ehealth conference 2011 - james sartain, cairns base hospital
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Dr James Dr James SartainSartain MB BS FANZCA FRCAMB BS FANZCA FRCAActing Director Acting Director
Dept Anaesthesia, Intensive Care & Dept Anaesthesia, Intensive Care & PerioperativePerioperative MedicineMedicineCairns Base HospitalCairns Base Hospital
The AARKThe AARK(Automated Anaesthetic Record Keeping)(Automated Anaesthetic Record Keeping)
ProjectProject
- Breaking Down System Silos
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Disclosure-AARK ‘Product Champion’ Acute Pain Module-User of Medtel Winchart since 2001
Acknowledgements- A/Prof Mike Steyn, Royal Brisbane & Women’s Hospital - A/Prof John Archdeacon, Cairns Base Hospital- Mr John Crouch, Queensland Health AARK
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Anaesthesia 1846Anaesthesia 1846Massachusetts General HospitalMassachusetts General Hospital
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Anaesthesia 2010Cairns Base Hospital
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Manual Record Keeping Manual Record Keeping (much of Australia today)(much of Australia today)
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Automated Anaesthetic Record Keeping Automated Anaesthetic Record Keeping
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AARK Project – Background
• 2005 – QH responding to Bundaberg disaster
• Staff despondency regarding culture, pay & conditions
• Clinical Advisory group
• Anaesthesia services−Largest specialist doctor group in QH
−Impact on >60% of acute hospital activity
−No investment in Anaesthesia including IT
Anaesthetists abandoning QH for private sector
• Clinical Networks and Information Division (ID) plan
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AARK Project – Background
• Anaesthetists
• Nurses
• Anaesthetic Technicians
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AARK Project – Background
• Swapnet & Anaesthetic Directors
• Need for Automatic Anaesthetic Record
− Agreed to common Record and systems
• QH ID strategy - $250M
− $17M assigned to AARK
• Medtel Winchart product successful
− Initial development in Cairns 1999-2001
• AARK roll out commenced 2008
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AARK SitesAARK Sites26 hospitals “live”; 18 more engaged
CairnsCairnsRedcliffeRedcliffeCabooltureCabooltureRoyal Brisbane & Royal Brisbane &
Women's Women's Queen Elizabeth IIQueen Elizabeth IIRockhamptonRockhamptonToowoombaToowoombaIpswichIpswichTownsvilleTownsvilleLoganLoganMackayMackayPrincess AlexandraPrincess AlexandraAthertonAtherton
MareebaMareebaInnisfailInnisfailCooktownCooktownDalbyDalbyEmeraldEmeraldBiloelaBiloelaChinchillaChinchillaWeipaWeipaGladstoneGladstoneKingaroyKingaroyLongreachLongreachRedlandsRedlandsThursday IslandThursday Island
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AARK ObjectivesAARK Objectives
Improve access to patient informationImprove access to patient information
Improved patient safetyImproved patient safety
Improved clinical management reportingImproved clinical management reporting
Increased efficiency in the Increased efficiency in the perioperativeperioperativeenvironmentenvironment
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Pre-Operative Theatre
Acute Pain ServicesPACU
The AARK Solution The AARK Solution ––the the PerioperativePerioperative JourneyJourney
PACU
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Patient Monitor
AARK PC
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AARK Project – Recovery (PACU)
Patient MonitorAARK PC
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AARK Project - APS Module Motion Computing C5 tablet
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Induction dramaInduction drama
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AARK Patient SafetyAARK Patient Safety–– ReadableReadable
Improved communication and care
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AARK Patient Safety AARK Patient Safety –– ReliableReliable
Automatic data recording– medico-legally robust
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AARK Patient Safety AARK Patient Safety –– RetrievableRetrievable
••Access to records stateAccess to records state--widewide••Previous episodes of care instantlyPrevious episodes of care instantly••Previous adverse eventsPrevious adverse events
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AARK WinchartGraphical Console
AARK Patient Safety AARK Patient Safety -- Real time assistanceReal time assistance
Recovery 1
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AARK Patient Safety AARK Patient Safety -- Real time assistanceReal time assistance
Operating theatres
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Low BP
Low O2 Sats
No pEEG monitor
High Anaes Gas level
AARK Patient Safety AARK Patient Safety -- Real time assistanceReal time assistance
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ShortestLongestShortestLongest
4
15
1.35.2
9.5
21
5.4910.3 9
37
3.03
Shortest
Theatre Short Case Theatre Long Case
Theatre Data Entry Time PACU Data Entry Time
.35
Data entry duration in minutesLongest
Pre AARKPost AARK
AARK Benefits AARK Benefits –– EfficiencyEfficiency of careof care
= More time (or 2 fewer staff
per 8 patient bay!)
