By KRISTA CONGER

Bonnie Kintner enjoys her job. “I just love showing this off to people,” the registered nurse said. “It’s so much fun.” As she speaks, she gazes at a brightly colored, complex grid on her computer monitor. Boxes of blue, pink, white and green – one for each room in the hospital – dance with colored dots and status messages on Lucile Packard Children’s Hospital’s newly instituted bed board: filled or empty, clean or dirty, assigned or up-for-grabs.

For eight hours a day, Kintner shepherds each bed through occupancy, unassigned vacancy, cleaning and re-occupancy.

Kintner’s goal to eliminate any needlessly empty room marks ongoing efforts at the hospital to increase the efficiency of bed space usage without compromising patient care. Increasing numbers of patients coupled with a static number of beds in the hospital have forced staff to streamline the discharge and bed-turnaround processes while also adding beds off-site. So far the efforts seem to be working.

Bonnie Kintner’s smile gets even bigger when she looks at her computer screen these days. A computerized “bed board” planning system now in place at Packard Children’s Hospital enables doctors, nurses and housekeeping staff to minimize the length of time a bed stays empty. Photo: Krista Conger

“The week of Jan. 16, Packard had the highest occupancy rate we’ve ever seen,” said Susan Flanagan, chief operating officer. “Occupancy has increased from 80 percent at this time last year to about 88 percent today.” In human terms, that means caring for an additional 20 children each month and significantly reducing the number of kids the hospital must turn away due to lack of space.

Kintner and the bed board are only one of the many changes afoot. Others include encouraging physicians to write discharge orders by 10 a.m. and striving to identify those patients likely to be discharged the following day.

“We have retooled our discharge process to focus on one question: What are the key things that need to happen for a patient and family to be prepared for discharge?” said Flanagan. “In the past, decisions about patient education, coordinating with parents and interpreting for the family were often made after the discharge order was written,” she added. “We were reacting to the situation, and we needed to be more proactive.”

Now patients’ families and hospital staff can work together in advance to arrange transportation from the hospital, obtain needed medications from the pharmacy and discuss how to care for the patient at home. The current average discharge time has shifted from 4:30 p.m. to 2:45 p.m. each day.

“Improving discharge times is important to make sure there are beds available in the early afternoon for emergency patients and children recovering from surgery. If beds aren’t available until six or seven in the evening, we can’t serve these patients as well as we can if we have beds at eleven in the morning,” said hospital chief of staff Harvey Cohen, MD, PhD.

Room cleaning after discharge has also come under scrutiny. All housekeepers now have beepers and are automatically paged as soon as a discharge order is entered into the computer. The housekeepers report when they start and finish each room, allowing Kintner to track their progress on the bed board and assign beds as soon as they are available.

“This multidisciplinary approach to alleviating the bed crunch has resulted in an increased ability to care for more children,” said Cohen, professor of pediatrics. “Now we don’t have to turn away as many kids who need our help. We’re also doing a better job of taking care of the needs of our community doctors.”

Finally, the addition of eight new Packard Children’s Hospital beds at El Camino Hospital in Mountain View last month has eased some pressure. The beds are earmarked for low-acuity general pediatric, pulmonology, pain and rheumatology patients. Kintner works closely with the admitting physicians to determine which patients are appropriate for the new site. An additional eight beds at El Camino Hospital are planned to open this spring.

“It’s important to think about where kids can best be cared for,” said Cohen. “Now that we are seeing patients there, we are able to open up beds on the general pediatric unit here.”

Weekly patient progression meetings are attended by nursing leaders, case managers, physicians and the housekeeping staff to ensure that the changes continue to improve discharge coordination and utilization of beds. “We measure our results against our goal and discuss areas that can be improved,” said Flanagan.

“The physicians are happy because they can see the results of this. They can see that we are able to admit more patients and that that we no longer routinely have patients waiting in line for beds,” said Flanagan. “The support of the housekeepers has also been tremendous. When they heard that we are now able to serve about 200 more patients per year, the pride on their faces was worth a thousand pictures.”

Kintner has also heard lots of positive feedback. “We’re striving for more efficient patient care, and it seems to be working really well,” she said. “I spent four months as an area case manager before taking this job, and this system is like an answer to my prayers.”