Children’s National Health System

Background
Children’s National Health System is a premier provider of pediatric care in the Washington, D.C. area. For more than 140 years, Children’s National has pioneered new therapies and treatments across a wide array of medical specialties, from neonatal services to cancer care. Ranked among the top 10 pediatric hospitals in the United States, Children’s National places firmly on the prestigious Honor Roll of the U.S. News & World Report 2015-16 Best Children’s Hospitals.

The Children’s National Cancer Center (CCBD) is a very busy outpatient clinic, with over 100 providers, seeing more than 200 patients each day. At CCBD, successful cancer treatment is not just about delivering medication, but also about providing a friendly, comfortable environment where patients can feel safe for the duration of their treatment. This includes providing art and music therapy to patients while they wait.

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Challenges
Although patients and their families were very happy with the treatment they received at CCBD, as well as with the doctors and nurses, excessive wait times, and a general lack of information made for a less than pleasant patient experience. Dr. Jeffrey Dome, Chief of Hematology and Oncology, explains: “We realized the clinical processes had become inefficient; we didn’t have data to track the patient flow so we could find and fix bottlenecks.” In addition, CCBD wanted to make the system more transparent to families, making it possible for everyone to know where they stood in line to be seen by their providers.

When a child comes in for cancer treatment, the visit often is a multi-step process that takes hours. Accompanied by their parents or other caregivers, patients typically must sign in, give vital signs, have blood drawn, wait for lab results, see clinicians, and perhaps sit through lengthy chemotherapy infusions.

“It could take 10 minutes searching through hallways to locate where our patients were. They may be in the art room or on the infusion side, in an exam room but if so, which one?”

Children’s National makes these visits as emotionally supportive as possible, even providing an art therapy room for children to use as they wait. But chronically ill patients typically must visit the health center repeatedly, so reducing unnecessary waiting at each appointment would add up to meaningful time given back to patients and their families. To do that, Children’s National tackled the challenges inherent in paper-based information flows—and in the process also increased its own staff efficiency.

One bottleneck was simply knowing where a patient was located at any given time. After the child signed in, a primary care technician (PCT) would take his or her vital signs and place a lab slip in a nurse’s in-box to draw a blood sample. However, the slip would not necessarily indicate where the patient would be by the time the nurse went looking.

“There are so many moving parts going on at one time,” says Victor Cooper, Clinic Operations Manager at Children’s National. “Lab results might take an hour or two and patients would get bored and wander. Or, they might leave the unit for radiology or some ancillary service and we would just need to track them at every turn. We spent too much time simply looking for our patients.”

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“It could take 10 minutes searching through hallways to locate where our patients were. They may be in the art room or on the infusion side, in an exam room but if so, which one? They may have gone to the cafeteria or off to visit another patient,” says Kristen Brown, a Children’s National Clinical Manager. Insight into clinical workflows was similarly opaque. It was difficult to know if a high number of patient sign-ins during a short time had left PCTs short-handed to take vital signs. Clinicians in their exam rooms, meanwhile, might not even realize that delays were creating a backlog of patients waiting to be seen.

Solution
To solve these problems, Children’s National turned to Savance Health and its partner HP. After hearing the problems experienced by Children’s National, Savance proposed customized version of its Patient Self Check-In, Waiting Room Display, and Patient Tracking & Flow solutions, helping Children’s National completely transform the workflow of its cancer and blood disorders unit (similar Savance solutions power the Children’s National Neuroscience unit). Now when a patient arrives at the clinic, their adult caregiver signs them in at an easy-to-use touch-screen kiosk.

Savance Health Patient Self Check-In can pull information straight from an ID card, a driver’s license, or an insurance card, and easily fill out the patient’s address, phone number, current doctor, current medications, insurance, and date of birth. The solution delivers two key benefits: accurate and complete patient information – acquired through a patient-friendly process.

“If I’m in clinic I can look at the board and see where my patients are. Before, I wouldn’t know if the patient had checked in, and if there were three others in the waiting room to see me.”

Once the patient has signed in, Savance’s Patient Tracking & Flow solution takes the mystery out of clinical workflows and patient location. The software tracks where patients are at any given time, and how much time they spend in each area. A display screen in the waiting room —with patient names symbolized by pictures of animals to maintain confidentiality— tells families how many patients are ahead of them to see their specific provider.

Another screen in the clinic workroom shows where patients stand in the day’s workflow—information that also is available to clinicians via a web interface. “If I’m in clinic I can look at the board and see where my patients are,” Dr. Dome says. “Before, I wouldn’t know if the patient had checked in, and if there were three others in the waiting room to see me. I can also access the information remotely without calling the clinic, and plan my time accordingly.”

All this allows Children’s Health not only to find patients quickly without searching the building, but also to see where process breakdowns occur and take steps to increase workflow efficiency. “In healthcare today, the patient experience is of utmost importance,” Clinical Manager Brown says. “By accurately capturing where our delays were, we were able to identify our primary challenges and implement solutions to directly impact those areas.”

Results
With data in hand, there was a clear need to hire two additional PCTs. “The system allowed us to drill down and see that some of our delays were because we just didn’t have enough patient care technicians taking vital signs at peak times,” Brown says. “So, we were able to validate additional staffing requirements to help move patients through more quickly.”

The flow data also guides in-the-moment decisions to move staff where they are most needed, or to switch the linear order of processes in a patient’s visit to use available staff time more efficiently. Even moving certain appointments from morning to afternoon can ease the entire day’s workflow.

“I’ve experienced it both ways, with and without the tracking system,” says PCT Shonteal Laine. “Now, we don’t have to keep searching through the hallways. With just a little click, we can know what exam rooms are open, we can track our kids better and move them through faster.”

The new Patient Tracking & Flow system helped Children’s National reduce the time it takes to send blood draws to the lab. It also revealed a need to partner with other hospital departments to reduce overall wait times. “Treatments depend on lab and pharmacy turnaround times” Kristen Brown says. “We were able to show them, ‘This is how long patients are waiting to get their infusions started. How can we decrease this?’ It’s allowed us to work together to improve processes.” Addressing specific pockets for ongoing delays with data-driven solutions, she adds, is much more effective than merely pressuring everyone to hurry up.

The data also helps with infection control processes — especially critical in cancer care, where many patients are immunocompromised. A patient who comes in with an undiagnosed illness like chicken pox, for example, must be isolated. If unknowingly, the patient was in a waiting room with others, follow up must be done with any patients who came in contact with the infected one.

Brown estimates that before, it might have taken an hour to determine whom that chicken pox patient might have encountered. Now with every patient movement through the clinic time-stamped, it takes perhaps 20 minutes to compile the list. Overall faster workflows limit the number of potential exposures and enable quick intervention. “We have data points for everything,” Clinic Operations Manager Cooper says. “I can go into the Savance system and do a deep report, check the touch points where the patient went and pinpoint exactly where the bottleneck was — the front desk, the PCT, the provider, the lab, whatever — and streamline processes based on real data. That’s best practice.”

Best-practice healthcare, of course, is essential to improved outcomes and patient satisfaction. It also paves the way for business benefits including better use of staff time, reduced cost, and a healthier bottom line. “If you’re more efficient, you might see more patients and generate more revenue, or reduce costs,” Dr. Dome says. “If you improve customer satisfaction, patients will refer others to you. These are all downstream benefits that can accrue over time.”