Forward Thinking

More people turn to Grady for quality care than any other hospital in Atlanta. That has created obstacles that sometimes kept patients in the hospital longer than medically necessary.

To improve the quality of our care, Grady has invested in a new hospital operating system, with a control center called the Capacity Hub (“the Hub”). The new system provides 24/7 central coordination of patient admission, placement, flow, and service department testing and procedures. Registered nurses combine case management and operations skills to drive patient progression and improve patient flow.

Decreasing the average patient’s length of stay by half a day opens up 40 beds a day. That helps reduce the number of patients held in the Emergency Department until beds open up, accommodate more patients, and improve outcomes and patient satisfaction and safety.

Grady’s Emergency Department is one of the busiest in the world, handling more than 150,000 visits per year. Frequent ED users make up fewer than 10% of all emergency patients but account for about 25% of all visits, typically because they lack access to preventive care services.

To address this need, our Chronic Care Clinic is using Grady’s Epic electronic medical records software to connect frequent ED patients with the services they need to improve and maintain their physical and emotional health. Epic Healthy Planet technology helps us direct our resources and assess our progress with individual patients through sophisticated applications that include real-time and predictive analytics, role-based daily metric dashboards, chronic disease registries, and care gap reports.

Healthy Planet enables us to identify and monitor the holistic care of high-risk patients and address social barriers to treatment. Patients are assigned a care team that includes advanced practice providers, clinical pharmacists, behavioral health specialists, and community health workers who collaborate to connect patients to the support they need - whether it’s finding them housing and transportation, addiction treatment, or nutritional support. The software addresses root causes and helps keep patients on track. Since we deployed this system, ED visits have dropped by nearly 50% in the target population.

Being on the front lines in health care can take a toll on providers and staff, producing secondary trauma, including feelings of personal responsibility for bad outcomes and reduced confidence. As these experiences accumulate, they can lead to burnout, compassion fatigue, and even despair.

The WeCARE peer-responder program supports the psychological health and well-being of our staff and providers who are called upon to care for a flow of critical patients. The program creates a confidential, peer-to-peer “safe zone” where secondary trauma victims from any department can voluntarily discuss their response to traumatic events. Peer responders are trained to take action as soon as possible following an event, and then follow up regularly to provide empathy, keep victim staff members connected, and help restore their confidence.

Effective cancer treatment requires coordination. The best outcomes often depend on responsive, regular scheduling of infusion therapy.

In 2019, we worked with LeanTaaS, a company that uses advanced data science to help hospitals solve tough operational problems, and introduced a platform that uses data science and machine learning to help optimize infusion scheduling so that our patients are cared for as efficiently as possible. Grady and LeanTaaS collaborated to make sure common obstacles, like pharmacy compounding time, delays in getting lab results, or late-running patients, do not compromise effective treatment.

Visualizing this data allows schedulers to give nurses the time they need to spend with each patient. Analytics will help us make smart decisions about staffing as we open capacity even more.

LeanTaaS has already enabled us to schedule more patients and reduce the time from medical oncology order to first treatment by nearly three days, which is good news for everyone.

Harm events are hospital-acquired conditions that can change patients' lives forever. Grady is using technology and new processes to keep patients safer.

In October 2019, we launched a house-wide program with Jvion, an artificial intelligence company focused on hospital patient safety. The project aimed to help us identify patients at higher risk for falls. Jvion software analyzes patient clinical data and socioeconomic factors, such as income, food insecurity, and education, to assess each patient's risk and recommend patient-specific interventions.

Nurses then implement bedside interventions to reduce risks. The technology analyzes documented falls and uses updated data to learn to better predict which patients are at-risk and alert care teams. In the last quarter of 2019, we reduced falls with injury by 62% and improved health outcomes. We are now planning for a project to identify patients susceptible to pressure injuries.

For years, most of Grady's lung cancer patients were in late stages of the disease – typically the most difficult to treat successfully.

To identify patients during earlier, more treatable stages, we created a collaborative team of caregivers to educate and encourage patients with high-risk habits – like smoking – to quit and get screened. Then we built a multidisciplinary thoracic oncology team to steer the patient from screening to treatment, using state-of-the-art technology to guide diagnosis and care.

For example, Grady was the first Metro Atlanta hospital to use the Veran Electromagnetic Navigation system to help physicians find and biopsy the tiniest and hardest-to-reach nodules to detect lung cancer at much earlier stages when it's easiest to treat.

As a result of our education and screening efforts, we are seeing more patients with earlier-stage lung cancer. A key to our success has been a concerted effort to make it easier for patients to get the care they need by coordinating the routine appointments a lung cancer patient requires. Our Multidisciplinary Lung Clinic puts our medical oncologists and radiation oncologists in a single clinic to streamline the patient experience and keep these patients connected to care.

Grady’s Correll Cardiac Center recently installed the latest robotic technology in our newest catheterization lab, enabling Grady cardiologists to perform coronary interventions more precisely than ever before.

From a control room separate from the patient room, cardiologists use joysticks to direct the robot’s movements that can measure a coronary stenosis or blockage precisely to the millimeter, which is necessary for precise stent positioning. This technology gives cardiologists better control, visibility, and limits radiation exposure for everyone involved in the procedure. Possible future applications for this robotic technology include intervention for acute stroke and acute myocardial infarction.

Recently, the Marcus Stroke and Neuroscience Center’s neuroendovascular team published the first report on a series of three patients with symptomatic carotid artery stenosis who were successfully treated with the robotic-assisted technology.

Eventually, these robotic systems could allow our interventionists to perform robotic coronary and neuro interventions in other parts of the country, or even other parts of the world.

With stroke, time is brain. If a neuroendovascular specialist can open an artery faster and safer in the event of an acute stroke, that can mean brain cells saved and lives saved.

Grady’s Viz.ai technology makes that more possible by enabling the rapid diagnosis and treatment of large vessel occlusion (LVO) strokes. CT scan images of patients with acute stroke symptoms at remote hospitals are electronically sent to Grady’s HIPAA protected central software program designed to capture, store, distribute, and then display medical images for review.

In collaboration with the Marcus Stroke and Neuroscience team, Viz.ai artificial intelligence technology was developed to interpret the scans, flag potential LVOs and hemorrhages, and push high-resolution, real-time smartphone alerts to our stroke team. In the time it takes to make a phone call, the whole process is complete.

Physicians can provide real-time guidance to community physicians and then decide whether a patient should be transported to the Marcus Stroke Center, allowing us to individualize treatment and deliver the most effective care.