Introduction
Multiple barriers of technical character may hinder the quality of healthcare services provided in an institution. The strategies that aim at addressing such limitations should be designed and implemented in a timely manner. Cooperation of senior hospital management and health informatics specialists is essential for the delivering of high-quality technical support to decision-making practices. This report addresses the factors that adversely influence workflow processes on the example of the X Hospital. A clinical case is presented to illustrate the limitations of applied tools in decision-making. The problem of outdated software and hardware is discussed in the context of increasing patient flow. The information served as the basis for further recommendations and implications.
Environment, Issues, and Provider Objectives
The X Hospital is a healthcare institution located in the rural area in the U.S. Recently, the patient flow has rapidly escalated due to the increase in local population. As the result the healthcare staff needs to attend to a larger number of patients at higher risks of mistakes and confusion. Deficiencies in systems that provide health information may cause severe faults in the process of clinical decision-making. That is why technological improvements are needed to effective patient management and optimization of workforce utilization. Provider objectives should concern the methods of analysis and optimization of information technologies.
Information Systems Configuration
The hospital under discussion actively employs information technologies for processing patient flow management. However, the EHR solution and hardware that is used in the institution is significantly outdated. The basic EHR system denies several functions and guidelines that the staff could utilize. Such EHR systems do not use alerts or clinical reminders and lack the documentation on the standards of care (Krousel-Wood et al., 2017). Such functions are necessary to minimize error risks under the condition of rapid growth in the number of patients. The absence of such technologies jeopardizes the reputation of the hospital.
The basic EHR system has limited use in patient management and clinical decision-making, supporting only general information concerning patients’ medical history and current problems (Balgrosky, 2015). Old versions do not allow tracking nursing assessment data or managing patient preferences. Such systems limit the possibility of educational needs management and do not account for clinical orders with extended descriptions (Krousel-Wood et al., 2017). In addition to this, the EHR system that is being employed in X Hospital today does not provide consistent informational support for drug dosing decisions (Krousel-Wood et al., 2017).
Situation
The illustrative situation reveals the negative effect that outdated EHR systems may have on clinical decision making and patient safety. The issues come to light concerning an individual nurse-reported case. The discussed situation took place in the ICU and involves a patient, A. D., who was admitted to the care unit with symptoms of food poisoning of average severity. The problem caused diagnostic challenges and resulted in excessive lab testing. The absence of drug-lab alerts in the applied EHR system caused unnecessary complications of the process. The case of the patient A. D. demonstrates the flaws in information management in outdated systems due to several reasons.
Background
After being admitted to the hospital, A. D. was asked about the prior medication use and reported the taking of aspirin for headache (300 mg). Anti-vomiting and antidiarrheal drugs (bismuth subsalicylate and loperamide) were prescribed to the patient in the care unit. Sodium chloride infusions were used for mitigating dehydration. Besides the level of body temperature about 99.5°F, other vital signs were normal. Stool culture tests were conducted twice and revealed no pathogenic bacteria. As the patient addressed the probability of mushroom poisoning, AST, and ALT were done. The liver function indicators appeared to be slightly higher than normal without any physical symptoms, for example, skin color change or swelling.
Assessment
The fact that the patient had taken aspirin was adequately recorded and entered into EHR. Due to the failures in software functioning, it was not correctly displayed in the system. As the staff had limited time to check the information, this fact was not taken into account during the interpretation of AST and ALT levels. However, this drug temporarily increases these results (Doganer et al., 2015). The mistake did not affect the safety of the patient as it was detected later. The software used in the hospital and its technical characteristics are the cause of the problem that occurred in this case.
Under the conditions of increasing patient flow and healthcare specialists’ workload, their ability to focus their attention suffers, and severe system flaws may aggravate the situation. Cases similar to the discussed one will cause adverse outcomes in diagnosing and nursing decisions. The implementation of a current comprehensive EHR system has the potential to eliminate such mistakes and enhance effective decision-making. Such technologies have a number of specific functions, including drug-lab interactions, alerts, and extended reports (Henry, Pylypchuk, Searcy, & Patel, 2016). Thus the need for software and hardware improvement is urgent in the current situation.
Recommendations
The limited functions of informational technologies applied in the X Hospital may result in clinical mistakes and slowing down the work processes in different units. To avoid these problems, the management should consider the ways of minimization of the necessity to collect data from various sources. The time on excluding mistakes and double-checking the information should also be reduced. These goals may be reached by the implementation of modern EHR systems, as their functions allow managing of such issues. Moreover, the hardware used in the X Hospital is old desktop computers that cannot support the work of the programs correctly (Or, Tong, Tan, & Chan, 2018). The speed of workflow would benefit from the implementation of faster hardware equipment.
Upgrading software is a recommendation that can improve patient management in the X hospital. The problems identified in the discussed situation relate to human-factor mistakes and their influence on patient outcomes. That is why the new equipment should be chosen with an emphasis on the functions that prevent medication management and diagnostic mistakes. For example, IBM Micromedex is the solution that is integrated into the EHR system and increases patient safety. It uses alerts to inform providers about all the details of treatment. The implementation of this or similar technology will positively influence patient outcomes and workflow management.
The hospital’s staff requires education on the aspects of new software use and the current state of technology. Cloud-based web conferencing services may be used to improve decision-making and enhance information exchange (Balgorsky, 2015). Instant message applications can improve communication and reduce data breaches, especially when video conferencing is not available. Such tools can be utilized by staff to inform about software errors or other issues that occur in the workflow. The information about protocols is insufficient, but such models as Internet Protocol or Transmission Control Protocol should be utilized (Balgorsky, 2015). Moreover, further evaluation of the issues related to information technology for patient management should be conducted.
Conclusion
The issues caused by outdated EHR systems and slow hardware were identified as the threat to patient safety in the X Hospital. Old EHR and EMR systems lack the set of functions necessary in the increasing patient flow. The situation of the patient A. D. proves the influence of data presentation errors on nursing decision-making and patient outcomes. The solutions that will enhance information collection and presentation are recommended. First of all, new hardware and software should be purchased. Secondly, the programs compatible with EHR should be implemented. Moreover, the extensive use of instant messaging or web conferencing is recommended.
References
Balgrosky, J. A. (2015). Essentials of health information systems and technology. Burlington, MA: Jones & Bartlett Publishers.
Doganer, Y. C., Rohrer, J. E., Aydogan, U., Agerter, D. C., Cayci, T., & Barcin, C. (2015). Atherosclerosis and liver function tests in coronary angiography patients. The West Indian Medical Journal, 64(4), 333-337.
Henry, J., Pylypchuk, Y., Searcy, T., & Patel, V. (2016). Adoption of electronic health record systems among US non-federal acute care hospitals: 2008-2015. ONC Data Brief, 35, 1-9.
Krousel-Wood, M., McCoy, A. B., Ahia, C., Holt, E. W., Trapani, D. N., Luo, Q.,… Milani, R. V. (2017). Implementing electronic health records (EHRs): Health care provider perceptions before and after transition from a local basic EHR to a commercial comprehensive EHR. Journal of the American Medical Informatics Association, 25(6), 618-626.
Or, C., Tong, E., Tan, J., & Chan, S. (2018). Exploring factors affecting voluntary adoption of electronic medical records among physicians and clinical assistants of small or solo private general practice clinics. Journal of Medical Systems, 42(7), 1-12.