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Scholle: We worked with IT and the SmartRoom Team. At that point, through our Small Business Ventures division, they pulled together a small company that is affiliated with the UPMC corporation. And the very first nursing unit to try it was Unit 12 North, which is an abdominal transplant step-down unit. And we looked at the physical environment. We have private rooms and semi-private rooms at Presby, and we initially wanted to focus on a unit with private rooms, which 12 North had; and I felt very strongly that we needed to work with a staff that would be highly engaged in developing this. And 12 North had been very involved with the Transforming Care at the Bedside work advocated by IHI [the Cambridge, Mass.-based Institute for Healthcare Improvement].
It's really a rapid-cycle change method-you would try something new and quickly tweak it, and then spread it. So they were very familiar with this kind of concept, and receptive to it, and were able to give us the kind of feedback we were looking for, to improve care processes and make life easier for front-line caregivers. So we met with them formally weekly, but the SmartRoom team folks and the unit leader, Marcia McCaw, R.N., talked daily. So it was a developmental process and continues to be.
We went live with this in June 2010, so we've been live there for a year. And then a couple of months after the implementation there, we went live in the GI surgery unit. And that was particularly interesting, because one of the physicians who admits patients there and does surgery is Dr. Andrew Watson, who is the medical director at UPMC's Center for Connected Medicine, and who has some very cool ideas for things he'd like to do to expand communication capabilities with patients.
So right now, we are live on five units, and are working on a sixth. Our campus includes the Presbyterian building and the Montefiore building, and we plan to have the Montefiore building entirely live. Our hospital is called UPMC Presbyterian-Shadyside, which consists of the Presbyterian campus and the Shadyside campus. I'm on the Presbyterian campus, in the Montefiore building, and the units that have gone live are in the Montefiore building. But our goal is to have the whole Montefiore building live by the end of the year.
REAL-WORLD IMPROVEMENTS
HCI: How has this made a difference in care delivery?
Scholle: Among other things, it has saved steps for the nurses. We actually had the nurses wear pedometers, and found that they were walking an average of 4.5 miles per shift; and they got that down to about 3.8 miles per shift; so they were able to save steps. And every minute that they're walking around instead of with a patient decreases their face time with patients. We have also had the kinds of things that nursing assistants are able to do, when they do their vital signs-so there's some ability to do documentation right at the point of care, via the touch screen monitors in the rooms.
HCI: When the caregiver enters the room, the smart screen announces the caregiver by name to the patient. That seems like a very strong patient and family satisfier.
THE CAREGIVERS AT THE POINT OF CARE ARE VERY BUSY TAKING CARE OF PATIENTS WHO ARE MORE COMPLEX THAN THEY'VE EVER BEEN CLINICALLY. SO IT'S REALLY HARD TO GET CHANGE ACCEPTED.
Scholle: Yes, and we had talked about the whiteboards, and prior to that, the nurse was supposed to come in and write their name on the whiteboard, but of course there's the human factor, and sometimes the nurse would forget, and the previous nurse's name would still be on there. And the patients do appreciate knowing which doctor is coming in. The doctors are electronically badged, so their names appear; and we're in the process of universalizing that identification system across all caregivers, including physical therapy.
Another really nice feature for the patients that we just went live with in January and that we're still trying to optimize is our patient education feature. Based on the things the nurse knows about the patient, and what the patient needs to know to take care of themselves and understand their situation, the nurse can go into the smart screen and select some videos and education. And some of those can be very specific. For example, in the transplant unit, they and their patient would have to present this information to patients and family members right after their transplant. And we took that content and adapted it so that it could be made into a module for SmartRoom education; so in addition to attending a class, the patient has that information available at any time.
THE DOCTORS ARE ELECTRONICALLY BADGED, SO THEIR NAMES APPEAR; AND WE'RE IN THE PROCESS OF UNIVERSALIZING THAT IDENTIFICATION SYSTEM ACROSS ALL CAREGIVERS, INCLUDING PHYSICAL THERAPY.
Anyone who knows about transplant patients knows that compliance is a huge issue. Their care is very complex, and the medication regimes are very complex; the kinds of things you can and can't do if you're had an organ transplant-there's a lot of information to know and remember. Some of these patients are taking 28 or 30 pills in the morning and have more to take later in the day. And that piece of education is so critical to their surviving and thriving, and yet is so difficult to deliver successfully, that you can't reinforce it enough. So that's one piece of education available through the SmartRoom technology. And that's one of 200-some videos available.
