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May 24, 2016

On May 6, Texas Children’s celebrated an impressive milestone – 365 days and counting with zero acute care patient denials at Texas Children’s main campus and Texas Children’s Hospital West Campus.

“I am so proud that our teams pulled together to achieve a performance record of this kind,” said Texas Children’s Executive Vice President John Nickens. “This demonstrates the value of teamwork and commitment to creating a safe environment for patient care while ensuring every child has access to our services.”

From October to March, Texas Children’s typically experiences a seasonal surge in patient volumes, and during this busy time of the year, patient census has reached historic highs – at or beyond the hospital’s 671-bed capacity – resulting in many children being denied the opportunity to receive care at Texas Children’s.

Realizing that managing real-time capacity is crucial to predicting and planning for current and future demands, teams from across the organization embraced this opportunity to optimize patient flow across the system.

Click here to watch a patient flow video at Texas Children’s.

In FY 2015, Texas Children’s leaders, physicians, nurses and clinical and nonclinical support staff began working strategically to access the organization’s previous approach to patient flow decision-making. As a result, several innovative strategies were implemented and interdisciplinary roles dedicated to patient flow were created.

“We began thinking about patient flow as a system-level issue,” said Jennifer Sanders, clinical director of Patient Flow at Texas Children’s. “For example, we no longer approached the PICUs at Main Campus and West Campus as separate units. Instead, we monitored patient flow across the system, accessing the capacity between these units and other inpatient care units when deciding on the best place to send a child for care.”

Texas Children’s also changed the way it activated census alerts. Previously, census alerts were based on color codes – green, orange and red – with “red” indicating no beds were available. These triggers were based on the percentage of bed capacity filled but did not necessarily take into account daily admissions and discharges.

“When we moved to a single census alert, we were either on capacity alert or not,” said Jackie Ward, vice president of Nursing at Texas Children’s. “If we reached a point where our capacity was being challenged, we would activate census alert in order to mitigate not having any beds available. This improved process helped us proactively manage patient flow across the acute care areas of the hospital rather than be reactive.”

Mobilizing rotating teams of operational leaders and physicians focused on patient volume every day, a “real-time demand and capacity” process was also implemented to assess patient flow at three pivotal points during the day – 9 a.m., 1 p.m. and 9 p.m. These 15-minute meetings helped leaders and staff more accurately forecast bed capacity, manage demand and capacity mismatches and resolve patient discharge barriers. The new role of chief resident of flow was also created to assist with eliminating medical barriers to discharge.

“We looked at how many patients were being admitted and discharged, the total capacity of the system, and focused on discharging patients, effectively, efficiently and with accountability,” said Dr. Michelle Lyn, medical director of Patient Flow at Texas Children’s. “We wanted to maximize team communication and we served as their support system on the back end.”

Coupled with these new processes, Texas Children’s successfully increased acute care capacity with the opening of the 10-bed Acute Care Holding Unit at West Tower in late December and the newly renovated 16-bed acute inpatient care unit at 5 North Abercrombie which opened on February 26.

“This was a huge collaborative team effort,” Sanders said. “From our administration to our nurses, providers, ancillary services, respiratory, and our facilities and environmental service teams, we worked together to ensure we deliver on our promise to make Texas Children’s the best possible place to give and receive care.”

To meet the growing number of children seeking our care in the future, Texas Children’s capacity will expand even more with the addition of Texas Children’s Hospital The Woodlands – scheduled to open in 2017 – and our inpatient critical care Tower E at main campus which is currently under construction.