Dr James Dr James SartainSartain MB BS FANZCA FRCAMB BS FANZCA FRCAActing Director Acting Director

Dept Anaesthesia, Intensive Care & Dept Anaesthesia, Intensive Care & PerioperativePerioperative MedicineMedicineCairns Base HospitalCairns Base Hospital

The AARKThe AARK(Automated Anaesthetic Record Keeping)(Automated Anaesthetic Record Keeping)

ProjectProject

- Breaking Down System Silos

Disclosure-AARK ‘Product Champion’ Acute Pain Module-User of Medtel Winchart since 2001

Acknowledgements- A/Prof Mike Steyn, Royal Brisbane & Women’s Hospital - A/Prof John Archdeacon, Cairns Base Hospital- Mr John Crouch, Queensland Health AARK

Anaesthesia 1846Anaesthesia 1846Massachusetts General HospitalMassachusetts General Hospital

Anaesthesia 2010Cairns Base Hospital

Manual Record Keeping Manual Record Keeping (much of Australia today)(much of Australia today)

Automated Anaesthetic Record Keeping Automated Anaesthetic Record Keeping

AARK Project – Background

• 2005 – QH responding to Bundaberg disaster

• Staff despondency regarding culture, pay & conditions

• Clinical Advisory group

• Anaesthesia services−Largest specialist doctor group in QH

−Impact on >60% of acute hospital activity

−No investment in Anaesthesia including IT

Anaesthetists abandoning QH for private sector

• Clinical Networks and Information Division (ID) plan

AARK Project – Background

• Anaesthetists

• Nurses

• Anaesthetic Technicians

AARK Project – Background

• Swapnet & Anaesthetic Directors

• Need for Automatic Anaesthetic Record

− Agreed to common Record and systems

• QH ID strategy - $250M

− $17M assigned to AARK

• Medtel Winchart product successful

− Initial development in Cairns 1999-2001

• AARK roll out commenced 2008

AARK SitesAARK Sites26 hospitals “live”; 18 more engaged

CairnsCairnsRedcliffeRedcliffeCabooltureCabooltureRoyal Brisbane & Royal Brisbane &

Women's Women's Queen Elizabeth IIQueen Elizabeth IIRockhamptonRockhamptonToowoombaToowoombaIpswichIpswichTownsvilleTownsvilleLoganLoganMackayMackayPrincess AlexandraPrincess AlexandraAthertonAtherton

MareebaMareebaInnisfailInnisfailCooktownCooktownDalbyDalbyEmeraldEmeraldBiloelaBiloelaChinchillaChinchillaWeipaWeipaGladstoneGladstoneKingaroyKingaroyLongreachLongreachRedlandsRedlandsThursday IslandThursday Island

AARK ObjectivesAARK Objectives

Improve access to patient informationImprove access to patient information

Improved patient safetyImproved patient safety

Improved clinical management reportingImproved clinical management reporting

Increased efficiency in the Increased efficiency in the perioperativeperioperativeenvironmentenvironment

Pre-Operative Theatre

Acute Pain ServicesPACU

The AARK Solution The AARK Solution ––the the PerioperativePerioperative JourneyJourney

PACU

Patient Monitor

AARK PC

AARK Project – Recovery (PACU)

Patient MonitorAARK PC

AARK Project - APS Module Motion Computing C5 tablet

Induction dramaInduction drama

AARK Patient SafetyAARK Patient Safety–– ReadableReadable

Improved communication and care

AARK Patient Safety AARK Patient Safety –– ReliableReliable

Automatic data recording– medico-legally robust

AARK Patient Safety AARK Patient Safety –– RetrievableRetrievable

••Access to records stateAccess to records state--widewide••Previous episodes of care instantlyPrevious episodes of care instantly••Previous adverse eventsPrevious adverse events

AARK WinchartGraphical Console

AARK Patient Safety AARK Patient Safety -- Real time assistanceReal time assistance

Recovery 1

AARK Patient Safety AARK Patient Safety -- Real time assistanceReal time assistance

Operating theatres

Low BP

Low O2 Sats

No pEEG monitor

High Anaes Gas level

AARK Patient Safety AARK Patient Safety -- Real time assistanceReal time assistance

ShortestLongestShortestLongest

4

15

1.35.2

9.5

21

5.4910.3 9

37

3.03

Shortest

Theatre Short Case Theatre Long Case

Theatre Data Entry Time PACU Data Entry Time

.35

Data entry duration in minutesLongest

Pre AARKPost AARK

AARK Benefits AARK Benefits –– EfficiencyEfficiency of careof care

= More time (or 2 fewer staff

per 8 patient bay!)

AARK Benefits AARK Benefits –– ReportingReportingCARM (Clinical Analysis and Reporting Module)CARM (Clinical Analysis and Reporting Module)

Clinical Quality AssuranceClinical Quality Assurance–– Antibiotic prophylaxisAntibiotic prophylaxis

–– AntiAnti--emeticsemetics

–– Adverse eventsAdverse events

AdministrativeAdministrative–– ACHS Indicators ACHS Indicators

–– Resource allocationResource allocation

–– Staff trainingStaff training

AARK Benefits – Reporting example

Trainee, Junior

Trainee, Senior

Trainee, Junior

Trainee, Senior

AARK Benefits – Reporting (cont’d)

Trainee, Junior

Trainee, Senior

AARK successAARK success-- why has it worked?why has it worked?

SeductionSeduction

Silo reductionSilo reduction

AARK success AARK success SeductionSeduction

‘‘WhatWhat’’s in it for me?s in it for me?’’–– Automated data Automated data –– Time savingTime saving–– Quality of recordQuality of record–– Efficiency of careEfficiency of care–– MedicoMedico--legal defencelegal defence–– More desirable than More desirable than

an ian i--Phone!Phone!

AARK success AARK success Silo reduction (1)Silo reduction (1)

Recognise they exist:Recognise they exist:

Doctors, Nurses, Different Doctors, Nurses, Different hospitals, IT specialists, health hospitals, IT specialists, health administrationadministration

Different drivers and pressures Different drivers and pressures on themon them

Speak different languagesSpeak different languages

AARK success AARK success Silo reduction (2)Silo reduction (2)

Collaboration:Collaboration: Started with clinical and Started with clinical and AnaesAnaes

group needs/goalsgroup needs/goals

Validated by QH Administration Validated by QH Administration

Doctors/nurses/techs/hospitals Doctors/nurses/techs/hospitals found common ground found common ground (eg (eg SwapnetSwapnet, Directors), Directors)

Clinician leader advocateClinician leader advocate

AARK success AARK success Silo reduction (3)Silo reduction (3)

Strategic rollStrategic roll--out:out:

Process engineeringProcess engineering

Implementation Implementation

Software testingSoftware testing

Technical & hardware Technical & hardware supportsupport

AARK success AARK success Silo reduction (4)Silo reduction (4)

Success in development Success in development and rolland roll--out by out by utilisation of:utilisation of:–– The multiThe multi--linguallingual

–– The converted nativesThe converted natives

–– The PhilistinesThe Philistines

AARK AARK ChallengesChallenges

ClinicalClinical–– Areas with less automation Areas with less automation

(Pre(Pre--Op and APS)Op and APS)–– Need for valueNeed for value--added functions added functions

AdministrationAdministration–– Priorities for fundingPriorities for funding–– Partnership mindPartnership mind--setset–– Publicity (good or bad)Publicity (good or bad)

The AARK Project

Acute Pain Services

Theatre PACU

PACU

Pre-Operative