title: Hospital-wide implementation of an electronic-workflow solution aiming to make surgical practice improvement easy.
abstract: BACKGROUND
  In measuring quality of health-care delivery, digital infrastructure is essential. The aim at this tertiary centre was to create a hospital-wide workflow system that collected data prospectively as part of daily practice.
  
  
  METHODS
  In moving towards an electronic health record, a hospital-wide integrated workflow system was introduced in 2013, which electronically managed the perioperative patient journey while simultaneously facilitating surgical audit. Analysis of its implementation was carried out presenting early outcomes using general surgery as an example.
  
  
  RESULTS
  Theatre-bookings (44 953) were made with compliance approaching 90% for all services. Of 7179 general surgical operations over 24 months, 5785 (80%) had an operation note created using the new system. Cumulative summation of uptake of synoptic operative reporting (SOR) for laparoscopic cholecystectomy (LC) was 81% with documentation being superior in terms of antibiotic use and steps to safe cholecystectomy (P < 0.001). A LC SOR took 4 min to complete (interquartile ranges 2-5 min, n = 425) and was immediately available on the day of surgery compared to narrative operative reports taking 2 days (interquartile ranges 1-5 days, n = 174) (P < 0.001). From July 2014 to November 2015, 557 (10%) complications were recorded for 5749 general surgical operations with 99% of complications being reviewed.
  
  
  CONCLUSIONS
  The rapid and sustained uptake of both theatre-bookings and SOR likely reflect high end-user satisfaction with the system. Service metrics indicate a significant improvement in the time of delivery. The ability to seamlessly complete the audit cycle at an individual, department and hospital level has been achieved.
authors: Department of General Surgery, Christchurch Hospital, Canterbury District Health Board, Christchurch, New Zealand.
authors: Magdalena M
authors: MM
authors: Sakowska
authors: Department of General Surgery, Christchurch Hospital, Canterbury District Health Board, Christchurch, New Zealand.
authors: Megan V
authors: MV
authors: Thomas
authors: Department of General Surgery, Christchurch Hospital, Canterbury District Health Board, Christchurch, New Zealand.|E-Clinical Health Lead, Christchurch Hospital, Canterbury District Health Board, Christchurch, New Zealand.
authors: Saxon
authors: S
authors: Connor
authors: Department of General Surgery, Christchurch Hospital, Canterbury District Health Board, Christchurch, New Zealand.
authors: Ross
authors: R
authors: Roberts
mesh_terms: D057286:Electronic Health Records / Q000458:organization & administration* / Q000706:statistics & numerical data; D013502:General Surgery / Q000458:organization & administration* / Q000706:statistics & numerical data; D019983:Guideline Adherence; D017408:Guidelines as Topic; D066275:Health Information Exchange; D006284:Health Plan Implementation / Q000458:organization & administration*; D006801:Humans; D011183:Postoperative Complications / Q000453:epidemiology; D016730:Program Development; D015397:Program Evaluation; D011446:Prospective Studies; D013503:Surgery Department, Hospital / Q000458:organization & administration; D057188:Workflow
keywords: electronic health record; surgical audit; surgical training; synoptic operative reports