Field Notes: Small-Town Critical Access Facility Goes Big with Technology Upgrade

Jackson Parish Hospital (JPH) is a 25-bed critical access hospital located in Jonesboro, Louisiana. The hospital provides services in family medicine, pediatrics, oncology, emergency medicine, outpatient procedures, rehabilitation, occupational, and speech therapies, swing bed services, and laboratory and radiology. The facility was built in 1962 and is a publicly owned, tax-based hospital. JPH employs 155 full-time employees, 65 part-time employees, and has approximately 80 contracted physicians on staff. Until the present time, no renovations had been completed on the facility since an addition in 1972 shortly after the original construction. The patient mix consists of about 20-25 percent private, 30-35 percent Medicare, and 40 percent Medicaid. The facility has been a 5-star rated hospital by the Centers for Medicare and Medicaid Services (CMS) the last two years.

The Challenge

Due to limited improvements to JPH since its construction, the chief problem was an outdated facility with outdated infrastructure. This structure was built to withstand previous Cold War-era concerns for shelter and less toward modern healthcare initiatives. For example, the older layout of the hospital did not provide showers within each patient room; instead, it favored a common bath area, and more routine hospital features, such as built-in oxygen and suction, were not available in all patient rooms, thus requiring portable tanks and equipment to be at bedside. When the hospital was first built, the design suited it well, but, over time, needs and uses change, and the hospital facility did not keep up. Staff were asked to do more in the same amount of space, and distant shower facilities meant patients had to leave their rooms for baths while navigating the maze of portable devices in their room, sometimes being forced to bring them along down the hallway. An almost 60-year-old infrastructure led to reliability problems with wiring and plumbing, with staffing having to frequently shut down patient rooms for maintenance and transfer patients to other rooms when problems were found. It wasn’t ideal, and it did not instill confidence in the care being provided when other facilities in nearby cities were far more up to date.

The renovation to JPH is being completed within several stages in order to ensure patient care isn’t disrupted during the process, with the first stage being to remodel the patient wings and the next steps being an expansion of the new infrastructure to support an emergency room (ER) renovation as well as a redesign of the hospital-owned ambulatory clinics.

The Patient Wing Renovation

The patient wing renovation project encompassed a complete overhaul of the facility’s acute care patient wing infrastructure and incorporation of state-of-the-art technology. This included all new plumbing, wiring, LED lighting, UV air purification, negative pressure built into every room, bedside telemetry monitors with vital signs capability, new patient beds with nurse call integration for status reporting, vacuum and oxygen lines, Wi-Fi, asset tracking, and suite-style accommodations for patients and family. Along with the physical renovations, new technological additions included patient wing status and monitoring dashboards at the nurses station, nurse-locator badges for nurse call system automation, and individual digital whiteboards in each patient room that update in real time with the electronic health record system. Every patient room and the patient wing hallway were equipped with wall-mounted computer cabinets housing an all-in-one PC and bar code reader to allow for bedside medication administration and automated charting, and new systems like the bedside telemetry monitors and mobile vital signs monitors were integrated directly into the chart, as well, to reduce the workload on staff for documentation.

The new asset tracking system allows mobile items like wheelchairs and IV poles to be quickly located when needed or if misplaced and alerts facility staff if they leave defined zones. These renovations also included radiology department improvements such as 3D mammograms with artificial intelligence (AI) and machine learning (ML) capabilities, a CT system with 64 slice scans, and a new, next-generation ultrasound imaging with AI to improve quality and efficiency while minimizing costs to the patients. The implementation of AI and ML in the radiology department allows for cross-collaboration within departments to provide optimal care while integrating multiple specialties. Tesla Technologies is in the test phase of a Holographic Medical Pod, which is on the facility wish list for late 2021. This will involve regenerative technology and reduce healthcare costs by up to 80 percent.

Dr. Jason Thomas, COO, CIO, was the project manager and senior leadership champion for this massive project transpiring over the last 24 months. “Our stakeholders include all levels of staff and users,” Thomas says. “We recruited physicians, nurses, patient care technicians, revenue cycle analysts, health information management personnel, maintenance technicians, and IT staff to assist in the planning and project plan once our project charter was established. The governing board was extremely supportive, as well as our community, which provided valuable feedback on the changes and the transition in the look and feel of the facility developed.”

