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Pediatric hospital successfully activates CPOE in critical care units

The Hospital for Sick Children (SickKids), affiliated with the University of Toronto, is the largest organization dedicated to improving children’s health in Canada. These clinicians provide the best in complex, specialized care for some of our country’s youngest patients.

We’ve always been impressed by the compassionate team at SickKids, but perhaps never so much as when we collaborated with them to complete five successful Allscripts Sunrise™ activations in 2015. We recently spoke with Steven M. Schwartz, M.D., FRCPC, FAHA, who led the implementation of Sunrise™ Acute Care in the Cardiac Critical Care Unit (CCCU), about the effort.

Dr. Steven M. Schwartz led the successful implementation of Sunrise Acute Care in the Cardiac Critical Care Unit of SickKids.

Describe your department and what prompted you to move to Sunrise.

The Department of Critical Care Medicine at SickKids is responsible for both the Cardiac Critical Care Unit (CCCU) and the Paediatric Intensive Care Unit (PICU).  Between us, we have 41 beds to care for these critically ill infants, children and adolescents.

Our hospital has been using Allscripts [electronic health record (EHR) system] since the 1990s, and other parts of the organization had moved to Sunrise (Clinicals) years ago. It was time to upgrade the ICUs, to have the same modern functionalities as everyone else, particularly with regard to computerized order entry.

What did you do to prepare for the switch to Sunrise?

Getting to successful implementation was years in the making, but there are a few things that worked really well for us. First and foremost, we had clinician engagement at every level. This was very much a clinician-led implementation.

Next, we approached the project as a team. We had a large working group of about 20 people representing technical, clinical, operational and educational disciplines. We met every week for about a year before go-live day to look at everything as the system was being developed. It worked better for us than having smaller, separate teams. With a larger group, we were able to make things happen quickly, with everyone in the room at the same time.

I think it also helped to go live in the neonatal intensive care unit (NICU) first. That unit has fewer orders and less technology with which to interface than the CCCU and PICU. We were ready for activation a couple of months later.

On “go-live” day, the CCCU and PICU were operating beyond full capacity. How did you manage the activation during such a busy time?

We always must be prepared to care for patients in over-capacity situations. It was important that the implementation did not interfere with patient care.

We had trained several nurses to be Sunrise “super users” to answer questions, but we needed them at the bedside instead. Allscripts was able to provide extra people to make sure the activation went smoothly.

Implementation isn’t the end – training and support have to keep evolving. We have a terrific educator group at SickKids that provides a lot of our ongoing training needs.

What can you do with Sunrise that you couldn’t do before?

The absolute biggest change is Computerized Physician Order Entry (CPOE). It provides us with the same benefits as the rest of the organization. It helps improve continuity of care, because when kids leave our unit for the ward, those clinicians can find our notes and flowsheets in the same system that they are using on their wards. With the new system it’s easy to navigate to things like X-ray and test results. Our teams are learning the advantages of electronic medication reconciliation and clinical documentation.

Is there anything else you’d like to share about your experience?

It’s been a good team effort. The big lesson we learned is that, to be successful with an activation, you need to have everyone at the table, including the vendor. It helps to have people who have been through this before to help solve problems quickly.

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