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As clinical and financial challenges evolve, providers look to operating room processes for opportunities to achieve improvements in efficiency, revenue capture, and care quality. IT for perioperative management can play an important role. Robert Sumter, COO and CIO of Regional Medical Center at Memphis, describes the impact that Perioperative Management by SIS has had on his operating room processes.
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Answers for life. A914CX-HS-131756-M1-4A00
Copyright © 2013 Siemens Medical Solutions USA, Inc. All rights reserved.
OR Clinical and Financial
Success at The MED
July 18, 2013
A914CX-HS-131756-M1-4A00
Copyright © 2013 Siemens Medical Solutions USA, Inc. All rights reserved.
• Robert Sumter, PhD, Executive
VP, COO, CIO
• Currently responsible for clinical
and professional information
technology and process
improvement operations at The
Regional Medical Center at
Memphis (The MED)
Today’s Speaker
A914CX-HS-131756-M1-4A00
Copyright © 2013 Siemens Medical Solutions USA, Inc. All rights reserved.
Today’s Agenda
• How and why The MED selected its
perioperative solution
• Lessons learned from the six-month
implementation
• The value of a complete
perioperative record, including
automating anesthesia
• Results from automating surgical
services
Regional Medical Center at Memphis
• An academic medical center that includes a Level I trauma center serving a five-state region
• Using perioperative automation to position to meet challenges of: – Growing surgical volumes – Managing surgical expenses and improving revenue
capture – Becoming a data-driven organization – Delivering and documenting high-quality care
The Situation
• The MED elected to implement a perioperative system as part of its strategic plan to ensure that its EHR infrastructure was positioned for Meaningful Use
• The MED’s goals included: – Managing perioperative costs – Improving technology support for clinical workflows – Eliminating manual processes – Creating a complete, fully automated perioperative record
that was interoperable with the hospital’s new Siemens Soarian® solution
Why Perioperative Management by SIS?
• Legacy system in OR and PACU • Paper in PAT • Paper in Anesthesia
– no data flow – redundant documentation • Paper Charge Capture
– lost charges • Manual reports
– delayed analysis
Needed continuity of care and patient information to
flow with the patient.
Patient Information
Clinical, Operational, and Financial Outcomes At-a-Glance
• Within one month after going live with the Perioperative Management by SIS solution: – Decreased length of PAT visits by 70% – Decreased anesthesia documentation time by 50% – Increased on-time case starts by 41% – Decreased calls for patient status information by 90% – Reduced room turnover time by over 20% – Achieved 100% compliance with SCIP measures in the OR in
the first quarter after go-live – Reduced nursing overtime by 12.5%
Since go-live: – The MED recognized $10 million in additional charges over
projected budget
SCHEDULING AND PAT
Scheduling Benefits
System Security
Legible
AFTER
Web Scheduling for PAT and OR from clinics electronically.
Illegible
Confidentiality
BEFORE
Faxed Scheduling Sheets
Pre-Admission Testing: Old Process
• Completed 3 page form upon arrival to PATS • Form reviewed with patient for accuracy • Vital signs added to form • Nurse completed assessment form (VS,HT,WT) • MAR completed by hand entering all meds • All forms sent to ASU for input by ASU nurse the
morning of surgery
• Perioperative Management by SIS allows us to choose whether the patient assessment will be done as a phone call or a PATS visit
MAR completed by selecting meds from pharmaceutical list, including strength, frequency and route of dose
Patient is then sent to the OR
Information is entered into SIS
All information rolls over from the PATS Module to the ASU Module
Morning of surgery is now a verification process as opposed to a data entry process
HT & WT, VS, Medication Reconciliation Verification remains on paper at present.
Results: Length of Visit
went from 115 to 35
minutes
Pre-Admission Testing: New Process
Appointment Screen
PAT Scheduling
Surgical Scheduling (with Block Times Shown)
NURSING PRE-OP
Nursing Pre-Op
• Specialty wizards designed for ASU Pre-Op • SCIP measures incorporated in nursing assessments • Patient information gathered in PATS flows to Pre-Op
record, decreasing duplicate charting. • PNDS care plans built for pre-op patients and are
modified for each individual patient’s needs.
Nursing Pre-Op
Holding
ANESTHESIA
Anesthesia
BEFORE
Paper Block Forms
Paper Anesthesia Records
Hand Written labs from Meditech data
Paper Pre-Op
Paper Post-Op
AFTER
Auto-populates scheduling and PAT information
Auto-populates across all perioperative phases of care
Auto-populates previous cases
Wizards enable documentation by exception
• Decreases the documentation time
• Increases ease of use
Customized wizards to accommodate specific needs of each OR
Anesthesia
NURSING INTRA-OP
Intra-Op
NO electronic tracking of implants, time consuming
Care Plans were NOT established
Paper changes, time consuming, lost charges
BEFORE
Automated charge capture by exception
PNDS Care Plans
Integrated tissues and implants automation
AFTER
PACU
PACU
PNDS care plans built.
