Kaz Sobczak 1 , Joyce Nacario 2 , Ho Lom Lee 3

1. TheCost Effectiveness and Efficiency of Using a CaseView as a Web-Based Resource Technology to Expedite Patient Care and Cost-Saving for an Operating Room Kaz Sobczak1, Joyce Nacario2 , Ho Lom Lee3 1University of California Medical Center, San Francisco, CA (USA) 2University of California Medical Center, San Francisco, CA (USA) 3University of California Medical Center, San Francisco, CA (USA) Kaz.Sobczak@ucsfmedctr.org, Joyce.Nacario@ucsfmedctr.org, Holom.Lee@ucsfmedctr.org

2. Purpose and Background • UCSF operating room has developed a novel, easy-to-use tool to visualize and manage operating room use in real time called CaseView. • CaseView was built specifically as an information tool for medical, administrative, and perioperative staff. • The purpose of this study was to examine cost effectiveness and efficiency levels resulting from using CaseView as a web-based technology to expedite patient care and cost-saving for an operating room in clinical practice.

3. CaseView as a Web-Based Resource Technology • Joyce Nacario-a nursing informatics expert and clinical nurse IV at UCSF Medical Center Operating Room, helped design and run a web-based resource called CaseView with the cooperation of Ho Lom Lee, a programmer, and Dr Kulli, a perioperative medical director [3]. • CaseView was developed using existing computer infrastructure, Microsoft Net, information processes, and information technology. • CaseView provides dynamic and sophisticated information, using text, still images, video, audio files, and various web design techniques without incurring any external costs. • Using internal resources, CaseView is supported by one informatics nurse and one programmer

4. CaseView Feature • The data elements used to build the CaseView display include: • Room (OR) number • Surgeon name • Name of anesthesiologist • Name of surgical procedure • Patient name • Scheduled case start time • Scheduled case duration • Actual case start time • Actual case duration

5. Real-time information The operating room and PACU display are shown below. • The color purple indicates that the patient has arrived at the surgical waiting area. • Green indicates that the patient is in the preop area. • Blue indicates that the patient is in the OR and pink is used to record that the patient is in PACU. • Yellow indicates that the patient is still going to the OR (pending cases).

6. Start and End Times: Turnover Times • Cases completed, underway, and upcoming are all shown on the same screen. • Completed cases are depicted using actual start and end times. • Case start and end times are displayed down to the minute, not in 15 or 30 minute increments.

7. CaseView Supplies • . • CaseView tracks all supplies used in the operating room at UCSF Medical Center Hospital. • It is now being applied to map out a cost-effective approach to supply usage. • This report summarizes the application designed to specific procedures

8. Setting and Methodology • The test of CaseView was conducted in the operating room unit of an academic medical center, UCSF. • The study took place from February 2010 to June 2010. • All operating room staff members were invited by email to participate in a web-based survey asking them to evaluate how CaseView affected the health care team's efficiency, knowledge, retention, team building, leadership skills, professional development, knowledge management, evidence-based practice, and, most importantly, patient safety. • The convenience sample (N = 119) was selected from an academic medical center, UCSF over a 3-month period and consisted of surgical staff using CaseView. • The survey included open-ended and closed-ended questions, multiple choice questions, matrix questions, as well as dichotomous yes/no questions, with “yes” signifying positive and “no” negative effects.

9. Results • Over 90% of the respondents said that CaseView expedited patient care and cost-saving clinical practice. • It was also described as environmentally friendly, as it eliminates the need to print out hundreds of pages of paperwork daily.

10. Conclusions • CaseView web-based technology addresses health care providers’ needs for better time management and improved cost-effectiveness by providing a powerful yet intuitive visual interface to data that already exist in clinical databases. • It allows stakeholders to make decisions based on the most up-to-date information and promotes efficiency as well as situational awareness regarding the OR. • Results of the survey show that without CaseView, monitoring data and recording the business of providing health care would be inefficient and would further strain the hospital’s resources. • The current pace of change in health care knowledge and information technology continues to accelerate. • CaseViewoffers tools for health care providers to manage this exponential increase in information technology so that the most cost-effective treatment decisions can be made that will result in the optimal outcomes for patients.