Integrated systems Improve safety and efficiency
Operating rooms are one of the most challenging environments to automate be-cause the process pulls staff from the OR for training. Successful implementations depend on gradually introducing new technology, carefully integrating clinical and operational data, and designing software to match clinicians’ workflow.
At Mayo Clinic, Rochester, Minn., the surgery-anesthesia IT environment consists of internally developed OR management components integrated with a highly customized automated anesthesia record-keeping system (AARK). The AARK is part of the electronic medical record and merges data from various systems to provide a seamless view of patient information. It automatically captures data from the cardiac monitors and other biomedical equipment. Automated scripting leads the clinician through various charting actions, including physician signatures, induction documentation and changes in staffing during the case.
Mayo’s systems have evolved during the past 25 years to fit its surgical workflows. Nurses receive four hours of training on the anesthesia systems, and physicians have one-on-one training as they perform their first case or two. “It typically takes a CRNA four to six weeks to become fully proficient on the system—meaning they can chart without having to think much about it and can chart at full speed,” says Jessica Grosset, chair of the IT department. “The physician charting is not as complex, and it takes much less time to become proficient. Just a day or two will find them charting at full speed.”
Nurses at Saint Luke’s Health System, Kansas City, Mo., have been using a surgical management system since 2005. They usually become proficient within one to two weeks, depending on whether they were primarily circulators (the nurse who traditionally performs the intraoperative documentation). Workflow was reevaluated and in some cases, staffing ratios had to be reassessed. “Large, complex cases would require two circulating nurses, while smaller, quick cases would require only one circulator,” says Deborah Gash, vice president and CIO. “Now, quick cases require two circulators—one to work the room and the other to complete the documentation within the time constraints of the case.”
Vanderbilt University Medical Center, Nashville, Tenn., developed its own integrated OR management system, which is used daily by more than 800 surgeons. The software was designed to mimic standard workflow processes. Users familiar with paper OR charting can easily make the transition to electronic charting, and less than one day of training is needed to get up to speed.
VUMC has nearly a quarter-million surgeries recorded in the system. “Our goal was to create an electronic system to capture the gamut of perioperative operational and physiologic data for the purposes of process improvement, efficiency and safety,” says Paul St. Jacques, M.D., director of perioperative informatics and chair, QA/CQI committee, department of anesthesiology. Financially, the system has virtually eliminated missed billing opportunities and improved throughput without additional capacity. In terms of safety, VUMC has realized a 50 percent improvement in prophylactic antibiotic compliance and a 50 percent reduction in overall surgical infections in the same time period.
This article first appeared in the Winter issue of HHN's Most Wired Magazine.
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