2001 OPEN FORUM Abstracts
IMPACT OF A RADIOFREQUENCY MANAGEMENT INFORMATION SYSTEM ON THE PROCESS AND TIMING OF PROVIDINGRESPIRATORY CARE SERVICES.
Lucy Kester, MBA,RRT, FAARC, Doug Orens, RRT, MBA, James K. Stoller, MD, The Cleveland ClinicFoundation, Cleveland, Ohio.
BACKGROUND: Although radiofrequency (RF) systems have proliferated with the intention of simplifying thedelivery of care in many clinical settings, little information is availableregarding the impact of such RF systems on the actual delivery of patient care.Having used a handheld management information system in our Respiratory TherapySection for 15 years, we wished to assess the impact of an RF system versusour existing handheld devise-based system on the delivery of respiratory therapy(RT) services. Presently, the sequence of events in our institution for placingRT orders is as follows: 1. A physician writes an order for an RT treatmentor an RT consult, 2. A unit secretary transfers the order to a computer orderentry system and places a copy of the printed orders in the unit?s RT notebook,3. The order entry system interfaces with the RT Section management informationsystem (CliniVision, Nellcor/ Puritan Bennett, Carlsbad, California) thereby?notifying? RT of the order, 4. Therapists pick up ?new notifies? in the RTSection at the beginning of their shift and at mid-shift. Prior to making assignmentsfor the next shift, all therapists must be paged to report the number of neworders added to the workload as well as orders that have been discontinued.
Methods: A single nursingunit dedicated to pulmonary and ENT care was selected for the RF trial. Baseline(pre-RF) data were collected over three separate 1-month intervals (Sept.?97,Feb.?99, Feb.?00) with the main outcome measures being the time between notificationof RT orders and the time treatments were started and RT consults were completed.Activities required for making assignments for the next shift were manuallytimed. Starting 6 weeks after therapists (3 to 4 per shift) were trained touse the RF system, similar data were collected while using the RF system fortwo 1-month intervals (Feb. and Mar. ?01).
Results: Table 1 presentsoutcomes using the handheld (HH) vs. the RF systems.
TABLE1. (time in hours)
|HH System||RF System||P value|
Number of patientswith RT orders
Mean time (±SD) from notify to start of therapy
Number of patientswho waited >8 hrs for therapy
|32 (16.4%)||14 (9.4%)||0.083|
Number of consultevaluations
Mean time (±SD) from notify to consult eval.
|10.0 (± 30)||2.2 (±2.4)||0.003|
Number of patientswho waited >8 hrs for eval.
|26 (18%)||3 (3.7%)||0.013|
Shift Assignments(time in minutes)
|HH System||RF System||D (min)|
Calculating andassigning workloads
Time for handheldupload
Time for down-loadinghandheld computers*
Time for printingreports (*done during printing)
Total timefor shift assignment
Conclusions: Compared witha handheld system, use of a radio frequency system for processing respiratorytherapy orders was associated with several benefits: 1. Reduced interval betweenreceipt of an order for RT and delivery of the treatment, 2. Reduced intervalbetween request for and completion of a RT consult, 3. Reduced proportion ofpatients for whom the interval between the order and a consult evaluation exceeded8 hours, 4. Shortened time for supervisors to make shift assignments. Theseresults invite further assessment of the clinical benefits associated with accelerated delivery of respiratory therapyservices.