Epic Edasap User Group April 08


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From EPIC ED/ASAP Forum- April 2008

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Epic Edasap User Group April 08

  1. 1. Going for The Big Bang Change Adam Black, RN Joshua Feinstein, MD Diane Mitchell Wendy Scibielski Wanda Taylor, RN Melinda Tillman, RN
  2. 2. University Of Texas Medical Branch <ul><li>We were the first Medical School in the UT system, founded 1891 </li></ul><ul><li>In the past we “ Stopped for No Storm ” (Hurricane of 1900) but for Rita (2005) we did a total evac (5 hospitals on campus – John Sealy, Waverly Smith Pavilion, Rebecca Sealy, Children’s, and Hospital Galveston). </li></ul>
  3. 3. More Statistics (FY ’07) <ul><li>Annual hospital admissions: 41,281 </li></ul><ul><li>Annual ED visits: 54,592 </li></ul><ul><li>Admissions from ED: 11,879 </li></ul><ul><li>Admit Rate 21.8% </li></ul><ul><li>Annual Clinic Visits: 682,294 </li></ul><ul><li>Telemedicine visits: ≈ 35,000 </li></ul>
  4. 4. ED Physical Plant Stats <ul><li>Square Feet: 90,000 (2.07 acres) </li></ul><ul><li>Care areas: 4+ (Resuscitation, Main, Rapid Treatment Area, Pedi, Emerging Infectious Disease (neg pressure), one area reserved for “Clinical Decision Unit” </li></ul><ul><li>Terminals (current hardwired):44 </li></ul><ul><li>Additional (supposed to be in 11/2007; installed in 3/08):20 add’l </li></ul><ul><li>COWS – 5 now, 5 more to be corralled </li></ul><ul><li>Does not count 4 tablets </li></ul><ul><li>Total: 78 terminals </li></ul>
  5. 5. History: Epic in the ED <ul><li>Dec 2005 </li></ul><ul><ul><li>POE for Rad & Lab orders only using Sum04 </li></ul></ul><ul><li>Dec 2006 </li></ul><ul><ul><li>Discharge Instructions, eMAR and Imm/Injections using Sum05 </li></ul></ul><ul><li>March 2007 </li></ul><ul><ul><li>Full cPOE, and conversion to Preference List Composer using Sum05 </li></ul></ul><ul><li>Aug 2007 </li></ul><ul><ul><li>Medication Reconciliation using Sum05 </li></ul></ul>
  6. 6. Scope of our project : EPIC <ul><li>Eliminate patient tracking and nursing documentation legacy system </li></ul><ul><li>Application Build Scope Using Sum05: </li></ul><ul><ul><li>Provide method of documentation for RN’s, PCT’s, Care Manager’s, Patient Rep’s, ED Coders </li></ul></ul><ul><ul><li>Renumber and rename all rooms/beds/care areas </li></ul></ul><ul><ul><li>Trackboard, Manager, Map </li></ul></ul><ul><ul><li>ED Treatment team </li></ul></ul><ul><li>Interface Build Scope: </li></ul><ul><ul><li>Waiting & Expected registration (No ADT) </li></ul></ul><ul><ul><li>Treatment team only in ED, not IP </li></ul></ul>
  7. 7. Scope of our project : Flow <ul><li>Improve discharged patient throughput (i.e. reduced length of stay) </li></ul><ul><li>Reduce LWBS </li></ul><ul><li>Increase Staff and Patient satisfaction </li></ul><ul><li>Make a complete change that is thought through and implemented (after ripping off 14+ years of bandages) </li></ul>
  8. 8. How do I get there? <ul><li>Take I-45 South until you get about a mile off the coast… </li></ul>
  9. 9. The Nation
  10. 10. The Region
  11. 11. Our Side of the Causeway
  12. 12. Closer Still
  13. 13. Successes con’t <ul><li>Epic Application </li></ul><ul><ul><li>Dedicated workflow super users and Epic super users both on hand during go-live </li></ul></ul><ul><ul><li>Overall staff acceptance positive </li></ul></ul><ul><ul><ul><li>Users no longer working in two systems </li></ul></ul></ul><ul><ul><ul><li>Documentation mimics TNCC guidelines </li></ul></ul></ul><ul><ul><ul><li>Workflow changes took the BIG hit in staff satisfaction </li></ul></ul></ul><ul><ul><li>The Departmental Map! </li></ul></ul>
  14. 14. Adam’s Map
  15. 15. Successes con’t <ul><li>Epic Application </li></ul><ul><ul><li>Better documentation of vital signs </li></ul></ul><ul><ul><ul><li>PCT’s like to stamp out red bells </li></ul></ul></ul><ul><ul><li>Staff strives to be compliant in documentation despite no hard blocks- especially with Triage and Discharge </li></ul></ul><ul><ul><li>Since go-live, we have not experienced any substantial issues with system responsiveness or availability </li></ul></ul>
