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System Downtime
According to LaTour & Maki (2010) downtime is a period of time when there is a failure of the system to perform or provide its primary function. Downtime may either be planned or unplanned during which the proper functioning of the system is compromised or it is unavailable to user, and this is often caused by either environmental factors, computer system failure, network failure, software failure, interface failure, and/or routine scheduled upgrades or maintenance.
According to the staff working at the hospital i.e. KKUH, downtime occurrence with regards to HIMS does not take place often at the hospital. For example, the last time a downtime was experienced at the hospital was two months ago and it only lasted for about a half an hour at the emergency department only. The eSIHI was implemented recently meaning it is still new for all staff at KKUH.
On the other hand, apart from unplanned downtime it is possible for a downtime to be planned or scheduled, that is, a period during which through a deliberate or intentional alterations or modifications the health information system is unavailable to users or is not able to function properly. During planned downtime, the system may not be affected as a whole or in totality, meaning some functions may still perform properly or the system may still be available to some users. The purpose of planned or scheduled downtime is mainly scheduled maintenance, system upgrades and updates.
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During a down-time whether unplanned or planned, the admission procedures at the Emergency Department changes to ensure health care services continue. At the Ambulatory and Emergency Department, during a period of downtime the officer responsible for all kinds of documentation is the physician in-charge and ensures instant scanning of the documents.
Unit clerk/nurse is responsible of providing all necessary forms during downtime, and ensures that the scanned instantly and uploading of the documents is done when the system recovers. Down Time Support Team has the responsibility of uploading documents that were scanned during a downtime and entering of orders in eSIHI upon the recovery of the system, usually before that day ends.
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Admission officers at the Emergency Department should be aware of the appropriate procedures during a downtime because the office of Admission is responsible of registration of all patients for admission (Moore & Fisher, 2012). The standard admission procedures are as follows:
- For new admissions, during a down-time a manual ADMISSION face sheet is completed by admission officers for each admitted patient.
- The patient is then sent to the appropriate unit for further emergency care because Emergency Department cannot offer such care for long especially when it is intensive.
- The patient is accompanied by the following documents: 1) the manual ADMISSION face sheet; 2) patient labels as well as armbands; 3) patient admission orders (when they are available).
- In the absence of the patient admitting orders, the Nurse or any other designated person who is appropriate calls the Admitting orders from the admitting physician.
- If the Admission orders arise from the nursing unit, especially in case of a newborn the Admission desk is called by the nursing unit for their notification about the new admission.
- The Admission unit clerks/officers/designee uses a downtime packet to establish a patient’s chart, and each page must be labeled with the name of the patient, FIN NUMBERS or medical record number, room and bed of the admitted patient as well as the name of the admitting physician.
- Discharges should be limited as much as possible during downtime due to the increased potential for errors, but when necessary to discharge the Admission desk is called by the discharging unit for their notification about the discharge. The manual discharging documents during downtime are added to the chart of the patient and maintained on the nursing unit where the patient was admitted until the system recovers when the documents are uploaded.
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Documentation by Admission officers during a downtime should ensure that: 1) all forms filled during downtime are labeled accordingly using two identifiers for the patient (at minimum the date of birth and name); 2) the downtime forms are always required to have a date, time, and signature; 3) on top of each medication order, the nurse must indicate “Allergy”; 4) the filling of all paper forms is done as part of the medical record for the patient.
References
LaTour, K. M., & Maki, S. E. (2010). Health information management concepts, principles, and practice. Chicago, Illinois: American Health Information Management Association.
Moore, A., & Fisher, K. (2012). Healthcare Information Technology and Medical-Surgical Nurse: The Emergence of a New Care Partnership. CIN: Computers, Informatics, Nursing, 30(3), 157-163.
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