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BRIGHT IDEAS
CE Team’s Collaborative Efforts Help Streamline Temperature Control Monitoring Joseph Sheffer
In 2009, installation of a new wireless, automated temperature monitoring system was completed at the Women & Infants Hospital in Providence, RI. The state-of-theart system came with the promise of increased productivity; elimination of loss for vital supplies such as medications, blood products, and breast milk; and an overall improvement in patient care. In 2013, Jillyan Morano became director of clinical engineering at the hospital. She quickly noticed that a lack of strategic management was impeding the temperature monitoring system from reaching its full potential. Morano and her team provide clinical engineering (CE) support for the Care New England Healthcare System, including Women & Infants Hospital, through ABM Healthcare Support Services. ABM is one of the leading healthcare support service providers in the nation, specializing in clinical engineering and healthcare technologies. The CE team also includes four technicians and Samantha Herold, a clinical engineering intern—who took the lead on the project. Women & Infants Hospital of Rhode Island, a Care New England hospital, is one of the nation’s leading specialty hospitals for women and newborns. With approximately 8,400 deliveries per year, Women & Infants is the 11th largest stand-alone obstetrical service in the United States. It also serves as a major teaching affiliate of The Warren Alpert
Medical School of Brown University for obstetrics, gynecology, and newborn pediatrics, as well as a number of specialized programs in women’s medicine. The hospital, which was named a U.S. News & World Report 2014–15 Best Children’s Hospital in Neonatology and a 2014 Leapfrog Top Hospital, opened its neonatal intensive care unit (NICU) in 2009. At the time, it was the largest single-family-room neonatal ICU in the nation.
Challenge In the spring of 2014, Morano and Herold began to take a closer look at the wireless temperature monitoring system, which was in use in the laboratory areas, as well as in certain clinical and research areas. The system monitors several pieces of equipment, including refrigerators, incubators, breast milk refrigerators, and “minus 80” freezers. The system consists of temperature probes, sensors, repeaters, and access points. “The overall management for the temperature monitoring system needed to be clarified,” said Morano. “There was a lack of accurate inventory. In addition, the roles, responsibilities, and processes of the key players involved in managing the system— information services (IS) staff, end users, and the CE team—had not been clearly defined. We also recognized a need to educate these individuals more comprehensively on the system’s capabilities.”
At a Glance SUBJECT
ABM Clinical Engineering Team at the Women & Infants Hospital of Rhode Island LOCATION
Providence, RI SIZE
167 adult beds (45 medical/ surgical and 122 obstetrical), 80 neonatal intensive care unit beds, 60 newborn bassinets STAFF
Six key team members from ABM Clinical Engineering: Robert Clarke, Noel Fleck, Brian Haynes, Samantha Herold, Jillyan Morano, and Garabed Tashian
Biomedical Instrumentation & Technology March/April 2015
129
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Columns and Departments
Herold added that the process for conductSolution ing server change management for the Through performance monitoring activities Joseph Sheffer system also lacked structure. “CE and the end and mapping of the temperature monitoring is publications users were not notified when this change system, the CE team identified gaps in specialist at AAMI. management was occurring. Sometimes, it E-mail: jsheffer@ coverage and innovative ways to bridge them. aami.org would happen on the weekend when CE staff “A key aspect of the performance monitorwere not around, and as a result, we would be ing activities was validating the inventory of greeted on Monday by a barrage of service sensors—the actual devices that monitor requests from end users who were overtemperature,” said Herold. “We cataloged whelmed by alarms,” she said. the sensors according to department and The confusion and downtime resulting made sure they were named correctly and from this maintenance served as a wake-up could be easily found. This was one of the call for Morano and Herold, signaling that biggest steps, especially for our breast milk more in-depth scrutiny of the processes refrigerators.” surrounding the Herold also said that system was needed. the CE team spent a The process of mapping resulted “The downtime good deal of time in a formal document that events were really the getting familiar with lightning bolt,” said the mapping of the identified IS and CE roles and Morano. “So when we system—or how it’s responsibilities for the various met with IS, our goal connected throughout components of the system. first and foremost was the hospital’s network. This document then was made to reschedule server “Going through this maintenance so it was process helped clarify available to members of the not performed on the the areas that IS and departments to streamline weekend. That was the CE were responsible troubleshooting procedures. tipping point. We for troubleshooting,” realized that when the she said. system was installed, The process of mapping resulted in a formal no clear-cut plans had been put in place for document that identified IS and CE roles and maintaining and updating it. This is a responsibilities for the various components of mission-critical system; if it isn’t working the system. This document then was made correctly, medications, breast milk, and