Update: Workflow Diagram

The updated workflow diagram is shown below. We are still getting some feedback on the diagram.
But early feedbacks are positive.

RPA Site Visit

On Friday afternoon, Hendy and I made our way to the RPA for a meeting with Angela Ryan. We verified all workflow diagrams surrounding the care of the patients. Only minimal changes need to be made. These include:

• Redefining "Doctor On Call"
  
• Nurse workflow additions to admission, discharge and bed management.
• Extra workflows regarding the requests for tests (e.g. x-rays and blood gas).
• Routine workflows regarding nurses and doctors

Hendy and I will post the updated workflows once we have updated them.

Project Plan and Tasks for the coming week

On Friday, I handed in my project plan. For an electronic copy click here.

For the following week, Hendy and I have organised to meet with RPA personnelto elicit and uncover workflows in an ICU. Preliminary schedule is as follows:

Tuesday: 8.30am - shadow and interview Doctor
Wednesday: 1.30-4.30 - shadow and interview nurses.
Thursday: TBC
Friday: TBC

ICU General Workflow (Meeting with Angela on 25th and 27th July 2007)

On the 25th and 27th of July 2007, Hendy and I had meetings with Angela Ryan of RPA hospital. Briefly, the core purposes of the meeting were to discuss:

• The ICU structure at the Royal Prince Alfred Hospital
• The flow of patient in a general ICU.
• Brief overview of the “Whiteboard”
• Core users of RPA ICU’s information system; CareVue
• Extension of Functional and Non Functional Requirements

ICU Department at RPA

The ICU at the RPA hospital is divided into three/four sub division/department based on the three types of patient that is administered into the ICU. They are:

1.General ICU – The most generalised ICU unit that is designed to deliver the highest of medical and nursing care to the sickest of patients with non-unique conditions.
General ICU High Dependency Unit (HDU)– deals with patients which need constant care. Often up to two nurses can be assigned to each patient in the High Dependency ICU

2.Cardiothoracic Intensive Care Unit (CICU)/High Dependency Unit (CICU-HDU) - CICU cares for patients who need heart (cardiac) and chest (thoracic) surgery. Surgical procedures may include operations on the heart, the heart’s blood vessels, the chest or the lungs.

3. Coronary Care Unit (CCU) - The Coronary Care Unit or CCU cares for patients who have heart disease and occasionally other medical or surgical problems. In RPA, this unit is more or less combined with CICU.

4. Neurosurgical Intensive Care Unit (NICU)/High Dependency Unit (NICU-HDU) - The Neurosurgical Intensive Care Unit cares for patients with brain or spinal cord conditions and occasionally other medical or surgical problems. (Source)

The General ICU and Neurosurgical ICU/HDU patients are cared by specialist doctors relevant to their area whereas the General ICU HDU and Cariotherastic ICU/HDU care is driven by ICU specific doctors.

Flow of patient in a general ICU

Patients who come into ICU often need constant monitoring and medical care. These are usually patients from lengthy surgery, unconscious and/or require ventilation hookup. A new patient administered into the ICU would follow the procedure:

1. Upon arrival (or even before arrival) a new patient is created in CareVue. Given the MRN, a linkage to the hospital’s patient administration system automatically uploads all other administrative (not medically relevant) data.

2. The patient physically arrives to the ICU department, usually accompanied with several nurses and doctors. During the setup procedure, necessary equipment (such as ventilator, machines measuring vital signs) are attached and linked to the patient. Once linked some of these medical equipment automatically update data into CareVue.

3. Nurses and/or doctors then create a care plan for the patient. (Different depending on diagnosis or investigation).

4. Nurses and doctors perform their duty in caring for the patient (To be investigated next week).

ICU Whiteboard

In almost all hospital departments, exist a whiteboard used to record and keep track of patients, nurses and doctors on shift. The RPA’s ICU uses a whiteboard as a tool to map patients to nurses and to record which doctors are on shift.

Core Users of CareVue

• Doctors – heavy user
• Nurses – heavy user
• Physios – medium user
• Dieticcian – heavy user
• Social workers – light users
• Visiting Medical Teams – medium users
• Speech Pathologist – medium users

Note: Physios, Dieticians, Speech Pathologists and Pharmacists are usually referred to as Allied Healthcare professionals. These set of users have limited use in CareVue. They often view CareVue information and only enter notes compared to Doctors or Nurses whom extensively use CareVue.