Improving the Pre-Admission Testing (PAT) Through Informatics Enhancement

Abstract

<h3>Introduction</h3> At Mercy Medical Center (MMC) the Pre-Admission Testing (PAT) Department ensures diagnostic documents (DD) required by the Anesthesia are in the Chart by the Day of Surgery (DOS) to facilitate the perioperative process. Missing pre-operative diagnostics can lead to DOS OR Case Cancelations due to an identified medical reason and/or a need for medical clearance. These cancelations are problematic for the patient and the organization. <h3>Identification of the Problem</h3> Following the implementation of an Electronic Medical Record (EMR) in the Fall of 2018, the PAT Staff recognized difficulties locating the DD in the patient's EMR. This decrease was resulting in an elevated DOS Cancelation Rate "due to medical reasons" which reached a high of 1.6% in September 2018. A need for EMR Enhancement was identified along with a focused collaboration with the Surgical Team. <h3>QI question/Purpose of the study</h3> Does collaboration with EMR Analysts and Leadership improve availability of DD within the EMR increase the efficacy of PAT staff to complete pre-surgical charts and result in a decrease of case cancellations on DOS? / To improve the integration process of DD in the EMR thus reducing DOS cancellations by 0.8 % in 1 Year. <h3>Methods</h3> Collaboration with the EMR Analysts and Leadership to fine-tune the EMR to increase the ability for PAT staff to complete the presurgical chart. <h3>Outcomes/Results</h3> The targeted goal was to decrease the DOS Cancelations "due to medical reasons" to be below 1.6%. In September of 2020* the DOS Cancelations "due to medical reasons" reached 0.7%. *The COVID Pandemic impacted the final stages of implementation and delayed outcome data. <h3>Discussion</h3> Collaborations with the PAT Staff, Specialty Offices, and Leadership took place February to July 2019. PAT Staff also met with the EMR Analysts to enhance the EMR. The changes made to the EMR workflow for scanning DD were implemented. <h3>Conclusion</h3> Continued collaboration with PAT Staff, Informatics, the Surgical Team, Anesthesia Providers, and Leadership is key to ensure the required DD are present in the EMR to decrease the chance of a DOS Cancelation due to medical reasons. <h3>Implication for Perianesthesia nurses and future research</h3> Continuous monitoring, evaluation, and collaboration with the entire team are essential to consistently improve patient safety and preparedness for the DOS.