Intelligent Hospital ED Script 2015

PLEASE EMAIL pfrisch@ihassociation.org with any suggested changes

Table of ContentsScenario3ED1 Staff Identification (Intelligent Insites)4ED2 Wireless Network (Extreme Networks)4ED3 RTLS System4ED4 Patient Flow Visibility and Analytics: Improve Patient Experience, Operational Efficiency and Patient Throughput (Stanley Healthcare)Error! Bookmark not defined.ED5 RFID Locating Overflow Management (TBD)6ED6 Supply Availability - KanBan Replenishment (Cardinal Health)7ED7 Mobile Wearable Device (Vocera)7ED8 Environment Controls (Stanley)7ED9 Receiving Information while Ambulance is in Transit (TBD)8ED10 Consultation from Ambulance (Zebra Motorola)8Patient #2: Bed 1: Samantha Millhouse:8ED11 the Worst Headache I have ever had": (Extension Healthcare)8ED12 Hand Hygiene (AiRista)9ED13 Bedside Registration (Zebra)9ED14 Communication direct to clinician Vocera / ASCOM9ED15 Initial Assessment Physician Orders Extension Health10ED16 Device Connectivity (Nuvon)10ED17 Print Vial Labels at bedside (Zebra and Sunquest)10ED18 Pneumatic Tube System (Swisslog)10ED19 Smart Infusion Pump with EMR Interoperability (CareFusion)11ED20 Care Team Communications: (Vocera)12ED21 Bed Assignment Overflow Management (Airista)Error! Bookmark not defined.ED22 Asset Tracking Infection Control - (Airista)14ED23 RoboCourier Autonomous Mobile Robot (Swisslog):14ED24 Staff Emergency Button (ASCOM / RTLS)14ED25 Real Time Vent Surveillance (CPC)14ED26 Medication Order & Blood Sample Delivery (Swisslog)15ED27 MedRover Mobile Dispensing Cabinet / MedPortal Inventory Management Software (Swisslog)15ED28 Eliminating Transfusion Errors and Increasing Efficiencies (Sunquest)15ED29 Medication Administration Infusion Pump Hospira16ED30 Find Available Pump Emanate Wireless16ED31 Pump Utilization: Emanate Wireless17ED32 High Value Supply Management (Cardinal)17ED33 Workflow Monitoring Patient Experience (Intelligent Insites)17ED34 Analytics (CreatAsoft)Error! Bookmark not defined.Still to be added to script:18HID Global: HID supports compliant Electronic Prescriptions for Controlled Substances (EPCS18HID Global:ActivID Tap: NFC Tablet and Mobile Phone authentication with ID Badge19

Revised: March 28, 2015

Scenario

Patient #1:

Name: Robert Grant

Age: 59 years

Condition: Mid-sternal chest pain radiating to his left jaw

Aortic Stenosis

Type II Diabetes, Hypertension, Hypercholesterolemia, Obesity

Status: Sent directly to the Cardiology Suite (Cath Lab)

Patient # 2:

Name: Samantha Millhouse

Age: 59 years

Condition: Worst Headache ever: Neuro Case

Patient #3:

Name: Jacob Smith

Age:

Condition: Trauma Case: multiple orthopedic injuries

Status: Assessed and routed to the OR

Patient #4:

Name: John Halloway

Age:

Condition: critical condition, He is awake, agitated, and complaining of severe chest wall, and right ankle pain. He is tachycardic and hypoxic and placed in bed #1

Status: Admitted Bed 1 in the ED

Start:

ED1 Staff Identification Visibility (Stanley Health) ** Updated Mar 6 (Extension Health) ** Updated Mar 18, Mar 28

Hello, Welcome to the Emergency Department of the Intelligent Hospital. As you can see, I am automatically identified as I entered the room through my real-time location system, or RTLS, tag, working in conjunction with the hospital wireless infrastructure. (Point to Main screen when picture appears)

[Actor 1 points to patient badge on wrist, Actor 2 points to tag on lab coat] Applying these tags to patients, staff and equipment enables the ability to accurately locate patients, staff and available lifesaving equipment as well as room status by color codesall on one screen. Throughout the hospital rapid changes can directly impacting the delivery of care. [Actor points to wall mounted iPad] A digital room signs mounted outside the patients room verses visual controls traditionally located at the nursing stations provides real-time information about whats happening in the room[Actor points out the different areas on the screen on the wall mounted monitor] room status, patient information and location, staff in room, wait time and special needs.

