Located in the heart of the hospital, Humber River Health’s Command Centre is a NASA-styled “mission control” room that works behind the scenes to help make every patient’s experience at Humber better, faster and safer. The purpose of the Command Centre is to monitor, measure, and analyze for risk. It informs decision-makers to facilitate action, where improvements can be made, or if adverse events can be avoided.

The Command Centre at Humber is the first in Canada and started with the goal to move to highly reliable care and address some common issues that most hospitals face including long wait times, capacity challenges, poor patient flow and slow bed turnover, often challenged resource planning, as well as inadequate access to real-time information and analysis.

The solution: a Command Centre.

Why does it work?

The Command Centre brings together data, analytics and human input to support patient safety and better health outcomes. It is a centralized operating system that utilizes operational and clinical data that is already being collected across the hospital so that more informed decisions can be made on how to improve overall efficiency and deliver better care. Different professionals within the Command Centre are able to monitor various aspects of the hospital through clinical applications or analytic tiles, displayed on the Wall of Analytics, which are comprised of large monitors at the front of the centre. These tiles combine real-time data, early warning systems, machine learning and predictive analytics in an effort to alert staff of changes to patient status and potential risks.

The tiles themselves are fully customizable and the data and analytics they generate can be tailored to the individual needs of each clinical and operational team for decision-making. The information is available when and where needed, already analyzed with actionable prompts to aid the best decision. Departments across the hospital contributed to developing the tiles that would be most effective and efficient, including physicians, environmental services staff, front-line nurses, allied health staff and all interdisciplinary staff, among others. Humber has used the process of developing the Command Centre capability to engage its staff, clinicians and leadership in a broad change management process resulting in what should be a permanent, sustainable culture of continuous improvement.

Technologies

Patient monitors that measure and record patients’ vitals are attached to all 600+ rooms in the hospital and are connected to Humber’s electronic medical record (EMR) so that patient data can be distributed to the Command Centre in seconds to minutes. Once the data is collected, cleaned, organized and processed using purpose-built logic and algorithms, predictive analytics and machine learning are applied and used to prioritize high-risk or urgent cases. This is crucial, as with the data Humber is able to, for example, anticipate when we need to increase or decrease staffing to meet pressures and predict when there could be a spike in emergency visits due to outside events.

Another significant component of the patient tiles is artificial intelligence (AI), which is able to perform tasks and make decisions without intervention. For example, if patient data has not been updated for an extended period of time, or if a patient’s condition is perceived to be changing, this is flagged by the systems AI and all appropriate staff are alerted to take appropriate action. This real-time alerting prevents errors within the system for safer outcomes.

Outcomes

The Command Centre allows Humber to provide patients with an environment that is safer, as clinicians have as much support as they need to deliver seamless and high reliability care. Since the launch of the Command Centre, Humber has seen a reduction in avoidable errors, improved clinical decision-making, positive health outcomes, and decreased mortality. Since implementation, a 29 per cent reduction in hospital harm was observed, significantly below the province’s standards and peer groups. This includes a 10 per cent decline in sepsis reported.

Improved coordination of services and movement within the hospital allowed for patient stay at the hospital to be minimized. By setting efficiency targets for dirty bed turnaround time, portering, diagnostic imaging, length of stay and admissions, Humber observed a 30 to 50 per cent time decrease across all of these key target areas. Humber also saw a decrease in wait times for inpatient diagnostics and emergency rooms, with a 34 per cent reduction in the average time a patient in the emergency department waited before being placed in a bed. A 38 per cent reduction was seen in the time patients wait to receive certain diagnostic test results and a 16 per cent reduction in inpatient ultrasound time, down four hours from request to completion.

In the first year, Humber enhanced patient flow that saved the equivalent of 35 hospital beds, which was 2.5 times quicker than anticipated. Through the reduced length of stay and patient flow optimization, more capacity was created without additional costs or new beds. Humber observed a 51 per cent increase in portering benchmark compliance, which assigned porters in a target of less than 10 minutes. In addition, Humber had a 45 per cent decrease in the time to clean inpatient beds with accurate bed planning. Allied health initial assessment delays were also reduced by 76 per cent. These results demonstrated direct efficiencies and savings.

Furthermore, a 41 per cent decrease in inpatient Code Blues was observed when comparing data prior to and after implementation of the Clinical Deterioration tile during Generation 2. In addition, patients and families were more aware of what was occurring during their stay for further understanding, which enabled better questions to be asked, leading to an overall better experience and improved health outcomes.

As clinical staff, nurses and physicians received increased and improved data that is actionable, they were able to save lives, and have better access to information that helped them make informed clinical decisions. This also led to higher staff satisfaction, as they saw improvements in their own workflows and lessened the administrative burden. From a cost perspective, the Command Centre resulted in a permanent reduction in operating costs based on maintaining existing capacity and functions. Humber achieved full payback on investment in eleven months, well below the planned two and half years.

Next Steps

Through these tiles and technologies, the Command Centre is able to enhance safety, enable risk mitigation, and improve outcomes. Humber has now evolved its use of the Command Centre starting with operational functions in Generation 1, such as patient flow and improved diagnostic wait times, through Generation 2 focused on clinical improvements. Moving forward now with Generation 3, the focus is on extending the Command Centre’s abilities to support health and wellness, virtual visits, home monitoring and patient access and education with actionable, real-time data.

Overall, we believe that all healthcare facilities should consider implementation of their own Command Centre for the utmost high-reliability care and patient experience. Humber’s challenges were not unique, but our approach to addressing them was at the time and can be used as a key learning element for others. Humber has learned a lot from other hospitals and we have something to offer in the Command Centre to our colleagues in Ontario. The Command Centre will continue to evolve to meet emerging needs within our hospital, ensuring higher reliability care every step of the way.

To learn more about Humber River Health’s Command Centre, please visit www.humbercommandcentre.ca.