The countdown has begun.
After more than four years of construction, the Pavilion, Penn Medicine’s new 1.5-million-square-foot inpatient facility at the Hospital of the University of Pennsylvania (HUP), will open for patient care on October 30. To ensure a smooth transition, health care teams moving across the hospital campus have undergone extensive training, including “rehearsals” of day-to-day processes.
Now, in less than two weeks, the final piece of this complex process will be put into action: safely transporting almost 400 patients —including the most complex —in their beds across the hospital campus. The entire process must be completed over the course of a single day, while barely interrupting the flow of patient care.
Planning this herculean task has been ongoing for months. Mapping out this transition — determining, for example, the order and time in which each unit should be moved, which staff should accompany each patient, and patient room assignments — has required input from a multidisciplinary group of stakeholders. This includes not only nurses and providers but also Clinical Engineering, Information Services, Facilities, Admissions, and support services for patient care, such as radiology and lab medicine, among others. Neil Fishman, MD, HUP’s chief medical officer, and Paul Harrington, MSN, MBA, HUP’s associate chief nursing officer, have served as executive leads, with Kelly Hoenisch, MSN, Surgery department director for Cardiac, Transplant, and Vascular Surgery, who is the operational lead.
Moving an Emergency Department in an Instant
Because the flow of patients into the emergency department (ED) is so unpredictable, the transfer of emergency care from the current ED location in HUP’s Silverstein building to the Pavilion needed a strategy of its own to ensure a smooth transition. And that happens first thing in the morning on move day.
Here’s the plan: At exactly 7 a.m. on October 30, the ED in Silverstein on the west side of 34th Street will close and the Pavilion’s ED on Convention Avenue will open, simultaneously. “It will be a firm cutover,” said Robin Wood, PhD, RN, clinical director of Emergency and Observation Nursing. “HUP will only have one active ED.” Both locations, however, will remained staffed until the last patient at the current ED is treated and either discharged or admitted to a unit.
To help patients who arrive at the current HUP ED after 7 a.m. on the Pavilion’s opening day, “Security and one or two ED nurses will be stationed in the legacy ED waiting room to help redirect them to the new location,” Wood said. An ambulance will be available to transfer patients with trauma or acute emergency to the Pavilion, but the HUP ED “will have the capability to deliver immediate care to any truly emergent patient,” said Keith Hemmert, MD, medical director of the ED, for example, someone having heart attack or stroke, or gunshot victim. “What’s most important is patient safety.”
Two care pathways will be used for patients arriving at the HUP’s Silverstein building ED prior to 7 a.m. who need to be admitted to a patient care unit moving to the Pavilion. Depending on when that unit is scheduled to transfer care, “the patient will either be sent up to that unit that is slated to move later in the day and transported over with the rest of the unit or remain in the HUP legacy ED an hour or two longer, until that unit has moved into the Pavilion,” Hemmert explained. “At this point the patient will be sent directly to the patient care unit in the Pavilion.
“We’ll collaborate with the patient command center to see where we can fit that patient into the move sequence,” Hemmert said. “It will be a case by case, unit by unit, patient by patient decision.”
A Hospital on the Move, 12-15 Patients at a Time
Here’s how the move will take place for the hundreds of HUP inpatients whose units will soon be relocated to the Pavilion.
Starting at 9 a.m. on October 30, patients in Critical Care units will be the first to be brought across the street. Only when these patients are safely in the Pavilion will the next unit on the schedule start the transitioning process. Hoenisch said they worked closely with leaders of each unit to schedule the move time, being respectful of operations that need to happen first, such as nursing evaluations and interventions, giving medications, and allowing time for patients to eat breakfast.
Depending on patient acuity (how sick the patient is), the transport team accompanying the patient might include several people. “It’s very patient specific, consisting of whatever a patient needs,” she said. So, in addition to the patient transporter and the patient’s care team, there might be extra support staff, such as a respiratory therapist. “We’re also creating an RN transport team just for that day, to provide one-on-one nursing for the actual physical move of each patient,” Hoenisch said. “Once they get to the Pavilion, the patient’s primary nurse will assume their patient’s care.”
Maintaining continuity of care for each patient is a top priority, Hoenisch stressed. “There will be no additional handoffs at the Pavilion, which is best for the patient,” she said. As a HUP unit empties, patient care teams will cross to the new location with their patients. It is only when the last patient has been moved out of the unit that the last care team will leave and the unit will be empty.
In addition to the clinical care team accompanying each patient, “all routes will be strategically aligned with safety observers and clinically emergency support for any changes in patient condition,” Hoenisch said. All told, there will be 350 clear and identified roles of responsibilities.
During that day, four patients will be moved simultaneously on one of four designated tracks (i.e., routes through HUP to the Pavilion) to the patient bridge or tunnel leading to the Pavilion. “Our existing care areas have a huge footprint but leaving the building is not always a straight shot, she said. For example, Rhoads and Silverstein are very easy to move patients out — they’re both so close to the tunnel or bridge leading into the Pavilion — but Founders is harder; there’s more walking involved to get to the track. “We’re going into a larger footprint but the elevators are centralized and hallways are straight.”
The estimated time to move a patient will range from 8 to 12 minutes, depending on how much equipment (for example, IV poles) the patient needs to ensure a safe crossing. “At any one time, 12-15 patients will be mobilized,” she said.
The move has been months in the planning but the days — and hours — before the move will be especially crucial to its success. “We plan to meet with Admissions and nurse managers from all areas on Monday that week, running patient censuses, looking at acuity challenges and potentials for discharge,” Hoenisch said. “And we’ll do it again with our Admissions partners at 4 a.m. on the morning of the move, developing a queue list to understand what patient is being slotted to what bed. And, to determine if a patient’s clinical situation worsens, what will be the plan within the unit,” for example, moving a non-ICU patient into an ICU.
Hoenisch said that the move was planned with “our patients and families in mind. We want it to have a very positive impact to their day, to their medical interventions and treatments,” she said. “They will continue to receive the excellent care delivery that brought them to HUP — and, they get to play a part in a historical moment at Penn Medicine.”