Pediatric Informatics: Computer Applications in Child Health (Health ...

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84 W.H. Drummond et al. A recovery room implementation of an IT system may unexpectedly slow down transfer processes. Consequently, the number of cases admitted from the operating room may exceed the number of unoccupied beds in the recovery room, resulting in canceled surgeries and dissatisfied patients and providers. Change may interrupt the healthcare process at multiple levels, requiring analysis, subsequent modifications and interventions to respond to the interruptions. Change (especially IT implementation) can make existing latent failures of the care system more pronounced, because previously established work-arounds no longer function. One example is the implementation of a CPOE system in a hospital where the admission, discharge, and transfer (ADT) process is not working effectively. Previously, providers were able to order on paper, even if the patient’s medical record number was not yet available. With CPOE system, the patient must be registered and must “be in the system” in order for a provider to place an order. The work-around (the piece of ordering paper) has effectively been rendered useless without being replaced by another “break-the-glass functionality” for quick interventions in critically ill patients. IT implementations in health care venues can fail on many levels. 4–7 In “worst case” scenarios, poorly designed or implemented IT systems may impact an entire healthcare system and may lead to a removal of the HIT system, as occurred at Cedars-Sinai Hospital. 4, 8–10 In health care, unanticipated consequences may not only have a negative effect on the institution and the providers, but may be dangerous and detrimental to the health of patients. 11–13 8.2 Scenario A: Change and Consequences Summary: This case study explores the failure of a quality improvement (QI) initiative in a neonatal critical care unit. The scenario highlights how important human factor analysis is to the success of every change process involving human systems, while illustrating how HIT may sometimes become an obstacle to optimum patient care. 8.2.1 Quality Improvement Goal: Achieving Optimal Oxygen Saturation Newborn Intensive Care units (NICU) struggle with managing the oxygen saturation of premature infants in an optimal range. Too much oxygen may cause blindness; too little causes brain injury. In this scenario, two NICUs within the same health system implemented a QI protocol to improve oxygen management in premature infants that had been successfully used in other institutions (Fig. 8.1). Nurses set the oxygen alarm limits on the patient’s monitor as per physician order. The percent of time that the oxygen saturation limits were set as ordered during random audits was selected as outcome measure. In the first 3 months, the intervention failed completely in NICU B, while NICU A could show some moderate success (Fig. 8.2).
8 Complexity in Healthcare Information Technology Systems 85 Request orders for routine or custom saturation limits Routine Set saturation monitor limits to 85-95% Custom Set saturation monitor limits as ordered (PPHN, DH, congenital hearts) Low Alarm sounds Saturation
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Health Informatics (formerly Comput
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Editors Christoph U. Lehmann George
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vi Series Preface changes to both t
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viii Foreword This text will prove
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x Preface financial investment and
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How to Use This book This book is t
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xvi Contents 9 Pediatric Care, Safe
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xviii Contents Part VII A Vision an
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xx Contributors Donna M. D’Alessa
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xxii Contributors Christoph U. Lehm
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xxiv Contributors Mark M. Simonian,
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4 G.R. Kim pharmacy, medical educat
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6 K.B. Johnson and G.R. Kim Deaths
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8 K.B. Johnson and G.R. Kim 2.4.1 I
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10 K.B. Johnson and G.R. Kim 2.4.3
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12 K.B. Johnson and G.R. Kim Educat
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14 K.B. Johnson and G.R. Kim 2.6 Co
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Chapter 3 Core Pediatric Data Kevin
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3 Core Pediatric Data 21 3.3 Pediat
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3 Core Pediatric Data 23 3.6 Pediat
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Chapter 4 Neonatal Care and Data De
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4 Neonatal Care and Data 27 Essenti
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136 D.M. D’Alessandro 10.4 Pragma
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138 D.M. D’Alessandro 4. Case ser
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140 D.M. D’Alessandro Ontario, BC
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142 D.M. D’Alessandro Table 10.1
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144 D.M. D’Alessandro Children ar
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146 D.M. D’Alessandro 17. Ely JW,
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Chapter 11 Clinical Practice Guidel
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11 Clinical Practice Guidelines: Su
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162 M.J. Feldman in patients withou
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164 M.J. Feldman The art of medicin
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166 M.J. Feldman important design g
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168 M.J. Feldman Incorrect or missi
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170 M.J. Feldman Fig. 12.4 GIDEON D
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172 M.J. Feldman system or etiology
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174 M.J. Feldman ED-12: “Practica
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176 M.J. Feldman Fig. 12.7 DXplain:
