Here a Patient, There a Patient AN ALL-TOO-FAMILIAR PROBLEM OF FINDING AVAILABLE BEDS HAS LED TO A FEDEX-LIKE TRACKING SYSTEM. Some days Gabe Kelen can only shake his head. The director of emergency medicine is seeing the worst overcrowding in the ED in more than two decades, with up to 12 patients sometimes being treated for prolonged periods in hallways. The congestion starts mounting when patients needing admission to Hopkins Hospital have to wait hours for a bed to open.  Somewhere, beds are available, but figuring out the competing demands for them— patients emerging from operating rooms, coming out of catheterization, waiting for discharge, entering from outside-physician referrals—produces an all-too-familiar bottleneck and a backlog in the ED. “There’s this period of time, during days when the census is high in all the departments, when incoming patients are sort of homeless,” says Mary Margaret Jacobs, the Hospital’s director of patient and visitor services. By the end of the day—7 p.m. or as late as midnight—all the incoming patients get a bed in the proper place. But the pitfalls in the present system for assigning beds prompted nephrologist Paul Scheel to begin thinking outside the box about a solution—right after a delivery service dropped off a package to his office last year. “Federal Express can tell you exactly where a package is anywhere in the world,” says Scheel, vice chairman of the Department of Medicine. “We can’t tell you whether we have an empty bed or not. That’s ridiculous. I figured if they could do it, we can do it.” Scheel’s Federal Express epiphany led to a nearly year-long, multidisciplinary collaboration between Johns Hopkins Medicine Computer Information Systems (JHMCIS), the Office of Corporate Communications, Operations Integration and the Department of Medicine to create a unique solution: a paperless, Web-based, single-page patient assignment system dubbed “MedBed,” which goes live this month in general medical units. Additionally, MedBed is being coordinated with the electronic bedboard, a computerized admission/discharge/transfer system for quickly determining bed availability developed at Johns Hopkins Bayview. The combined systems, Jacobs explains, will create a powerful tool for streamlining the admissions and bed-assignment process for patients. Judy Reitz, Hopkins Hospital’s executive vice president and chief operating officer, assembled an oversight group that includes Kelen, Harold Fox, director of the Department of Gynecology and Obstetrics and chair of the Hospital Medical Board, Beryl Rosenstein, vice president for medical affairs, Mike Weisfeldt, director of medicine, and Julie Freischlag, surgery director, to work with this task force in identifying immediate and long-term solutions for the problem. Scheel’s idea proved exceptionally promising. On a typically busy day in Medicine’s inpatient units, for example, 30 to 40 patients are admitted, many of them coming in via the Emergency Department. Until this month, the administrative procedures entailed in these admissions required ED staff and Medicine shift coordinators to become immersed in what Jacobs calls “the beeper-phone business,” an often frustrating and always time-consuming game of telephone tag and paper shuffling. The foot-patrol, paper-driven system of bed assignment now used in most departments requires unit nurses to walk their floors to determine how many beds are empty and report back to the shift coordinators—“and they still don’t know who’s going home,” says Scheel. “It’s like having an air traffic controller who’s only looking out the window, having no idea which planes are coming in, which ones are taking off, and whether they’re going to have a gate available or not. It’s an archaic system.” Shift coordinators also must spend an inordinate amount of time on the telephone, responding to constant calls and pages from staff in the ED and elsewhere, asking about available beds. With MedBed, the shift coordinator’s paper notebook that lists open beds becomes a laptop computer, and the information is placed on a single Intranet Web site that is updated constantly. That will enable everyone involved in the patient assignment process—the ED facilitators, the nursing staff, clinics, cath labs—to check the page and find out what the shift coordinators know about bed availability without having to constantly call or page them, explains Charles Reuland, the Department of Medicine administrator. “Perhaps most important, with the availability and accumulation of data, we will be more likely to predict patient flow over a given period of time, which will help us plan better for our inpatient care demands,” Reuland says. “If the system works well, we plan to make it available to other departments.” Reitz says the creation of the tracking systems is a major step toward the Hospital’s becoming more patient-service oriented in its admissions process.  MedBed will work nicely with the electronic bedboard, which uses a color-coding system to show which units in a department have open or available beds. Scheel says a link to the physician order entry system still is needed, so that once a physician enters discharge instructions, the electronic bedboard and MedBed will reflect an opening is imminent. A related, unresolved issue involves overcoming departmental barriers to placing patients, regardless of their type of illness, in open beds on any unit. “We don’t share beds well,” Jacobs observes. MedBed and the electronic bedboard address only pieces “of a very complex puzzle,” she notes, but they should provide considerable help in solving it. Change March 9, 2004 Volume 8 Number 3