July 13 2010
Featured Article
No more day-of-surgery surprises

Secure Web-based software optimizes preoperative information work flow at Wentworth-Douglass Hospital.

Gathering vital patient information in advance of a procedure is traditionally a difficult and time-consuming process. Unanswered phone messages, inaccurate or incomplete information and miscommunication create unnecessary delays and day-of surgery cancellations.

Conceived as a 30-bed hospital in 1904, Wentworth-Douglass Hospital (Dover, NH) currently operates with 178 beds. It is the largest acute care hospital on the Seacoast. The hospital strives to meet the medical needs of the community it serves, changing with the times while keeping quality and patient satisfaction a top priority. With approximately 7,000 surgical cases a year, the hospital quickly realized that phoning patients in advance of a procedure to conduct preoperative evaluations was an inefficient process. In addition to being time consuming for medical staff, it was inconvenient and frustrating for patients.

Prior to 2009, Wentworth-Douglass Hospital's preoperative clinic operated with two full-time nurses dedicated to the preoperative process. The nurses were responsible for cold calling patients to schedule surgeries and gather vital medical information in advance of their procedure. Each patient was then required to come in to the hospital for verbal and physical preoperative information gathering.

"We knew there had to be a better way to conduct preoperative screenings," says Glenn Bacon, DO, chair of the department of anesthesiology at Wentworth-Douglass Hospital. "One of our main goals in streamlining this process was to obtain required patient data for a surgical procedure in a timely and accessible manner that was convenient for the patient, yet cost effective and efficient for the facility."

Day-of-surgery cancellations have decreased 43 percent since Wentworth-Douglass Hospital implemented One Medical Passport, which allows patients to create and submit their own preoperative medical histories online before they have surgery.

To ensure high adoption rates, Dr. Bacon knew the solution had to be easy to use for patients, hospital staff and the entire surgical practice. "It had to be flexible and easily adaptable as processes and physical components changed," he says. "Additionally, it had to take into account the anesthesiology department's detailed information requirements for each patient."

While attending an anesthesiology conference in Boston, Dr. Bacon was introduced to One Medical Passport by Medical Web Technologies. "I was immediately impressed by the system," he says. "After speaking with the founder and CEO of the company, Dr. Stephen Punzak, I quickly got our IT department involved. I was excited for the hospital to begin using it."

It wasn't long before Wentworth-Douglass Hospital implemented One Medical Passport. The secure Web-based software application is specifically designed to optimize preoperative information work flow. Using One Medical Passport, patients securely create and submit their own preoperative medical histories via the Internet. When patients are scheduled for procedures, they simply access a secure Web site and provide responses to a medical questionnaire.

"Because patients fill out their medical history online and at their convenience, it is easier for them to look up personal records, including medical dates and prescriptions relevant to their upcoming surgical procedure," says Shelly Stuart, nurse manager for surgical services, same day and pre-admission services at Wentworth-Douglass Hospital. "We have found information submitted is much more complete when patients arrive for their surgical procedure. No more day-of-surgery surprises."

All documentation is collated electronically, and the completed medical history is available to the nurses, anesthesiologists and other relevant Wentworth-Douglass staff in advance of the patient's appointment, ending day-of surgery snags and cancellations.

The solution facilitates an information-checking work flow and provides tools that manage missing/incomplete information before it affects scheduling. Electronic documentation eliminates incomplete charts and lost faxes, and tracks who has done what to prepare charts along the way. Additionally, the medication reconciliation component of One Medical Passport automatically populates medications added into the software into a format that mirrors the hospital's approved format. This eliminates the need for nurses to copy medications onto specialty forms so they can be reconciled.

Because the solution is highly customizable, Wentworth-Douglass Hospital was also able to have a specific medical request form incorporated into the software within minutes. As needs change, these forms can easily be adjusted.

Wentworth-Douglass Hospital has experienced consistent growth, adding operating rooms and surgeons each year to accommodate its burgeoning needs. To address the increase in patient flow, the endoscopy unit initially planned to hire two additional nurse practitioners in 2009 with the sole responsibility of conducting preoperative assessments. "Because of the efficiencies gained using One Medical Passport, we were able to accommodate the growth utilizing our existing staff and this solution," says Dr. Bacon.

Today, the endoscopy unit's annual 4,700 patients are all screened with approximately half the hours of one full-time RN; a 75 percent reduction in personnel resources. No additional teaching or training is required. Once-lengthy nurse-assessment interviews now take a fraction of the time to validate patient data.

"Since implementing the solution, day-of-surgery cancellations have decreased 43 percent, improving our bottom line by reducing back-end labor costs resulting from cancelled or delayed procedures," explains Dr. Bacon. "We have also eliminated the time, expense and risks associated with manually and repetitively entering data on each form."

"Patient convenience and satisfaction also shows a marked improvement because most screenings are done prior to their arrival," says Stuart. "Now, only patients requiring additional medical attention are required to visit the clinic for in-person preoperative screenings.

"Immediate access to an automated medical history that is generated once a patient arrives for (his or her) surgical procedure enables our nurses and physicians to know the clinical needs of patients when they walk through the door," says Stuart. "This knowledge helps put patients at ease and provides them with an increased level of confidence in their medical staff."

One Medical Passport is currently being used for all endoscopy patients. "We have been extremely pleased with the solution. In fact, I am working to expand its use to include all in- and out-patient procedures, hospital-wide, by the end of 2010," says Dr. Bacon.

For more information on One Medical Passport from Medical Web Technologies, click here.

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