How Royal Wolverhampton centralized workflow decisions to reduce length of stay

Overview

Royal Wolverhampton case study cover

Many hospital leaders and staff spend too much time tracking down workflow data, such as equipment, bed, and clinician locations. This slows down clinical decisions and bed placement, causing delays across the organization and extending length of stay for patients.

The organization

The Royal Wolverhampton NHS Trust, is an acute care provider with three hospitals and more than 20 community sites located in Wolverhampton, England, UK.

The approach

The Royal Wolverhampton NHS Trust implemented a real-time location system (RTLS) technology and centralized staff in a command center to more accurately track workflow data and direct resources. This centralized workflow decisionmaking and provided an integrated approach to tackling bottlenecks across the organization.

The result

The Royal Wolverhampton NHS Trust cut average length of stay in their medical units nearly in half and significantly decreased the average time to turnover beds.

Solution

Due to significant capacity restraints, The Royal Wolverhampton NHS Trust invested in a real-time location system (RTLS) to quickly identify care delays across the organization. While the technology was initially helpful, the biggest impact came after The Royal Wolverhampton NHS Trust centralized their patient flow team into a command center—shifting workflow and bed placement decisions from unit-by-unit to hospital-wide.

The four steps

1. Invest in RTLS technology

The Royal Wolverhampton NHS Trust invested in RTLS, which automatically identifies and tracks the location of objects or people in real time through the use of badges, location sensors, and software. All 4,000 staff who have direct contact with patients—including nurses, doctors, allied health professionals, and porters—wear electronic location tracking badges. In addition, beds and equipment are tagged, and patients wear wristbands to track their location at all times. This information populates an organization-wide dashboard giving leaders and staff real-time visibility of all patients, staff, beds, and equipment.

Initially, Wolverhampton invested in RTLS technology to track hand hygiene compliance among staff. They had some success, but found that it was hard to use the system to accurately monitor compliance. However, their RTLS investment didn’t go to waste, as the real-time data provided an accurate and timely picture of where staff, patients, and equipment were in the hospital. As a result, leaders decided to use the system to improve patient flow.

Securing clinician buy-in on RTLS

Staff at the Royal Wolverhampton NHS Trust initially had concerns about RTLS tracking their locations. Leaders held open discussions with staff to discuss how the tracking information would be used. They assured staff that location data would be used only when relevant to patient and safety care, never to monitor their behavior. These discussions helped gain buy-in and, over time, staff recognized the power of RTLS to improve care and efficiency.

To further secure clinician buy-in, we recommend creating a policy document that outlines how RTLS data will and will not be used. Additionally, throughout the process be sure to consult with change management experts, human resources, and key leaders to ensure staff cooperation and adoption of RTLS technology.

Technology considerations

For most organizations, implementing the RTLS technology costs between $750 and $1,500 per bed. Beyond the up-front cost of the technology and installation, the RTLS system requires ongoing software licensing—The Royal Wolverhampton NHS Trust spends about £200,000 (approximately $245,000) per year on licenses.

Vendors estimate that it can take between 4 and 12 months to implement a patient flow system, depending on the functionality used and the size of the implementation.

There are many different types of RTLS technology on the market, and it’s common for technologies to be used in combination depending on an organization’s needs. See supporting artifacts for a summary comparison of major RTLS technologies and tips to implement RTLS at your organization.

2. Centralize RTLS data in a command center

Over a year after repurposing their RTLS investment for patient flow, leaders realized that improved visibility from real-time data wasn’t resulting in fewer care delays. They realized this was because patient placement was still operating in silos. For example, one capacity team member told us that it wasn’t uncommon for them to think a bed was open on a unit and alert a doctor that a patient could be admitted, then find out that the bed had already been filled. They’d have to scramble to find another open bed.

To change this, leaders at The Royal Wolverhampton NHS Trust decided to pair the RTLS technology with a command center-–one central location where all the people, processes, and information come together to make organization-wide workflow decisions. Royal Wolverhampton NHS calls their command center the “Care Traffic Control Center.”

3. Redeploy staff to support the command center

The Care Traffic Control Center is staffed by a centralized team physically located in one place. They monitor and respond to RTLS data in real time. This co-located patient flow team includes a variety of clinical and non-clinical roles. Below is a table that outlines the command center staff roles and responsibilities.

Care Traffic Control Center staff  Responsibilities
Lead patient flow nurse
  • Leads the patient flow team, working 12-hour
    shifts with the support of an administrator
Patient flow coordinators
  • Typically senior nurses
  • One patient flow coordinator is in charge during
    the day shift, and another during the night shift
On-call manager
  • Located off-site
  • Offers clinical decision-making support to the
    command center
Integrated health and social care
manager
  • Acts as a bridge between the hospital-based
    care team, the social and community reps in
    the command center, and the post- and sub-
    acute facilities in the community
Representatives from social care and
volunteer agencies
  • Direct their agencies’ resources to facilitate
    discharge and transitions out of the hospital
Unit-based patient flow assistants
  • Non-clinical patient flow assistants support the
    Care Traffic Control Center’s work
  • Do not sit with the dedicated team
  • Work alongside unit staff and support clinicians
    with discharge preparation and updating bed
    boards
  • One flow patient assistant per unit

With the exception of the unit-based patient flow assistants, The Royal Wolverhampton NHS Trust already employed all of the staff for the command center. Previously, staff were based on specific units. When Wolverhampton implemented the command center, staff were centralized.

Securing clinician buy-in

To get the patient flow team on board with the Care Traffic Control Center. To overcome this, The Royal Wolverhampton NHS Trust decided to parallel process. For one week, part of the team continued working the way they always had–-walking the wards, calling for updates–-while the rest of the team monitored the real-time data. The approach worked, and the patient flow team realized the new data was accurate and enabled them to do more to oversee and manage beds.

4. Use-real time data to make informed patient flow decisions

The centralized patient flow team uses real-time data to make workflow decisions as an organization rather than at the unit level. For example, the team uses a real-time view of bed status to direct admissions. The patient flow team can easily see which patients need a bed and which beds are free. Prior to implementing this centralized system, staff tracked bed status manually by walking the halls and making countless phone calls to the units. As a result, the tracking system was almost always out-of-date, leading to suboptimal bed placement for patients. The table below outlines how the centralized team uses real-time data for several other workflow decisions.

Workflow decisions  Change in workflow  Impact on staff
Specialist referrals
  • Clinicians used to call to schedule patient
    referrals, matching patient needs to
    available resources
  • Now, a daily list of referrals is
    automatically generated for
    physiotherapy, occupational therapy,
    social care, and other services
  • Specialists and ancillary teams pull their
    list of referrals and can automatically see
    patient location by unit
Discharge planning
  • Staff previously called units to identify
    pending discharges
  • Now, potential and confirmed discharges
    display in the system
  • Flow team and staff proactively pull
    forward discharge processes for
    confirmed and potential discharges
Tracking equipment
  • Staff called other units or physically
    searched to locate needed equipment
  • Now, there is a searchable dashboard to
    locate equipment
  • Staff can immediately identify equipment
    locations and if that equipment is clean or
    in use

Results

Real-time data improves decision-making, eases capacity

The Royal Wolverhampton NHS Trust’s RTLS system combined with the Care Traffic Control Center heavily streamlined staff work and improved workflow decisions.

49%  Decrease in average length of stay in medical units


86%  Decrease in average bed turn time per day


81%   Reduction in surgical cancellations


28%  Decrease in emergency department breaches
(when a patient remains in the ED for more than 4 hours)