Intelligent Hospital™ OR Script 2015
Revised: Updated March 24 2015 PHF
Table of Contents
Use Cases to be added: 3
Introduction: 3
OR1 Staff Identification: (Sponsor to be Determined) 3
OR2 OR Platform Infrastructure: (Skytron) 4
OR3 Temperature and Humidity Monitoring (Pending Sponsor) 4
OR4 Integrated Management System (Extreme Networks) 4
OR5 Environmental Metrics (Planned Removal) 4
“Pre-op” Preparation: 5
OR15 Case Supply Management Integrated with ORIS (Omnicell) 5
OR9 Surgical Tray (Cardinal) 5
Cardinal Health 5
Start Procedure Patient Ready: 5
OR6 Nurse Call communication and workflow utilization (ASCOM) 5
OR7 Wireless Communications ( Vocera) 5
Ascom/Vocera 5
OR10 RFID Personnel Tracking (Sponsor to be Determined) 6
OR11 Wireless Messaging (Vocera) 6
OR8 Information System (TBD / Sunquest / Skytron) 6
Or12 Central Line Kit (Cardinal) (Update required supplies Dr Landa) 6
Cardinal Health 6
Or13 RFID Tagged Equipment (Intelligent Insites) Should be with Hospira !! 7
OR14 Infusion Pump: (Hospira) 7
Hospira 7
OR16 Anesthesia Delivery System (Drager) 8
OR17 Anesthesia Workstation and Narcotic Control in OR (Omnicell Codonics) 8
8
OR18 Capnography monitoring in OR: (Nuvon **) 8
OR19 Remote Collaboration Platform (Intouch Health) 9
Intouch Health 9
OR 19 A: Sample Collection Positive ID: (Sunquest) 9
Positive/Accurate Patient Identification and Container Labeling using Mobile Specimen Collection System 9
OR20 Pneumatic Tube System (Swisslog) 10
Swisslog 10
OR21 Family Notification (ASCOM) 10
Ascom 10
OR22 Usage Capture Station (Cardinal) 10
Cardinal Health 10
OR 22a Eliminating Transfusion Errors and Increasing Efficiencies using Sunquest Transfusion Manager (Sunquest **) 11
OR23 Housekeeping Update (ASCOM) 11
Ascom 11
OR24 Surgical Instrument Management 11
Cardinal Health 11
OR25 Track Low Value Assets 11
DeRoyal 11
DeRoyal: Automated Usage Capture of OR Materials 12
Conclusion 12
Business Intelligence - Room Utilization Reporting (Intelligent Insites) 12
Intelligent InSites 12
Notes
1: Updated Howard Landa Comments
2:
Name: Robert Grant
Age: 62 years
Condition: Mid-sternal chest pain radiating to his left jaw
Aortic Stenosis
Type II Diabetes, Hypertension, Hypercholesterolemia, Obesity
Introduction:
Welcome to the Intelligent Hospital Pavilion Advanced Perioperative Suite developed by the Intelligent Health Association. This advanced perioperative environment is supported through our partnerships with industry leaders in perioperative and healthcare solutions. Through our collaborative efforts, we share with you today a modern vision of an integrated OR environment that offers seamless connectivity and communications. Both quality of care and patient safety are enhanced utilizing advanced clinical applications and cutting edge medical devices, enabling unparalleled information access and real-time clinical staff awareness. The clinical scenario that follows is integrated with other Intelligent Hospital Pavilion departments, as you will find throughout your tour of our facility.
Patient Demographics
Allen Grant is a 62 year old male admitted through the ED who has undergone an emergency cardiac catheterization and was discovered to have aortic stenosis requiring valve replacement as well as a coronary bypass. Mr Allen a previous patient of the Intelligent Hospital has a documented history of type II Diabetes, hypertension, hypercholesterolemia and obesity.
OR 01: ActivID Tap: NFC Tablet and Mobile Phone authentication with ID Badge (HID Global)
As hospitals increase their dependence on mobile and wireless devices there becomes an increasing requirement for heightened security to protect system access and patient specific information. The Intelligent Hospital has implemented a two factor authentication process for access to cloud-based or Microsoft ADFS services. Staff simply Tap their enabled ID Badge to any Windows or Android phone or tablet verifying access authority.
