Lean strategies reduce bottlenecks
By Brenda Joslyn, August 2011
Achieving clinical automation through the use of a real-time locating system.
Workflow is when one action or event triggers the start of another action or event that is meant to take place. In most industries, automating workflows can be a relatively straightforward process. All one has to do is look to manufacturing or even FedEx to see the impact automated processes have had: lower production times, scary-exact estimated delivery times and lower overall production/delivery costs.
Within healthcare, human touch is essential — which makes automation of workflows more challenging. In fact, automated clinical workflows are typically understood to mean manual completion or documentation of one task before the next step should be performed based on a system that has been put into place. The information is only as precise as the documenter's accuracy, attention to detail and workload acuity. If you're lucky, the information you've documented will be communicated to all who need to know, and the person responsible for the next step in the patient's care plan will notice the new piece of information.
But this model of automated workflow is far different than what is actually possible to achieve, and we are proving that each day at Eastern Maine Medical Center's CancerCare of Maine. We are not just clicking the appropriate box in a clinical software application and knowing the information will be there and available for the next person. Our automated workflows take this a step further by automatically alerting the people who need to know when a patient is ready for the next step in care.
There's no doubt that there are complexities involved, and we had to commit to clearly outlining our processes in order to automate our clinical workflows, but the results have been well worth it. We're achieving clinical automation through the use of a real-time locating system (RTLS) from Versus Technology.
By providing location ID badges to our patients and staff, Versus is able to determine the exact locations of patient and staff, including who interacted with whom and when. Versus is then able to correlate these interactions to the patient's exact stage in his visit progression. Therefore, when one of our care providers — whether a nurse, physician or phlebotomist — sees a patient, this is automatically documented and visually available for appropriate personnel to see, thus eliminating telephone calls, manual documentation and manual patient handoffs. The person responsible for the next stage of a patient's treatment has visual notification of the patient's readiness for the next step in care.
If you're trying to figure out how to automate clinical workflows, let me give you an example of some of the things you'll find (A) and then offer the comparison to a system that is truly automated (B).
Which one represents true automation?
A: Card swipe to switch users at a workstation; or
B: User is dynamically recognized and logged in, with screens adjusted to user preference automatically?
A: The phlebotomist scans the patient's ID badge and enters into a system that he is with the patient; or
B: The phlebotomist's presence with a specific patient is automatically documented, resulting in the order for a blood draw being automatically labeled "in progress" and, when she is no longer with the patient, the order labeled "complete"?
A: A consultant is hired to document how much time a small percentage of the patient population actually spends waiting; or
B: Both the patient's alone time and time with a physician (or other caregiver level) for the entire patient population is automatically documented and available for reporting — for all patients as well as individual patients?
Fostering this type of clinical workflow automation requires one to step back from healthcare's traditional view of workflow automation. And now that we have all this data, data that we don't have to work to collect or maintain, it's made a big difference in how we are able to document the excellent care we provide. We are able to glean data from the reports to implement lean strategies to reduce bottlenecks in our processes, drastically reducing patient wait times. We have established communication efficiency reducing staff footsteps, thus increasing productivity and satisfaction. Automating our clinical workflows has made it easier to support our patients and staff, make adjustments, respond to an increased patient population and communicate patient care progression more effectively.
I challenge you to discover this definition of automated workflow for your patients and staff.
Brenda Joslyn is manager of nursing services, CancerCare of Maine, Eastern Maine Medical Center.
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