Computer-generated rounding report increases workflow efficiency. Presented by Zhenghong Liu, Juliana Kan & Tay Sook Muay, Singapore General Hospital, at HINZ 2014, 11 November 2014, 11.37am, Plenary Room 2

1. Computer- generated rounding
report increases workflow efficiency
Dr Liu Zhenghong
Dr Juliana Kan
A/Prof Tay Sook Muay

2. Contents
Pre- rounding
Problems with pre- rounding
Solution
Results
Sustainability of results
Learning points

3. Pre- Rounding
• Common practice amongst junior doctors
worldwide
• Junior doctors see patients on their own
before the entire team does the morning
round
• Makes a preliminary entry and formulates
provisional plans

4. Pre- Rounding
Practical Benefit
• Saves time during morning round
• Collates necessary information
Learning Benefit
• Opportunity to practice making
clinical decisions

5. Problems with Pre- rounding
Working hours
• Residents exceed work restriction of 80h/week
• Sleep deprivation/ burnout
Transcription errors
• Large amounts of data copied
• At early hours e.g 5am
• Implications on patient safety

6. Project Selection : Problem Worth Solving
------------------- Pre-rounds ---------------------- Rounds
1. Look
through
overnight
events
2. Copy vitals
&
Input/Output
3. See
patient
4. Case
assessment
and plan
5. Rounds
with senior
doctor
Process analysis

7. PGY1s find the following aspects of pre-rounding
useful to learning (n=57)
Writing overnight events 29.8%
Copying Vitals, I/Os 15.8%
Copying lab values 22.8%
Seeing patient 75.4%
Writing issues and plans 85.2%
Communication with nurses 15.8%

8. Project Selection : Problem Worth Solving
------------------- Pre-rounds ---------------------- Rounds
1. Look
through
overnight
events
2. Copy
vitals &
I/Os
3. See
patient
4. Case
assessment
and plan
5. Rounds
with senior
doctor
Remove the step of least learning value/most mechanical (Step 2)

9. Solution
• Computerized morning round report
• Generates report with pre- populated data
from electronic medical records
• Generated and printed with a single click
every morning

10. Doctor's Orders:
Vital Signs: 29/06/14 13:42
T: 37 Tmax: 37 (29/06/14 13:42)
BP: 120/80 (120-120/80-80)
HR: 60 (60 - 60)
RR: 20 (20 - 20)
SPO2: 99 (99 - 99)
O2 Therapy: 10
Hypo(24hr):
LX TEST 8 (95M)
W44C
Lab Values:
U:
Na:
K:
Cl:
Bi:
Cr:
Hb:
TW:
Plt:
29/12/13
12:49
5
140
6
105
21
30
01/01/14
10:23
20
5
300
29/12/13
12:48
5
140
4
105
21
30
29/12/13
12:42
20
5
300
Input/Output: 30/06/14 06:00
NET: 300
Examination:
Issues, Plan:
Subjective/Overnight Events:
IN: 300 OUT:
Urine Total:
Vomitus:
Others:
PU x 5 BO x 1
IV: 100
Blood:
TPN: 200
Others:
Aspiration(net):
Dialysis(net):
30/06/2014
X0121080110I
01/09/1918
6713101528I
Length Of Stay: 307d (27/08/2013)
Morning Round: ________________
(Team Name / Consultant Name)
POD:
Abx: Neomycin Sulfate Tablet(245d), Clarithromycin Tablet(97d), CefaZOLin Injection(97d)
Cont. IV drips: Premix N/S 0.9%(0.5L)
Allergy: Mepacrine, A-LICES SCALP AND BODY HYGIENE SHAMPOO, A.M. - BEACONS
PHARMACEUTICALS
Signature & Name Chop:___________________ Page No.____
All of the above reviewed & approved by:___________________Time:___________
Data captured is a time point capture. Please review all data and results in SCM.
Time:_____________
(Senior Doctor)
Printed By: Zhao Hainan, (Visiting
Consultant)
Time Printed: 13:48 hrs

12. • Ensure accuracy of data
• Refining report
Implementation
Trial
Oct 15-Nov 5
• Feedback from doctors/ nurses
and improvements to report
Implementation
November 19
• Continued collation of feedback
Maintenance
January 2014
onwards

13. Methods
Pre- and post-implementation:
• Collecting earliest log-in timing to
computer system
• Questionnaire

14. Results - Usage
•Up to 99 users print rounding report per day
•Total no. of post-graduate year 1 doctors: 113
87.6%uptake rate
(*not including those who print for their colleagues)
Self-reported usage: 86.3%

15. Results - Average log-in time
Pre-implementation: 6:27am
Post-implementation: 6.56am
15
Average time saved: 29min/day
Self-reported time saved: 27.8min/day

16. Results - How time saved was spent
16

17. Results - Reduction in transcription errors
78.7% reported reduction in transcription errors
17

18. Results - PGY1 satisfaction with pre-rounding
18

19. Results - PGY1 satisfaction with pre-rounding
19
100% find the rounding report helpful
86.3% want to continue using the report

20. Results - Feedback from PGY1s
“Good and very helpful”
“Save time and looks more neat and standardized”
“Easy to review when reading back old entries”
“Presents information in an easy to read and understand format”
20

21. Results - Feedback from senior doctors
“More structured and give focus to the HO pre-rounding”
“Facilitates faster ward round”
“More reassured that the numbers written down are accurate”
“It ensures there is a baseline level of quality in the rounds”
“A nice step in the direction of a completely electronic medical record”
21

22. Further implementation
• Approved for roll-out to all disciplines in Singapore General
Hospital after Joint Commission International accreditation in
June 2014
• Team facilitating implementation of report in other tertiary
public hospitals in Singapore

23. Learning points/ Strengths
• Involvement of all parties: junior/senior staff, nurses, IT
• Ensures that solution is relevant to all
• Minimizing change to daily workflow
• Allows for ease of transition

24. Learning points/ Weaknesses
• One size fits all vs personalisation
• Single version may not be applicable for all
• Data collection
• Largely subjective data
• Further studies needed to
• Correlate login time and actual time saved
• Assess for reduction in clinically significant medical
errors

25. Thank you
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