Software helps maintain orderly, efficient facility

Bar codes track patients from start to finish

Trying to manage and track 100 patients daily through an outpatient surgical center can be chaotic and expensive. That’s why Baystate Health Systems in Springfield, MA, turned to the latest technology when it opened its new center last June.

"One of the challenges we had upfront was making [the facility] operational without making it too costly. We made a commitment to try to leverage as much technology as we could to make the whole building run efficiently," explains Liz Thiebe, RN, MBA, director of perioperative services at Baystate.

Thiebe thought it was important to have different methods of communicating between caregivers at the center without the work interruptions caused by telephones. She also wanted to make it easier for patients and their families to use the building. With this in mind, she and other Baystate managers visited other health care facilities across the country to see how other facilities managed their patient flow.

One facility used a colored bar graph to show patient status. That started the wheels turning, Thiebe says. "We thought it was interesting and wondered if we could broaden that idea to expand beyond just knowing the status of these patients."

Baystate asked Robinson Consulting, also in Springfield, to work with them to develop a work-flow manager and patient-tracking system using color-coding and bar-coding technology. A core team comprising Robinson director Renee Lizotte-Broadbent, software developers, Thiebe, a Baystate anesthesiologist, and the director of surgical services, worked on the specifics of the software.

The prototype made the rounds of the health system and elicited heavy clinical input. Modifications were made and the AdvanTRAX system was up and running when the center doors opened.

"The application has exceeded our expectations," Thiebe says. The system, which uses Baystate’s network, tracks the patients from the moment they check in at the center to the time they are discharged. Through a variety of data representations, the system displays the location and status for each patient, a schedule for each physician, plus a daily schedule for each of Baystate’s 12 operating rooms in the surgical center.

The tracking takes place through bar codes. The day before the patient’s visit, the patient’s medical information is manually entered into the system. When he or she checks in the next day for surgery and enter the reception area, the patient is given a wristband that has a bar code with the medical record number on it.

Each time the patient proceeds to the next step through the surgery process, the wristband is either scanned with a radio frequency hand-held bar code scanner or entered into the system through keyboard strokes. Then a staff member scans the bar code of the appropriate event on a procedure chart at each location. The two-step scanning process enters five pieces of information into the system:

1. the unique ID for the patient;

2. the current date;

3. the current time;

4. the current location of the patient;

5. the current task/procedure being performed on the patient.

The system has a preassigned color to indicate each step in the process. For example, one color indicates that the patient has arrived in the operating room. The color of the operating room displayed on the screen will change to indicate that the patient is ready for anesthesia. The color changes are particularly noticeable on the systems’ floor monitor screen. (For an example of this screen, see box, above.)

"One of the nice things the system does is give you a visual presentation of the entire unit," Thiebe says. "It’s like a map on a screen."

The floor plan monitor screen refreshes every five seconds, Broadbent adds. "As things are happening to patients, and transactions in the database are getting updated, the screen is constantly in flux as the colors change."

Users can also get more information from the screens by selecting a certain area on them. From the floor plan monitor or the OR summary screens, for example, users can select a patient and get a detailed list of everything that has happened to that patient since he or she walked in the building. (For an example of the patient tracking screen, see box, p. 174.)

Selecting a particular operating room on the OR summary screen gives users the entire schedule for that room on that day — including patients, surgeons, times, and procedures. And if users hold the mouse down over a room on the floor plan monitor screen, a balloon appears with the name of the patient in that room. Users then have the option of seeing all the activity for that patient or the schedule for the room for that day.

The system also gives physicians a daily report of their schedules. They can see where their patients are in the process, what time they are scheduled for surgery, and in what operating room.

Families get quick updates

Families of the patients like the system because they can get quick updates, Thiebe says. "We have four suites with 10 beds in each suite that surround the surgery areas. The patient’s family is told which suite to go to and which bed the patient is in. It’s easy for them to find."

Patients, though, were an initial concern. "We were concerned that the patients would feel that they were in an assembly line with the bar codes on their wristbands," she says. This hasn’t been the case. "They’re hardly aware of the process we are going through in terms of updating the events."

The system also produces a variety of reports, of which Thiebe says she is just beginning to use. "A lot affects the operating room efficiency. Some of them are: Did the surgeon show up on time? Was the equipment processed correctly? Did staff have what they needed? Were personnel up to speed? Did the procedure take longer than expected?"

Looking at room activity comparisons on a daily basis allows the charge nurse and the floor manager to try different options to get a room to run more efficiently. "Some teams work better together, too. You can pick that up as you go. It’s interesting. It’s information we’ve never had before."

The system also generates an automatic report of operating and recovery room charges. Without the system, nurses would have to manually write down the time the patients entered the rooms and what time they left and then bill on a per-minute basis.

Now the bar codes log it automatically. Since Baystate doesn’t have an interface yet with its billing department, the report is printed out daily. "It has eliminated the need to tally numbers," Thiebe says. She adds that Baystate hopes to soon add an interface between the AdvanTRAX system and the operating room scheduling software and the billing system.

Thiebe says without the system, she would probably need three or four additional secretaries to answer the phones and track patients. "That’s something you can’t afford in health care today — added cost without adding any value."

"A lot of money is tied up in operating rooms," Thiebe continues. "The equipment is expensive, and the personnel costs are high. A lot of resources are spent. Anything you can do to make it more efficient is the way to go."

"The key to the success of this program is that we had a clear vision. Then we found programmers who could translate our vision into something great."

[Editor’s note: AdvanTRAX is now commercially available and can be customized for different facilities. For more information, call Renee Lizotte-Broadbent at (413) 746-6392.]