]]> http://www.ellipticase.com/2011/07/24/scutsheet-1-2-submitted-to-app-store/feed/ 0 http://www.ellipticase.com/2011/06/02/waste/ http://www.ellipticase.com/2011/06/02/waste/#comments Thu, 02 Jun 2011 23:49:39 +0000 ellipticase http://www.ellipticase.com/?p=148 I know how you feel . . .

Yesterday I spent about 6 hours sitting in front of a computer typing up discharge summaries for a number of patients on the ward I’m covering. They were all new admissions to my ward but most had been in hospital for a few weeks.

Because of the way departments are funded, the job of recording all the complications, procedures, treatments and outcomes onto the discharge summary is vital for keeping the unit going (economic rationalism has it’s foothold). The tricky thing is that when we take over a patient it is only through the patients documentation (progress notes and med charts mainly) and their investigations that an adequate summary can be made.

And this is where the waste comes in.

Of the 6 hours I spent at the computer I estimate that about 4 was spent trawling through separate databases for demographic, pathology, and radiology data then manually copying and pasting it into a stand alone word document. This drives me crazy. Essentially, instead of having an automated process that draws those data together into a single document, which is nothing groundbreaking in terms of IT (in fact it’s the whole point of databases), I have to wade through different systems with different logins to extract the data one hard earned bit at a time.

Deleting Scutsheet and reinstalling should allow you to open the program, but with the loss of existing data. For this reason, we recommend waiting until patient’s a discharged or you go off service before upgrading.

Scutsheet Lite is available from the App Store.

From the review:

the patient data entered into Scutsheet is still entered manually and, as of now, cannot be shared with other doctors. However, for anticipating how tablet computers may actually be used at the bedside and for creating a visually beautiful app, we should congratulate the makers the Scutsheet.

Read the whole thing here.

To access vital sign ranges, click on the vital sign title (P, BP, RR, SpO2, CVP, or MAP). Click again to toggle back.

Scutsheet 1.1 also includes more options for oxygenation. Select from room air, nasal cannula, non-rebreather, “V-Mask”, CPAP, BiPAP, assist control, pressure support, pressure control and SIMV and the associated settings. Scutsheet only shows you what you need.

Also included:

-More calculations: BSA, BUN/Cr ratio, albumin-adjusted anion gap and corrected calcium.
-Albumin now appears in the chem 10 widget.
-Absolute cell line counts automatically calculated.
-Convert height and weight between english and metric.
-New lipid panel.
-Haptoglobin now included with iron studies.
-New one line assessment field.

Scutsheet 1.1 is available at the iTunes App Store.

Medfools.com has a Scutsheet for every specialty and level of experience. Download and print as PDFs.

Virginia Commonwealth Internal Medicine is also a great source. They also have rounding tips for medical students and housestaff.

And of course, you can always make your own. That’s how this project started.

Operations begin at 7:30, rounds start at 6:00, and the four students arrive at 5:00 am to prepare progress notes and “make THE LIST” of patients on the service. The resident progress note is a template printed from Microsoft Word and put into the patient’s chart (a three-ring binder). “THE LIST” is printed from a web based program, but an e-mailed Word table suffices at other sites. Surgical rounds are too early for AM labs, but on the Medicine Service, these also make it onto the progress note.

The vitals and raw ins and outs (I&Os) are required on each of these sheets of paper. At this particular hospital, nurses record vitals and I&Os in the electronic medical record, but because they can’t be usefully printed, they still need to be recopied. Elsewhere, vitals are recorded on “the flowsheet”, a sheet of paper kept in the often misplaced “order book.” In surgery, I&Os from the last 8 and 24 hours are calculated. And in Pediatrics, the child’s weight is used to report urine output in cc/kg/hr.

Because there are can be 30 patients with 30 progress notes, and because each member of the team (there are 10) needs a copy of THE LIST, students cut out slips of paper on which they hand-write the vitals and I&Os, and tape them onto the appropriate forms, and run to the copy machine to have 10 copies ready by 5:55.

To recap, vitals, which were entered into the computer by nursing, are hand copied onto a progress note, then again into the sign out, and in some cases, a third time onto notecards and scutsheets.

This is was the workflow that led to Scutsheet, and while it doesn’t solve it, it illustrates the problem.