August 17 2010
Featured Article
Increase OR efficiency by nixing paper

A new automated perioperative system at St. Vincent's East dramatically increases operating-room efficiencies and helps the healthcare system remain competitive with local hospitals.

By Mitch Work, MPA, FHIMSS

Executives, managers and clinician leaders at St. Vincent's East, one of five hospital facilities comprising St. Vincent's Health System in Birmingham, Ala., have been moving forward to implement, improve and optimize their clinical operations in the operating room (OR) and other perioperative areas in their facilities. Their work in this area has resulted in an ongoing evolutionary process that over time has required numerous steps and phases, as the St. Vincent's Health System moves forward toward automation of the entire perioperative process - one of the last areas to become automated in most hospitals.

This process began when St. Vincent's East (formally known as Medical Center East) executives decided that a new automated perioperative system was needed in order to increase OR efficiencies and help the healthcare system remain competitive with local hospitals. They realized that their existing, largely paper-based, system would likely not support the anticipated growth of surgical procedures. St. Vincent's East leaders issued an RFP, assessing the potential offerings of a variety of vendors. After a series of site visits and product demonstrations by several perioperative vendors, Alpharetta, Ga.-based Surgical Information Systems (SIS) was selected, The final selection was motivated by two main factors: the flexibility of the system enabling the hospital to do its own customizing of screens and reports without having to go back to the vendor for support; and the vendor's future development plans to offer new perioperative IT solutions were in keeping with the hospital's strategic IT goals.

Implementation of the new system began at the 274-bed St. Vincent's East, which became a beta site for the vendor's product suite and has participated in a series of product upgrades, new releases and applications with new functionality that is ongoing. Implementation began with nursing documentation in the OR and took nine months to fully complete. To demonstrate the reliability of the new system and to address concerns of nurses and physicians regarding the accuracy of a new automated system, the hospital ran a brief parallel data-entry process comparing the data entered into the paper chart to the automated data entry system. The results were positive, and the paper charting was eliminated. Training was conducted by the vendor with OR managers and then with nurses and physicians. This has since evolved into a train-the-trainer method, with super-users identified on each OR team to assist others in using the new system and new modules as they became available.

"When you compare the original paper-based environments with the automated environment we have here now, there's no question that this is a more efficient environment for everyone, particularly for nurses," says Theresa Tyndal, administrative director of surgical services at St. Vincent's East. To begin with, there is the core nursing documentation element of the SIS system, which Tyndal says has been very important in improving every aspect of how nurses work in the OR. Since implementing the nursing documentation module, Tyndal notes, nurses are able to very quickly enter key data in a timely manner. Such data includes the utilization of specific surgical implements and supplies, which must be entered in order to accurately track supply utilization for charge capture purposes. They can also access the system in order to maintain information on surgeons' preferences for specific implements and supplies through the use of electronic physician preference cards.

Identifying benefits

By optimizing perioperative processes, the hospital has seen many benefits from the implementation that has taken place at St. Vincent's East, and administrators look forward to continuing to ramp-up implementation of more modules available from the vendor. "There are so many areas in which automation can make a difference," says Kim Agee-Gordon, Surgical Services System Administrator for St. Vincent's East. "For example: Before the initial implementation of the system, it took 2.5 hours to hand deliver the surgery schedule to all involved staff. After the system was installed, virtually no time was required to hand deliver the surgery schedule, because we were able to send the schedule electronically. This automation also reduced the time required to complete each scheduling form from 2.5 minutes to 1.5 minutes." Given that St. Vincent's East performed 10,777 surgical procedures in 2009, these time savings are substantial and permit clinicians to spend more time on direct patient care.

