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The presence of computers in the operating theatre is on the increase. Sheena Craig, theatre manager at the Western General Hospital, Edinburgh, describes how the Operating Room Scheduling and Office System (ORSOS) was installed in her theatre suite and asks, 'Was it worth the effort'?!
Each year the Medical Defence Societies report cases where litigation has arisen due to errors in operating theatres. Incorrect details on operating lists increase the risk of such errors. The Medical Defence Societies, in conjunction with the nursing profession, have produced recommendations to reduce the risks of errors in operating theatres (1). The patient's full name and hospital number should be checked against the theatre list by the receiving nurse. Abbreviations should be avoided and operating lists should be altered as little as possible and never by telephone. Current practice in our hospital is that operating lists are typed by the consultant's secretary, using information drawn from handwritten lists submitted by junior doctors or from admission lists. Currently the final operating list is not routinely double-checked. The possibility that such a system could lead to potentially dangerous errors prompted an audit of operating lists for a one-month period, including all specialties at the Royal Hallamshire Hospital, Sheffield. The aim was to measure the incidence of errors, omissions and alterations in completed operating lists.
This article highlights the process of establishing a computerized scheduling and materials management system in a surgical department. The following facets of the computerization process are discussed: options staff members should consider when choosing a computer system, the importance of scheduling and inventory control, cost savings, how computer systems work when using electronic data interchange and bar coding, and case studies.
Clinical engineering can have a key role in the redesign of existing hospital patient monitoring systems. This paper presents a systematic approach to the process of reinstrumenting highly specialized cardiovascular operating suites. A detailed definition of system requirements is presented for both basic and specialized instrument sets. Configuration flexibility was given the utmost attention. The method presented here suggests that system requirements should reflect information gathered from direct interviews of both the clinical and support personnel. Consideration is given to all applicable codes, standards, and practices. Special attention must also be focused on proper and efficient interfacing of the components of the new system to all components of the existing system. The project described here was conducted within and supported by the University of Alabama Hospital of the University of Alabama at Birmingham.
The Operative Registry (DA Form 4108) has been the information source for surgical data supporting quality assurance and utilization review efforts at Madigan Army Medical Center. Recently, Madigan's requirements for data and reporting changed. Like other government medical facilities, Madigan began pervasive quality-improvement efforts. This resulted in new ideas to measure hospital performance. Consequently, requirements for surgical data required to support quality and resource management reporting, utilization review, residency review reporting, research and credentialing changed. This article details Madigan's approach to addressing these requirements via development of a comprehensive computing solution. It discusses Madigan's fragmented data environment before system development, and gives the reader perspective on the decision-making process that led to system development rather than purchasing a commercial product. Finally, the article describes how a strong partnership between staff and developers was key to providing a solution that exceeded established goals.
Renowned Texas cancer center uses perioperative software to boost its billing and revenue collection, and to make real-time patient information an enterprise capability.
Hand-written or manually typed operation reports which are still in use in most hospitals are no longer sufficient to handle the ever-increasing amount of reports that need to be processed. We developed a thesaurus for general surgery to be used within the speech-recognition system ISSS (IBM Speech Server Series). From dictation in the operation theatre, the operation report will be generated simultaneously in its written form using a fast PC as interface.
Using a newly developed computerized intraoperative data acquisition system, the apparent adequacy of rewarming and its relation to the energy exchange between the patient and the bypass system was investigated. Retrospective analysis of comparable patients identified two groups that had, at the end of surgery, either a nasopharyngeal temperature (NPT) of 36 degrees C or more ("warm" group, n = 19), or a NPT of 35 degrees C or less ("cold" group, n = 19). Temperatures from the nasopharynx, thenar eminence skin, and bypass pump arterial and venous lines were continually recorded and sent to the computer data base together with the pump flow rate. There were no significant differences between the groups regarding time on perfusion, time taken to cool, time of hypothermia, or the time interval from end of perfusion to the end of surgery. However, rewarming time was greater in the warm group (P less than 0.01). The cold group were subjected to more profound hypothermia (P less than 0.001), and had lower NPTs and skin temperatures at the end of bypass (P less than 0.0001 and P less than 0.01, respectively). However, the difference between NPT and thenar skin temperature in each group at either the end of bypass or the end of surgery was the same. The net energy exchange between patient and pump was significantly different (mean in warm, 130 kJ [SD = 530]; in cold, -389 kJ [SD = 427]; P less than 0.003). In conclusion, the adequacy of rewarming can be expressed in terms of the energy exchanged in the bypass system, and cannot be assessed by the nasopharynx:skin temperature gradient.
A bar code system reduces the amount of time that nurses spend manually documenting patient care and performing other clerical tasks. By implementing a bar code system, nurses can spend more time giving patient care, risk managers can have more legible and complete documentation, and managers have access to a wide variety of useful reports.
