Northeastern Nevada Regional Hospital

Getting you the treatment you need

By CAROL LAIRD- Northeastern Nevada Regional Hospital

You’ve been feeling sick for a while – a bad case of indigestion, but now it hurts in your chest. Heartburn or heart attack? A family member recalls reading about a short window of time in which to get medications to prevent major heart damage, so you’re off to the Emergency Room.

At Northeastern Nevada Regional Hospital, your chances of getting those meds on time are improved considerably, with the advent of the new Pro-MED Clinical System.

Pro-MED is “a comprehensive clinical management process that helps to ensure consistent, high quality care in the Emergency Department.” What that means to you, the patient, is the implementation of a tool to assist physicians, nurses, and even admitters in getting you the treatment you need in the most thorough, efficient manner possible. It also means a system of checks and balances so that subtle symptoms don’t get overlooked and that alerts your caregiver at the first sign of critical abnormalities.

Pro-MED utilizes a computerized program to assist with the management of patient care, standardize appropriate treatment protocols, evaluate assessment and diagnostic findings, optimize regulatory compliance, and provide important data for measuring overall department performance. NNRH’s system consists of the following modules:

Patient Manager - automates the triage process, provides patient tracking capabilities, and statistical reporting for tracking and trending.
Nursing Documentation – a series of complaint-specific templates for improved documentation of assessments and ongoing care.
Patient Teaching Assistance – provides hundreds of injury, illness and medication topics that are available in multiple languages
Continuous Performance Improvement – provides a method to conduct performance improvement reviews with online reporting for tracking and trending
Complete Data Management – includes over 70 standard reports and a query writer to monitor staff productivity and analyze performance. Monthly Executive Summary reports are also provided to management to assist in the formulation of administrative decisions.

It lets NNRH professionals look at what they are doing much faster and make sure the right things are being done all the time. Each patient’s individual parameters are programmed, so treatment can be customized within consistent standards of care across the system. The system increases efficiency by storing important information about each patient.

Dr. Stefanko, Director of Emergency Services at NNRH, concurs. “Technologically, it moves us forward,” he said. “It puts us on par with emergency departments in major medical centers and allows us to provide even better, more comprehensive care to our patients.”

But what about our heartburn/attack friend? What actually happens to him/her upon arrival at NNRH?

The person presents to the ER admitter, noting that he/she has upper abdominal/chest pain. That information is immediately entered into Pro-MED and is seen by all staff in the Emergency Department. Since the presence of chest pain can always mean potential critical illness, admitting notifies the nurse, who would come out immediately to triage the patient.

The nurse may choose at that moment to bring the patient directly into the ER, or to allow the person to stay and complete the admission process. The system will NEVER slow down treatment for the purpose of inputting data. The triage nurse makes that decision.

Once the patient is entered into the system – and into the ER itself – Pro-MED finds any medical history such as allergies and current medications, the patient may have had at NNRH, assists with and keeps track of his/her progress as different disciplines begin their work. Lab tests, x-rays and other diagnostic procedures can be ordered on line, and all are tracked by the system. Caregivers can log on to see the status – has the test been completed, run? Are the results available or on their way to the doctor?

Says Dr. Stefanko, “If a patient has been here more than once, since Pro-MED was implemented two and one-half years ago, their information will be in the computer. If they have a complex medical history, their medications will be in the system, and all we have to do is review and update that list. We don’t have to rely on the patient to give us a complete list each time, or if they come in unable to give us the information. This information retrieval system also speeds up the treatment process.”

The system allows for customized, updateable diagnostic and treatment parameters to be programmed, and even offers suggestions to the clinicians. “The physician ‘maps’ the tests they use for specific complaints. When that complaint is logged in, a list of potential tests will come up, and the physician can choose from those tests or can order different or additional ones,” Stefanko said, adding that the system is “completely physician driven. It does not drive the diagnosis or the physician’s decision making, it ASSISTS them.” And that assistance can save valuable time, Stefanko added. “It’s like the adding machine compared to a (high-speed) calculator or like standard internet access compared to broadband high-speed internet access.”

Lab tests ordered at the bedside go directly to the clinical laboratory, essentially bypassing any “middlemen” who used to have to write them, deliver them, and return for results. A tech can be dispatched within seconds, the blood drawn, the tests run immediately or “STAT” if necessary, and the results back as quickly as the specimen can be processed.

Other added benefits include the ability to set consistent standards of care, track and trend issues which might present opportunities for improvement, and the ability to measure the quality of care delivered in the Emergency Room, Stefanko said. “It provides an opportunity for the nurses to capture and measure information.”

Certain information can also be used to improve overall treatment processes and procedures. Patient data, such as length of stay in the ED, is easier to track and helps make hospital staff and professionals more responsive to patient care needs. By reviewing this data daily, staff can again look at what they are doing, make sure it is being done right, and to provide better care. Average length of stay in the ER is less than two hours; a number that NNRH staff is very proud of.

But one of the most valuable aspects of Pro-MED is the ability to impact the patient even after they are discharged from the Emergency Room. Happily, our heartburn patient had just that, and not a heart attack. He was discharged to his home, but instead of taking just a few handwritten instructions, he received an entire Pro-MED packet of information about his condition, his need for follow up with a primary care physician, and all of those same customized discharge instructions. In the packet, the patient and his family members could read about the condition itself, some parameters within which to make a decision about “do I return to the ER?” and what symptoms to look for. It also reviews all medications given and prescriptions written so that the patient and family can digest the information in the peace of their home – as opposed to trying to keep it all straight on the way out of the ER. It allows them to become more active participants in their care, and the instructions are available in Spanish, too.

If our patient had experienced a heart attack, the increased speed of test results and stabilization treatment at NNRH “would have expanded our window to get him to a cath lab (a clinic, usually in Reno or Salt Lake City, where a heart catheterization would be performed for more complete diagnosis of the problem).”

Overall, this real-life “ER” cast agrees, Pro-MED enhances NNRH’s patient care, speeds up the ER process, and provides patients with more information about their health.

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