| White Paper on Cetrea Surgical |
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How Clinical Logistics Can Increase Efficiency, Productivity And Quality Of Care In ORs. by T.R. Hansen and T.H. Bank Executive Summary Using the digital technologies at hand to effectively handle and manage the work flow in the operating ward improves both productivity, efficiency and the quality of care among other benefits. Tools, such as whiteboards and phones, can only do so much in a highly dynamic environment where changes occur fast and often. This white paper explores the challenges faced in the operating ward and suggests a solution where large interactive screens, tracking systems and mobile devices brings dramatic benefits to the work flow. ORs: One Whiteboard for Everyone Collaboration, coordination and communication are crucial in maintaining an efficient and smooth flow of work in an operating ward. A considerable amount of time and energy is spent on getting information about where people are located, what they are doing, getting information about changes in plans, and ensuring that the right staff is present inside the operating room at the right time, including the patient. Large whiteboards, electronic booking systems and a constant flow of phone calls are some of the tools that clinicians use to communicate, to stay aware on the flow of the work, and to maintain a social awareness of one another. The whiteboards, however, are only visible at one location in the operation ward - typically the coordination central - and are often not updated with the latest information about changes in the operating program. A booking system is great for booking patients, but is not geared to quickly respond to changes in the program or getting real-time information about whereabouts of clinicians and status in the operating room. Nor is it effective in any way in providing clinicians with an overview or facilitating communication between personnel or departments. Phone calls are useful since they offer immediate access to knowledge and information that can be used in the coordination of the work flow, but the price is high; often the recipient is busy doing other activities and the call comes as a great disturbance and will maybe be left unanswered. “Sometimes it’s like having to put a lot pieces together – who can operate on this patient, who can operate on that patient – and then you have to, you know... Yes, it’ s a puzzle” - Nurse, Regional Hospital of Horsens, Denmark. Even though useful, these tools cannot be integrated with each other and have several shortcomings that can be grouped together:
A study from 2010 shows that 67% of the surgery in the scheduled plan in the OR is changed and only 56% of all operations are elective. Coordinating such a dynamic work flow calls for a more efficient and appropriate technology than a whiteboard and phones. What is apparent is that the old tools in the OR are not able to provide a sufficient overview, support efficient communication and insure smooth coordination. Being one of the most expensive resources in the hospital, it is very important to try to avoid delays in the work flow in the OR. The features of ubiquitous computing in clinical logistics solution can solve many of the technical problems in the OR’s work flow. Clinical logistics Imagine the amount of time and resources that can be spared if clinicians could have a complete and real-time overview of the ORs incoming patients, video from the operating rooms, a board showing the available clinicians as well as their location and being able to immediately respond to delays or acute patients. Such a system would be able to save time and resources, which could be used to increase productivity and improve patient care. Clinical logistics is a class of solutions that uses the advances in ubiquitous computing to provide clinicians with a complete and real-time overview of a ward’s patients, personnel and other resources, so that it is possible to coordinate and adjust the work flow to it is optimal. A clinical logistics solution consists of (but not limited to) several forms of ubiquitous computing:
The clinical logistics solution uses the recent advances in technology to improve the work flow and communication in the OR. Besides the positive improvements stemming from a more efficient work flow, such as increased productivity and utilization of resources, two studies shows that the clinical logistics solution Cetrea Surgical has a notable positive effect on how the personnel perceived the work environment.