The automated workplace (AWP) of anesthesiologist developed by the early 1990s provided data collection and processing, viewing of all monitors, and printing of anesthesiological chart (AC). AWP is a subject of continuous modification and adaptation to variable conditions. Computer monitoring including various measuring devises equipped with series interface RS-232 was implemented in Russian Research Center for Surgery. Rapid progress in computer network technologies made it necessary to adapt AWP to operation in computer networks. Since 1999 the computer network has been connected to the Internet. The use of computer technologies, including Internet, provides remote access to AC, thereby providing conditions for remote monitoring. AWP of anesthesiologist can be regarded as an automated control system of the patient state operated by anesthesiologist. Specific features of data processing in AWP are described. The AWP system is planed to be multiprocessor with distributed data flow. The suggested structure of computer network system for surgery rooms meeting the requirements of WWW-technology connected to the Internet is a promising approach to remote monitoring in medicine.
As an introduction to a study day devoted to informatic in surgery, some basis knowledges are summarized: architecture and function of computers, programmation language, data bases. They are illustrated by various applications made in the "Cliniques St Luc" te Brussel namely patient monitoring, artificial pancreas, office system and operating room management system. The future use of local area network is proposed in order to achieve medical department independence and the needed cooperation between all users of medical and hospital informatic.
Will the perioperative arena step out of the dark ages and into the new millennium with informatics? A paradigm shift must occur in both the perioperative arena and health care organizations. Health care organizations must realize the value of informatics and the importance of integrating the informatics nurse into the organizational information system's team. This article discusses how the informatics nurse can accelerate the paradigm shift in the perioperative arena if given the opportunity. The informatics nurse's proactive involvement in the perioperative environment will ensure that information handling technologies benefit the perioperative specialty and, ultimately, enhance patient care.
The completeness of data contained in a microcomputerized audit system has been compared with the operating theatre record book. The computerized audit system contained details of only 63% of the operations performed. Of the missing patients, 52% had never been completed. There were no failures of the computer system itself. Serious deficiencies in the methods of data entry were found and methods are described to overcome these deficits. The collection of audit information requires a disciplined approach and close supervision by a designated member of the surgical team.
A data collection system on microcomputer connected with an automatic medical report system for operations, was developed to facilitate both medical report as well as documentation. Linking different commercial software products by use of a Pascal programme, we were able to speed up daily routine work as well as establish efficient graphical statistics of patient data.
We are developing a dynamic prototype visual communication system for the operating room environs. This has classically been viewed as an isolated and impenetrable workplace. All medical experiences and all teaching remain in a one to one closed loop with no recall or subsequent sharing for the training and education of other colleagues. The "Anesthesia Point of Care" (APOC) concept embraces the sharing of, recording of, and presentation of various physiological and pharmacological events so that real time memory can be shared at a later time for the edification of other colleagues who were not present at the time of the primary learning event. In addition it also provides a remarkably rapid tool for fellow faculty to respond to obvious stress and crisis events that can be broadcast instantly at the time of happening. Finally, it also serves as an efficient and effective means of paging and general communication throughout the daily routines among various healthcare providers in anesthesiology who work as a team unit; these include the staff, residents, CRNAs, physician assistants, and technicians. This system offers a unique opportunity to eventually develop future advanced ideas that can include training exercises, presurgical evaluations, surgical scheduling and improvements in efficiency based upon earlier than expected case completion or conversely later than expected case completion and even as a unique window to development of improved billing itemization and coordination.
The growing complexity of the performance processes in medicine makes it mandatory that the flow of information is faster and more consistent, especially when the sites of health care are far away from each other. The Regensburg model, a realization of lean telemedicine from a low-cost domain, using PC-based standard videoconferencing systems shows the use of modern telecommunications, especially in trauma surgery. In 203 prospectively evaluated teleconsultations between 15 participants a total of 697 images were transmitted via videoconferencing. In 95% of the trauma cases the transmitted material was judged as at least sufficient. In project-attending evaluations the efficacy of these systems and their use were clearly demonstrated. Savings in transportation costs of up to 4,400 DM per case were achieved. Through quicker flow of information quality improvements for all participants resulted; to some extent considerable costs for health care were avoided or reduced. Based on these thoughts, a new platform of communication will be established in Regensburg as a closed medical intranet for the region of eastern Bavaria.
Nowadays systematic documentation of surgical procedures is absolutely necessary in all departments of surgery and will soon be required by law. Therefore code systems are essential. Amongst numerous systems the ICPM-GE classification has been chosen as basis. In the department for abdominal and transplantation surgery at Hanover Medical School the ICPM-GE classification has been extended by a concept of coding main and suboperations. This concept considers the fact that in an individual patient the surgical procedure may consist of different and standardized suboperations. This concept widens and simplifies the possibility of documentation considerably.
The registration of adverse events is an important issue in the field of medicine. Even today adverse event screening and registration is not part of the routine in most medical areas. In 1994, the Department of Neurosurgery at the University of Heidelberg implemented a conference for screening and registering adverse events. The aim was to record all complications occurring for an internal quality control. High priority was given to improving the process of data screening and registering. The conference is held every 2 weeks and all medical staff and residents of the department are obligated to be present. Screening of the adverse events encompasses all operations performed during a bi-weekly period. Every single operation is revised for an adverse event during or following the hospital stay. Adverse events are registered on a standardized data sheet and later transferred to a database for use in further investigations. After 6 years, the conference has been fully accepted and become an integral part of the workflow of the department. During this period, 8160 operations were screened and 1335 adverse events registered. The next step will be to integrate the data-collection process into the daily ward rounds using a personal digital assistant (PDA). This process is less time consuming and may perhaps augment the number of registered cases.