As I’m standing in line at my favorite coffee shop, I’m thinking about how baristas have perfected workflow; and now have improved perfection by allowing me to eliminate the line entirely by ordering
in advance with my smart phone. It always excites me when I see a sequence of steps refined for optimum efficiency. I know it's odd, but I'm really strange like that.
It reminds me of transplant programs and the number of people it takes to coordinate care. Pre-transplant programs review tons of documentation, especially large multi-organ programs. Care coordinators sift through a great number of lab results and physician notes reported by organ recipients on a regular basis. Notes are often in a narrative format and include many lab results multiple pages long. Can this workflow be improved? Let’s explore.
Your pre-transplant workflow can change quickly or unpredictably, which doesn’t change availability of your team members; this creates a pressure point to handle the workload. Time is always a factor, as is accuracy, and attention to detail. I have a special appreciation for nurse coordinators and the evaluation team, especially in pre-transplant. So much hope is on the line and often a pressure to work quickly.
The organ selection process drives a need for reviewing comprehensive history and analysis. Once an organ becomes available, it takes a long time to enter all relevant data or sort it for your selection committee; often times, just the minimum information is entered. Technology is available to manage this peak in workflow, even where interfaces are designed for transplant centers from major reference labs. There is no guarantee patient reported labs are reported in the EMR, and even where inpatient information exists in the clinical database. This is where advanced data capture can help.
If we had the nurse coordinators take a vote to choose to locate and enter data manually or spend more time with their patients, I suspect it would be a unanimous decision in favor of spending face-to-face time with every organ candidate.
When your coordination team requests records from the patient, it’s tempting to hold onto paper due to the level of effort to find information quickly. Since we have adopted electronic records in most every transplant center, it makes sense to leverage the trending tools made available. You likely have access to some of that data in your inpatient records, but the fact is, most transplant information is maintained in a separate transplant database. Even more challenging, are the cases where HLA testing is performed outside, thus the results are returned on paper. Wouldn’t it be more valuable to the entire team to have tools to automate the data entry process and ensure accuracy?
Third party services are available to gather or aggregate pre-transplant records; your program might be using this type of service now. Have you ever encountered a situation where you receive a single or contiguous electronic file in the form of a PDF? Sometimes those records are stored as an image scan link in your EMR, but finding them among pages and pages of notes can be very time consuming (and frustrating). Wouldn’t it be a time saver to automatically sort out just the lab results or physician notes, and have them automatically entered into the electronic record? This is another area where advanced data capture can help. Imagine how helpful it would be if you have the ability to find documents for anyone in the waiting list by content or document type and quickly move the data into your patient record without manual entry. Imagine how the entire evaluation team will benefit.
There are two groups of thought regarding pre-transplant documentation workflows: those who think that manual methods are more efficient, and those who don't know they have a choice. Okay, I’ve finished my coffee now and I'm headed for a refill. But I want you to know, there are better ways to manage pre-transplant documentation. Think about it, you could be spending more time with your patients. I hope this pops in your head while you are ordering your next cup.
