New ED opening

[name?]

Any horror stories from new ED go-lives/renovations that anyone wants to share? We're opening a new department later this year...

Anticipation of disaster isn't enough to avoid it--any major lessons learned?

Thanks!

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[Old_Mil]

Cerner is an ancient Sumerian name for Satan. In the legend, McKesson is his faithful cohort. Be warned.

Despite the lies that the pretty sales girl just out of college told you a core 2 thin client with 4 gigs of RAM is not enough horsepower to run Windows 7/10, your institution's security software, Dragon, your EMR, your single sign on software, the doc using google/uptodate/epocrates/mdcalc, the nurse shopping for shoes on Amazon, and various servers pushing updates. Every computer in your department should be at least an i5 with 8 gigs of RAM. Mission critical machines that physicians are using should be i7s with 12-16. Instantaneous response should be the bar to clear for your hardware. Your people cost too much per hour to have them sitting around waiting on cheap computers.

There's not much in life more useless than the fuel that's not in your gas tank, the sonosite locked away in radiology, or the glidescope that is locked away in the OR.

You can either have two oxygen ports in your rooms to facilitate apneic oxygenation while intubating or one oxygen port and an extra respiratory therapist (to blow into the O2 tubing of the BVM or nasal cannula, your choice).

Don't pay someone a lot of money to come up with a list of things to fix. The people you work with can probably give you a better (and longer) one for free.

Good luck with your launch

 

[Groove]

Cerner is an ancient Sumerian name for Satan. In the legend, McKesson is his faithful cohort. Be warned.

Despite the lies that the pretty sales girl just out of college told you a core 2 thin client with 4 gigs of RAM is not enough horsepower to run Windows 7/10, your institution's security software, Dragon, your EMR, your single sign on software, the doc using google/uptodate/epocrates/mdcalc, the nurse shopping for shoes on Amazon, and various servers pushing updates. Every computer in your department should be at least an i5 with 8 gigs of RAM. Mission critical machines that physicians are using should be i7s with 12-16. Instantaneous response should be the bar to clear for your hardware. Your people cost too much per hour to have them sitting around waiting on cheap computers.

There's not much in life more useless than the fuel that's not in your gas tank, the sonosite locked away in radiology, or the glidescope that is locked away in the OR.

You can either have two oxygen ports in your rooms to facilitate apneic oxygenation while intubating or one oxygen port and an extra respiratory therapist (to blow into the O2 tubing of the BVM or nasal cannula, your choice).

Don't pay someone a lot of money to come up with a list of things to fix. The people you work with can probably give you a better (and longer) one for free.

Good luck with your launch

LOL

 

[witzelsucht]

this is probably not the type of thing you're looking for, but i heard anecodtally of an ED opening where they didnt realize the pth from EMS entrance to main ER went past a pediatrics block so every now and then the kiddos would get a full frontal of chest pounding some dead gomer

 

[Vandalia]

To clarify, are you talking about standing-up a completely new ED, or moving an existing one to a new location? I have a bit of experience with the latter, and none with the former.

The only thing I would say is to take a page from restaurants: Round up as many friends/family/employees as possible and stage at least one dry run. Arrange with EMS to do some runs with mock patients. You will never be able to work out all the kinks, but physically having people present, dealing with patient flow, and having real people do patient things like using the restrooms will turn up some of the flaws.

 

[name?]

To clarify, are you talking about standing-up a completely new ED, or moving an existing one to a new location? I have a bit of experience with the latter, and none with the former.

The only thing I would say is to take a page from restaurants: Round up as many friends/family/employees as possible and stage at least one dry run. Arrange with EMS to do some runs with mock patients. You will never be able to work out all the kinks, but physically having people present, dealing with patient flow, and having real people do patient things like using the restrooms will turn up some of the flaws.

Yeah...we're moving into a new building--1970s to 2015 in the blink of an eye.

Thankfully, sonosite, glidescope will all be at hand (with our 2 O2 ports...and air, which I have mixed feelings about)

Great thoughts, thanks!

