High-tech center helps patients avoid delays at hospital

Host Amber Smith: Upstate Upstate Medical University in Syracuse, New York, invites you to be The Informed Patient, with the podcast that features experts from Central New York's only academic medical center.

I'm your host, Amber Smith.

Upstate recently opened a state-of-the-art Throughput Operations Center in East Syracuse, and to understand what this center does, I'm talking with nurse Kyle Choquette, who oversees the center. Mr. Choquette is an associate director for nursing at Upstate.

Welcome to "The Informed Patient," Mr. Choquette.

Kyle Choquette, RN: Thank you so much, Amber. I'm happy to be here.

Host Amber Smith: I understand this Throughput Operations Center used to operate in the basement of the downtown hospital, but now you've settled into office space in the Telergy Building, off of Carrier Circle, and I'm told it looks a little like NASA's mission control.

What can you tell us about the center?

Kyle Choquette, RN: Absolutely. It really does look like mission control at NASA. It has some stadium seating. We have 28 workstations with 22 live-feed monitors on a huge dashboard wall that show various information to our staff that is working in that center. It brings together a lot of different departments into one area that can optimize our patient flow and movement throughout our whole health system.

Host Amber Smith: Now since the hospital's 24 hours, I'm assuming this operation center is 24 hours as well?

Kyle Choquette, RN: That is correct. It's 24 hours, 365 days a year. We never close the center.

Host Amber Smith: So you said 28 workstations. Is that how many people work there?

Kyle Choquette, RN: No. So currently, we have, on average, around 10 people per shift that work there, over 30 people total that work there, but it goes by shift. The 28 workstations are going to allow us to expand. In the basement (of University Hospital, its former location), we only had nine workstations, so we're really excited to be able to expand and add new things into the operation center. One of those areas that we're going to be adding is virtual nursing, in the next couple months, is going to be added into the operation center.

Host Amber Smith: Now, are all of the people who work in the operation center, are they all nurses?

Kyle Choquette, RN: They're not. Most of the people that work in the operation center are nurses, but we also have our patient transport dispatch team that works out of the operation center. That's our internal patient transport team. They are not RNs (registered nurses).

And then we are adding our AMR dispatcher to help coordinate our patient movement between our hospitals, and they are not an RN.

Host Amber Smith: And so AMR, that's the ambulance service.

Kyle Choquette, RN: That is correct. We have a contract with them to coordinate our patient between our two hospitals and within our children's pavilion for our psychiatric patients as well.

Host Amber Smith: Now, how many live-feed monitors do you have, and what are they looking at?

Kyle Choquette, RN: So we have 22 dashboards. We have live-feed monitors into our helipad, so we can see when our critical patients land on the helipad. We can notify those nursing areas that the patient is on the way down. We have EMS (emergency medical services) offload at both hospitals, so we can see when the ambulances start to back up.

Other live feeds that we have in there, a lot are capacity related, where we have capacity, where we don't have capacity, on what the status of our internal transport team is today and what the status of our environmental services (cleaning) team is doing and how efficiently they're turning over those rooms and where those bottlenecks exist along the patient flow altogether.

Host Amber Smith: What is the overall goal of the Throughput Operations Center?

Kyle Choquette, RN: The goal is to bring together different departments that work together to collaborate together. Before, we used to make phone calls and try to get ahold of somebody that was maybe doing another task. Now we're essentially bringing them into the room together, so they can coordinate, they can talk together, they can resolve bottlenecks in real time, eliminate those, extra phone calls that didn't need to happen and that slowed down the process of resolving bottlenecks and moving patients more efficiently to their next destination.

Host Amber Smith: What are some of the common bottlenecks that you mentioned?

Kyle Choquette, RN: A lot of the bottlenecks are around the discharge side of getting patients out of the hospital, whether that be transportation to their next destination, whether that be home or whether that be to a skilled nursing facility. So we see a lot of bottlenecks that result in that transportation, so we try to help resolve that.

Other bottlenecks are in the hospital. Patient needs X test to be completed before they can leave, so we can help facilitate that test getting completed, so they can get home. And then, just patient movement in general. Patients that are ready to, say, leave the ED (emergency department) and go to their inpatient bed, but there's a time where there's no one available to transport that patient. So we utilize our transport team to help move those patients up more efficiently to their next destination, freeing up that ED space for that next patient.

Host Amber Smith: So it sounds like a lot of it's in the hospital from the emergency department to other departments or floors where they're going to be, but you also have to communicate with entities outside of the hospital. You mentioned, like, the nursing homes or the rehab centers, that type of thing.

Kyle Choquette, RN: Yeah, absolutely. And our case management team, that doesn't currently work in the operation center, does a lot of that communication, but we work with them in resolving delays, discharge delays is what we call them, a reason a patient can't leave the hospital because they have something pending to either be completed or something to be set up, so they can go home. So entering those discharge delays into our system allows us to track them and then better facilitate, in the future, process improvements based on that data.

Host Amber Smith: So if there's someone in the emergency room that is going to be admitted, your operation center would know where they're going to go and whether the bed's available. You would have all that information ahead of you.

Kyle Choquette, RN: Absolutely. So our bed management team coordinates all patient's bed assignments out of the ED or the PACU or other hospitals that come in. They look at the picture of all the patients that need access to beds, throughout the day. They manage those beds. They work with the EVS (environmental services) supervisor team to get bed cleans needed stat if we need one that's emergent, or if they work with our transport team, to facilitate those patients being moved.

