'Virtual white board' helps to cut hospital length of stay

First there was the chalkboard. Then the dry-erase board came along. Now, hospitals are replacing the departmental white board with electronic alternatives.

"Turning this manual board into an electronic white board with large monitors is more consistent, saves time and improves visibility not only on the floor unit but throughout the hospital. It also lets clinicians input other codes and times to help manage patient status and overall length of stay," Robert Watson, who works in strategic process improvement at Inova Health System in Falls Church, Va., writes in Hospitals & Health Networks.

While some software packages can cost upward of $200,000, Inova took a homegrown approach at the health system's Mount Vernon Hospital in Alexandria, Va., setting up Microsoft Excel worksheets with special formatting, numerous macros and customized design for each hospital unit, with the goal of reducing patient length of stay.

The virtual white board tracks length of stay by requiring a time stamp of each patient's arrival on the hospital unit. Mount Vernon's director of case management insisted that the display include a planned discharge date and provide automatic notifications, in the form of color-coded visual cues, on the appointed date. Other color codes indicate special status like a patient's risk of falling, isolation and do-not-resuscitate orders. "The nurse or doctor can view the board at a glance and understand patient status immediately," according to Watson. "Also, color coding when a patient gets discharge orders helps the flow of patients on the floor."

Building the system required input from physicians, nurses and administrators in each unit, and the decision to build in Excel came from the medical-surgical floor, which piloted the virtual white board. The IT department also created a summary board, located on a separate server, for administrators to track patient metrics.

Since the board went live in June 2009, average patient length of stay is down by three-quarters of a day, Watson reports. Time to transport patients from the ED to an inpatient unit has been halved. "We would like to claim that it was all due to the board; however, the board just provided more visibility for LOS data and helped in the reduction."

For additional details:
- read Watson's Hospitals & Health Networks commentary