Dedicated Staff and Careful Planning Drive ED Automation Success at Chilton Memorial Hospital
(5/14/2009)

After Chilton Memorial Hospital (Pompton Plains, NJ) completed an extensive renovation and enlargement of its Emergency Department, leaders there had expectations that the quality of care would improve as well. However, they quickly found the ED's paper-based system of tracking patients couldn't keep up with the organization's lofty goals and state-of-the-art technologies. So, in early 2008, the site began planning for the implementation of MEDITECH's Emergency Department Management (EDM) product. And now that they're LIVE with the software, Chilton is starting to reap the rewards of an automated ED that is integrated with the rest of the hospital.

"Our hospital has been using MEDITECH for the inpatient setting for some time, but Emergency Department Management is the first Advanced Clinical System application we've implemented," says Karen S. Smith, RN and director of information systems and telecommunications at Chilton. "Like many EDs, we see around 60 percent of inpatient admissions initially coming through our doors. That's why it's so important for patients to have their information flowing through the continuum."

Smith says one of the biggest factors contributing to Chilton's implementation success wasn't even the technology, but the people driving it. Staff members working on the project understood the direction the hospital needed to go in, and the patient experience they wanted to provide.

"We all wanted to bring care to patients, to conform our processes to their needs, instead of making patients adjust to the routines we felt comfortable with. This was really the philosophy behind all the changes we were making."

Paper charts were making the ED a difficult place to administer quick and efficient care. According to Lee Carney, RN, MS, CEN, and director of emergency services at Chilton, patients were often experiencing needlessly long waits between arriving at the ED and seeing a provider.

"Things were really slow for us at the front end—it would take at least a half-hour for all but the most urgent patients to get through the manual registration process," she says. "And once they were registered, all we had was a magnetic whiteboard to track them. Nurses were giving 'air orders' on the fly without documenting the information, and it was very chaotic getting patients from triage to beds. We were also dealing with misplaced charts and handwritten prescriptions: a bad combo for maintaining patient safety. Overall, there was just far too much reliance on the human factor in our care processes."

Working Together and Sharing a United Vision
But Carney and other leaders at Chilton knew that in order for a new I.T. system to work in the ED, it would need to be embraced by the entire hospital community—both those who were computer-savvy, and those who were not. The project implementation team—consisting of key staff from the I.S., ED, and finance departments—collaborated with additional support from MEDITECH to figure out the best options and implementation strategies for their site.

"We allowed the clinicians and I.S. staff to 'duke it out,' so to speak. We all met every week for the last six months before going LIVE, in order to push through issues," says Carney. "One group didn't dictate to the other—we knew we all needed to work together and share a unified vision in order to move forward."

Since the executive leadership at Chilton was supportive of the ED project, the teams had the benefit of updated hardware on which to build the new software system. "The hospital was willing to give us the resources we needed to make this work, which was crucial," notes Jodi Chere, lead analyst for information systems. "By investing in wall-mounted monitors, computers on wheels (COWS), wireless connectivity, palm pilots, and quiet workspaces for physicians, our leaders made sure we had the redundancy and flexibility behind us to make our system a success. We knew we weren't going to run into hardware issues that our clinicians would blame on the new software."

But even with a stable hardware platform, the team still had to maintain its commitment to achieving those predetermined goals. "Setting goals and sticking to them were our main priorities," says Carney. "It's all too easy to let deadlines slide, and tack on another month before go-LIVE. There's never a perfect time to implement new technologies; we had to make ourselves ready to move on as we planned."

Implementing Strategies for Securing Staff Buy-In
Implementation team members set the stage to secure staff buy-in by concentrating on a couple of training strategies. First, since there were various levels of computerization among the ED nurses, the core team solicited the help of those who were most comfortable working with I.T., to serve as superusers. Second, a well-respected physician was chosen to serve as physician champion.

"Early on, we identified those whom we knew would need additional help using the system, so we could work with them one-on-one," says Chere. "Our superusers are terrific—for them, teaching their colleagues is an opportunity to learn more about the system. Having a physician champion was very helpful as well, because it gave I.S. staff one point of contact for addressing the needs of those users."

Chilton mandated practice sessions for all ED clinicians to attend, to learn the basics of the system. "We required 16 hours of formal training for our physicians and nurses, and four hours for our technicians," says Smith. "We paired staff members up for additional buddy sessions, so everyone got hands-on experience going through the electronic charts."

The team also focused heavily on teaching the nurses to strengthen their medication management process with Bedside Verification and the electronic Medication Administration Record (eMAR). "This was one of the more difficult parts of the training process for us, since we had to help these clinicians to relearn their entire process for documenting medication administration," says Carney.

"We had a lot of support from other Nursing units which were already LIVE with eMAR. They walked the ED nurses through various patient scenarios of administering meds, which really helped. It was a huge change for them, but fortunately, the learning curve is not steep with MEDITECH. Within four weeks, our nurses were sailing through all of their routines."

Reaping the Rewards since Go-LIVE
Chilton went LIVE with its new EDM software in November 2008, after nearly a year of planning and preparation. And even though clinicians have only been using the system for a few short months, ED and ancillary department leaders are already noticing differences in the quality of care.

"Finally, we've achieved integration with the rest of our hospital," says Carney. "No matter where our patients go for treatment, their providers always have the data they need to deliver safe, effective care."

According to Carney, Chilton's ED has also seen a dramatic decrease in patient wait times since implementing EDM. "We're very proud of our 20 minute door-to-doc time," she says. "Some of our clinicians initially had concerns that I.T. would slow them down. But we've actually seen a considerable amount of time shaved off the care process, especially at registration. Now, it's much easier for our caregivers to handle higher volumes of patients, and to organize their workloads more efficiently. One improvement which came as a pleasant surprise to the ED staff was in the area of billing.

"Because the ED nurses are now documenting assessments electronically, charges are being sent to the financial applications automatically, and charges are getting to patients more quickly," says Smith. "Our unit secretaries also receive automated reminders for co-pays on every patient, which has made an enormous impact on our revenue cycle. Any hospital that implements a system for their ED should be aware of how it will improve processes financially, as well as clinically."

In the near future, Chilton plans to implement MEDITECH's Operating Room Management, as well as Physician Care Manager in 2010. Smith expects the collaboration between the I.S. staff and hospital clinicians to serve them well as they progress further with the Advanced Clinicals. "Implementing software is easy. The hard part is changing habitual workflow processes," she says. "But we've proven that if hospitals have a common goal, a strategic plan to get there, and the will to grow, they can live up to their fullest potential."

 

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