No. 5: UAB Health System

The University of Alabama Hospital, the cornerstone of the UAB Health System, is a 908-bed, tertiary- and quaternary-care teaching facility. As the only Level I trauma center in Alabama and one of the largest transplant centers in the southeastern U.S., UAB Hospital provides the highest quality and cutting-edge patient care in the region, serving almost 42,000 inpatient admissions and more than 54,000 emergency room visits annually.

The system, not satisfied with the industry standard for biomedical device integration, or BMDI, implementations, partnered with our electronic health-record vendor to develop and implement cutting-edge software and hardware solutions that not only integrated our existing clinical system but established the foundation for future bedside device integrations as well.

Traditional BMDI implementations have many opportunities for documentation errors. The majority of devices were often associated based on patient location, limiting accuracy of information to admission, discharge and transfer data. Manual device association and clinical data documentation are also labor-intensive and prone to error.

UAB Hospital recently implemented an EHR in May 2008, resulting in a significant increase in nursing electronic documentation. The system’s goal of improving patient safety and nursing workflow efficiency meant creating a better solution, requiring a paradigm shift to associate devices with patients instead of the industry standard of associating devices to locations.

The BMDI implementation project engaged a truly multidisciplinary team, including BioMed to support medical devices, programming and installation of adapters; nursing for design, workflow, testing and training; and information

technology, which worked closely with our EHR vendor to build the application. One of the key components of the BMDI implementation project was the use of positive patient identification by using bar codes and scanners. To effectively integrate the system, the nursing workflow was redesigned. The sequential scanning of the patient’s monitor and armband ensures that the right patient’s health information is incorporated into that person’s medical record. One of the key components of this new workflow design is that it ensures no results are ever written to the patient’s medical record without a nurse verifying the accuracy of the information.

As a result of the BMDI implementation, nursing has achieved a significant reduction in average time for documenting vital signs, dropping from four minutes to 20 seconds, a 92% efficiency gain. The total time that was reallocated to direct patient care per nurse per shift varied from 227 minutes to 79 minutes depending on the specific unit’s care protocols. The implementation also resulted in a dramatic increase of nursing satisfaction with electronic documentation. We were also fortunate in being able to leverage our existing facilitywide standardized biomedical devices such as ventilators to reduce both implementation time and cost.

The BMDI project is part on an ongoing initiative that over the past 12 months cost approximately $800,000, including technology and other resources. However, we feel that the significant improvement in nursing workflow, allowing for more direct patient care significantly enhancing our patient safety efforts, while improving nursing satisfaction with electronic documentation, has been a more than compelling return on our investment of these resources. Currently UAB Hospital has 146 intensive-care-unit beds automated with monitors, all 126 ventilators are capable of automation, and we are in the process of rolling them out to the different nursing units.

Next in the UAB Health System’s biomedical device integration pathway are smart pumps. Smart pumps are an integral part of the system’s goal to move toward a more integrated EHR. Smart pumps would enhance our patient-safety efforts as well as adherence to the five rights of medication administration by using bar-coding technology and electronic medication libraries to ensure that the right patient gets the right drug at the right dosage at the right time via the right route.

With stimulus funding support, UAB Health System would be able to expedite implementation of the smart pump pilot project and help us raise the bar higher to provide even safer patient care.

Joan Hicks
Chief information officer
UAB Health System
Birmingham, Ala.

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