Vital signs are now automatically entered by connecting EKG Monitor to computer.
Able to track PACU minutes via SIS Analytics.
Charges are no longer entered by hand, but done automatically by computer. Families are updated on patient’s progress via tracking board. Charting time has been decreased allowing the nurse to spend more time at the bedside.
Family Waiting Room
PACU Vital Sign Graph
NURSING POST-OP
Nursing Post-Op
• Post-op instructions modified to each patient • PNDS care plans built to meet the needs of majority
of patients, but able to be modified to meet each patient’s needs
Information from PACU Module flows to Post-Op Module, reducing charting requirements for nurses
Nursing Post-Op
CHART VERIFICATION Generation of Charges
Generation of Charges (Time Charges)
RESULTS
Perioperative Services: Benefits
Achieve Process Improvements
Chart for the Future
Decrease Double Documentation
Increased Charge Capture
Improvements in Data Analysis
Smoother Workflow
• a Surgical Care Improvement Project
SCIP
Num Den Rate Num Den Rate Num Den Rate Num Den Rate Num Den Rate
SCIP-INF - 1: Prophylactic
Antibiotic Received Within
1 Hour Prior to Surgical
Incision
50 51 98.0% 43 44 98.0% 33 36 92.0% 33 33 100.0% 161 164 98.2%
SCIP-INF - 2: Prophylactic
Antibiotic Selection for
Surgical Patients
51 52 98.1% 43 45 96.0% 35 35 100.0% 33 33 100.0% 162 165 98.1%
SCIP-INF - 3: Prophylactic
Antibiotics Discontinued
Within 24 Hours After
Surgery End Time
47 51 92.2% 41 42 98.0% 32 33 97.0% 31 31 100.0% 151 157 96.2%
SCIP-INF - 4: Cardiac
Surgery Pts With
Controlled 6 A.M. P/O
Serum Glucose
0 1 1 100.0% 0 1 1 100.0% 2 2 100.0%
SCIP-INF - 6: Surgery
Patients with Appropriate
Hair Removal
156 156 100.0% 132 132 100.0% 142 142 100.0% 110 110 100.0% 540 540 100.0%
SCIP-INF - 9: Urinary
Catheter Removed on POD
1 or POD 2
42 42 100.0% 44 44 100.0% 46 47 98.0% 32 32 100.0% 164 165 99.4%
SCIP-INF - 10:
Perioperative
Temperature Mgmt
155 155 100.0% 137 137 100.0% 140 141 99.3% 115 115 100.0% 587 588 99.8%
SCIP-Card - 2: Surgery Pts
on Beta Blocker Therapy
PTA Received Beta
Blocker During the
Perioperative Period
8 13 61.5% 15 15 100.0% 15 17 88.2% 9 9 100.0% 47 54 87.0%
SCIP-VTE - 1: Surgery
Patients with
Recommended Venous
Thromboembolism
Prophylaxis Ordered
121 122 99.2% 121 122 99.0% 126 126 100.0% 96 96 100.0% 464 466 99.6%
SCIP-VTE - 2: Surgery
Patients Who Received
Appropriate Veneous
Thromboembolism
Prophylaxis Within 24
Hours Prior to Surgery to
24 Hours After Surgery
120 122 98.4% 120 122 98.4% 122 126 97.0% 96 96 100.0% 458 466 98.3%
SCIP - Appropriate Care
Measure
(All SCIP Measures)
147 160 91.9% 133 139 96.0% 133 144 92.4% 116 116 100.0% 529 559 95.0%
Legend FY 2012 < 95% 96-98% 99-100%
FY2012 YTD 4QFY2012 2QFY20121QFY2012 3QFY2012
One month after go-live: SCIP Measures hit 100% in the OR for the first time
in history
INSIGHTS
Build Complete/Accurate Procedure Cards
Have Updated Implant and Material File
Strong Dedicated Build Team -- Commitment
Strong Staff Champions for Implementation
Dedicated Training Time
Next Steps
Interoperability •Lab interface •Global Session Manager
–Single sign-on –Patient, user and clinical context sharing between Soarian
and SIS •Medication Administration Check™ (MAK) integration
–MAK patient record can be opened from the perioperative workflow
–Medications ordered from the perioperative workflow can be administered and documented in MAK then sent back to the perioperative patient record
Summary
• Reduced perioperative costs – Reduced overtime, while increasing hours of operations – Reduced supply cost usage
• Improved clinical workflows – Eliminated many bottlenecks caused by paper
• Automated processes from PAT to PACU • Converted to digital record • Used analytics to help drive decision-making • Increased revenue capture
– Anesthesia and other areas
A914CX-HS-131756-M1-4A00
Copyright © 2013 Siemens Medical Solutions USA, Inc. All rights reserved.
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