December 18, 2017

Hartford HealthCare’s new logistics center aims to fill beds, reduce wait times

HBJ Photo | Steve Laschever
HBJ Photo | Steve Laschever
Beth Ciotti, head of the Hartford HealthCare Logistics Center, is overseeing the health system’s new approach to how it moves patients to and from hospitals.
HBJ Photo | Steve Laschever
Nurses who work in Hartford HealthCare’s Newington logistics center include Carolyn Bousquet.
HBJ Photo | Steve Laschever
Nurses who work in Hartford HealthCare’s Newington logistics center include Jessica LeRoux and Sue Fortier.
HBJ Photo | Steve Laschever
Nurses who work in Hartford HealthCare’s Newington logistics center include Jessica Costa.

Tucked away in a Newington administrative building, 10 nurses and other staff from Hartford HealthCare are working the phones, coordinating patient transfers to approximately 1,800 inpatient beds across Connecticut.

Nearby flatscreens display myriad key metrics across Hartford HealthCare's statewide network of five (and counting) hospitals: the number of occupied and open beds; the number of patients in the emergency room; the number of patients awaiting a transfer; and a live feed of Life Star helipads.

The $1 million Hartford HealthCare Logistics Center — known internally as the nerve center or mission-control hub, evoking NASA-esque imagery — is the latest effort by the health system to better control the flow of patients to its various hospitals.

Hospital officials hope the control center will help them fill more beds and produce more revenue at Hartford HealthCare's growing roster of community hospitals that often have room to spare, while freeing up space at the bustling Hartford Hospital for the most serious illnesses and injuries.

"Hartford Hospital was overflowing, particularly in the [intensive care units]," said Dr. Rocco Orlando, the health system's chief medical officer.

A busy hospital can mean longer wait times for patients who need a bed, said Elizabeth Ciotti, a registered nurse who is vice president of patient logistics. She runs the logistics center.

Better coordination will reduce those wait times, resulting in greater patient satisfaction, and will also help produce higher-quality care, Hartford HealthCare officials say.

With Hartford Hospital and its sister facilities — MidState Medical Center, Hospital of Central Connecticut, Windham Hospital and Backus Hospital — now operating on the same electronic medical record system, more strategic thinking about where to send patients is now possible, when it hadn't been feasible before, Ciotti said.

(Hartford HealthCare recently acquired Charlotte Hungerford in Torrington, but it will take a few years to get it on the same medical record system.)

"I don't think we could have done it because we couldn't see what was happening at the other facilities," Ciotti said. "Now that we have visibility into all of the beds at all of the hospitals, when we get a call we can ask 'what's the best place for this patient?' It might not be Hartford."

If the system wants to transfer a patient to a community hospital instead, it's ultimately the patient's call. Community hospitals are capable of handling a number of serious illnesses, and sometimes they may be located much closer to a patient's home, she added.

Traditionally, for example, if an elderly patient with heart failure showed up at Windham's emergency room and doctors determined she needed to spend several days stabilizing on a respirator, that patient would likely have been transported to Hartford Hospital. Now, doctors might ask the patient if she would like to be admitted to Norwich-based Backus Hospital instead.

Multiply that by several dozen or more similar instances a month, and Hartford Hospital is freeing up significant capacity for the sickest patients that can only be treated there (or sent outside the system).

The key test, Orlando said, will be making sure the logistics hub makes triaging decisions carefully. Hartford HealthCare is tracking whether patients at the community hospitals end up transferred to Hartford anyway, which would defeat the point. That hasn't happened yet, he said.

Saying ‘no’ less

Ciotti previously oversaw Yale New Haven Health's logistics center, Y Access, which manages patient transfers at two of Yale's Connecticut hospitals. She has returned to work at Hartford Hospital a decade after starting its original transfer center.

She said health systems are increasingly adopting logistics centers, and there are plenty of software and vendor options available to do it. However, she said one logistics center overseeing five hospitals is cutting edge.

Jeff Flaks, Hartford HealthCare's chief operating officer, agrees.

The logistics hub is the result of a decade or more of work, he said.

"It's a historic disruption to the way we work," Flaks said. It's not a regular occurrence that Hartford Hospital, which is a comprehensive trauma center, can't admit a seriously sick or injured patient, but it does happen. Those patients might end up at Yale or in Boston instead.

"We don't want to say 'no,' " Ciotti said.

Soon, they may be saying it less often.

During the second full month of operation in November, the logistics center transferred 52 patients to one of Hartford HealthCare's community hospitals. Just months ago, virtually all of them would have ended up at Hartford Hospital. The community hospitals previously only received inpatient transfers from their own emergency rooms.

The goal is to reduce the number of transfer denials to zero, Orlando said.

Available assets

Hospital beds are valuable assets, and staffing empty ones can be expensive. A more even distribution of patients to available beds can only help Hartford HealthCare's community hospitals, some of which are emptier than others.

According to state data, the 144-bed Windham Hospital has seen the greatest decline in bed occupancy, which fell from 33 percent in 2013 to 16 percent in 2016. Meanwhile, 373-bed MidState Medical Center's occupancy rate fell to 60 percent in 2016 from 74 percent in 2013. Backus has had relatively flat occupancy in the 55 to 57 percent range, while Hospital of Central Connecticut's occupancy since 2013 has ticked up 5 percentage points, to 60 percent.

Hartford Hospital has maintained an approximate 80 percent occupancy rate in recent years, compared to the statewide average of 76 percent.

Both Flaks and Orlando said they expect to see those occupancy rates rise as a result of the logistics center's work.

"Even a modest increase in occupancy rates makes sense to us," Orlando said, referring to the logistics hub's return on investment.

Hartford Hospital has the greatest capabilities within the Hartford HealthCare system, and like the flagships of most health systems, that makes it the costliest to operate on a per-bed basis.

Ensuring it can accept the sickest patients, which often produce the most revenue, is also part of the equation, Orlando said.

Patient logistics efforts are also often centered around bringing in more patients overall in the long run, said Scott Newton, vice president of care model solutions for Pittsburgh-based Teletracking, which has helped approximately 100 hospitals and systems build logistics centers (and is not involved in the Hartford HealthCare project).

"It's a game of minutes, actually," Newton said of patient logistics. "You might save three, four, five minutes. When you scale that through all the patients that come through a health system on any day, month or year, those add up quickly."

Data driven

The logistic center's real-time information that nurses and others use is provided through Epic, a healthcare software company. But another company, General Electric, is helping Hartford HealthCare make sense of its data.

As part of a seven-year contract with Hartford HealthCare that also includes unrelated radiology services, GE will mine the system's past data — a complicated process because the hospitals used different record-keeping systems in the past — to provide a baseline to evaluate performance against moving forward, Ciotti said.

Wait times and the number of patients transferred to community hospitals will be among the key metrics.

Before the new system went live, Hartford Hospital took in upward of 700 transfers a month. Ciotti expects to see that number, when applied across five hospitals, to rise significantly.

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