It’s evident in the wide range of improvements and accommodations for both patients and staff that substantial feedback was both solicited and incorporated into the patient wing project to both fix past issues and create future opportunities.

Patient Room Technology Upgrades

A testing environment model of Cerner, WestCom, and Dragon was established with pseudo patients such as Harry Potter to allow the providers and clinicians to test all phases of the EHR documentation before implementing the technology upgrades. Providers were supplied with iPads to utilize voice recognition through Dragon into the EHR, ensuring that patient care can be provided quickly and efficiently. This allows for documentation to be reviewed for accuracy by the physicians and signed immediately, thus eliminating any delays in patient treatment. All clinicians have Sonitor proximity badges that interface with the WestCom nurse call system, allowing the platform to notify the nursing station of their location in the facility as well as their arrival into each specific patient room. Upon entering a patient room, the wall-mounted digital screen, or Patient CareBoard™, informs the patient who has entered their room. If the staff member is responding to a patient request, it also incorporates their reason for visiting into the notification.

The Patient CareBoard was adopted after review of multiple facilities, one of which was Guadalupe Regional Medical Center. Results obtained from GRMC demonstrated a 32 percent reduction in patient call light requests; 100 nursing hours were saved every day and gained in direct patient care; and 80 percent of the patients surveyed reported an increase in the level of comprehension in communication from care providers.

An additional benefit of the location tracking built into the nurse call platform is a small emergency button built into the proximity badge each staff member wears. If they need help at any time, they can press the button and an alarm is triggered in the nurses station, alerting the staff of who needs help and their exact location. As the testing was conducted, the providers and clinicians contributed ideas for improvements and suggestions for patient enhancement. The patient enhancements in each room include displaying critical information related to their treatment and discharge planning on the Patient CareBoard, allowing patients to stay engaged with their care and know of changes as they happen in the EHR.

Each room also has an exterior digital screen that allows for nurse interaction with the nurse call platform without the need to go back to the nurses station or log into a workstation and make updates. From this room exterior console, the nurses can set timers for common tasks like medication administration, bed pan changes, or patient bed turns. They can also see room status alerts at a glance, such as the need to don personal protective equipment before entering, get alerts on if the patient is not in the room, such as if they’ve been taken to radiology for an exam, or if they are currently receiving a bed bath and need privacy. An additional monitor mounted above the exterior nurse call console also displays the status of the negative pressure system in the room, giving nurses and staff peace of mind that the system is working when needed to help reduce the risk of infection and transmission. The feedback from the patients and their family members has been remarkable, with unanimous praise and many long-time community residents telling hospital staff that they are proud of the facility, the care they and their loved ones have received, and the direction the hospital is going. The quality outcomes and the patient involvement in their treatment and care is expected to improve. Data is presently being collected, as this project is multiphased, and the first wing opened for care in March 2021.

Results and Next Steps

According to Thomas, being a small critical access hospital allows for a more personal touch regarding patient care. This personal touch required these drastic improvements in the previous infrastructure of the 1960s-era building. Complaints from both patients and staff were instrumental in driving a change to improve the hospital experience for all stakeholders. Improved patient care and satisfaction required a complete restructure of not only the physical building, but also the process in which healthcare is delivered, as modern methods conflicted with past design. These renovations are occurring in various stages to minimize disruption to the 24/7 hospital facility. Although the tasks have been monumental, both the patients and staff are excited for the changes and improvements. Future projects include patient wing dashboard screens in the ER physician sleep rooms to keep them aware of the status of hospital patients and a complete overhaul and expansion of the emergency room to incorporate new technology and processes into this area of the hospital. As JPH celebrates its 60-year anniversary next year, they’re proud to show off both the long-standing legacy of service and commitment to their patients, as well as the forward-looking momentum of bringing state-of-the-art care and technology to the communities they serve in Jackson Parish.

Jason Thomas is the COO and CIO of Jackson Parish Hospital.

Michelle Martin is an associate professor at Louisiana Tech University.

Joanna Ward is an assistant professor at Louisiana Tech University.

Brad Coody is an assistant professor at Louisiana Tech University.