  16. 16. Challenges <ul><li>Training </li></ul><ul><ul><li>Contract Staff training ongoing </li></ul></ul><ul><ul><li>ASAP build continued during training </li></ul></ul><ul><ul><ul><li>(plus) Student input was valued </li></ul></ul></ul><ul><ul><ul><li>(minus) Screens changed from class to class </li></ul></ul></ul><ul><ul><li>Training of other Epic projects during same timeframe </li></ul></ul><ul><li>Physical ED </li></ul><ul><ul><li>Layout not designed for efficiency or PCs </li></ul></ul><ul><ul><ul><li>Overcrowded workstations </li></ul></ul></ul><ul><ul><li>Building a wall on go-live day! </li></ul></ul><ul><ul><li>Wireless connectivity </li></ul></ul>
  17. 17. Challenges con’t <ul><li>ASAP Application Challenges </li></ul><ul><ul><li>IP NOT doing daily nursing documentation </li></ul></ul><ul><ul><ul><li>Therefore, ED utilizing LDA’s or I/O at this time </li></ul></ul></ul><ul><ul><li>Quality of nursing assessment documentation </li></ul></ul><ul><ul><ul><li>Assessment navigator vs ED Notes  </li></ul></ul></ul><ul><ul><li>Hyperspace reports - too much scrolling </li></ul></ul><ul><ul><li>Post discharge documentation issues </li></ul></ul><ul><ul><ul><li>UTMB does not yet have a formal policy for nursing post discharge documentation in Epic </li></ul></ul></ul><ul><ul><ul><ul><li>No access to ED Chart at this time </li></ul></ul></ul></ul><ul><ul><ul><ul><li>No access to ED Census Snapshot report at this time </li></ul></ul></ul></ul><ul><ul><li>ADT issues especially during downtime </li></ul></ul>
  18. 18. Challenges con’t <ul><li>Clarity Reporting </li></ul><ul><ul><li>Not enough report writer involvement in build process </li></ul></ul><ul><ul><li>Not speaking same language about where data lived, what data meant, how ADT Events were impacted </li></ul></ul><ul><ul><li>Not enough report writers </li></ul></ul><ul><ul><ul><li>Clarity reports bottlenecked </li></ul></ul></ul><ul><li>The NEW Workflow </li></ul><ul><ul><li>Not enough team players </li></ul></ul><ul><ul><li>Shifting the paradigm from a push flow to a pull flow </li></ul></ul>
  19. 19. EPIC ASAP training <ul><li>Diane Mitchell </li></ul><ul><li>UTMB Lead IT Training Specialist </li></ul>
  20. 20. Instructor Led Training 5 roles trained in 3 week period <ul><li>87 Nurses in 8 classes </li></ul><ul><ul><li>8 hour class with lunch provided </li></ul></ul><ul><li>36 Patient Care Technicians/HUCS (clerks) in 5 classes </li></ul><ul><ul><li>2 hour class </li></ul></ul><ul><li>7 Care Managers in 2 classes </li></ul><ul><ul><li>1 ½ hour class </li></ul></ul><ul><li>5 Patient Service Representatives in 3 classes (1 ½ hour class) </li></ul>
  21. 21. Training <ul><li>Presentation at ED Faculty meeting- attended by 15 physicians, physicians assistants and Nurse practioners </li></ul><ul><ul><li>Handouts for those unable to attend </li></ul></ul><ul><li>Total of 150 ED Staff Members in 16 sessions </li></ul>
  22. 22. Successes <ul><li>Training </li></ul><ul><ul><li>Teamed with Subject Matter Experts on: </li></ul></ul><ul><ul><ul><li>Class content </li></ul></ul></ul><ul><ul><ul><li>Building training patients </li></ul></ul></ul><ul><ul><ul><li>Questions during training sessions </li></ul></ul></ul><ul><ul><li>Positive Feedback from staff </li></ul></ul><ul><ul><li>100% attendance by full time staff </li></ul></ul><ul><ul><ul><li>Only 1 make up class added </li></ul></ul></ul><ul><ul><ul><li>Access dependant on class attendance </li></ul></ul></ul><ul><ul><ul><li>Lunch Provided – Nursing Class </li></ul></ul></ul>
  23. 23. Next Challenges <ul><li>Optimization Training </li></ul><ul><li>Upgrade to Spring 07 release </li></ul><ul><li>Physician Documentation </li></ul>
  24. 24. Conclusions and Recommendations <ul><li>Closer involvement of report writers and build team </li></ul><ul><li>Workflow change with Epic is good, but some of our changes haven’t worked as intended </li></ul><ul><li>Training went really well </li></ul>
  25. 25. Questions?