ED1A: Passive RFID Asset Management: (Borda)

Additionally, in this room all the medical devices are identified and attached with UHF passive RFID tags (Actor points to a device with UHF Passive RFID tag attached on) which you can read from a distance without a need of line of sight. This enables you to do the inventory count dramatically faster. With this solution the duration of inventory count in an average hospital having around 3000 assets reduces from 6 to 8 weeks to just 1 day with the highest accuracy you could ever get.

As you can see on the screen asset counting is as simple as picking up the handheld device and selecting the room that is going to be counted from the list and start counting. As seen on the screen all the assets are being counted by using the handheld RFID reader in a very short time and it is even possible to perform asset counting every day in an Emergency Department or in an Ambulance. (Actor (1) picks up the handheld device, (2)Actor points to the Borda Display (3) selects the room from the list on the handheld device, (4) clicks start counting, (5) points the handheld to the medical devices in the room and (6) hits the trigger of the handheld to read them. In the meanwhile handheld screen is shown on the Borda Display in the room.)

Business Analytics reports can also be generated for better and safer asset management at the Intelligent Hospital.

With this solution it is also possible to find a specific device in a very short time lets say which requires calibration. You can easily find that specific device in a room even if it is hidden inside a cabinet.

This solution gives you great control over your assets throughout your hospital. It also makes it easier to handle the protection management of your assets.

ED1B: Staff Identification Visibility Part II:

Staff can easily see if patient is not in the room and where they are or if a room is soiled and ready for cleaning services. [Actor pushes the button on the tag next to the iPad, waits and then points to the color change on the monitor] Staff can also request physician consult or lab needed for the patient which changes the color displayed on the digital sign and automatically sends an alert to the appropriate staff. They can accept and/or cancel the request from their mobile device. [Actor 2 holds up the Extension device] . Coupled with an EMR integration, extending the visibility of an RTLS patient flow solution to the room level, your care team has up-to-the-minute information. Additionally, this captured data can be analyzed to understand underlying trends for process improvement or investigate root causes of a particular issue around wait times, room utilization and cycle times.

in the ED. (Actor point to wireless devices (RTLS/Smartphone/wireless tablet) and then general indication to ceiling area

When integrated with an ancillary notification system, a unit care team can benefit from greater awareness of other care team members or key assets. During a Code Blue alarm, the location of the closest crash cart can be provided to responders on their smart phone screen. A pharmacist or Intensivist responding from another unit can see a real-time status on who has reached the patients room. Additionally, this captured data can be analyzed to understand underlying trends for process improvement or investigate root causes of a particular issue around wait times, room utilization and cycle times. [Screen Shots: 1.) Engage Mobile on Zebra Android: Code Blue Alert with Crash Cart notation, 2.) Engage Mobile /Zebra Android Code Blue Event Response] (Extension Health)

ED4b Real-Time ED Optimization with Predictive Analytics (CreateASoft * Updated Mar 18)

By leveraging existing RTLS systems, A real-time optimization engine constantly predicts near-future performance of the ED. Utilizing historical data trends, current EMR information and existing RTLS tracking data, suggests predicted staffing levels and improved workflows in order to minimize patient wait times and reduce left without being seen. ED providers and management are presented with alerts and notifications identifying the impact of suggested changes and associated efficiency gains.

Actor1 points to dashboard (screenshot) alert identifying a need for workflow changes and their impact, projected to be needed in the near-term for the ED. Actor1 directs Actor2 to take proactive measures to request additional bed availability and additional staffing.

ED4C: Bedside workstation/ Tablet authentication (HID, Zebra) * Updated Mar 18

The ED equipped with a bedside PC workstations which can be wall or cart mounted or a hand held tablet replacing the larger solutions. This PC or tablet is capable of running all the hospital applications and provides the clinician bedside access to the EMR, PACS, Lab information system, cardiology management data or medical history data.

Proving you are who you say you are, by utilizing One Time Password security into cloud applications can be accomplished leveraging your ID Badge and NFC communication protocol with a single tap of the card. The innovative technology card both generates and sends a One Time Password without the inconvenience of re-entry. (Actor picks up the tablet and taps their ID badge to the tablet screen shot of the authentication application).

In addition the PC provides the capability to print and scan barcode labels, and can also be integrated with RFID reader. These integrations ensure patient centric identification and association of all devices, supplies, medications, samples and documentation is directly associated to the patient.

(Actor 1 Walks in at the start of the next paragraph, and immediately uses the hand washing dispenser)

ED4D: 1a: Overflow Cart (Emerson)

The Emergency Department also deploys an Overflow Cart improves the speed of care by combining the storage capacity of a supply cart with the efficiency of a mobile computing workstation on wheels (WOW). The compact footprint gives nursing the ability to treat and chart in any available space in a hospitals busy ED while providing access to supplies and critical information no matter where the patient is treated.

