SOURCE
Joe Fisne, CIO Community Medical Center Healthcare System 1822 Mulberry St. Scranton, PA 18501 Phone: 570-969-8789 Fax: 570-969-8951 Email: joe.fisne@CMCHealthSys.org
PROBLEM
Community Medical Center's (CMC) Emergency Department in conjunction with the hospital's Chest Pain Center and Regional Trauma Center, covers a seven-county area in northeastern Pennsylvania. Each year the emergency department treats more than 34,000 patients, and accounts for a large percentage of our admissions. However, lengthy waiting times in the emergency department were causing decreased patient satisfaction.
Physicians, nurses, and other staff wanted to be responsive to each patient's needs, but did not have a tool to monitor the progress of patients moving throughout the system. Critically ill patients always merited priority, diverting resources from those with minor ailments. Moving all patients through the system swiftly was difficult.
Emergency department staff firmly believes that all patients are important, no matter the level of their injury or illness. Without constant visual monitoring, however, only the most critical patients receive efficient care. The old process reclassified non-critical patients throughout their stay, breeding dissatisfaction with increasing waiting times. Meanwhile, the emergency department became a bottleneck for the rest of the hospital, causing delays in admissions and routine re-allocation of resources throughout other departments.
SOLUTION
In July 1998, a multidisciplinary team composed of emergency department staff and affiliated departments was formed and decided to investigate electronic patient tracking systems. They chose four vendors who presented their products to all staff members who would benefit from the system (administration, emergency room physicians and nurses, management information systems, radiology, lab, etc.). The team then narrowed the prospective vendor list to two finalists, re-evaluated their offerings, and chose Wellsoft.
Wellsoft representatives worked with the hospital to go live with the system February 15, 1999. The installation occurred on a day when patient volumes experienced an unusually high spike, but fortunately the installation went smoothly and did not impair services.
Emergency department physicians and staff can now track every patient moving through the system. Visual indicators provide a snapshot of each patient's status and warn when a patient enters inappropriate timeframes for receiving care. These color-coded indicators draw attention to patients, eliminating the need for a crisis to draw a staff member back to the patient.
Another improvement implemented was a greeter on the front end who works together with traditional admissions personnel. The greeter meets every patient, enters appropriate information into the system, and tracks patient flow.
INSTALLATION
Planning for the installation began in October 1998. Software and hardware installation occurred in early January 1999.
Components: ICMS from Wellsoft is a true 32 bit Windows application, enabling CMC to capitalize on existing hardware investments. ICMS runs on a Windows NT 4.0 server across a 10 megabit Ethernet LAN. Our initial complement of seven workstations was expanded to 15 using a mix of both Windows NT 4.0 workstations and Windows 95 operating systems. Several of the workstations are also used for other applications including the SMS Invision document scanning system.
Consultants: James Peck, Wellsoft's Director of Technical Services, worked closely with the emergency department's multidisciplinary team from the time the contract was signed, through installation and go-live.
In addition to technicians, Wellsoft sent an emergency room physician, John Santmann, M.D., FACEP, who is skilled in using the software, to work with the staff. This peer-to-peer interaction advanced CMC's understanding of the system, and increased the staff's buy-in and ability to use the system. Wellsoft consultants continue to offer the medical director, nursing director, and emergency department staff advice and opportunities for improved process flow.
Training: CMC operates a computer-training center on its campus. The hospital's MIS department arranged for the emergency department staff to meet with Wellsoft trainers and learn the entire system. The trainers walked staffers through the package, presenting its advantages, furthering buy-in for those who work in the trenches.
Cost: The cost for implementing the system was approximately $175,000, not including staff time.
RESULTS
Increased productivity was the most important outcome of the implementation. The emergency department has reported better performance and increased morale of their staff. Elopements have decreased from over 100 a month to 65-70 a month.
Improved productivity is also evident in upstream departments due to the system's promotion of a more efficient admissions and discharge process. The system also made staffing and data collection easier and more accurate. The staff now immediately detects elopements and other trends, providing instant feedback to decision makers and staff members alike.
Selasa
Isnin
Patient’s trip
Admitting. At check-in, the patient is given a tracking badge, which is attached to his wrist, next to the hospital ID bracelet. The badge emits continuous IR signals to ceiling-mounted sensors throughout the area. It also has a unique barcode associated with the patient that is typed into the OR Tracker system.
Let the tracking begin. The tracking — of time and location — now starts and doesn’t end until the patient is discharged or admitted to the nursing unit. For each milestone (such as entering the surgery suite or recovery) that the patient reaches, a new sub-clock begins, so nurses can determine how long patients spend, for example, in the waiting room, in the pre-op room and prepped and waiting to go into the OR. Location is always tracked; even if a patient is in the restroom, the patient’s location is on the board where everyone who needs to know can view it.
