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Patient Safety

VA strengthens critical patient-safety procedure

Two systems replace traditional paper-based informed-consent process with an electronic time-out checklist integrated into electronic records.


he “time-out” process is an established, but often overlooked, mechanism for preventing a critical patient-safety issue: wrong-site/ wrong-procedure/wrong-patient surgery. At a minimum, this process involves a standard by which members of the surgical team are required to agree on the correct patient identity, the correct procedure site and the procedure to be performed.

Mandated by the Joint Commission for all hospitals, ambulatory care facilities and offi ce-based surgery prac- tices, the time-out process is frequently implemented via a paper checklist. Some organizations, however, have begun leveraging their existing IT infrastructure to design and implement a stronger, more-effective computer- assisted time-out process.

of a 73-bed hospital and 32 sub-specialty clinics. Prior to automation, both of these VA organizations relied on a traditional paper-based method to obtain and document the entire patient informed-consent process. At VABHS, “Departments created their own consent forms using standardized nomenclature unique to their specialties,” says Margaret Wrana, clinical information- systems manager. “However, out of necessity, the pre-printed sections of these forms included only very general information. Physicians were forced to write out all pertinent patient-specifi c details, including the risks and benefi ts of the recommended procedure. They then needed to ensure each document made its way to the medical record department for scanning into the patient record.”

Potential for lost documents

This process was suboptimal for several reasons, she

A staff member signs off on the completion of the time-out checklist using an AICA and a digitized signature capture in an outpatient clinic. (Photo courtesy of Kim Ondrick)

Two institutions in the forefront of this automation effort are part of the Department of Veterans Affairs (VA) health system. The VA Boston Healthcare Sys- tem (VABHS) and the Providence VA Medical Center (PVAMC) are both primary and secondary healthcare facilities providing a full range of patient-care services with state-of-the-art technology. VABHS is a 448-bed in- tegrated organization encompassing three campuses and six community outpatient clinics. PVAMC is comprised

28 April 2010

says. First was the potential for paper documents to be lost or misplaced. Even with documents in hand, how- ever, reading the important handwritten information they contained could be diffi cult. The risk of patient confi dentiality breaches also arose from the need to physically transfer documents for scanning. Thus, the VA decided to standardize and automate the entire informed-consent process. VA facilities now generate, for example, procedure-specifi c consent forms, advance directive documents and patient-education materials. The resulting benefi ts include uniform, leg- ible consents that are easy to track because they reside in the secure document-imaging system within seconds of their completion. With the electronic consent process forming a founda-

tion, VABHS staff began to further explore avenues to improve patient safety through automation. A commit- tee that had fostered implementation of the automated informed-consent process raised the idea of ensuring that the time-out was performed in a consistent manner ac- cording to standards. An electronic format to complete these standards seemed like a natural extension of the automated informed-consent process.

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