ED2 Wireless Network (Extreme Networks)

Vital these operations are the underlying high performance wireless network providing a seamless blend of multi-carrier cellular and Wi-Fi services. This critical component is a key enabler for many of the new technologies and applications being reviewed here today. The high-performance wireless network extends the reach of these devices and allows enhanced information exchange and real-time communications for the many varied users typically present

ED6 Supply Availability - KanBan Replenishment (Cardinal Health)

Vital to the rapid management of a diverse set of patients is access and verification of the proper supplies and medications. The ED staff can interactively monitor and confirm the availability of all required supplies. General supplies are managed using the two-bin RFID system, which ensures optimum stock levels and demand accuracy. This practice eliminates the need for manual demand assessment rounds by triggering replenishment requests by users only when a predefined batch of a product has been depleted. When a compartment is empty, the RFID-enabled location tag is transferred to the RFID replenishment board. (Actor takes last item of a supply from a bin and transfers tag from the bin to the board). Independent of replenishment management, unitary consumption can also be captured and linked to patients with the patient charging kiosk (Actor point to the kiosk) and handheld RFID reader (Actor point to the RFID reader). The user can select a patient on the touch-enabled kiosk and use the RFID reader to scan the RFID-enabled location tag on the bin from which the supplies are taken(Actor touches a name on the kiosk, pick the supply needed and uses scanner to scan a tag). The supplies will then be charged to that patient, creating a record for the hospitals billing system.

ED7 Mobile Wearable Device (Vocera, Extension Health ** Updated Mar 18, 28)

All clinicians utilize multiple mobile hand held and wearable devices enabling them to readily communicate and deliver critical information, such as access to the clinical or lab data. These systems are typically (Hold up iPhone andVocera Badge) integrated to the hospital phone system enabling incoming and outgoing calls. These devices improve the efficiency of care team communication and coordination by integrating with EHRs, across mobile and desktop devices. Alerts can be sent to these devices directly by the communications system or through vendor-neutral alarm management/secure messaging system to provide notification of new orders and test results.

ED8 Environment Controls (Stanley) ** Updated Mar 5,14

Within the ED patient care environment, devices like refrigerators and freezers that store pharmaceuticals, blood and other critical tissues as well as patient and supply rooms [Actor point to the temperature on the STANLEY large monitor top right] require strict temperature and humidity monitoring to ensure proper ranges for quality patient care and safety. Relying on manual data collection is time consuming, subject to human errors and only a snapshot of the environmental levels. If a refrigerator goes out of range, it could be hours before its noticed and remediedresulting in a potential patient safety risk and product loss. [Actor points to tag in the room mounted on the wall] Automated temperature and humidity monitoring allows you to continuously monitor conditions in real-time. When temperatures go out of range, the system pro-actively notifies appropriate personal, reducing the chance of spoilage. It also allows for corrective actions to be documented, complying with Joint Commission and other agencies audit requirements. [Actor points to shared monitor with screenshot] Visual dashboards provide an easy-to-understand overview of the environmental conditions in the ED and even hospital wide, with problematic devices prioritized. [Actor points to shared monitor with screenshot again] The visual analytics drive better operational decision making, identify areas for process improvement and apply predictive analytics to identify potential device malfunctions before they happen. A system like this helps improve patient safety, facilitate regulatory compliance, increase staff efficiency and productivity all while avoiding unnecessary costs.

Patient #1: Robert Grant (Bypasses ED Directly to the Cath Lab)

We start the scenario with Robert Grant, a 59 year-old male, who called 911 after an hour of mid-sternal chest pain radiating to his left jaw.

(Note: Patient Bypasses ED gos directly to Cath Lab, OR , etc)

ED9 Receiving Information while Ambulance is in Transit (Zebra)

Receiving patient physiological data and demographics, while the patient is in transport can significantly impact the response time and treatment delivery, increasing the likelihood of a positive outcome. Even when outside the physical boundaries of the hospital, it is possible for the ambulance team to seamlessly leverage the available multi-carrier cellular network to connect directly with the hospital EMR. The ambulance team can transmit Robert Grants 12 lead ECG data and analysis, along with vital parameters, including invasive pressure, temperature, capnography, SpO2, and cardiac output and establish consultation with the ED physicians and for some patients triage can be performed directly in the ambulance and in this case the patient can bypass the ED and be directed to the Cath Lab for further testing and follow-up diagnosis.

Patient #2: Bed 1: Samantha Millhouse:

The next patient a 59-year old woman Samantha Millhouse arrives in the ED complaining: "The Worst Headache I have ever had". Blurred vision and neck pain - A sudden, severe headache that feels different than any other headache I have ever had -Its the worst headache that Ive ever had and I have pain in my neck- I feel like I am ready to pass-out - every time Im near light, I get really nauseous. (Enter Actor 2, and walk right to beside 1, without washing hands).

