Medical Center Simplifies Operations with Smooth Transition to 3 Levels of Patient Care

PROJECT BACKGROUND

A licensed 489-bed medical center providing four levels of patient care including an intensive care unit, an intermediate intensive care unit (Level II intensive care), a telemetry step-down unit, and a general medical-surgical unit, experienced issues related to patient safety, capacity constraints, nursing staff job satisfaction, and billing compliance.  After an evaluation of patient placement practices, the medical center’s administration decided to consolidate from four to three levels of care by eliminating the intermediate intensive care unit and relocating others.  They hired Integrated Project Management Company, Inc. (IPM) to provide professional project management services to lead the scope development, preliminary planning, and final planning phases of the project.

THE CHALLENGE

The medical center staff faced two major issues:  the availability of resources to properly manage this project and the capability to develop an effective implementation plan.  They needed a plan to delineate the steps to prepare the affected units and incorporate considerations for potential patient census scenarios, doctor and nurse roles and responsibilities, modification of information management systems, and the relocation of patients and equipment.  

IPM was challenged to suggest changes to the unit structure, lead the team in creating an effective implementation plan, and suggest improvements to enhance low employee engagement scores.  Recommendations related to nursing leadership and its emphasis on morale, nursing training requirements, and communication gaps between the physicians and nursing staff were required.

IPM’S SOLUTION

IPM completed a full analysis of the medical center’s situation by interviewing hospital stakeholders including members of the hospital’s management team, clinical practitioners, and selected medical staff.  A steering committee and two sub-committees were formed as a means to incorporate and engage hospital staff throughout planning and solicit their input during decision making.

The approach to implementing the project was derived from IPM’s program management methodology and included three distinct program modules:  Unit Preparation, Renovations and IT Installs, and Patient Relocation.  These modules were defined and tailored to facilitate little disruption and an expedient and seamless transformation of the hospital to three levels of patient care.  Via the established committees, the project scope was vetted and verified to ensure that all identified gaps were filled. 

IPM detailed a strategy composed of a communication plan, risk management plan, cost estimate, and scenario-driven implementation schedules.  Lean and 5S principals were applied to identify opportunities to reduce clutter and waste throughout the impacted nursing stations, just-In-time rooms, and nurse-servers.  Current and future state unit profiles were developed, which allowed a comparison of facilities and equipment between existing spaces and future locations.  These unit profiles highlighted the differences and were used to facilitate agreement on the setup of the future locations.

PROJECT RESULTS

IPM’s strategy delineated the aggressive bed management requirements necessary to achieve lower census goals, positioning the team to relocate patients without surprises.  The plan included two all-inclusive relocation schedules for the project, sustaining up to 51% of the inpatient capacity.  One schedule prepared for a 14-hour transition time with a census of up to 129 patients while the other schedule equipped the team to handle up to 179 patients by planning for two 12-hour days.  IPM made recommendations to address the medical center’s issues and laid the foundation to realize the following anticipated benefits:  

  • Optimize unit bed capacity and patient placement
  • Increase availability of ICU beds
  • Standardize nursing stations
  • Minimize patient movement to improve nurse-patient continuity
  • Improve nurse and physician job satisfaction
  • Improve billing compliance