Part one of a three-part series

With pager, laptop, cell phone and binder in hand, Krystal Haduik starts making her rounds.

As a patient care supervisor with Acute Care Access Services (ACAS) she’s a member of a team that helps safely place patients in the right beds, and facilitates transfers and discharges for patients to their home or communities.

Patient care supervisor, Krystal Haduik, meets with Donna Lee, clinical coordinator, on 6300 neurosciences during her rounds.

Patient care supervisor, Krystal Haduik, meets with Donna Lee, clinical coordinator, on 6300 neurosciences during her rounds.

“I start my shift with a report that tells me how many patients we have in the emergency departments and on our hospital units, including how many are scheduled for surgery,” says Haduik. “We also know how many are waiting for direct admissions – for example, a patient who’s waiting at home for a bed to open on the oncology unit, so they can come in for chemotherapy.”

When Haduik does her rounds, she works with the clinical coordinators and charge nurses to find out what’s happening at the unit level.

“Our goal is to manage bed availability and prevent bottlenecks in the system to patient placement. Our patient flow rounds give us a collaborative overview of what patients are coming in versus going out, and any barriers that need to be addressed,” she explains, adding that some of the most common questions she finds herself asking are: “Is this the right placement for this patient? Which units require additional beds? How many? Do we have enough staff for additional beds?”

Hadiuk is one of 19 patient care supervisors on the 36-person ACAS team, which also includes patient placement clerks, managers, a director and an administrative coordinator.

Patient care supervisors

The patient care supervisors are all registered nurses who have a strong clinical background and exceptional analytical skills.

“The supervisors apply their nursing knowledge and experience to assess the unique care needs of each patient and to safely place each one,” says Kerri Dolgopol, ACAS educator who doubles as a patient care supervisor when required.

“For example, the supervisors can’t just look at a patient diagnosis and say, ‘That’s appendicitis. We’ll simply place them here.’ The patient might be bariatric, have several co-morbidities and be a fall risk, so this patient will need a special bed with unique equipment and may require observation.”

Dolgopol compares the complexity of finding patients the right bed to air traffic control at the airport.

“Similar to the air traffic controllers who have a view of a pilot’s airspace and the aircraft within that space, the patient care supervisors have a view of all three hospitals and the beds on each unit within the hospitals through the Region’s electronic patient flow bed management system,” says Dolgopol.

The Allscripts patient flow bed management system provides the supervisors with real-time data, allowing them to see which beds on each unit are occupied or have been reserved, which have been vacated and need to be cleaned or have already been cleaned and are available, and which have patients requiring a bed transfer.

“On any given day, the bed management system might tell us there are 27 patients in the emergency department at Royal University Hospital requiring placement, 10 direct admissions for the day, and a patient in the ambulatory care clinic needing urgent admission,” Dolgopol says, adding that while they always have a plan in motion, it can be changed in an instant if they get new information on a patient’s condition or discharge plans.

“When this happens, we have to go back to a unit and say, ‘Change of plans. These two patients need to go here instead, and we’re going to divert these two over here,’” she explains. “In the meantime, we may be at overcapacity and have to re-allocate patients. It’s a lot of juggling, with the supervisors’ pagers going non-stop.”

There’s always a supervisor on-site at Royal University Hospital and St. Pauls’ Hospital, ensuring patient placement is flowing 24 hours a day, seven days a week, 365 days a year. A third supervisor works from Royal University Hospital from 9 a.m. to 9 p.m. to cover both Saskatoon City Hospital and Royal University Hospital. Between the three hospitals, the supervisors place an average of 120 patients each day.

“Because we’re here 24 hours a day, we get involved in everything,” Haduik says, explaining that they also facilitate problem-solving around clinical and staffing challenges, including reassignment of staff when necessary; transferring patients back to hospitals in their home communities; helping with patient transfers between hospitals and regions; and opening and closing surge capacity areas.

“We’re a resource to the units and staff and a link to the on-call team after hours,” Dolgopol adds, explaining that the supervisors assist Client Patient Access Services (CPAS) with getting patients back to their home communities on evenings and weekends.”

Patient Placement Clerks

The patient placement clerks also work 24 hours a day year round. The clerks are located at RUH and provide coverage for all three sites.

“The patient placement clerks are the communication link between the supervisors and the physicians requesting patient admissions. The clerks will enter a patient’s placement requirements into the bed management system, which electronically notifies the supervisors of the new admission request,” Dolgolpol says, adding that the clerks also complete all the admission, discharge and transfer information into the patient flow system.

Once the patient is in a bed, the clerks do the crucial behind-the-scenes work to make sure all the relevant departments (e.g., lab, dietary, switch board) know where the patient is located. If a patient status changes, they update the bed management system and share this information with the patient care supervisors.

“The information the clerks put into the system supports the nursing units,” says Dolgopol. “For example, when a patient is called in for an admission, they will ask the physician, ‘When do you expect this patient to be discharged?’ The clerks will then put that information into the bed management system. At any time, the nurse caring for the patient can go into the system and update it if the patient needs to be in hospital for longer than expected.”

The ACAS managers

“The ACAS managers have the big picture overview of the entire system,” says Mark Crowe, one of two managers who leads staff and manages bed capacity at Saskatoon’s three acute care sites.

“We look at bed management from a high-level overview of all the units throughout each of the facilities,” Crowe explains.

As managers, he and Clare Johnston are concerned with the overall intake and outflow of patients, whereas the supervisors are involved in the details of patient placement on the specific units to which they are assigned.

“For example, I have an understanding of how many people require isolation versus observation, but I don’t know the finite details of which patients are being placed where,” he says, adding that what he likes most about his position is the knowledge that he’s indirectly helping both staff and patients.

“We care about the patients. That’s the reason we’re all here,” he says.

“Knowing that you’ve kept the flow of patients moving, safely placed patients and creatively found solutions is fulfilling,” Dolgopol adds.

Leighton Tieszen, a patient care supervisor for nine years, agrees. “Sometimes you think, ‘How is it possible to find spaces for all the patients who need beds? “But at the end of the day, it works out, and that’s very rewarding,” he says.

This article is part of a three-part series.

Client Patient Access Services: Helping patients navigate the healthcare system (Part 2 of 3)

Acute Care Access Line: Linking physicians to provide better care for patients (Part 3 of 3)