Computer-generated rounding report increases workflow efficiency
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The document discusses a project aimed at improving workflow efficiency through a computerized rounding report for junior doctors, which addresses common issues faced during pre-rounding. It outlines the benefits of this solution, including time savings and reduced transcription errors, alongside positive feedback from users highlighting its ease of use and accuracy. The report is set for implementation across all disciplines in Singapore General Hospital following its initial trial.
Computer-generated rounding report increases workflow efficiency
- 1. Computer- generated rounding report increases workflow efficiency Dr Liu Zhenghong Dr Juliana Kan A/Prof Tay Sook Muay
- 2. Contents Pre- rounding Problems with pre- rounding Solution Results Sustainability of results Learning points
- 3. Pre- Rounding • Common practice amongst junior doctors worldwide • Junior doctors see patients on their own before the entire team does the morning round • Makes a preliminary entry and formulates provisional plans
- 4. Pre- Rounding Practical Benefit • Saves time during morning round • Collates necessary information Learning Benefit • Opportunity to practice making clinical decisions
- 5. Problems with Pre- rounding Working hours • Residents exceed work restriction of 80h/week • Sleep deprivation/ burnout Transcription errors • Large amounts of data copied • At early hours e.g 5am • Implications on patient safety
- 6. Project Selection : Problem Worth Solving ------------------- Pre-rounds ---------------------- Rounds 1. Look through overnight events 2. Copy vitals & Input/Output 3. See patient 4. Case assessment and plan 5. Rounds with senior doctor Process analysis
- 7. PGY1s find the following aspects of pre-rounding useful to learning (n=57) Writing overnight events 29.8% Copying Vitals, I/Os 15.8% Copying lab values 22.8% Seeing patient 75.4% Writing issues and plans 85.2% Communication with nurses 15.8%
- 8. Project Selection : Problem Worth Solving ------------------- Pre-rounds ---------------------- Rounds 1. Look through overnight events 2. Copy vitals & I/Os 3. See patient 4. Case assessment and plan 5. Rounds with senior doctor Remove the step of least learning value/most mechanical (Step 2)
- 9. Solution • Computerized morning round report • Generates report with pre- populated data from electronic medical records • Generated and printed with a single click every morning
- 10. Doctor's Orders: Vital Signs: 29/06/14 13:42 T: 37 Tmax: 37 (29/06/14 13:42) BP: 120/80 (120-120/80-80) HR: 60 (60 - 60) RR: 20 (20 - 20) SPO2: 99 (99 - 99) O2 Therapy: 10 Hypo(24hr): LX TEST 8 (95M) W44C Lab Values: U: Na: K: Cl: Bi: Cr: Hb: TW: Plt: 29/12/13 12:49 5 140 6 105 21 30 01/01/14 10:23 20 5 300 29/12/13 12:48 5 140 4 105 21 30 29/12/13 12:42 20 5 300 Input/Output: 30/06/14 06:00 NET: 300 Examination: Issues, Plan: Subjective/Overnight Events: IN: 300 OUT: Urine Total: Vomitus: Others: PU x 5 BO x 1 IV: 100 Blood: TPN: 200 Others: Aspiration(net): Dialysis(net): 30/06/2014 X0121080110I 01/09/1918 6713101528I Length Of Stay: 307d (27/08/2013) Morning Round: ________________ (Team Name / Consultant Name) POD: Abx: Neomycin Sulfate Tablet(245d), Clarithromycin Tablet(97d), CefaZOLin Injection(97d) Cont. IV drips: Premix N/S 0.9%(0.5L) Allergy: Mepacrine, A-LICES SCALP AND BODY HYGIENE SHAMPOO, A.M. - BEACONS PHARMACEUTICALS Signature & Name Chop:___________________ Page No.____ All of the above reviewed & approved by:___________________Time:___________ Data captured is a time point capture. Please review all data and results in SCM. Time:_____________ (Senior Doctor) Printed By: Zhao Hainan, (Visiting Consultant) Time Printed: 13:48 hrs
- 12. • Ensure accuracy of data • Refining report Implementation Trial Oct 15-Nov 5 • Feedback from doctors/ nurses and improvements to report Implementation November 19 • Continued collation of feedback Maintenance January 2014 onwards
- 13. Methods Pre- and post-implementation: • Collecting earliest log-in timing to computer system • Questionnaire
- 14. Results - Usage •Up to 99 users print rounding report per day •Total no. of post-graduate year 1 doctors: 113 87.6%uptake rate (*not including those who print for their colleagues) Self-reported usage: 86.3%
- 15. Results - Average log-in time Pre-implementation: 6:27am Post-implementation: 6.56am 15 Average time saved: 29min/day Self-reported time saved: 27.8min/day
- 16. Results - How time saved was spent 16
- 17. Results - Reduction in transcription errors 78.7% reported reduction in transcription errors 17
- 18. Results - PGY1 satisfaction with pre-rounding 18
- 19. Results - PGY1 satisfaction with pre-rounding 19 100% find the rounding report helpful 86.3% want to continue using the report
- 20. Results - Feedback from PGY1s “Good and very helpful” “Save time and looks more neat and standardized” “Easy to review when reading back old entries” “Presents information in an easy to read and understand format” 20
- 21. Results - Feedback from senior doctors “More structured and give focus to the HO pre-rounding” “Facilitates faster ward round” “More reassured that the numbers written down are accurate” “It ensures there is a baseline level of quality in the rounds” “A nice step in the direction of a completely electronic medical record” 21
- 22. Further implementation • Approved for roll-out to all disciplines in Singapore General Hospital after Joint Commission International accreditation in June 2014 • Team facilitating implementation of report in other tertiary public hospitals in Singapore
- 23. Learning points/ Strengths • Involvement of all parties: junior/senior staff, nurses, IT • Ensures that solution is relevant to all • Minimizing change to daily workflow • Allows for ease of transition
- 24. Learning points/ Weaknesses • One size fits all vs personalisation • Single version may not be applicable for all • Data collection • Largely subjective data • Further studies needed to • Correlate login time and actual time saved • Assess for reduction in clinically significant medical errors
- 25. Thank you This presentation contains information which is confidential and/or legally privileged. No part of this presentation may be disseminated, distributed, copied, reproduced or relied upon without the expressed authorisation of SingHealth.