Nurse System Demonstration Observation

‘Thick Description’ Piece

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The first goal of our second visit to Fountain Valley was to observe the MedHost system demonstration from a nursing perspective. Respectively, after meeting Dr. Anderson at the main entrance of the emergency department, he walked us into the hospital to first obtain required ‘visitor’ tags for security purposes. Once the entire group was tagged, we all walked behind Dr. Anderson going through different hallways of the hospital till we reached the administrative offices section of the emergency department. This was great, as it provided us with a chance to observe what was going on from an administrative perspective, rather than only being able to observe the clinical area of the emergency department. As we were walking, it was quite surprising to notice the many files and various sorts of paper documents stacked up on the floors of the different cubicles within the administrative offices. One would expect that with the implementation of an electronic system that the amount of hard copy documents should be minimal. In relation to this, it is important to note that the system was only live for about a month prior to this visit. It therefore might be fine to assume that this is a transitional period, thus it is expected that the amount of paper work being stacked up will be reduced as time progresses.

Our walk ended with Dr. Anderson asking us to wait in a certain cubicle until the designated nurse was to come and demonstrate the system for us. After waiting for about seven minutes, Dr. Anderson phoned someone, and then looked at us and said: “Alright, it seems that the nurse is currently busy, so we will have to delay demonstration for a while. In the mean time, lets go to the clinical area, where I will provide you with a system demonstration, and once done, we will hopefully be able to come back here for the nurse demonstration”.  Accordingly, our group once again followed Dr. Anderson to the clinical area.

About two hours later, after gaining a great perspective of the system based on both Dr. Anderson’s demonstration (refer to the ‘Physician’ observation) and our own observations of the emergency department, it was time to go back to the administration to get our awaited nursing demonstration of MedHost. Upon our arrival to the administrative offices, Dr. Anderson introduced us to Ms. Kim Toms, the Emergency Nursing Coordinator. Ms. Toms was very pleasant as she welcomed us into her cubicle. It was apparent, however, that Ms. Toms was not the same nurse whom we were waiting for two hours ago. It is possible that her colleague was still busy, and that Dr. Anderson respectively requested Ms. Toms to provide us with the demonstration.

After huddling around Ms. Tom’s desk, she started the demonstration by first logging onto the MedHost system. Similar to Dr. Anderson, she also had to enter her password a few times before gaining access to the system. Once logged on, she showed us the entire process of system utilization from a nursing perspective. Her demonstration started with creating a ‘dummy’ patient to be used for the sole purpose of demonstration. The ‘dummy’ patient was then taken through the process of registration, as well as triage, which ultimately completes the nursing process up to the point that the physicians take over. The process of registration and triage took approximately ten minutes to complete, and included data entry into multiple windows. The first window that was completed was relative to the patient’s personal information, inclusive of the patient’s language. Once the ‘dummy’ patient was registered, Ms. Toms showed us how the patient appears as ‘waiting’, and how this automatically alerts the triage nurses for their respective action. She then went on by demonstrating the triage data entry process. This included data entry of information related to the patient’s complaint, method of arrival, medications, allergies, as well as past history of drug and alcohol use. Ms. Toms also indicated that triage nurses could also make other assessments before assigning a bed to a patient. She also stated: “Triage nurses work in concert crosschecking each other’s entries, making sure that all information is properly and correctly entered into the system”.

Throughout the demonstration, it was evident that Ms. Toms was quite familiar with the different processes and windows of the system, even though she was only using it for a short period of time. In light of this, a question was posed to her: “Were you provided with training on the MedHost system, and if so, for how long?” She responded with: “Well, personally, given that I am an administrator, I was selected to be a ‘Super User’. Super Users of the system were provided with four hours of training, whereas, the regular nursing user was provided with three hours of training. However, as a super user, I was responsible for training other nurses, this provided me with more practice on the usage of the system”. She then paused for a few moments and continued by saying: “Four hours of training was not enough for a system with so may features”.

As we reached the end of the demonstration, we wanted to conclude by asking Ms. Toms one more question, namely “Overall, do you think that the system is helpful?” She responded by stating: “The system is very helpful and has made life in the ED easier. In comparison to how things were done previously, the workflow has changed from finding and writing, to typing and clicking. The system is very helpful, especially in relation to charting and ease of use.”