blood available to members of the departments to products are put at risk. Therefore, institutstreamline troubleshooting procedures. ing a definitive protocol was essential.” CE rolled out a collaborative education “The problems we were seeing with the program that was led by Herold. Previously, system involved multiple components of during calibration of the system by the IS—the server side, the application side, and manufacturer, Morano and Herold had been the desktop support side,” added Morano. given “super user” privileges, but they were Other issues identified by the CE team the only ones in CE holding the keys to the included a lack of standard procedures for city. Now, the entire CE team has been user training, creation/deletion of user trained on various system functions, which access, and troubleshooting, as well as has greatly enhanced its ability to respond confusion among end-user clinical staff quickly to issues that arise. CE has provided about who monitors and services the system. education resources to end users, which has boosted their ability to effectively monitor responsibilities. CE also coordinated an “The problems we were seeing with the system involved education plan to inform other key hospital multiple components of IS—the server side, the application educators on the monitoring system. About the Author
side, and the desktop support side.” — Jillyan Morano, director of clinical engineering
Results By working with each department to create streamlined workflows, the CE team has
130
Biomedical Instrumentation & Technology March/April 2015
© Copyright AAMI 2015. Single user license only. Copying, networking, and distribution prohibited.
Columns and Departments
improved the hospital’s ability to meet compliance standards and achieve maximum return on investment of the temperature monitoring system. CE and IS also have worked to optimize the change management procedures for system updates and upgrades. “Clarifying the roles and responsibilities for maintaining the system, for troubleshooting, for ordering broken parts, is a great help to everyone involved,” said Morano. “It really makes the entire system work a lot more efficiently.” Ken Thomas, IS site manager at Women & Infants, believes managing the temperature monitoring system is preparing a strong foundation for future projects. “It was great to begin working with the CE team on this project, as we have a common goal of providing faster responses to our clinicians’ needs. Our two worlds, CE and IS, are becoming more and more intertwined as healthcare technology expands, and we look forward to working with them in future endeavors to better serve the needs of the hospital.” The efforts of CE to harmonize roles has not gone unnoticed by the clinical end users. “We’ve received a lot of positive feedback from the clinical staff,” said Morano. “They are especially happy that unplanned downtime is now a thing of the past.” Sara Murphy, manager of the hospital’s blood bank, also speaks highly of the work that was done. “The system went through a major overhaul that improved its performance immensely. It now functions accurately and with minimal problems, 24 hours a day, and alerts the proper people to any issues so they can be resolved in a timely manner.” Herold noted that the systematic clarification of roles has been highly instructive for CE. “Going through that process has given us comprehensive knowledge of the many functions of the system, from setting up alert escalations to understanding how alerts are relayed to end users,” she said. “As a result, we’ve been able to pass along what we’ve learned to the clinical super users, which has improved their ability to manage the system, and get alerts in a timely manner.” Morano underscored this point, noting that “alert recognition” for the temperature monitoring system has improved among the clinicians. “They’re recognizing the visual
The ABM clinical engineering team at the Women & Infants Hospital of Rhode Island. Back row, from left to right: Garabed Tashian, Noel Fleck, and Brian Haynes. Front row, from left to right: Robert Clarke, Samantha Herold, and Jillyan Morano.
“We are logging troubleshooting data more efficiently. That has increased our ability to share learned information within the CE team, and the efficiency of service calls also has improved as a result. Now, as issues arise, having that information readily available will improve our ability to respond quickly and effectively.” — Samantha Herold
Figure 1. Chart showing reduction in average response time for temperature alarms following staff education
Biomedical Instrumentation & Technology March/April 2015
131
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Columns and Departments
CE staff members Brian Haynes, left, and Garabed Tashian work on installing a temperature sensor and probe in a breast milk refrigerator.
service calls also has improved as a result. Now, as issues arise, having that information readily available will improve our ability to respond quickly and effectively.” To ensure continuous quality monitoring and improvement of the temperature monitoring system, the ABM CE team also has begun holding quarterly meetings. A subcommittee was formed that will be governed under the hospital’s quality council, which is made up of senior leadership and other key stakeholders. On a semiannual basis, the team will report back to the quality council on the effectiveness of the system and any performance issues. The necessity for these regular check-ins underscores the “missioncritical” nature of the system, said Morano. “It needs to be governed at a high level, so having the full attention of the quality council is vitally important,” she said.
