Hospital inefficiencies observed during a surgery rotation

by Anar Mikailov

I recently finished my surgery rotation at a Level 1 Trauma Hospital in Philadelphia and amidst the ephemeral eight weeks I quickly realized the immense demands of a surgical residency. So, as an avid technology enthusiast and a team member, I took note of inefficient workflows with potential for technology driven solutions. By discussing the observed inefficiencies and potential solutions I hope to inspire others to do the same.

The data acquisition time sink

Acquisition of critical patient data (vital signs, labs, prior admissions and imaging) is the single greatest time sink for surgery teams. After eight-weeks of calculating the time to accomplish certain tasks, my findings are as follows:

  1. 40 – 50% of time spent per patient was dedicated to data gathering, 40 – 50% for patient interaction, and 5 – 10% for case discussion
  2. Hand writing of the identical information must occur at least three times for each patient

Such inefficiencies present multiple problems; perhaps the most obvious is the potential for error. Additionally, repetitive and cumbersome work extends an already impressive resident workload.  Furthermore, a workflow that requires significant time for data gathering minimizes time for learning more important skills like the physical exam and clinical pathophysiology.  I strongly believe a web-centric and workflow oriented solution can re-balance the scale in favor of efficiency where 70% of time is spent on the patient interaction, 25% on case discussion, and 5% or less on data gathering!

Technologically driven solution

The hospital in this scenario uses a rudimentary EMR, which allows data retrieval and order entry only. Furthermore, the hospital uses disjoint systems for imaging, labs and prior admission data.  To address the data acquisition time sink in a hospital that depends upon an archaic system architecture, a web-based solution should be considered.  In the proposed model, existing legacy data systems will not be discarded, nor will they be used directly by clinicians.  Instead a new web-portal will beautifully (read intuitively) display the combined patient data after querying those legacy data systems. Additionally, the web-portal will allow medical providers to type progress notes for printing or sending to an EMR. To ensure pervasive adoption, the product will place significant emphasis on elegant and efficient user design/experience (ala Apple).  The only requirement to access the web-portal will be a simple Internet connection from any device.

With the new system a residents would open their tablet/iPad, log onto the web-portal, and select patients to follow. As patient data populates the clinician can proceed to the physical exam and then write the progress note. Much more time to see the patient, just a few minutes for gathering data and no more redundant writing on paper. A typing-friendly tablet would be perfect for this (see iPad ClamCase).

Thankfully, some of the ideas discussed here are implemented by a web-app called TheList by TouchConsult.  Their product is already in use at University of Cincinnati and Carolinas Medical Center. In my conversation with Dr. DiPaola, TheList is used for sign-out during shift change; however, their web-app can be a great inspiration for the above ideas. Today, their main challenge is not technical, and rather it is the mindsets of healthcare administrators.

I encourage clinicians everywhere to continue this discussion and provide more evidence of inefficiencies that need to change.  Atul Gawande, said it best in Better, “Find something to change … Write about it. See if you can keep the conversation going.”

Disclaimer: I am in no way affiliated with or compensated by any company or product mentioned.

Anar Mikailov is a medical student who blogs at Medical Singularity.

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