Director of Perioperative Nursing discusses Peri-Op Documentation

In a new ‘Feedback from the Frontline’ feature we sat down with Pamela Turner, a former Director of Perioperative Services and current healthcare consultant working with operating rooms (ORs), medical and surgical companies.

Pamela is a seasoned OR professional and was Director or Perioperative Services at a Level 1 Trauma Center with a wealth of experience around peri-op documentation.

Below is an abridged version of a discussion we had on why OR inventory management is so difficult, and the impact of not capturing full item and charge capture during the surgery.

OR utilization data is a crucial element of healthcare management. Let’s investigate the importance of OR data and the impact that robust data collection in the OR can have on healthcare management.

Interview with Director of Perioperative Services

In this video Pam Turner shares her thoughts on the challenges of OR supply chain documentation and gives her feedback on a breakthrough tool that uses image-recognition and AI technology for more speedy and efficient recording of product utilization.

Below the video you can read the FULL interview.

Biography:

Qualifications: RN for 43 years, ORN for 30 years and MSN for 23 years

Rising through the ranks: Pam started off as a Staff Nurse and then went on to become Head Nurse, then Nursing Supervisor with a focus on education and performance improvement. In 2004 she became Director of Pediatric OR, leading to her role as Director of Perioperative Services.

FULL interview with Director Perioperative Services – transcription:

Q. Today we’re going to be speaking to Pam Turner who has a total of 43 years’ experience working in nursing and management roles in the OR setting. Welcome Pam, nice to have you with us. I wonder if you could tell me what you feel the current challenges are for Directors of Perioperative Services and other management roles in the perioperative setting.

A. Well, one important issue is making sure that our perioperative processes ensure that the electronic medical record EMR is complete and correct for every patient, particularly the implants information.

The challenge of an incomplete EHR after surgery

The problem is that a lot of the products used aren’t in the EHR system, which causes a big problem. So, for example, if you’re using multiples and they’re not preloaded in the system, then that means that the circulating nurse has to physically enter them.

There are actually maybe two written records of the implants consumed in surgery, as well as the digital documentation. If there’s a sales rep, then they will be keeping track of their products that are used, and then the circulating nurse may also be writing up a manual implant log. So, not only are the nurse be typing items into the system, but they’re often also making a written entry in an implant log that will probably go into a binder.

We keep these written records for at least 10 years, so that if there’s a product recall, then we can go into that chart. Once we have the date of the surgery we can go back to that year and that date and go through the manual records to verify that we did have the surgery that day and we can check are the products that were used.

So going back to the documentation, it really is important, and it’s a legal requirement too, but of course, all this time spent documenting.

Perioperative documentation challenges in the operating room (OR)

Q. So, all this time they’re supposed to be focused on the patient, and supporting the physician to make sure that surgery is going well, it sounds like quite a distraction for the staff.

A. Well, you know, time is money, and we want to make sure that we continue to do our surgical procedures, including all the surgical supply documentation, in a timely and efficient manner, but again, you know these are the one-off cases that we see that really put time constraints on the nurse.

Q. And, in your management role where you liaising with other parts of the organization because the OR utilization data is important for organizational workflows isn’t it?

A. Absolutely. As an administrative team it was the Chief of Surgery, myself, the CNO, the CFO, and we also had the Director of Finance and we would get together about once a month to go over where we are with our charge captures, so the charges that have been placed out, the monies that we’ve received back, and where there is a little bit of deficit that we need to focus on to get it to the next step. Because most insurance companies don’t pay between 90 and 120 days out, so you’ve got a lot of capital that’s going through here, and again you want to be able to justify the charges that are being dropped.

Sometimes the charges are automatically done by the computer but it’s not until Finance looks at it that sees that there’s information omitted and that we need to go back and plug that information in.  That’s another time-consuming task, because I don’t have a lot of ‘fluff in the administration and the operating room, so a lot of it has to be done by myself in order for that to be complete – so everything else is on hold while I complete that task.

Q. So as the Director or Perioperative Services you ended up keying in data to get the records right?

A. Yes.

Q. I’m surprised to hear that. I mean, I guess, whoever does it, it sounds like a long process.

A. It certainly is. It can take hours, and sometimes days to get the appropriate information in the chart.

OR charge capture challenges

Q. Describe the challenges that staff face documenting utilization into the patient chart in the EHR.

A. The charging of products can be very labor intensive. Not all products are in the charge master. Anything that is not must be manually typed into the EMR. In some cases, this could be a bag full of product information that needs to be plugged into the system. Full item information such as product name, description, item expiration date, how many of the product were used – for every single item. It takes time.