And then lastly, they work with our throughput nurses. If there's a large, amount of discharges that happen on one unit, they'll dispatch that throughput nurse to go to that unit to help that unit facilitate those discharges to open up those beds for that ED patient.

Host Amber Smith: What is the PACU?

Kyle Choquette, RN: That is the post-recovery unit (post-anesthesia care unit) after you come out of the OR (operating room).

Host Amber Smith: Oh, so after surgery.

Kyle Choquette, RN: After surgery. That is correct.

Host Amber Smith: Gotcha. Now, what sorts of data are you able to collect that administrators review?

Kyle Choquette, RN: A lot of data. We get a lot of capacity data. We look at service line capacity data. We look at our external transfers coming into the hospital from other hospitals, what percentage we accept of those, what percentage we decline based on we don't have capacity for that patient at that time.

We also look at our metrics for our EVS team, our environmental services, how efficiently they're cleaning rooms, how efficiently they're responding to those rooms, and then our patient transport team, how effectively they are responding to the requests and fulfilling those requests to move a patient from one location to another location.

And lastly, probably one of the most important metrics we track is how long it takes a patient to get from one space to another space when that bed is clean and ready for them. So that's called our occupied time. So how long it takes, and an example is from the emergency room, when they're ready to leave that to get up into their clean and ready bed on the floor.

So these metrics we track, through our patient transport team and through our system that allows us to get those timestamps and tracks that information.

Host Amber Smith: So it sounds like you're able to give them the data to back up whether something's working well or if something needs to be changed to work better.

Kyle Choquette, RN: Absolutely. Yes. We use that data to look for process improvements all the time. If we find an area that's underperforming based on set metrics, we look at how we can improve that. We bring it to a committee, our throughput optimization committee, and then that committee looks for ways to improve that process, in order to effectively assist our patients getting to the next location.

Host Amber Smith: This is Upstate's "The Informed Patient" podcast. I'm your host, Amber Smith.

I'm talking with nurse Kyle Choquette, who runs the Throughput Operations Center for Upstate University and Upstate Community hospitals.

Are there other hospitals that have throughput operation centers?

Kyle Choquette, RN: Yes, they're throughout the country. They're called a few different things.

We actually got to tour them when we were looking at building our operation center. We've toured many of them, in different states, so it was great to see what they had and what worked well for them as we built our center.

Host Amber Smith: Would patients who are admitted to the hospital ever interact with the Throughput Operation Center?

Kyle Choquette, RN: No, they would not interact directly with the operation center, but they would be working with our teams, the throughput nurses, the patient transporters, that are helping, assisting, moving them through the hospital. So indirectly, yes; directly, no.

Host Amber Smith: So would they know that they're being tracked necessarily? It would feel the same to them, right?

Kyle Choquette, RN: It would feel the same for them. And we don't directly track the patient individually. We track the progression of their movement through our patient transport team or the EVS cleaning team.

Host Amber Smith: Let me ask you about the role of the Throughput Operations Center during a mass casualty incident.

Kyle Choquette, RN: This center would allow us to manage the capacity and facilitate the bed needs of incoming patients. If we knew that we were going to have an influx of patients into our emergency department, we can efficiently move patients out of the emergency department into other areas. because we know what areas are available and what beds are available for capacity. It allows us to streamline our resources for patient flow and enhance the acceptance of patients that might be coming in in an incident like this.

Host Amber Smith: Have you done drills for that or have you gone through, a mass casualty incident?

Kyle Choquette, RN: We have not gone through one. We have done some limited drilling on that. This year, we're going, as now we are moved into the center, we're going to be doing actual drills related to directly this.

Host Amber Smith: Now I know the center, during the pandemic, you guys were in the basement of the hospital. Did you play a role during the pandemic?

Kyle Choquette, RN: Absolutely. So this started during the pandemic. We used to have, each of our hospitals did, their bed management at each hospital. The pandemic brought us together to do unified bed management, and that allowed us to see where our resources were and where our patients could go based on the bed availability at both hospitals, instead of just looking at one hospital individually.

Now we get an enterprise-wide view of where those patients could go based on their needs and based on what's available at each hospital.

Host Amber Smith: Now, would the center ever expand into outpatient medical offices? Because I know Upstate has quite a few of those. Would you have a role in that, ever?

Kyle Choquette, RN: Possibly. We do accept patients from our outside clinics (doctors' offices) into our hospital, into our emergency room or direct admit into a bed. So they already worked directly with our transfer center in the operation center to get that patient admitted if they need to be. We have looked at the possibility of assisting more on the clinic side, the ambulatory (outpatient) side, but we're not quite there yet.

Host Amber Smith: So for now, it's the Community hospital and the downtown hospital, including the Golisano Pediatric Hospital?

Kyle Choquette, RN: Yes, that is correct.

Host Amber Smith: Well, thank you so much for explaining this. It's very exciting.

Kyle Choquette, RN: It is very exciting. and as we are into the center now, we're excited to learn and, keep, gathering the data to keep improving the processes and making patient care a little more efficient here at Upstate.

Host Amber Smith: My guest has been nurse Kyle Choquette, an associate director for nursing at Upstate who oversees the Throughput Operations Center.

"The Informed Patient" is a podcast covering health, science and medicine, brought to you by Upstate Medical University in Syracuse, New York, and produced by Jim Howe, with sound engineering by Bill Broeckel, and graphic design by Dan Cameron.

Find our archive of previous episodes at upstate.edu/informed.

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