ED5 RFID Locating Overflow Management (Stanley Healthcare) ** Updated Mar 6

The ED s extremely busy today Samantha is placed in one the EDs to overflow locations. Of particular concern in most EDs is patient flow with a constant flow of patients a broad range of issues and acuity. The ED is a high pace environment requiring rapid triage, diagnostics, assessment and the transport patients to appropriate treatment area of the hospital. A critical and very common issue within the ED is patient overflow. To manage large numbers of patients and avoid diversion to other hospitals, RTLS solutions are used to establish and define virtual locations within the ED. Patients are doubled up and tightly placed in any location, within the corridors and even overlapping within the bays. [Actor points to the bank of stretcher on the back wall] In order to effectively manage patients, these virtual locations must enable patient centric identification and association to staff, equipment, supplies and pharmaceuticals. These applications require high accuracy RFID locating. Dedicated Location Transmitters are used receive signals from the RTLS tags enabling high resolution location definition, separation and tracking (actor points to the antenna) of equipment and other assets enabling the ED to flex its capacity at critical times of overflow.

ED12 Hand Hygiene (AiRista)

As you can see, the clinician failed to sanitize their hands prior to entering the ED. An RTLS badge identifies staff through the RTLS reader correlating whether that tag was sensed at the hand-washing dispenser. (Point to staff badge and hand washing dispenser and the turns around and points to the screen showing AiRISTA Hand Hygiene Real Time Page) Because the clinician entered the patient area without following the hand hygiene protocol, the RTLS badge provides a signal/reminder upon entry, allowing the clinician an opportunity to self-correct. (Point to the RTLS Badge and speak to gentle vibration reminder) Returning to the hand sanitizer dispenser and using the dispenser, the embedded dispenser module positively identifies the clinician and sends a wireless signal to the badge which cancels the alert. (Actor returns to hand washing dispenser and performs hand hygiene, then returns back to bedside) (Actor points to large display with screen shot) table and dashboard pause 5 seconds)The Hand Hygiene Compliance Monitoring web-based software application provides administration and leadership with real-time validation and metrics, allowing collected hand hygiene compliance data to be evaluated over time.

ED13 Bedside Registration (Zebra)

To expedite Samanthas admission process, a quick registration is performed at the bedside using a unique identifier. The hospital has a label printer mounted at the bedside enabling a wristband to be printed directly at the point of care. The patient wristband has a combination of bar code, passive along with text information. Using patient centric unique identifiers enables visibility to all aspects of the patient care processes around this patient, including patient identification, specimen, medication, asset, and staff identification.

An active RFID tag is added enabling visualization and tracking, both locally and institutionally. This unique ID is reconciled later to the patients electronic medical record .(Print wristband. Wrist band already around the arm of the patient in bed 1) (Actors 1 and 2 remain on the side of bed 1)

ED14 Communication direct to clinician Vocera / ASCOM ** Updated Mar 6,28

Once the nurse completes the admission process, the nurse uses her integrated voice and messaging application on her smartphone to communicate to the physician assigned to the patient (show home VCS screen with chat/voice/alert options). Here, she leverages templates to communicate the request to increase the patients pain medication, and for the doctor to visit the patient when possible (show screen shots of templates, and the message once its been created). This message is received on the physicians smartphone (Show screen capture of new alert with the message) and the physician is able to reply, indicating they will be there shortly. The nurse receives this information on her smartphone (show screen shot of the message back and forth).

The staff can also press the workflow button, automatically paging the physician notifying him that the patient is ready to be seen. (ASCOM) (Which ever actor is closest to the workflow buttons will press button)

ED15 Initial Assessment Physician Orders Extension Health ** Update Mar 18

After initial review the ED Physician orders a STAT MRI to rule out the potential for brain aneurysm, brain bleed, clot, and/or tumor as well as a blood panel is Chest X-ray, ECG monitoring, and a urine analysis. These physician STAT Orders are sent via the hospitals ancillary notification system and accepted by ED Nurse on the voice over IP badge. [Screen Shots: Zebra Android phone showing STAT Orders]

ED16 Device Connectivity (Nuvon) ** Updated Mar 4

Patients in ED are typically monitored for vital signs, including pulse and blood pressure. Research has shown that simple metrics associated with the monitoring of individual vital signs have been effective in identifying patients at high risk for onset of septicemia. Continuous monitoring of vital signs provides clinicians with access to real-time data, enabling them to identify patients trending towards adverse events. (Nuvon)

The physiological data is available throughout the hospital as well as centrally, and can even be accessed from home. Connectivity to the EMR, was automatically established when the medical device was associated to the patient, through the positive patient identification process.

