Johns Hopkins using high-tech computers to treat more people & predict patient volume

The Capacity Command Center is the 1st of its kind

On July 25, 2017, Rodney Matthews had gotten off work and was headed to a day spa to buy his wife a birthday gift. He was checking out when he started experiencing minor pain in his chest. He barely made it to the chair. When he sat down, he could no longer feel his legs.

“My life was on the line and I didn't know what was going on with me,” said Matthews.

The woman at the counter called 9-1-1. Matthews called his wife and his mom letting them know he was going to the hospital. 

He remembers being picked up by the ambulance. 

“All I knew, from what I can remember, was saying ‘God, I don't want to die,’” said Matthews.

He only learned what was going on with him after he awoke following ten hours of surgery at Johns Hopkins Hospital in Baltimore.

Johns Hopkins medevac transported Matthews from Howard County General Hospital to Johns Hopkins

Matthews suffered an aortic dissection. A condition that kills 50 percent of people within 48 hours without surgery. For Matthews, every second and minute counted that day. 

“I could've been brain damaged, I could've been paralyzed, I could've been dead in a matter of just a few hours,” Matthews said.

If he had taken his motorcycle, which he thought about doing; if he was swimming, which he had planned on doing later; or if he was driving or on the metro when the tear in his aorta occurred, Matthews could’ve been dead on the spot.

It was by chance that Matthews was at the day spa when his medical crisis occurred, but it was the Johns Hopkins Capacity Command Center that made sure he received treatment as quickly as he did.

The system, powered by GE Healthcare, uses simulation modeling, optimization modeling, and predictive analytics to better manage the hospital capacity every minute of every day.

Scheulen on addressing emergency department boarding

 

The wall of computer monitors assess, predict, and inform operators of the status of every bed, operating room, machine, and personnel.

And the system worked perfectly back on that day in July.

“As the physicians were talking, bed managers knew he was coming, so they were finding a place, the lifeline transport team knew they were going to have to go get him, so they were dispatching the aircraft. All of those things came together in perfect synchrony to get him here as quickly as he got here,” said Jim Scheulen, chief administrative officer of emergency medicine and capacity management for Johns Hopkins Medicine.

To optimize efficiency and increase coordination, Scheulen looked to NASA and air traffic control and realized he needed all the key people in the same room.

“What we're trying to do is get the right patient to the right bed at the right time and what the air traffic control system tries to do is get the right plane to the right airport in the right time and we're both trying to do it safely,” Scheulen said.

He said patients get to Hopkins faster and because of that they have better outcomes. And in the two years the center's been here, they've seen improvements.

“We've increased the number of patients we're able to take from outside hospitals, we significantly reduced our ED boarding time, which is a major issue with ED crowding and we have dramatically improved the number of cases we're able to do in our operating rooms, which means we're able to serve the community better than we have in the past,” said Scheulen.

It’s a leap forward but not a solution to a problem plaguing emergency departments all across the country, particularly in Maryland where emergency room wait times are the worst in the country.

ER wait times

 
 

The red numbers flashing across the screens are meant to trigger alarm, but here, they’re a common theme.

“They're running at 97 percent occupancy. Neuro is 99 percent full. Medicine is overcapacity so that means there are patients in the ED, there are patients in procedure areas waiting to go to beds,” said Scheulen, interpreting the numbers on the monitors.

He said since they can't add beds, they're trying to deal with the influx as best they can by working to turn beds over faster. The system even added environmental services staff into the equation.

“We may have staff on this floor but the pressing need is for three beds on this floor, so let's move some staff down, have them help out and clean these other beds and then go back to their regular duties,” said Scheulen.

Never before has Scheulen seen numbers like these.

Some screens update within a matter of seconds and the oldest piece of information is three minutes.

“We are able to tell the status of every bed in the hospital every minute,” said Scheulen.

The predictive models are constantly learning and are even able to show hospital capacity in the future.

“We are 96 percent sure that at six o'clock two days from now, two mornings from now, we're going to be at a census of 186 in the department of medicine,” said Scheulen.

 
Scheulen: “We are able to tell the status of every bed in the hospital every minute"

 

While Scheulen and his team only see numbers, they know the people behind them are real and require their help. They don’t treat them medically, but their key role helps patients like Rodney beat the odds. 

“Every day I come in here and I ask people, ‘how many lives have you saved today?’ And their answer is typically, ‘all of them.’ And while it's a light-hearted joke, I think everybody who works here understands that we're here and what we do impacts patients every minute of every day. And I think it's a great source of pride for the people who work here that they really do impact patient's lives. Look at what happened to Rodney," said Scheulen. 

The Johns Hopkins Capacity Command Center was the first command center in the world at one time. There’s now one in Toronto. GE Healthcare also said it expects to open 5-10 command centers across 30 hospitals this year.

Scheulen said everyone who is considering opening a center has visited the Capacity Command Center in Baltimore.

And while they're not for every hospital, for large systems like Hopkins, Scheulen believes this model is the future of health care.