Use of Hospital Capacity Command Centers to Improve Patient Flow and Safety: A Scoping Review

Abstract

ObjectivesDelayed emergency department (ED) and hospital patient throughput is recognized as a critical threat to patient safety. Increasingly, hospitals are investing significantly in deploying command centers, long used in airlines and the military, to proactively manage hospital-wide patient flow. This scoping review characterizes the evidence related to hospital capacity command centers (CCCs) and synthesizes current data regarding their implementation.MethodsAs no consensus definition exists for CCCs, we characterized them as units (i) involving interdisciplinary, permanently colocated teams, (ii) using real-time data, and (iii) managing 2 or more patient flow functions (e.g., bed management, transfers, discharge planning, etc.), to distinguish CCCs from transfer centers. We undertook a scoping review of the medical and gray literature published through April 2019 related to CCCs meeting these criteria.ResultsWe identified 8 eligible articles (including 4 peer-reviewed studies) describing 7 CCCs of varying designs. The most common CCC outcome measures related to transfer volume (n = 5) and ED boarding (n = 4). Several CCCs also monitored patient-level clinical parameters. Although all articles reported performance improvements, heterogeneity in CCC design and evidence quality currently restricts generalizability of findings.ConclusionsNumerous anecdotal accounts suggest that CCCs are being widely deployed in an effort to improve hospital patient flow and safety, yet peer-reviewed evidence regarding their design and effectiveness is in its earliest stages. The costs, objectives, and growing deployment of CCCs merit an investment in rigorous research to better measure their processes and outcomes. We propose a standard definition, conceptual framework, research priorities, and reporting standards to guide future investigation of CCCs.

Boarding in the emergency department: challenges and mitigation strategies

“…Active bed management can decrease the length of stay for boarding patients in the ED. A recent scoping review suggested that capacity command centers, responsible for the bed management of a specific healthcare facility or system, could improve patient flow and safety, thus reducing ED boarding [50 ▪ ]. The implementation of a centralized coordination center to systematically coordinate emergency transfers was associated with a reduction in the ED LOS [51 ▪ ].…”

A Novel Role to Manage Capacity and Flow in Hospital Medicine

“…In 2019, the hospital opened a formal capacity center, physically combining the functions of admitting, bed management, hospital transfers, ED transfers, and capacity management, serving as the new home of the MOD. [8][9][10] This allowed for daily collaboration on capacity challenges and transfer priorities.…”

Increasing Hospital at Home Enrollment Through Decentralization With Agile Science

“…[8][9][10] Although command centers are widely used in traditional hospital settings for optimizing patient throughput, effectiveness of HaH command centers is unclear, particularly for patient enrollment. 11 It has not been described if HaH patient enrollment is best performed by a centralized command center or by local healthcare team members. and bedside registered nurses (RN) located in a remote command center.…”