Distributed situation awareness: a health-system approach to assessing and designing patient flow management.

Patient flow management is a system-wide process but many healthcare providers do not integrate multiple departments into the process to minimise the time between treatments or medical services for maximum patient throughput. This paper presents a case study of applying Distributed Situation Awareness (DSA) to characterise system-wide patient flow management and identify opportunities for improvements in a healthcare system. This case study employed a three-part method of data elicitation, extraction, and representation to investigate DSA. Social, task, and knowledge networks were developed and then combined to characterise patient flow management and identify deficiencies of the command and control centre of a healthcare facility. Social network analysis provided centrality metrics to further characterise patient flow management. The DSA model helped identify design principles and deficiencies in managing patient flow. These findings indicate that DSA is promising for analysing patient flow management from a system-wide perspective. Practitioner summary: This article examines Distribution Situation Awareness (DSA) as an analysis framework to study system-wide patient flow management. The DSA yields social, task, and knowledge networks that can be combined to characterise patient flow and identify deficiencies in the system. DSA appears promising for analysing communication and coordination of complex systems. Abbreviations: CDM: critical decision method; CTaC: carilion transfer and communications center; EAST: event analysis systematic teamwork; ED: emergency department; DES: discrete event simulation; DSA: distributed situation awareness; SA: situation awareness; SNA: social network analysis.

A Blended Transfer and Communications Center: Designing a State-of-the-Art Mission Control.

Health systems frequently are challenged by barriers to patient flow and transfer intake processes. To achieve the goals of seamless entry of patients into the health system, coordination of the safest, most appropriate transport of these patients, and efficient management of hospital throughput needs, our tertiary health system created a central transfer and communications center. From the design of the center's physical space to the collaborative education efforts, the immediate synergies created by this new "Mission Control" model impacted throughput and customer service. Achievement of these goals is facilitated with state-of-the-art technology, including an electronic throughput and flow software system, which provides real-time capacity updates and status of confirmed and pending discharges. Because a centralized, information-centered approach to coordination has been such a success, expansion to other departments is underway. We are also finding that our operations center is playing a more central role in emergency operations and disaster management logistics at both the local and regional levels. Centralization of key throughput components of health systems is quickly becoming best practice. Revenue savings can be gained by combining departmental resources as well as supporting throughput efficiencies.