Computerised Theatre Regis-ter Minimum Dataset Project in Acute Hospitals in Cork & Kerry

Judy CroninDr. Orla Healy

Heather Hegarty

Dept. of Public Health, HSE

South

Presentation to HISI Thur Nov 17th 2011

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Background

A review of theatre activity in 2008 in all HSE hospitals in Cork and Kerry was conducted under the Reconfiguration of

Health Services.

Theatre logbooks or registers varied from place to place

All were manually entered, paper based systems

Computer systems existed, they did so in parallel with paper based systems

Similar but not standardised data

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Key Data Management Recommenda-tion:

“A standardised computerised theatre logbook

system developed in all hospitals.”

HSE Performance Report February 2009 (2nd April 2009); page 32

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Extracting data for THEATRE review, audit or service planning is extremely difficult

o time consuming

o labour intensive

o inefficient

o expensive

o a major logistical challenge

o security concerns

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Project Purpose

o Requirement for high quality information.

o The HSE needs to be able to source, analyse and interpret routine data to inform key decisions.

o Standardised and computerised theatre registers will facilitate quality assurance, performance monitoring, audit, look-back and research.

o We can’t keep manually counting and re-counting log book entries for patient recalls/reviews

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The advantages of an electronic logbook:

• More efficient data access

• Higher data quality

• Increased ability to conduct quality improvement and clinical research activities.

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Scope

The scope of this project was as follows:

1) Minimum Dataset (MDS):o Agree MDS o Develop data dictionary

2) Computerisation:

o Identify what computer systems are currently in use in hospitals and theatres relevant to computerising theatre registers.

Establishment of Computerised Minimum Dataset (CMD) Group

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iSoft Operating Theatre Module

MDS Collationacross all Hospitals

Cork & Kerry

Meetings withTheatre Managers

Systems in useNationally

Meetings with CUH IT

Meetings with TPOT Group

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MDS Theatres – Current picture

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Systems in use NationallyTable 1 Results of Operating Theatre Telephone Questionnaire

No Computerised Operating Theatre System

34 (61.8%)

Dual Paper-based AND Computerised Operating Theatre System

6 (11%)

Fully electronic Operating Theatre System

8 (14.5%) (2 Hospitals very unhappy with similar system)

Electronic Orthopaedic Operating System only

5 (9%)

No Reply 2 (3.6%)

Total 55 (100%)

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Fact Finding Mission – Meetings with Theatre Managers

• HSE WEST IPMS Operating Theatre presentation

• Roll-out of IPMS Theatre module in Letterkenny, Sligo & UCHG

• Senior Management and IT support critical.• Used ICD-10 HIPE Codes• Recommends a succession plan post implementation (add a procedure)

• On-site visit to Tallaght• High level Governance group & excellent IT support (dedicated IPMS IT Project

Co-Ordinator)

• Product Initiation Document and Cost Benefit Analysis Report. Extra data points, PC’s – Thin Client and washable keyboards.

• Used ICD-10 HIPE Codes – manually inputted.• Procedure codes associated with each Consultant – system monitors time &

adjusts time. • Used widely for audit and has vastly improved efficiency.

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CUH IT – IPMS Operating Theatre Pro-ject

IPMS Theatre IT Project driver in CUH

• Theatre 3 Neurosurgery – fully implemented 24/7

• CUMH Gynae/Obstetrics – fully implemented 24/7

• Theatre 1 and 1A Cardiothoracic – one year, then stopped.

• Currently used for theatre bookings or elective list in 1, 1A, 5, 6 & 7, 8.

OBSTACLES

• Key Theatre staff drivers (willing to run with this)

Governance (at Mgt. level to push project forward)

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“there is no legal reason why we cannot move to a fully computerised Theatre Log Book”

In-house HSE Barrister

“Theatre register should be kept in every theatre to record essential details of all surgical procedures. It can be either paper, book format or electronic.”

Standards & Recommendations for Safe Peri-Operative Practice (Pg 28Afpp 2007) 1.12.2.

Legal status of Log Books

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IPMS Screen Shots – Theatre Overview CUH

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CUH IT – IPMS- In-Theatre Details Tab

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Data Dictionary

IPMS

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TPOT Project – The Productive Operating Theatre group

TPOT is interested in …

data that could or would be useful when

looking at making improvements in the

future.

the same core data collected via IPMS is at the

centre of both projects.

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New South Wales Health Department, Operating Theatre Management Project Report

Only 29 facilities were using the same definitions. The report states that

“establishing common data definitions was essential to ensure comparability of activity data..

A revised MDS be mandated across NSW Health System”

New South Wales Health Department, NSW Health Operating Theatre Management Project Report, NSW, 2002

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Where we are at now……

TPOTCMD

IPMS

Combine our efforts.CUH• Local Theatre Manager drivers identified• Orthopaedics is now the Productive Theatre “Showcase

Theatre”• Implementing IPMS Operating Theatre module Theatre

by Theatre

TGH• Building their Theatre  IT systems/scheduling system in

Kerry from paper basis.• Eager and ready to move to IPMS

Nov 2011 Kerry General is scheduled to go-live

MUH & SIVUH• Just implemented IPMS across the Hospitals (with the

intention of making the Operating Theatre Module available)

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It is our recommendation that ..

• All Acute Hospitals computerise the theatre register

• Where available IPMS be used as the system to achieve automation

• Where other IT systems are employed, the same core MDS is collected

• TPOT review the minimum dataset and data dictionary agreed by this group with a view to national adoption.

• TPOT review the extra key data items recommended by this group and consider what other items will be required for performance monitoring in the future

• TPOT liaise with the HSE National iSoft Liaison link to negotiate a consistent coordinated approach to IT development in Theatres and minimise the costs involved

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CMD Group MembersDr. Orla Healy – Project Lead Reconfiguration

Judy Cronin Health Informatics Manager DPH

Heather Hegarty Senior Research Officer DPH

Catherine Buttimer Theatre Manager MUH

Donnacha Jordan Theatre Manager MUH

Eilish Daly CNM2 for Theatres SIVUH

Fionuala O’Gorman Perioperative Facilitator CUH

Andrea Kennedy CNM1 for Theatres CUH

Caitriona Hayes CNM3 for Theatres KGH

Mary O’Regan-Barsum CNM2 for Theatres BGH

Margaret Angland, A/Clinical Nurse Manager 2 SMOH Ortho

Lorraine O’Connor Clinical Nurse Manager 2 for CUMH Theatres

Geraldine Keohane Director Of Midwifery CUMH

Sheila Spillane Nursing IT CUHMary-Rose Dennehy IT CUH