Using real-time operations to achieve systemness and accelerate patient flow: Insights from NewYork-Presbyterian and Saint Luke’s Health System

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Operational challenges create significant pain and are costly for hospitals and health systems.

Over 22% of hospital days are excess days -- the equivalent of a full excess day per patient -- translating to over $17M in annual waste for a 300-bed facility. These inefficiencies are not only bad for patient care and experience, but also tax clinicians who already are experiencing unprecedented burnout. Fortunately, it does not have to be this way.

During a May 27 virtual roundtable sponsored by Qventus as part of Becker's Hospital Review’s 11th Annual Meeting, three healthcare leaders discussed how organizations are advancing care delivery and decreasing the complexity across their systems by using real-time operations:

  • Craig Albanese, MD, MBA, group senior vice president and chief medical officer, NewYork-Presbyterian
  • Deborah Gash, senior vice president and chief digital officer, Saint Luke's Health System (Kansas City, Mo.)
  • Mudit Garg, MBA, co-founder and CEO, Qventus

Here are five key insights from the session:

1. Addressing operational challenges is paramount to improve care delivery and reduce staff burnout. Healthcare operations today rely on manual steps, and the processes underlying care vary across individuals, units and facilities. So to achieve systemness, leading health systems are focused on strengthening operational reliability and standardizing processes.

NewYork-Presbyterian leadership developed a three-pronged, system-wide strategy with workforce engagement at the center: standardization to reduce variability, virtualization to enhance care, and regionalization to achieve synergies. “With 10 campuses, we needed to move from a holding company model to an integrated system. Part of that aspect of systemness is standardizing operational procedures, gaining economies of scale, and using best practices across the network,” said Dr. Albanese. “It’s one thing to say we want to move our patients through more efficiently, but we can’t do that with inefficient processes. That just leads to burnout, a high attrition rate, and discontent with teams working at the bottom of the license.”

2. Leading health systems are complementing the EHR with a real-time operations platform. While the EHR is foundational to digitizing patient data, health systems recognize that relying solely on the EHR does not equip them to address underlying issues that result from manual processes. New capabilities are required, and real-time operations can automate and bring intelligence and insights to teams who in the past have relied on those manual, EHR-dependent processes.

Saint Luke’s recognized an urgent need for these new capabilities to address systemness and patient flow. “We focused on maximizing our Epic infrastructure and functionality as much as possible to help us improve throughput across all of our facilities, but we still had challenges with throughput. In order to go further, we really felt that machine learning, predictive algorithms, and behavioral science was what was going to take us the next step beyond where we had already plateaued,” said Ms. Gash.

"One of our partners described digitizing systems of record as paving over cow paths but not redesigning what lies underneath," Mr. Garg added. "Real transformation depends on people, processes and technologies coming together." Qventus has built a real-time operations system that uses AI and behavioral science to transform operations. In addition, the company has developed best-practice solutions and invested in expert services to help organizations establish the governance and change management needed to operationalize the technology.

3. NewYork-Presbyterian, in partnership with Qventus, standardized discharge planning and unlocked significant system capacity. NYP routinely operates at 95 percent census or greater, so patient flow is a major issue. Most patients were discharged after 2 p.m., creating backups in operating rooms, intensive care units, and their emergency departments. Although the organization implemented interdisciplinary rounds (IDRs) five years ago, discharge planning processes were difficult to standardize; they required teams to spend significant time on documenting plans and following-up on orders; and, it was hard to sustain improvements over time.

In response, NYP partnered with Qventus for real-time operations to improve inpatient capacity. NYP care teams now use Qventus Care Progression Manager to drive the IDR process for discharge planning, and the AI predicts estimated date of discharge and likely discharge barriers. This ensures that discharge barriers are consistently identified and nothing falls through the cracks. Qventus then helps ancillary teams resolve those barriers via priority queue boards and mobile nudges. Leadership can also see how teams are adhering to best practices in real-time, and the system automatically escalates issues so that leaders can take targeted action when needed.

As a result, NYP has decreased length of stay by half a day at its Columbia-Cornell campuses. This freed up 35 beds — the equivalent of a new hospital unit. In addition, 30 percent of patients are discharged before noon in select areas.

“We’re more level loading our discharges throughout the day, which is fabulous. Patients benefit and so does our staff. All providers have more time at the bedside and are working at the top of their license with less manual coordination of back and forth phone calls, emails, hallway conversations, and sifting through notes. For the organization, we have greater standardization. We feel very different on a daily basis. And we're going to do more and more with this,” said Dr. Albanese.

4. Based on early successes, Saint Luke's sees real-time operations as a key differentiator that sets them apart from competition and improves staff and provider satisfaction. To manage throughput challenges -- which became even more acute during the pandemic -- Saint Luke's first started using Qventus’ ML-based capacity prediction models, which informed their decision to actually continue elective cases during an anticipated Covid surge last July.

Now, Saint Luke’s is deploying Qventus throughout inpatient, perioperative, and command center settings to improve throughput across the system. Ms. Gash said that the health system has immediately realized significant value since first launching less than three months ago (in March 2021), noting: "To date, we've saved over 1,200 patient days, which equates to more than half a million dollars in savings. Qventus has been very impactful in a short period of time."

An "aha moment" in Saint Luke's journey to become a real-time health system came from its ancillary units. Historically, these teams received work lists for patient orders generated from the EHR using a "first-in, first-out" algorithm. Teams now “love” using the Qventus priority queue boards that use intelligence to rank and prioritize tasks based on discharge goals.

With the new system, care teams are consistently hitting discharge goals, and that sets Saint Luke’s apart from competition. “We're getting patients out the door sooner and they're getting their orders accomplished faster...and that's an important differentiator from what we had prior to doing this,” said Ms. Gash.

Qventus has also dramatically reduced physician interruptions throughout the day. "Prior to implementing [Qventus], our physicians would get messages throughout the day from so many folks asking questions related to discharge. We've now seen a significant reduction in the number of messages that go to physicians -- so they’re very pleased with that,” said Ms. Gash. “That helps them stay focused, keep their work moving, and they're not getting all of those interruptions throughout the day.”

5. Real-time operations have broad application across the entire continuum of care and are foundational to future care delivery models. As health systems increasingly centralize and virtualize care, the pressure to have strong operational reliability will become even more important. In their work with leading health systems across the country, Qventus sees a heightened urgency to put the foundation of real-time operations in place in order to realize immediate value and take full advantage of the long-term opportunity.

“There is just so much more opportunity on the horizon. These real-time health system concepts can be applied in many more areas, whether it's about how about a patient accesses care in the future, the flow of their care, or the resources that are needed to provide that care. The dimensions and variables of care that need to be managed are only increasing as care is virtualized and centralized. So there's a tremendous role for this real-time health system approach,” said Mr. Garg.

To view the webinar, click here. For more information about Qventus, click here.

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