Introduction
The QEII hospital carries out hip and knee operations. As with any hospital procedure the patients’ treatment follows a series of steps known as the pathway. The pathway can be disrupted by variances, both good (early discharge) or bad (post operative complications). In the past a pathway form was used to record these variances. Forms would be collected after the patient was discharged and either keyed in to a database or fed through an OCR scanner. As the process was labour intensive only 5% of forms were captured. In addition, as the pathway form remained in the patient file until discharge only historic data was available and the data did not provide information concerning the time interval between events or the sequencing of these events.
The Solution
The solution was to use Digital Pen and Paper technology. Doctors and Nurses in the QEII hospital were provided with Digital Pens. A pathway form was printed using a laser printer, for each patient. Concurrent with printing the form template a dot pattern (used by the pen to track its movement over the page) was also printed. The form was kept in the patients file and regularly updated by clinicians using Digital Pens. Every time a clinician ticked a box on the form the tick was time stamped by the Digital Pen. At varying intervals the clinicians docked their pens in USB connected docking devices. The data from the pen was automatically uploaded into the pathway database.
The Result
The end user acceptance of the Digital Pens was very high with no pens being lost and all data accurately uploaded. Pathway and variation data was available at near real time and made available to clinicians throughout the patients stay. As the data was time stamped it was possible to analyze the data to establish correlations between events and translate the variances in number of days in hospital.
The graphical representation of the data (see below) was available to clinicians. The view represented here shows those complications that have length of stay implications. Potentially this information could be used to highlight areas where service improvement interventions could be applied.
Digital Pen and Paper Technology proved to be highly effective in the collection near real time information concerning the pathway and variations to the pathway. The technology was readily accepted by clinicians. One unexpected and very important result was that because for the first time enough data was collected, it became clear that the content of the form should be redesigned to allow clinicians to record better information associated to the variances of the clinical pathway.
