Making the best better
Northwest Michigan Surgery Center in Traverse City, Mich., performs in the top 1 to 2 percent nationally in all statistics, including size, volume and quality of care indicators. So, how does a high-volume ambulatory surgery center continue to thrive and not only maintain its leadership status, but also set the bar higher?
NMSC turned to technology and installed the Versus Advantages™ IR/RFID Realtime Locating System to track patient progression and automate patient flow, while passively automating EMR data entry.
Patient flow and room turnover
NMSC’s initial interest in the Versus Advantages RTLS was to enable more efficient patient flow through pre-op and post-op. Supply chain manager Brett McGreaham explained, “We have the per-service benchmark data and we were better than average for some service types, but not for others. We know the average time per case, but we weren’t as efficient breaking down the pre-op and post-op times.”
Jim Stilley, CEO and administrator of NMSC at the time of implementation, added, “Actual surgery times are case- and physician-dependent. Pre-op and post-op — this is where you have control.” With four procedure rooms, six full ORs and an average of 85 patients per day, ensuring smooth flow from pre-op to the OR to post-op is essential.
With Versus Advantages, NMSC staff know in real-time, without manual data entry, when vitals are done, when a nurse, surgeon or anesthesiologist is (or was) with the patient. They can also tell how long a patient has been in the operating room.
“If you know the average time a patient stays in the operating room is 20 to 25 minutes, and you see the patient is at 18 minutes, you know the room will be opening up soon,” said Hortensia Dziedzic, endoscopy coordinator. PACU staff know to prep the recovery area, and pre-op staff know to move the next patient into the OR.
Since installing the Versus RTLS, NMSC has dropped its average time in recovery by approximately 5 to 10 minutes, with a significant effect on costs. “When you’re talking about 19,000 patients times 10 minutes, that’s a lot of time,” Mr. Stilley said.
Through benchmarking, NMSC has also tracked other marked improvements. According to Mr. McGreaham, the overall length of stay for gastro-intestinal procedures has dropped 12 minutes; time in post-op for hand surgeries is down 13 minutes; and OLOS for cataract surgeries dropped four minutes.
Mr. McGreaham added, “With such high patient volumes, shaving a few minutes from each pre-op and post-op stay means thousands of dollars in savings.”
Reducing clinical staff hours
NMCS quickly realized Versus Advantages could also be used to manage staff productivity.
Before Versus, NMSC knew the patient load varied throughout the day, but without accurate data, they were unable to adjust staffing. Before real-time tracking of their “pod” system (four patients to one pod monitored by a nurse and an aide), patients were often placed in an unused pod before the previous one filled up. This wasted staff resources in one area while not fully utilizing them in another.
With the situational awareness Versus provides, NMSC can now achieve their pod utilization goals and adjust staffing appropriately.
The facility anticipates being able to schedule one less nurse per day. “We’re getting staff hours leveled out,” said Cynthia Lawson, PACU team leader. “This alone will pay for the system — and then some — very quickly.”
Design and implementation timeline
NMSC and Versus discussed in-depth workflow and system design during January and February 2012. “Versus delved into the details with us,” said Mr. McGreaham. “We mapped out every possible patient progression scenario so that we could automate patient flow. We relied heavily on Versus’ expertise in these areas.”
The system went live in April 2012. According to Tina Piotrowski, clinical director, “The implementation process was much less involved than the EMR, and it has immediate, lasting value.”
Benchmarking through the EMR; validating with Versus
Versus Advantages RTLS is integrated with NMSC’s SourceMedical Vision EHR™. Staff enter the Versus badge number into SourceMedical when they register a patient. The badge is worn by the patient, and from then on, the patient’s location is linked to his or her medical record. Staff interactions with the patient are also recorded.
The EMR data is validated with real-time information from Versus. Mr. McGreaham explains, “By using Versus to passively collect the data and to examine and audit the data in the EMR, we are assured two things: one, skilled staff are not spending time on low-skill data entry tasks; and, two, there are no data collection errors. It’s completely passive and it cannot be fudged or forgotten.”
Versus also pulls data from the EMR for display on workstations and high-definition Glance-and-Go™ boards located throughout the treatment area. Patient name, physician, type of surgery, scheduled surgery time and any related notes are displayed alongside a running timer of the patient’s overall length of stay and time at current stage. Through custom iconography, staff can also see the status of each patient care process, and which staff are currently with or have already seen the patient.
Glance-and-Go™ boards provide a real-time view of staff, equipment and patient location, as well as the status of a patient’s care process and the current state of surgery suites.
Mr. Stilley describes the value of the RTLS compared to the EMR: “Whereas the EMR allows us to document an individual patient’s care, the Versus RTLS allows us to focus on delivering that care as effectively as possible, while auto-populating the EMR with data that RNs would otherwise have to manually input.”
Along with OLOS by service type — which is benchmarked through the EMR — Versus times and records each patient care milestone. With Versus’ Reports Plus™ Analytics application, each metric can be reported on individually, on a clinic-wide basis, or by provider or service type.
HIPAA-compliant and family-friendly
For those left wondering in the waiting room, NMSC deployed a “family waiting view” on a large HD monitor. Displaying the patient’s first name and physician, it uses a checkmark system to indicate when the patient is in pre-op, OR and recovery or when the patient is “ready for family.”
“Family members worry about their loved ones,” Mr. Stilley said. “They’re often anxious, wanting to know what’s happening beyond those double doors.”
Prior to using the Versus system, family would question NMSC’s front-desk staff. Staff would have to interrupt the unit clerk to find out where the patient was, and the unit clerk would have to find the nurse. This not only interrupted workflow, it also frustrated staff and family members alike.
It makes front desk staff look uninformed and doesn’t leave a favorable impression with family members—ultimately impacting whether they’d choose or recommend the facility in the future.
With Versus, NMSC keeps both families and staff informed, in real-time. “It’s like an airport,” Mr. McGreaham says. “You just walk up and see your status.” Mr. Stilley added, “Making the patient’s current status available to waiting family members has been a huge patient and staff satisfier.”
Learn more about Versus.
