Is a Central “Command Center” in Your Future?
Learn how one health system developed a centralized unit to monitor its pediatric patients.
// By Lisa D. Ellis //
Managing the many events and crises that occur in a major children’s hospital requires a lot of oversight and coordination, not unlike skills used by air traffic controllers who coordinate flight patterns for busy airports.
More than a decade ago, Stephen Lawless, MD, senior vice president and chief clinical officer at Nemours Children’s Health System, recognized similarities between hospitals and airports, and decided to adopt an air traffic control “command center” model to streamline operations in the Nemours Children’s Hospital in Orlando.
The concept has been gaining traction in the field, with a variety of other facilities now trying something similar. Nemours built its own command center. Other organizations are implementing GE Healthcare Command Center’s solution.
Is a hospital command center right for you?
The Need for a Clinical Logistics Center
Nemours’ initiative, called the Clinical Logistics Center, is a special unit that uses the latest technology to enable specially trained paramedics to monitor patients remotely using a host of technologies. This allows center staff to follow patients’ vital signs and test results. The center also automatically pulls data from the patient’s electronic health record, displaying it in a dashboard to help draw a clear picture of the child’s health status.
Various patient alarms sound in the logistics center. When one occurs, paramedics can access patient rooms by video and audio to assess the situation and alert a rapid response if medical intervention is needed.
Avoiding Alarm Fatigue
Lawless explains that the driving force for creating this center really stems from his ICU training a few decades ago, when he noticed that so many alarms go off every few seconds in hospitals. With most of them being for non-critical events, staff can become immune to them after a while, and this can pose real risks. The biggest danger with such alarm fatigue is that when a real life-threatening event occurs, staff may overlook the alarm or not respond quickly enough.
This concern prompted Lawless to devise a better way to have units monitored by dedicated experts who would respond to situations and alert staff as needed.
Adopting Air Traffic Control Tactics
“When we initially set out to design this center, I thought we should look to air traffic control for some strategies. All of the flight monitoring is done in a million-dollar shop monitored by two or three people. This made me wonder: ‘Why can’t we adopt something similar?’” Lawless says. This led Nemours to envision its current logistics center, which looks like something out of an action-packed movie, complete with paramedics following patients’ progress on walls of monitors that show key health indicators and risk factors in an easy-to-follow fashion.
Testing the New Model
With locations spread out among five different states, Lawless points out that Nemours was not ready to dive right in and create something systemwide. Instead, the health system decided to start testing the idea at Nemours Children’s Hospital, which opened in Orlando in October 2012. Since most of the associates were new, they were being trained to adapt to a new culture anyway. This made it a natural fit for the time and location, Lawless says.
Once this model was up and running in Orlando, the center increased its capacity to take on monitoring units of the Nemours/Alfred I. duPont Hospital for Children in Delaware as well.
“When we initially set out to design this center, I thought we should look to air traffic control for some strategies.”
Stephen Lawless, MDNemours Children's Health System
Helping the process along as it scaled the concept was the fact that Nemours had also committed to investing in its electronic health record system. The investment paid off, with Nemours reaching the highest level of sophistication for EHR use: an entirely paperless system. This provided an ideal way to build on the growing technological capacity and help tie all of the pieces together, he adds.
Filling an Existing Need
“In our ICU, patients are watched around the clock. But on other floors where the nurse-to-patient ratio is not the same, we recognized that the command center can fill a very essential role,” Lawless says. In fact, this can provide doctors, nurses, and families with reassurance that the young patients are watched 24 hours a day, seven days a week, and that people are standing by, ready to respond in an emergency.
Exploring the Logistics
Today, the Orlando-based command center monitors about 200 patients a day between both hospital locations — with paramedics following patients on more than a dozen wall monitors that show heart rates, oxygen levels, and other health indicators of the pediatric patients. Less critical alarms also go directly to the logistics center for paramedics to act on. They tune in remotely to a patient’s room using a high-resolution camera and audio capacity to assess the situation and call or text nurses as needed to respond. The most critical alarms go to nurses’ phones and also to the center, adding an extra level of safety.
In terms of patient privacy, Lawless points out that the paramedics announce themselves before the camera is turned on in the room. “For most families, nothing is scarier than being in the room with their child when the alarm goes on and no one is answering,” he says. The system offers an important layer of reassurance.
“In addition, we can connect one of our specialists to remotely check the patient in real time without needing to travel there,” Lawless says.
“Our goal in everything is to relieve the technology burden on the staff. We don’t want to take patient care away from them but want to ease up some of their responsibilities to give them more time to do their job,” he adds.
On a broader level, the hope is that Nemours can use this same technology and infrastructure to remotely monitor patients at its many affiliated community hospitals, as well.
GE Healthcare’s Central Command Center Strategy
GE Healthcare has pioneered a new holistic type of command center, working first with Johns Hopkins Hospital in Baltimore and now with providers in Canada, England, and across the U.S. The Judy Reitz Command Center (JRCC) at The Johns Hopkins Hospital opened in February 2016.
Other GE-affiliated command centers include Humber River Hospital, Toronto, Ontario, Canada; and Oregon Health & Science University Hospital (OHSU) in Portland, Oregon. In 2019, GE Healthcare plans to open command centers in Pennsylvania and Washington, as well as two in Florida, one in England, and one in Georgia.
“GE Healthcare’s command centers are holistic AI-powered NASA-style mission control centers that use predictive and prescriptive analytics that provide staff with insights to take immediate action,” says Jeff Terry, CEO of GE Healthcare Command Centers. “The goal of our centers is to help caregivers provide the best possible care for patients and families.”
Each command center is unique. They include co-located existing functions and new “mission controllers” — typically nurses — who constantly monitor real-time analytics outside the EMR on GE Healthcare’s “Wall of Analytics.”
“A typical command center has 10-20 tiles or apps that stream information to the command center and to staff across the hospital via smartphones, PCs, tablets, and other devices,” Terry says. Functions within the command centers can include clinical care pathway management, imaging optimization, staffing, procedural scheduling, bed management, transfer center, ambulance and flight dispatch, virtual hospital, care management, and much more.
What makes this approach so valuable is the command center serves as not only an air traffic control tower, but also a goalie and a coach. Real-time data from a variety of systems integrated into one comprehensive predictive model enables the staff to assess situations and head off problems.
“When done right and at scale, such precision health efforts can improve quality, decrease cost, and increase access for patients around the world,” Terry says. “By 2030, every hospital will use a command center. The value for caregivers and patients is too big to ignore.”
Lisa D. Ellis is a contributing writer for eHealthcare Strategy & Trends. She is a journalist and content development specialist who helps hospitals and other health care providers and organizations shape strategic messages and communicate them to their target audiences. Email her at firstname.lastname@example.org.