Palomar Health: Ready Set RUN Configuration of Actionable Alerts Ben Kanter MD FCCP, CMIO Jennifer Sloane, RN, BSN, MBA, PMP

Transcription

1 Palomar Health: Ready Set RUN Configuration of Actionable Alerts Ben Kanter MD FCCP, CMIO Jennifer Sloane, RN, BSN, MBA, PMP DISCLAIMER: The views and opinions expressed in this presentation are those of the author and do not necessarily represent official policy or position of HIMSS.

2 Learning Objectives 1. Demonstrate a successful automation of physiological monitoring information to the EHR and routing alerts to mobile devices for enhanced communication for clinicians 2. Recognize why it is important to have clinical perspectives of the physician, nurse and other ancillary staff regarding design decisions 3. Generate real lessons learned for the routing of physiological monitoring data to the EHR, the central monitoring room, and mobile devices

3 Conflict of Interest Disclosure Ben Kanter and Jennifer Sloane have no real or apparent conflicts of interest to report HIMSS

4 If everyone is responsible then no one is responsible If every event is alarmed then no event is alarmed If everyone is alerted then no one is alerted

5 The New Palomar Medical Center Planning Design Implementation Go-Live 90 days post go-live

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7 Palomar Pomerado Health 3 Hospitals 2 Skilled Nursing Facilities 5 Outpatient Health Centers Ambulatory Surgery Center 4 ExpressCare Retail Facilities

8 PPH by the Numbers 4000 Employees 825 Physicians (all private practice) 700 Volunteers 28,000 Discharges 20,000 Surgeries 100,000 Emergency Visits 850 Square Mile Health District 2,200 Square Mile Trauma District The Largest Public Health District in California by area Primary service area of >500,000 individuals and growing A Magnet System (hospitals and SNFs)

9 Palomar Medical Center 750,000 sq. ft. hospital complex includes: Inpatient (Distributed Nursing Model) Medical/Surgical 268 Diagnostic & Treatment Interventional Platforms 6 Surgery 12 Emergency Dept. 56 Imaging Rooms 18 Opened August 19th 2012

10 Evidenced Based Design the process of basing decisions about the built environment on credible research to achieve the best possible outcomes Sadler BL, Berry LL, et al. Fable Hospital 2.0: The Business Case for Building Better Health Care Facilities. Hastings Center Report 2011;13-23.

11 Goals for Quality Improvement» IOM goals : Increase safety Efficiency Effectiveness Person centered care Quality of care Timeliness» IHI quality improvement efforts: 100K & 5M lives campaigns Innovation communities» Quality Improvement Foci People Process Technology Physical Environment!! A Better Building facilitates the physical, mental, and social well-being and productive behavior of its occupants.

12 Goals Keep the nurse and patient as close together as design and technology will permit Decrease ambient noise while improving communications between the physician, nurse and patient

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15 Operational Challenges Gardens/Mobility Monitoring Communication Location Distributed nursing Communication IHI 2x2 findings Nursing ratios BYOD environment Multiple new remote clinics Telepresence

16 7 Rights of Communication The right information The right format The right actor The right time The right context The right technology The right security Ben Kanter, 2012

17 Rauland Borg Responder 5 Nurse Call System Patient Station Staff Terminal Duty Station Nurse Station Console Corridor Light PC Console

18 Cisco 7925 VoIP Phone

19 Middleware RFP: RNs, MDs, IT and more Extension Ascom Amcom Emergin/Phillips Intellispace Event Management Cerner Connexall

20 Go Live Requirements Single assignment system for RNs Philips monitors Rauland Responder 5 Teletracking (bed management system) integration Cisco 7925 voip handsets Maquet Ventilators

21 Phases 1.5 and 2 Integration with Sotera s ViSi platform Physician alerting on smartphones Physician look up directory

22 RFP Lessons Learned No one best solution Do you have any drop dead issues? Significant variability Different historical context Importance of all stakeholders Importance of knowing your devices Importance of understanding workflow Leverage internal and external talent

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24 Project Initiation - Approach 1. Review current industry documentation and trends 2. Site visits 3. Review internal events and near misses (root causes, trends) 4. Review current monitor settings and utilization for each area No standard monitor montage Customization is an opportunity Proper prep to avoid needless alarms 5. Review and update existing procedures 6. Clinical Decision Team: Each Department is represented (ED, Tele, IMC, CCU) 7. Determine the educational needs of clinicians regarding alarm management

25 Project Considerations

26 Lessons Learned +/- Topic Situation Recommendations & Comments OFI New Facility Decisions were difficult to conceptualize not being able to walk the halls. Use pictures and video until groups are able to get access OFI Monitoring room and techs Use of an CSR was new. Practicing communication between the RN and the tech via alerts and phone calls was key. Spend more time focusing on CCU/Tech relationship and roles/responsibilities

27 Lessons Learned +/- Topic Situation Recommendations & Comments OFI Staffing model Changes to staffing model Ensure your staffing model (unit secretaries and nurse techs) other support staff fit into the future design

28 Physiological monitoring alerts Parameter Name ALERT CATEGORY ie: Crisis, Warning, Advisory, Message, System Warning 1st Level Response Time to Escalate 2nd Level Response Time to Escalate 3rd Level Response Asystole Crisis CSR 30 sec RCP RN Charge RN 30 sec Resource RCP Resource RN Extreme Tachy Warning CSR 120 sec RN 120 sec Resource RN Irregular Heart Rate Advisory CSR 120 sec RN 120 sec Resource RN

29 Lessons Learned +/- Topic Situation Recommendations & Comments OFI Scope Collaborative approach did not provide consensus. A few voices made the decision for the group. Proscriptive approach. Limited universal initial scope. Utilize lessons learned from site visits and research. Standardize training

30 Physiological monitoring parameters Department Total Physiological Alarms Route alert to Monitor Tech (first) Intermediate Care Telemetry Stroke Emergency Critical Care Route alert to RN (first) * ED routes to both the tech and RN at the same time

31 Lessons Learned +/- Topic Situation Recommendations & Comments Worked well Workflow Diagrams Use Visio diagrams to document future processes DO document workflows. Worth their weight in gold for discussions, meetings, making decisions, use in testing and training!

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33 +/- Topic Situation OFI Code Blue Rapid Response Lessons Learned Many assumptions and undocumented decisions based upon ad hoc conversations. Recommendations & Comments Get the right people in the room to make decisions including PBX and physicians. Document! Worked well Vendor Management Vendor dependencies Ensure you have primary PM oversight over the project portfolio.

34 +/- Topic Situation OFI Education Lessons Learned Brisk timeline and access to the facility - The ambiguity and unknowns in process made training difficult. The outstanding decisions created inconsistency in educator messages. Recommendations & Comments Understand your culture. When opening a new facility there are unique challenges. Ensure that there is a venue for educational messages and last minute updates. Worked well Education The SME's created the materials for their departments and did the training. They became the knowledge leaders and go-to for staff in their department Do keep your SME's available for post go-live support. Issues don't start surfacing until after the system has been used a while.

35 +/- Topic Situation Lessons Learned Recommendations & Comments Worked well Changes Change process: Develop a team approach with realistic, implementable strategies for improvements SME's are floor point person during project. Continue to include in monthly change control board. Worked well Changes Work closely with BioMed, IT, Facilities and Help desk for roles and responsibilities A lot of moving parts. Key to everyone knowing who is first responder, who owns it.

36 Summary Clinically driven, IT enabled Take a conservative proscriptive approach This is a portfolio of projects Have a fallback position that s focused on patient care

37 THANK YOU!! Jennifer Sloane