ED17 Print Vial Labels at bedside (Zebra and Sunquest) ** Updated Mar 6, 18

Following the STAT Physician orders, the ED nurse draws standard trauma vials by using Collection Manager on a handheld device to scan the patients wristband, positively identify the patient and print lab vials at the patients bedside. This minimizes the chance of mislabeling or not labeling a specimen, ensures that all draw samples are verified for that patient and meets the patient identification requirement in the National Patient Safety Goals.

(Actor 2 is in the middle of the beds, uses scanner to scan wrist band and print labels. Actor then pretends to stick label on the sample vials) The vials are sent to the using the hospital pneumatic tube system.

ED20 Care Team Communications: (Extension Health *Update Mar 18, Vocera)The moment the radiological and laboratory results are final, the ancillary alarm notification system delivers a Critical Finding notification is sent to all members of the care team on their wireless device or desktop. The ED physician is reviewing a patients chart in the EHR app on her smart phone, and needs to review the case with the Radiologist. From the EHR application, the physician simply selects the name of the Radiologist and instantly opens with the option to call or send a secure text message. The physician opts to call, and the Radiologist receives the call on his Vocera badge and answers in a hands-free manner.

The ED physician can additionally coordinate calls between the patients attending doctor to discuss the next steps and it is determined that emergency interventional neuro surgery is required. [Screen Shots: Engage Mobile on Zebra Android screen: ED Physician viewing patient care team roster]

A message is sent to the OR scheduling staff to inform them of the pending procedure, Upon receiving an acknowledgement, the Neurosurgeon presses a single button on the screen to initiates a call to the OR Scheduling to clear an OR Suite and PREP for the procedure.

In preparation, the physician orders pain medications and an IV beta-blocker to stabilize the patient for transport to the OR.

ED20a: Medication Dispensing System (CareFusion) Comment by Carefusion User: CareFusions medication dispensing system needs to be listed here before the CarFusion infusion pump. The script & images for this section were created to support this joint scenario. Needs to be under patient #2, bed 1, Samantha Millhouse.

The nurse taking care of Samantha needs to get their medication STAT; in the ED there is no time to wait! Luckily, the medication they need is stored in this centrally located automated dispensing cabinet system. The nurse can quickly dispense the medication needed for Samantha using an efficient, safe, patient-focused workflow. Comment by Carefusion User: Screen shot (1)CareFusion_ED ##_nurse.jpgComment by Carefusion User: Screen shot (2)CareFusion_ED ##_needed.jpgComment by Carefusion User: Screen shot (3)CareFusion_ED_safe.jpg

[Screen shot: (1) Shows close-up of nurse touching My Patients, (2) selecting the patient from their My Patients list, (3) and accessing patient order information, including Labetalol HCL]

The system provides the nurse with integrated patient and medication details which can be critical in making the rapid decisions required in the very busy ED environment.Comment by Carefusion User: Screen shot (4)CareFusion_ED ##_details.jpg

[Screen shot: (4) Shows close-up of patients med profile including Labetalol HCL with patient and med information expanded]

The system also includes label printing functionality to make sure a medication is labeled with the proper dose and patient detail for safer medication administration.

[Actor: Point to printer and show label sample]

Pharmacy configures the label printing feature, ensuring the right meds are properly labeled while making the process simple and efficient for nursing. Comment by Carefusion User: Screen shot (5)CareFusion_ED ##_properly.jpg

[Screen shot: (5) large view of label]

Thanks to the capacity of the highly configurable pockets, larger IV bags, syringes and other bulky medications can be securely stored here. Comment by Carefusion User: Screen shot (6)CareFusion_ED ##_pockets.jpgComment by Carefusion User: Screen shot (7)CareFusion_ED ##_bulky.jpg

[Screen shot: (6) Shows image of drawer open and (7) CUBIE pocket with IV bag.]

[Actor: Show FH CUBIE 2x5 sample.]

In this case, the nurse is removing a bag of medication which needs to be labeled specifically for Samantha.Comment by Carefusion User: Screen shot (8)CareFusion_ED ##_removing.jpgComment by Carefusion User: Screen shot (9)CareFusion_ED ##_labeled.jpg

[Screen shot: (8) Shows med removal screen; (9) image of labeled IV bag.][Actor: Pick up label by printer, pretend to put on IV bag, show IV bag already labeled.]

The medication has now been conveniently, safely and efficiently removed from the automated dispensing cabinet system and properly labeled for Samantha. Using this technology to support rapid, accurate medication dispensing allows the nurse to focus more of their time on patient care.

