The University of Maryland Medical System designed a PSPAT that provides an integrated workflow engine, rules engine, logistics engine, MER repository, and interface engine, coupled with extensive connectivity to all relevant external enterprise systems. PSPAT will passively monitor the location and availability of patients, staff, supplies, instruments, equipment, and operating facilities; watch the convergence of the surgery team, supplies, instruments, and equipment around the patient and intervene to assure that critical personnel and physical requirements are met in real time; and initiate alternative protocols and actions when planned perioperative schedules cannot be met or patient safety is at risk.
The basic concepts in PSPAT are information uptake from a wide variety of clinical systems; calculation of current state of clinical processing; and generating a set of reactions to current state in order to move it towards organizational goals for efficiency, safety, and improvement of patient outcomes (Fig. 8.4).
In the context of an automated operating room of the future, it is essential to wrap information technology around the surgery to support the entire perioperative
process, and orchestrate behavior between heterogeneous systems that exist outside, yet support the surgical procedure, and are mandatory for patient safety and support of treatment before and after surgery. In particular, it is essential to provide a lightweight MER repository capable of managing the information input of a patient record, diagnostic and triage information, vitals and I/Os data collection, automated lab tests and patient scans, treatment plans, order sets and protocols, surgeon preference lists for supplies and equipment, Web-based visual display of patient information for external telemedicine clinicians, and reordering and restocking supplies management. Postsurgical care, discharge summaries, and externally posting of updates to the patient's medical record are essential. The medical facility picking up the patient for postsurgical care must have up to date medical information that incorporates all procedures, medications, and diagnoses, along with discharge medications and recommendations for follow-up.
PSPAT will use existing clinical and logistics systems to the maximum extent possible. For example, there is an enterprise-wide clinical repository that supports computerized physician order entry. Several equipment and supply information systems support perioperative activities. Integration with these systems allows PSPAT to use these systems as both data sources and implementation systems for adaptive process improvement.
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