Electronic Documentation for Improved Workflow

By Joshua Scheller, MHA, RT(R)

October 2009 — Similar to other hospitals and imaging departments, the interventional procedures of Community Hospital South in Indianapolis, IN, whether performed in CT, ultrasound, or the IR lab, were bogged down by inefficiency and time consuming processes. We struggled with duplicate documentation and a very paper heavy documentation and reporting system. In an effort to improve the nursing portion of these procedures, we have transitioned to an electronic patient monitoring and procedure documentation system.
 

In the previous workflow, our outpatients would arrive in day beds, where the pre-procedural work up was completed. Nurses in the day beds unit would enter patient medical history and baseline patient vitals into an outpatient database. This process would take approximately 30 minutes prior to the patient being transported to radiology for the procedure.
 

Upon arrival in the imaging suite, the radiology nursing staff would duplicate the pre-procedural documentation process by filling out patient information, baseline data, and other requirements on paper forms unique to radiology. This process added another 30 minutes to the process before the patient ever entered the procedure room. Procedural documentation was also paper based, along with The Joint Commission-driven medication reconciliation and timeout forms. After it was all done, our nurses were juggling 7 or more pieces of paper for each case.
 

To help develop a new workflow, we installed patient monitors and implemented a patient monitoring and procedure reporting system. The new monitoring and reporting system utilizes a centralized server based platform for data storage and a customizable electronic reporting template for documentation. Data is entered into the system through the main patient monitoring interfaces, remote patient monitors, or nurse workstations. The main module for patient monitoring and reporting resides in the IR suite with the server located in our data center. We have patient monitors and workstations in IR, CT, and day beds.
 

In the current workflow, the patient again starts in day beds, where the same pre-procedural data is entered into the patient monitoring and procedure reporting system rather than the outpatient database. Upon arrival in radiology, and after completion of the consent, the patient goes directly into the procedure room. In this case we have eliminated the duplicate data collection by our nurses. They simply access the patient file started in day beds and continue monitoring.
 

Patient monitoring data automatically feeds into the system pre- or post procedurally through the patient monitors and nurse workstations, or through the main patient monitoring interface during an IR procedure. The data populates the procedure template without additional interaction from the staff. Blood pressure, respirations, oxygen saturation, and EKG graphics all become part of the final report.  Medications that are administered anytime during the case are entered through a series of drop down menus or through a text field. All paper based forms have been incorporated into the system’s electronic report template.
 

Occasionally, the patient will be transported directly from the IR suite to CT for additionally imaging. We are able to transfer the patient to the CT patient monitor and workstation where the patient’s monitoring and procedural data continues to automatically feed into the system. Supplies used during the procedure are not included in our report because we use a separate inventory management system that allows reporting for each procedure.
 

Following the procedure, the patient returns to day beds for recovery, where the staff again accesses the electronic procedure record. During recovery, the patient’s monitoring data continues to populate the exam record in addition to any medications or notes that are entered.
 

In addition to the reduction of duplicate data entry, the new processes allow for additional efficiencies and safety measures. The reduction in manual data entry reduces the likelihood of associated errors or missed documentation points. The electronic record also becomes available at several points of care, including pre-procedure holding, the exam suite, and recovery. We have all but eliminated lost paper procedure records and unreadable written documentation. Also, the final procedure report allows for the radiologist, along with the staff involved with the case, to sign 1 form rather than 4 or more paper forms.
 

The next steps in this process are to add additional workstations in ultrasound for ultrasound guided procedures such as a biopsy or thoracentisis, and to interface the system with the Health Information Management (HIM) system to allow for a direct feed of the final report into the patient’s medical record.
 

It has been estimated that a great deal of efficiency can be generated in our healthcare system by the use of an EMR, CPOE, telemedicine, and other electronic data management systems. This has proven to be true, even if on a very small scale, with our current implementation and workflow change. 

Joshua Scheller, MHA, RT(R) is the director of medical imaging for Community Hospital South in Indianapolis, IN. Joshua received his MHA from the University of Southern Indiana and is an active member of the AHRA and has contributed to Radiology Management. He may be contacted at jscheller@ecommunity.com.