KENYATTA UNIVERSITY TITLE: APPLICATION OF GIS TECHNOLOGY TO HOSPITAL MANAGEMENT, PATIENT CARE AND PATIENT FLOW SYSTEMS

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1 KENYATTA UNIVERSITY ESRI 2 ND EDUCATIONAL CONFERENCE UNIVERSITY OF DAR ES SALAAM TITLE: APPLICATION OF GIS TECHNOLOGY TO HOSPITAL MANAGEMENT, PATIENT CARE AND PATIENT FLOW SYSTEMS BY MUGAMBI KELVIN MWENDA - FINAL YEAR (4 th ) STUDENT SCHOOL OF ENVIRONMENTAL STUDIES (DEPRTMENT OF COMMUNITY DEVELOPMENT) PROJECT SUPERVISOR PROFESSOR SIMION.M. ONYWERE , UNIVERSITY OF DAR ES SALAAM, DAR ES SALAAM, TANZANIA 1

2 APPLICATION OF GIS TECHNOLOGY TO HOSPITAL MANAGEMENT, PATIENT CARE AND PATIENT FLOW SYSTEMS 2

3 INTRODUCTION The Campus Editing Arc GIS 10 is an Arc Map editing map and set of editing work flows for managing building, interior space and related exterior campus data. It is an editor that can be used by mapping technicians in a college university, private corporation, or public works agency to streamline the collection, maintenance and use of asset information. The Campus Editing map can be used for this case to capture the interior bed location of each patients ward on the proposed university referral hospital and also all the available rooms within the hospital and the department of service they are attached to for the purpose of management. Workflows Management The editing map supports three data management work flows that can be optimized to create or import the interior features (beds and the design of the wards) that is the ability for CAD import work flow for the hospital floor plan integration. Attribute Assistant Attribute Assistant is an editor extension that uses a series of pre-defined methods to automatically populate attributes for the user (nurse) when updating or adding new interior features and information (new patient occupying an existing bed from a recovered patient or a room converted into other purpose i.e. the Dressing room changed to causality ward) to the geo-database. Doctors, nurses, laboratory workers, radiologists, radiology technicians, and an array of other healthcare workers interact to varying degrees in the care of a given patient in the healthcare system. If there these processes, and the people who provide these processes, are not positively and proactively cooperating to develop a seamless system (then) the provision of healthcare begins to appear to the patient having been functionally soloed in that service, 3

4 and therefore handoffs and transitions are not effectively handled. The story has always been the same in most referral hospitals in Kenya. Bed managers are sent to find empty beds. Two hours later, they return with stories of unreported empty beds, and hours later, people are calm. Somehow, free beds have appeared and everyone leaves exhausted, knowing this daily ritual will be repeated. In addition Faced with the daily reality of ever busier referral hospital environments, it is understandable that many health professionals and their patients have come to perceive extended waiting times, delays in treatment and/or care, and even the cancellation of services as an unfortunate but necessary part of contemporary healthcare delivery. This report is based on the application of Arc Gis technology that Provides evidence that this is not the case. It also highlights that these problems of smooth patient flow do not result because health professionals lack commitment but rather the lack of available existing work plan that the software provides for each medical Staff. The key constraints identified included patient care systems, the patient flow, and hospital management that are discussed below-; PATIENT CARE Patient care is the treatment, management of illness and the preservation of the wellbeing of a patient within the hospital ward. When hospitals operate at full capacity or overcapacity, the quality of patient care is often compromised. For lack of space, patients are placed in inappropriate a location throughout the hospital that is Time-sensitive care is inmost instance delayed. The above problem can be easily addressed by the Campus editing (ARCGIS 10) that allows the use of location as an integral data component and various data sets to be combined so that hospital personnel (nurses and doctors) can turn to one digital location for information retrieval. With information centralized, automated, and networked via computers, data accuracy can be improved therefore increasing the retrieval speed of the 4

