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The hospital is a basic nursing and control supply facility with 416 beds, which are distributed over 8 clinical departments:
• Clinical Department for Internal Medicine
• Clinical Department for General, Visceral and Vascular Surgery
• Clinical Department for Accident and Restorative Surgery
• Clinical Department for Gynaecology and Obstetrics
• Clinical Department for Paediatric and Juvenile Medicine
• Clinical Department for Ear, Nose and Throat Medicine
• Clinical Department for Anaesthesiology and Intensive Care Medicine
• Clinical Department for Psychiatry and Psychotherapy
Furthermore, the hospital also houses the departments for diagnostic imaging, laboratory medicine, physical therapy, a hospital pharmacy and the centre for sterile product supply.
Almost 700 staff – doctors, nurses, medical technicians, physiotherapists, personnel in administration, technical services and the
supply unit – attend to about 15,000 patients a year.
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Dr. med. Roland Schneider has been head of the clinical department for anaesthesiology and intensive care medicine since May 1, 2001.
Besides the head physician, the clinical team also includes 3 senior registrars, 9 assistant doctors – 5 specialists and 4 assistants in advanced training – 19 nursing staff in the ICU and 9 nursing staff in
anaesthetic services, as well as 1 secretary.
About 6,000 anaesthetic services are provided each year and more than 700 patients are treated in the interdisciplinary ICU. The ICU with 10 beds is run by a responsible senior registrar, an assistant
doctor in advanced training, an assistant doctor from the clinical department for internal medicine as part of the obligatory “on the job” training for Intensive care medicine.
The spectrum of the clinical department for anaesthesiology and intensive care medicine includes all current anaesthetic procedures, intensive care medicine, emergency medicine and the treatment of pain. Furthermore, procedures are used to avoid the use of foreign blood
– autologous blood transfusions and mechanical auto-transfusions.
When it moved into the new premises the clinical department for anaesthesiology and intensive care medicine was fitted out almost completely with new medical equipment. Prior to the move equipment from all well-known manufacturers – monitors, ventilators, anaesthetic equipment, etc. –was tested over a period of about one year.
The decision to use Datex-Ohmeda * equipment was made in agreement between doctors and nursing staff. At the same time, the course was also set for an EDP-supported narcosis protocol and the PDMS from DEIO * in the ICU. The decision was also finally influenced by the plans to unify the operational philosophy.
Up until the introduction of the EDP-supported narcosis protocol and the PDMS in the ICU, the narcosis protocol in the operating theatres
and medical prescribing in the ICU were written by the ward physician and charts were plotted manually by the nursing personnel.
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Following the decision to use Datex-Ohmeda * and DEIO *, the necessary data for implementing the EDP-supported narcosis protocol and the PDMS for the ICU were collected in a run-up phase for a
period of about half a year by 4 doctors, 4 ICU nurses and 2 nurses from the anaesthetic services together with staff from DEIO.
Whereas the introduction of the EDP-supported narcosis protocol went relatively smoothly, and has been in operation since January 2003 as the only documentation recording system, the PDMS in the
ICU has proved to be somewhat more problematic.
Despite the positive side of optimised working conditions, a lot of effort was still necessary on the part of staff when using the new equipment. New systems have to establish themselves in routine clinical practice, and naturally this does not always take place without some friction.
An issue was posed to start with by the interface between the main system (CLINICOM®) and the subsystem (PDMS). The hospital quickly realised that if this issue was not clarified in detail in the forefront, with hindsight this could lead to a lot of trouble and unnecessary costs. The unfortunate situation here was that the part-interfaces to
KIS had been commissioned through the new development/medical engineering planner, but had been cancelled for cost reasons. In the end, the system was implemented without an interface. This led to additional work and effort at the beginning (patient admissions/data transfer).
Another challenge was that personnel had been inadequately familiarised with the complex system. As a consequence, a “double documentation system” was used to start with, in order to avoid
data loss (paper charts and PDMS). This took more time, of course, which led to irritation, as the time savings which had been hoped for failed to materialise. However, because the chief of staff Dr. Schneider insisted on introducing such a system, the decision was made mid-2003 to completely do away with paper and to document everything online. The initial scepticism concerning the loss of data was quickly overcome with the backing and support of the chief physician.
Another obstacle resulted from the fact that the responsible staff from DEIO * could be reached by telephone, but were not on site. For this reason, troubleshooting also took a lot of time initially.
At the current time, virtually everything is running smoothly. So far, longer downtimes have been avoided, whereby one should point out that even 2 hours can be critical, for example, if drugs have to be prescribed. The online documentation system also saves time in comparison to the previous paper-based documentation (especially for long-term patients). Today, all values are continuously on-hand. All members of staff are now optimally conversant with the system, despite the initial ‘teething problems’, and would not wish to do
without it.
* Today GE Healthcare
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Expectations for the future:
The long-term objectives are to have a comprehensive cost-benefit analysis available at the end of treatment, so that detailed information
is available about the benefits the patient has received from the time of admission to discharge and what costs have arisen.
