Boston Medical Center’s Emergency Operations Team Accomplishes a Safe Transition for Patients & an Efficient Adjustment for Hospital Operations
Consolidating multiple hospital locations is an enormous, demanding job—and one that requires a dedicated team. In 1996, Boston City Hospital—one of the first municipal hospitals in the United States—and Boston University Medical Center Hospital merged to form what’s now known as Boston Medical Center (BMC). Since then, the hospital has worked to efficiently integrate departments and continue to offer medical care at both campuses, which until recently meant patients were often shuttled the two-block distance by ambulance from one specialist to another. In 2014, the hospital started a $270 million construction and renovation project to consolidate the hospital’s campuses—all while maintaining the same high-quality level of care and service.
Combining the two campuses—which concluded in the fall of 2018—was a vast undertaking that required years of meticulous research and planning. As part of the renovation, eight new ORs and approximately 70 patient rooms were added to the former Boston City Hospital site. Outpatient facilities and the gastroenterology department were expanded; a 48,000-square-foot women and infants center with 10 private rooms in the Neonatal Intensive Care Unit was added; and the entire campus was updated with a more modern aesthetic. The hospital’s crowded emergency department is the busiest in Massachusetts, with approximately 132,000 patient visits in 2017. It also expanded its capacity by nearly 30 percent. However, even with the additions, the consolidation still shrunk the hospital’s footprint by about 329,000 square feet, to just less than 2.1 million square feet.
These renovations also meant closing and selling buildings on the former University Hospital campus—areas that were still housing patients and contained bustling clinical and operational departments. To make the transition as seamless as possible, the hospital used the emergency management department to make the move, explains Maureen McMahon, RN, BSN, MS, director of emergency management at BMC.
“My team was responsible for moving patients from the old building to the new location,” McMahon says. “We started by doing a lot of research, and what we quickly discovered was that no one had ever maintained a functioning hospital while at the same time undergoing major construction and renovations. We were basically building a hospital—and doing so with people still inside. It was critical that we maintained safety, comfort and convenience for both our patients and staff.”
Not an Overnight Move
After meeting with the incident management team, McMahon and her staff decided it was best to use their controlled evacuation plans to move the patients out of the old building. “We had to be out of the building by Oct. 30, 2018,” McMahon explains. “That firm deadline helped us develop a timeline and formulate our plans.”
Planning for the move took almost two years, as the transition team worked to identify and mitigate potential problems and communicate with all stakeholders. Various transition sub-teams were responsible for other aspects, such as coordinating staffing, day-to-day planning and inventory allocation. The clinical teams reviewed the patient and staff impact of each move and developed strategies for ensuring effective clinical care during the transition. Meanwhile, supply teams planned for inventory and stocking, making sure there was enough equipment and furniture.
Concurrently, a command center tracked and documented patient departures and arrivals. All team members were trained and assigned specific roles to guarantee a safe and efficient move. (See sidebar for responsibilities of team members.)
Three Tips for Moving a Hospital
Moving a hospital requires strategic thinking and the input of leaders from multiple departments, explains Maureen McMahon, RN, BSN, MS, director of emergency management at Boston Medical Center (BMC). As the incident commander for BMC’s latest move, she shares these three tips.
1. Include your emergency manager in the planning from the beginning. The emergency management team is experienced in efficiently and safely moving patients. Use your hospital’s emergency operations plan and team to keep patients safe.
2. Determine how elements of your evacuation plan could be employed. Review all of your hospital’s emergency plans. For BMC, the controlled evacuation plan worked best. Plus, the experience helped the team gather data for future incidents.
3. Brainstorm all contingencies and identify weak points. There’s more to consider than just moving patients from one spot to another. Multiple things could go wrong, from call bells not working, to hot water being off, to missing fire extinguishers. Spend time ensuring staff is well-trained and prepared for any potential problem.
“It truly took a village to make this happen,” McMahon continues. “Our move and administration teams consisted of 45 people, and every person was an integral piece of the puzzle. Having the right players in the right places ensured that the move could happen without disrupting clinical care or jeopardizing patient safety.”
When it came time to physically move patients, they divided into two sub-teams—the sending unit and the receiving unit—and followed a step-by-step scheme:
• The receiving unit leader indicated readiness for group one patients.
• The sending unit leader sent transport to retrieve patients.
• Patients were tracked upon departure from the sending unit and transferred to ambulances in the departure area.
• Patients were tracked upon egress from departure area and transported by EasCare Ambulance with BMC staff members.
• The sending unit leader sent transport to retrieve group two patients.
• Group one patients arrived at new location and were transferred to BMC beds in the arrival area.
• Group one patients were transported to the receiving unit, then settled into assigned rooms.
A Role for All
The plan sounded simple, but patient conditions in various units, such as the intensive care unit or med/surg department, led to adjustments in the sequence of events, McMahon says. Working behind the scenes were clinical leaders assigned to monitor each patient’s condition, equipment and supply teams to ensure medical equipment and materials were available and operational, and cleaning teams to come behind each transported group of patients to clean and decommission units. The teams also had contingency plans for all types of events—from elevator failure to medical emergencies to even a patient’s refusal to leave. Whatever the event, McMahon’s team was prepared.
“We bent over backwards to ensure patients were comfortable and understood the reason for the move. We had warm blankets for patients as they left and double-checked to make sure they had all of their belongings. We offered special shuttles for family members and had hospitality lounges set up for them with food and drinks,” McMahon explains.
The intricate planning for all contingencies paid off. “We have video footage of the move, and every patient has a big smile on their face,” she says. “Our team ensured all patients were happy and comfortable.”
Moving just one unit sometimes took an entire day, with activity starting around 8 a.m. and concluding around 7 p.m. The entire moving process took about two months, with the hospital transporting 331 patients from pediatrics, labor and delivery, NICU, med/surg, intensive care unit, critical care unit and other departments. Also moved to the new location were the blood bank, laboratory, radiology, supply warehouse and more.
“It was a massive team effort,” McMahon says. “We’re proud of the people that made it all happen.”
Boston Medical Center’s Move Execution Team
|Incident Commander||Move progress and command operations|
|Move Operation Chief||Move execution, patient and employee safety|
|Sending Unit Leader||Sequencing and timely, efficient and safe departure of patients|
|Receiving Unit Leader||Timely, efficient and safe reception of patients|
|Departure Area Manager||Safe transfer of patients for ambulance transport|
|Arrival Area Manager||Safe reception of patients from ambulance transport|
|Tracking Officer||Manage the electronic tracking board to document move|
|Logistics Chief||Manage and deploy all support services|
|Clinical Staff||Care for patients and ensure patient safety|