 

[link2swim06]

Cerner is an ancient Sumerian name for Satan. In the legend, McKesson is his faithful cohort. Be warned.

Despite the lies that the pretty sales girl just out of college told you a core 2 thin client with 4 gigs of RAM is not enough horsepower to run Windows 7/10, your institution's security software, Dragon, your EMR, your single sign on software, the doc using google/uptodate/epocrates/mdcalc, the nurse shopping for shoes on Amazon, and various servers pushing updates. Every computer in your department should be at least an i5 with 8 gigs of RAM. Mission critical machines that physicians are using should be i7s with 12-16. Instantaneous response should be the bar to clear for your hardware. Your people cost too much per hour to have them sitting around waiting on cheap computers.

Can you please tell my hospital admins this x 1000 times.

 

[RustedFox]

It boggles the mind how bad Cerner is. It really does. Everything is small, jammed-in closely together, and indistinguishable from each other; not unlike trying to read a Chinese newspaper when you don't recognize a character.

 

[Birdstrike]

It boggles the mind how bad Cerner is. It really does. Everything is small, jammed-in closely together, and indistinguishable from each other; not unlike trying to read a Chinese newspaper when you don't recognize a character.

I remember when they first rolled this out around 2002ish when I was in residency. My God it was bad. Sounds like it hasn't changed.

 

[NinerNiner999]

In a word - OWNERSHIP! This is a rare opportunity to have nursing staff and physician staff unite behind a new "home." Take advantage of it. Hold regular update meetings with staff/nursing to elicit issues that need to be fixed. Provide real-time feedback with these issues. If you can keep up the momentum, you will develop a core team of united providers who look at the department as a new home, and their pride of "ownership" will promote retention, recruiting, and good morale for years to come. That is the best investment you can get from a new facility!

 

[RustedFox]

I remember when they first rolled this out around 2002ish when I was in residency. My God it was bad. Sounds like it hasn't changed.

I just recently changed primary job sites and left a Meditech/pDoc based system for a Cerner/Dragon based system. Dragon saves the day; but Cerner needs to learn one thing: I don't want to hunt thru dozens of irrelevant options/orders to find the only one that makes sense. Make it easy, make it easy on the eyes, and the world will beat a path to your door.

 

[Old_Mil]

In a word - OWNERSHIP! This is a rare opportunity to have nursing staff and physician staff unite behind a new "home." Take advantage of it. Hold regular update meetings with staff/nursing to elicit issues that need to be fixed. Provide real-time feedback with these issues. If you can keep up the momentum, you will develop a core team of united providers who look at the department as a new home, and their pride of "ownership" will promote retention, recruiting, and good morale for years to come. That is the best investment you can get from a new facility!

Ownership in emergency medicine is like grabbing an AR 15 and heading off to fight ISIS ...only to subsequently realize "Oh crap, its full of blanks..."

 

[link2swim06]

I just recently changed primary job sites and left a Meditech/pDoc based system for a Cerner/Dragon based system. Dragon saves the day; but Cerner needs to learn one thing: I don't want to hunt thru dozens of irrelevant options/orders to find the only one that makes sense. Make it easy, make it easy on the eyes, and the world will beat a path to your door.

All the EMRs kinda suck from that standpoint. If you really sit back and look at the screen, ~50% of the buttons are never things I have even clicked on, needed to click on, and just clutter the screen. But again it's not made for physicians, it's made for billing and admin people.

If they really wanted to make it up to date (or hell even up to era 2012), they would give me an ipad, with app with easy button, that let me click my orders while I was in the pt room and then login and sign with my finger print (like my iphone). Instead I go back to my computer (because god knows I am not waiting 3 minutes for the in room computer to login), click through 15 screens, hit confirm 17 times and then wait for **** to load. This technology already exist...I mean existed when I was a college student.

 

[Apollyon]

I've said it before, I'll say it again - you can search on SDN to prove it: when it comes to EMRs, it isn't which one is best, but which one sucks the least.