Putting Clinical Logistics To Work The Regional Hospital of Horsens (RHH) have been one of the pioneer hospital in clinical logistics. The operating ward at RHH implemented Cetrea Surgical - a clinical logistics solution by Cetrea - in 2004. Today, the clinicians at RHH could not imagine going back to the old whiteboard: “Today, [clinical logistics] is one the pillars in our work here at the hospital, and we have a system which the workers say that they do not want to work without” - Chief Physician at RHH The Cetrea Surgical solution installed at RHH consists of:
The large touch screen are placed in strategic hubs in the department, while the smaller 19” screen clients are placed in each operating room and also running on the computers in the OR (e.g. in doctor offices and the reception). Using ultrasound clips (see picture 1) the system is automatically updated with the position of clinicians and in the future also the patients whereabouts. The idea is that no matter where the clinicians should be able to instantly get an easy overview over the work flow and resources in the department and one’s own work schedule. Results Individual studies of Cetrea Surgical at the OR in RHH have shown several positive effects stemming from the installation of the Cetrea Surgical clinical logistics solutions. First of all, the productivity in the OR has been increased by 4% annually amounting to between 520-700 additional procedures undertaken each year. The utilization of operating rooms has increased by 15% and the number of cancelled operations has been reduced by 66%. “We have increased our productivity and minimized the time wasted in the department. Before we would sometimes waste time waiting for each other and we had to call around to find people which consumed a lot of time. Today we know exactly where people are and our work flow has become really efficient.” - Chief nurse Marie-Louise Ulsoee Second, the staff reports that they now have a better overview of the work tasks and the work flow making it easier to coordinate the work. They also report that the system has reduced the number of interruptions and the traffic in and out of operating rooms. The number of steps taken each day has been reduced by 33% and the staff finds it easier to locate coworkers. Third, the clinicians feel that the work environment in the OR has improved. This should be expected to decrease sick days, stress and improve the wellbeing of each worker. “Our work environment in the OR has really improved. There’s less disturbances and much less stress, and we have a much more calm environment now.” Because of the success with implementing Cetrea Surgical in the OR, RHH has moved forward and are now using similar solutions in their emergency ward (Cetrea Emergency) and patient ward (Cetrea PatientWard). The effect of these installations has not yet been thoroughly studied, but chief physician Ove Gaardboe in the RHH emergency ward concludes: “With Cetrea Emergency we have experienced a remarkable increase in our ability to react to when something is wrong and it has improved the safety of the patients.” The positive effects of the Cetrea clinical logistics solution suggest that clinical logistics systems can improve productivity and efficiency with monetary benefits as a direct result. A return on investment analysis of the system in RHH shows that the system has paid for itself within the first year. Furthermore, the work environment is improved and a new way communicating and coordinating the work in the OR seems to be the result of such a system.
About Cetrea Cetrea is the leading provider of clinical logistics solution to hospitals around the world. Cetrea pioneered the concept of clinical logistics and the Cetrea solutions are based on the latest advances in research and technology. Covering more than 80% of the hospitals in Denmark the solutions have proven that they are able to improve the work flow and communication in the OR with an increased productivity as a result. Cetrea’s solutions are developed in close collaboration with clinicians and researchers, and every hospital get a unique configuration suited to their needs and organization. For more information about Cetrea and Cetrea Surgical, please visit www.cetrea.com
References “Applying Mobile and Pervasive Computer Technology to Enhance Coordination of Work in an Surgical Ward” Thomas Riisgaard Hansen and Jakob E. Bardram (http://www.itu.dk/people/bardram/pdf/MedInfo2007v5.pdf)
“Why the Plan Doesn’t Hold – a Study of Situated Planning, Articulation and Coordination Work in a Surgical Ward” Thomas Riisgaard Hansen and Jakob E. Bardram (http://www.itu.dk/people/bardram/pdf/541-bardram.printed.pdf)
“Trajectories in Multiple Group Coordination: A Field Study of Hospital Operating Suites” Yuqing Ren, Sara, Kiesler, Susan Fussell, Peter Scupelli Human-Computer Interaction Institute Carnegie Mellon University (http://sfussell.hci.cornell.edu/pubs/Manuscripts/Ren_HICSS07.pdf)
”Medicinsk teknologivurdering af Det Interaktive Hospital (Health Technology Assesment)“ Jensen LG, Ehlers L, Bech M, Hansen TR, Lauridsen JT, Kjølby M. MTV og Sundhedstjenesteforskning |