Using the Electronic Medical Record to Maximize Practice Efficiency: An Example in the Neurosurgery ICU

Christopher Michael Nickele, MD1, Joshua Medow, MD1

1Madison, WI United States

Keywords: critical care, software, History, database, surgery

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     Care of neurosurgical patients can be time intensive. However, time spent in the neurosurgical ICU may not be billable critical care time, or may otherwise be an inefficient use of the neurosurgeon’s time.
     The electronic medical record can automate certain tasks, allowing the neurosurgeon’s time to be spent more wisely. This can be applied across a practice, but is exemplified here in organ donor patients.
     Brain dead donor patients.
     An order set was created for managing brain dead donor patients, which included nursing protocols for management of blood pressure, serum sodium, ventilator settings and other parameters. Programs were built into the electronic medical record to automatically determine the proper response to blood pressure fluctuations, free water deficit, etc. Data was collected prospectively on the neurointesivist’s critical care hours spent and pages answered before and after creation of the order sets.
     Prior to the order set, average critical care hours spent managing a brain dead donor patient was 5.9+/-0.4, with 12+/-1 pages answered (n = 3). After instituting the order set, hours spent were 2.3+/-1.2 with 10+/-7.3 pages answered (p values 0.001 and 0.65 respectively, n = 8). At $850 per hour for critical care time, 3.6 hours average difference amounts to $3060 per patient.
     This is a retrospective study.
     The electronic medical record, used as an instrument to automate that patient care which can be protocoled, can significantly modify the mix of hours spent in the ICU.
     This can allow neurosurgeons to spend their hours in a more cost-effective manner, caring for more acute patients, operating, or in clinic.


Project Roles:

C. Nickele (), J. Medow ()