Clinical Operations Dashboard

Business problem
Bed management in the medical/surgical units is a critical issue, driving a hospital's ability to accept new admissions. Without effective bed management, our hospitals were sometimes forced to send potential admissions elsewhere, losing the revenue from that admission and potentially future admissions. We needed real-time data about the capacity of all inpatient units, as well as some indication of expected demand from the emergency departments or operating rooms.

Getting the data
At the time, we were just beginning to build a data warehouse, and didn't have anything approaching real-time data. Bill figured out how to grab up-to-the-minute data from our Meditech system about inpatient bed status, as well as surgical day care and emergency department admissions, discharges and transfers (ADT). An automated process runs these reports continuously, round-the-clock, every 10-15 minutes.

Building a dashboard
Working with physician and nursing leaders, we designed a dashboard to display the current bed capacity for each hospital, with the ability to drill down to the individual bed (shown below).

The status of each hospital and each service within each hospital is displayed graphically, color-coded as explained in the "mouse-over" info button (shown below).

Emergency department status is also color-coded, as explained in the "mouse-over" info button (shown below).

The user can click on any button for a hospital or a service at a hospital. Depending on which button is selected, the relevant inpatient units are listed, color-coded by status and showing the available beds for each (shown below). In addition, there are three tools to help try to project bed demand for the remainder of the day:

• Expected admissions (input directly by admitting department staff based on their knowledge of pending admissions)
• Historical admits (mean number of patients admitted on this day of the week during the past six weeks, with one standard deviation [i.e., 18 +/-4])
• OR schedule (pulled directly from the PICIS operating room system database)

Selecting one of the clinical units, in this case the medical/surgical unit listed above, displays the summary for that unit (shown below). Physical beds are pulled directly from the Meditech system, and may be fewer than the number of beds for which the unit is licensed.

Definitions for each data element are displayed in the "mouse-over" for the info button by the unit's name (shown below).

Clicking the name of the inpatient unit displays the final drill-down level for that unit. For each physical bed in the unit, the inpatient service, length of stay (LOS) and gender of the current patient are displayed (shown below).

Emergency department status
The other part of the dashboard attempts to show basic information about the status of each ED (shown below).

Lessons learned

• Not every tool is a hit. The Clinical operations dashboard was designed per customer specifications to meet a perceived need, and provides timely data that senior managers believed were critical for effective management. However, front-line clinical managers never incorporated the dashboard into their daily workflow, and the dashboard does not get enough use to justify its development effort, for reasons that are still not entirely clear.
• It is impossible to know in advance whether a specific application will be a hit. Some applications have enthusiastic business sponsors but a low level of usage. Other applications have no specific business sponsor but have a high adoption rate and provide huge value.
• Even if a specific application (such as this dashboard) does not achieve its full potential, the automation and/or data developed for the application can often be re-purposed for other applications, providing a net benefit to the organization which is much greater than the expected impact from the original application.

Posted 27 April 2008