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AARK Benefits AARK Benefits –– ReportingReportingCARM (Clinical Analysis and Reporting Module)CARM (Clinical Analysis and Reporting Module)
Clinical Quality AssuranceClinical Quality Assurance–– Antibiotic prophylaxisAntibiotic prophylaxis
–– AntiAnti--emeticsemetics
–– Adverse eventsAdverse events
AdministrativeAdministrative–– ACHS Indicators ACHS Indicators
–– Resource allocationResource allocation
–– Staff trainingStaff training
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AARK Benefits – Reporting example
Trainee, Junior
Trainee, Senior
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Trainee, Junior
Trainee, Senior
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AARK Benefits – Reporting (cont’d)
Trainee, Junior
Trainee, Senior
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AARK successAARK success-- why has it worked?why has it worked?
SeductionSeduction
Silo reductionSilo reduction
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AARK success AARK success SeductionSeduction
‘‘WhatWhat’’s in it for me?s in it for me?’’–– Automated data Automated data –– Time savingTime saving–– Quality of recordQuality of record–– Efficiency of careEfficiency of care–– MedicoMedico--legal defencelegal defence–– More desirable than More desirable than
an ian i--Phone!Phone!
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AARK success AARK success Silo reduction (1)Silo reduction (1)
Recognise they exist:Recognise they exist:
Doctors, Nurses, Different Doctors, Nurses, Different hospitals, IT specialists, health hospitals, IT specialists, health administrationadministration
Different drivers and pressures Different drivers and pressures on themon them
Speak different languagesSpeak different languages
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AARK success AARK success Silo reduction (2)Silo reduction (2)
Collaboration:Collaboration: Started with clinical and Started with clinical and AnaesAnaes
group needs/goalsgroup needs/goals
Validated by QH Administration Validated by QH Administration
Doctors/nurses/techs/hospitals Doctors/nurses/techs/hospitals found common ground found common ground (eg (eg SwapnetSwapnet, Directors), Directors)
Clinician leader advocateClinician leader advocate
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AARK success AARK success Silo reduction (3)Silo reduction (3)
Strategic rollStrategic roll--out:out:
Process engineeringProcess engineering
Implementation Implementation
Software testingSoftware testing
Technical & hardware Technical & hardware supportsupport
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AARK success AARK success Silo reduction (4)Silo reduction (4)
Success in development Success in development and rolland roll--out by out by utilisation of:utilisation of:–– The multiThe multi--linguallingual
–– The converted nativesThe converted natives
–– The PhilistinesThe Philistines
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AARK AARK ChallengesChallenges
ClinicalClinical–– Areas with less automation Areas with less automation
(Pre(Pre--Op and APS)Op and APS)–– Need for valueNeed for value--added functions added functions
AdministrationAdministration–– Priorities for fundingPriorities for funding–– Partnership mindPartnership mind--setset–– Publicity (good or bad)Publicity (good or bad)
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The AARK Project
Acute Pain Services
Theatre PACU
PACU
Pre-Operative