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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 “legacy”Electronic 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 patient’s 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 Module”which 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 patient’s  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  a“wish  list”for  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  patient’s  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  Center’s 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 “legacy”EHR.Conclusion:  The PACU Staffmet with IT personnel and developed a “Data Dictionary”that 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, Oracle’s 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. 

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