2. Kaz Sobczak 1, Joyce Nacario 2, Ho Lom Lee 3 1 University of California Medical Center, San Francisco, CA (USA) 2 University of California Medical Center, San Francisco, CA (USA) 3 University of California Medical Center, San Francisco, CA (USA) Kaz.Sobczak@ucsfmedctr.org, Joyce.Nacario@ucsfmedctr.org, Holom.Lee@ucsfmedctr.org

3. Purpose and Background  UCSF operating room has developed a novel, easy-to- use tool to visualize and manage operating room use in real time called CaseView.  CaseView was built specifically as an information tool for medical, administrative, and perioperative staff.  The purpose of this study was to examine cost effectiveness and efficiency levels resulting from using CaseView as a web-based technology to expedite patient care and cost-saving for an operating room in clinical practice.

4. CaseView as a Web-Based Resource Technology  Joyce Nacario-a nursing informatics expert and clinical nurse IV at UCSF Medical Center Operating Room, helped design and run a web-based resource called CaseView with the cooperation of Ho Lom Lee, a programmer, and Dr Kulli, a perioperative medical director [3].  CaseView was developed using existing computer infrastructure, Microsoft Net, information processes, and information technology.  CaseView provides dynamic and sophisticated information, using text, still images, video, audio files, and various web design techniques without incurring any external costs.  Using internal resources, CaseView is supported by one informatics nurse and one programmer

5. CaseView Feature  The data elements used to build the CaseView display include: Room (OR) number Surgeon name Name of anesthesiologist Name of surgical procedure Patient name Scheduled case start time Scheduled case duration Actual case start time Actual case duration

6. Real-time information The operating room and PACU display are shown below. The color purple indicates that the patient has arrived at the surgical waiting area. Green indicates that the patient is in the preop area. Blue indicates that the patient is in the OR and pink is used to record that the patient is in PACU. Yellow indicates that the patient is still going to the OR (pending cases).

7. Start and End Times: Turnover Times  Cases completed, underway, and upcoming are all shown on the same screen.  Completed cases are depicted using actual start and end times.  Case start and end times are displayed down to the minute, not in 15 or 30 minute increments.

8. CaseView Supplies.  CaseView tracks all supplies used in the operating room at UCSF Medical Center Hospital.  It is now being applied to map out a cost-effective approach to supply usage.  This report summarizes the application designed to specific procedures

9. Setting and Methodology The test of CaseView was conducted in the operating room unit of an academic medical center, UCSF. The study took place from February 2010 to June 2010. All operating room staff members were invited by email to participate in a web-based survey asking them to evaluate how CaseView affected the health care team's efficiency, knowledge, retention, team building, leadership skills, professional development, knowledge management, evidence-based practice, and, most importantly, patient safety. The convenience sample (N = 119) was selected from an academic medical center, UCSF over a 3-month period and consisted of surgical staff using CaseView. The survey included open-ended and closed-ended questions, multiple choice questions, matrix questions, as well as dichotomous yes/no questions, with “yes” signifying positive and “no” negative effects.

10. Results Over 90% of the respondents said that CaseView expedited patient care and cost- saving clinical practice. It was also described as environmentally friendly, as it eliminates the need to print out hundreds of pages of paperwork daily. Over 90% of the respondents said that CaseView expedited patient care and cost- saving clinical practice. It was also described as environmentally friendly, as it eliminates the need to print out hundreds of pages of paperwork daily.

11. Conclusions  CaseView web-based technology addresses health care providers’ needs for better time management and improved cost-effectiveness by providing a powerful yet intuitive visual interface to data that already exist in clinical databases.  It allows stakeholders to make decisions based on the most up-to-date information and promotes efficiency as well as situational awareness regarding the OR.  Results of the survey show that without CaseView, monitoring data and recording the business of providing health care would be inefficient and would further strain the hospital’s resources.  The current pace of change in health care knowledge and information technology continues to accelerate.  CaseView offers tools for health care providers to manage this exponential increase in information technology so that the most cost-effective treatment decisions can be made that will result in the optimal outcomes for patients.