Conclusion
CE team members Noel Fleck, left, and Robert Clarke
alert cues more quickly. They understand the process better and therefore are utilizing the system more effectively. Alerts are addressed in a timelier manner.” Figure 1 illustrates the dramatic reduction in average response time to alerts following CE’s education efforts. Another happy byproduct of gaining a clearer understanding of the system has been improved record keeping by the CE team. “We are logging troubleshooting data more efficiently,” said Herold. “That has increased our ability to share learned information within the CE team, and the efficiency of
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Biomedical Instrumentation & Technology March/April 2015
Because the temperature monitoring system spans disciplines throughout the hospital, educating key players on the various team was critical to its success. Morano identified this buy-in as being the greatest factor driving improvement. “Temperature monitoring in the hospital clearly affects many health professionals—lab supervisors, clinical supervisors, infection control specialists, IS; the list goes on,” she said. “Having this multidisciplinary team involved in the project was essential because CE can only resolve issues if a collaborative environment exists.” “Proper documentation obviously is the foundation for managing any system, but it’s only useful if its distributed among the users of that system” added Herold. These concepts described by Morano and Herold—interacting with healthcare technology and sharing the right information with the right people—are central aspects of systems thinking and human factors engineering. Information cannot exist in a vacuum; it must be shared for that system to succeed. The efforts of the ABM CE team to rally the multidisciplinary team, improve its understanding of the temperature control system, and set out clear roles and responsibilities highlight the invaluable role that CE plays in improving patient care. n
© Copyright AAMI 2015. Single user license only. Copying, networking, and distribution prohibited.
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WITH “The articles are written specifically about Biomedical challenges and successes.” - Biomedical Engineer
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Columns and Departments
BRIGHT IDEAS
CE Team’s Collaborative Efforts Help Streamline Temperature Control Monitoring Joseph Sheffer
In 2009, installation of a new wireless, automated temperature monitoring system was completed at the Women & Infants Hospital in Providence, RI. The state-of-theart system came with the promise of increased productivity; elimination of loss for vital supplies such as medications, blood products, and breast milk; and an overall improvement in patient care. In 2013, Jillyan Morano became director of clinical engineering at the hospital. She quickly noticed that a lack of strategic management was impeding the temperature monitoring system from reaching its full potential. Morano and her team provide clinical engineering (CE) support for the Care New England Healthcare System, including Women & Infants Hospital, through ABM Healthcare Support Services. ABM is one of the leading healthcare support service providers in the nation, specializing in clinical engineering and healthcare technologies. The CE team also includes four technicians and Samantha Herold, a clinical engineering intern—who took the lead on the project. Women & Infants Hospital of Rhode Island, a Care New England hospital, is one of the nation’s leading specialty hospitals for women and newborns. With approximately 8,400 deliveries per year, Women & Infants is the 11th largest stand-alone obstetrical service in the United States. It also serves as a major teaching affiliate of The Warren Alpert
Medical School of Brown University for obstetrics, gynecology, and newborn pediatrics, as well as a number of specialized programs in women’s medicine. The hospital, which was named a U.S. News & World Report 2014–15 Best Children’s Hospital in Neonatology and a 2014 Leapfrog Top Hospital, opened its neonatal intensive care unit (NICU) in 2009. At the time, it was the largest single-family-room neonatal ICU in the nation.
Challenge In the spring of 2014, Morano and Herold began to take a closer look at the wireless temperature monitoring system, which was in use in the laboratory areas, as well as in certain clinical and research areas. The system monitors several pieces of equipment, including refrigerators, incubators, breast milk refrigerators, and “minus 80” freezers. The system consists of temperature probes, sensors, repeaters, and access points. “The overall management for the temperature monitoring system needed to be clarified,” said Morano. “There was a lack of accurate inventory. In addition, the roles, responsibilities, and processes of the key players involved in managing the system— information services (IS) staff, end users, and the CE team—had not been clearly defined. We also recognized a need to educate these individuals more comprehensively on the system’s capabilities.”
