ER Tracking System Prevents "Lost" Patients - Community Medical Center implements patient-tracking system - Company Operations

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.