ED19 Smart Infusion Pump with EMR Interoperability (CareFusion) ** Update Mar 6, Extension Health ** Updated Mar 18

The nurse receiving the infusion medication will now get it ready for administration using a smart pump. What makes this pump smart is that it has a central processor that contains a library of drugs with individual maximum & minimum dosing limits and safety parameters. These limits help prevent programming errors which can lead to over /under dosing of the medication. The pump also communicates over the hospitals wireless network to the electronic medical record enabling bi-rectional flow of data to close the loop on IV medication safety.

[Nurse Actor scans the barcode on the patient wristband, drug label, and pump][Screen Shots: workflow: scanning of wristband, scanning of drug label, scanning of pump]

As soon as the nurse scans the barcodes on: the patient ID band [Nurse Actor pause], medication [Nurse Actor pause],, and on the infusion pump [Nurse Actor pause], an association is established with the electronic medical record which pre-populates the infusion parameters with the exact dose and rate that the physician ordered. The nurse then verifies the parameters on the pump and starts the infusion, decreasing opportunities for error that can come with manual programming.

[Nurse Actor hangs the bag, verifies the parameters, and presses START.][Screen Shots: EMR screen, verification of parameters on pump, pressing START]

The nurse receiving this medication order will now get it ready for administration using a smart pump which communicates over the hospitals wireless network to the electronic medical record. The pump is designed to support multiple infusions with a central processor that contains a library of drugs with individual maximum & minimum dosing limits and safety parameters. These limits help prevent programming errors which can lead to over and under dosing of the medication.

[Nurse Actor scans the barcode on the patient wristband, drug label, and pump][Screen Shots: workflow: scanning of wristband, scanning of drug label, scanning of pump]

As soon as the nurse scans the barcodes on: the patient ID band, medication, and on the infusion pump an association is established which pre-populates the order for the ordered drug and programs the pump with the exact dose and rate that the physician ordered.

[Nurse Actor hangs the bag, verifies the parameters, presses NEXT, finishes verification and presses START.]Screen Shots: verification of parameters on pump, pressing NEXT / START]

the association between the smart pump and EMR system is bi-directional, which allows all of the infusion status information to flow back to the EMR. Every titration, pause, start and stop is recorded in near real-time. This provides a single reliable record to increase accuracy and timeliness of infusion documentation.

[Nurse Actor stands at the workstation on wheels as if typing in documentation. Monitor shows a close up of the pump screen with I&O flow sheet receiving documentation messages.]

[Screen Shots: EMR documentation, data feed going into EMR.]

Patient #3: Bed 2:

The next patient is Jacob Smith. He has arrived in critical condition and been sent priority one. He is awake, agitated, and complaining of severe chest wall, right ankle pain and has lost a significant amount of blood as a result of an automobile accident. He is tachycardic and hypoxic and placed in bay #5 (Actor 2 Point to bed 1). As before the initial assessment requires the patient be registered, placed on physiological monitoring and requires a blood laboratory panel to be performed.

ED 3 Workflow Dashboard (Zebra) ** Updated Mar 6, Mar 18

Within the ED patient status is continuously monitored using the workflow status dashboard highlighting the state of the entire ED at a glance. (Actor 2 points to the dashboard scenario) The center pane shows the map view the two beds are shown on the left of the map as bay 04 and bay 05. The left-most pane shows patients that are waiting to be seen by a nurse and the right-most pane shows patients that are waiting to be seen by the physician. As soon as the nurse enters the bay to take vital signs, the RFID system will automatically detect the patient-staff interaction and will automatically assign the nurse to the patient. Notice that the patient drops off of the "waiting for nurse" list. When the physician consults with the patient in the other bed the RFID system detects the physician-patient interaction and removes the patient from the "Waiting for Doctor" list [point to right pane when the name of the patient Samantha Millhouse is taken off of the waiting for doctor list]. Notice the most important metrics that drive ED efficiencies, like "The average time to first encounter", "Arrival to disposition", etc.(Point to the metrics and ED efficiencies part of the screen) - they are all viewable at a glance. Auto-assignment also helps the RTLS system drive a number of activities downstream. (Click) Once the assigned nurse has completed the assessment, the patient appears on the list entitled Waiting for Doctor , here on the right side of the screen. Likewise, these work list reminders appear for other caregivers when specific care activities are completed. (Click)

ED22 Asset Tracking Infection Control - (Airista)

In the rapid throughput environment infection control management is enhanced by the ability to track the history of devices and their association with specific patients. Using a historical View of an Assets movement following an exposure outbreak track and trace asset location history to prevent further exposure within the hospital.

