Department of Surgery, University of Miami Miller School of Medicine, Miami, Florida.
Department of Medicine, University of Miami Miller School of Medicine, Miami, Florida.
Ann Surg. 2020 Oct;272(4):669-675. doi: 10.1097/SLA.0000000000004347.
We present a holistic perioperative optimization approach led by a CI team with the goal to optimize the workflow within our EHR, improve operative room metrics and user satisfaction.
The EHR has become integral to perioperative care. Many approaches are utilized to improve performance including systems-based approaches, process redesign, lean methodology, checklists, root cause analysis, and parallel processing. Although most reports describe strategies improving day or surgery productivity, few include perioperative interventions to improve efficiencies.
An interdisciplinary CI team consisting of clinicians, informatics specialists, and analysts spent 6 weeks assessing users and optimizing all perioperative areas (scheduling, day of surgery, postop discharge/admission). Elbow-to-elbow retraining and simultaneous content development was performed utilizing an Agile workflow process optimization with the Scrum framework. This iterative approach averaged 1 week from build to change implementation. Pre/post optimization surveys were sent.
Two hundred forty-two perioperative enhancements were completed. While most impacted documentation, all areas were enhanced including billing, reporting, registration, device integration, scheduling, central supply, and so on. FCOTS improved from <70% to >85% and total delay was halved. These parameters were consistently sustained for over 1 year after the 6-week optimization. While only 5% of pre-optimization users agreed to proficiency in the EHR system, this improved to 70% post-optimization. Furthermore, EHR confidence and acceptance improved from 40% to 90%.
To improve workflow efficiency, all who contribute to the perioperative process must be assessed. This IT driven initiative resulted in improved FCOTS, perioperative workflows, and user satisfaction.
我们提出了一种由临床信息学团队主导的整体围手术期优化方法，旨在优化我们电子病历系统中的工作流程，改善手术室指标和用户满意度。
电子病历系统已成为围手术期护理的重要组成部分。许多方法被用于提高工作效率，包括系统方法、流程重新设计、精益方法、检查表、根本原因分析和并行处理。尽管大多数报告描述了提高手术日或手术效率的策略，但很少包括改善效率的围手术期干预措施。
由临床医生、信息学专家和分析师组成的跨学科临床信息学团队花了 6 周时间评估用户并优化所有围手术期领域（手术安排、手术当天、术后出院/入院）。通过使用 Scrum 框架的敏捷工作流程优化，进行了手把手的再培训和同时的内容开发。这种迭代方法从构建到变更实施平均需要 1 周时间。在优化前后发送了调查。
完成了 242 项围手术期增强功能。虽然大多数增强功能都影响了文档，但所有领域都得到了增强，包括计费、报告、注册、设备集成、排班、中央供应等。快速周转时间从<70%提高到>85%，总延迟减半。这些参数在优化后的 6 周后持续了 1 年以上。虽然只有 5%的术前优化用户同意在电子病历系统中具备熟练程度，但这一比例在优化后提高到了 70%。此外，电子病历系统的信心和接受度从 40%提高到了 90%。
为了提高工作流程效率，必须评估所有参与围手术期过程的人员。这项由信息技术驱动的计划导致快速周转时间、围手术期工作流程和用户满意度得到改善。
