Computer Health Assessment by Telephone - CHAT
WHY WAS CHAT DEVELOPED?Today the system for perioperative assessment of patients includes elements which date from the nineteenth century. Largely paper based and labour intensive, it is open to errors and an inefficient use of valuable hospital staff time.
Currently, most public surgery patients for non-day surgery procedures attend an Outpatient’s Clinic for their assessment prior to surgery. This involves a large team of nurses, anaesthetists, surgical staff and pharmacists. It is also a burden on patients having to take time off work, or travel from the country to a city public hospital.
A survey of hospital staff showed that anaesthetists and nurses felt that some patients don’t need to attend an outpatients clinic, as this took up a great deal of their time, hand written notes were difficult to use and share with colleagues, and it was inconvenient for many patients.
New hospital infrastructure needs twenty-first century systems. Better systems will improve patient safety and wellbeing, plus enable the nation’s 400,000 health staff to operate more efficiently - that means shorter waiting lists, faster patient throughput, with a priority on safety and care.
That’s why Professor Guy Ludbrook (pictured right), Royal Adelaide Hospital anaesthetist and University of Adelaide Professor of Anaesthesia, and colleagues have developed CHAT.
WHAT ARE THE BENEFITS OF CHAT?There are many benefits and reasons why CHAT should be considered for use.
CHAT is safe:The CHAT questionnaire consists of a comprehensive clinically verified collection of the physiological, pharmacological and pathology information required by anaesthetists, nurses, pharmacists and surgeons. Computer based, it uses a tree structure and identifies all areas of interest and explores full patient details. Easy to use, CHAT interviews can be performed by clerical staff. After the patient interview CHAT produces a report on the designated hospital’s form, and this is readily available for all clinical staff to access when required.
CHAT has been piloted at the Queen Elizabeth Hospital and Lyell McEwan Hospital in parallel with the old system. It is currently in clinical trial at the Royal Adelaide Hospital. Anaesthetists have verified that the clinical information provided by CHAT is equal or better than the information gathered by the paper based system.
CHAT is efficient:Surveys of clinical staff show that they estimate about half the patients undergoing face-to-face assessment could have by-passed Outpatients. In fact the CHAT pilot studies at QEH and LMH confirmed that CHAT could achieve an average 50% reduction in patients attending Outpatients, simply by being called on the phone for a CHAT. In one surgery group the bypass rate was potentially 80%. Of course, if patients want to see their anaesthetist for peace of mind, they can still attend the hospital.
Savings for hospitals:The perioperative assessment conducted through Outpatients in a large hospital may use 10 nurses and the equivalent of 3 anaesthetists. Plus there is the time that pharmacists and surgeons spend reviewing wads of forms. In the survey of clinical staff, many said they waste considerable time in searching for paper work and diagnoses. Sometimes a diagnosis needs to be repeated due to misplaced reports. So the cost of the old system could run into many millions of dollars per annum for a public hospital.
CHAT can double the efficiency of this expense. With CHAT a hospital could redeploy nurses and anaesthetists to more critical duties. A hospital could turn this saving into reduced waiting lists and higher patient throughput. Or to save cash a hospital could use efficiency gains to reduce staff. It’s up to the hospital how it benefits from the efficiency gain, but the cost of using CHAT is only a fraction of the savings a hospital can make.
CHAT in your hospital:CHAT is a manageable software application that can be installed on hospital IT systems. Patient interviews can be conducted by hospital staff, or by the CHAT call centre. After the interview the patient assessment report will be available for all clinical staff to access, and can be printed for patient notes.
The CHAT team will train hospital staff in using CHAT, and how to maximise the tree structure of the interview. Ongoing IT support and assistance will be available.