ER Automation in the Face of Housewide Integration

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ER Automation in the Face of Housewide Integration
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?Level IV Trauma Center ? 17,000 Annual Visits ?
10 Beds
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Best of Breed vs. Integrated HIS

• Management decision
• Resource availability

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Courtesy Meditech.com
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ER Documentation

• Live 3/97 using standard Process Intervention
  screens
• Down 9/97
• too many keystrokes
• too time consuming
• poor printout
• unable to view in PCI

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Issues

• Concise documentation to accommodate rapid
  patient turnover
• Minimal keystrokes
• Separation of subjective and objective info
• Admission, ongoing and discharge documentation
  all on one page, in one place

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Working Team

• Nurse Manager
• 3 RNs
• 1 ERT
• 1 ER Doc
• Clinical Informatics Nurse

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Brainstorming

• Logical flow to adapt to how they worked
• Skip fields that did not apply
• Multiple logins, multiple sessions
• Analyze what they wrote and how they worked
• Classified patient types
• 6 months to redesign

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Hardware Issues

• Dumb terminals at each bedside
• Convert to workstations to allow multiple logons,
  multiple sessions

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Staff Training

• Use of new forms
• group responses
• attributes
• on line documentation, ENA standards
• Use of multiple logins, multiple sessions
• Mandatory 1.5 hr. classes with checkoff

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Access from Assessments
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Functionality

• gt80 of patients done on ER VISIT form
• Single large custom screen
• Heavy on programming attributes
• Consistent lookups across routines
• Divided into 3 sections
• Initial assessment
• Ongoing notes
• Discharge

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Shared Queries

• Allergies
• Reason for Visit
• Current meds
• Hospitalizations
• These flow to the Nursing Admission Assessment

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Printing

• Using Patient Profile
• First print after initial assessment, for MD to
  view
• Final print after discharge, discard first print

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PCI View
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The last one entered on that date is the final,
complete version
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Thank You!
Debbie Kelly, RNC, BSN Clinical Informatics
Coordinator Olympic Medical Center (360)
417-7233 debk_at_olypen.com http//www.olypen.com/deb
k