The impact of hospital command centre on patient flow and data quality: findings from the UK NHS

Abstract

Background: In the last six years, hospitals in developed countries have been trialling the use of command centres for improving organisational efficiency and patient care. However, the impact of these Command Centres has not been systematically studied in the past.

Methods: It is a retrospective population based study. Participants were patients who visited Bradford Royal Infirmary Hospital, accident and emergency (A&E) department, between Jan 01, 2018 and August 31, 2021. Outcomes were patient flow (measured as A&E waiting time, length of stay and clinician seen time)and data quality (measured by the proportion of missing treatment and assessment dates and valid transition between A&E care stages).Interrupted time-series segmented regression and process mining were used for analysis.

Results: A&E transition time from patient arrival to assessment by a clinician marginally improved during the intervention period; there was a decrease of 0.9 minutes (95% CI: 0.35 to 1.4), 3 minutes (95% CI: 2.4 to 3.5), 9.7 minutes (95% CI: 8.4 to 11.0) and 3.1 minutes (95% CI: 2.7 to 3.5) during ‘patient flow program’, ‘command centre display roll-in’, ‘command centre activation’ and ‘hospital wide training program’, respectively. However, the transition time from patient treatment until conclusion of consultation showed an increase of 11.5 minutes (95% CI: 9.2 to 13.9), 12.3 minutes (95% CI: 8.7 to 15.9), 53.4 minutes (95% CI: 48.1 to 58.7) and 50.2 minutes (95% CI: 47.5 to 52.9) for the respective four post-intervention periods. Further, length of stay was not significantly impacted; the change was -8.8hrs (95% CI: -17.6 to 0.08), -8.9hrs (95% CI: -18.6 to 0.65), -1.67hrs (95% CI: -10.3 to 6.9) and -0.54hrs (95% CI: -13.9 to 12.8) during the four respective post intervention periods. It was a similar pattern for the waiting and clinician seen times. Data quality as measured by the proportion of missing dates of records was generally poor (treatment date=42.7% and clinician seen date=23.4%) and did not significantly improve during the intervention periods.

Conclusion: The findings of the study suggest that a command centre package that includes process change and software technology does not appear to have consistent positive impact on patient safety and data quality based on the indicators and data we used. Therefore, hospitals considering introducing a Command Centre should not assume there will be benefits in patient flow and data quality.