The show must go on !

Continuity of patient care is important in emergency, outpatient, and inpatient settings.

In the case of a series of brief interventions the sum of wait times between interventions can easily exceed the sum of the intervention times, increasing agency overhead whilst decreasing patient satisfaction and outcomes.

This post is all about automated resource allocation of tasks, handoffs, and collaborative consultations and how ACM/BPM (adaptive case management/business case management) software can increase patient throughput and decrease clinical errors.

Let’s start with what, who, where, and when.  If an agency has a set of best practices these can be placed in line and used to guide patient processing.  Orders post automatically to user InTrays on the basis of process map logic and pre-assigned routings at steps or interventions.  If the agency encodes documentation (forms, certificates) at interventions staff no longer has to hunt for forms and handoff of the patient is automated – committing one step results in immediate posting of the next-in-line step to the appropriate group of users .

One particular type of handoff that requires special attention is where one individual starts to perform an intervention but is then distracted by other work or goes off shift, leaving the intervention in a suspended state.

Hospital/clinic protocol requires that a performing user expressly surrender control of the intervention (“putback”) so that others are able to take over and complete the intervention.  When this does not take place any user who goes to the intervention must authorize engagement of a “break glass” protocol.

Break glass protocol involves contacting the performing user to confirm the state of the intervention and then recording, at the intervention, a record of the telephone call, with appropriate details.  If the user cannot be reached by telephone most ACM/BPM software suites will accommodate out-mail messages and in-mail responses to/from PDA’s.  Again, the contact must be documented by posting a copy of both the outgoing and incoming e-mail messages at the intervention so that users who take over interventions see the out/in messages and so that the documentation will find its way to the patient EMR.

Collaborative consultations should be handled the same way – the intervention is placed on hold, an out-message is sent and the hold is only released once a response is received to the out-message.

In order to avoid built-in time delays in the provision of services to patients and documentation gaps, it is important that in-messages do not go back to the originator of any request for the simple reason that the originator may either be distracted with other tasks or may have gone off shift and may or may not have done a “putback”.  If an in-message goes to an originator in many cases there will be a 16-hour delay.  The delay will be minimized if the response instead goes to the intervention. Any user who then accesses the patient\workflow\intervention will see the out-message inquiry as well as the in-message response.

Since it is not guaranteed following handoff that the replacement user needs to wait for a response to an inquiry (i.e.  The replacement user may in fact be a domain expert who is able to perform the intervention without having to make an inquiry and wait for response), the software system must accommodate a commit at the intervention in the absence of a response to an inquiry.

Patient care software that is supportive of ACM/BPM can reduce agency overhead by 20-30% in many agency settings.

If you would like more information on how to improve continuity of care for patients, call or e-mail as follows:

Civerex Systems Inc.

North America 800 529 5355

Elsewhere 450 458 5601


Management consultant and process control engineer (MSc EE) with a focus on bridging the gap between operations and strategy in the areas of critical infrastructure protection, connect-the-dots law enforcement investigations, healthcare services delivery, job shop manufacturing and b2b/b2c/b2d transactions. (C) 2010-2018 Karl Walter Keirstead, P. Eng. All rights reserved. The opinions expressed here are those of the author, and are not connected with Jay-Kell Technologies Inc, Civerex Systems Inc. (Canada), Civerex Systems Inc. (USA) or CvX Productions.
This entry was posted in Automated Resource Allocation, Business Process Management, FIXING HEALTHCARE and tagged , , . Bookmark the permalink.

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