Abstract:
A computer-assisted method of tracking a patient through a perioperative process. The process includes entering a location of the patient into a patient tracking system, entering at least one procedural time into the patient tracking system, and tracking, via a terminal connected to a distributed computer network, the patient through the perioperative process based on the location of the patient and the procedural time.

Description:
CROSS-REFERENCE TO RELATED APPLICATIONS  
         [0001]    (Not applicable)  
         STATEMENT REGARDING FEDERALLY SPONSORED RESEARCH  
         [0002]    (Not applicable)  
         BACKGROUND OF THE INVENTION  
         [0003]    1. Field of the Invention  
           [0004]    The present invention is directed generally to a system and method for tracking a patient and, more particularly, to a system and method for tracking a patient through a perioperative process.  
           [0005]    2. Description of the Background  
           [0006]    As a patient advances through a perioperative process, it is difficult for the hospital staff to track the progress of the patient. Staff members must monitor the patient using a combination of verbal communications via telephone calls and in-person conversations, and personal observations.  
           [0007]    A real-time patient tracking system is described in: Rotondi et al., “Benchmarking the Perioperative Process. I. Patient Routing Systems: A Method for Continual Improvement of Patient Flow and Resource Utilization”, J. Clin. Anesth., vol. 9, March 1997, pp. 159-69; Williams et al., “Benchmarking the Perioperative Process. II. Introducing Anesthesia Clinical Pathways to Improve Processes and Outcomes and to Reduce Nursing Labor Intensity in Ambulatory Orthopedic Surgery”, J. Clin. Anesth., vol. 10, November 1998, pp. 561-68; and Williams et al., “Benchmarking the Perioperative Process. III. Effects of Regional Anesthesia Clinical Pathway Techniques on Process Efficiency and Recovery Profiles in Ambulatory Orthopedic Surgery”, J. Clin. Anesth., vol. 10, November 1998, pp. 570-77. The described system uses barcode and client-server, or local area network (LAN) technology, to track the progress of patients during the perioperative process. The described system does not use the distributed capabilities of the Internet to allow access to the data in the system. Further, the described system does not have a means for tracking delays that are inherent in the perioperative process.  
           [0008]    Thus, there is a need for a system and method for tracking a patient through the perioperative process that use the distributed capabilities of the Internet so that, for example, hospital staff and patient families can view the progress of the patient through the process. There is also a need for a system and method for tracking a patient through the perioperative process that allow for delays to be entered into the system so that the patient&#39;s progress can be tracked in light of such delays. There is a further need for a system and method for tracking a patient through the perioperative process that use wireless technologies to register the patient at various stages of the process.  
         SUMMARY OF THE INVENTION  
         [0009]    The present invention is directed to a computer-assisted method of tracking a patient through a perioperative process. The process includes entering a location of the patient into a patient tracking system, entering at least one procedural time into the patient tracking system, and tracking, via a terminal connected to a distributed computer network, the patient through the perioperative process based on the location of the patient and the procedural time.  
           [0010]    The present invention represents a substantial advance over prior systems and methods of tracking patients through the perioperative process. The present invention has the advantage that it allows for the tracking of a patient through the perioperative process using the distributed capabilities of the Internet so that, for example, hospital staff and patient families can view the progress of the patient through the process using a distributed computer network, such as the Internet or the hospital&#39;s intranet. The present invention also has the advantage that it allows for the tracking of a patient through the perioperative process while allowing for delays to be entered into the system so that the patient&#39;s progress can be tracked in light of such delays. The present invention has the further advantage that it allows for the tracking of a patient through the perioperative process using wireless technologies to register the patient at various stages of the process. 
       
    
    
     BRIEF DESCRIPTION OF THE DRAWINGS  
       [0011]    For the present invention to be clearly understood and readily practiced, the present invention will be described in conjunction with the following figures, wherein:  
         [0012]    [0012]FIG. 1 is a diagram illustrating the stages of a typical perioperative process;  
         [0013]    [0013]FIG. 2 is a diagram illustrating a patient tracking system;  
         [0014]    [0014]FIG. 3 is a diagram illustrating an embodiment of a flow through the system of FIG. 2; and  
         [0015]    FIGS.  4 - 15  are screen printouts illustrating an example of a software implementation of the system of FIG. 2.  
