Proposed Topic (Most preferred): :
Clinical Safety and Quality Service II (Projects aiming to enhance clinical safety and outcomes, clinical governance / risk management)
Proposed Topic (Second preferred): :
Research and Innovations (new projects / technology / innovations / service models)
Authors (including presenting author) :
Tse SW(1), Lai KW (2), Lam KK (3), Ngai YY(4)
Affiliation :
(1) Department of Anaesthesia, Pain and Perioperative Medicine, QMH
(2) Department of Anaesthesia, TWH
(3) Department of Cardiothoracic Anaesthesia, QMH
(4) GMH, TWH
Introduction :
In line with the Smart Hospital Initiative of the Hospital Authority, Hong Kong West Cluster (HKWC) - Tung Wah Hospital (TWH), Duchess of Kent Children Hospital (DKCH), Grantham Hospital (GH), and Queen Mary Hospital (QMH) pioneer in the adoption of the new version of the Anaesthetic Clinical Information System (ACIS) and development of a cluster-based smart Pre Anaesthetic Assessment (PAA) System.
HKWC provides comprehensive perioperative services, with QMH, as a quaternary referral centre, dealing with ultra-major and complex surgical cases; DKCH and GH take care of orthopedic and ophthalmic cases; while TWH deals with a high volume of cases under a number of surgical subspecialties with short turnover time. A cluster-based ACIS/ PAA system enhances documentation of peri-operative anaesthetic records and facilitates seamless patient care during the postoperative period in the Post-anaesthetic Care Unit (PACU) and in wards, smoothening the perioperative workflow and interhospital communication. Thus, facilitating the provision of effective integrated- care along the patient management pathway, with an emphasis on better patient allocation and centralization of the anaesthetic service, as well as maximizing the efficiency and effectiveness of the department's resources management.
Moreover, Quality and Safety can be improved by electronic, instead of handwritten, documentation, allowing clear documentation and effective communication. This is significant as communication breakdown can potentially lead to serious consequences during the perioperative period, especially in emergency or crisis situations.
In addition, with the rapid expansion of perioperative service and technological advancement, a comprehensive perioperative data management system will not only facilitate the enhancement of perioperative services through patient review and audit but also enable the creation of a risk prediction model for the local population. This will allow patients to receive optimal perioperative care based on their risk profiles, resulting in better patient outcomes and reduced healthcare costs.
Objectives :
To facilitate communication and patient handover among hospitals in HKWC
To advocate paperless operation and clear documentation
To enhance patient safety
To enhance workflow efficient
To promote Patient-centred care
To facilitate evidence-based research and the development of a perioperative risk prediction model
Methodology :
HKWC Anaesthetists & Nurses set up a workgroup to develop a Cluster-based Smart PAA system and ACIS system that tailors the cluster clinical workflow and includes various features that enhance the quality of patient management.
The workgroup collaborated with representatives from the Anaesthetic departments within HKWC and co-designed a standardized system configuration within the cluster, ensuring effective communication and patient handover, as well as data collection for patient review and audits. The challenges encountered included but were not limited to, the drafting of a template suitable for use by all hospitals in the HKWC. QMH, as a territory-wide quaternary referral centre, deals with a wide variety of complex surgical cases, DKCH and GH operating theatres specialize in taking care of orthopedic and eye cases; while TWH deals with a high volume of cases under a number of surgical subspecialties with short turnover time. Through thorough discussion amongst different stakeholders, the system is designed in such a way that staff rotating amongst the three hospitals can work with the system with minimal difficulty but at the same time, it caters for the needs and characteristics of practice in individual hospitals.
Partnering with the QMH perioperative medicine team to include current perioperative services, including the echo clinic, post-op surveillance program, Nurse-led PAC (NPAC) etc. into the PAA system.
Developing a software system by working with IT Consultants from Philips Electronics Hong Kong Limited and Vesta Technology and System Limited.
Collaborating with HAIT for System enhancement and interface with HA CMS and OTMS.
Organizing Cluster-based workshop for system demo and user feedback collection for system customization.
During the phase of implementation, a number of technical problems were encountered. However, with the involvement and dedication of different stakeholders of the four hospitals, the problems were solved.
Result & Outcome :
A smart PAA system and ACIS with features that fit the objectives were developed for perioperative use.
To facilitate communication and patient handover among hospitals in HKWC:
- The system is easily accessible via all CMS and ACIS workstations in HKWC and doctor I-pads, allowing Anaesthetists and nurses to assess the system for patient assessment and review anywhere, anytime.
- The standardized template was designed and used for all hospitals in HKWC.
To enhance patient safety and promote Patient-centred care:
- The system is incorporated with commonly used risk scores that are generated automatically after patient assessment, providing information on perioperative risk that facilitates shared decision-making with patients.
- Patients can be labeled after investigations are ordered, which serves as a reminder for the anaesthetist to follow up on the investigation ordered, minimizing the risk of missing investigations.
- A list of medications with important anesthetic implications is included and grouped e.g. anticoagulants, antiplatelets, SGLT2 inhibitors etc. to aid anesthetic planning.
- Special alert for cases remarked as potentially difficult anesthetic cases
To advocate paperless operation and enhance workflow efficiency:
- The system replaces paper forms for pre-anesthetic assessment and allows EPR upload.
- With close communication with HA IT, the system allows an interface for the Allergy, investigation and OTMS data from the CMS system, that enhances the clinical efficiency and minimizes human error. And the workgroup is exploring more integration with the CMS system.
- The system allows Anesthetists to extract patient information and medical history documented in previous consultations.
- The “ Copy from previous PAA” function allows for copying patient history from previous assessments
- The “ Copy from NPAC” function allows doctors to copy patient assessments done by nurses.
To facilitate Evidence-based research and the Development of a perioperative risk prediction model:
- A standardized template with structured data was developed for HKWC. Moreover, with close collaboration with IT consultants, the integration of pre-, intra-, and post-operative data was achieved.
- Comprehensive perioperative services are incorporated into the system.
The New ACIS system is in full operation in TWH, DKCH, and GH, and will be adopted by the QMH after Redevelopment.
