A butterfly flaps his wings...

[Jeff698]

It all started with a nut. And a squirrel. It went down hill quickly.

Our hospital/system is highly dependent on computers with many, many interlocking, interdependent networks. We use computer charting, ordering, resulting, PACS, tracking, you name it. All of our network 'brains' are housed in a master control center.

It seems the master control center is dependent on electricity. From a transformer. In general, transformers make poor places for nuts. Or squirrels.

We lost our entire network system yesterday. For our ED. Our hospital. All of our clinics. All of our hospitals.

Apparently our clinics are prepared for this possibility and wisely have a back up plan. "Go to the ER".

We went back to using white boards, paper charts (we made copies of one blank universal form a resident was hanging onto for sentimental value), ordered everything on paper, walked it to a clerk, had labs hand delivered to lab (which, in a fit of normalcy, promptly lost them), results delivered by a runner, read plain films on the little 9 inch display-thingee on the digital developer and wrote out paper discharge instructions.

While I'm sure there are folks whose departments function like this all the time, we went from fully electronic to fully paper based in about 45 minutes. Suboptimal.

In our debriefing of today, we were making plans for the next squirrel. We pulled out the old ER form.

Note the singular "form".

There was one form that the nurses would put the triage/vital signs on, the resident would mark off orders and write a brief note, hand to the clerk for input, faculty would write their brief note on and the resident would fill in the discharge instructions. An entire ED visit on one simple form.

Good thing we improved things with our entire digital system. How barbaric things used to be. Can you imagine?

I'd always heard of the butterfly effect but not the squirrel effect.

Take care,
Jeff

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[pseudoknot]

Was this the squirrel from your avatar, or a different one?

 

[deleted109597]

One page. Some people I know would have had to learn to write small. (Nobody here, that I know of anyway).

 

[primadonna22274]

OMG Jeff this is so timely...we have had a squirrel in our building (outpatient but oversized family practice clinic) since at least Saturday. There have been several squirrel sightings and plenty overhead-squirrel-rumblings. The squirrel has been cornered twice in the computer room (why on earth do they want to be around all the network cords?) but the wily thing has eluded us over and over. Yesterday afternoon one of the staff walked down to the lunchroom and saw the squirrel eating the banana pudding (yup, leftover crap from drug rep lunch). I wish someone had shot a picture. So this morning, I kid you not, my supervising doc brings his SHOTGUN into clinic at 8am intent on shooting the damn squirrel. I'm thinking to myself, what vortex did I step into...one minute I'm sipping a latte in Portland and the next I'm in the downtown Redneckville, coffee-deprived, and boycotting disgusting sweet tea, where my SUPERVISING PHYSICIAN brings his SHOTGUN to work??? So he couldn't catch the little bugger either and tonight he sets up a trap in the lunchroom.
Poor little squirrel.

 

[WallowaWanderer]

There was one form that the nurses would put the triage/vital signs on, the resident would mark off orders and write a brief note, hand to the clerk for input, faculty would write their brief note on and the resident would fill in the discharge instructions. An entire ED visit on one simple form.
Jeff

That's exactly what we (that's nice to say "we") have at DG. I hope it never changes. No logins, no fighting for the computers, no eyestrain, no searching for an order in the computer. I can write my note while I'm in the room with the patient and then just drop it in the clerk's rack with the orders, put a mark on the grease-board, and it's off to the next patient.

I love kickin it old school. With my luck I'll show up in the fall and there will be computers everywhere.

 

[Jeff698]

I love kickin it old school.

As much as I enjoy telling the Tale of the Great Squirrel, the real thing I learned here is that no matter how fancy all those computers look, they have made things more complicated rather than simpler.

Computer systems are great for collecting information that is searchable and useable later. They're horrible for point of care service.

The use of a physical chart that goes places (rack outside pt room, clerk's desk, etc) serves as a physical prompt for what is going on with the patient. We haven't figured out yet how to get that same prompt from our electronic systems. Something about the 'clunk' of a chart in rack is viscerally different than an icon on a screen.

Not that I think we should go back to all paper, I just think we're at an early stage in the evolution of EMR systems. We've had decades to perfect the systems built around paper-based EDs. It'll take time but I think we'll get there eventually.

