January 26, 2020
Florida's medical command centers

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AdventHealth's Orlando command center features 60 monitoring screens.

Economic Backbone - Health Care / Hospitals

Florida's medical command centers

Amy Keller | 11/26/2019

Hospitals around the state are building high-tech nerve centers to maximize bed capacity, predict staff shortages, catch deadly conditions such as sepsis and tackle other problems. Here’s a look at a few ...

Mission Control

AdventHealth, Orlando

As Hurricane Dorian inched across the Atlantic last summer, staff in AdventHealth’s Mission Control center used a stream of real-time data and analytics to help them place an influx of patients being evacuated from hospitals on Florida’s east coast.

The 12,000-sq.-ft. command center — the largest of its kind in the country — features 60 monitors that provide a bird’s-eye view of open beds at all nine AdventHealth hospitals in Central Florida, while simultaneously tracking helicopter and ambulance status. It’s staffed 24/7 by more than 50 nurses, EMS and flight dispatchers.

“We knew immediately where all our capacity and capability was and were very easily able to accept almost 40 patients,” says Eric Stevens, CEO of Acute-Care Services for AdventHealth’s Central Florida division.

Although the $20-million facility that opened in August wasn’t specifically built with hurricanes in mind, Stevens says it’s an example of the kind of problems the technology can solve.

“They call it ‘insight at scale,’ ” he says. “We have up to 500 data points per second that update from all of our electronic systems, so these teams know exactly where every patient is in our system, every patient that’s trying to get in our system, where they are and what their needs are so those can be mapped real time to the appropriate location.”

For patients, that translates into shorter waits for rooms, fewer transfers to sister facilities and shorter hospital stays. The technology can also use artificial intelligence and machine learning to predict potential staff shortages and solve other problems.

For example, if 20 patients need a certain level of intensive care and only five beds are available, the system can look at imaging results, lab values and other parameters to help sort out which patients should get the critical beds. Before it implements the technology, staff would work through such issues with back-and-forth phone calls and spreadsheets. “It just has streamlined that so much for us,” Stevens says.

Clinical Logistics Center

Nemours Children’s Hospital, Lake Nona

Nemours Children’s Hospital in Lake Nona pioneered the concept of medical command centers in Florida when it opened in 2012 with a special unit overseen by paramedics who electronically monitor the health status of 200 pediatric patients, on average.

Screens inside the Clinical Logistics Center display the vital signs and lab results of patients in Florida and at Nemours’ Alfred I. duPont Hospital for Children in Delaware and also indicate when patients press a call light or an alarm sounds. If something seems amiss, the first responders can alert the patient’s nurse with a call or text or communicate directly with the patient and ask to get a closer look through cameras installed in the rooms.

Nemours is also using the technology to get a jump-start on treating sepsis — a sometimes deadly immune response to an infection — and shock, which occurs when body tissues aren’t receiving enough oxygen and nutrients to function adequately.

Signs of sepsis can include a sudden drop in blood pressure, an increased heart rate or rapid breathing. The logistics center tracks these and other signs and feeds them into a sepsis scoring system, which can predict when a patient is headed for danger. If a patient hits the threshold sepsis score, the medical team can jump into action with IV fluids, antibiotics and other life-saving treatments.

Stephen Lawless, senior vice president and chief clinical officer of Nemours Children’s Health System, says that it used to take several hours to get those treatments on board. “On average, we are giving those treatments within 50 minutes of the initial call,” Lawless says. “That’s very, very fast. It’s a remarkable feat, and we’ve been recognized at how well we’re doing with that.”

Next on Lawless’ agenda is using the command center to remotely connect consulting physicians to the logistics center. “Even if we have residents and they need an attending (physician), if you call the attending and ask for advice, it takes them awhile to get to the hospital. We’re working on ways to connect the attending from home by telemedicine right to the logistics center, so they can get instantaneous access to help with bedside care.”

CareComm

Tampa General, Tampa

Cost: About $13.5 million

Size: 8,000 square feet on the second floor of the hospital’s east Pavilion

Tech Features: Designed by GE Healthcare, CareComm features 38 large screens and 20 artificial intelligence apps (known as tiles) that monitor patient flow and delays in care. It can also detect early warning signs of patients in need.

Efficiencies: Since its launch in December 2018, the center has reduced the average patient stay by half a day, reduced readmissions and generated $10 million in savings. It also allowed the hospital to open a “departure lounge” — with comfortable chairs, TV and snacks — where discharged patients can pick up their take-home medications or wait for rides, freeing up beds more quickly.

The Future: Peter Chang, a physician and vice president of Care Transitions at TGH, says the next step is using the systems’ artificial intelligence and predictive analysis for early detection of disease and remote monitoring. Within a couple years, CareComm will reach beyond the hospital’s walls to remotely monitor organ transplant recipients and other vulnerable patients at home, Chang says. “The idea of the command center is using artificial intelligence and predictive insights to manage patients in real time, so when I see an icon pop up or a patient’s name turns red, I’m not just relying on patients or family to notify us.”

Knee Help: Sarasota Memorial Hospital is using a ROSA robotic surgical assistant (above) to help surgeons perform knee replacements. The equipment uses 3-D imaging software to create a custom surgical plan for each patient. The robot helps surgeons better position the new knee. At Jupiter Medical Center, Dr. Vincent A. Fowble performed the hospital’s first total knee replacement surgery using the MAKO Robotic-Arm Assisted Technology in mid-October. — By Art Levy

Strike Two: The National Nurses United union said nurses affiliated with the union at two Tenet-owned hospitals, Florida Medical Center in Lauderdale Lakes and Palmetto General Hospital in Hialeah, held a one-day strike in September, which the union said was the first hospital strike by registered nurses in Florida. Nurses at 10 other Tenet hospitals in Arizona and California also struck for the day. The union said it wants better staffing levels. Tenet said it was disappointed by the action and that it had been negotiating in good faith on a new contract. — By Mike Vogel

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