Cedars-Sinai Medical Center

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A BI-WEEKLY PUBLICATION FROM THE CEDARS-SINAI CHIEF OF STAFF March 15, 2013 | Archived Issues

Improvements Made to CS-Link

Several improvements were added to CS-Link™ on March 5. They include updates to Task Reminder and Chart Review, expansion of the Inter-Facility Transfer workflow, and improvements in the Notes function.

Details and screen shots of these changes can be found at cslinkcentral.org

Updates to Task Reminder

Physicians who have telephone orders that have been unsigned for more than 36 hours will receive a "pop-up" alert (task reminder) directing them to their inbasket to sign them at log in.

This improvement will:

  • Eliminate unsigned orders over a 24-hour period
  • Increase ordering efficiency
  • Result in fewer physicians on suspension

Expansion of Inter-Facility Transfer Workflow (Form)

The new Inter-Facility Transfer workflow provides an electronic form for physicians (NPs or PAs) transferring their patient to a skilled nursing facility. This form captures critical elements needed to ensure high-quality patient care at the nursing facility. Once completed in CS-Link, the form is printed to accompany the patient to the skilled nursing facility.

The inpatient special providers piloted this form over the last several months. It will now be available to all units and services and is to be used in place of the paper process.

This improvement will streamline the efforts for coordinating and communicating pertinent clinical information between the medical center and patient's post-discharge care facility.

Updates to Chart Review

Improvements to Chart Review will provide a more user-friendly experience when searching for information within Chart Review.

These updates will take place in four categories:

  • Columns have been updated to provide consistency between tabs with matching content sources.
  • Quick filters have been added to provide easy access to pertinent data elements that might otherwise be easily buried in a large sum of records.
  • User-defined filter options have been updated and adjusted to provide intuitive and relevant choices.
  • Some content has been reorganized, such as transfusions moving to the Other Orders tab and Central Line, and theoracentesis and paracentesis procedures moving to the Procedures tab. Inpatient Consult orders have been updated to reflect as such and display their own tab.

This improvement will:

  • Provide a more user-friendly experience when searching for data
  • Allow for user-defined filter options

Updates to Notes Structure

Changes to the Notes activity improve physicians' ability to search and locate notes in a more intuitive fashion.

All midlevel and physician notes will display in the Physician tab, and the Progress Notes and Misc tabs have been removed. There is now a Use of Service field for midlevel and attending providers.

New notes types have been created which include Pre-Op and Post-Op. New note types will also include cosign note settings.

Improvements to existing note types include:

  • The Psych Note has been changed to Psych Consult – Initial
  • Operative Report now replaces OR Surgeon

All procedure-based notes will fall under the Procedures tab.

This improvement will:

  • Allow more efficient Note documentation
  • Allow for easy usability

Updates to Diabetes Alerts

CS-Medicine has requested diabetic Best Practice Alerts for the Inpatient setting. These BPAs will alert care givers to provide statins in the appropriate setting and use metformin with caution when diabetes patients have elevated creatinines.

This improvement will increase patient care and safety.

Improvements to Hospice/Palliative Ordering

The order for Consult to Hospice/Palliative Care is now split into two separate orders: Consult to Hospice, and Consult to Palliative Care.

This improvement will:

  • Improve patient documentation
  • Eliminate the misperception that palliative care and hospice are the same thing

Prevention of Duplicate Vent Check Orders

In the recent past, Respiratory Therapy started noticing duplicate vent procedures for certain patients who are already on an active vent. The duplicate procedure adds an extra point in the Points by Region Report when the staff changes shift. The solution to this issue is a new duplicate procedure check that verifies a patient is already on an active vent.

Improvements specific to Emergency Department

Updates to the Cedars-Sinai Emergency Department Notewriter Procedure preference lists allows for Emergency physicians to have access to existing Intubation, Central Line, and Chest Tube Insertion Notewriter Smartforms available to the Emergency physicians

Seven new Procedure Notewriter Templates determined by ED Only Procedures have been created:

  • Laceration Repair
  • Suture Removal
  • Epistaxis Management
  • Foreign Body Removal
  • Ear Cerumen Removal
  • Orthopedic Injury Treatment
  • Splint Application

Flowsheet name has been changed from "Flo G SHCH ED Ice Pack Given" to "Ice/Heat Applied" to allow for ED techs to include documentation if heat was applied to an area on the patient

Modifications have been made to Physician Notewriter print group to show only the final version of the note, eliminating unnecessary addendums to print appropriate discharge instructions for the patient.

Other general changes to CS-Link

  • Results Review Tree: Changes to the Results Review Tree enable end users to easily locate lab results that were not previously categorized. Previously, these lab results typically fell under the "Other" section.
  • After Visit Summary: The AVS will automatically pull in MRSA and Coumadin information, which will benefit patients who receive information about self-care. The change also improves compliance with state laws.
  • Home Health: Home health coordinators will now be able to ensure a smooth transition between inpatient care and home health agencies by having the ability to edit and annotate relevant patient information with the creation of a new SmartText. Upon its completion, home health coordinators can then print and fax the note to the agencies.
  • New RT orders: "PEP Valve" and "Acapella Flutter" procedure orders will now be available for Respiratory Therapy.

For more information and screen shots of these improvements, visit cslinkcentral.org