Maintaining a Successful Infection Control Program while Transitioning from a Military Medical Center to an Ambulatory Surgical Center

Abstract

PROJECT: After implementing an electronic computerized surveillance system (TheraDoc ) in conjunction with Hospital Epidemiology, its impact on workflow was studied for three months. Epidemiology technicians perform numerous surveillance activities for inpatient units. For the study, interviews were conducted with technicians regardingworkflow before and after implementation of the computerized system; time study observations were performed using manual and computerized surveillance; before and after workflow process mapping was completed; and value stream mapping of workflow before the computerized system was completed to analyze areas of inefficiency. RESULTS: Epidemiology technician time spent performing surveillance activities was reduced approximately 50% with the electronic computerized surveillance system. Time savings was approximately 1.5 hours per day, or 7.5 hours per week, per technician for five technicians (37.5 total hours per week saved). The processes that contributed to surveillance time savings included: creating/reviewing computer-generated infection work lists for 11 organisms; starting transmission-based isolation precautions earlier (up to 72 hours) by utilizing real-time results and alerts; electronically exporting and uploading HAI work lists to the NHSN; automatically generating notifiable disease reports; and assisting in the management of technician assignments by showing total patients viewed and time logged in for each technician, as well as the number of infection and notifiable disease work lists generated by technician, allowing work assignments to be adjusted as needed. LESSON LEARNED: Surveillance for HAIs is labor intensive. The demands on limited infection prevention and surveillance resources continue to increase as more mandatory HAI reporting is required. Our project documents the positive impact an electronic surveillance system has on Hospital Epidemiology surveillance workflow. The time savings identified has allowed Hospital Epidemiology to perform new mandatory surveillance and reporting requirements using current staff resources. Although difficult to measure, with the availability of real-time results there is a presumed decrease in the transmission of organisms and HAIs as patients requiring transmission-based precautions are identified and placed on transmission-based precautions up to 72 hours earlier.