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Eisenhower Medical Center: From Pen and Paper to
Computerized Anesthesia Documentation

By Christopher Cantilena, MD
Chairman of Surgery
Eisenhower Medical Center
Rancho Mirage, Calif.

Banishing Ballpoints
About a year ago, leaders at Eisenhower Medical Center decided that clinicians would no longer use pens, but instead would rely on computers to document clinical care in the surgical suite. I like technology, but I'd always had a certain affinity for pens, and I was used to grabbing a trusted ballpoint to jot down my notes while delivering anesthesia care in the operating room.

After using the system, I've come to a quick conclusion. Computerized documentation improves anesthesia care and efficiency in the OR. A look at how I delivered care with a pen compared to using an electronic health record (EHR) illustrates why I've become an advocate for paperless medicine.

Completing Cumbersome Paper Chores
A typical workflow during my pen and paper days:

  I reviewed the paper charts to get up to speed on each patient. Sometimes the notes in the
    charts were incomplete or difficult to read.

  In the OR, I monitored the field, blood loss and changing levels of surgical stimulation. At the
    same time, I anticipated the next steps in the procedure and documented care in the
    paper chart.

  Sometimes, when patients experienced problems, I had to delay putting pen to paper to
    make a chart notation. With the delay, sometimes I would question whether or not I was
    recalling all of the details.

  When there were difficult clinical situations during surgery, I relied on memory and experience
    to deliver best practice care to my patients.

Creating Computerized Efficiency
Shortly after the McKesson Anesthesia Care™ solution was implemented in June 2009, our anesthesiologists disposed of our pens. Now, anesthesia care is delivered with the assistance of a touch screen computer, not a ballpoint. And life has changed considerably — for the better.

Streamlined Access to Information: Instead of pulling paper charts, now I access patient information from any Internet-connected computer — even from the comfort of my own den. I access the patient schedule as well as the patient's medical, anesthetic and surgical history via McKesson's physician portal.

Online Support for Best Practices: The IT system promotes patient safety by providing prophylactic antibiotic alerts, drug allergy contraindications and cross-checking for adverse drug events. With the data we're collecting, eventually we'll be able to identify best practices, standardize procedures, reduce costs and capture lost revenue.

Documentation at the Point of Care: The electronic solution enables me to document each phase of care at the point of care. I now can suspend care in the operating room and then move into the PACU to continue documenting on the case. I can't close the case until care is completely documented, which helps improve billing, making it possible for us to achieve optimal reimbursement.

Improved OR Efficiency and Services: With online access to patient and practice information, anesthesiologists can have a positive impact on case turnover time, post-acute care unit recovery time and the scheduling of add-on cases.

The surgical suite is an important component of any hospital's success. According to the American Hospital Association, 70% of all patients are admitted to hospitals via the OR. Because the anesthesia IT solution is providing efficiencies that make it possible to optimize OR suite scheduling, it has helped improve our overall surgical services and revenue. In addition, this efficient level of service from anesthesiologists reinforces the surgeon's decision to operate at this hospital, instead of scheduling operations at alternate facilities.

Christopher Cantilena, MD, is a practicing anesthesiologist and Chairman of the Department of Surgery at Eisenhower Medical Center, Rancho Mirage, Calif. He attended Northwestern University Medical School, and after graduating in 1988, he undertook a surgical internship and anesthesia residency at the Naval Medical Center, Portsmouth, Va. He is presently pursuing a Master of Medical Management degree through the University of Southern California — Marshall School of Business.

During surgery, it is critical for the anesthesia team to have quick and easy access to medications they need to prepare and treat the patient. Previously, Shore Memorial Hospital in Somers Point, N.J., used a completely manual process to manage medications during procedures. This was extremely time-consuming, increased the potential for narcotic diversion, and resulted in inventory management issues for anesthesiology.

After moving to storage of commonly used surgical case medications in a standard kit in medication cabinets, Shore Memorial decided to become a beta partner in McKesson's development of an anesthesia medication dispensing cart. The Anesthesia-Rx™ dispensing cart is pre-filled with the medications anesthesiologists need for their surgical cases.

Anesthesiologists use a touch screen and open a drawer to get the medications they need. Because the system electronically tracks and documents actions for charge capture and an audit trail, there is reduced need for paperwork. The dedicated cabinet also provides more control over medications and narcotics.

"The biggest benefits that we are seeing are improved workflow and drug utilization accountability," said Pharmacy Director Barbara Giacomelli, PharmD, who leads the Anesthesia-Rx initiative at the two-surgical-suite, 296-bed hospital. "In the pharmacy, we have reduced the workload (checking, charging, and restocking) of our pharmacists and techs, documentation is much easier to manage, and because we have more control over our high-alert drugs and controlled substances, we've improved regulatory compliance."

In addition, pharmacy technicians no longer have to prepare kits for the two surgical suites, which saves staff 15 minutes per day. They restock the carts only once per day, and the anesthesiologists and CRNAs have everything they need in one place. The Anesthesia-Rx™ medication dispensing carts were so well received that the anesthesiology team asked for more in the first week. Shore now is using six mobile anesthesia carts.

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