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In effect, the staff of the OR, short-stay and PACU
units at Providence St. Vincent gained a system that
could track patients in ways NORAD uses to track objects
orbiting in space above Earth: precisely and in real
time. With a glance at a computer screen, a keystroke
or a mouse click, any staff member can know where a
patient physically is located, from admission to release,
and know which patient is in a particular room, and
their status, in real time.
Replacing the old greaseboard was an "e-greaseboard"
based upon new OR Tracker software from Healthcare IT
Inc. OR Tracker shipped in early March, at the same
time as it went live at Providence St. Vincent, which
became the first installed location for the new software.
Here was a new, enhanced central nervous system for
all the tasks the greaseboard had previously tracked,
visible from the Web browser screen of every staffer's
computer in the unit.
The e-greaseboard uses words, iconic images and maps
to great effect. A patient list shows each patient's
location, including bed or surgery suite number, as
well as answers to important questions. Is the patient's
name similar to another in the hospital's system? If
so, a warning icon appears next to the case details,
indicating to staff that a patient with a similar last
name is also on the schedule. Is the patient allergic
to latex gloves? Are there any roadblocks, missing prerequisites
such as signed orders for consent, or physical exam
results? Does the patient have a cold? The details are
a glance or a click away. Or, is the patient ready whenever
the OR is? If so, a green light appears next to their
name. If it's a pediatric patient, an icon displaying
little ABC blocks appears.
As the patient's discharge approaches, the e-greaseboard
even shows staff if the patient stored valuables in
the hospital's safe. In each case, a glance or click
replaces what had often been a series of time-consuming
phone calls to find the answers.
For the nurses scheduling use of the surgery suites,
the e-greaseboard provides other immediately useful
information. If a surgery is running late or finishing
up early, all resources and people can be updated right
away and personnel summoned or apprised of a postponement.
Nurses can answer family and friends' questions right
away. New, special hospital-provided pagers let guests
wandering elsewhere at the hospital know right away
when they should check in for important updates.
The e-greaseboard also leverages the graphical user
interface of the browser. "If I hold the cursor
over my last name, it shows my cell phone number and
shows that I'm taking care of patient Abbott in Room
24," Ketchum said. Hold the cursor over the listing
for the blood sugar machine, and the e-greaseboard shows
its exact location-for instance, between room 24 and
25. An online map shows the entire short-stay unit.
"If I hold the cursor over the map of an OR room,
it shows me what procedure is being done there,"
she said. A red dot shows the location of the blood
sugar machine. A separate screen shows how many patients
the PACU unit has, and how long they've been there.
If the e-greaseboard is the new shared brains of the
unit, the wireless phone system and upgraded nurse call
system represent some of its new senses.
Today, when admitting personnel push one particular
call system button in a short-stay room, it automatically
rings the appropriate nurse's new wireless phone and
tells him or her about a new patient to greet. After
the nurse appears and greets the patient, pushing the
"patient in" button lets all staff know the
patient has been greeted. Pressing a "patient ready"
button displays on the e-greaseboard that the patient
is ready for surgery. Pressing a "dirty" button
lets housekeeping staff know that a room is now empty
or dirty, and pressing a "clean" button signifies
to the charge nurse that the room is now clean and ready
for use again.
While Ketchum says that implementation of the new system
"was a breeze," it involved two years of careful
planning and communication, including with some initially
skeptical nurses. One of the first visible changes:
Charge nurses and transport teams received the wireless
phones. Other changes were more dramatic. Management
decided to cut over to the new e-greaseboard all at
once, so one day in early March, the old greaseboard
was simply gone, and the e-greaseboard was in use. "We
felt if we left a crutch, it would be used," Ketchum
said. Instead, the downtime contingency plan consists
of printing out the day's schedule in the morning, and
referring to that if needed. There's only been one significant
episode of downtime since March, she said.
Hospital management is conducting surveys to measure
the effectiveness of the automation measures. "I
know they're really tightening down on staffing, but
now it's easier for them to track charges, which is
helpful," Ketchum said. "The short-stay unit
is kind of a dumping ground for any unit that closes
after 5 o'clock. We're open until 11. Once a patient
enters our unit from another unit that doesn't use patient
tracking badges, a function of the way our system works
is they will receive a tracker badge like any other
patient. We can track how much time we spend on that
unit's patient, and that time can be charged back to
that other unit."
The majority of the nurses in the unit have drawn a
line at wearing their own tracking devices, however.
"We're working on that," Ketchum said. "Not
to record their own time, but to record their interaction
with patients. Staff is against this, mostly because
they think someone will track their time in the bathroom
or time at lunch. But the system can track a patient
or person only if the infrared sensor was installed
in that room. The sensors will not be installed in a
staff room or lounge."
While other aspects of care at the unit, such as charting,
still are awaiting automation, every day someone in
surgical services thinks of a new way to use the new
system, Bahlman said. "We are still tweaking the
system to meet the needs of the patients and staff."
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