Overview of the Hospital

University Hospital Dr. Josep Trueta in Girona has around 400 beds and hosts approximately 700,000 people per year. It is the referral hospital for 5 regional hospitals. Offers all medical and surgical specialities, including cardiac surgery and excluding transplants.

The ICU hosts trauma, urgent and programmed surgical and medical patients, excluding coronary pathology treatments.

The new ICU with 18 beds has been furnished with state-of-the-art technologies. Healthcare equipment, including comprehensive IT system, constant vital signs monitors and Clinical Information Systems for electronic patient record (EPR) management, have been acquired for the new ICU. Thanks to Centricity Clinical Information Systems by GE Healthcare Girona is the first paperless ICU in Catalonia. It offers a fully computerised care process management with seamless integration of Centricity and medical devices.

System set up

Centricity Critical Care installation in ICU has 18 medical grade Care Stations at bedside (one station per bed) and 9 Remote Stations located as follows:
- 3 in the medical sessions room, where doctors usually prescribe, document medical notes and follow patients cases in the daily sessions, projecting Centricity on a screen
- 1 in the nursing room
- 2 in the nursing control
- 1 in the secretary desk, who checks the discharge information and other administrative data
- 1 in the Head of Department office
- 1 in Pharmacy Department, where pharmacy staff can check daily medication and fluids orders and provide according doses per patient to the ICU

There are 3 access points to Reporting Tool

Devices Connection

Centricity is connected to 18 GE Solar 8000 i monitors

Connections have been made directly to Care Stations at bedside through RS-232

Systems integration

Centricity is connected to the HIS for patient admission and discharge. Patient demographic and admission data are sent to Centricity and a discharge notification message is sent to HIS. Centricity pdf discharge report is saved and can be accessed by HIS. In the near future, the hospital’s HIS will be replaced by SAP^™

Centricity is also integrated with labs system for tests orders and results.

These integrations have been developed with Centricity Infoway

GE Products

All ICU monitoring is GE: monitors at bedside GE Solar 8000 i, 2 monitoring centrals GE CicPro and one transport monitor GE TransportPro.

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The goal of the hospital and the Intensive Care Service was to increase the number of beds available in the region for critically ill patients, including clinical, postsurgery and trauma patients. It was decided to divide the new unit into two areas: the support area with administration, medical offices, storage, etc. and the healthcare unit with 18 beds, one operating room (OR) for minor procedures and wound care rooms, etc. “The basic idea was to have a modern ICU and an exclusive Information Technology (IT) system to manage clinical patient records electronically,” explains MD Alfons Bonet, Head of the ICU.

“We wanted to have the latest complete patient monitoring system for critical patients including new monitoring techniques, such as bispectral index (BIS), continuous cardiac output by impedance and hemodynamic as well as volumetric monitoring. The integration of the patient monitors and the Clinical Information System had to be perfectly seamless, and this led us to consider GE Healthcare as the single provider for the CIS and the monitoring system.”

“The technological capabilities of GE Healthcare’s Centricity Critical Care Clinical Information System allow the nurses to chart and the electronic patient record to be linked to the Hospital Information System (HIS), pharmacy and hospital laboratory,” MD Bonet continues. “Another important aspect was the possibility of integrating the old ICU’s database with the Centricity Critical Care database and data extraction tool. Among the tools we reviewed, GE’s Centricity Analyzer reporting tool proved the easiest to use,” doctor Bonet explains.

The ICU is now equipped with 18 Centricity Critical Care stations and 18 Solar 8000i Patient Monitors with iConnect Unity Network ID interface devices. Further there are two iCentral CIC centralised surveillance and clinical review stations at the nursing station and eight Centricity Workstations in physicians’ offices and at the secretary’s desk.

Comprehensive tools now ensure a smooth flow of information, improve the workflow, reduce medication errors and help physicians to take the right decisions. Intelligent standardisation, evaluation, planning, digital documentation and detailled analysis are the basis to efficiently guide the patient through the care process. Medical staff and patients alike profit from clear processes, secure results and more efficiency in the ICU department.

Huge change to paperless environment

“Implementation of the new systems meant making a significant change within our organisation,” MD Bonet explains. “For two months we carried out a major training effort. GE Healthcare customised the system, simulated imaginary patients and provided training for our medical staff on admissions, diagnostics, discharge report preparation, pharmacy prescriptions, and so on.” Ms Susanna Martín, Unit Supervisor, adds they had also been preparing themselves since months for the idea of changing from paper to electronic patient records.

“We formed groups of three nurses for every shift. They were in charge of reviewing, improving and transferring all the protocols that we had on paper to the Centricity Critical Care System with the assistance of GE specialists. These individuals, who had already been trained, extended the training to the rest of the nursing staff, including those in rotating shifts, those on leave and their replacements.”

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“Since the very first moment everybody pulled their weight with great enthusiasm and got acquainted with the new system. There were no significant delays in drug administration and no lack of attention to the patients or significant incidents,” MD Bonet describes. “After the first week, we were able to breathe better and after a month you could see a change in the environment and the new working practices.”

According to experts, it takes a long time to get used to such a big change and the implementation of a departmental Information System such as Centricity Critical Care. The ICU department in Girona believes it beat the record. In four months the paperless ICU became reality.

“The keys to our success can be summarised by good planning and early training together with an open, positive and co-operative attitude. After a week, we had all adapted to the new situation”, Bonet proudly describes.

Benefits gained

Internal surveys have shown that the staff would not choose to go back to the old system. They feel comfortable with Centricity Critical Care, the workload is pleasant and the information the department provides to the rest of the hospital is much more organised. Staff has rapid access to extended patient information throughout the care process at the right time and place.

The system is seemlessly integrated into the hospital environment and supports secure medical decisions. Time earlier spent on laborious data management can now be spent wisely and together with the patient. The improved flow of critical patient information improves efficiency and the workflow of the ICU department. “In brief, it has been a real success,” summarises Ms Martín.

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Ms Martín expects that in the future they will have more time to improve patient care, but for that they need to start using the database and develop statistics that will allow them to redefine care processes, cures and techniques.

For MD Bonet, mid-term expectations revolve around a new heart surgery program implemented at the hospital in late 2006. “The Centricity Critical Care System has helped us succeed in this area. Another objective is improving report preparation and learning how to use the Centricity Analyzer reporting tool.”

How does MD Bonet expect the role of systems such as Centricity Critical Care Clinisoft to evolve in ICUs within the next few years?

“Currently, the problem we have in Spain is that few hospitals have computerised their medical records. ICUs will probably lead the way in this field with departmental applications such as the Centricity Critical Care System.
I think that in time our departmental solutions will have to adapt to general electronic medical record (EMR) software. We are at the point of no return.
Newly built hospitals will have no departmental programs. Instead they will have applications that will globally manage medical records with specific modules for emergency, anaesthesia, critical care, floor and other services,” MD Bonet envisions.

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