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Clinical Information Systems – Managing the Key Issues of Implementation
CACCN (VIC) INC. 9TH CONTINUING EDUCATION MEETING 2 3 JUNE 1995 ABSTRACTS
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Critical care nurses should consider whether primary nursing is an appropriate and desirable method of care delivery in our particular nursing context. A nursing care delivery system that promises a professional practice model at a time when every hospital is reaffirming its commitment to "patient-centred"care requires our objective evaluation.
Is There a Place for Managed Care in ICU? Caryl P. Wynne St. Vincent's Private Hospital, Melbourne Managed Care and Critical Paths are widely used terms in today's Victorian health care setting. With the introduction of Diagnostic Related Groups (DRGs) into the Victorian public hospitals system; Managed Care is being utilized to manage costs by, facilitating early discharge within funding guidelines, by reducing length of stay while maintaining quality outcomes. Managed Care is a unit-based patient care delivery system designed to achieve specific patient outcomes within a defined time.lt includes the activities of all members of the multi disciplinary team, and sets a specific time schedule for patient care. It sets out clearly day-by-day what should happen: tests, treatment medications consultations, education, discharge planning, referrals. It's basically a tool to plot the course of treatment for a specific diagnosis. Patients and families can be shown the plan and will then know exactly what to expect during their hospitalization. It is avaluable teaching tool and can be used for auditing purposes while also fulfilling a hospital's continuous quality improvement activity. In the intensive care setting, in the United States of America Managed Care is being utilized in the form of Case Management. In Melbourne there are several public hospitals utilizing Managed Care Plans in the form of Critical Paths, as Managed Care plans lend themselves to particular diagnoses that can be standardized i.e. Coronary Artery By-Pass Grafts, Angioplasties. It seems likely that in the future we will see Managed Care Plans being accepted into intensive care units for weaning patients from mechanical ventilation. Managed Care increases the opportunitiesto critically assess a patient's length of stay and helps determine what anticipated patient outcomes we would like for patients. Ultimately this helps discover what can be changed so as to continually improve the quality of care given to each patient.
The Experience of Inverse Ratio Ventilation - Is it a Winner? Cabrielle Hanlon Alfred Hospital, Melbourne Inverse ratio ventilation has been used in the treatment of ARDS since the 1970's. Most reports had small samples, used historical comparisons, and had different controlled variables, inclusion criteria, study foci and outcomes. The main benefits of pressure controlled inverse ratio ventilation (PCIRV) are said to be increased oxygenation and decreased risk of barotrauma. Sideeffects include hypercapnia, haemodynamic compromise and poor patient tolerance necessitating increased use of sedation and relaxants.
We surveyed the use of PCIRV in 12 patients with severe ARDS over an 18 month period to assess its effect on oxygenation, C02, barotrauma, circulation, and sedation and relaxant usage. Patients (9 males, 42+16 yrs) developed ARDS as a result of trauma (3), burns (3), overdose with aspiration (2), laryngopharyngoesophagectorny (I), pneumonia (2), and near drowning (1). PCIRV was instigatedfor inadequate Sa02 despite 100% inspired 0 2 and PEEP212 cm H20 in SlMV mode. PCIRV resulted in a significant increase in Pa02 (65+13 to 104k50 mmHg, p ~ 0 . 0 1 despite ) a reduction i PEEP (15rt3 to1 1*2 cmH20, p <0.01) and a reduction in F102 in 2 patients. There were no significant changes in rate, tidal volume, minute ventilation or PaC02. Nor were there significant changes in heart rate or blood pressure although inotropes, sedation and relaxants were increased. Two instances of barotraumaoccurred after the instigation of PCIRV. Overall mortality was 5112 (42%). This study showed PCIRV to be effective at improving oxygenation at a cost of increased sedation, paralysis and inotrope doses.
Clinical Information Systems - Managing the Key Issues of Implementation Jennifer O'Brien Clinical Nurse Consultant, St Vincent's Hospital, Melbourne At St. Vincent's Hospital a new model of patient care has been implemented with the key objective of restructuring work processes to support continuous improvement in the quality of patient care. Incorporated with this model is the hospital's commitment to a comprehensive clinical information technology infrastructure. The Intensive Care Unit (ICU) is one of the first areas in the hospital to benefit from the investment in information technology with the installation of a Clinical lnformatrion System (CIS). The experience of St. Vincent's ICU is that successful implementation and realisation of the full benefits of a CIS is dependent on recognition and judicious management of a host of critical issues. Most important amongst these are: 1. Full support and involvement of all levels of the hospital executive. 2. Selection of an effective implementation team. 3. Incorporation of the CIS into the existing I.T. infrastructure and in an enterprise-wide I.T. strategy. 4. Sharing the implementation experience with other clinical sites in a similar stage of development. 5. Application of the CIS technology to supporting improvement in processes of quality of patient care. 6. User driven customisation and application configuration. 7. Providing effective end user training in a busy clinical setting. 8. Anticipating and managing the human issues associated with change. The implementation of a CIS is a long term commitment to continual improvement. Achieving the maximum potential from a CIS requires the understanding that this technology is not the solution to current inefficiencies in work Drocesses but the catalyst for a broader initiative of quality driven change.