ED24 Staff Emergency Button (ASCOM / RTLS)

Before any results are returned or the physician can get to the bedside, Mr. Smith becomes highly agitated. His heart rate increases and pulse oximetry decreases. (Drager) The nurse pushes the Staff Emergency button on the patient station for extra assistance. (ASCOM) Activating this button generates a call at the staff station as well as notifying the appropriate responders. (Actor 1 presses the patient emergency button on patient console, then points to the table where the Nurses console station is to show the emergency call. Actor 2 then holds up the Vocera pendant showing that the staff emergency call also went to other responders) Notice the flashing green light which indicates that help is needed immediately.(Point to light)

At times while trying to settle the patient it is hard to reach the wall console. In these cases it is possible to issue a staff emergency call from the staff worn RTLS Badge Tags. With this simple pull [TBD ] multiple staff members wearing badge tags can be notified of this emergency and the user's location which appears as a text message on their badge. [focus shifts to second actor that shows the B4 tag message and points t] This web based software enables proximity-based alerts so those closest to an emergency can get there without logging onto a computer, and it makes this notification visible throughout the Hospital. TBD )

It is determined that Mr. Smiths worsening symptoms are due his hypoxemia which requires him to be intubated for ventilation management and placed on IV and transfused.

ED25 Real Time Vent Surveillance (CPC) * Updated Mar 18To enhance ventilator patient management the Intelligent Hospital has deployed real time surveillance of ventilator patients using WiFi wireless bridges on their mobile critical devices, such as the ventilator. This enables patients to be monitored anywhere in the hospital regardless of their location. All ventilator and oximetry parameters, respiratory rate and tidal volume along with pulse oximetry can be wirelessly monitored in real time at any location in the hospital, as well as delivered to mobile devices throughout the facility. Mr. Smith is put on the ventilator in the ED, and is later transferred and admitted to the ICU. (Actor 1 points to the ventilator)

Patient 4: Automobile Accident

As the next patient arrives into the ED he is quickly triaged, registered and placed on a monitor. This trauma patient has been involved in severe automobile collision is bleeding, and clearly has orthopedic injuries.

ED33 a: Workflow Reporting: (Intelligent Insites * Updated Mar 18)

As soon as the nurse enters the bay to take vital signs, the RFID system will automatically detect the patient-staff interaction and will automatically assign the nurse to the patient. The Emergency Department Throughput Report focuses on the different parts of a patients visits and reflects the patients experience in the ED, including key parameters-Time it takes for nurse to enter the room Time it takes Dr. to enter the room Imaging and Lab turnaround time Time it takes from patient arrival to disposition Total time patient is in the emergency department. This information is available to trigger alerts if patients have not seen a staff member for more than a specific time and used to review and optimize operations. (Intelligent Insites)

ED33b: E-Prescribing class II-V narcotics (HID Global)

Once all the patient information is available the physician places orders for medication via the HIS including saline, pain medications, and has ordered a transfusion to be administered as soon as possible. Rather than write a prescription for pain, send it to the local pharmacy so it will be ready when the patient arrives. According to DEA requirements, to write this type prescription on-line the physician needs to be identity proofed and bound to a certified credential. At the point of ordering the script, within the EHR module, two factors of authentication must be presented. You need to prove you are who you say you are. The prescriber can do any one of the following supported methods:

[Actor#1: Holds up ID Badge, inserts it into desktop reader, types four digit PIN 1234]

Insert their ID credential for presentation of their digital certificate, and add PIN.

[Slide 2: Screen shot: Identity accepted]

OR, the prescriber can initiate a One-Time-Password from the certified credential, types in six numbers. 123456

[Actor#1: Holds up ID Badge, types six digit PIN 123456]

[Slide 3: Screen shot: Identity accepted]

OR, the prescriber can use a biometric that matches the issuer profile.

[Actor#1: Holds places index finger on the sensor]

[Slide 4: Screen shot: Identity accepted]

[Slide 5: Prescription successfully sent to the Pharmacy]

ED26 (Removed)ED28 Eliminating Transfusion Errors and Increasing Efficiencies (Sunquest) ** Updated Mar 6,18

If a patient requires a blood transfusion, the caregiver uses Transfusion Manager on the same handheld device to positively identify the patient by scanning their armband. The caregiver scans the unit of blood to electronically confirm the right blood is going to the right patient. This electronic verification saves time by eliminating the need for a second nurse verifier, and can save money by replacing secondary blood bank wristbands. Once the patient and blood unit are positively matched, the caregiver can proceed with the transfusion. If there is not a match, the system will give a hard stop, preventing a mis-transfusion from occurring. (Actor/Actress uses handheld device to scan patient ID and carries out positive patient identification.)

