Opening SRMC has brought many successes, but also many challenges. As a physician, it can be particularly frustrating to run into barriers that prevent you from taking care of your patients. That’s why we believe it is absolutely essential to resolve problems as quickly as they develop and to communicate the solution back to you. We wanted to use this space to let you know about some of the obstacles that we have encountered and how they have been overcome.

Many physicians have had difficulty receiving pages both in and outside of the hospital.

RESOLUTION: An Aquis paging tower was erected on the roof of the building and repeaters were installed on hospital floors to increase paging reception. However, paging reception remains a challenge in Radiology due to the lead walls.

RESOLUTION: A new paging system has also been implemented called “Amion” which allows only the on-call physician’s paging information to display to our PBX operators. This has been implemented to eliminate unneeded pages and the physician on-call schedules are also verifiable and viewable for physician practices on the internet.

Physicians were having difficult viewing and signing patient’s records after discharge.

RESOLUTION: HCare and the portal are two systems that have been added to make it easier for physicians to view and sign off on their discharged patient’s charts. The portal is used to process outstanding orders and other chart deficiencies and is accessible after logging into HCare. HCare is the main portal for viewing patient information post discharge. HCare can be accessed via the web, and all records are picked up at the facility the day after discharge to be scanned electronically into the system.

Other issues and resolutions:

TASK: Physicians had to sign orders in both Meditech and HCare and in some cases drugs administered in the OR were rolling into the operating physician’s queue to be signed instead of anesthesia’s queue.

TASK COMPLETION PROCESS: Verbal and telephone orders need to be signed within 24 hours  of giving the order and all verbal orders must be signed within 24 hours after discharge or they will need to be signed both in HCare and Meditech.  Also anesthesia orders were rolling into the operating surgeons queue because the system was not recognizing that anesthesiologists were dispensing the medication during a procedure and drugs were being assigned to operating surgeon.

RESOLUTION: All verbal orders must be signed 24 hours after the order and outstanding orders within 24 hours of discharge.  All anesthesia medications dispensed have been pulled from operating surgeon’s queues in HPF.

DATE RESOLVED: 9/28/2010

TASK: Physician orders are not crossing into the nursing Meditech module and as a result the nurse is not seeing the physicians order.

TASK COMPLETION PROCESS: Physician orders were crossing over into nursing queue.  On further examination, it was determined orders did not immediately appear due to pharmacy verifying the order and then transferring it into the nursing module.

RESOLUTION: Physician orders were confirmed that they were crossing over. Between 8 am and 11 pm, on-site pharmacists verify physician orders and a central pharmacy verifies orders between 11 pm and 7 am. We are currently monitoring order turn-around times when orders are sent down to the central pharmacy for verification.

DATE RESOLVED: 9/22/2010

TASK: Diagnostic forms are on the internet for physician practices to access.

TASK COMPLETION PROCESS: A diagnostic form was developed, bar-coded and placed on SRMC’s internet page for practices to print and fill out.

RESOLUTION: Order form has been placed on the internet:{60A3250A-D7FB-4A90-B932-95554447B664}

DATE RESOLVED:  9/22/2010

TASK: Physician access to computers is expiring after 30 days and MDs and other staff are locked out of the computer system.

COMPLETION PROCESS: Meditech lock-outs were determined to be a corporate IT security policy that deactivated accounts which were inactive for 30 days.

RESOLUTION: On-site IT&S is monitoring physician Meditech accounts and identifying potential inactive accounts and reactivating them.

DATE RESOLVED: 8/20/2010

TASK: Pharmacy was not taking verbal orders from physician.

TASK COMPLETION PROCESS: Physician contacted Pharmacy and gave a verbal order to a pharmacy tech.  Pharmacy tech was unable to take the verbal order, however a pharmacist can take a verbal order from a physician.

RESOLUTION: Physician must give any verbal orders to a pharmacist.

DATE RESOLVED: 7/28/2010

TASK: Physicians are unable to find technology support on the floors.

TASK COMPLETION PROCESS: Each department identified staff and has trained them in the physician documentation and order entry modules. The nursing supervisor received a list of all staff that were trained as Super-users.  In order to contact a Super-user, a hotline was developed: extension “4-DOC” (4362), which can be dialed from any phone and just ask either the nursing supervisor or PBX operator for a Super-user and inform them of your location at the hospital.

RESOLUTION: Staff training was completed and a list distributed to the nursing supervisor. For any Meditech or other concerns dial 4-DOC inside the hospital and a super user will assist you.

DATE RESOLVED: 7/21/2010

TASK: Physicians are concerned regarding the difficulty of navigating Meditech and entering orders.

TASK COMPLETION PROCESS: We can develop templates customizable to physician specialties that will streamline both Meditech’s appearance and the type of information displayed.  Order sets can also be developed for each physician specialty. Any order sets containing medication or clinical protocols must be approved by the monthly meeting of the Pharmacy and Therapeutics committee composed of community and hospital based physicians from each specialty. After approval the order set will go to Jean Barchet to program it into Meditech

RESOLUTION: Contact Wendi or Kristin from our physician relations department or Barbara Wiggins from pharmacy to have order sets developed.  Jean Barchet can be contacted for Meditech questions

DATE RESOLVED: 7/21/2010

TASK: Physicians are concerned about when consults are entered.

TASK COMPLETION PROCESS: Consults have been differentiated into two types of consults with separate instructions for each:

1. Call non-urgent consults at 7am when new covering MD takes over

2. Call emergent/urgent consults immediately

RESOLUTION: Communicated to staff when to call consults to physicians

DATE RESOLVED: 7/21/2010

TASK: Physician Pages – It is difficult to contact physicians through their answering service and were are encountering resistance from the service.

TASK COMPLETION PROCESS: A fax was sent to all offices and physicians about correct contact information.  We contacted the answering service and affirmed that it was correct to call them to contact physician that was on-call

RESOLUTION: Answering service can be contacted for physicians

DATE RESOLVED: 11/5/2010

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