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Critical care nurses should consider whether primary nursing is an appropriate and desirable method of care delivery in our particular nursing context. A nursing care delivery system that promises a professional practice model at a time when every hospital is reaffirming its commitment to "patient-centred"care requires our objective evaluation.
Is There a Place for Managed Care in ICU? Caryl P. Wynne St. Vincent's Private Hospital, Melbourne Managed Care and Critical Paths are widely used terms in today's Victorian health care setting. With the introduction of Diagnostic Related Groups (DRGs) into the Victorian public hospitals system; Managed Care is being utilized to manage costs by, facilitating early discharge within funding guidelines, by reducing length of stay while maintaining quality outcomes. Managed Care is a unit-based patient care delivery system designed to achieve specific patient outcomes within a defined time.lt includes the activities of all members of the multi disciplinary team, and sets a specific time schedule for patient care. It sets out clearly day-by-day what should happen: tests, treatment medications consultations, education, discharge planning, referrals. It's basically a tool to plot the course of treatment for a specific diagnosis. Patients and families can be shown the plan and will then know exactly what to expect during their hospitalization. It is avaluable teaching tool and can be used for auditing purposes while also fulfilling a hospital's continuous quality improvement activity. In the intensive care setting, in the United States of America Managed Care is being utilized in the form of Case Management. In Melbourne there are several public hospitals utilizing Managed Care Plans in the form of Critical Paths, as Managed Care plans lend themselves to particular diagnoses that can be standardized i.e. Coronary Artery By-Pass Grafts, Angioplasties. It seems likely that in the future we will see Managed Care Plans being accepted into intensive care units for weaning patients from mechanical ventilation. Managed Care increases the opportunitiesto critically assess a patient's length of stay and helps determine what anticipated patient outcomes we would like for patients. Ultimately this helps discover what can be changed so as to continually improve the quality of care given to each patient.
The Experience of Inverse Ratio Ventilation - Is it a Winner? Cabrielle Hanlon Alfred Hospital, Melbourne Inverse ratio ventilation has been used in the treatment of ARDS since the 1970's. Most reports had small samples, used historical comparisons, and had different controlled variables, inclusion criteria, study foci and outcomes. The main benefits of pressure controlled inverse ratio ventilation (PCIRV) are said to be increased oxygenation and decreased risk of barotrauma. Sideeffects include hypercapnia, haemodynamic compromise and poor patient tolerance necessitating increased use of sedation and relaxants.
We surveyed the use of PCIRV in 12 patients with severe ARDS over an 18 month period to assess its effect on oxygenation, C02, barotrauma, circulation, and sedation and relaxant usage. Patients (9 males, 42+16 yrs) developed ARDS as a result of trauma (3), burns (3), overdose with aspiration (2), laryngopharyngoesophagectorny (I), pneumonia (2), and near drowning (1). PCIRV was instigatedfor inadequate Sa02 despite 100% inspired 0 2 and PEEP212 cm H20 in SlMV mode. PCIRV resulted in a significant increase in Pa02 (65+13 to 104k50 mmHg, p ~ 0 . 0 1 despite ) a reduction i PEEP (15rt3 to1 1*2 cmH20, p <0.01) and a reduction in F102 in 2 patients. There were no significant changes in rate, tidal volume, minute ventilation or PaC02. Nor were there significant changes in heart rate or blood pressure although inotropes, sedation and relaxants were increased. Two instances of barotraumaoccurred after the instigation of PCIRV. Overall mortality was 5112 (42%). This study showed PCIRV to be effective at improving oxygenation at a cost of increased sedation, paralysis and inotrope doses.
Clinical Information Systems - Managing the Key Issues of Implementation Jennifer O'Brien Clinical Nurse Consultant, St Vincent's Hospital, Melbourne At St. Vincent's Hospital a new model of patient care has been implemented with the key objective of restructuring work processes to support continuous improvement in the quality of patient care. Incorporated with this model is the hospital's commitment to a comprehensive clinical information technology infrastructure. The Intensive Care Unit (ICU) is one of the first areas in the hospital to benefit from the investment in information technology with the installation of a Clinical lnformatrion System (CIS). The experience of St. Vincent's ICU is that successful implementation and realisation of the full benefits of a CIS is dependent on recognition and judicious management of a host of critical issues. Most important amongst these are: 1. Full support and involvement of all levels of the hospital executive. 2. Selection of an effective implementation team. 3. Incorporation of the CIS into the existing I.T. infrastructure and in an enterprise-wide I.T. strategy. 4. Sharing the implementation experience with other clinical sites in a similar stage of development. 5. Application of the CIS technology to supporting improvement in processes of quality of patient care. 6. User driven customisation and application configuration. 7. Providing effective end user training in a busy clinical setting. 8. Anticipating and managing the human issues associated with change. The implementation of a CIS is a long term commitment to continual improvement. Achieving the maximum potential from a CIS requires the understanding that this technology is not the solution to current inefficiencies in work Drocesses but the catalyst for a broader initiative of quality driven change.
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