At a Glance SUBJECT
ABM Clinical Engineering Team at the Women & Infants Hospital of Rhode Island LOCATION
Providence, RI SIZE
167 adult beds (45 medical/ surgical and 122 obstetrical), 80 neonatal intensive care unit beds, 60 newborn bassinets STAFF
Six key team members from ABM Clinical Engineering: Robert Clarke, Noel Fleck, Brian Haynes, Samantha Herold, Jillyan Morano, and Garabed Tashian
Biomedical Instrumentation & Technology March/April 2015
129
© Copyright AAMI 2015. Single user license only. Copying, networking, and distribution prohibited.
Columns and Departments
Herold added that the process for conductSolution ing server change management for the Through performance monitoring activities Joseph Sheffer system also lacked structure. “CE and the end and mapping of the temperature monitoring is publications users were not notified when this change system, the CE team identified gaps in specialist at AAMI. management was occurring. Sometimes, it E-mail: jsheffer@ coverage and innovative ways to bridge them. aami.org would happen on the weekend when CE staff “A key aspect of the performance monitorwere not around, and as a result, we would be ing activities was validating the inventory of greeted on Monday by a barrage of service sensors—the actual devices that monitor requests from end users who were overtemperature,” said Herold. “We cataloged whelmed by alarms,” she said. the sensors according to department and The confusion and downtime resulting made sure they were named correctly and from this maintenance served as a wake-up could be easily found. This was one of the call for Morano and Herold, signaling that biggest steps, especially for our breast milk more in-depth scrutiny of the processes refrigerators.” surrounding the Herold also said that system was needed. the CE team spent a The process of mapping resulted “The downtime good deal of time in a formal document that events were really the getting familiar with lightning bolt,” said the mapping of the identified IS and CE roles and Morano. “So when we system—or how it’s responsibilities for the various met with IS, our goal connected throughout components of the system. first and foremost was the hospital’s network. This document then was made to reschedule server “Going through this maintenance so it was process helped clarify available to members of the not performed on the the areas that IS and departments to streamline weekend. That was the CE were responsible troubleshooting procedures. tipping point. We for troubleshooting,” realized that when the she said. system was installed, The process of mapping resulted in a formal no clear-cut plans had been put in place for document that identified IS and CE roles and maintaining and updating it. This is a responsibilities for the various components of mission-critical system; if it isn’t working the system. This document then was made correctly, medications, breast milk, and blood available to members of the departments to products are put at risk. Therefore, institutstreamline troubleshooting procedures. ing a definitive protocol was essential.” CE rolled out a collaborative education “The problems we were seeing with the program that was led by Herold. Previously, system involved multiple components of during calibration of the system by the IS—the server side, the application side, and manufacturer, Morano and Herold had been the desktop support side,” added Morano. given “super user” privileges, but they were Other issues identified by the CE team the only ones in CE holding the keys to the included a lack of standard procedures for city. Now, the entire CE team has been user training, creation/deletion of user trained on various system functions, which access, and troubleshooting, as well as has greatly enhanced its ability to respond confusion among end-user clinical staff quickly to issues that arise. CE has provided about who monitors and services the system. education resources to end users, which has boosted their ability to effectively monitor responsibilities. CE also coordinated an “The problems we were seeing with the system involved education plan to inform other key hospital multiple components of IS—the server side, the application educators on the monitoring system. About the Author
side, and the desktop support side.” — Jillyan Morano, director of clinical engineering
Results By working with each department to create streamlined workflows, the CE team has
130
Biomedical Instrumentation & Technology March/April 2015
© Copyright AAMI 2015. Single user license only. Copying, networking, and distribution prohibited.
