Intelligent Hospital™ ED Script 2015
PLEASE EMAIL with any suggested changes
Table of Contents
Scenario
ED1 Staff Identification (Intelligent Insites)
ED2 Wireless Network (Extreme Networks)
ED3 RTLS System
ED4 Patient Flow Visibility and Analytics: Improve Patient Experience, Operational Efficiency and Patient Throughput (Stanley Healthcare)
ED5 RFID Locating Overflow Management (TBD)
ED6 Supply Availability - KanBan Replenishment (Cardinal Health)
ED7 Mobile Wearable Device (Vocera)
ED8 Environment Controls (Stanley)
ED9 Receiving Information while Ambulance is in Transit (TBD)
ED10 Consultation from Ambulance (Zebra Motorola)
Patient #2: Bed 1: Samantha Millhouse:
ED11 the Worst Headache I have ever had": (Extension Healthcare)
ED12 Hand Hygiene (AiRista)
ED13 Bedside Registration (Zebra)
ED14 Communication direct to clinician Vocera / ASCOM
ED15 Initial Assessment – Physician Orders Extension Health
ED16 Device Connectivity (Nuvon)
ED17 Print Vial Labels at bedside (Zebra and Sunquest)
ED18 Pneumatic Tube System (Swisslog)
ED19 Smart Infusion Pump with EMR Interoperability (CareFusion)
ED20 Care Team Communications: (Vocera)
ED21 Bed Assignment Overflow Management (Airista)
ED22 Asset Tracking Infection Control - (Airista)
ED23 RoboCourier ® Autonomous Mobile Robot (Swisslog):
ED24 Staff Emergency Button (ASCOM / RTLS)
ED25 Real Time Vent Surveillance (CPC)
ED26 Medication Order & Blood Sample Delivery (Swisslog)
ED27 MedRover® Mobile Dispensing Cabinet / MedPortal™ Inventory Management Software (Swisslog)
ED28 Eliminating Transfusion Errors and Increasing Efficiencies (Sunquest)
ED29 Medication Administration Infusion Pump Hospira
ED30 Find Available Pump Emanate Wireless
ED31 Pump Utilization: Emanate Wireless
ED32 High Value Supply Management (Cardinal)
ED33 Workflow Monitoring – Patient Experience (Intelligent Insites)
ED34 Analytics (CreatAsoft)
Still to be added to script:
HID Global: HID supports compliant Electronic Prescriptions for Controlled Substances (EPCS
HID Global:ActivID Tap: NFC Tablet and Mobile Phone authentication with ID Badge
Revised: March 24, 2015
Scenario
Patient #1:
Name:Robert Grant
Age:59 years
Condition: Mid-sternal chest pain radiating to his left jaw
Aortic Stenosis
Type II Diabetes, Hypertension, Hypercholesterolemia, Obesity
Status:Sent directly to the Cardiology Suite (Cath Lab)
Patient # 2:
Name: Samantha Millhouse
Age:59 years
Condition:Worst Headache ever: Neuro Case
Patient #3:
Name: Jacob Smith
Age:
Condition:Trauma Case: multiple orthopedic injuries
Status: Assessed and routed to the OR
Patient #4:
Name:John Halloway
Age:
Condition:critical condition, He is awake, agitated, and complaining of severe chest wall, and right ankle pain. He is tachycardic and hypoxic and placed in bed #1
Status:Admitted Bed 1 in the ED
Start:
ED1 Staff Identification Visibility
(Stanley Health) ** Updated Mar 6 (Extension Health) ** Updated Mar 18
Hello, Welcome to the Emergency Department of the Intelligent Hospital. As you can see, I am automatically identified as I entered the room through my real-time location system, or RTLS, tag, working in conjunction with the hospital wireless infrastructure.(Point to Main screen when picture appears)
[Actor 1 points to patient badge on wrist, Actor 2 points to tag on lab coat] Applying these tags to patients, staff and equipment enables the ability to accurately locate patients, staff and available lifesaving equipment as well as room status by color codes—all on one screen. Throughout the hospital rapid changes can directly impacting the delivery of care. [Actor points to wall mounted iPad] A digital room signs mounted outside the patient’s room verses visual controls traditionally located at the nursing stations provides real-time information about what’s happening in the room—[Actor points out the different areas on the screen on the wall mounted monitor] room status, patient information and location, staff in room, wait time and special needs.