OR1 Staff Identification: (Stanley)
As you can see, I was automatically identified as I entered the room through my real-time location system or RTLS, tag. (Actor 1 motions to thelarge screen when their picture appears) The OR unit combines a robust network and wireless infrastructure coupled with real time operational intelligence from multiple RTLS / RFID systems with integrations including several modalities of communication and visualization that provide rapid enterprise level interaction as observed on the large screen, or a handheld device. (Actors point to large screen, hold up Tablet)
OR2 OR Platform Infrastructure: (Skytron)
Within this advanced OR suite, we find the foundation of a modern OR infrastructure. This hybrid surgical environment has state-of-the-art Ultra-slide surgical tables and high intensity, advanced optic, LED surgical lighting systems (Touch table and aim surgical lights onto surgical field). The integrated precision HD camera system offers a brilliant view of the surgical field via the boom mounted video routing and control platform (Walk over to Skyvision system and route camera to display 4). By utilizing the intuitive touch interface, our Intelligent OR medical staff is able to display, share, and archive digital media and many other clinical information sources effortlessly. (Touch the equipment boom) The OR is capable of routing surgical video feeds and any visual display sources to other areas of the hospital for central planning and monitoring. The OR platform integrates with a C-Arm X-ray imaging system enabling dynamic imaging to be performed within the surgical field minimizing surgery time. These images are routed to the hospital PACS system and available anywhere in the institution for consultation.
Additionally this hybrid OR is designed to support multiple surgical modalities and incorporates minimally invasive surgical platform including a endoscopic devices, video camera, lights, insufflators, and scopes all mounted on one of the booms to support advanced laparoscopy equipment and procedures (Stryker). The OR also incorporates a surgical navigation systems enabling a fully integrated computer assisted surgery solution. A dedicated digital camera tracks instrumentation and provides tracking information to endoscopes, fluoroscopes and surgical microscopes. (Stryker)
OR3 Temperature and Humidity Monitoring (AiRista)
The Intelligent Hospital OR suite is equipped with solutions for centralized temperature and humidity monitoring coupled with the RFID systems providing event driven alerts to aid in the management of regulation compliance and required reporting for the Joint Commission. [Tech points out temperature and humidity modules) These real-time environmental conditions within the OR suites are fed to the OR control area for automated limit monitoring which sends alarms or text messages to the communication badges of designated parties if room temp and/or humidity nears ‘breach’ levels, (Actor holds up badge) helping prevent patient care issues before they occur.
OR4 Integrated Management System (Extreme Networks)
A versatile array of modular switches supporting everything from an enterprise/campus connectivity right up to cloud data centers. The system provides Terabit-class performance, high availability and redundancy, our simple, scalable and intelligent switching and routing products as required by the hospital. A integrated management system that provides wired/wireless visibility and control from the IT data center enabling the IT organization to optimize the efficiency of network operations
OR5 Hands-Free Communication (Vocera)
Intelligent communication solutions enable care team members on their device of choice; smartphones and with our hands-free badge pre-designed messaging options, and vocal responses to answer calls, all care team members benefit from an efficient and consistent communications experience.
OR 6: Real Time Schedule Optimization: (CreatAsoft)
Scheduling and management of OR operations is critical to provide an optimized utilization of the OR resources. OR tracking utilizes RTLS technology coupled with real-time predictive analytics and integrated optimization engine to maintain on-time procedure completion and increase operating department efficiency. Dynamic real-time dashboards present dynamic schedule adherence views comparing planned, actual and forecasted schedules along with real-time staff notifications. This toolset empowers the OR department staff to proactively increase efficiency and reduce scheduling delays.
Actor1 points to screenshot of alert identifying a proposed schedule changes that are projected to be needed in the near-term for the OR. and directs Actor2 to take proactive measures to shift case schedules and to begin room preparation the case schedule.
“Pre-op” Preparation:
OR6A OR Device Preparation, locating and tracking (Borda Tech)
In preparation for the surgical procedure the OR’s required portable equipment complement is gathered and setup for the specific case. The use of real time location system enables the required devices to located. Using a hybrid system that multiple technologies combining NFC, UHF passive RFID and active RFID to merged into a single platform, enables devices across the institution to monitored across a wide base of applications. This system provides a seamless integration with many OR systems providing real time availability, tracking and utilization to monitored and dynamically determined.
OR25 Automated Usage Capture DeRoyal * Update Mar 16
During the course of the procedure general supplies are tracked utilizing RFID / Barcode coupled Kiosks strategically mounted within the Operating Room or available on movable stands. Required supplies are scanned and associated to the patient eliminating the manual recording process which links or documents supply utilization directly into electronic medical record, ERP & Financial systems. This information is available in real-time and documented into the case file as the procedure case is closed.
