In most of the operating rooms at Massachusetts General Hospital in Boston, surgeons, nurses, and anesthesiologists have to ask one another for information that only one of them may be seeing—such as how a patient’s blood pressure is faring—and wait for an answer. In two ORs, however, such information has become visible to everyone in the room. Clinicians can look at a 40-inch flat-screen monitor on the wall to see patient information immediately.
“A surgeon may notice that a patient is starting to bleed more and can glance up and know immediately if his or her blood pressure is also decreasing, instead of having to ask the anesthesiologist,” says Dawn Tenney, associate chief nurse for peri-operative services. The surgeon, as well as the nurses and other staff members, have a better view of how the surgery is affecting the patient, she adds.
The screens display real-time data pulled from patient monitors and medical devices as well as from nursing documentation software and other information systems. Clinicians can see the name of the patient, the procedure taking place, allergy information, the names of all staff members present in the room, and streams of physiological data, such as heart rate and blood pressure.
The immediate, visual availability of information is improving patient safety and keeping clinicians in the OR better informed, staff members at the hospital say. That impact has been difficult to quantify, and some staff members admit they don’t look at the monitors, acknowledges Bethany Daily, administrative director for operating room business and information systems. Nevertheless, the basic premise of sharing information on large screens visible to everyone is very strong, she contends.
The hospital will roll out the technology to the majority of its more than four dozen operating rooms over the next several years. “It is just another safety net, another level of awareness,” Daily says. “There’s nowhere else that we post the patient name up on a board for everybody to see. There’s nowhere else where we are saying which staff members are in the room.”
Looking for Integration
Clinicians and administrators at Massachusetts General, which is part of Partners HealthCare System, started to talk about integrating real-time data from different electronic sources and computer systems in the operating room in 2002. But it wasn’t until two years later that the hospital found a company that would help it develop the technology, Daily says.
The hospital worked with LiveData, a Cambridge, Mass.-based computer integration firm. The vendor now sells the Web-based system, called OR-Dashboard, commercially.
Massachusetts General first developed and used the technology in its “operating room of the future,” a special room designed to facilitate the testing of new information systems and equipment. Implementing this system in other operating rooms is one of the hospital’s largest attempts to convert technology tested in the operating room of the future into widespread use, Daily says.
The idea of using a large electronic display to aid physicians and nurses could have great value because of its potential to increase clinicians’ awareness of all aspects of a surgery, says Yan Xiao, associate professor of anesthesiology and information systems and director of human factors and technology research at the University of Maryland. He has studied computers in care settings and has looked at how clinicians use such tools as whiteboards, large panels that can be written on with markers. Hospital staff members often use whiteboards to write patient demographic information and staffing details where a large number of people can see it.
Yet hospitals will face challenges in implementing technologies such as the OR-Dashboard, which is like an electronic version of a whiteboard, he suggests.
The key factors to consider when evaluating such technology are whether the information on the display is up-to-date, if the screen is located in a place that is easy to see, and what decisions people can make using the data that is presented.
“It is like the electronic displays of flight information in airports. If the information is accurate, updated, and easy to see, it would be useful,” Xiao says. “People should also be able to adapt it so that they are seeing the most relevant information.”
Two Out Of Three
To implement the system at Massachusetts General, administrators asked a team of nurses, anesthesiologists, and surgeons to identify what information would be most useful to see on a large screen in an operating room. One requirement was that all data selected should be relevant to at least two of the three disciplines—nursing, the medical specialty and anesthesiology.
“Even though the screen is large, it is still limited real estate,” Daily says.
That guiding principle helped the development team tremendously, says Wilton Levine, M.D., an anesthesiologist and clinical director of the Department of Anesthesia and Critical Care. “We had to think about what would benefit the most people in the room. It turned out that what was core knowledge tended to be core across the disciplines, and the process went very smoothly.”
Once the team outlined what data it wanted on the screen, the vendor created XML interfaces between the new system and specific medical devices and information systems.
For example, data comes into the new system from nursing documentation software developed in-house, which nurses in the operating room update throughout surgical procedures using computers in the operating rooms, Daily says.
The system also receives data from a position tracking system from Andover, Mass.-based Radianse, Inc. Staff members wear radio frequency identification badges, which communicate where they are at all times. When a new physician or nurse walks into the operating room, their name immediately appears on the monitor so that everyone can see who it is.
“Our goal was to create a high-level communication tool that would not require human interaction to make it work,” Levine says.
Be the first to comment on this post using the section below.