Using image recognition technology as a new way to document product utilization in OR

Q. Tell us your reaction to seeing Snap&Go in action. This is a new way of documenting product utilization in surgery, using image recognition and AI technology. No more barcodes.

A. I was very excited to see this innovative technology at work. I see the benefit in reduced time spent manually inputting data into the EMR. Also, the quality of information – with every detail recorded. It leads to all utilization charges being in the computer and ready for submission, speeding up the billing process, as well as making sure reimbursement is maximized, so there will be an increase in financial revenue. And of course, the quick documentation ensures that patients get more RN attention during the surgery, which has to impact on the quality of care. Then when surgery is over, if a product recall takes place, it takes very little time to manage the recall, whereas in the past the nurses were hunting down recall information. With Snap&Go that information is at your fingertips via the managing system.

Comparing computer vision technology to barcode scanners as a point-of-use system

Q. In terms of getting utilization right during the surgery, when we showcase Snap & Go point-of-use system for product usage documentation, at nurse network meetings, we do get a lot of interest from nurses. A lot of them are using barcode scanning systems which can be quite frustrating at times. How do you feel image recognition technology compares to barcode scanning as a perioperative documentation tool?

A. Barcode scanning is what we have, but it’s not all-inclusive and that’s where I think we missed the boat. We want to be able to have something at our fingertips that we can truly trust.

If we can capture all of the information that is necessary for the case, as well as for implants, as well as for recalls, it’s a win-win situation. It’s a win for the patient because now the nurse isn’t spending all that time, you know, not only having an ear towards the patient, and the doctor, and the scrub person – but you’re busy taking care of everything.  I think it would make everybody’s life easier.

And on the other hand, you’ve got your OR financial revenue being done immediately, and what better way – instead of having a nurse typing that in one product at a time – the nurse can place the item under the camera and see it zoom through the system. The screen will display all the product information -it’s got the product name, the product information, it’s got the serial number, the reference number, the company, and the expiration date. All in 3 seconds.

And it’s mesmerizing and the fact is, that if I needed to do a recall, I would just have to type it in, and it would come right back to me as a report – it’s a very simple process.

Q. How easy is it for nurses to use Snap&Go in the operating room?

A. All the perioperative nurse needs to do is place each consumed product under the camera and wait until the light turns green. Then they just remove the product, and the screen is already displaying all the product details. It assures us that the product has been placed into the chart.

There is no way on earth that you could spend 3 seconds putting product information into an EMR. It just can not be done. You cannot do it in three seconds, and I’m assured that if it’s used in an operating room under a trauma case, or if it’s a regular routine case, it’ll make life easier by putting utilization in the fast lane, and again the nurse will be spending more time focusing on the patient.

Thank you so much for your time and your insight, Pam.

It’s clear that managing operating room inventory is complex, and that the

point of use system needs to be able to quickly and accurately record every consumed item.

That simply isn’t happening right now, and as Pam describes, there is firstly, a lot of manual

utilization documentation going on, (even if an automated system is in place), and secondly,

a lot of post-surgery admin and reconciliation is necessary, as the patient chart

simply isn’t complete or correct by the end of surgery.

Healthcare providers understand that being proactive, and getting surgical utilization right while the surgery is still taking place, is the best way to ensure the best patient outcomes, optimized OR revenue, and smooth-running OR supply chain operations.

About Snap&Go – This brand-new approach to recording surgical supplies is patent-protected technology that maximizes the business potential of OR & procedural rooms while increasing patient safety.

Powered by image recognition, AI, and machine learning technology, this easy-to-use image-recognition platform provides 100% data capture of medical implants and consumables, documenting their use and cost in ERP, EHR, and MMIS systems, as well as tracking product integrity (recall and expiration dates).

If you have to enter additional items post-surgery. or carry out documentation checks then this is the red flag that tells you that your point-of-use system is inefficient.

Talk to us to find out a more proactive way to ensure full item and charge capture during surgery, before wheels out. Our next-generation data sensing healthcare solutions are taking smart providers up to the next level.