"Yes Board" facilitates rapid sharing of key data, trims LOS in the ED by 40 minutes

Key developer is an emergency medicine physician with a computer engineering background

Sometimes home-grown solutions are the best ones. And if you happen to have an emergency medicine physician in your midst who is also a computer engineer, the pathway between a new idea and implementation can be especially short. It's an opportunity the Mayo Clinic in Rochester, MN, was able to take advantage of when the institution's own engineering department informed the ED that it was no longer going to support the antiquated locator board monitoring system that had been in place since the 1990s.

Powered through a single computer, the crude system in place at the time basically monitored the lights that were in place to indicate where patients were in the process of care. "It would monitor each one of the lightbulbs to see if there was power, and if there was, it would show up on a monitor," explains Vernon Smith, MD, an emergency medicine physician who was working at the Rochester, MN, clinic at the time, but spent the first 15 years of his professional life working as a computer engineer. "Basically, the monitor would show you whether the lights were on or off."

When Mayo's engineering department made it clear that the ED was going to have to come up with a different monitoring system, Smith and his colleagues concluded that they needed a customized solution. "We wanted to create a web-interface board so that people could get to it no matter where they were," he explains. This way, anyone with access to the main network could click on the ED page with all the lights and get a rough feel for how busy the ED was, which patients had been seen by physicians, which patients had been seen by nurses, who was in X-ray, and so on, he says.

This formed the basis of what would come to be called the Yes Board, a web-based monitoring system that Smith designed with the help of his clinician colleagues. What's more, the Yes Board has continued to evolve since it was first launched in September of 2007.

Early tweaks trim LOS

Some of the first tweaks to the Yes Board were in response to the fact that ED staff were repeatedly going into the system to see whether labs and other tests were back. In fact, people checked on these issues an average of 12 times for every patient that they saw, explains Smith. "It was really time consuming, so the first thing we did was put up an indication to show immediately whether such tests were completed."

However, then the clinicians got to thinking that it would nice for the people who were cleared to access clinical information not only to know whether a patient's labs or radiology tests were back, but also what the results actually were. So Smith and colleagues built mechanisms into the system so that clinicians could not only drill down and actually retrieve the specific test results, but also observe icons that would indicate if a particular result was a bit abnormal or perhaps critically abnormal.

"I see patients all the time. That's really important because I know what it is that my colleagues are doing. I know what they have to put up with because I am having to put up with it just as much as they are," says Smith. "But I know how to fix it. I know how to make it better for them."

Early pre- and post-implementation data suggest the innovation shaved as much as 40 minutes off of length-of-stay (LOS), although Smith says it's tough to separate out all the factors that could have influenced the data. Today the Yes Board — a name that was chosen simply because developers wanted a moniker that was more appealing than "ED locator board" — has also been implemented at the Mayo Clinic in Phoenix, AZ, where Smith now works, and it will soon be implemented at other Mayo-affiliated hospitals as well.

Clinical input drives improvements

The rich trove of data that is available through the Yes Board is all the result of direct feeds that flow automatically into the innovation from as many as 15 different data systems the hospital is already using. "We made that the goal. We hate having to set up anything where you have to do something to get information out of it," notes Smith. "We have a direct feed from the lab system so that we know when a test has been ordered, we know when it is on the pending list, and we know when results are in. The same is true with radiology and vitals. We have an EMR [electronic medical record] that we enter the vitals into, and we just take the data right off of it."

With in-house expertise at the ready to make changes or add functionality based on clinical input, the Yes Board is almost continually in flux, even from week to week, notes Smith. "The board that you see today closely resembles the board of last week, but there are some differences," he says. "It is always changing by just a little bit."

For example, one recent enhancement in functionality gives ED staff more complete information about the admissions process. "We had already established a system where if a patient was being discharged from the hospital, a purple light would come on, and if the patient was being admitted, then the purple light would flash, so everyone knew that this was the case," explains Smith.

However, it became clear that there are about six different steps involved in the admissions process, and what was happening in some cases was that there would be a break in the chain somewhere, and the system would get bogged down.

"The service wouldn't get paged, and then the physician hand-off wouldn't occur, and people wouldn't know that the service had already been assigned because no one let anyone know about that," explains Smith. "To resolve the problem, what we did was break the purple light up into five segments, so it is almost like a battery meter. Each little square on it represents one more step in the admissions process, and you can watch the squares fill up as each one of the steps is completed. This way, everybody knows what it is that we are waiting on next, and if there is a break in the chain, we all know about it."

Dialogue is key

While most EDs don't have a physician on site who is able to appreciate every problem both from the standpoint of the provider, but also as a problem-solving engineer, there is always the opportunity for clinicians to establish closer working relationships with in-house IT staff as well as outside vendors. Smith emphasizes that smart vendors will use the opportunity to take advantage of a clinician's knowledge and wisdom in patient care. In fact, it is a wonder that more such dialogue isn't taking place, given the impact that IT has on the way care is delivered.

"When you buy an EMR you think you are buying some piece of software, but what you are really doing is buying workflow; you are buying a process and the database behind it," observes Smith. "Everything else in that product is going to drive what it is that you do, whether it is how you take temperatures, how fast patients get placed in a room, or how you know when they get placed in a room."

Source

  • Vernon Smith, MD, Emergency Medicine Physician, Mayo Clinic, Phoenix, AZ. E-mail: smith.vernon@mayo.edu.