Staff can easily see if patient is not in the room and where they are or if a room is soiled and ready for cleaning services. [Actor pushes the button on the tag next to the iPad, waits and then points to the color change on the monitor] Staff can also request physician consult for the patient which changes the color displayed on the digital sign and automatically sends an alert to the appropriate staff. They can accept and/or cancel the request from their mobile device. [Actor 2 holds up the Extension device]. Coupled with an EMR integration, extending the visibility of an RTLS patient flow solution to the room level, your care team has up-to-the-minute information. Additionally, this captured data can be analyzed to understand underlying trends for process improvement or investigate root causes of a particular issue around wait times, room utilization and cycle times.
in the ED.(Actor point to wireless devices (RTLS/Smartphone/wireless tablet) and then general indication to ceiling area
When integrated with an ancillary notification system, a unit care team can benefit from greater awareness of other care team members or key assets. During a Code Blue alarm, the location of the closest crash cart can be provided to responders on their smart phone screen. A pharmacist or Intensivist responding from another unit can see a real-time status on who has reached the patient’s room. Additionally, this captured data can be analyzed to understand underlying trends for process improvement or investigate root causes of a particular issue around wait times, room utilization and cycle times. [Screen Shots: 1.) Engage Mobile on Zebra Android: Code Blue Alert with Crash Cart notation, 2.) Engage Mobile /Zebra Android Code Blue Event Response] (Extension Health)
ED4b Real-Time ED Optimization with Predictive Analytics(CreateASoft * Updated Mar 18)
By leveraging existing RTLS systems, A real-time optimization engine constantly predicts near-future performance of the ED. Utilizing historical data trends, current EMR information and existing RTLS tracking data, suggests predicted staffing levels and improved workflows in order to minimize patient wait times and reduce left without being seen. ED providers and management are presented with alerts and notifications identifying the impact of suggested changes and associated efficiency gains.
Actor1 points to dashboard (screenshot) alert identifying a need for workflow changes and their impact, projected to be needed in the near-term for the ED. Actor1 directs Actor2 to take proactive measures to request additional bed availability and additional staffing.
ED4C: Bedside workstation/ Tablet authentication(HID, Zebra) * Updated Mar 18
The ED equipped with a bedside PC workstation’s which can be wall or cart mounted or a hand held tablet replacing the larger solutions. This PC or tablet is capable of running all the hospital applications and provides the clinician bedside access to the EMR, PACS, Lab information system, cardiology management data or medical history data.
Proving you are who you say you are, by utilizing One Time Password security into cloud applications can be accomplished leveraging your ID Badge and NFC communication protocol with a single tap of the card. The innovative technology card both generates and sends a One Time Password without the inconvenience of re-entry. (Actor picks up the tablet and taps their ID badge to the tablet – screen shot of the authentication application).
In addition the PC provides the capability to print and scan barcode labels, and can also be integrated with RFID reader. These integrations ensure patient centric identification and association of all devices, supplies, medications, samples and documentation is directly associated to the patient.
(Actor 1 Walks in at the start of the next paragraph, and immediately uses the hand washing dispenser)
ED4D: 1a: Overflow Cart (Emerson)
The Emergency Department also deploys an Overflow Cart improves the speed of care by combining the storage capacity of a supply cart with the efficiency of a mobile computing workstation on wheels (WOW). The compact footprint gives nursing the ability to treat and chart in any available space in a hospital’s busy ED while providing access to supplies and critical information no matter where the patient is treated.