Columns and Departments
improved the hospital’s ability to meet compliance standards and achieve maximum return on investment of the temperature monitoring system. CE and IS also have worked to optimize the change management procedures for system updates and upgrades. “Clarifying the roles and responsibilities for maintaining the system, for troubleshooting, for ordering broken parts, is a great help to everyone involved,” said Morano. “It really makes the entire system work a lot more efficiently.” Ken Thomas, IS site manager at Women & Infants, believes managing the temperature monitoring system is preparing a strong foundation for future projects. “It was great to begin working with the CE team on this project, as we have a common goal of providing faster responses to our clinicians’ needs. Our two worlds, CE and IS, are becoming more and more intertwined as healthcare technology expands, and we look forward to working with them in future endeavors to better serve the needs of the hospital.” The efforts of CE to harmonize roles has not gone unnoticed by the clinical end users. “We’ve received a lot of positive feedback from the clinical staff,” said Morano. “They are especially happy that unplanned downtime is now a thing of the past.” Sara Murphy, manager of the hospital’s blood bank, also speaks highly of the work that was done. “The system went through a major overhaul that improved its performance immensely. It now functions accurately and with minimal problems, 24 hours a day, and alerts the proper people to any issues so they can be resolved in a timely manner.” Herold noted that the systematic clarification of roles has been highly instructive for CE. “Going through that process has given us comprehensive knowledge of the many functions of the system, from setting up alert escalations to understanding how alerts are relayed to end users,” she said. “As a result, we’ve been able to pass along what we’ve learned to the clinical super users, which has improved their ability to manage the system, and get alerts in a timely manner.” Morano underscored this point, noting that “alert recognition” for the temperature monitoring system has improved among the clinicians. “They’re recognizing the visual
The ABM clinical engineering team at the Women & Infants Hospital of Rhode Island. Back row, from left to right: Garabed Tashian, Noel Fleck, and Brian Haynes. Front row, from left to right: Robert Clarke, Samantha Herold, and Jillyan Morano.
“We are logging troubleshooting data more efficiently. That has increased our ability to share learned information within the CE team, and the efficiency of service calls also has improved as a result. Now, as issues arise, having that information readily available will improve our ability to respond quickly and effectively.” — Samantha Herold
Figure 1. Chart showing reduction in average response time for temperature alarms following staff education
Biomedical Instrumentation & Technology March/April 2015
131
© Copyright AAMI 2015. Single user license only. Copying, networking, and distribution prohibited.
Columns and Departments
CE staff members Brian Haynes, left, and Garabed Tashian work on installing a temperature sensor and probe in a breast milk refrigerator.
service calls also has improved as a result. Now, as issues arise, having that information readily available will improve our ability to respond quickly and effectively.” To ensure continuous quality monitoring and improvement of the temperature monitoring system, the ABM CE team also has begun holding quarterly meetings. A subcommittee was formed that will be governed under the hospital’s quality council, which is made up of senior leadership and other key stakeholders. On a semiannual basis, the team will report back to the quality council on the effectiveness of the system and any performance issues. The necessity for these regular check-ins underscores the “missioncritical” nature of the system, said Morano. “It needs to be governed at a high level, so having the full attention of the quality council is vitally important,” she said.
Conclusion
CE team members Noel Fleck, left, and Robert Clarke
alert cues more quickly. They understand the process better and therefore are utilizing the system more effectively. Alerts are addressed in a timelier manner.” Figure 1 illustrates the dramatic reduction in average response time to alerts following CE’s education efforts. Another happy byproduct of gaining a clearer understanding of the system has been improved record keeping by the CE team. “We are logging troubleshooting data more efficiently,” said Herold. “That has increased our ability to share learned information within the CE team, and the efficiency of
132
Biomedical Instrumentation & Technology March/April 2015
Because the temperature monitoring system spans disciplines throughout the hospital, educating key players on the various team was critical to its success. Morano identified this buy-in as being the greatest factor driving improvement. “Temperature monitoring in the hospital clearly affects many health professionals—lab supervisors, clinical supervisors, infection control specialists, IS; the list goes on,” she said. “Having this multidisciplinary team involved in the project was essential because CE can only resolve issues if a collaborative environment exists.” “Proper documentation obviously is the foundation for managing any system, but it’s only useful if its distributed among the users of that system” added Herold. These concepts described by Morano and Herold—interacting with healthcare technology and sharing the right information with the right people—are central aspects of systems thinking and human factors engineering. Information cannot exist in a vacuum; it must be shared for that system to succeed. The efforts of the ABM CE team to rally the multidisciplinary team, improve its understanding of the temperature control system, and set out clear roles and responsibilities highlight the invaluable role that CE plays in improving patient care. n
© Copyright AAMI 2015. Single user license only. Copying, networking, and distribution prohibited.
get more
WITH “The articles are written specifically about Biomedical challenges and successes.” - Biomedical Engineer
Get a free issue of 24x7 Magazine!
Go to 24x7mag.com/subscribe for more information.
