Increase in day surgery rates
Ireland’s Health Service Executive (HSE) estimates that day case procedures are on average almost 60% less costly than inpatient cases (1). As well as the reduced cost to the hospital, there are benefits to the patient such as recovering in their own home and less chance of a hospital acquired infection. Hospitals are required to increase day surgery rates and to identify potential areas for improvement.
In 2012, around 247,000 surgical procedures were carried out in Irish hospitals of which 80% were elective. 69% of the elective cases were treated on a day surgery basis, an increase from 55% in 2006 (1). To address how elective surgery can be best delivered, the Elective Surgery Programme (a joint programme between the HSE, the College of Surgeons and the College of Anaesthetists) have produced guidelines and pathways to help standardise good practice and enable surgical services staff develop local care pathways (2).
Integrated Care Pathway benefits & their alignment to Electronic Medical Records
Integrated Care Pathways (ICPs) are designed by clinicians and based around the needs of the patient. They provide a coordinated way of working for the multidisciplinary team involved in pre, intra and post-operative care of the patient. There are many benefits such as:
- Streamlining documentation
- Incorporating evidence based practice into clinical care, and
- Reducing duplication amongst the multidisciplinary team
The benefits of an ICP are very much aligned with those of an Electronic Medical Record (EMR). An EMR such as Vitro can provide an electronic version of locally designed ICPs with added intelligence to further enhance the benefits. The end user is presented with a familiar user interface but with the power of technology supporting it.
Tailored EMRs can enhance the benefits of ICPs in the following ways:
- Documentation is streamlined and the ICP is available to all staff, regardless of location, on desktops and tablets;
- Evidence based care is facilitated through use of the clinically designed pathways, links to evidence based material, local protocols and guidelines;
- Duplication is reduced through pre-population of patient details from the PAS system, sharing of information between apps within the ICP and display of results from other hospital systems such as laboratory and radiology.
Added advantages of moving to an EMR include; reportable fields within the ICP for audit purposes and monitoring of KPIs for surgical services. Use of mandatory fields to ensure complete documentation and fulfil requirements for regulatory bodies. Safe practice is facilitated through timely sharing of information. For example; anaesthetic nurses can view the pre-op anaesthetic assessment in theatre prior to the patient (& chart) arriving.
Requirements for nerve blocks, difficult airway etc. can be prepared thus facilitating safe and efficient use of theatre time. Throughput in theatre is further enhanced with an electronic World Health Organisation Checklist, database of procedure codes, a recovery room app that nurses can complete without having to ‘wait for the chart’ and display of reports/summaries such as anaesthesia monitoring. Surgical templates can be available to surgeons to minimise writing/typing or the need for transcribing. For example, an orthopaedic surgeon can choose a Knee Arthroscopy or Hip Replacement template that has prepopulated information common to all procedures. Ability to upload photos and draw using a stylus adds flexibility to the solution.
On the ward, there is an electronic (legible) record available to staff, regardless of patient location, of the compete episode of care, which facilitates comprehensive discharge planning. Bar coding and scanning facility can cater for any external paperwork associated with the patients care. Once the patient is discharged, charts no longer need to be ‘ordered’ from medical records for subsequent visits to physio or outpatient consultant reviews. A patient portal or access to health record/educational material can also be facilitated. All of these efficiency gains at various points along the ICP can facilitate the requirements of an increase in day case surgery capacity.
What steps are required to move from paper to an EMR in day surgery?
- Documentation of process flows of the patient journey in the elective surgical pathway;
- Design of ICPs with input from all members of the multidisciplinary team;
- Use of locally designed ICPs as a basis for requirements for an EMR solution.
As hospitals have varying workflows, a ‘one size fits all’ or ‘modular’ approach for an EMR will not facilitate the desired benefits of ICPs. Vitro can adapt to these workflows which are patient centred and clinician led which leads to a system that users will engage with and benefit from. The result is a system that can be used by nurses, anaesthetists, surgeons and all members of the team. Information is shared between all departments; outpatients, pre assessment, wards and theatre.
The implementation of an EMR, to support the elective surgical pathway, is essential to realize the financial savings associated with increased numbers of day case procedures.
Sinéad Kane - Project Leader at Sláinte Healthcare
Sinéad has over 20 years nursing experience in both public and private hospitals and has worked in Ireland, Australia and the UK. She has received a BSc & Higher diploma in Nursing and a MSc in Health Informatics. As Project Leader for Sláinte Healthcare she co-ordinates the roll-out and manages project deliverables, of the eHealth software Vitro and Claimsure to hospitals and healthcare organisations.