     
    
     DETAILED DESCRIPTION OF THE PREFERRED EMBODIMENT  
       [0016]    [0016]FIG. 1 is a diagram illustrating the stages of a typical perioperative process  10 . An ambulatory patient enters same-day surgery  12 , and then may enter a pre-op holding area  14 . The patient then enters the operating room  16 , followed by a post-anesthesia care unit  18  and a second-stage recovery room  20 . Optionally, the patient may proceed from the operating room  16  to an intensive care unit  22 . An inpatient may enter a pre-op holding area  14 . The patient then enters the operating room  16 , followed by a post-anesthesia care unit  18 . Following the post-anesthesia care unit  18 , the patient returns to an inpatient bed. The perioperative process  10  is supported by the hospital&#39;s operating room scheduling process  24 , a central sterile area  26 , an operating room supply area  28 , and various ancillary services  30 . The process  10  is also supported by the various labor components  32  of the hospital such as, for example, surgeons, nurses, anesthesiologists, technicians, supply technicians, managers, and transport personnel. Patient families  34  are also involved in the process  10  because they are interested in monitoring the process  10 .  
         [0017]    The perioperative process  10  can be monitored by tracking some or all of the procedural times and any delay codes at each stage. Table 1 illustrates procedural times, Table 2 illustrates procedural and scheduling definitions and time periods, and Table 3 illustrates utilization and efficiency indices, including delays, that can be tracked. The entries in Tables 1, 2, and 3 are described in further detail in Donham et al., “Glossary of Times Used for Scheduling and Monitoring of Diagnostic and Therapeutic Procedures”, Supplement to the American Journal of Anesthesiology, September/October 1996, pp. 4-9, which is incorporated herein by reference.  
                             TABLE 1                       PROCEDURAL TIMES                                    1.1   Patient In Facility               (PIF)           1.2   Patient Ready For               Transport (PRT)           1.3   Patient Sent For (PF)           1.4   Patient Available (PA)           1.5   Room Set-up Start               (RSS)           1.6   Anesthesia Start (AS)           1.7   Room Ready (RR)           1.8   Patient In Room (PIR)           1.9   Anesthesiologist, First               Available (AFA)           1.10   Procedure Physician,               First Available (PPFA)           1.11   Anesthesiologist of               Record In (ARI)           1.12   Anesthesia Induction               (AI)           1.13   Anesthesia Ready (AR)           1.14   Position/Prep Start (PS)           1.15   Prep Completed (PC)           1.16   Procedure Physician of               Record In (PPRI)           1.17   Procedure/Surgery Start               Time (PST)           1.18   Procedure/Surgery               Conclusion Begun (PCB)           1.19   Procedure Physician of               Record Out (PPRO)           1.20   Procedure/Surgery Finish               (PF)           1.21   Patient Out of Room               (POR)           1.22   Room Clean-up Start               (RCS)           1.23   Arrival in               Postanesthesia Care               Unit/Intensive Care Unit               (APACU)           1.24   Anesthesia Finish (AF)           1.25   Room Clean-up               Finished (RCF)           1.26   Ready-for-Discharge               From Postanesthesia Care               Unit (RDPACU)           1.27   Discharge From               Postanesthesia Care Unit               (DPACU)           1.28   Arrival in Same-Day               Surgery Recovery Unit               (ASDR)           1.29   Ready-for-Discharge               From Same-Day Surgery               Recovery Unit (RDSDSR)           1.30   Discharge From Same-               Day Surgery Recovery               Unit (DSDSR)                      
 
         [0018]    [0018]                             TABLE 2                       PROCEDURAL AND SCHEDULING DEFINITIONS       AND TIME PERIODS                                    2.1   Anesthesia Preparation               Time (APT)           2.2   Average Case Length               (ACL)           2.3   Block Time (BT)           2.4   Case Time (CT)           2.5   Early Start Hours (ESH)           2.6   Evening/Weekend/Holiday               Hours (EWHH)           2.7   In-Own Block Hours               (IBH)           2.8   Open Time (OT)           2.9   Outside-Own Block               Hours (OBH)           2.10   Overrun Hours (OVRH)           2.11   Released Time (RT)           2.12   Resource Hours (RH)           2.13   Room Clean-up Time               (RCT)           2.14   Room Close (RC)           2.15   Room Open (RO)           2.16   Room Set-up Time               (RST)           2.17   Service           2.18   Surgical Preparation               Time (SPT)           2.19   Start Time (ST)           2.20   Total Cases (TC)           2.21   Total Hours (TH)           2.22   Turnover Time (TOT)                        
         [0019]    [0019]                             TABLE 3                       UTILIZATION AND EFFICIENCY INDICES                                    3.1   Adjusted Percent               Service Utilization (ASU)           3.2   Adjusted Percent               Utilized Resource Hours               (AURH)           3.3   Potential Causes of               Delays           3.3.1   Patient Issues           3.3.2   System Issues           3.3.3   Practitioner Issues           3.4   Early Start           3.4.1   Early Start With Overlap           3.4.2   Early Start Without               Overlap           3.5   Late Start           3.5.1   Late Start With No               Interference           3.5.2   Late Start With               Interference           3.6   Overrun           3.7   Productivity Index (PI)           3.8   Raw Utilization (RU)           3.9   Room Gap           3.9.1   Empty Room (or Late               Start) Gap (LSG)           3.9.2   Between Case Gaps               (BCG)           3.93   End of Schedule Gaps               (ESG)           3.9.4   Total Gap Hours (TGH)                        
         [0020]    [0020]FIG. 2 is a diagram illustrating a patient tracking system  40 . The system  40  tracks the progress of a patient through the perioperative process by collecting times associated with the entries contained in Tables 1, 2, and 3 at various stages of the process. The system  40  may be implemented as an Internet-enabled system which can track a patient&#39;s progress in real time. The system can be implemented using, for example, a Microsoft Distributed Network Architecture (DNA) arrangement.  