ED30 Find Available Pump Emanate Wireless ** Updated Mar 6

To rapidly locate an available infusion pump we refer to the RFID system where you can see the location and availability of all the hospital infusion pumps. RTLS enables all devices to be tracked globally throughout the institution. Since the RTLS solution also integrates with various institutional applications, such as inventory management system and biomed database, accurate device business status is always available. Advanced WiFi RTLS tag mounts on your asset in line with the AC power. It contains a rechargeable lifetime battery so once its mounted on the asset, you never need to replace it. .(Point to the tag upon starting the script.

ED31 Pump Utilization: Emanate Wireless ** Updated Mar 6,28

From a business perspective this implementation can assess the true utilization of your devices based on power consumption measured over time. (Actor points to display) This information provide metrics to determine your lease or rental budget for the next fiscal period. The tag has a low energy Bluetooth interface to connect with your mobile device when coupled with the mobile application can help find the device within the last 30 feet. In this mode all the devices within range are listed. By selecting the device from the list, the tag will provide an audible and visual alert to quickly identify the specific device. which device Im looking for ( Point to the utilization report on the monitor when highlighting reporting power consumption) (Point to "finder mode" screen shot when talking about mobile application) Push button on mobile device to have tag blink and flash.

ED29 Medication Administration Infusion Pump Hospira, Extension Health ** Updated Mar 18

The Intelligent Hospital has deployed an advanced infusion system operating wirelessly with interoperability with the EMR system. This integration helps to close the safety loop in the medication administration process by associating the pharmacy validated order with the patient, the medication, the IV pump, and the patient record using bar code medication administration technology.

The physician has ordered medication for continuous infusion to the patient. To ensure the complete 5 Rights administration of the medication, the nurse first scans the patient wristband with the clinical vendor's Barcode Medication Administration device to verify his identity, then, using the same device, scans the barcoded IV medication, and finally scans a permanent barcode on the IV pump. Comment by Hospira User: Display image Hospira1Comment by Hospira User: Display image Hospira2Comment by Hospira User: Display image Hospira3

(Where indicated by script, Actor will use the wireless handheld Barcode Medication Administration prop to scan the patient's wristband, scan the barcode of the IV medication bag hanging on the IV pole, and then scan the barcode on the pump.)

This IV Clinical Integration solution enables infusion pumps to be Auto-Programmed from the Barcode Medication Administration system, ensuring 5 Rights administration of pharmacy-verified orders. Device starts/stops, alarms, and events can also be Auto-Documented to EMR. Interoperability can enhance hospitals ability to reduce medication errors, increase efficiency, and avoid preventable costs.

(Actor mocks veryifying the onscreen order by tracing it with their finger, the mocks pressing Start button on device do not actually press)

With IV pump integration, not only is the device automatically programmed, but infusion data is automatically documented to the patient's eMAR and I&O Flow sheet. This combination of Auto-programming and Auto-documentation strengthens the clinicians ability to enhance patient safety, improve outcomes, and spend more time with patients thanks to a more efficient workflow.Comment by Hospira User: Display image Hospira6

In the ED, pharmacy-verified physician orders are not always available for IV Medications. If no order is available, infusion pumps can be pre-programmed with multiple protocols that allow clinicians to quickly administer the IV medications most commonly used in this environment.

ED32 High Value Supply Management (Cardinal)

Based on the ED assessment we know that the patient additionally has multiple orthopedic injuries. The trauma surgeon is called to discuss the case and determines to send him to the OR for a small fracture operation once stabilized in the ED. Prior to transferring the patient to the OR, the trauma nurse checks available inventory and its location using an inventory wireless app. (Actor uses WaveMark inventory program on ElitePad or on the stand alone desktop touch screen. Pretends to check for inventory in the OR) (Actor 2- during the WaveMark inventory section, makes their way outside the door and waits there for the hand hygiene piece)

It is determined that two small fracture kits are available. At this point the surgical team can use the app to notify the manufacturers rep of the case and request assistance. A message is also sent to the OR scheduling staff to inform them of the procedure. (Cardinal)

Environmental Management Housekeeping (ASCOM) * Updated Mar 18

Within this ED scenario as the patients become stable and are admitted or discharged the nurse call system can integrate the hospital systems such as bed management, cleaning services, and biomed automatically notifying these services to prepare the area for the next patient.

Please visit the other rooms in the Intelligent Hospital to find out how our patients fair, pick up an ED Tour Guide and visit our sponsors in the Pavilion kiosks to learn more about these dynamic technologies. Please leave your headset in the wall pockets prior to exiting the room.

Thank you

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