5 required information. This information can later Using intuitive, information-packed digital maps, used to view occupied beds for a particular floor then can select the floor plan theme to view rooms with beds color-coded by type of patient stay. This is contrary to the poor Kenyan context whereby the management of beds in the hospital is that of using a large board showing rooms and patient beds, in paper forms in which takes more time for the nurses to check on the empty beds but for this case the application of the Arc GIS campus editing provides an automatic system that takes in the concept of that paper work and renders a digital map In addition, type of visit, age, gender, and attending physician can be used to refine the search criteria. Treatment strategy can be used as other criteria to refine the room selection. This is because pairing patients with similar treatment to the same room provides an optimized, comfortable room setting and ease in patient attendance. 5

6 ELECTRONIC BED BOARD SHOWING BED OCCUPATION IN DIFFERENT WARDS 6

7 PATIENT FLOW Patient flow is an operational process that entails the movement of patients, staff(doctors and nurses) as part of patients care pathway. The concept of using flow is to improve care within the hospital, especially in relation to reductions in patient waiting times for emergency and elective care. Clinicians may have different focus. Their focus could be on the progression of a patient's health status, disease progression and/or the clinical knowledge and understanding of both. There has to be a close relationship between both the operational and clinical perspectives. What happens to a patient clinically will dictate his or her movement through different steps and settings, as well as the movement of associated information, equipment, samples etc. Improving patient flow is one way of improving health services. Enhancing patient flow also increases patient safety and is essential to ensuring that patients receive the right care, in the right place, at the right time One way to engage and ensure that patient flow incorporates the clinical view is to include clinicians in mapping sessions and this is easily adapted by the use of Arc GIS software( Campus editing Arc GIS 10) that develops a work flow system design that provides the ability to have information of the patients inflow record inclusive of the demographic and clinical information that assist in right referral, right diagnostic tests, right diagnosis, right information and communication, right advice, right treatment, right aftercare and right handover. The information available in the attribute table in the software(campus Editing 10) also ensures that each step of the patient attendance Programme is planned for and scheduled so that everyone (doctors and Nurses) knows what to expect and when to expect it hence helps to co-ordinate and pace resulting to effective attendance of in-patient flow. 7

8 PATIENT ATTENDANCE AND ADMISSION PROCEESS WITHOUT USE OF ARC GIS Day 1 processes Day 2 processes Day 3- till recovery 8

9 PATIENT ATTENDANCE AND ADMISSION PROCESS WITH USE OF ARC GIS Clinical and demographic info Update of the info Use of the data Update of changes in the data The nurse records all the demographic and clinical information of the patient and updates it in the ArcGIS campus editing attribute table then updates the info Then forwards to docs server The doc is then able to prescribe medication and treatment on time The patient receives the treatment and if its admission its easily administered to and the progress still recorded with effective Administered medicine on time Ability to be released on time Process within Hours in 1 day Process within Hours in 1 day Actions with same day 9

10 EMERGENCY WARD DEPARTMENT CROWDING Emergency department (ED) crowding is a frequent health delivery problem that in most instances adversely affects the outcomes of patients requiring admission. According to the American College of Emergency Physicians (2002) Emergency Department crowding is defined as any time when "inadequate resources to meet patient care demands lead to a reduction in the quality of care." Patient crowding in the emergency department (ED) has become a daily challenge to providing high-quality care in EDs worldwide and is a critical problem affecting more than 114 million patients annually in the United States alone(institute of Medicine, 2006) Although there are so many dimensions of overseeing performance across several departments and sections within the hospitals in Kenya, there are several reasons why addressing emergency department crowding is crucial.the above mentioned statement is supported by the fact that; 1. Emergency Department crowding is costly. 2. Emergency Department crowding compromises the care quality of patients hence increases on in patient Mortality probability. The application of Campus editing Arc GIS 10 will therefore ease in the initiation of timesensitive care, such as the administration of antibiotics in sepsis, may result in shorter physician waiting times and consequently shorter durations of stay in the ED. The above is possible due to the ability to updating of information in the attribute table containing the patient s clinical information such as the type of drug to be taken, the prescription, the progress and the dressing periods to the injury patients in the ED wards. 10

