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From the December 2003 Issue |
More of a Good Thing Surgical information system upgrades help Pennsylvania hospital eliminate paper records and improve revenue management. A spike in surgery cases spurred a South Central Pennsylvania hospital to revisit its longstanding perioperative system, and to renew its investment with additional system modules. Hospital leaders knew that to keep pace with patient volume and to speed record-keeping, operating room (OR) staff would need an automated charting system. The hospital also needed a program that could link the perioperative system with the hospital’s financial system to capture lost billing data and increase revenues. Altoona Hospital and its 250 affiliated physicians provide office care, outpatient services and inpatient hospitalization care for the acutely ill in Altoona, Pa. Medical specialties include cardiac care, kidney dialysis, cancer care, pain management, women’s reproductive health, pediatrics, trauma/emergency services and neurosurgery. The 346-bed hospital employs 1,500 workers. The need for operating room efficiencies, along with an increase in surgical volume, led OR managers at Altoona Hospital to expand utilization of ORSOS, their perioperative information system from Atlanta-based Per-Se Technologies Inc. ORSOS—a rules-based system that automatically manages surgical staff, equipment and inventory to schedule complex, multiple procedures—enables Altoona’s staff to optimally plan its OR resources enterprisewide. Altoona Hospital has observed a steady increase in surgical cases, from 17,936 in fiscal year 2000-2001 to 18,940 in fiscal year 2002-2003. These growth indicators fueled the purchase of new modules such as Perioperative Charting and Revenue Maximizer to help make the OR more efficient and to reduce paper-based, post-case data entry, says Michael Wertz, R.N., ORSOS coordinator, Surgical Services. Altoona Hospital now has three surgical areas: its main facility with 11 operating rooms and an endoscopy suite, plus the newly opened ambulatory surgery center with five operating rooms. Altoona’s three surgical areas operate as independent cost centers but report under the same department of surgery, Wertz says. While they maintain separate appointment books, they share access to the system’s centralized database of surgical case records and corporate reporting functions. Charting New Courses Altoona Hospital’s department of surgery rolled out Perioperative Charting to its 77 registered nurses in September. The module allows the RNs to document—in real-time and at the point of care—all events occurring before and during the patient’s surgical case. Its user-defined design of check boxes and look-up fields helps the caregiver work more efficiently and eliminate OR paperwork. Wertz says adding the new modules is a “work in progress.” The perioperative charting module replaces a paper-based record-keeping system. Under the old system, a nurse in the operating room took notes during the procedure and logged information including the patient’s condition prior to and during surgery, surgery start and end times, names of staff assisting the patient, which procedures were performed, medications administered and equipment used. The nurse then sent the report to a hospital secretary, who entered the information into a computer system to create a post-case record. With perioperative charting, a nurse uses a wireless PC on a mobile cart and enters patient and procedure data as the surgery is performed. Once the surgical record is complete, the information is automatically written to post-case data, eliminating the need for clerical staff to key in the data. With data entered and completed at the point of care, Altoona Hospital will ultimately eliminate the three- to four-day backlog of surgical records encountered when secretarial staff entered them manually. “Your statistical data is available immediately and you’re eliminating that duplication of work,” Wertz says. He estimates the potential for time savings is substantial. “We do about 60 to 70 cases on some days, and the average post-case data entry time is about three to six minutes,” he says. “You’re going to free up that data entry clerk for other jobs he or she needs to complete.” Wertz estimates clerical staff ultimately will save approximately 25 to 30 hours of data entry per week. Training all OR nurses to use perioperative charting was not without its challenges, according to Wertz. “The surgery schedule continues regardless of what you’re implementing,” he says. Finding a way to conduct training without interrupting the surgery schedule was a hurdle. Wertz and a colleague first received training through Per-Se so they would serve as instructors. Then, fortunately, hospital administrators allowed him to offer after-hours paid training, which helped alleviate some of the pressure he faced in getting the rest of the nurses trained. Today, staff attend training classes the week before perioperative charting arrives in their unit. The morning of go-live, an instructor accompanies the nurse into surgery to ensure he or she is documenting information and using the system properly. Wertz hopes to roll out the module to one specialty unit per week, until perioperative charting is complete, before the end of this calendar year. Maximizing Revenue Next, Altoona Hospital will implement Per-Se’s Revenue Maximizer module, a program that will help the healthcare facility automate the capture of lost billing charges and streamline OR patient billing data to the hospital’s finance system. Currently, staff relies on the traditional system of surgeon preference cards. This process allows supply staff to select the appropriate instruments and supplies for each surgery. Once a procedure is complete, an OR staff member notes which items were used and which were not. The information goes to the secretarial staff, who code each item for entry into the hospital’s financial system. Revenue Maximizer will serve as an interface between ORSOS and the hospital’s financial system, eliminating the need for manual charging, according to Wertz. There will be a mirrored image of each preference card in ORSOS, so staff members can see the image of the card on screen, make any necessary adjustments and then send the information to the financial system for billing. “The objective is to reduce error, streamline efficiency and capture more cost,” Wertz says. “Obviously, anytime you have someone coding something by hand, you increase the chance for mistakes.” Wertz stresses that Altoona Hospital has a lot of behind-the-scenes work before it can roll out the next module. Staff must update nearly 1,900 preference cards and ensure that all inventory items have a billing number. Wertz says the hospital has not set a go-live date for this portion of the upgrade, but that once everyone is comfortable with the automated charting module, “we can shift our focus,” and go forward. SOURCE Michael Wertz, R.N. PRODUCT/COMPANY
For more information about ORSOS from Per-Se Technologies, www.rsleads.com/312ht-204 © 2003 Nelson Publishing, Inc |
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