Effect of a hospital command centre on patient safety: an interrupted time series study

Mebrahtu, Teumzghi F; McInerney, Ciarán; Benn, Jonathan; McCrorie, Carolyn; Granger, Josh; Lawton, Tom; Sheikh, Naeem; Randell, Rebecca; Habli, Ibrahim; Johnson, Owen

doi:10.1136/bmjhci-2022-100653

Cited by 3 publications

(1 citation statement)

References 13 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Eight papers discuss the benefits of physically co-locating staff with respect to patient management parameters [16,23,41,[43][44][45][46][47]. For example, Kane et al analysed the existing patient capacity in a health care system and set out to enhance patient flow by reducing patient boarding in the ED, and improving critical transfer care processes from outside facilities [41].…”

Section: Resultsmentioning

confidence: 99%

Application of a Human Factors Systems Approach to Healthcare Control Centres for Managing Patient Flow: A Scoping Review

Paterson,

Chari,

McCormack

et al. 2024

J Med Syst

View full text Add to dashboard Cite

Over the past decade, healthcare systems have started to establish control centres to manage patient flow, with a view to removing delays and increasing the quality of care. Such centres—here dubbed Healthcare Capacity Command/Coordination Centres (HCCCs)—are a challenge to design and operate. Broad-ranging surveys of HCCCs have been lacking, and design for their human users is only starting to be addressed. In this review we identified 73 papers describing different kinds of HCCCs, classifying them according to whether they describe virtual or physical control centres, the kinds of situations they handle, and the different levels of Rasmussen’s [1] risk management framework that they integrate. Most of the papers (71%) describe physical HCCCs established as control centres, whereas 29% of the papers describe virtual HCCCs staffed by stakeholders in separate locations. Principal functions of the HCCCs described are categorised as business as usual (BAU) (48%), surge management (15%), emergency response (18%), and mass casualty management (19%). The organisation layers that the HCCCs incorporate are classified according to the risk management framework; HCCCs managing BAU involve lower levels of the framework, whereas HCCCs handling the more emergent functions involve all levels. Major challenges confronting HCCCs include the dissemination of information about healthcare system status, and the management of perspectives and goals from different parts of the healthcare system. HCCCs that take the form of physical control centres are just starting to be analysed using human factors principles that will make staff more effective and productive at managing patient flow.

show abstract

Section: Resultsmentioning

confidence: 99%

Application of a Human Factors Systems Approach to Healthcare Control Centres for Managing Patient Flow: A Scoping Review

Paterson,

Chari,

McCormack

et al. 2024

J Med Syst

View full text Add to dashboard Cite

show abstract

A command centre implementation before and during the COVID-19 pandemic in a community hospital

Grosman-Rimon,

Wegier,

Rodriguez

et al. 2024

BMC Med Inform Decis Mak

View full text Add to dashboard Cite

Introduction The objective of the study was to assess the effects of high-reliability system by implementing a command centre (CC) on clinical outcomes in a community hospital before and during COVID-19 pandemic from the year 2016 to 2021. Methods A descriptive, retrospective study was conducted at an acute care community hospital. The administrative data included monthly average admissions, intensive care unit (ICU) admissions, average length of stay, total ICU length of stay, and in-hospital mortality. In-hospital acquired events were recorded and defined as one of the following: cardiac arrest, cerebral infarction, respiratory arrest, or sepsis after hospital admissions. A subgroup statistical analysis of patients with in-hospital acquired events was performed. In addition, a subgroup statistical analysis was performed for the department of medicine. Results The rates of in-hospital acquired events and in-hospital mortality among all admitted patients did not change significantly throughout the years 2016 to 2021. In the subgroup of patients with in-hospital acquired events, the in-hospital mortality rate also did not change during the years of the study, despite the increase in the ICU admissions during the COVID-19 pandemic.Although the in-hospital mortality rate did not increase for all admitted patients, the in-hospital mortality rate increased in the department of medicine. Conclusion Implementation of CC and centralized management systems has the potential to improve quality of care by supporting early identification and real-time management of patients at risk of harm and clinical deterioration, including COVID-19 patients.

show abstract

Implementing an artificial intelligence command centre in the NHS: a mixed-methods study

Johnson,

McCrorie,

McInerney

et al. 2024

Health Soc Care Deliv Res

View full text Add to dashboard Cite

Background Hospital ‘command centres’ use digital technologies to collect, analyse and present real-time information that may improve patient flow and patient safety. Bradford Royal Infirmary has trialled this approach and presents an opportunity to evaluate effectiveness to inform future adoption in the United Kingdom. Objective To evaluate the impact of the Bradford Command Centre on patient care and organisational processes. Design A comparative mixed-methods study. Operational data from a study and control site were collected and analysed. The intervention was observed, and staff at both sites were interviewed. Analysis was grounded in a literature review and the results were synthesised to form conclusions about the intervention. Setting The study site was Bradford Royal Infirmary, a large teaching hospital in the city of Bradford, United Kingdom. The control site was Huddersfield Royal Infirmary in the nearby city of Huddersfield. Participants Thirty-six staff members were interviewed and/or observed. Intervention The implementation of a digitally enabled hospital command centre. Main outcome measures Qualitative perspectives on hospital management. Quantitative metrics on patient flow, patient safety, data quality. Data sources Anonymised electronic health record data. Ethnographic observations including interviews with hospital staff. Cross-industry review including relevant literature and expert panel interviews. Results The Command Centre was implemented successfully and has improved staff confidence of better operational control. Unintended consequences included tensions between localised and centralised decision-making and variable confidence in the quality of data available. The Command Centre supported the hospital through the COVID-19 pandemic, but the direct impact of the Command Centre was difficult to measure as the pandemic forced all hospitals, including the study and control sites, to innovate rapidly. Late in the study we learnt that the control site had visited the study site and replicated some aspects of the command centre themselves; we were unable to explore this in detail. There was no significant difference between pre- and post-intervention periods for the quantitative outcome measures and no conclusive impact on patient flow and data quality. Staff and patients supported the command-centre approaches but patients expressed concern that individual needs might get lost to ‘the system’. Conclusions Qualitative evidence suggests the Command Centre implementation was successful, but it proved challenging to link quantitative evidence to specific technology interventions. Staff were positive about the benefits and emphasised that these came from the way they adapted to and used the new technology rather than the technology per se. Limitations The COVID-19 pandemic disrupted care patterns and forced rapid innovation which reduced our ability to compare study and control sites and data before, during and after the intervention. Future work We plan to follow developments at Bradford and in command centres in the National Health Service in order to share learning. Our mixed-methods approach should be of interest to future studies attempting similar evaluation of complex digitally enabled whole-system changes. Study registration The study is registered as IRAS No.: 285933. Funding This award was funded by the National Institute for Health and Care Research (NIHR) Health and Social Care Delivery Research programme (NIHR award ref: NIHR129483) and is published in full in Health and Social Care Delivery Research; Vol. 12, No. 41. See the NIHR Funding and Awards website for further award information.

show abstract

Effect of a hospital command centre on patient safety: an interrupted time series study

Cited by 3 publications

References 13 publications

Application of a Human Factors Systems Approach to Healthcare Control Centres for Managing Patient Flow: A Scoping Review

Application of a Human Factors Systems Approach to Healthcare Control Centres for Managing Patient Flow: A Scoping Review

A command centre implementation before and during the COVID-19 pandemic in a community hospital

Implementing an artificial intelligence command centre in the NHS: a mixed-methods study

Contact Info

Product

Resources

About