Air traffic control center for patients helps Duke hospitals manage COVID-19 crisis
As the number of COVID-19 patients soared this month, hospitals across North Carolina used all sorts of strategies to try to make sure they had enough beds, staff and equipment for everyone who came through their doors.
At Duke Health, the centerpiece of that effort is a basement room full of computers and big screens that looks and functions like an air traffic control center.
The CARE Hub runs 24 hours a day, seven days a week, tracking the planned admissions and departures of patients at Duke’s three hospitals in the Triangle. Data from surgical and emergency departments as well as information about transfers from other hospitals and available beds all comes together in one place, so planners can tell where and when beds will be needed and when they’ll become available, said Mary Martin, chief operating officer at Duke University Hospital.
“It’s four big computer screens in the front and individual desks with folks with their own computers, each doing discrete tasks to make sure that we’re landing the planes, or the patients, on time,” Martin said.
Working with GE, Duke began developing and testing the CARE Hub in 2019, well before the coronavirus pandemic. But the system (the acronym stands for Capacity Access Real-time Engagement) has been invaluable in helping Duke deal with the crush of COVID-19 patients, Martin said, by showing planners when they need to postpone surgeries or make room for patients coming in from the emergency department.
The people who transport patients and clean patient rooms are also plugged in, so they can be ready when needed, Martin said.
Duke estimates it was able to accept 500 more transfer patients from other hospitals in the 10 months ending last March using the CARE Hub to know when beds would become available.
“What used to happen is someone would call the transfer center at 3 p.m. and say, ‘Could you accept someone?’ and we’d say, ‘No, we’re full,’” she said. “We didn’t have this ability to enter the fact that by 8 p.m. we’d have seven ICU beds open because of transfers out. Now we can see that and say, ‘Yes, we’ll bring you in.’”
Managing hospital beds becomes critical
The coronavirus pandemic has pushed hospitals to, and sometimes beyond, their limits. Between Thanksgiving and mid-January, the number of COVID-19 patients in hospitals statewide on a given day doubled to nearly 4,000.
Managing the use of hospital beds has become crucial, said Rowell Daniels, chief operating officer for UNC Hospitals. At UNC Medical Center in Chapel Hill, administrators used a data system similar to Duke’s to determine that the number of surgical patients admitted to the hospital varied by day of the week, from 13 to 31, Daniels told members of the hospital’s board of directors. Eliminating the peaks helped keep the hospital from being overwhelmed on some days, he said.
“Working with our surgeons, we’ve been able to move patients from days that we anticipate being high to days that we would have lower volumes,” Daniels said. “And that’s created a smoothing effect. We’re still caring for all the patients that we need to, but we’ve been able to move them to times of the week that would not normally have higher admit rates.”
The most visible step taken to address hospital bed shortages occurred in the foothills west of Winston-Salem. Caldwell UNC in Lenoir suddenly found itself treating 49 people with COVID-19 on Christmas, pushing the total number of patients in the hospital to 126, more than twice the normal load, said Laura Easton, president and CEO. The emergency department got so full that the hospital began seeing emergency patients in an X-ray room.
“We were definitely beyond our max,” Easton told members of the UNC Health board of directors this week.
Caldwell UNC and four other small hospitals in the region asked the humanitarian group Samaritan’s Purse to set up a field hospital in Caldwell’s parking lot to treat COVID-19 patients. The 30-bed tent hospital began accepting patients Jan. 7 and should no longer be needed by the second week of February, Easton said.
Hospitals across the state are seeing a similar easing of COVID-19 caseloads. On Friday, 3,048 people were hospitalized with COVID-19 statewide, down from a high of nearly 4,000 on Jan. 14, according to the state Department of Health and Human Services.
Duke’s three hospitals peaked in mid-January as well, at more than 200 patients a day spread over its three hospitals in Durham and Raleigh. Martin said the post-holiday surge was hard on doctors, nurses and others in the hospitals.
“It was very difficult on our team, I’m not going to lie,” she said. “We managed to get through the week, but it was a full-court press every day.”
She said the CARE Hub saved a lot of work for hospital planners and helped Duke make the most of its beds and staff.
“Without it, I fear that we would not have been able to take as many transfers or keep as many of our surgical procedures for those that really need care,” she said.
This story was originally published February 1, 2021 at 6:00 AM.
