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December 2001
Volume 65 |
Number 12
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WHAT'S
NEW IN…
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| Operating Room Management:
The Quest for Information |
M. Christine Stock, M.D.
Association of Anesthesia Clinical Directors
There is more information immediately available to us now than
ever before. Yet, medicine lags seriously behind in the electronic
information explosion, and the cost of catching up will be prohibitive
for many institutions.
Our current culture mandates that high-quality medical care be
delivered with efficiency, reduced costs, appropriate resource
allocation and effective conflict resolution, particularly in
our high-cost areas such as the operating room (O.R.), emergency
departments, intensive care units, labor and delivery areas and
interventional laboratories. We cannot quantify attributes such
as utilization, efficiency or profit margin without data. We also
require data to execute our “rules of engagement” fairly
and equitably and to understand and to evaluate how our systems
perform. This article will discuss O.R. data collection systems
and opportunities for interinstitutional data analysis.
Our perioperative systems share many industrial engineering elements
with manufacturing systems; “total case time” can be
equated to “duty cycle,” for example. Therefore, many
of the principles of systems analysis apply to our environment.
One of the most fundamental of these principles requires that
we clearly define and name data elements so that we communicate
in consistent terms, both for internal evaluation and comparisons
between institutions (“benchmarking”). Several years
ago, the Association of Anesthesia Clinical Directors (AACD) published
The Procedural Times Glossary. This document has become the industry
standard for defining the intervals and events of interest in
managing O.R. systems and was endorsed as such by the Association
of Operating Room Nurses and the American College of Surgeons.
Anesthesia information system vendors are creating data collection
templates from the AACD glossary and are working toward a standardized
data format. We should exert our consumer influence on these vendors
to work rapidly toward adopting a standardized electronic format,
which is a necessary component in the creation of a national,
perioperative event electronic data bank.
Data collection methods vary from wholly manual collection (people
with pencils and clipboards) to wholly electronic collection.
How one designs a data collection system should be governed by
what one wants to learn. Although this precept sounds ridiculously
simple, one should avoid the temptation to force one’s O.R.
system to fit an apparently attractive electronic system. It is
not uncommon for institutions to find a seemingly attractive software
package and then attempt to get the institutional systems to conform
to the software. Therefore, before embarking on data collection
or prior to engaging in the purchase of a data collection system,
one should first identify clearly the goals for data collection.
Only after these goals have been defined can one build data collection
systems around these goals. Although electronic information systems
have great potential to help us measure and evaluate our systems,
they are expensive to purchase and laborious to install. The purchaser
should define institutional goals explicitly for the vendors and
write these goals into the purchase contract. For example, if
one of the institutional goals is to enhance compliance with Center
for Medicare & Medicaid Services (CMS) billing regulations,
then it is imperative that the electronic system have a method
to force the user to complete the required fields to assure that
the CMS-mandated data are included before the record can be closed.
There will be many goals common to most institutions. Again, we
should use our consumer influence to encourage vendors to include
these types of features in their standard packages and insist
that institutional goals of this nature be met at the time of
purchase.
Some components of information systems to consider include:
Preoperative evaluation and consultations
(this should populate all other components of
electronic record; for example, allergies entered on admission
should appear in all other parts of the record)
- Anesthesiology intraoperative record
Nursing O.R. medical record
Intraoperative anesthesia medical record
Postanesthesia medical record
- Anesthesiology:
Physiologic information
Professional billing
Institutional bill
- Compliance with federal regulations and Joint Commission on
Accreditation of Healthcare Organizations standards
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Quality management studies and reports
Just as our medical decisions and judgments are based on data,
our advice and decision-making processes in the province of O.R.
management also must be data-driven. Intellectual interest in
the science and innovation of O.R. systems and O.R. management
styles are shared by the members of the AACD. Formed in 1988,
AACD conducts two annual educational activities: a nationally
acclaimed spring workshop and a half-day annual meeting on the
Sunday of the ASA Annual Meeting (see <www.aacdhq.org>
for further information). The Procedural Times Glossary
is published in the members-only section of the AACD Web site.
Hospitals, ambulatory surgical centers and office-based surgical
practices look to anesthesiologists for direction in setting guidelines
that promote efficient use of precious resources while delivering
high-quality care. Our goals in this capacity are to find safe,
cost-effective methods of conducting O.R. practices that allocate
resources fairly and predictably with minimal negative surprise
and conflict. Additionally, a large national database will allow
us to study clinical outcomes with statistical power not yet possible
in any current data set. It is imperative that we, the consumers,
insist that the electronic systems vendors establish a standard
format for data acquisition so that we can realize the power of
our clinical data.
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M.
Christine Stock, M.D., is James E. Eckenhoff Professor and
Chair, Department of Anesthesiology, Northwestern University
Medical School, Chicago, Illinois. |
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