Ensuring effective isolation management

An effective isolation management strategy is directly linked to the rapid identification of ‘isolation’ patients and includes timely and efficient cohorting, such as assigning two patients with MRSA to the same room, as well as 24/7 real-time communication of this information throughout the hospital. By closing communication gaps related to isolation patients, hospitals are able to maximise efficiency of inpatient flow. However, the impact of isolation management – including informed decisions regarding cohorting when necessary – is sometimes overlooked when considering effective inpatient throughput. Indeed, the management of this type of patient flow in many hospitals today is, at best, laborious and untimely. Often characterised by avoidable delays in transferring patients from unit to unit, the classic scene in many hospitals is that of frustrated patients waiting for long periods in the emergency department for an inpatient bed – a bed that might otherwise be available if real-time information could be accessed regarding isolation needs. Quite often, inefficiencies in managing isolation patients can worsen during ‘off’ hours, when infection prevention staff are not available to assist in the ongoing challenge of managing bed assignments when isolation procedures need to be enacted. It is fair to point out that delays in cohorting determinations are sometimes unavoidable, due to overall patient census and acuity, as well as staffing levels. However, poor processes in managing isolation patients should not be one of the contributing factors.

Manual tracking limitations

Many hospitals currently rely on manual processes that do not support effective real-time management of isolated patients, which can therefore hamper the ability of the infection preventionist to deploy a proactive approach. This inefficient method impacts patient throughput. It creates a reactive response to isolation management that can result in an inaccurate assessment of bed availability and increase the potential of exposure for room mates of newlyidentified infectious patients. Under a manual system, an infection preventionist’s typical day will start with a paper report of isolated patients and their current status which was generated that morning. The information in this report typically includes room location, diagnosis and the latest information on their condition. One challenge posed is that the original list becomes increasingly outdated with each passing hour, as patients are admitted, transferred and discharged throughout the day. It becomes a difficult task to remain informed on the real-time hospital-wide isolation requirements at any given point in time. Without real-time alerting, provided by an electronic surveillance system, facilitation of isolation management results in the time-consuming task of making numerous inquiries via phone or computer. In contrast, with an electronic surveillance system, clinicians are able to visualise the hospital-wide status of isolation patients and strategise accordingly in a concurrent, pro-active manner. Inefficient patient throughput can lead to potentially frustrated patients, physicians, and staff. It can also directly impact the bottom line in a variety of ways. Consider the following scenario, for example: An infection preventionist arrives at work at 8 am and is immediately informed the facility’s bed status was declared full at 2 am. As a result, the emergency department has been directing the local Emergency Medical System to divert potential patients with non-life threatening needs to a nearby hospital. In today’s fiscal bottom-line healthcare environment, this means that a patient, and the potential revenue that patient represents, will be redirected elsewhere.