​Lindsay Hogeboom, Manager, Access and Flow at William Osler Health System (Osler) manipulates one of the large touch screens in one of Osler’s Operational Command Centres. Built in-house with the input of key frontline stakeholders, the user-friendly dashboards can also be accessed by clinical teams 24/7 on their mobile phones, and remotely by decision-makers when offsite. Photographer: Jag Gundu, Jag Photography

By: Donna Harris, Manager of Public Relations and Digital Media at William Osler Health System

As hospitals brace for the annual cold and flu surge and a possible second wave of COVID-19, one hospital is looking to its innovative new Operational Command Centres to help reduce gridlock, enhance quality and patient safety, and support an improved patient and staff experience. Launched at the height of the COVID-19 pandemic, the rapidly emerging model is already yielding positive outcomes for William Osler Health System (Osler).

"Our Operational Command Centres were born out of a broader long-term vision to create both a physical and virtual hub that provides senior and clinical leaders with a 'real time' birds-eye view of emergency department and inpatient care activity across our acute care sites at Brampton Civic Hospital and Etobicoke General Hospital," says Clint Atendido, Vice President, Clinical Services. "It's akin to an air traffic controller in the sense that we can see where every inpatient is, quickly identify barriers to access, and take immediate action to relieve any bottlenecks."

Although the concept was already in the developmental stages pre-COVID, the onset of the pandemic accelerated the planning process, and within months, the Operational Command Centres were launched at both Brampton Civic and Etobicoke General, with technology playing an instrumental role in helping to mobilize teams to action to safely and swiftly isolate and manage the growing influx of patients positive or suspect for COVID-19.

"The Operational Command Centres consolidate key teams together in one physical location at each site where joint decisions can be made in real time, eliminating delays due to missed phone calls, text messages and emails," says Lindsay Hogeboom, Manager, Access and Flow. The centres house staff from Admitting, Access and Flow, and Environmental Services (housekeeping, portering), as well as Infection Prevention and Control (IPAC) and Staffing, fostering relationship-building and improved teamwork.

Leveraging technology to facilitate timely transitions in care

Comprehensive online dashboards give those within the centres a real time view of where every inpatient is from the moment they are admitted to the Emergency Department (ED) to the moment they are admitted to a bed on one of Osler's inpatient units. This helps teams identify staffing needs for cleaning inpatient rooms, portering, etc. while also ensuring nurses on receiving units know when to expect an incoming patient.

Built in-house with the input of key frontline stakeholders, the user-friendly dashboards can also be accessed by clinical teams 24/7 on their mobile phones, and remotely by decision-makers when offsite. Designed to support transparency and accountability, they feature an escalating alert system that notifies leaders when there is a delay in any aspect of the admissions and transition process.

Everyone - whether they're a clinical nurse, director on call, ED physician, access and flow leader or manager – has a clear understanding of what is going on in the system so that actions can be escalated in the moment to support patient and staff safety, patient experience, and overall efficiencies across the organization.

"The dashboards help identify where we have surge and provides digital access to all open beds across the hospital and those likely to be open soon, allowing us to take immediate action," says Hogeboom. "We can see how many beds are available, who is being discharged, who is a potential for discharge and where there may be barriers, so that we can safely move patients from the EDs in a timely manner to the right inpatient bed on the right unit, particularly those requiring isolation." 

This proved very useful when Osler needed to quickly maximize its space to accommodate an influx of elderly residents transferred from long-term care home partners during the height of the pandemic. It was also very helpful in identifying the availability of specialized rooms for patients. For example, due to COVID-19, the number of ED patients who required isolation rooms jumped from 10% in 2019 to 30% in April 2020, and the dashboards allowed these rooms to be clearly identified.

The dashboards currently house several integral features including sub-pages for bullet rounds, patient flow, electronic transfer of accountability (eTOA), COVID-19, alternate level of care (ALC) and long-term care (LTC). An emergency department section will be added this fall that features ED length of stay (LOS), visits and admits. Large touch screens on the units feed into the dashboards, replacing the often cumbersome manual whiteboards previously used by teams to track patients.

"We know from the research that adverse events often take place within the first 72 hours of admission and can be directly attributed to poor transitions," says Tony Raso, Associate Vice President, Quality. "The eTOA plays a key role in enhancing patient safety because it reduces risks to patients during the transfer of accountability by giving nurses digital access to everything about a patient from the moment they arrive in the ED."

With an anticipated second wave of COVID-19 this fall, together with the gridlock that often accompanies cold and flu season, Osler is looking to its Operational Command Centres to help it proactively manage demand.

"The transparency and accountability built into the system means we're empowering our leaders, physicians and staff to make more timely decisions that will not only help us minimize gridlock, but also enhance the overall patient and staff experience," says Atendido.