Take care,
Jeff

 

[DrQuinn]

Pretty funny story, and it does keep things in perspective.

Where we're at in DC we use "Azyxxi" which was bought out by Microsoft as "Amalga" which is basicaly a really awesome software program that melds PACS, med records, triage, clinic notes, radiology images and reports, op notes, DC summaries, etc, into one big program that usually when it is working is fan-F'ing-tastic. However, once in a blue moon (probably every 3-4 weeks) the system just "shuts down" and it is chaotic. You can't DC anyone (except writing on old DC forms we have stored in hte back), ordering stuff has to be done hand written, and basically the ED turns into a civil war.

It is kind of nice to be able to write a quick note, however, I am pretty risk averse, and I don't like to downplay my documentation because of a computer snafu in the ED.... but that's just me. It is funny to see the absolute panic on everyone's face though when teh system shuts down. Thankfully it has only happened to me twice in two years.

Q

 

[Wackie]

Was this the squirrel from your avatar, or a different one?

He does look a bit mischievous, doesn't he.


Our system occasionally has to update and the night shift suffers through it. The entire system has to go down for this update and we go to paper and gofers. There's a few docs who sing joyful praises when the system goes down because they hate it so much (it's a system for the hospital converted for ER "use" and I use the term "use" lightly). I'm convinced one doc in particular is taking up homemade device lessons and will bomb the mainframe in the near future.

 

[NSAIDAllergy]

http://www.ironydesign.com/gallery/addLOGO4.gif

 

[WilcoWorld]

Umm, I thought it was a prairie dog

 

[Jeff698]

Was this the squirrel from your avatar, or a different one?

The real rodent in question is a bit crispy right now.

In case you're wondering, he tasted sort of like chicken.

Take care,
Jeff

 

[EM_Rebuilder]

The real rodent in question is a bit crispy right now.

In case you're wondering, he tasted sort of like chicken.

Take care,
Jeff

Just released!! This was taken just *moments* before the ol S&W computer crash: Culprit

 

[Jeff698]

Just released!! This was taken just *moments* before the ol S&W computer crash: Culprit

Ooooh, that's good. Unfortunately, I just gave a presentation today at conference summarizing my investigative findings into this "incident".

 

[Jeff698]

I discovered that it was actually a terrorist plot by a group of killer data squirrels who hate us for our electronic freedom.

Through some intensive detective work, I was able to obtain some illustriative images that tell the True Story.

The public face of the enemy.

Peace, love, understanding....

Please. We know the Truth. They hate us.

This is the ringleader of the dreaded terrorist network of killer data squirrels, SquirrelQueda.

They hate us because of our electronic freedom. Our ability to rapidly look up patient's medical histories and trend lab values drives them crazy.

They like their recruits to be heavy on testosterone and light on brains.

SquirrelQueda in training

Apparently, some recruits have moments of misgivings. They need to cleanse their minds of the evil that they do.

Here's the little bastard who brought our hospital to it's knees. This picture catches him in the act. He cut the power to our electronic bat cave and took out all of our network servers.

Oh, the humanity!

Paper charts! Grease boards! Handwritten orders!

The horror, the chaos! Would it never end?

We must seek revenge!

Our young warriors in training

The terrorist squirrels have tasted the hot blade of our vengence.

The moral of the story?

Don't Mess With Our Data!

 

[deleted109597]

Wow. If I remember correctly, that office isn't much bigger than that grease board.
Importantly, the flat screens in every room still worked, right? No sense in ruining good press-ganey scores because of something like this.

 

[Jeff698]

Wow. If I remember correctly, that office isn't much bigger than that grease board.
Importantly, the flat screens in every room still worked, right? No sense in ruining good press-ganey scores because of something like this.

The office is in the new department and it's relatively large. That's the physician work room. There was another board like it out by triage.

I took that picture after the carnage was past but right before we took the board down. For some strange reason, it didn't occur to me to take a picture while the chaos was ongoing. I got lucky and came on duty as the systems were beginning to come back on line.

You're right about the TVs though. I'm not sure if the movies-on-demand feature went down. Now THAT would have been a catastrophe!

Take care,
Jeff