At the Catalonian Hospital General de Manresa (HGM), a new procedure has been organised since 1996 to try and integrate the Short Stay Surgery process into a smooth running automated workflow system. The HGM staff is collaborating with the SEMA Group, provider of the FORO method which is dedicated to the definition and use of workflow engines. FORO is being implemented in the Esprit-supported WIDE-project dealing with workflow management of enterprise-wide processes in a cooperative, distributed environment. Manresa Hospital offers an ideal project embedded into everyday reality in order to prove the efficiency of the WIDE workflow tool.
Short Stay Surgery constitutes a new challenge and approach to the HGM partners in the WIDE project. First of all, they had to define the administrative and medical circuits involved in the process before any programming could be done. The need to create clear-determined objectives led up to the following plan. Identification and treatment of patients with pathologies susceptible to surgical interventions allowing them to enter and leave the hospital within a 24 hour period forms the initial step. Next to this, attention should be focused on reducing waiting times for the patient and on maximising usage of professional staff, operating theatres and beds. Of course, the overall aim to maintain a safe and high quality service must be respected at all times.
Translated in organisational and technical terms, this means providing informatic support for the document and information flows as well as allowing access to protocols for standardised patient/doctor interviews. In order to gain operational control over the short stay process, the program should include statistics about the patients and appropriate tools for both enforcing plus validating information entry and, by all means, triggers, alarms and exception reports. One should also take in account eventual process changes with the possibility of simulating their effects before implementing them in the active process definition.
The Manresa partners distinguish six successive steps in the description of the process. Initially, the patient identification/demographic information is introduced in the Hospital Information System (HIS) as well as the appropriate clinic and assign codes for the pathology, the severity of the condition and the priority for the clinic appointment. The patient is advised by a system generated letter. Next, the consultant examines the patient and by means of this diagnosis, the clinical record is updated with specification and request for surgical intervention, if the patient accepts. Pre-operational tests and an appointment with the anaesthetist are being integrated in the system. The HIS then accesses the appropriate appointments diaries allocating provisory dates to the patient.
During the pre-operation appointment, the patient is subjected to a series of tests which are judged by the anaesthetist the same day. If patient and doctor agree, the patient signs a consent form to undergo surgical intervention. This information is integrated in the HIS followed by a confirmation date for the operation. Before the surgical intervention, the patient is seen by a ward nurse, the surgeon and the anaesthetist to check if he is fit for operation. Afterwards, the operation results are recorded while the anaesthetist and the surgeon evaluate the patient's recovery. If there are no complications, the post-operational appointment is confirmed and the patient is released with a pain relief plan and medication. Finally, the consultant surgeon sees the patient at the post-op appointment. If all is well, the short stay process ends here.
Often enough, the process will scarcely follow a normal course without any complications. Patients are free at all times to withdraw from the program and appointments may be delayed or postponed without previous notice. In this case, the whole procedure's operational efficiency is affected. Therefore, the workflow system has to be provided with tools of awareness if something goes wrong. The installation of alarms and exception reports are highly necessary as well as the integration of a 'responding' function to the unprogrammed reception of information from patients or hospital staff. The WIDE team has to come to term with the challenging effort of transforming a daily hospital experience into an almost independently thinking workflow system before the end of April 1998. Come and see how they are doing at the WIDE site on the Web.