images, not just reports, through Epic. This capability supports our Care Logistics Center strategy. Prior to any patient transfer, patient imaging is immediately available to any future caregivers, which informs the decision-making process about the goals of the transfer. Images are immediately available to caregivers and radiologists prior to the transfer, allowing a determination of the treatment plan before the patient arrives. In some cases, image availability leads to a decision to avoid transfer and treat in the local facility.
Solutions support sustainability
The main driver of all our logistics initiatives is to improve care quality and patient safety. But our analyses show that improving patient movement is also economically advantageous.
Rocco Orlando III, M.D.
Improved efficiency leads to lower costs, which can benefit both individual health networks and the U.S. health care system as a whole. As our industry continues to evolve, making better use of resources will be the key to long-term sustainability. It will also help us provide the right care at the right time and in the right place to as many patients as possible.
About the author: Rocco Orlando III, M.D., is senior vice president and chief medical officer for Hartford HealthCare, which has more than 18,000 employees and $2.4 billion in net revenue.