BACKGROUND:Hospitals use time-motion studies to monitor process effectiveness and patient waiting. Manual tracking is labor-intensive and potentially influences system performance. New technology known as indoor positioning systems (IPS) may allow automatic monitoring of patient waiting and progress. The authors tested whether an IPS can track patients through a multistep preoperative process.METHODS:The authors used an IPS between October 14, 2005, and June 13, 2006, to track patients in a multistep ambulatory preoperative process: needle localization and excisional biopsy of a breast lesion. The process was distributed across the ambulatory surgery and radiology departments of a large academic hospital. Direct observation of the process was used to develop a workflow template. The authors then developed software to convert the IPS data into usable time-motion data suitable for monitoring process efficiency over time.RESULTS:The authors assigned tags to 306 patients during the study period. Eighty patients never underwent the procedure or never had their tag affixed. One hundred seventy-seven (78%) of the remaining 226 patients successfully matched the workflow template. Process time stamps were automatically extracted from the successful matches, measuring time before radiology (mean +/- SD, 77 +/- 35 min), time in radiology (105 +/- 35 min), and time between radiology and operating room (80 +/- 60 min), which summed to total preoperative time (261 +/- 67 min).CONCLUSIONS:The authors have demonstrated that it is possible to use a combination of IPS technology and sequence alignment pattern matching software to automate the time-motion study of patients in a multidepartment, multistep process with the only day-of-surgery intervention being the application of a tag when the patient arrives.

Object The operating room is rich in digital data that must be rapidly gathered and integrated by caregivers, potentially distracting them from direct patient care. We hypothesized that current desktop computers could integrate enough electronically accessible perioperative data to present a unified, contextually appropriate snapshot of the patient to the operating room team without requiring any user intervention.Materials and methods We implemented a system that integrates data from surgical and anesthesia devices and information systems, as well as an active radiofrequency identification location tracking system, to create a comprehensive, unified, time-synchronized database of all digital data produced by these systems. Next, a human factors engineering approach was used to identify selected data to show on a large format display during surgery.Results A prototype system has been in daily use in a clinical operating room since August 2005. The system functions automatically without any user input, as the display system self-configures based on cues from the primary data. The system is vendor agnostic with respect to input data sources and display options.Conclusion Automatic integration and display of teamsynchronizing data from medical devices and hospital information systems is now possible using software that runs on a personal computer.

Introduction: Capacity constraints make improving hospital efficiency a necessity. INCOMING! is an integrated real time system to monitor patient flow between the recovery room (PACU) and the surgical floor designed to ease PACU burden and reduce PACU waitlists. Methods: A computer generated web-based platform was constructed to monitor patient progress from the OR to the PACU. Time stamps culled from the OR database were made accessible to the patient floors through the hospital intranet. A default stay of 60 minutes in the PACU was assigned to each patient. The default could be modified by the PACU staff. This was then fed into an automatic paging function which forewarned the charge nurse on the floor 15 minutes before presumed discharge. The tool was piloted on theGeneral Surgery, Thoracic Surgery and Surgical Overflow services beginning in late 2004 with the automatic paging function added in mid-March 2005. Times into and out of the PACU were recorded. Mean PACU times were calculated for the General Surgery service and compared to General Surgery patients placed off service or without INCOMING! selection and an Orthopedic Surgery concurrent control both before and after paging capabilities of the system were enabled. Results: SEE TABLE: Conclusion: INCOMING! decreased the time in the General Surgery intervention group by 25.5 minutes while the General Surgery group that did not have an INCOMING! selection had an increase of 8.7 minutes. However, there were no statistically significant differences between groups other than the Orthopedic Surgery control group and the post-paging intervention group. This pilot study tested the system but generated some confusion amongst the staff in the PACU as it was not uniformly applied to all patients. Nevertheless, INCOMING! is our first attempt at real-time communication between the OR, PACU and surgical floor. Hopefully, in the future, integrated real-time systems will continue to evolve and improve hospital efficiency.

Location tracking systems are becoming more prevalent in clinical settings yet applications still are not common. We have designed a system to aid in the assessment of clinical workflow efficiency. Location data is captured from active RFID tags and processed into usable data. These data are stored and presented visually with trending capability over time. The system allows quick assessments of the impact of process changes on workflow, and isolates areas for improvement.

We have developed a vendor agnostic, full disclosure system for the capture, display, and storage of operative systems data. This system allows door to door capture of data from multiple sources including monitors from competing vendors, integration under a single platform, and storage for future use. Full disclosure functionality includes the ability to retrieve and display archived data including full waveform and trend physiologic data, synchronized to the surgical video and other OR devices and data sources.

The integration of disparate information systems in the operative environment allows access to information that is typically unseen or unused. Through a collaborative effort, a variety of information systems and surgical equipment are being integrated. This provides improved context-sensitive information display and decision support and improved access to information to improve workflow, safety and visualization of information that was previously unattainable.

The integration and presentation of information from a number of disparate sources in the operative environment raises a number of usability and human factors challenges. Through a collaborative effort, a display combining persistent and dynamically switching panes provides a rich source of information to help orient team members, provide indications of case progress, and organize information into stage-based tabbed panes. This provides maximal flexibility within visibility and usability constraints.

From the time a patient enters the surgical arena until the time they leave, a tremendous data stream is produced. These data pass through various unrelated systems mostly going unnoticed and unrecorded. We have developed a system to integrate these various systems and display the real-time integrated data in an easy to visualize system. The system captures, records and displays data from anesthesia and surgical devices and OR/hospital information systems, consolidating information on a single operating room display. The system will provide improved contextual real-time monitoring of physiological data, real-time access to readiness information and improved patient identity management.