Mass.
Emergency Department Improves Communication, Efficiency with
Patient Trackers
(6/12/2009)
 As the second
busiest community hospital ED in Massachusetts and
the only facility in the south coast region to
provide 'round-the-clock emergency care, St. Luke's
Hospital (New Bedford, MA) knew its patients had
suffered their share of long wait times and
overcrowding. Three years ago, the organization set
out to improve its emergency services through an
extensive renovation project which not only
modernized the facility, but also its care processes.
A key component to the strategy was implementing
MEDITECH's Emergency Department Management,
transforming the department's paper-based logbook
into automated patient trackers. "Our ED receives more than 80,000 visits per year—three times the national average for a community hospital," says Michael McLaughlin, M.I.S. Applications Director at St. Luke's. "Since going LIVE with EDM in November 2008, the tracker component of the software has helped our physicians to provide safer, more efficient care to the community." The physician adoption rate in St. Luke's ED is 100%, thanks to a successful implementation and beneficial EDM components such as the tracker. Now, the department is seeing reduced wait times and improved communication, all while giving physicians fast access to the information they need. The "Divide and Conquer" Approach A major part of the ED's transformation involved replacing an antiquated, paper-based logbook system with 10 public and private trackers. The logbook approach would not be effective in the newly renovated ED, which was now divided into five care teams based on patient populations and acuity. "We took a 'divide and conquer' approach with the trackers," says McLaughlin. "By giving each care team its own tracker, we were able to improve communication among team members. If a clinician wants to look at overall ED activity, he or she can access a department-wide tracker and quickly see all the teams' workloads at any given time."  St. Luke's department-wide trackers, visible on monitors located at the nurses' station, keep physicians and nurses informed of how long patients have been waiting, status events, and indicators, as well as order status and result availability. In addition, physicians have their own private trackers, which provide them with access to their patients' clinical information at a glance, from fixed workstations in trauma and triage; they no longer waste time tracking down nurses' notes, or the nurses themselves, for patient information. For example, physicians can use their own trackers to access clinical data such as results stored in Patient Care Inquiry (PCI), vital signs in the Patient Summary, and information from repeat patients' visits via Emergency Department Data. MIS Manager Sandra Capano says, "Our experience with another vendor's tracker helped us to figure out what the physicians wanted on the screen, so we were better able to meet their needs. Once the trackers went LIVE, they didn't want anything removed. Instead, they wanted additional information available to them, including the attending physicians' names and additional scripts." Losing the Logbook Although feedback from physicians has been very positive, Patricia Keenan, RN, manager of patient care, admits providers were apprehensive about automating some ED workflow processes, namely the logbook. "As antiquated as the process was, physicians had become so accustomed to checking the logbook for new patients that they had a hard time imagining how things would work without it. Before we went LIVE with EDM, they were very concerned about 'post-log life' in the ED, but now they don't even miss it," she says. Physicians feel communication has improved among the care teams, giving them a better understanding of what's happening department-wide. Gregory Hunt, MD, ED physician champion at St. Luke's, explains, "If we see the scroll button on the waiting room tracker, we know there are more than 22 patients to be seen, because there are 22 spaces on the tracker. We're better able to prioritize patients and we're not wasting time searching for paper charts, which makes for a more efficient ED." Hunt expects he'll soon have the statistics to back him up. St. Luke's is in the midst of a Lean/Six Sigma pilot study to track turnaround time and status events in the department. "Our goal," says Keenan, "is to use the statistics to help us set up a "door to doc" program. Clinically-Driven Project = 100% Physician Adoption Capano, who managed the project, says strong provider leadership made the difference in enabling the department to achieve its stellar 100% physician adoption rate. Hunt, along with Daniel Shea, MD, ED director, supported provider decisions and maintained a positive attitude throughout the project. "Dr. Hunt took on the responsibility of demonstrating EDM to the other physicians. He sat down with each provider, one-on-one, to review the software and answer questions. His participation really had an impact on getting the other physicians to be receptive to change," she says. In addition, Hunt and the ED physician champions representing Southcoast Health System's other two facilities—Tobey Hospital (Wareham, MA) and Charlton Hospital (Fall River, MA)—met weekly during all three implementations. The entire Southcoast Health System is LIVE with EDM, utilizing the trackers, and yet the physician champions continue to meet every four to six weeks to standardize content across the EDs and to discuss upcoming enhancements from MEDITECH. Although everyone else involved in the project credits Hunt's extraordinary efforts with smoothing the transition from paper-based to automated physician workflow processes, he is quick to point out one factor he believes attributed to the high acceptance rate. "Most of our physicians are enthusiastic about these systems and have a pretty high comfort level with the technology," says Hunt. "That certainly made the transition easier." His advice to other EDs about to implement MEDITECH's solution is simple. Don't overload the physicians, he says. Give them information slowly, not all at once, and make sure you give them plenty of heads' up. In the Works... According to McLaughlin, St. Luke's ED plans to implement MEDITECH's CPOE during the summer of 2010. "Single sign-on is in our future plans, too, as well as Physician Documentation as the final step," he says. With several implementations on the horizon, Capano seems surprisingly unruffled. Perhaps it's because St. Luke's has an award-winning implementation under its belt. The core team—comprising I.S., ED, and Admissions staff members—received the team award of the 2008 Southcoast President's Award for Excellence. "The award is especially significant to us, because we were nominated by our co-workers," says Capano. "Their recognition means a lot, and gives us the confidence to keep moving forward with MEDITECH." St. Luke's
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MEDITECH
Medical
Information Technology, Inc.
MEDITECH Circle
Westwood, MA 02090
781-821-3000
www.meditech.com