IT Incidents (Is this the Emergency Department?) D A V E H I L E M A N

IT Incidents (Is this the Emergency Department?) D A V E H I L E M A N

Intro It is not the healthy who need a doctor, but the sick Luke 5:31

Agenda About UPMC My Trip to the Emergency Department Help Desk/Service Desk Triage What can we apply?

About UPMC UPMC is an $8 billion integrated global health enterprise headquartered in Pittsburgh, Pennsylvania, and is one of the leading health systems in the United States. UPMC operates 20 academic, community, and specialty hospitals and 400 outpatient sites, employs more than 2,700 physicians, and offers an array of rehabilitation, retirement, and long-term care facilities. UPMC s health insurance arm serves more than 1.4 million members and has some of the fastest growing health plans in the region. It offers commercial, Medicare, Medical Assistance, CHIP, behavioral health, employee assistance, and workers compensation products. Through its International and Commercial Services Division, UPMC has launched a portfolio of new businesses and international ventures.

My Disclaimer The opinion, content and commentary within this presentation does not necessarily represent that of my employer.

My Trip to the Emergency Department Triage Registration Exam Room Diagnosis and Treatment Tools Disposition

The Emergency Department First stop = triage Each patient's condition is prioritized Less urgent (fast track) Urgent, but not immediately life threatening Immediately life threatening (emergent) Why? necessary so that someone with a life-threatening condition is not kept waiting because they arrive a few minutes later than someone with a more routine problem. All patients must receive a medical screening exam regardless of their ability to pay

Triage - definitions 1a : the sorting of and allocation of treatment to patients and especially battle and disaster victims according to a system of priorities designed to maximize the number of survivors 1b : the sorting of patients (as in an emergency room) according to the urgency of their need for care 2: the assigning of priority order to projects on the basis of where funds and other resources can be best used, are most needed, or are most likely to achieve success French, sorting, sifting, from trier to sort, from Old French MERRIAM-WEBSTER

The 5-Tier Triage System FAST TRACK Level 5: The least acute patients, requiring little treatment Level 4: Patients likely requiring a quick consultation or a minor treatment, such as a lab test or prescription of medication Level 3: More acute patients who may require multiple tests and more treatment URGENT Level 2: High risk patients who may exhibit signs of stroke, heart attack or other conditions that could become fatal EMERGENT Level 1: The most acute patients in immediate danger, exhibiting life-threatening conditions

Registration Obtain vital statistics Gather insurance information, Medicare, Medicaid or HMO card Verify or develop a medical record medical history, lab tests, X-rays, etc. If the patient's condition is life-threatening or if the patient arrives by ambulance, this step may be completed later at the bedside.

Examination Room Subdivision areas: pediatric ER chest-pain ER fast track (for minor injuries and illnesses) trauma center (usually for severely injured patients) observation unit (for patients who do not require hospital admission but do require prolonged treatment or many diagnostic tests). Additional information gathered ED nurse + ED physician Differential diagnosis List of possible causes of symptoms The most likely diagnosis is determined by symptoms and physical examination If inadequate to determine the diagnosis, then diagnostic tests are required Blood tests, etc

Diagnosis and Treatment Determination of treatment then begin Or, more tests More Physicians, Surgeons, tests Then, Determination of Treatment and begin

ED - Tools of the Trade Stethoscope Cardiac Monitor Suture Tray Orthopedic equipment Crash Cart Defibrillator intubation equipment Central vein catheters Cardiac drugs Chest-tube tray Ear, nose and throat tray Electronic Health Record / computing devices

Disposition Depending on a patient's specific medical condition, physicians will either: Admit Discharge w/discharge instructions (either written specifically for you or pre-printed) that explain medications and other treatments Transfer - if your condition is better treated at another institution.

30-Minute Goal + Examples North Texas hospitals tout online wait times for ER visits 30-Minute Admission The 30-minute goal sets an aggressive standard for transferring patients and requires coordination between patient registration, nursing supervisors, housekeeping and emergency staff "Bedside triage helps keep the waiting rooms clear and gives patients peace of mind that their care is underway."

Incident Management Process Identification Logging Categorization Prioritization Initial diagnosis Escalation Investigation & Diagnosis Resolution Disposition and Recovery Incident Closure

The 5-Tier Triage System FAST TRACK Level 5: The least acute patients, requiring little treatment Level 4: Patients likely requiring a quick consultation or a minor treatment, such as a lab test or prescription of medication Level 3: More acute patients who may require multiple tests and more treatment URGENT Level 2: High risk patients who may exhibit signs of stroke, heart attack or other conditions that could become fatal EMERGENT Level 1: The most acute patients in immediate danger, exhibiting life-threatening conditions

Help Desk Triage Priority Issue Contact Resolution 1 Issue of the highest importance--mission-critical systems with a direct impact on the organization (Examples: widespread network outage, payroll system, sales system, telecom system, etc.) Immediate-- 5 minutes 30 minutes 2 Single user or group outage that is preventing the affected user(s) from working (Examples: failed hard drive, broken monitor, continuous OS lockups, etc.) 3 Single user or group outage that can be permanently or temporarily solved with a workaround (Examples: malfunctioning printer, PDA synchronization problem, PC sound problem, etc.) 4 Scheduled work (Examples: new workstation installation, new equipment/software order, new hardware/software installation) 15 minutes 1 hour 30 minutes Same Day 1 hour 1-4 days 5 Nonessential scheduled work (Examples: office moves, telephone moves, equipment loaners, scheduled events) Same Day 5 days

Prioritizing Incidents Mission critical systems or issues that affect a large number of people should always come first (i.e. Severity Level 1). - EMERGENT Bulk of reported problems are often individual problems with desktop PCs (i.e. Severity Level 3, 4, 5) FAST TRACK Considerations when deciding on problem severity include: How is productivity affected? How many users are affected? How many systems are affected? How critical are the affected users/systems?

Closing - What else can we apply? Differential Diagnosis formal or informal Fast Track Admission Goals Online wait times Crash Cart What about Urgent Care centers, Telemedicine, or WebMD?

Questions

Discussion 1. How many Priority levels do you use? Why? 2. How are calls routed to the next level of support? 3. What Remote Support tools do you use? 4. Do you have any Self Help or Self Service portals? 5. What statistics do you report on? 6. What statistics would you like to report on?