America doesn’t have enough hospital beds. This could help.

Every day, across the nation, patients wait hours or days in emergency departments until a bed opens up for them in the hospital.

Patients in smaller hospitals wait to get transferred to larger ones that can handle their complex health needs.

And patients ready to leave the hospital often wait hours before they’re released, tying up beds that others need.

The problem will only get worse, experts project, due to a collision of the aging population, changes in health policy and insurance coverage that impact hospital finances, and shortages of clinical staff.

But a study shows one way that hospitals can make the most efficient use of every bed they have and give patients access to the care they need more quickly.

Published in the New England Journal of Medicine Catalyst, it details the impact of the command center M2C2, short for Michigan Medicine Command Center, that U-M opened three years ago, to coordinate inpatient bed use across the three Ann Arbor hospitals of University of Michigan Health.

In its first two years, the authors report, the command center and other operational changes increased bed use efficiency so much that it was as if U-M Health had opened 63 more adult inpatient beds.

The authors hope their detailed report will help other hospitals start or fine-tune their own command centers and the procedures that guide their clinical operations.

“We have tackled a lot of factors that affect the length of a hospital stay, and created procedures that let us use every last bed all the time, and optimize the capacity in the system,” said Vikas Parekh, M.D., associate chief medical officer for U-M Health and the study’s senior author.

“There’s still work to be done, but our efforts have translated into shorter waits for patients and increased the number of patients who can get the care they need from our highly skilled clinical teams.”

Key achievements in hospital bed use efficiency

The M2C2 project was co-led by the paper’s lead author Jennifer Pardo, MHSA, a senior information technology project manager, and Maxim V. Garifullin, M.S., a lead solution architect in the Capacity Management team.

The new paper assessed performance before, and two years after, the M2C2 opened.

In that time, the team found:  

• The total time adult patients spent waiting for available beds at University Hospital and the Frankel Cardiovascular Center dropped by 33%. This included a 37% drop in the time it took to get a bed assigned to adults who arrived at U-M via the emergency department and were approved for an inpatient stay.

• Children waiting for beds at the U-M C.S. Mott Children’s Hospital had a 13% reduction in the bed-assigning time.  

• U-M Health went from accepting 70% of requests to transfer patients from other hospitals to accepting 80% of them, thanks to new processes for prioritizing transfers in a data-driven way so that more patients can receive high-level quaternary care.

• Patients who were ready to leave the hospital procedures experienced a 12% drop in the time from discharge order to departure for adults, and 9% for children, thanks to streamlined processes after physicians sign discharge orders.

• Length of stay for adults dropped 8%, even after adjustment for patient complexity.

And while the command center cost $2.1 million to build in converted space on the medical campus, and the staff needed to run it cost $1.5 million per year, the effort has still yielded an estimated $19.5 million net positive impact on U-M Health’s bottom line. Some of the funds to create M2C2 came from donors.

Technology plus operational improvements

Pardo notes that the M2C2 command center relies heavily on two technological tools: the data dashboards made possible by the Epic electronic health record system that U-M Health and many other hospitals use, and an artificial intelligence patient placement tool developed in-house by a team led by her colleague and co-author.

“These data and analytical tools are critical, but so are the structure, governance, workstreams, procedures and goals that allow our staff to make the most of them,” she said.

She notes that because U-M Health built its own data infrastructure, rather than purchasing services from one of the companies offering such tools, it was able to share the information publicly through the paper. 

M2C2's full name is the Michigan Medicine Capacity Operations and Real-time Engagement, or C.O.R.E., Center. It combines the operations of several units that previously coordinated bed use and transfers.

The walls of its three rooms are covered with 32 huge screens displaying key information that staff can monitor and use in decisions about moving patients into beds or accepting them from another hospital.

Key data are available via intranet to staff anywhere, with color-coding for levels of real-time bed availability.

How it started, where it’s going

Part of the impetus for creating M2C2 was the COVID-19 pandemic, and the abrupt and prolonged change in bed use that happened in its first months.

But even before then, U-M Health had faced high demand for inpatient care, with hospital occupancy rates far above national averages.

Just last month, the command center also helped U-M Health pull off the feat of moving 186 adult inpatients from University Hospital and the Frankel CVC into newly opened beds in the D. Dan and Betty Kahn Health Care Pavilion, which will soon have a total capacity of 264 beds, all in private rooms.

It was also instrumental during the opening of several observation units, most recently this April, for patients whose care requires a very short stay, often after an emergency department visit.

Two levels of the building known as University Hospital South, which once housed the children’s hospital, have been converted for such care to accommodate demand.

Now, the team is working with hospital leaders in U-M Health’s regional network by implementing aspects of the system at UM Health-Sparrow in Lansing and UM Health-West in the Grand Rapids area.

The command center will also be instrumental to the upcoming project to renovate and change bed use in University Hospital, which opened 40 years ago when two-bed rooms were the norm.

A pattern for others to follow

The space has become a magnet for visitors from other health systems seeking to emulate U-M Health’s success, and for students from the U-M Medical School, College of Engineering, School of Information and School of Public Health.

Hospitals seeking to build their own command centers should start by focusing on exactly what they are trying to achieve, and then using tools such as Epic’s dashboards to get there, said Garifullin.

"The key is building solutions for each challenge, such as managing transfers, or the goal of ‘no beds fly empty’, using technology, people and processes,” he said.

Parekh, who is a hospitalist physician and professor of internal medicine, agrees.

“You can’t put a command center on top of a non-optimized system. You have to optimize the system first,” he said.

Having buy-in from top leadership to align all relevant resources around the command center structure and governance – from information technology to nurse staffing – is also critical.

Erica Herbst, R.N., who manages the team of patient flow coordinators in M2C2, notes that the opening of the command center has allowed her team to take a proactive approach to placing patients in beds.

“What once required hours of manual work has become much easier based on a proactive approach, and the staff feel better supported to make difficult decisions,” she said.

In the end, said Parekh, “Our focus is on how to get rid of avoidable delays in the system that affect the patient’s journey, by leveraging every resource we have. A more efficient hospital stay also means meeting evidence-based milestones along the way – even something as simple as timely urinary catheter removal or getting a patient up walking soon after surgery. That will create better clinical outcomes, reduce length of stay and lead to fewer readmissions."

Additional authors:  Many additional individuals contributed to the study and to M2C2’s outcomes. Some notable mentions include Niki Farquhar, M.S.E., a co-author on the Catalyst paper, as well as members of the M2C2 management and administrative team including Herbst, Christina Tikkanen M.S.W., Jess Bethel, Denyce Henderson R.N., Paul Paliani M.B.A., and Dolorence Okullo M.H.I.

Paper cited: “Designing a Hospital Command Center with Proven ROI: The University of Michigan M2C2 Model,” NEJM Catalyst. DOI: 10.1056/CAT.25.0080