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178 M.J. Feldman For GIDEON: Rabies
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180 M.J. Feldman KB on infectious d
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182 M.J. Feldman 4. Johnson KB, Fel
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Chapter 13 Managing Pediatric Knowl
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13 Managing Pediatric Knowledge Res
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Chapter 14 Supporting Continuing Pe
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14 Supporting Continuing Pediatric
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14 Supporting Continuing Pediatric
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Chapter 15 Pediatric Care Coordinat
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15 Pediatric Care Coordination: The
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Chapter 16 Prioritizing Pediatric I
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16 Prioritizing Pediatric Investmen
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Chapter 17 Aligning Pediatric Ambul
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17 Aligning Pediatric Ambulatory Ne
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258 G.R. Kim and C.U. Lehmann Elect
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260 G.R. Kim and C.U. Lehmann 18.2.
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262 G.R. Kim and C.U. Lehmann There
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264 G.R. Kim and C.U. Lehmann 13. C
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266 K.B. Johnson and C.G.M. Weigle
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280 C. Sable et al. computer for la
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282 C. Sable et al. Table 20.3 Tele
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284 C. Sable et al. without increas
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286 C. Sable et al. Fig. 20.1b Wash
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288 C. Sable et al. prior to case d
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290 C. Sable et al. presence of con
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292 C. Sable et al. 17. Sable C, Ro
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294 A.E. Zuckerman and G.R. Kim 21.
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296 A.E. Zuckerman and G.R. Kim �
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Chapter 22 Privacy Issues David M.N
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22 Privacy Issues 305 22.3 Pediatri
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22 Privacy Issues 307 patient must
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22 Privacy Issues 309 and receipt o
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Chapter 23 Electronic Mail in Pedia
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23 Electronic Mail in Pediatric Pra
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Chapter 24 Information Management b
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24 Information Management by Patien
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Chapter 25 Overview of Pediatric In
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25 Overview of Pediatric Inpatient
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Chapter 26 Prescribing/Ordering: Co
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26 Prescribing/Ordering: Computeriz
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346 S.H. Mitchell et al. 27.2.1 Med
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348 S.H. Mitchell et al. context of
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350 S.H. Mitchell et al. 27.3.3.1 C
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352 S.H. Mitchell et al. challenges
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354 S.H. Mitchell et al. work round
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Chapter 28 Medication Administratio
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28 Medication Administration and In
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Chapter 29 Understanding and Preven
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29 Understanding and Preventing Err
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386 D.C. Stockwell and A.D. Slonim
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400 J.H. Schneider a number of prob
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402 J.H. Schneider on governance, u
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404 J.H. Schneider 31.6.1 Data Rele
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406 J.H. Schneider Understanding op
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408 J.H. Schneider of this componen
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410 J.H. Schneider Table 31.1 (cont
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412 J.H. Schneider References 1. Am
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Chapter 32 Developing Pediatric Dat
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32 Developing Pediatric Data Standa
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430 G.R. Kim and S.T. Rosenbloom Co
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432 G.R. Kim and S.T. Rosenbloom No
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434 G.R. Kim and S.T. Rosenbloom pr
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436 G.R. Kim and S.T. Rosenbloom ab
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Chapter 34 Pediatric Research and I
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34 Pediatric Research and Informati
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Chapter 35 The Moving Picture of Pe
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35 The Moving Picture of Pediatric
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470 G.R. Kim and K.B. Johnson Cente
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472 G.R. Kim and K.B. Johnson 36.4
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Index A 2006 AAP recommendations on
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Index 477 psychological data, 45 se
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Index 479 High frequency flow inter
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Index 481 O Online Mendelian Inheri
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Index 483 Standards development org
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