Question

Case Study “ Why can’t admitting remember to change these patients to pre-admit so that we can see the information from the emergency room in their electronic record and view their current medication?” the scribe complained to the cath leb nurse. “ I will never understand why it is so difficult to get cath lab patients transferred from an ED patient to pre-admit.” The scribe stops trying to record patient information in the electronic health record and calls the admitting department. The scribe is so frustrated because admitting has not updated the patient type listed in the electronic health record. This patient was seen a few minutes ago in the ED for an acute myocardial infarction. The patient had come into Western States Hospital with a chest pain. An EKG was ordered for the patient and the EKG showed that the patient had a STEMI. Once this diagnosis was made, the patient was emergently transferred to the cath lab. Although the electronic health record used by the facility has many features that allow care providers to access necessary patient information, the system has a few issues. The issue that caused the most headaches in the cath lab was the fact that the cath lab personnel could not view important patient information or chart new information until the admitting department changed the patient type from ED to pre-admit. Although there was a way to override the system to view the necessary information, this process was also concerning. Charting within the system was not possible even with the override, and there had been some instances where the latest information from the ED was not in the system if the system had been overridden. Time frames were also problematic. Quality measures and reporting requirements necessitate accurate times. “ Door-to-balloon times” are an important reporting measure. Without the ability to chart in real time, the time of arrival to the cath lab and the time the vessel was opened are not accurately reflected in the system. As Western States Hospital collects data to determine how long it takes cath lab staff to open a vessel once the patient is in the cath lab, the report is showing that it happens very quickly, it almost seems like the average time is unrealistic. The procedure in the cath lab is that a scribe or technician is responsible for developing everything that happens during the encounter. Without the ability to document directly into the electronic health record, the scribe or technician sends precious time contacting admitting and documenting the encounter on paper. This information must then be transferred into the electronic health record or “back charted.” At Western States Hospital the scribe calls the admitting clerk and states, “ The patient from ED room 5 is here in the cath lab and patient type is still set at ED. You do realize that I cannot do my job when you do not do yours, right? Why can’t you admitting clerks figure out how to get these patient types changed faster and do your job so that I can do mine?” The admitting clerk responds, “ I have been busy taking care of other patients and didn’t realize this was your patient that was taken to the cath lab. I do have other patients to take care of besides the one that you have in the cath lab. Just override the system so that you can view the information until I get the type changed,” to which the scribe states, “ Truly you don’t understand the ramifications of what your job entails and the problems this can cause the patient. Just make the change. Now!” The patient type is changed and the technician is now trying to document what has happened to this patient in the cath lab from memory. Case Study Questions 1. In your opinion, is there an opportunity for improvement in this system? Why or why not? 2. If there is room for improvement, is a PI team appropriate in this context? 3. From your knowledge of hospital organizational structure, who should be on the PI team? What departments should be represented? What staff positions would you include? What is your rationale for including each individual.? Application Activity: Create a cause-and-effect diagram for the case study provided in chapter 4 on page 70. Causes in the areas of manpower, materials, methods, and machinery should be identified.

Answer 1

1. Yes certainly there are oppurtunities for improvement. There are issues with time management and communication between cath lab and admitting department. As the patients data are not entered it consumes more time which may result in any serious issues with patient health ,because they maynot be transferred to inpatient department at correct time. In a crucial moment like STEMI door to balloon times is esssential, all departments should complete any procedure within 30 minutes and handover to next provider for continuing treatment as the patient may collapse at any second .If it occurs that may lead to bad name to the hospital resulting in less productivity.

2.The performance improvement team always set a measurable target for improvement for any issue. . The supervisor of the admitting department should be consistent and regularly keep an eye on the work done by the department staffs. He should find out the cause for why the admitting department staff repeatedly donot transfer the patients admission status from ED patient to pre-admit after sending patient to cath lab . If the workforce is lacking , adequate staffs should be appointed. Regular updation and service of EHR systems to resolve unknown issues. If still the issues remains better to choose a EHR system that offers integration with all departments. Admitting department clerk and other professionals should be given in house training at regular intervals to handle an emergency situation, to save time and work efficiently .

Th scribe also should be given regular training how to handle EHR , and time management. If the scribe didnot change or work efficient, it is better to recruit new scribe as time management is necessary quality for all technicians working in the hospital. Due to negligence activity of scribe and admitting department staff we may end up losing patients which may pose a threat to hospital's fame . A small mismanagement which remains unattended may become a big issue in future.

3.The chief of medical records department, Nursing supervisor, Chief of physician department, HIM department manager,administrative department incharge ,EHR vendor and CATH lab incharge should be in the performance improvement team.

Nursing supervisor is engaged in PI team because the problem is between nursing and admitting department .

HIM department manager is included as the admitting and computing department staff is not working efficiently .

EHR vendor team may help the nursing and other departments by providing insight to handle any situation at crucial times .