March 7, 2019

eStar updates and time change procedure announced

Time Change This Weekend: eStar Impacts

This weekend, Daylight Saving Time begins and clocks will “spring forward” one hour at 2:00 AM on Sunday, March 10. eStar will remain up (no downtime), as will other major clinical systems (e.g., lab, radiology, blood bank, cardiology diagnostics).

However, because eStar essentially loses an hour (skipping from 2:00 AM to 3:00 AM), there will be some impacts of which colleagues should be aware when providing clinical care or performing operational responsibilities:

  • Medication doses and procedures scheduled to occur during the non-existent 2:00-3:00 AM hour will be automatically rescheduled
  • Worklist tasks scheduled to fall between 2:00-3:00 AM will appear as overdue at 3:00 AM
  • System warnings triggered by Medication Administration times may be “off” due to the missing hour (e.g., patient lab for nurse-managed heparin or insulin protocol due 6 hours after medication dose of medication may not be scheduled correctly if time span crosses the time change; the task will have to be manually “staggered” forward an hour because of the lost hour).
  • Graphed data may be impacted by the missing hour, including:
    1. Flowsheets
    2. Results Review
    3. Synopsis
    4. Accordion reports
  • In areas that track event times (e.g., labor times, operative or procedure case events, ED admit to discharge times, etc.), these times will be inaccurate if the event crosses the time change. If these values are important to the historical record, they should be manually corrected.
    1. Operative & C-Section Case Event Tracking: Updating event times in this way ensures that the patient is charged correctly and that surgeons have the appropriate amount of time added to their procedure averages. Add a nursing note that specifies the actual times at which case tracking events occurred for the patient. This ensures that the actual times at which events occurred are documented in the patient's chart.
    2. Labor Summary: manually calculate all labor lengths that span the time change and document this information in a note. After signing the Delivery Summary, clinicians should correct the patient's labor length in the Obstetrics History activity (values to check/correct: Labor length, Time since rupture of membranes, Time since last cervical exam).
    3. Emergency Department: Impacts for the ED include:
      • ED alert timers appearing overdue sooner than expected
      • Artificially high values for reporting measures such as length of stay or Doc to Dispo
      • Inaccurate infusion charging and infusion volume calculations
      • AVS checks, BPAs, and other rule‐driven warnings not appearing as expected, because the rule that governs them contains time‐sensitive properties

Users should take the extra hour into account when using a patient's tracking times and event‐to‐event times to make decisions (e.g., clinicians should take the extra hour into account when using total visit times to determine which patients to assign themselves to from the Track Board).

Removal of Some POC Tests from Order Sets

In areas that utilize integrated iStat devices to administer point-of-care (POC) tests, orders for some of these tests will no longer need to be manually entered as of March 6. The administration of the POC test will automatically trigger the order within eStar. Impacted tests are:

  • POC GLUCOSE-HANDHELD [POC10]
  • POC LYTES-ICA-GLU-BUN-CREAT-HCT-HGB-HANDHELD [POC21]
  • POC CREATININE-HANDHELD [POC47]
  • POC POTASSIUM-HANDHELD [POC139]
  • POC TCO2-HANDHELD [POC143]
  • POC SODIUM-HANDHELD [POC144]
  • POC CHLORIDE-HANDHELD [POC145]
  • POC HEMATOCRIT-HANDHELD [POC147]
  • POC IONIZED CALCIUM-HANDHELD [POC148]
  • POC LACTATE-HANDHELD [POC150]
  • POC BUN-HANDHELD [POC162]

In their place, a nursing communication order, “NUR993 (POC NURSING COMMUNICATION ORDER)” should be used. This nursing communication order contains the lab options listed above. Users will place the order, noting specified labs so that the nurse knows which labs to select when using the iStat device.

This change has been made to prevent patients from receiving duplicate charges for the same lab test.

eStar Upgrade Coming April 7

A number of enhancements will be made to eStar on April 7, 2019. Some of these major changes include a new visit taskbar, “TheBrain” functionality for better shift planning and documentation for nursing, and the debut of the Avatar feature, which will allow easy location for lines, drains and airways.

Additional information, including details on the training available to users, will be provided on the HealthIT website and in My VUMC over the next several weeks.