This synchronized effort is playing out in Upstate University Hospital’s new Throughput Operations Center, or TOC, a state-of-the art command hub designed to orchestrate patient flow with precision and efficiency. The $2.38 million center opened in February in an office building, equipped with 11 live-feed monitors and 28 computer stations.
“This facility is like our mission control,” Robert Corona, MD, CEO of SUNY Upstate Medical University in Syracuse, N.Y., said in a statement. “It’s like the heartbeat of the hospital. By streamlining patient flow, enhancing communication and minimizing bottlenecks, it enables the hospital to deliver timely, efficient care while improving patient outcomes and operational efficiency across the board.”
Beyond the technology, the TOC also centralizes key personnel, such as bed manager nurse specialists, transfer coordinators and environmental services dispatchers. Upstate also plans to expand the team to include virtual nurses, outbound coordinators and a dedicated throughput physician.
Becker’s recently connected with Scott Jessie, MSN, RN, chief nursing officer at Upstate University Hospital, and Kyle Choquette, MSN, RN, associate director of nursing for throughput operations, to learn more about what inspired the creation of the TOC, the key metrics Upstate is tracking to measure success and what other hospitals can learn from their approach.
Question: Are there any immediate impacts Upstate has seen in the weeks following the opening of the new Throughput Operations Center?
Scott Jessie: Upstate has been on a journey to improve the management of patient throughput, flow and access since 2018. We opened our first throughput operations center as COVID started, using a small conference room and a few computers. We transitioned to a larger space in 2021, and now, in February of this year, opened the new TOC in its permanent home. We have seen significant operational improvements with each iteration of the TOC. With the opening of the brand new TOC, we have more dashboards available, allowing the team to monitor and address more patient flow and throughput activities and issues. Over time, we will be adding more key roles to the TOC including ambulance dispatch, outbound coordinators, virtual nurses and an onsite throughput physician.
Q: What key metrics are you tracking to assess the value of the throughput operations center on patient flow and hospital efficiency?
Kyle Choquette: We measure and act in real time to improve multiple key metrics including:
Occupied time — An efficiency metric that shows how long it takes a patient move when the following criteria are met:
- A patient has admit/transfer orders
- The patient is ready to move
- The destination bed is assigned, clean and ready
- The target is 30 minutes for ED to inpatient; [post-anesthesia care unit] to inpatient; or inpatient to inpatient.
Environmental services turntime or EVS — An efficiency metric that shows how long it takes EVS to clean a dirty room. We track:
- Response time
- Actual cleaning time
- Any delays
- Target is 65 minutes for total turn time
Patient transport time/auto dispatch — An efficiency metric that shows how long it takes the patient transport team to transport a patient between locations. We track:
- Response time
- Active transport time
- Any delays
- Target is 30 minutes for total entire process start to finish
Discharge order to actual discharge — An efficiency metric that shows how long to discharge a patient from the discharge order being placed to the patient leaving the hospital. We track:
- Time of order entry
- Time until removed from the system
- The target is 120 minutes
Multiple other metrics we track and manage include:
- Transfer center accept/decline rates
- Discharge before noon
- Discharge before 2 p.m.
- Compliance with eEstimated date of discharge
- Assigned bed time
- Discharge hospitality center usage
Q: Upstate officials visited several health systems with established throughput centers before launching this initiative. What were the biggest takeaways from those visits and how did they influence the design and operations of your center? Were there any unexpected lessons that changed your approach?
SJ: We started investigating the science and technology of patient flow and throughput in 2018 by first attending the [Institute for Healthcare Improvement’s Hospital Flow Professional Development Program, and then began exploring technology solutions that could help us manage this critical work. We developed a core team of nurses, physicians, and IT staff and visited several locations including Kettering (Ohio) Health, Yale New Haven (Conn.) Hospital, and Penn State Hershey (Pa.) Medical Center. As we continued to develop our plans and operations we also visited the Carilion Clinic in Roanoke, Va.
These visits were tremendously informative and guided us to our current state. Some of the biggest takeaways were the importance of the TOC concept, what roles were needed, general operational principles and the incredible impact of having all the right roles in one location, working in concert with one another to improve operations in real time. When visiting these centers we saw TOCs of all different sizes and realized we could start small and scale up. That concept helped us move ahead more quickly, as we navigated the process of securing funding, space, et cetera for the new TOC we have today. One of the biggest unexpected lessons was that the TOC doesn’t need to be onsite. We had originally always planned to have the TOC located in one of our hospitals, but after seeing various types of operations, our perspective on that changed and we were able to free up valuable hospital real estate and ultimately build the new TOC offsite.
Q: A recent UCLA study projects that hospital capacity rates will rise to 85% by 2032. How do these findings align with what you’re seeing at Upstate, and what role do you anticipate the Throughput Operations Center playing in managing sustained high occupancy levels over the next decade?
SJ: The 85% occupancy metric is the ideal spot to allow hospitals to operate efficiently, have adequate space for turnover and patient movement and manage patient care effectively. Our efforts on this work started because we were at 95% to 100% occupancy back in 2018. Today, we typically run 100% to 105% occupancy and remain exceptionally full. Despite the increase in occupancy, we have seen real operational improvements in capacity, access for transfers, surgical procedures and general throughput operations due to our innovations in throughput and flow and development of the TOC. We see these efforts as pivotal to our future success, especially as our region is primed to grow due to a $100 billion investment by Micron to build multiple chip fabrication plants and bring 50,000 jobs to the region.
Q: Leaders highlighted that the center will enhance efficiency for nurses by streamlining admissions, discharges and transfers. Can you provide a specific example of how this will reduce administrative burdens or free up clinicians to focus more on direct patient care? How do you see this affecting workforce satisfaction and retention?
KC: Our virtual nurse team will operate out of the TOC, doing virtual admissions and discharges, saving 20 to 30 minutes of time per activity, and allowing the beside nurses to focus on other essential direct patient care. These efforts enhance patient flow, reduce bedside nurse administrative tasks and make receiving multiple admissions to any given floor a less burdensome process. Over time, we plan to expand our virtual nurses to add additional tasks such as virtual rounding, call-bell response, patient teaching, medication reconciliation and on demand expert nurse consultation to support the bedside nursing staff. Our pharmacy team has also joined our virtual efforts and has begun virtual patient medication review and teaching.
Q: Is there anything else on the topic we didn’t get to that other health system leaders should know?
KC: This concept of patient throughput and flow management and TOC development remains relatively new. Be willing to start small, embrace change and continuous process improvement, and understand this is an iterative process. Minutes matter and saving minutes anywhere in the patient flow and throughput stream makes an impact. Most importantly, just start!
