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As many patients know firsthand, surgery is a critical and often lifesaving part of the healthcare delivery system. It is also the financial lifeblood of a hospital--a revenue producer that can't afford to be undermanaged or inefficient. But often, within the confines of operating room suites, underutilization of information technology equates with waste.

Texas Children's Hospital in Houston is a 697-licensed-bed, internationally recognized pediatric hospital in the Texas Medical Center and the largest children's hospital in the U.S. As part of the specialized care that the organization provides, its surgical staff operate 24 hours a day in three different sites, treating patients ranging from newborns to adults. The challenge of managing costs and revenue for this demanding area is formidable, but it's a challenge met by Judy Swanson, R.N., director of perioperative services, who has managed operating rooms (ORs) like Texas Children's for more than 17 years.

Soon after joining Texas Children's Hospital in February 2001, Swanson discovered that an existing perioperative information system in the department needed upgrading. This basic system required a lot of manual data entry and contributed to inefficient workflow and inaccurate data. Because Swanson's team could not generate statistical reports from the system, they had to manually enter information into Excel spreadsheets, which was costly and resource-intensive.

Scheduling was computerized, but intraoperative nursing documentation and inventory control were handled on paper--often with illegible handwriting. Surgeon preference cards were stored in Microsoft Word, so there was no automated method in place to keep these updated and ensure all supplies used in the operating room were recorded.

These shortfalls contributed to an inefficient charging process that was continually at risk for errors and often riddled with them. Nurses documented surgical cases and calculated OR charges manually, in addition to caring for patients. If an implant was omitted from the documentation, this costly supply would be missed on charges, amounting to significant lost revenue for the department.

About 40 percent of patient records sent to billing contained missing or wrong information that needed to be reconciled. Errors might be as significant as the wrong patient name, medical record number or account number, or they might be a simple misspelling. Regardless of the reason, all errors were routinely sent back to the OR department for correction.

Inaccuracies wasted staff time, sent nurses scurrying around trying to correct information and caused reimbursement problems. The department might spend up to 11 days to process a bill for surgical charges, and anything beyond the five-day limit of some managed care companies could lead to a late charge. Perioperative services averaged in excess of $100,000 a month in late charges.

Swanson knew that the department needed a comprehensive business system to address multiple user needs, not just a system to manage preference cards or billing. Department users wanted accurate and complete documentation and a complete record of patient care. She decided to replace their existing surgical software with a comprehensive OR management system that would be good for the hospital's business as well as good for clinicians and clinical documentation.

The hospital began looking for software that would automate all phases of surgical care, from scheduling and supply management to preference cards, nursing documentation and billing. The system also needed to provide easy-to-use data management capabilities and a complete electronic record of the surgical event.

Workflow Meets Automation

The hospital team evaluated all appropriate software systems on the market, and in 2001 they selected CareSuite OR Manager, a perioperative solution from Wakefield, Mass.-based Picis, a company that specializes in automating high-acuity areas of healthcare. They chose this system because they felt it offered the clinical and administrative functions that the hospital needed, electronic record-keeping from preoperative care through surgery to recovery, and complete OR management. The system also interfaced with the hospital's IDX admissions system and offered many different ways to capture and report statistical data without the need for manual data entry.

Swanson's staff set out to fully implement the system, so the organization could use this technology to its fullest. The implementation team examined in detail the functionality of the system and then streamlined organizational processes to maximize the use of its capabilities.

# posted by Medical Information : 11:56 PM