         [0021]    The system  40  receives data  42  from outside sources in, for example, Health Level 7 (HL7) format. The data  42  could be, for example, scheduling data received from a hospital scheduling system. The data  42  are processed by an HL7 processor  44 , which converts the data into database tables, and are stored by a database server  46 . The database server could be, for example, a Microsoft SQL server.  
         [0022]    A time stamp collector  48  collects time stamps generated by time stamp hardware  50  for storage by the database server  46 . Pieces of the hardware  50  can be located in multiple rooms in the hospital in which patients will travel during the perioperative process. The hardware  50  can be any type of hardware suitable to collect time stamps which track the patient through the perioperative process. For example, the hardware  50  can consist of devices that read passive radio frequency badges that accompany patients through the perioperative process. Alternatively, the hardware  50  can be infrared receivers that detect infrared (IR) signals transmitted by active infrared transmitters which accompany the patients through the perioperative process. In either case, when the passive RF or IR signals are detected by the hardware  50 , the time is recorded by the time stamp collector  48  and stored by the database server  46 . Each of the various pieces of the hardware  50  has a unique location identifier associated with it so that the location of the patient as well as the time stamp may be stored by the database server  46 .  
         [0023]    A message generator  52  receives triggers, or requests, from the database server and transmits requests to external paging software  54 . The paging software can be, for example, the Hiplink™ Paging Software sold by Cross Communications, Inc. Thus, when appropriate, the message generator  52  generates a paging message, text message, web message, or email paging message and transmits the message to the paging software  54 . The paging software  54  then transmits the message via the appropriate medium (e.g. a wireless paging network) to the appropriate client  56 . The client  56  may be a device that is used by, for example, the hospital staff or patients&#39; families to track the progress of the patient in the perioperative process. Thus, the client  56  can be, for example, a web browser on a personal computer, a personal digital assistant (PDA), or a wireless telecommunications device such as a pager. The database server  46  would thus generate a trigger when a patient entered a specific stage of the perioperative process. For example, the appropriate surgeon could be notified via a pager when a patient enters the operating room. Also, a patient&#39;s family could be notified via a pager when the patient enters the post-anesthesia care unit.  
         [0024]    A transaction server  58  is in communication with the database server  46 . The transaction server  58  can be, for example, a Microsoft Transaction Server that uses component object models (COM) and distributed component object models (DCOM). The transaction server  58  sets global variables  60  for processing purposes.  
         [0025]    A page server  62  is in communication with the transaction server  58 . The page server  62  generates pages  64  for use by the clients  56  when the clients  56  request information or data from the system  40 . The page server  62  can be, for example, a Microsoft Internet Information Server (IIS) using active server pages (ASP). The pages  64  can be, for example, HTML, DHTML, XML pages, VisualBasic Scripting, or JavaScript. Each of the clients  56  that are web browsers may view updated information by, for example, refreshing at certain intervals such as, for example, one-minute intervals. Alternatively, the page server  60  could “push” updated data to the clients  56  as the data are updated. Thus, if a client  56  is displaying an HTML page  64  which illustrates a GANTT chart of the status of the various operating rooms in the hospital and the underlying data for the page  64  are updated in the database server  46  every  30  seconds, the client would receive a fresh HTML page  64  with the updated data every  1  minute either by refreshing or by a “push” by the page server  62 .  
