Tracker follows patients through each step of care
Wait time dramatically reduced
A computerized "patient tracker" developed in-house at the University of Arkansas for Medical Sciences (UAMS) in Little Rock is being put to particularly effective use at the Myeloma Institute for Research and Therapy (MIRT), where patients move back and forth among different treatment areas during extended stays.
Perhaps the only institution in the country that exclusively treats multiple myeloma, the institute draws patients from all over the world, notes executive director Betsy Baldwin, MSHA. "More than 80% of our patients are not from Arkansas, so when they come here, they usually stay a while."
During stays that may be as long as two or three months, Baldwin says, patients undergo a lot of testing, including magnetic resonance imaging, bone marrow biopsies, PET scans, bone density tests and many other laboratory tests.
The institute does many stem cell transplants, which require patients to go through a lengthy process that includes donating their own stem cells, and are typically preceded by several weeks of chemotherapy, she adds.
Typically, some 200 myeloma patients are in town at any one time, she says. About 50 of those have just received stem cell transplants, are going through the recovery process, and are being tracked on a daily basis.
"All the while they're here, they may be anywhere — on campus, off campus, in their hotel — but if they're on campus, we want to know where they are," Baldwin says. "The idea behind the patient tracker is to find out where the patient is at any given time."
Patients being treated for myeloma, she notes, might be in the outpatient transplant unit, the inpatient transplant unit (both in the UAMS Medical Center), the chemotherapy room or the myeloma clinic, both of which are in the Arkansas Cancer Research Center (ACRC), among other locations, she adds. "They're pretty spread out."
When a patient checks in at the clinic waiting room, he or she is also "checked into" the patient tracker before registration takes place, she explains. "As patients move through the system, they are discharged [on the tracker] from one place and put in another." (See screen shot, below.)
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Although staff at the check-in desk now document patients' arrival in the appointment system and then separately activate them in the patient tracker, Baldwin notes there are plans to merge the two systems to eliminate redundancy.
"We want to make the job easier," says Terry Lewallen, a software developer in the UAMS information technology department who designed the patient tracker. "Right now [registrars] have to work in two different systems. We have an appointment system that the various clinics put their appointments into, and from that I get a ‘dump' every morning and display those."
When a patient presents in the clinic, he explains, the registrar has to find the patient's name on the appointment list that has been created, note the person's arrival, and then activate the tracker for that individual.
"We're waiting for a new appointment system to arrive," Lewallen adds, "but our goal is that when [the registrars record] the person in that system, the information would be [automatically] sent electronically across the network into my system."
Once the patients are checked in and entered on the tracker, Baldwin continues, they are taken by a patient care technician from the waiting area at the myeloma clinic to an area where vital signs are taken. When finished there, she adds, patients are "checked out" on the tracker, and taken to an examination room.
"When a nurse sees [on the tracker] that a patient is in room 750, she goes into the room and does the initial assessment," Baldwin says. "She checks in, indicating that she is there seeing the patient, so that [others] can see it on their screens. There is a little box that turns green. When she's done, she checks out by pushing a button on the computer, which is the signal that the patient is ready to see the physician."
Because the patient tracker is on the desktop computer of all physicians, nurses, and clinical research personnel who work in the areas where it is used, the physician can see from his office that the patient is ready to see him, she points out. When the physician enters the patient's room, Baldwin adds, either he checks in on the tracker or a nurse does it for him.
If a research nurse needs to see the patient, he or she checks in after the physician checks out.
The length of time the physician spends with the patient — and the time that elapses during every other step in the process — is recorded by the tracker, Baldwin says. "It's a great tool in terms of patient wait time, and [for documenting] when physicians complain that nobody has put the patient in a room."
Before the system was implemented, patients might sit in the waiting room for up to two hours, Baldwin says, with staff not sure who the person was supposed to see or unable to find the physician.
"Once physicians know they are being measured, it's amazing how efficient they are," she notes. "They're much more likely to maintain their schedule."
The patient tracker also eliminates the need "to have someone running around saying, ‘Mr. X is in room 750,'" Baldwin points out. "It's much better for the patient.
"One of the biggest problems we had before was the waiting, not knowing where the patients were," she adds. "Now we know [immediately] when a room is empty."
In addition to having the tracker in the clinic, Baldwin says, it is also used in the chemotherapy room, where patients are assigned to chairs in which they receive treatment.
The "macro" aspect of the patient tracker is that it is designed to work not only in each clinic in which it is placed, but also to see if a patient is in an outside area — like radiology or the laboratory — and get an idea of when they will be finished.
Although Baldwin was just beginning to receive data on how wait times have been affected by the patient tracker, anecdotal evidence indicates they are dropping dramatically, she says. "Patients notice a big improvement."
When six months' worth of results are in place, Baldwin adds, she plans to present data to physicians and nurses to demonstrate what's been happening. The length of time spent at various steps in the treatment process, she notes, also can be broken down by nurse or physician.
While patients typically don't even realize the tracker is being used, Baldwin says, "staff really like it. It's helped with the flow, synchronized things much better, and made it easier for nurses, physicians, and most of all for the patient."
(Editor's note: Betsy Baldwin can be reached at [email protected]. Terry Lewallen can be reached at [email protected].)
A computerized "patient tracker" developed in-house at the University of Arkansas for Medical Sciences (UAMS) in Little Rock is being put to particularly effective use at the Myeloma Institute for Research and Therapy (MIRT), where patients move back and forth among different treatment areas during extended stays.You have reached your article limit for the month. Subscribe now to access this article plus other member-only content.
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