What Is the Return on Investment for Implementation of a Crew Resource Management Program at an Academic Medical Center?

Crew Resource Management (CRM) training has been used successfully within hospital units to improve quality and safety. This article presents a description of a health system-wide implementation of CRM focusing on the return on investment (ROI). The costs included training, programmatic fixed costs, time away from work, and leadership time.

What Is the Return on Investment for Implementation of a Crew Resource Management Program at an Academic Medical Center?

Crew Resource Management (CRM) training has been used successfully within hospital units to improve quality and safety. This article presents a description of a health system-wide implementation of CRM focusing on the return on investment (ROI). The costs included training, programmatic fixed costs, time away from work, and leadership time.

The journey from precontemplation to action: Transitioning between electronic medical record systems.

Background: Health care organizations, in response to federal programs, have sought to identify electronic medical record (EMR) strategies that align well with their visions for success. Little exists in the literature discussing the transition from one EMR strategy to another.

Purpose: The analysis and planning process used by a major academic medical center in its journey to adopt a new strategy was described in this study.

Diagnosis-specific readmission risk prediction using electronic health data: a retrospective cohort study.

Background: Readmissions after hospital discharge are a common occurrence and are costly for both hospitals and patients. Previous attempts to create universal risk prediction models for readmission have not met with success. In this study we leveraged a comprehensive electronic health record to create readmission-risk models that were institution- and patient- specific in an attempt to improve our ability to predict readmission.

Infection control link nurse program: an interdisciplinary approach in targeting health care-acquired infection.

Background: We describe a successful interdisciplinary liaison program that effectively reduced health care-acquired (HCA), methicillin-resistant Staphylococcus aureus (MRSA) in a university hospital setting.

Methods: Baseline was from January 2006 to March 2008, and intervention period was April 2008 to September 2009. Staff nurses were trained to be liaisons (link nurses) to infection prevention (IP) personnel with clearly defined goals assigned and with ongoing monthly education.

Developing a multidisciplinary robotic surgery quality assessment program.

The objective of this study was to test the feasibility of a novel quality-improvement (QI) program designed to incorporate multiple robotic surgical sub-specialties in one health care system. A robotic surgery quality assessment program was developed by The Ohio State University College of Medicine (OSUMC) in conjunction with The Ohio State University Medical Center Quality Improvement and Operations Department. A retrospective review of cases was performed using data interrogated from the OSUMC Information Warehouse from January 2007 through August 2009.

Development and assessment of quality improvement education for medical students at The Ohio State University Medical Center.

This study tested the feasibility of a quality improvement (QI) program that provided first and second year medical students with education in QI processes and demonstrate their utility within the framework of a real-world QI project. Medical students assessed the use of the Surgical Safety Checklist at The Ohio State University Medical Center. Before performing audits students were required to complete a self-paced online program that provided preliminary education in QI, patient safety, leadership, teamwork, and patient-centered care.

Information warehouse - a comprehensive informatics platform for business, clinical, and research applications.

Since its inception in 1997, the IW (Information Warehouse) at the Ohio State University Medical Center (OSUMC) has gradually transformed itself from a single purpose business decision support system to a comprehensive informatics platform supporting basic, clinical, and translational research. The IW today is the combination of four integrated components: a clinical data repository containing over a million patients; a research data repository housing various research specific data; an application development platform for building business and research enabling applications; a business intelligence environment assisting in reporting in all function areas. The IW is structured and encoded using standard terminologies such as SNOMED-CT, ICD, and CPT.

Reversal of neurological deficit after chemotherapy in BCL-6-positive neurolymphomatosis. Case report.

Neurolymphomatosis, the infiltration of the peripheral nervous system (PNS) by malignant lymphatic cells, is a rare condition whose prognosis and treatment are not fully characterized. The authors report the case of a 69-year-old, previously healthy man who had a 1-month history of progressive pain in his right arm and associated weakness of several muscles of the right upper extremity when they first examined him. Initial MR imaging of the right brachial plexus showed no abnormalities, but over 3 months, symptoms gradually progressed to almost complete plegia of his right upper extremity.

Integrating systems requires balancing act.

A Web-based patient record system at The Ohio State University Medical Center dramatically speeds up interactions with referring physicians.

A comparative analysis of the dissemination of best practice measures for key populations.

In collaboration with the department of Quality and Operations Improvement, Clinical Applications and the Information Warehouse, we have leveraged available Information Warehouse data to build a Best Practice Compliance Measurement Dashboard. This tool combines information from our operating room charting system, our order entry system and coding information from the patient billing and management system to provide 'previous day', data on a patients current course of treatment.

Identification of potential surgical site infections leveraging an enterprise clinical information warehouse.