11 In addition, the Arc GIS information (present in the attribute table) may help in elimination of errors that may occur when systems are stressed by limited resources. The use of Campus editing can aid in the elimination of Over- crowding in the ED wards which often leads to placing patients on incorrect wards (i.e., medical patients placed in surgical wards) where staff may be less familiar with the patient s condition or less likely to detect early warning signs of problems. This can be achieved by the software through the provision of the attribute table that gives the current information of the ED wards this is inclusive of the available bed, the other alternative ward location where the excess casual patients could have been located within the hospital premises and also with the possible embrace of the software to other neighboring hospitals there can be ease in consultation on the availability of rooms where the excess patients can be transferred to be attended from. FLOW PLAN DESING OF EXISTING EMERGENCY WARD OCCUPATION 11

12 HOSPITAL MANAGEMENT AND DECISION MAKING The management of hospital effectively is one key aspect that can lead to effective attendance of patients within the hospital and also the general improvement of the patient s health care. This is evidently proved by the fact that it s the management section that is responsible for medical supplies (Drugs, inclusive of surgical equipment s and other medical tools) and other hospital facilities(beds, meals, beddings,) that play an important role in the general health improvement of the patient and the ease in presenting medical attendance. The above can easily be address to on time to avoid shortages of the equipment in the hospital. This can be through the use of Arc GIS software (Campus editing Arc GIS 10) that can give on the statistics for decision making on the available equipment s and those that need to be replaced or purchased. The software can also enable the management to get statistics on the available staff members and make decision on whether to increase the number that is after querying and identifying if there is any shortages that us through the information on the in-patient volume still recorded on the attribute of the software. CASE STUDY Downey Regional Medical Center Provision of High-Quality Patient Care through GIS Downey Regional Medical Center (DRMC) is a community-based hospital that has for more than 80 years maintained 199 licensed beds serving the city of Downey, California. The hospital annually admits more than 11,000 acute care patients and serves about 60,000 outpatients. 12

13 Working with state-of-the-art information system solutions and also with its leading health care professionals, DRMC has embarked on a groundbreaking GIS deployment that's using geographic applications as a central data nervous system integrated within its overall infrastructure. In so doing, DRMC sought a company with just the right expertise to lend a hand and selected Esri Business Partner Imagistics Corporation (formerly Regulus Corporation), a professional services firm based in Riverside, California. NEED FOR ARC GIS APPLICATION IN KENYATTA NATIONAL HOSPITAL (KNH) KNH is a State Corporation whose vision is To be a regional center of excellence in the provision of innovative and specialized health care. It is a national referral hospital and the teaching hospital for the School of Medicine of University of Nairobi (UoN) and other medical training institutions. KNH has a bed capacity of 1,800. There are 14,000 pediatrics admissions annually to four general pediatrics wards each with 60 beds. The bed occupancy is often over 100% and all patients are charged user fees. Most of clinical in-patient care is provided by trainee pediatrician s enrolled in a threeyear postgraduate pediatrics training Programme through the UoN. They are normally supervised by 25 pediatricians, out of whom 15 are academics from the university. The pediatricians are highly qualified with 22/25 being professors or having pediatrics subspecialty training (e.g. in cardiology or nephrology) in line with the hospital s vision. The KNH clinicians are answerable to the KNH head of pediatrics clinical services, while the academics and the trainee pediatricians are answerable to the Chairman of the Department of Pediatrics, UoN. There are 126 qualified nurses on the general pediatric wards; twelve to twenty nurses per working shift to cover the 240 bed pediatric unit. 13

14 CONCLUSION Emergency department crowding, nurse staffing shortages, and patient outcomes, complication rates, and even mortality rates have all been linked to shortages of hospital beds and associated stresses on staff when patient volume peaks. To compound the problem of inefficiencies and variability in patient flow, health care systems now face strenuous economic challenges. Arc GIS technology therefore provides the best grounded method to optimally manage patient flow, patient care and serves as an indispensable guide to effective operations and hospital management. As it improves management of patient information and records in hospitals, Improves efficiency in the health care delivery systems, allows for time saving, efficiency in resource allocation in hospitals and I therefore call for the need for wider adoption and use Arc GIS technology in Referral hospitals in Kenya. 14