The other benefits that Agee-Gordon and her colleagues have already identified from the phased-in implementation and upgrades of their perioperative IT system include:

  • Using their solution to enhance their financial and accounting processes by improving lost charge capture rates. In FY 2009, the organization realized a savings of $58,000 and a 25% improvement in lost charge capture by automating their pick sheets.
  • Storing historical data on patients who have undergone previous surgeries has saved 30 minutes per pre-op assessment time for repeat patients.
  • Following the automated documentation scripts enables pre-op nurses to gather all required information the first time, saving 30 minutes per day by avoiding the need for nurses to finish incomplete charts.
  • Capturing automatically over 125 vital signs from patient monitors in PACU (post anesthesiology care unit) saves nurses 30 minutes per procedure in documentation time.
  • Helping OR managers and nurses to understand the business aspects of the OR, by providing them with the data needed to track and compare a wide array of variables, including OR suite turnover times, equipment and supply costs, both by type of procedure and by surgeon.
  • Providing on-demand access to the pricing of equipment and supplies, which is helping the hospital's managers to track and control supply costs.
  • Facilitating regulatory compliance through archiving and rapid retrieval of data on each surgical procedure to document compliance with regulatory agencies such as the Oakbrook Terrace, Ill.-based Joint Commission. For example, the recent requirement of documenting time-outs preceding the initiation of a surgical procedure is now available automatically.

At St. Vincent's East, a broad range of preoperative modules has already been implemented, Tyndal notes, such as nursing documentation, scheduling, pre-admission testing, same-day services admission, interoperative record and PACU record, as well as modules within the documentation system that help managers and clinicians manage physician pick sheets and procedure cards.

You can learn more about SIS solution implementations and their effects - straight from the mouths of hospital executives, physicians, clinicians and IT professionals - by clicking on the video picture link above.

One good example is nursing documentation. "When we're in the room and circulating, we click on the materials tab in the system, and that procedure card is there, and the pricing is there. So we know, and can communicate to the surgeons, at a glance, how much a trocar costs or how much a catheter costs. And if they don't use something on the materials list, we delete it right there, so it doesn't show up on the charge sheet," Tyndal says, referring to the set of documents that must be filed with the payer for every surgical procedure. This process has always provided nurses and managers with frustrations in the paper-based world. "If we still had to do this on paper," she says, "we'd have to do this all manually. So using this information system saves time, costs, and provides us with a high level of efficiency. It's automatic. And everything's incorporated into the document."

Additionally, "We are immediately 100-percent compliant with the requirements of the medical record, as all the critical information defaults automatically into the patient's record," Tyndal says.

"We're participating in a supply chain management initiative now," Tyndal says. "We can pull up the daily costs of every procedure and analyze those costs along different dimensions."

And when it comes down to specifics in the regulatory area, there are other positives to report. For example, a recent change in the federal Centers for Medicare and Medicaid Services (CMS) guidelines on OR management has to do with clinician documentation of actions taken during surgery. Until recently, says Tyndal, CMS had two requirements around each action taken during surgery: documentation of the date of each action and a clinician signature. Now, she says, CMS requires documentation of the time of every action taken. Fortunately, because of the features available in our perioperative system, she says, "We went from zero-percent compliance to 100-percent compliance with the new requirement in one day with a new forms builder from the vendor."

Into the future

Looking forward, St. Vincent's East is considering the implementation of more perioperative modules and is continually planning how to further optimize OR processes. "In the near future, budgets permitting, St. Vincent's East surgery department would like to implement rules-based charging (RBC)," Agee-Gordon says, "a capability that will automatically populate the surgical patient's bill in real time while the patient is undergoing a procedure. This will help reduce billing time to fewer days and become more helpful to the accounts-receivable department."

As anyone who has worked in OR or perioperative services knows, such a step would be significant for nearly any hospital organization. With constant challenges to optimizing charge capture and days in accounts receivable, it seems that automation of such procedures should take off rather quickly among today's cash-strapped hospital organizations nationwide. Additionally, hospitals that have made the most progress in this area should be well positioned against their competitors in local markets when it comes to cash flow availability, financial stability and ongoing improvements in clinical efficiency.

St. Vincent's East is considering implementing new perioperative applications for areas like anesthesia management and tissue tracking. "The doctors are all positive about this," Tyndal reports. "They know that the automation is making things more efficient for them as they practice in our ORs. And the nurses are happy, as well."

"The working environment is so much more conducive to productivity and efficiency than the old, paper-based world was," Tyndal says. And as the hospital system continues to evolve its analytics capability, its managers will be able to develop more and better metrics to track and compare quality of care, administrative efficiencies and cost reductions in perioperative operations.

About the author

Mitch Work is president of The Work Group, Inc, a healthcare technology consulting company in Lincolnshire, Ill. For more information on Surgical Information Systems, click here. For more information on The Work Group, click here.

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