 

[shookwell]

Electronic T-system is by far the best ED EMR I have ever worked with.

 

[hoot504]

Electronic T-system is by far the best ED EMR I have ever worked with.

You're kidding, right?

 

[Old_Mil]

Electronic T-system is by far the best ED EMR I have ever worked with.

Electronic T's are decent. Pulse check is decent.

Those are pretty much the only two I would even assign a passing grade to for ED use.

 

[GatorCHOMPions]

Would a really bad EMR dissuade you from taking a job somewhere, assuming everything else was satisfactory? I'm still a resident and have only really been exposed to Epic so far.

 

[Hercules]

Would a really bad EMR dissuade you from taking a job somewhere, assuming everything else was satisfactory? I'm still a resident and have only really been exposed to Epic so far.

I can tell you it has most definitely kept me from picking up shifts at a facility. I saw the emr that one facility had and told them my rate just went up and that I would not work a shift without a scribe to make up for the terrible emr they had. They got scribes and I pulled some shifts there but the emr was still painful to use.

 

[RustedFox]

Would a really bad EMR dissuade you from taking a job somewhere, assuming everything else was satisfactory? I'm still a resident and have only really been exposed to Epic so far.

Yes. For sure.

Cerner is an abortion without Dragon.

 

[Arcan57]

Yes. For sure.

Cerner is an abortion without Dragon.

We are moving from electronic T to Cerner w/ Dragon. Supposedly with tons of macros, power notes is "doable".

 

[RustedFox]

No idea what "power notes" are, but I hope they work out for you.

Without dragon, cerner would make me decline a job.

 

[cbrons]

Cerner is such trash

 

[Psai]

Cerner is an ancient Sumerian name for Satan. In the legend, McKesson is his faithful cohort. Be warned.

Despite the lies that the pretty sales girl just out of college told you a core 2 thin client with 4 gigs of RAM is not enough horsepower to run Windows 7/10, your institution's security software, Dragon, your EMR, your single sign on software, the doc using google/uptodate/epocrates/mdcalc, the nurse shopping for shoes on Amazon, and various servers pushing updates. Every computer in your department should be at least an i5 with 8 gigs of RAM. Mission critical machines that physicians are using should be i7s with 12-16. Instantaneous response should be the bar to clear for your hardware. Your people cost too much per hour to have them sitting around waiting on cheap computers.

There's not much in life more useless than the fuel that's not in your gas tank, the sonosite locked away in radiology, or the glidescope that is locked away in the OR.

You can either have two oxygen ports in your rooms to facilitate apneic oxygenation while intubating or one oxygen port and an extra respiratory therapist (to blow into the O2 tubing of the BVM or nasal cannula, your choice).

Don't pay someone a lot of money to come up with a list of things to fix. The people you work with can probably give you a better (and longer) one for free.

Good luck with your launch

Everything here seems obvious to me and yet administrators seem to do the exact opposite every time. I don't get it.

 

[maxxor]

Everything here seems obvious to me and yet administrators seem to do the exact opposite every time. I don't get it.

Because they don't actually work on the ground.

 

[Birdstrike]

Everything here seems obvious to me and yet administrators seem to do the exact opposite every time. I don't get it.

It should make perfect sense. Administrators always want to do what's cheapest for them. That's not always what's best for hospital staff or patients.

 

[engineeredout]

You can either have two oxygen ports in your rooms to facilitate apneic oxygenation while intubating or one oxygen port and an extra respiratory therapist (to blow into the O2 tubing of the BVM or nasal cannula, your choice).

Our ED has the oxygen ports on the wall. What we do not have are enough flow regulators/Christmas trees for each wall port. I get very odd looks when I ask why don't we just have enough regulators for every port so when I'm trying to intubate someone and I want the BVM, the patients current oxygen source, and an apnic oxygenation NC running instead of having the bumbling cluster**** of trying to switch out the O2 sources and invariably plugging the wrong thing in.