October 20, 2009
EPIC 2009: We went live with EPIC in August of 2009 across all of the
inpatient units and ED, including both clinical documentation and CPOE. In
general, the implementation has been very successful. We conducted a
debriefing for all of our key inpatient units on October 14, 2009. This
allowed each of the areas to provide their feedback to the EPIC Core
Group. A similar session was held with the hospital-based medical
directors recently. There are a number of caveats that have surfaced,
since the go-live:
Training, while essential, is very difficult to provide in a meaningful
way. We tried to balance the amount of information presented, the time
needed to train and the reality that training was key to implementation
success. Results have varied. For many physicians, training was not
sufficient to create even a modest degree of comfort with EPIC. So, if
you are frustrated and want more training, let me know. If you want to
review even just a few things, let me know.
Remember that if you elected to train on documentation, but not order
entry (this meant two hours versus four hours), you cannot write orders
and you cannot discharge a patient. If anyone now wants more training to
be able to enter orders and discharge patients, let us know.
If you have not trained at all, you cannot access the system. This has
happened to a few physicians who tried to care for children once we went
live, by staying on paper. That is not an option. These physicians have
subsequently been trained.
Surgery goes live in November. This will be the next major milestone.
If you identify problems, issues or concerns, please let me know. At the
medical director meeting, I learned of a couple of problems that I did
not know existed. We have been able to address, or are scheduled to
further review all problems raised by the medical directors.
I suggest that you look up labs and imaging in either the chart review
function or off the index report for inpatients. Try not to use the
“results review” function. It needs more work.
ED/URGENT CARE INTEGRATION AND RENOVATION: Starting Sunday, November 1,
Dayton Children’s will no longer have a separate urgent care service at
the main hospital campus. The on-site urgent care will be integrated with
the Soin Pediatric Trauma and Emergency Center, with services available 24
hours a day, seven days a week. Urgent care will continue to be available
evenings and weekends at our Outpatient Care Center – Springboro location.
We are confident this change will ultimately result in improved service
and efficiency. Dayton Children’s treated over 59,000 children in the
emergency department last year. The increasing needs of the community have
resulted in growing emergency volumes and much needed renovations are
currently underway to expand the trauma and emergency center to meet the
increase in demand. The new space will improve patient care, reduce wait
times and create a better experience overall for patients and families and
is expected to be complete by spring 2011. For more information call Renae
Phillips, vice president for hospital operations, at 937-641-8127.
INFLUENZA 2009: A few comments, in no specific order. We remain on the
upslope of the epidemic curve for H1N1. Our ED and urgent care centers are
seeing between 350 and 400 children a day. We have adopted a very limited
approach to testing for H1N1 that reflects the CDC guidelines. Treatment
is also driven by the CDC guidelines. Health care workers can now return
to work 24 hours after they are afebrile and off anti-pyretics (this was a
change published on October 15, 2009). The CDC also has acknowledged that
the shortage of respirators (such as N-95 masks) means that alternative
forms of protection can and should be used. We have received 700 doses of
vaccine (400 are intranasal and 300 are injectable), and expect to have
most of our high-risk employees immunized by Wednesday. We are hoping to
see more vaccine this week. As of Friday, none of the five pediatric
practices that we surveyed have vaccine. Plans to immunize in the schools
are being developed by the health departments. Please check CDC.gov, click
on 2009 H1N1 flu, click on What’s New. Specific new recommendations were
made October 16, 2009, for diagnosing and treating children and for office
preparedness to give vaccine.
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