MAXIMIZING PATIENT CARE WITH EFFICIENT VITAL SIGNS ACQUISITION

9:05 • EMR woes: EMR takes longer due to more extensive 8:18 data entry (average difference of 1:47 minutes) DEFINE OBSERVATIONS 7:32 Conveyance 6:46 14% • Ergonomics for both patient and caregiver have a Problem Statement: Vital signs are the very beginning of every Care interaction was observed from the time 6:00 lot of room for improvement (access to patient 5:14 and placement of equipment) patient-caregiver interaction. Typical processes include multiple the patient was called from the waiting room, Misc. 4:28 Vital Signs 17% • Data transfer is not streamlined: all offices except one stations to capture base vital signs (height, weight, pulse, temperature through vital signs acquisition, to the time 3:42 47% used paper to record vital signs even when using EMR, and blood pressure); some stations are semi-public spaces. While the vital the patient was ready to see the physician. 2:56 2:10 transferring from different sources and locations signs process has not changed significantly in 30 years, the integration of The average time was 5 minutes, 7 seconds. 1:24 RFV • Accuracy: proper blood pressure positioning and Average Total Visit Time Visit Total Average 0:38 electronic medical records (EMR), new technologies and automated devices 22% procedures were rarely followed and room setup could have a significant impact on the overall efficiency of the process. Time Consistency Across Sites 1 2 3 4 5 6 7 8 9 10 11 12 13 does not help facilitate it Average total visit time varied between Total Visit Time Vital Signs Tests RFV Time Project Aim: Midmark partnered with a research firm to examine potential 3:17 and 9:02. Most of the difference is workflow efficiencies during the acquisition of vital signs, as well as the attributed to Reason for Visit (RFV). interaction between patients and caregivers, in an effort to identify near- and long-term implications for efficiency.

Project Focus: The study included non-acute care facilities ranging from IMPROVEMENTS + OUTCOMES independent practices to integrated delivery networks (IDNs), sites with paper-based medical records, and sites transitioning to EMR or fully Traditional Vital Signs Triage Nook Basic In-Room Vital Signs Connected In-Room Vital Signs integrated with EMR. The facilities also included automated and In Hallway or Triage In Exam Room In Hallway or Triage In Exam Room In Hallway or Triage In Exam Room In Hallway or Triage In Exam Room manual acquisition of vital signs. H W P T BP H W P T BP H W P T BP H W P T BP H W P T BP H W P T BP H W P T BP H W P T BP On Exam Chair

MEASURE/DATA Time Time Conveyance Savings Conveyance Conveyance Conveyance 30 Savings Data Collected: 42 42 52 20 Time 20 Savings Vital 69 Vital Vital Vital • Workflow and sequence to acquire base vital signs including height, Signs Signs Signs Signs 145 98 weight, pulse, temperature and blood pressure 115 115 • Time required to acquire base vital signs including height, weight, pulse, Total Time: 187 Seconds Total Time: 157 Seconds Total Time: 135 Seconds Total Time: 118 Seconds The traditional workflow requires an average of The triage nook workflow, when compared The basic in-room workflow, when compared with The connected in-room workflow, when compared 10 Triage temperature and blood pressure 187 seconds from the time the patient is called with the traditional, saves 30 seconds by the triage nook, saves 22 seconds in conveyance with the basic in-room, saves 17 seconds by taking 09 Traditional Vitals through vital signs acquisition. implementing automated vital signs capture. 11 Basic In Room Vitalstime by moving all vital signs to the exam room. 12 Connected Inroomthe Vitals weight, temperature, pulse and blood pressure • Location of vital signs acquisition on the exam chair.

667 patient interactions observed

12 non-acute care facilities

277 total hours of observation

68 medical assistants observed

Results of the Midmark study on vital signs acquisition indicated that taking a number of steps, including moving vital signs into the exam room and implementing automated vital signs, could reduce conveyance and acquisition time by as much as 36 percent. The Midmark Clinical Solutions vital signs workflow models developed based on the research findings provide a foundation for the integration of vital signs acquisition into a modern, efficient workflow. By rethinking vital signs workflows and MKT00280 © 2019 Midmark Corporation, Miamisburg, Ohio USA incorporating elements of these models into their own settings, health systems can streamline efforts without sacrificing accuracy or patient satisfaction.