A Locum’s ScrapBook: 49 & 50
Editor’s Note:
In the middle of this month, January 2017, I had the privilege of visiting and assisting three teams in the Midwest, representing an institution I have been at previously several times, and then a new venture a little further South, that implies two more clinical sites adding to the sum of hospitals I have pumped at during my tenure as a perfusionist.
The 49 & 50 thing?
That’s just a pure math end-point, not a notch on a perfusion belt, or some sort of chest beating symbolism which is obviously meaningless. What it plateaus to, is the very new and very real challenges in terms of proving yourself, acclimating, and adjusting to a different way of doing things.
Well my latest assignment ended up being a a re-visitation (in terms of systems) to when I trained as a student. Roller heads and venous bags. The newest challenge being a very robust effort to integrate a completely paperless and current Perfusion EMR system that draws information from multiple sources.
What follows is my assessment of how real time electronic data entry impacts perfusion performance in terms of attention to detail (your eyes on the pump and patient) versus data collection to make everything paperless- and being able to punch out a seamless pump record at the end of the case.
The Data Entry TightRope: Welcome to EMR!
I have noticed increasingly the emphasis of both Anesthesia as well as Perfusion teams to spend an exponentially larger portion of their attention to detail, to make sure the EMR is addressed and appropriately filled out. Those MDA’s spend more time looking at their previously entered data points (Time in; Intubation; Incision; etc;) data point checks that used to be on the tip of their tongues.
Gone are the days of reliance on short term memory- as we defer to the input on our electronic charts, and somehow we now need to look up routine clinical markers as opposed to just being able to spout them off as we used to do- by memory or casually looking at the paper record we had just imprinted on.
Having used repetitive paper entry and and realizing the fact the the actual effort of scripting in details essentially mirrors more closely the paradigm and mechanisms of our entire educational process that brought us here to begin with, we potentially retard our ability to recall data that at the last fingertip may have been recorded from a pre-defined drop down menu.
The point I am trying to make? When I spend more time trying to navigate and make sure that data entry to whatever program I am now a slave of- becomes a more difficult proposition than whatever ECC I am dealing with, well that’s about a 30% attention shift away from the clinical details of the operation.
In my practice the clipboard approach has some unrecognized residual merits. It’s basically a game plan in your hand that allows you to stay alert and represents a timeline and retrospective checklist that generations of perfusionists agree- it keeps them sharper.
When you have a drop down menu that says YES to the “completion of your pre-bypass checklist ” question- well that’s fun and easy, but perhaps a little too easy, and presents a check box that doesn’t prove anything aside from an easily filled out prebypass checklist.
My REC? Always have a backup paper plan for when the on-site EMR system becomes un-navigable, or just too time invasive to direct your attention away from the primary directive- pump the case and get the patient off the table alive as well as remembering who they are.
Any perfusionist worth their salt will pump the case first- and do the peri-operative data dump later 🙂
Peace
Frank