ED2 Wireless Network (Extreme Networks)
Vital these operations are the underlying high performance wireless network providing a seamless blend of multi-carrier cellular and Wi-Fi services. This critical component is a key enabler for many of the new technologies and applications being reviewed here today. The high-performance wireless network extends the reach of these devices and allows enhanced information exchange and real-time communications for the many varied users typically present
ED6 Supply Availability - KanBan Replenishment (Cardinal Health)
Vital to the rapid management of a diverse set of patients is access and verification of the proper supplies and medications. The ED staff can interactively monitor and confirm the availability of all required supplies. General supplies are managed using the two-bin RFID system, which ensures optimum stock levels and demand accuracy. This practice eliminates the need for manual demand assessment rounds by triggering replenishment requests by users only when a predefined batch of a product has been depleted. When a compartment is empty, the RFID-enabled location tag is transferred to the RFID replenishment board.(Actor takes last item of a supply from a bin and transfers tag from the bin to the board). Independent of replenishment management, unitary consumption can also be captured and linked to patients with the patient charging kiosk (Actor point to the kiosk) and handheld RFID reader (Actor point to the RFID reader). The user can select a patient on the touch-enabled kiosk and use the RFID reader to scan the RFID-enabled location tag on the bin from which the supplies are taken(Actor touches a name on the kiosk, pick the supply needed and uses scanner to scan a tag). The supplies will then be charged to that patient, creating a record for the hospital’s billing system.
ED6a: Overflow
The new Metro Starsys Emergency Department Overflow Cart improves the speed of care by combining the storage capacity of a supply cart with the efficiency of a mobile computing workstation on wheels (WOW). The compact footprint gives nursing the ability to treat and chart in any available space in a hospital’s busy ED while providing access to supplies and critical information no matter where the patient is treated.
ED7 Mobile Wearable Device(Vocera, Extension Health ** Updated Mar 18)
All clinicians utilize multiple mobile hand held and wearable devices enabling them to readily communicate and deliver critical information, such as access to the clinical or lab data. These systems are typically(Hold up iPad Vocera Pendant) integrated to the hospital phone system enabling incoming and outgoing calls. These devices improve the efficiency of care team communication and coordination by integrating with EHRs, across mobile and desktop devices. Alerts can be sent to these devices directly by the communications system or through vendor-neutral alarm management/secure messaging system to provide notification of new orders and test results.
ED8 Environment Controls(Stanley) ** Updated Mar 5,14
Within the ED patient care environment, devices like refrigerators and freezers that store pharmaceuticals, blood and other critical tissues as well as patient and supply rooms [Actor point to the temperature on the STANLEY large monitor – top right] require strict temperature and humidity monitoring to ensure proper ranges for quality patient care and safety. Relying on manual data collection is time consuming, subject to human errors and only a “snapshot” of the environmental levels. If a refrigerator goes out of range, it could be hours before it’s noticed and remedied—resulting in a potential patient safety risk and product loss. [Actor points to tag in the room mounted on the wall] Automated temperature and humidity monitoring allows you to continuously monitor conditions in real-time. When temperatures go out of range, the system pro-actively notifies appropriate personal, reducing the chance of spoilage. It also allows for corrective actions to be documented, complying with Joint Commission and other agencies’ audit requirements. [Actor points to shared monitor with screenshot] Visual dashboards provide an easy-to-understand overview of the environmental conditions in the ED and even hospital wide, with problematic devices prioritized. [Actor points to shared monitor with screenshot again] The visual analytics drive better operational decision making,identify areas for process improvement and apply predictive analytics to identify potential device malfunctions before they happen. A system like this helps improve patient safety, facilitate regulatory compliance, increase staff efficiency and productivity –all while avoiding unnecessary costs.
