AZ Alma has ambitious plans for Workflower

Preoperative Consultation—Doing more with the same resources 

AZ Alma’s operating theatre was increasingly busy, and the Preoperative Consultation (POC) Department was reaching its capacity limits … literally. There was neither the space nor the staff needed for the increasing number of patients.

So when Bingli came to the hospital to present its app, it got Fritz Defloor thinking: “If we could persuade some of our patients – for example, those undergoing a simple procedure – to complete the preoperative questionnaire at home rather than at the hospital, we would be well on our way to finding a solution. It would be good for the patients, too, as they could fill in the questionnaire at their convenience. A real win-win.”

Bingli is a powerful tool well able to handle the questionnaires. But it is also considered a stand-alone product, while AZ Alma wanted to integrate the questionnaires into the comprehensive preoperative process. The EPR could not support this process end-to-end.  “But we knew that Workflower is designed to be very generic: it’s a tool that can be used to digitise all kinds of work processes in a very flexible way. This was exactly what we needed,” Fritz says.

Preoperative consultation process:

The process set up with Workflower consists broadly of the following steps:

• When the decision is made that a patient will undergo surgery, a process, originating from the OR scheduling package, is initiated in Workflower.
• The patient must then complete a questionnaire before the surgery. For a relatively simple operation with few immediate risks, the patient may choose to complete the questionnaire at home. If the procedure is complex or the patient cannot complete the digital questionnaire on their own (for example, an elderly patient), then the questionnaire is completed in the hospital, under supervision if necessary.
• The POC nurse receives the patient’s completed questionnaire, and may ask additional questions if needed.
• Once the nurse has validated the patient’s data, the surgery appears on the anaesthesiologist’s waiting list for approval.
• Finally, the completed questionnaire, supplemented by the relevant data collected during the process (such as additional examinations like ECGs, etc.), is added as a PDF document to the EPR. The nurses thus have all the information they need on the day of surgery.

Advantages of the Preoperative Consultation (POC) process:

• AZ Alma no longer uses paper files for the anaesthesiologist’s surgery approval process. Using digital files means validation can be done anywhere. This makes the validation process considerably more robust, which greatly increases care safety: interventions can no longer slip through the validation process net.
• Since all the questions must be answered, nothing is missed. Illegible handwriting and writing errors are avoided.
• When a patient indicates an important issue in the questionnaire, such as “I take blood thinners” or “I have an allergy”, the application brings this to the attention of the nurses immediately.
• The preoperative consultation process is much safer, while the POC can see more patients without additional rooms or personnel.
• Everything is transparent in Workflower: it is clear exactly where each patient is in the process. Workflower issues a notification if there are any discrepancies. For example, if there is a patient scheduled for operation in a few days, but an ECG result has not yet been received. Previously, such a situation had to be sorted out manually.
• Finally, with this process, AZ Alma does not only have the data, but also the metadata. It is clear exactly which steps in the process have been dealt with, and when. This provides information on the quality of the work process.

Project approach:

Fritz Defloor: “This was a fairly complex project involving several parties, and it therefore required some work to set it up. But the go-live took place without any major problems.”

“It was crucial that the preoperative consultation process was well constructed from the outset, even before Workflower was involved. That certainly played a significant part in the success. But the importance of Amaron’s role throughout cannot be underestimated. At its core, Amaron is a company dedicated to the connectivity between the various applications in hospitals, including AZ Alma. With this foundation of know-how, they truly know the ins and outs of hospitals and their processes. And that certainly helped us.”

“Amaron also really thought alongside us. And while their technical support was critically important, the input they gave in terms of content may have been even more valuable.”

“Thanks to the cooperation of the three parties— the Bingli and Amaron teams and the AZ Alma POC team and anaesthesiologists—it was possible to create something very elegant.”

The innovative nature of the project brought it to the attention of the outside world, as well. In 2021, it was a top-three finalist for the Flemish “Care Innovation of the Year” award, in Ghent.

COVID and co.

AZ Alma had concrete plans to digitise several other work processes with Workflower, but COVID-19 impacted priorities. In order to provide an adequate and rapid response to the health crisis, the hospital implemented several Workflower processes:

1. Treating physicians can approve admissions after patients have tested negative for COVID-19, using a validation tool.
2. Patients receive an SMS reminder a few days before their appointment at AZ Alma. The day before the consultation, they receive a second SMS reminding them of the hospital’s COVID measures.
3. Automatic requests are generated from the on-call doctors’ post (where COVID testing is done) for AZ Alma’s clinical laboratory (where the analyses are performed).
4. Vaccinations of doctors and employees are recorded centrally and automatically reported to Vaccinnet (the care platform of the Flemish authorities). Furthermore, AZ Alma always has an accurate picture of the vaccination rate of the hospital staff, and the entire vaccine logistics process is running smoothly. When an employee comes for a vaccination, their ID is scanned and their data appears on the screen. The correct vaccine and its batch number are selected. Vaccine administration is then confirmed by checking the appropriate box.

“The COVID period wasn’t easy for anyone—Amaron also had mountains of work to do. But they always provided the support we needed. There are no alternatives, to my knowledge, unless you start developing things yourself. But with Workflower, we were able to set up these processes much faster and in a robust way,” continues Fritz.

Designing new processes yourself 

AZ Alma has plenty of plans in the pipeline for new work processes including:

• Employee requests for thematic leave;
• A process for internal printed documents, and their revision;
• The central lending service for nursing equipment;
• Patient requests for a copy of their patient record;
• Sending a text message after a surgery to inform the patient’s designated contact person that the patient is back in the hospital room. This should reduce the number of phone calls nurses have to answer, especially when they do not yet have news to convey.

“In time, we want to configure our processes ourselves in Workflower, and we are currently training a few people for this. Then, we will only need to engage with Amaron if we need an interface with another system,” says Fritz Defloor.

To conclude: a tip

“If you want to digitise work processes, it is crucial that you start from a process that is intrinsically well-constructed. So, before anything else, make sure that all the steps are correct. Also important: is the process well-embedded within your organisation? If these conditions are met—and this is certainly true for more complex processes, such as the POC—you are then ready to digitise the process with Workflower,” says Fritz Defloor.

“Over time, I would also like us to be able to work together with other hospitals, so that we do not have to re-invent the wheel. After all, we can learn a lot from each other. For example, simpler work processes or the processes that are required by law and therefore are the same across hospitals. As far as AZ Alma is concerned, more complex processes can also be shared. Not so much for the purpose of copying each other’s processes, but to exchange knowledge. Within a community, as it were, in which we work together and exchange processes/knowledge according to the principle of solidarity,” concludes Fritz Defloor.

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Are you considering implementing the preoperative consultation process or another Workflower process in your hospital? Do you have any questions? Don’t hesitate to contact us!

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