Sakowska Magdalena M, Thomas Megan V, Connor Saxon, Roberts Ross
Department of General Surgery, Christchurch Hospital, Canterbury District Health Board, Christchurch, New Zealand.
E-Clinical Health Lead, Christchurch Hospital, Canterbury District Health Board, Christchurch, New Zealand.
ANZ J Surg. 2017 Mar;87(3):143-148. doi: 10.1111/ans.13805. Epub 2016 Oct 21.
In measuring quality of health-care delivery, digital infrastructure is essential. The aim at this tertiary centre was to create a hospital-wide workflow system that collected data prospectively as part of daily practice.
In moving towards an electronic health record, a hospital-wide integrated workflow system was introduced in 2013, which electronically managed the perioperative patient journey while simultaneously facilitating surgical audit. Analysis of its implementation was carried out presenting early outcomes using general surgery as an example.
Theatre-bookings (44 953) were made with compliance approaching 90% for all services. Of 7179 general surgical operations over 24 months, 5785 (80%) had an operation note created using the new system. Cumulative summation of uptake of synoptic operative reporting (SOR) for laparoscopic cholecystectomy (LC) was 81% with documentation being superior in terms of antibiotic use and steps to safe cholecystectomy (P < 0.001). A LC SOR took 4 min to complete (interquartile ranges 2-5 min, n = 425) and was immediately available on the day of surgery compared to narrative operative reports taking 2 days (interquartile ranges 1-5 days, n = 174) (P < 0.001). From July 2014 to November 2015, 557 (10%) complications were recorded for 5749 general surgical operations with 99% of complications being reviewed.
The rapid and sustained uptake of both theatre-bookings and SOR likely reflect high end-user satisfaction with the system. Service metrics indicate a significant improvement in the time of delivery. The ability to seamlessly complete the audit cycle at an individual, department and hospital level has been achieved.
在衡量医疗服务质量时，数字基础设施至关重要。该三级医疗中心的目标是创建一个全院范围的工作流程系统，作为日常工作的一部分前瞻性地收集数据。
在向电子健康记录迈进的过程中，2013年引入了全院范围的综合工作流程系统，该系统以电子方式管理围手术期患者的就医过程，同时促进手术审计。以普通外科为例，对其实施情况进行了分析并呈现早期结果。
所有服务的手术预约（44953次）合规率接近90%。在24个月内的7179例普通外科手术中，5785例（80%）使用新系统创建了手术记录。腹腔镜胆囊切除术（LC）的概要手术报告（SOR）采用率累计为81%，在抗生素使用和安全胆囊切除术步骤方面的记录更优（P<0.001）。一份LC的SOR需要4分钟完成（四分位间距2 - 5分钟，n = 425），与需要2天完成的叙述性手术报告（四分位间距1 - 5天，n = 174）相比，在手术当天即可立即获取（P<0.001）。从2014年7月到2015年11月，5749例普通外科手术记录了557例（10%）并发症，其中99%的并发症得到了审查。
手术预约和SOR的快速且持续采用可能反映了终端用户对该系统的高度满意度。服务指标表明交付时间有显著改善。已实现了在个人、科室和医院层面无缝完成审计周期的能力。
