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A Dashboard for OR Patient Safety Optimization

July 23, 2012
by Mark Hagland
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At Saint Luke’s Health System in Kansas City, a breakthrough on ensuring patient safety in the operating room

In May of this year, leaders at the Saint Luke’s Mid America Heart Institute, a division of the 11-community-hospital Saint Luke’s Health System, based in Kansas City, Mo., went live with an advanced patient safety platform called OR-Dashboard, which was developed for Saint Luke’s by LiveData, Cambridge, Mass.

The installation, which went live in early May in all five of Saint Luke’s cardiac operating rooms, integrates information from critical clinical processes in the operating room (OR), enhancing overall workflow, with a focus on patient-centered care.

The solution combines the capabilities of OR-Dashboard with the OR1 suite from Karl Storz Endoscopy America, providing the surgical team with a complete picture of what’s going on in the OR precisely as it’s happening. Among the innovations involved, this installation automates the “safe surgery checklists” prescribed by the World Health Organization, the Joint Commission, and other groups.

Among other tasks, the LiveData OR-Dashboard solution helps to reduce surgical errors and complications in several ways, including by helping team members to document compliance with protocols for confirming the correct patient, procedure and site prior to the first incision.

Ricci Wells, R.N., clinical nurse manager in Cardiovascular Surgery at Saint Luke’s, and Christopher Christensen, R.N., program manager at the Saint Luke’s Patient resources team, recently spoke with HCI Editor-in-Chief Mark Hagland regarding this innovative program. Below are excerpts from their comments.

What were the overall objectives for creating the OR dashboard?

Ricci Wells, R.N.:  The most important  objective was to improve patient safety. And one of the big things we’re going to see being helpful in the future is adherence to Joint Commission, CMS, and SCIP guidelines [guidelines from the Surgical Care Improvement Project, created and sustained by a consortium of organizations, including the Centers for Medicare and Medicaid Services, the Centers for Disease Control and Prevention, the Joint Commission, the American College of Surgeons, the American Hospital Association, and others], promoting workflow efficiency and productivity, and promoting effective communication.

Ricci Wells, R.N., in front
of an OR at Saint Luke's
Health System

What were the first clinical and process measures loaded onto the dashboard?

The vendor showed us some examples, and then we customized them. The two main areas on the dashboard are the timeout [the process that runs through the checklist around operating on the correct patient, procedure, and site, and stops initiation of surgery if an error has been detected]; and we used the policy of what needed to be addressed in the timeout procedure; and the second one was the debriefing our sign-out procedure.

Can you explain those elements in a bit more detail?

The timeout is done when we bring the patient into the room, and the surgeon, anesthesiologist, scrub nurse, and circulating nurse are in the room, and sometimes there’s ancillary staff, too, such as perfusion, physician assistant, present, as well. And once everyone’s in the room, before starting, we confirm that we have the correct patient; any allergies; correct procedure; correct site or side for surgery; that we have proper positioning of the patient; that equipment or supplies needs have been addressed; and antibiotics—have they been given to anesthesia in the appropriate period of time.

Without a dashboard, do people tend to skip over things?

Possibly; we’ve been doing this timeout process for a long time. But with the dashboard, we click into everything and post it for everyone to see throughout the procedure, so you get consistent communication, so it involves things that have probably always been done; it’s just a more organized, consistent way of doing it.

What have the challenges on the IT side been?

Christopher Christensen, R.N.: Making sure of the integration between and among our surgical EMR [McKesson Horizon Surgical Manager from the Alpharetta, Ga.-based McKesson Corporation], the anesthesia EMR  [from the Wakefield, Mass.-based Picis Inc., now a division of OptumInsight], and LiveData solutions.

Who is inputting this data?

The nurses and the anesthesiologists, as they chart. And LiveData draws that in, through a server, onto a 48-inch flat screen in the OR.

Everyone can see the data?

Yes. And they have the patient’s name, vital signs, cardiac tracings, and other information listed.

How much customizing was involved in bringing this solution to the Saint Luke’s organization?

There really wasn’t much in the way of customization; LiveData just needed to know the mappings in the databases. They just needed to discuss the mappings from Picis or from HSM, and then they did the work on their side. They needed confirmation on where certain charting was done. From our standpoint, it was a pretty easy process.

Was any troubleshooting required?

No, in fact, LiveData came in and did lunch-and-learns, where they would review the data, and the staff would be involved in tweaking the data, and LiveData would tweak their system and bring it back. And when we went live, April 30 and May 1, there were really no issues at all. It was a turn-it-on-and-it-worked kind of situation. And I’ve been monitoring whether they’ve been having any issues with the monitors or anything, and I haven’t heard anything.

Has this improved clinicians’ satisfaction with processes in the OR?

Wells: I think so. Anything you add to someone’s processes, well, I think there was a little bit of skepticism when we first started talking about it, but when the physicians and nurses started training in this, people said, well, this might be a nice thing. So it’s not anything new we’re adding to our job other than having a big monitor with a checklist on it and nurses clicking on that checklist. So I’ve heard favorable comments, because everyone feels we’re doing the same things in the same way with each patient, and we’re being patient. So the vital signs and all the other data points are there; so it’s been very positive.

Is there anything you’d share with CIOs, CMIOs, and VPs of clinical informatics about this?

If they were looking at some kind of program like this, I would recommend that they involve some type of multidisciplinary group to plan this, as well as the informatics team that needs to ensure the integration of all the existing programs that feed into it, and that they look into customizing this and make this work for their area; because if you customize this, people will adapt to this better. And Storz, the vendor, Carl Storz Endoscopy, LiveData is one of their divisions; and they’ve had a group of people working with us. And I get reports on a daily basis saying we completed the timeout 100 percent of the time, the debriefing 100 percent of time.

And what lessons have been learned from the IT side on implementing something like this?

Christensen: Knowing your systems that they’re trying to pull their data from, and helping them out in terms of technical discussions, are very important. From the LiveData side, we were told this was probably their smoothest go-live, because we knew where all the mappings were, and could answer their questions pretty efficiently. And the LiveData people were very easy to communicate with.


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