Pre-op arrival. The patient heads to a pre-op room, escorted by a member of the admitting staff. She presses the a call button labeled “patient in” on the room’s wall, and two things happen: a light mounted outside the room lights up to signal that a patient is in the room, and a text message is sent to the cell phone of the nurse and nurse’s aide assigned to that room.
Readied for surgery. The assigned pre-op nurse arrives in the room, completes final documentation, starts the IV and preps the patient. When all pre-op tasks are completed, the nurse pushes the next call button on the wall, “patient ready.” The indicator light outside the room changes, and an icon shows up next to the patient’s last name on the e-greaseboard (OR Tracker), the many intranet-connected monitors staff check to determine patient location and progress.
To the OR. By looking at the e-greaseboard, OR staff now knows the patient is prepped, and an anesthesiologist and surgery nurse go pick him up. Before the patient is wheeled out, the “room dirty” nurse-call button is pushed, which changes the room dome light color and sends a text message to the housekeeper’s pager. (There is one staffer for all 56 pre-op beds.) The room status also shows up on OR Tracker so another patient isn’t assigned to the room until it’s clean. After housekeeping has cleaned the room, the “room clean” button is pushed, which turns off the indicator light and clears the room for use on OR Tracker.
In the OR. When the infrared /radiofrequency sensors detect the patient’s arrival in the OR, an icon — a little face with a surgical mask on it — appears next to the patient’s name on the e-greaseboard. The procedure start time is shown next to the scheduled start time. When the surgery is complete, before the patient heads to recovery, a nurse pushes the “change over” button, which signals that the room needs to be cleaned and prepared for the next case. A text message is sent to the crew who clean the room. A nurse then pushes the “short stay” or “PACU” call button, depending on where the patient is headed. The area where the patient is going gets a request via the e-greaseboard that the patient’s arrival is pending. The charge nurse assigns the bed number, which is instantly communicated to the OR and all the monitors.
Recovery time. The patient is wheeled to the proper recovery area; the infrared/ radiofrequency sensors detect the patient’s arrival and remove the patient name from all monitors but those in recovery and the front desk. A PACU nurse assigned to care for the patient is alerted to his arrival via the e-greaseboard. The badge is removed at discharge and disassociated with the patient.
Let the tracking begin. The tracking — of time and location — now starts and doesn’t end until the patient is discharged or admitted to the nursing unit. For each milestone (such as entering the surgery suite or recovery) that the patient reaches, a new sub-clock begins, so nurses can determine how long patients spend, for example, in the waiting room, in the pre-op room and prepped and waiting to go into the OR. Location is always tracked; even if a patient is in the restroom, the patient’s location is on the board where everyone who needs to know can view it.
Pre-op arrival. The patient heads to a pre-op room, escorted by a member of the admitting staff. She presses the a call button labeled “patient in” on the room’s wall, and two things happen: a light mounted outside the room lights up to signal that a patient is in the room, and a text message is sent to the cell phone of the nurse and nurse’s aide assigned to that room.
Readied for surgery. The assigned pre-op nurse arrives in the room, completes final documentation, starts the IV and preps the patient. When all pre-op tasks are completed, the nurse pushes the next call button on the wall, “patient ready.” The indicator light outside the room changes, and an icon shows up next to the patient’s last name on the e-greaseboard (OR Tracker), the many intranet-connected monitors staff check to determine patient location and progress.
To the OR. By looking at the e-greaseboard, OR staff now knows the patient is prepped, and an anesthesiologist and surgery nurse go pick him up. Before the patient is wheeled out, the “room dirty” nurse-call button is pushed, which changes the room dome light color and sends a text message to the housekeeper’s pager. (There is one staffer for all 56 pre-op beds.) The room status also shows up on OR Tracker so another patient isn’t assigned to the room until it’s clean. After housekeeping has cleaned the room, the “room clean” button is pushed, which turns off the indicator light and clears the room for use on OR Tracker.
In the OR. When the infrared /radiofrequency sensors detect the patient’s arrival in the OR, an icon — a little face with a surgical mask on it — appears next to the patient’s name on the e-greaseboard. The procedure start time is shown next to the scheduled start time. When the surgery is complete, before the patient heads to recovery, a nurse pushes the “change over” button, which signals that the room needs to be cleaned and prepared for the next case. A text message is sent to the crew who clean the room. A nurse then pushes the “short stay” or “PACU” call button, depending on where the patient is headed. The area where the patient is going gets a request via the e-greaseboard that the patient’s arrival is pending. The charge nurse assigns the bed number, which is instantly communicated to the OR and all the monitors.
Recovery time. The patient is wheeled to the proper recovery area; the infrared/ radiofrequency sensors detect the patient’s arrival and remove the patient name from all monitors but those in recovery and the front desk. A PACU nurse assigned to care for the patient is alerted to his arrival via the e-greaseboard. The badge is removed at discharge and disassociated with the patient.
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