Patient #1: Robert Grant (Bypasses ED Directly to the Cath Lab)
We start the scenario with Robert Grant, a 59 year-old male, who called 911 after an hour of mid-sternal chest pain radiating to his left jaw.
(Note: Patient Bypasses ED go’s directly to Cath Lab, OR , etc)
ED9 Receiving Information while Ambulance is in Transit (Zebra)
Receiving patient physiological data and demographics, while the patient is in transport can significantly impact the response time and treatment delivery, increasing the likelihood of a positive outcome.Even when outside the physical boundaries of the hospital, it is possible for the ambulance team to seamlessly leverage the available multi-carrier cellular network to connectdirectly with the hospital EMR. The ambulance team can transmit Robert Grant’s 12 lead ECG data and analysis, along with vital parameters, including invasive pressure, temperature, capnography, SpO2, and cardiac output and establish consultation with the ED physicians and for some patients triage can be performed directly in the ambulance and in this case the patient can bypass the ED and be directed to the Cath Lab for further testing and follow-up diagnosis.
Patient #2: Bed 1: Samantha Millhouse:
The next patient a 59-year old woman Samantha Millhouse arrives in the ED complaining: "The Worst Headache I have ever had". Blurred vision and neck pain - A sudden, severe headache that “feels different than any other headache I have ever had” -“It’s the worst headache that I’ve ever had and I have pain in my neck”- “I feel like I am ready to pass-out” - “every time I’m near light, I get really nauseous. (Enter Actor 2, and walk right to beside 1, without washing hands).
ED5 RFID Locating Overflow Management (Stanley Healthcare) ** Updated Mar 6
The ED s extremely busy today Samantha is placed in one the ED’s to overflow locations. Of particular concern in most ED’s is patient flow with a constant flow of patients a broad range of issues and acuity. The ED is a high pace environment requiring rapid triage, diagnostics, assessment and the transport patients to appropriate treatment area of the hospital. A critical and very common issue within the ED is patient overflow. To manage large numbers of patients and avoid diversion to other hospitals, RTLS solutions are used to establish and define virtual locations within the ED. Patients are doubled up and tightly placed in any location, within the corridors and even overlapping within the bays. [Actor points to the bank of stretcher on the back wall]In order to effectively manage patients, these virtual locations must enable patient centric identification and association to staff, equipment, supplies and pharmaceuticals. These applications require high accuracy RFID locating. Dedicated Location Transmitters are used receive signals from the RTLS tags enabling high resolution location definition, separation and tracking (actor points to the antenna) of equipment and other assets enabling the ED to flex its capacity at critical times of overflow.
ED12 Hand Hygiene (AiRista)
As you can see, the clinician failed to sanitize their hands prior to entering the ED. An RTLS badge identifies staff through the RTLS reader correlating whether that tag was sensed at the hand-washing dispenser. (Point to reader and hand washing dispenser)Because the clinician entered the patient area without following the hand hygiene protocol, the RTLS badge provides a signal/reminder upon entry, allowing the clinician an opportunity to self-correct. (Point to the RTLS Badge and LEDs on Badge) Returning to the hand sanitizer dispenser and using the dispenser, the embedded dispenser module positively identifies the clinician and sends a wireless signal to the badge which cancels the alert.(Actor returns to hand washing dispenser and performs hand hygiene, then returns back to bedside)The Hand Hygiene Compliance Monitoring web-based software application provides administration and leadership with real-time validation and metrics, allowing collected hand hygiene compliance data to be evaluated over time.
ED13 Bedside Registration (Zebra)
To expedite Samantha’s admission process, a quick registration is performed at the bedside using a unique identifier. The hospital has a label printermounted at the bedsideenabling a wristband to be printed directly at the point of care. The patient wristband has a combination of bar code, passive along with text information. Using patient centric unique identifiers enables visibility to all aspects of the patient care processes around this patient, including patient identification, specimen, medication, asset, and staff identification.