With just one click on the computer, any staff member in our hospital's Day Surgery Unit can tell where any patient is at any given time. We can tell if the patient is in pre-op, has entered the OR, what stage the procedure is in (anesthesia, induction, prep, surgery, closing) or if the patient is in the PACU.

Four years ago, our facility was selected as one of the initial beta sites for our computerized patient tracking system, called Entelechy. It provides staff, patients and their families with detailed information that makes everyone's day go better, and it provides management with a tremendous tool for improving efficiency. We found this automated information to be so valuable that we added the Pyxis system about three years ago to provide the same level of tracking for patient meds.

These days, we'd be hard-pressed to function without these systems in place. Although neither system performs our primary job - care of patients before, during and after outpatient surgery - they provide us with detailed information that helps us do our job better. Here's how we're using technology to keep better track of our patients and our meds.

Every step they take
We use the Entelechy software for all surgical patients in our hospital. Before the day of surgery, we enter patient data into the system, including name, assigned surgeon and anesthesiologist, required pre-surgical tests, assigned OR and scheduled start time. Entelechy assigns the patient a number and enters it and the patient data onto a "swipe" card that looks much like a credit card.

On the day of surgery, our receptionist places the Entelechy card in the patient chart. The nurse who escorts the patient to pre-op will explain the system to the patient and family member, and then swipe the card so the system knows the patient is in pre-op. We give the patient number to the family member, who can enter the number into the waiting-room computer to check on the patient's status.

Pre-op nurses swipe the card when the patient is ready to go to the OR. When the OR nurse takes the patient to the OR and enters the room, she click on the OR terminal the "In room" time stamp. The OR nurses simply click on the OR terminal (every OR has one) at each of the eight stages of the procedure:

• Anesthesia begins
• Induction begins
• Prep begins
• Prep ends
• Surgery begins
• Closing begins
• Surgery ends
• Patient to PACU

To check on patient status, our staff members can access a terminal in pre-op, any OR and PACU. The screen is color-coded so the staff can interpret patient status at a glance: Black means the patient isn't in the OR yet, blue means surgery has started and red means the surgeon is closing (this is when we alert the family and warn PACU).

We use this information to manage PACU beds. We can see when the patient will be coming, and if PACU is already full, can divert the patient to our inpatient PACU in another wing of the hospital. This also helps us manage the flow between Stage 1 and Stage 2 of the recovery area. We also have a special screen in the physician lounge with information updated every 30 seconds regarding which ORs are in use by which surgeons, the status of cases and which cases are scheduled next.

Throughout this time, the family member simply enters the patient number in the waiting-area terminal and sees any one of 10 pre-set messages that describe patient status, such as patient in holding, surgery in progress, patient transferred to PACU or patient resting quietly. This keeps the family informed while preventing interruptions to staff to check on patients.

Tracking meds
We also use the Pyxis system for medication dispensing throughout our hospital. The pharmacy department loads the meds daily, then gives us a printout that shows our inventory level. We post this above the med station each day. As the meds are dispensed, Pyxis informs the pharmacy directly about the change in inventory and alerts the pharmacists when restocking is needed.

To access meds, the staff member presses a thumb on a bioprint pad, which scans the thumbprint and presents a touch screen (to approved personnel only). The staff person selects patient name and medication on the touch screen, and the appropriate med drawer opens. Pyxis only gives access to the selected med, and then provides a record of who entered and took the med. It also provides a backup to the patient chart regarding the time the med was dispensed.

Pyxis lets us stay on top of med inventories and call the pharmacy when they are getting low. Before we had the system, we would often run out of meds, and some meds had to be ordered "per patient." That meant a staff member would have to run off the unit to get the meds from the pharmacy. Pyxis requires the nurses to verify narcotic counts before dispensing any medications and notes discrepancies that merit investigation.

How it helps
These systems offer obvious day-to-day benefits, but they also help us manage resources and improve efficiency.

Entelechy helped us determine our actual OR turnover time. Although we'd like to achieve the ideal time of 10 minutes per case, we don't have an anesthesiologist dedicated to this unit. Our cases were running an average of 15 to 20 minutes. We now have the system programmed to 20 minutes per case, and the surgeons cannot override it (they sometimes would reduce case times reported in the system). Now our schedule is running on time 85 percent of the time; previously, we were fortunate to be on time 50 percent of the time.

Without Entelechy, we didn't always know where the surgeons were, the PACU didn't know exactly when patients were coming, there was no way to track delays and we couldn't always respond to families asking about patient status. The information we have at our fingertips helps us to make better decisions about allocating staff and resources.

In terms of implementation, Entelechy was the most difficult for the OR teams. The nurses were not accustomed to clicking in the patient status as the procedure went along, and this took some practice. We found that the best way to address this was to stress the importance of swiping the patient card or clicking the computer every step of the way, and then reinforcing good habits with praise and recognition. By now, using Entelechy has become second nature.

Pyxis has greatly improved med security. We now know exactly who took what - or at least who provided access to the system. If the daily narcotics check shows a discrepancy, we know which staff members must justify the difference. Our general med inventory stays stocked with the right meds for the right patients, without diverting busy personnel to the pharmacy.

Upgrading for the future
As with any technology, we're looking to upgrade. This year we hope to:

• Integrate our OR scheduling software with Entelechy's patient-tracking capabilities.
• Control our supplies as well as our meds. We'll be trialing a Pyxis supply system for the supply area that serves all 23 ORs in the hospital. The goal is to automate preference lists and patient charges.