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Inefficient communication, lagging productivity, concerns
over patient privacy and patient safety. These comprise
some of nursing's biggest problems today. At Providence
St. Vincent Medical Center in Portland, Ore., a three-year
surgery expansion project provided the opportunity to
apply new information technology to help solve these
problems and bring about a quiet revolution.
Using a new wireless phone network, enhanced nurse
call, passive infrared tracking devices and a browser-based
electronic greaseboard, the Providence St. Vincent surgical
services unit has optimized the process of admitting
and caring for patients. These tasks include quickly
locating patients and critical equipment, communicating
impending patient arrivals, notifying staff that a room
is ready or vacant or indicating a patient's readiness
status, said Kristi Ketchum, RN, a certified ambulatory
perianesthesia nurse at Providence St. Vincent.
A baseline analysis before the implementation of these
new systems revealed alarming statistics. "Our
survey indicated that our perioperative staff made an
average of 11 phone calls per patient," said surgery
information systems manager Deb Bahlman, MS, RN. "Each
phone call was at least 15 seconds long. When you multiply
that times 80 to 100 patients per day, that's a lot
of time that could be used for patient care. Now that
all communication is on an 'e-greaseboard,' no one has
to make person-to-person phone calls, and you don't
have to try to remember whom you told and whom you haven't
told. It has totally changed the environment in the
surgery areas. You walk into the units and the one thing
you notice is how quiet it is, and [that] the phone
isn't ringing."
Providence St. Vincent Medical Center is believed to
be the only facility in the United States that has combined
these technologies to create a complete system within
a perioperative environment.
The expansion project created an upgraded, 60,000-square-foot
space with 27 new operating rooms, 28 PACU and 53 short-stay
beds and supply processing and distribution departments.
This enormous new space challenged the staff to create
new ways of communicating.
Distractions and delays were commonplace in the old
OR and short-stay unit. Admitting personnel or even
nurses themselves brought patients to short-stay rooms,
leaving paperwork on admitting nurses' desks to signify
a patient arrival, and recording arrival times on a
big greaseboard.
The short-stay unit's secretary would receive so many
phone calls, she created a series of codes to be sent
to the nurses' pagers conveying various information.
"She made a little chart for us," Ketchum
said. "Otherwise, we wouldn't know what the codes
meant." To act upon these pages or to get other
info, nurses had to find a regular phone to communicate
over any distance. The overhead voice pager system was
reserved for doctors. "We had a hard time getting
a hold of people," Ketchum said.
For the friends and loved ones waiting for updates
of a patient's status, the old system provided delayed
information, if any. "We would have huge discrepancies
in the time from a change in a patient's location or
status before even many personnel knew," Ketchum
said. "Our records could show that the patient
had never arrived in OR, simply because no one had recorded
the event. It would appear we had misplaced a patient,
when it was just a clerical error." Hours could
pass before family and friends received updates.
A key target for automation was the large, centrally
located greaseboard for surgical services. This ever-changing
schedule matched up surgeries, rooms, personnel assignments
of nurses, doctors, anesthesiologists and others, all
the while patients were arriving early or late, or were
subject to changing states of readiness for surgery.
New HIPAA federal privacy laws that restrict the way
hospitals divulge information about patients meant the
highly visible greaseboard had to go, to be replaced
by information on computer screens.
Another tricky task was keeping track of portable,
shared equipment like a blood sugar measuring instrument,
which moved around the unit throughout the day, necessitating
periodic searches for it. Buying lots of these devices
is not cost-effective.
Starting in early March, all that changed. Now, tracking
patients and equipment involves the careful integration
of advanced communication and passive wireless tracking
technology. In addition to receiving an armband, registration
personnel give each patient a triangular, wristwatch-sized
tracking badge to wear. The badge continuously emits
infrared and radio-frequency signals to ceiling-mounted
sensors in the expansion area.
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