Technology Drill Down (TD2) Methodology Identifies New Solutions to Persistent Problems
By Ugur Akinci, Ph.D.
Nurses work hard yet most of the time they are also painfully aware that working hard in itself is not enough to communicate well with other actors within the healthcare system plus patients and their families, to avoid errors, administer the right medication and save lives.
A major obstacle to providing better care is the complexity of procedures and workflows, and the inability to access the right technological solutions at the right time and place. For example, even if a computer is loaded up with a wonderful program that a nurses can use, it's not of much help if it cannot be accessed from right next to a patient's bed.
According to the extensive "Technology Drill Down" (TD2) study conducted in 2007, an average nurse spends only 30% of her or his time for patient care and the rest on documentation, bureaucratic chores, tracking down information, etc.
A case in point: sometimes half of the patient data is kept as paper-based documentation and the other half would be saved electronically in computer databases. The mismatch and lack of integration between these two different types of data storage would eventually give rise to communication bottlenecks and errors.
The study "Technology Targets: A Synthesized Approach for Identifying and Fostering Technological Solutions to Workflow Inefficiencies on Medical/Surgical Units" was funded by Robert Wood Johnson Foundation and carried out by the American Academy of Nursing (AAN) during March-May 2007.
TD2 selected 25 pilot hospitals and health care institutions to implement the new brainstorming methodology to identify solutions to such technological bottlenecks.
The pilot study consisted of gathering 20 to 30 multidisciplinary health care specialists from a wide range of areas for a two-day brainstorming session. Each team had at least four staff nurses and included other providers like "pharmacists, social workers, respiratory and occupation therapists, facilities management, and IT [information technology] experts" as well.
During day one, the specialists would identify four top areas that need improvement after examining "14 to 24 major categories of daily work" such as communicating with families, direct patient care, documentation, transporting patients, patient scheduling and medication administration.
On the second day, the participants would separate into smaller work groups drill down further to find out of the box solutions to the problems identified the previous day.
Here are some of the findings of the study which was presented at AAN's November 2007 conference.
The following were identified in most of hospitals as problem areas in dire need of new technological solutions:
- Communication among patients, families, physicians and across departments
- Streamlining equipment and supplies
- Medication administration
And here are some of the concrete technological solutions that the interdisciplinary teams came up with:
- Computerized Provider Order Entry (CPOE) systems would make documentation more efficient, consistent, and timely. Touch-screen, voice-activated, portable computers available to nurses in patients' rooms and their offices
- A centralized, computerized patient-scheduling system for all departments
- Wireless, hands-free devices to perform many of the documentation processes performed by hand
- Portable devices designed specifically to take measurements and administer medication
- A robotic medication delivery and a bar-coded medication-tracking system
- Radio Frequency Identification Devices (RFID) to improve the accessibility and tracking of medical equipment, patients, caregivers and supplies
Some hospitals have already taken such technological innovations to heart. The George Washington University Hospital in Washington, for example, now boasts "state-of-the art monitors, portable computers, a wireless system that operates only within hospital walls and bigger operating rooms."
Just five years ago, GWU Hospital could provide only four computers for 12 nurses. Now, in its new modern facility, every nurse has his or her own computer.
Hopefully 2008 will be the year in which more recommendations of the TD2 study would be adopted by more hospitals to help our hard-working nurses get the support they deserve in their daily struggle against steep odds.