"In future, such a PDMS will be indispensable in the context of our health-political developments. In the meantime, we have the advantage at our hospital that the system is running and we will be able to
satisfy the requirements of the payer organisations in future for the complete documentation of costs in the ICU. It is highly desirable that we can still continue to refer to patient documentation (backdated for a period of at least one year) in the context of the increasing number of queries from the MDK, which come with a time delay of 6 to 9 months after discharge of the patient from the ICU", according to Dr. med. Roland Schneider.
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Quick, well-founded decisions concerning intensive care treatment can be made with Centricity Critical Care, the multi-disciplinary, clinical information system from GE Healthcare, which ensures
access to extensive patient information for intensive care treatment, and cost-intensive errors can thus be avoided - from admission to planning to post-hospitalisation analysis. Access to patient data using the web browser allows a fast overview to be obtained, even outside the intensive care unit.
Centricity perioperative solutions automate narcosis recording in the operating theatre and postoperatively in the anaesthetic recovery
room. Automated documentation of vital patient data (trends, measurements) reduces documentation work to a minimum. Even in
critical situations, it is possible to keep track of things in the protocol, as misunderstandings due to poorly legible handwriting are avoided.
Operation of the Centricity Recorder uses the same tried and tested menu navigation as Datex-Ohmeda S/5 monitors – this makes it very easy to learn the functions. Valuable space is saved, as no additional equipment is needed besides the S/5 monitor. Data can be combined and printed out from the perioperative process (induction room, operating theatre, recovery room).
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Responsibility for life
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The system is flexible to accommodate different requirements. Configurable nursing protocols, scoring systems, prescription modules with associative trends, calculations, interactive chart diagrams and plausibility controls simplify the process of standardisation for routine tasks.
Using predefined drug and infusion plans and clearly visible allergy information, Centricity Critical Care helps to avoid errors. At the same time, interactive chart diagrams and web applications ensure fast access to the patient’s status and quality procedures are improved by statistical analysis.
The increase in efficiency and improved earnings demonstrate that the implementation of a documentation system can pay off in the short-term, even in the functional area of operating theatres.
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The move in 2002 was accompanied by the amalgamation of four hospitals and a complete repartition of personnel to various specialist
departments. At the same time, a new structure in the main KIS system was created.
Today, the hospital has an extensive electronic documentation system to integrate clinical, legal and administrative requirements, scalable solutions for different areas and needs, standardised archiving and evaluation of data, multiple connectivity of diverse equipment via RS232 or TCP/IP, a bidirectional HL7 interface to KIS
CLINICOM®, as well as enhanced user and patient safety. A RAID system/mirrored disks are used for data backup.
The hospital already started working with the CLINICOM® CareCenter hospital information system in 1993. This system has proved to be a very sound choice. There is area-wide communication
of work orders and results and five to six PC’s and medical workplaces on each ward – all things considered, a high level of integration.
Furthermore, the recording of diagnostic findings, imaging and the laboratory system X-Lab have also been well established for many years. A DICOM interface for laboratory data has been
created. CLINICOM® is the main system (master) for data transfer.
The CLINICOM® Theatre Management System works parallel to Centricity in anaesthesia documentation. Only filtered data of patients who have been moved to the intensive care unit are transferred. Everything which is recorded on the ICU is set up in Centricity Recorder in a transfer interface by CLINICOM®. When the patient is
called up in Centricity, the system checks whether the patient data is present in the transfer pool.
It is possible with the Centricity Analyser Tool for anaesthesia documentation to provide activity confirmation, especially for internal controlling purposes. Different reports can also be prepared with the Analyser and information about the allocation of times, medications, articles, statistical evaluations and data repositories can be generated. The objective is to provide medical controlling with a report over a period X, in order to obtain a cost-benefit analysis per patient.
Controlling has a data warehouse system which ensures data access/import via an SQL data bank. Agreement is reached about file and exchange formats to be used. If the data from the reporting
tool are valid, the report can be prepared.
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Facts & Figures
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Anaesthesia Operating Theatre
• Product Centricity Recorder – monitor with integrated narcosis protocol
• 19 workplaces: 10 x central theatres, 3 x external operating theatres, 6 x recovery rooms
• Office workplace: configuration, analysis
Intensive Care Unit
Product: Centricity Critical Care
• 10 beds
• 3 office workplaces: treatment planning, administration, configuration, analysis
Equipment Link to Bedside Workplaces
• Respirators
• Patient monitors (Datex-Ohmeda/GE Healthcare)
• Haemofiltration
• Fluid manager
• PICCO+
System Interfaces
Approx. 5,000 – 8,000 data sets daily, of which approx. 1,000 are
laboratory work orders
KIS (CLINICOM) – Centricity Critical Care
KIS (CLINICOM) – Centricity Recorder
Central laboratory (X-Lab) – Centricity Critical Care
Central laboratory (X-Lab) – Centricity Recorder
Treatment Statistics 2005
Klinikum Bad Salzungen: approx. 15,000 treatments per year, of which
approx. 700 are in the intensive care unit
Type: Interdisciplinary intensive care unit for all specialist departments
of the hospital
Monitoring areas/monitoring unit – Intermediate Care: 2 x 6 beds
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