TakeCare as a lean-tool

The introduction of TakeCare as a common electronic medical record (EMR) in Stockholm county council has been an enabler for improving work according to lean. In the emergency department at the Karolinska University Hospital latency has been shortened for patients, and at the radiology departments latency for imaging tests and answers has decreased.

Through the support of Take Care as an EMR the hospital management in Stockholm, Sweden has invested in new ways of working with a focus on patient benefits and introduced a flow-oriented management system for the healthcare processes.
The results are positive; the waiting time for doctors in the emergency department has decreased with approximately an hour over a period of two years. The proportion of patients finished within four hours has gone from 60 % to nearly 80 % measured over a 24-hour period. This has been done at the same time as financial savings have been implemented in the business. As an extra plus the healthcare professionals say that they are less stressed, and patient surveys show that the patient satisfaction has increased.

New ways of working
By digitalizing the health records management with TakeCare the occupational safety and health in the hospitals has improved at the same time as productivity has improved significantly. Stacks of old paper records are gone. Doctors dictate digitally and type the information directly into TakeCare.
To strengthen the process of improvement, it is important to keep businesses closer together. One way to do so is to use an application called the “Rate-board” that presents real-time information from TakeCare on computer screens, optimized for employees’ requests. The application makes it possible to see the times, activities, and when you yourself do something. This ensures that the right thing is done at the right time. The radiology clinic at Karolinska University Hospital in Huddinge was among the first to work with data from TakeCare in real time.
On their Rate-boards, they can see when a patient is coming, when an x-ray is initiated and when a radiologist can expect to get the images for analysis. The analysis of acute examinations is faster and reply can be sent immediately. This reduces the waiting time for x-ray responses.
A major benefit for radiology doctors is that they can see if they have signed the answers, which reduces the risk of an x-ray response being delayed. If a radiologist missed a signature, or if the patient had to wait too long the Rate-board turns from green to red. As a consequence, radiologists don´t have to be interrupted by phone calls about missed tests and can work more effectively and undisturbed.
For the Orthopaedic Surgery in Karolinska University Hospital in Huddinge the Rate-board has a different design. On the screen, staff can see exactly where the patient is in the flow. It makes work easier and creates a structure. Health professionals can see when the patient has showered or is ready for surgery. This makes it possible for staff to set up a plan for the entire day. Two main benefits are reduced stress and better communication.

Reduces time waste
By using information from TakeCare in conjunction with information from laboratory information systems it is possible to identify the sample path from the ER through the laboratory and back, and reduce the time from initial assessment to final test results by 30%.
The X-ray flow is improved with support functions and information from TakeCare. The department of Radiology in Karolinska University Hospital Huddinge has started a work that will improve the flow of emergency radiology. The goal is to shorten the time from first doctor assessment to x-ray response from an average of 2 hours and 20 minutes to 1 hour and 40 minutes.
An additional objective that is enabled by information from TakeCare is to handle four of the five emergency operations within one day. Acute orthopaedic patients should receive consultation and be assessed directly in the emergency ward, and prepared for surgery in the emergency care department. Many elements are about shortening the switching times between operations. The goal is to shorten the time from operation notification to operation start by 30%. Another goal is that 80% of all acute orthopedic surgery is carried out within 24 hours.

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TakeCare and Stockholm county council:
  • The proportion of patients finished within four hours has gone from 60 % to nearly 80 %.
  • The time from initial assessment to final test result has been reduced by 30%.
  • The healthcare professionals are less stressed.
  • The patient satisfaction has increased.