The nurse will select the appropriate patient from a list of cases received from the OR IT Scheduling system (nurse points towards the screen). RFID tagged supplies picked in preparation for the surgical procedure are linked to the specific patient prior to entry into the OR. As the nurse opens the surgical supplies, the wrappers or packaging is tossed into the cloud based Continuum Safe where the usage and other pertinent information is confirmed. Any items that were not picked prior to the surgical procedure will also be captured and linked to the patient by tossing the opened wrappers into the Safe. The nurse will also be alerted to any expired item introduced into the surgical procedure. Usage information is automatically sent the OR IT clinical record. Any items that were picked but not used in the procedure are scanned and returned to stock for chain of custody and tracking purposes. (The nurse picks up a supply, opens the package, content falls onto back table, wrapper is thrown away in the Continuum Safe (bin), and the nurse will see that the item is now displayed on the screen.)
OR15 Case Supply Management Integrated with ORIS (Omnicell) ** Updated Mar 24
During the course of the procedure general supplies and implants are routinely required. General supplies are associated to the patient’s case in the system prior to the procedure, requiring that only additions or changes are documented during the procedure. (Start new case in OptiFlex SS).
Supply usage may be captured from a secured storage cabinet or from open supply storage (product scanned into OptiFlex capturing product, serial and expiration). Information is sent to hospital clinical documentation systems while inventory is automatically tracked.
Once the case is closed and the patient goes to recovery or is admitted for post-surgical care, supply usage is also captured against the patient account. (Close case, view report) Data is available for trends in case cost, items pulled and not used on cases, and items added to cases, as well as supply usage for the entire patient encounter. (View case cost report)
OR9 Surgical Tray (Cardinal)
In preparation, the surgical technician immediately proceeds to the pre-op sterile instrument storage area and pulls an open heart surgical tray in anticipation of surgery.(Actor picks up tray in back of the OR brings to the surgical field and points out the RFID tags) The tray, prepared in central processing, is equipped with active RFID tags and surgical instruments integrated with passive RFID tags or bar code etched enabling institutional tracking and confirmation of the tray availability within the OR.
Start Procedure:
OR6 Nurse Call communication and workflow utilization (ASCOM)
Reliable and uninterrupted communication between patients and staff is vital within the OR environment. Complementary systems such as RTLS, Patient Monitoring, LIS and Order Entry can be integrated to effectively streamline information flow and improve response time.
In our clinical scenario using the workflow station, a notification has just been routed via theOR nurse call system, (Actor points to the Nurse Call system) to the OR from the preop area (Presses ready for patient button and starts the timer) indicating thatMr. Allen is ready to transferredto the OR.
OR7& OR 11 Care Team Communication & Collaboration ( Vocera) ** Update Mar 6
Members of the care team can communicate with one another using their device of choice that best addresses the clinical situation. For example, when hands-free communication is necessary, the care team can communicate using voice communication on a hands-free Badge (motions to the badge, presses button and places a call). When hands-free is not required, the care team can use an integrated voice and secure messaging smartphone application to send a secure text messaging, leveraging templates for instant and consistent communication both inside and outside of the hospital. (shows nurse or doctor using a smartphone to send a chat message to other members of the care team).
OR10 RFID Personnel & Workflow Tracking (Zebra) ** Updated Mar 6
You will notice that our OR staff are also wearing Zebra RFID tags (Point to and/or hold up your personnel RFID tag). The Intelligent Hospital RFID asset and personnel tracking system enables improved surgical environment awareness as to staff location and status, critical to ensuring effective care delivery in a timely manner. (Point to the Big Screen View that displays milestones of Staff arrival) Should any of the required personnel for the surgery not be present upon patient arrival, notification can be sent to appropriate staff via the Zebra Mobility platform for escalation.Surgeon walks into the OR to begin the case. The entrance of the surgeon into the OR suite marks a milestone “surgery in progess” which is an accurate case start time. This start time could then be communicated through the Surgical department as needed. Now that the patient has arrived in the OR the surgery is ready to get underway. The anesthesiologist notes that the patient needs central line venous access and has the nurse obtain the appropriate supplies including an IV pump and central line supplies. RFID tagged equipment such as IV pumps are managed utilizing the hospitals RTLS system. (Actor walks out of OR to get IV pump, Actor 1 will already be standing next to the Awarepoint dashboard) <Notify awarepoint> We can see that the IV pump has been identified as present in the OR on our equipment RTLS platform interface. (Actor points to the Awarepoint or Dashboard )The ability to track items throughout the facility results in dramatic improvements in equipment utilization for our hospital. The OR staff is able to quickly prepare and deploy the vast number of items needed for surgery thanks to our implementation of a robust inventory and materials management RFID solution