Case Study Week 3:Implementing a Post Discharge Follow-up Module for Nursing Personnel in an Ambulatory Surgery CenterCase Background: A busy ambulatory surgery center that completes approximately 100 procedures per daywas using a legacyElectronic Health Record (EHR) that was no longer supported by the software development company that had originally developed it. One function of the Post Anesthesia Care Unit (PACU, aka the Recovery Room) was to follow-up with each patient (or the patients designee) at three post-discharge time intervals: 3 hours, 12 hours, and 24 hours post operatively.While the Nursing staff wassatisfied with the basic functionality of the EHR in terms of clinical documentation, the system contained one major deficiency, as identified by PACU staff: there was not a robust Post Discharge Follow-Up Modulewhich enabled PACU staff to record the results of the telephone calls which they made to the patient post discharge.The legacy EHR only allowed PACU personnel to indicate whether or not the patient (or the patients designee) was contacted post-discharge. There was no provision for entering specific data regarding the outcome of the post-discharge calls.During the course of developing awish listfor the functionality of a replacement EHR, PACU staff identified ten specific fields that they hoped would be incorporated into a Post Discharge Follow-Up Module. These ten fields addressed such issues as the date/time of post-discharge contact, the status of that contact (i.e., Call Completed, Left Message, No Answer, etc.)and what action (if any) was necessary based on the information provided by either the patient and/or the patients caregiver. The PACU staff had a lively discussionconcerning the development of a comprehensive list of typical post-operative issues which patients most frequently encounter, as well as the development of a protocol for the notification of the attending surgeon and/or his/her designee.Data Collection, Preparation, and Analysis: The Clinical Manager of the PACU assigned three PACU personnel to work with the Surgical Centers Information Technology (IT) Departmentto develop a short-term strategy for collectingand managing thepost-operative follow-up information. Due to budgetary constraints and existing contractual obligations with the existing EHR Company, it was not feasible to convert to a new EHR for approximately 18 months. The Clinical Manager of the PACU instructed the assigned personnel to develop and implement a strategy for collecting and analyzing post-operative follow-up datathat could be used during the 18 month period prior to the replacement of the legacyEHR.Conclusion: The PACU Staffmet with IT personnel and developed a Data Dictionarythat represented the information that PACU staff deemed necessary to complete the Post Discharge Follow-Up Module.During the course of the meeting with IT staff, PACU staff learned that by using a programming technique called Open Database Connectivity (ODBC), IT staff could develop a relatively simpleand secure database that linked to the legacy EHR system while providing PACU staff with an intuitive user interface in order to access each individual case and record the necessary post-operative discharge information.The ODBC technique is an open standard application programming interface (API)for accessing a database. By using ODBC statements in a program, PACU staff was able to access files the legacy EHRsystem. The ODBC tool can also be used to connect other legacy databases to external databases,including those developed in Microsoft Access, Oracles SQL, and other popular commercial software products.Result:With approximately 10 hours of software development time, IT staff createda simple yet effective tool for PACU staff to access and record post discharge follow-up data.It was estimated that total PACU staff time for this project was approximately 65 hours, including database design, software testing, and training the full complement of PACU staff, including Nurses, Anesthesiologists, Physicians Assistants, and administrative support personnel.