         [0026]    The clients  56  can be in communication with the system  40  via, for example, the Internet or an intranet. The clients  56  can be HIPAA compliant such that data transmitted from the clients  56  to the system  40  is secure. Such security prevents, for example, patient families from viewing information that does not relate to their family member.  
         [0027]    Data such as time stamps may be entered via the clients  56  and stored in the database  46 . Thus, a hospital staff member may enter a time stamp into one of the clients  56  when a patient enters a room such as, for example, an operating room that does not have a piece of the time stamp hardware  50 .  
         [0028]    It can be understood that the servers  46 ,  58 , and  62  can be resident on one or multiple computers. Such a computer or computers can be, for example, a RISC System 6000 Workstation sold by the IBM Corporation or a Dell server that uses Microsoft Windows NT Server as the operating system.  
         [0029]    [0029]FIG. 3 is a diagram illustrating an embodiment of a flow through the system  40  of FIG. 2. At step  70 , one of the clients  56  requests a page  64  from the page server  62 . At step  72 , the page server  62  determines if the page requires data to be retrieved to “build” the page  64 . If the page  64  does not require data, the page server  62  serves the page  64  to the requesting client  56  at step  74 . If the page requires data, the page server  62  generates COM or DCOM objects to request the data at step  76 . The transaction server  58  requests the data from the database server  46  at step  78  and the database server transfers the data (and/or HTML) to the transaction server  58  at step  80 . The transaction server  58  then transfers the data (and/or HTML) to the page server  62  at step  82  and the page server  62  serves the page  64 , including the retrieved data (and/or HTML) to the requesting client  56  at step  74 .  
         [0030]    The system  40  can also handle storage of data (e.g. a time stamp input via one of the clients  56 ) in a similar manner as described in conjunction with FIG. 2. The data are transferred in the form of a request from the page server  62  to the transaction server  58 , and the transaction server  58  transfers the data to the database server  46  for storage.  
         [0031]    FIGS.  4 - 15  are screen printouts illustrating an example of a software implementation of the system  40  of FIG. 2. The screen printouts of FIGS.  4 - 15  can appear on user computers via the clients  56 . FIG. 4 is a screen printout of a main screen that is accessed when the system  40  is first started. The screen of FIG. 5 could appear when the system  40  is first used. The system  40  is thus able to tailor subsequent screens to the location of the client  56 . The system  40  stores a “cookie” on the computer which the client  56  is resident so that the system  40  can identify the location of the client  56  when necessary.  
         [0032]    [0032]FIG. 6 is a screen printout which appears when the “Main Location Entry Screen” option is selected from the screen of FIG. 4. The screen illustrated in FIG. 6 appears when the client  56  is accessing the system  40  at a location other than an operating room. FIG. 7 is a screen printout which appears when a patient is selected from the screen of FIG. 6. FIG. 8 is a screen printout which appears when the “Patient Data Entry Screen” option is selected from the screen of FIG. 4. FIG. 9 is a screen printout which appears when a patient is selected using the screen of FIG. 8. In the screen that is displayed in FIG. 9, patient information could be modified.  
         [0033]    [0033]FIG. 10 is a screen printout which appears when the “OR Data Entry Screen” option is selected from the screen of FIG. 4. When the “Select Patient” option is selected, the screen appears as in the screen of FIG. 11. After a patient is selected from the screen of FIG. 11, the screen of FIG. 12 appears. If a delay is encountered in the patient&#39;s perioperative process, the “Delay” option can be selected from the screen of FIG. 12. After the “Delay” option is selected, the screen of FIG. 13 appears and allows the operator of the computer on which the client  56  is resident to enter a delay code and the duration of the delay. Upon entering the operating room, is the operator of the computer on which the client  56  is resident can enter a time stamp into the system  40 . The client  56  can enter the time stamps listed on the screen in FIG. 12 in any order necessary or, if the process requires, the client  56  can enter multiple time stamps or retrospective time stamps. If the client  56  tries to enter multiple time stamps, the screen of FIG. 14 appears so that a multiple or retrospective time stamp may be entered.  
         [0034]    [0034]FIG. 15 illustrates an example of a GANTT chart that appears when the “Gantt Chart” option from the screen of FIG. 4 is selected.  
         [0035]    While the present invention has been described in conjunction with preferred embodiments thereof, many modifications and variations will be apparent to those of ordinary skill in the art. The foregoing description and the following claims are intended to cover all such modifications and variations, as well as any other applicable technologies which may appear in the future.