At The Ohio State University Medical Center (OSUMC), infection control practitioners (ICPs) need an accurate list of patients undergoing defined operative procedures to track surgical site infections. Using data from the OSUMC Information Warehouse (IW), we have created an automated report detailing required data. This report also displays associated surgical and pathology text or dictated reports providing additional information to the ICPs.

Predicting patient volume in cardiac catheterization laboratory to improve resource management.

Using historical data within the Information Warehouse of the Ohio State University Medical Center, prediction on daily patient volume to catheterization laboratory was attempted to facilitate resource management and planning.

Using data mining tools to discover novel clinical laboratory test batteries.

Using statistical analysis and data mining tools, we examined possible associations among clinical laboratory orders placed at the Ohio State University Medical Center between January and October of 2006. Upon applying the Frequent Itemset data mining technique to this data set, the results indicated that, while the most frequently ordered battery of tests was not associated with others, some highly associated orders may be good candidates to comprise new test batteries.

ICD9 Code Assistant: A prototype.

At The Ohio State University Medical Center (OSUMC) patient reports are available in real time along with other clinical and financial data in the OSUMC Information Warehouse (IW). Using the UMLS Meta Thesaurus we have leveraged the IW to develop a tool that can assist the medical record coders as well as administrators, physicians and researchers to quickly identify clinical concepts and their associated ICD-9 codes.

Using an information warehouse to screen patients for clinical trials: a prototype.

Success of a clinical trial recruitment process for drug discovery and new treatments depends on screening and identifying eligible patients in a timely manner. This can be a complex and tedious process that in many instances requires a research nurse to manually track patients that may be eligible. At the Ohio State University Medical Center (OSUMC) we have developed a web-based functional prototype that uses the data stored in the Information Warehouse (IW) to screen patients that meet the eligibility criteria for clinical trials.

Specificity of computerized physician order entry has a significant effect on the efficiency of workflow for critically ill patients.

Background: Critically ill patients require rapid care, yet they are also at risk for morbidity from the potential complications of that care. Computerized physician order entry (CPOE) is advocated as a tool to reduce medical errors, improve the efficiency of healthcare delivery, and improve outcomes. Little is known regarding the essential attributes of CPOE in the intensive care unit (ICU).

Impact of computerized physician order entry on clinical practice in a newborn intensive care unit.

Objective: To study the impact of computerized physician order entry (CPOE) on selected neonatal intensive care unit (NICU) practices.

Design: Retrospective review.

Setting: Nursing units in an academic health system where CPOE has been implemented in adult services since 2000 and in the NICU since 2002.

Impact of CPOE order sets on lab orders.

Introduction of the computerized physician order (CPOE) is intended to promote best practices, decrease practice variation among practitioners, and optimize the utilization of resources consistent with evidence based practice guidelines. Implicit in the use of CPOE is the assumption that the use of order sets might decrease utilization of resources such as the ordering of unnecessary laboratory tests. Conversely compliance with practice guidelines may necessitate ordering of certain tests that are deemed to be consistent with the good practice of medicine.

Information warehouse as a tool to analyze Computerized Physician Order Entry order set utilization: opportunities for improvement.

A Computerized Physician order entry (CPOE) system was successfully implemented at the Ohio State University Medical Center (OSUMC) in February 2000. The electronic entry and use of order sets is designed to standardize patient care and improve efficiency and patient safety. To evaluate the effectiveness of the CPOE system and to maximize its benefits, one needs to easily access and analyze the data.

Development of a Web-based event reporting system in an academic environment.

In pursuit of a strategy for patient safety and error reduction, The Ohio State University Health System developed and implemented a standardized voluntary event reporting system. The Web-based application is user friendly as well as context-sensitive and encompasses a broad range of errors, events, and near misses. A full organizational transformation was required to effectively implement the system, which involved process reengineering for event entry and for postentry automated workflows.

Immediate benefits realized following implementation of physician order entry at an academic medical center.

Objective: To evaluate the benefits of computerized physician order entry (POE) and electronic medication administration record (eMAR) on the delivery of health care.

Design: Inpatient nursing units in an academic health system were the setting for the study. The study comprised before-and-after comparisons between phase 1, pre-implementation of POE (pre-POE) and phase 2, post-implementation of POE (post-POE) and, within phase 2, a comparison of POE and the combination of POE plus eMAR.

Key attributes of a successful physician order entry system implementation in a multi-hospital environment.

The benefits of computerized physician order entry have been widely recognized, although few institutions have successfully installed these systems. Obstacles to successful implementation are organizational as well as technical. In the spring of 2000, following a 4-year period of planning and customization, a 9-month pilot project, and a 14-month hiatus for year 2000, the Ohio State University Health System extensively implemented physician order entry across inpatient units.