The Science Journal of the American Association for Respiratory Care

1999 OPEN FORUM Abstracts

EVALUATION OF THE PROCESS AND TIMING OF ORDERING AND PROVIDING RESPIRATORY CARE SERVICES.

Lucy Kester, MBA, RRT, Ed Hoisington, RRT, James K. Stoller, M.D. The Cleveland Clinic Foundation, Cleveland, Ohio.

BACKGROUND: To establish a baseline pattern for assessing the impact of a radio frequen-cyƱdirected management information system, we evaluated the current process and timing by which consult-based respiratory care services are ordered and delivered on inpatient wards at The Cleveland Clinic Foundation 1,000 bed teaching hospital.. Presently, the sequence by which orders are placed and administered is as follows: 1. a ward secretary transfers a written order to a computer entry system, and 2. The entry system interfaces with a respiratory care management information system (CliniVision, Nellcor Puritan-Bennett), which notifies Respiratory Care of the new orders. New orders are then incorporated into the therapists' workload during the mid-shift hand-held computer upload. When assignment are made for the next shift, each therapist is called for an update on the number of treatments added or discontinued from their workload. At the end of the shift, the current shift therapists walk to the Respiratory Care department in order to upload new patient information important to the next shift therapists' care. This information is then downloaded to the next shift therapists' hand-held computers.

Methods: Using our CliniVision database, we evaluated 95 patients covered by a therapist exclusively assigned to cover one nursing ward (G81) and 100 patients covered by a therapist assigned to (4 other wards (H51). The ordering process and timing of respiratory care was evaluated by several outcome measures: 1. The time elapsed between receipt of the order and initiation of respiratory therapy, 2. the number of patients for whom respiratory therapy orders were initiated prior to transfer of the written order to CliniVision, 3. the time required for all activities related to making work assignments for the following shift, and 4. the time interval between the end of the shift report and preparation of the hand-held computers for distribution to individual therapists. All measurements were based on the mean values for 3 assignment periods.

Initiation of Therapy G 81 H 51
Number of patients studied 95 100
Average time (hours) from notification to initiation of treatment 3.8 8.02
Number of patients started on therapy prior to notification 28 (29%) 7 (7%)
Number of patients who waited > 8 hours for therapy 6 (6%) 32 (32%)
New Shift Assignments Total For All Wards
Time to prepare next shift assignments (minutes) 35.4
Total time waiting for and up-loading all hand-helds (minutes) 28.3

Results: The following table shows these mean values:

Conclusions:

1. With the current system using hand-held computers, a substantial amount of time is spent preparing shift assignments and uploading the hand-held computers in order to assign workloads.

2. The time between notifying the therapist and initiating orders was less for a therapist assigned to a single ward than for a therapist assigned to multiple wards.

3. These data provide a baseline against which similar measurements using a radio-frequency system for information management should allow useful comparison for assessing the benefits of this new technology.

OF-99-128

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