1. Surgery Quality and Workflow Manager
Facilitator / Care Coordinator Nursing Workflow

2. Learning Objectives
After instruction, students will be able to complete the following tasks:
Access and navigate windows for Surgery Clinic Census, OR Census, and Misc Census
Access and complete the Surgical Readiness Status Form
OPENING TASKS:
Thank participants for coming.
Introduce training team.
Ask participants to introduce themselves.
Ask participants for name, where they are from, (if class participants are from various geographical areas), role with the VA, and what they want to get out of the training.
Inform participants about schedule, breaks, lunch, as well as the location of bathrooms, exits, food, etc.
Set Classroom Expectations (cell phones off, starting on-time, minimize distractions).
Lead participants through material on their desks.
EXPLAIN:
During the instruction, you will be given the opportunity to practice each of the tasks listed as a learning objective.
The purpose of today’s training is to provide an understanding of the functionality of the Surgery Quality and Workflow Manager tool, specifically the OR Census, Misc Census, Surgery Clinic Census, and Pending Work Census.
READ and DISCUSS Learning Objectives.

3. SQWM Documentation Icon
TRANSITION:
Selecting the SQWM Documentation icon takes you to the login screen for the Centricity Perioperative Anesthesia (CPA) application, which contains the documentation screens for both the anesthesia and surgery providers.
Let’s start by logging in to the system.

4. Access Perioperative Anesthesia
DEMONSTRATE:
After clicking the SQWM Documentation icon, enter your Login Name and Password. Click OK.
The Centricity Perioperative Anesthesia (CPA) login page allows the user to log into the Anesthesia Application and to change the password.
EXPLAIN:
The permissions granted are based on the role of the user. Some actions demonstrated may not be performed by all users. Role specific privileges are highlighted throughout the training.
NOTE:
As we walk through the examples and practice exercises, you see patient data display. All screenshots and training exercises take place in a training database, and no actual personal patient data is used.
TRANSITION: Let’s look at some of the features of the system.

5. Census Selection DISCUSS:
As we work in the different areas of the software, we discuss several different censuses. A census is a list of patients or items needing attention. Different logins have a different census as the default, which is the list that opens automatically on log in. This is usually established by role.
The Census options for a Facilitator or Care Coordinator are OR Census, Surgery Clinic Census, Miscellaneous Census, and Pending Work Census.
The Surgery Clinic census lists the patients scheduled for a consult in the surgery clinic.
OR Census lists patients scheduled for surgery on a particular day.
Miscellaneous Census, which is also called Waitlist Census, lists patients who are indicated for surgery. This is also where users can track medical readiness. Patients are placed on this census once they are indicated for surgery and remain there until the surgery is performed.
The Pending Work Census lists the unsigned notes or other items that require attention.
TRANSITION:
Let’s look at how to search for patients.

6. Search Options EXPLAIN:
Patients display on the Surgery Clinic census following a consult request. To search for patients in the Surgery Clinic or on the Misc Census, select a clinic from the Unit dropdown, such as General Surgery, Orthopedics, etc.
A default unit for the user can also be designated for users in the Surgery Clinic Census and the Misc Census. Surgery and Misc census have multi-select instead of a dropdown menu. You can select multiple units or use the multi-select option to select all units. However, if you use the Select All option, the system limits your results to the first 500.
Other search criteria, such as date, name, etc. can be added. You can enter a date range, or if looking for today’s patients only, leave it set to the default of the current date. You can now search by Social Security Number, or use the Quick Search option. The quick search is the first initial of the patient's last name and the final 4 of the Social Security Number. In some areas, the Search functionality is a smart search and narrows options as you type. Other filters you can use include selecting Status, Surgeon, or PCP. The Status and Service fields also have multi-select options. Once the appropriate entries are made, click Search. The entries matching your search criteria display. Results columns can be sorted by double clicking on the column header.
NOTE:
You must have a Unit selected before searching to get any results.
TRANSITION: Let’s look at some new toolbar icons and what they do.

7. Census Navigation and Toolbars
Surgical Consult and Misc Census Toolbars
OR Census Toolbar
EXPLAIN:
Many of the Toolbar icons are the same for all the Census windows:
Back takes you back to the clinic you were in before or returns to the previous page.
Log Out allows the user to log out and enables someone to log in as a different user.
Census displays the dropdown of the available Census options for the current user.
Approval is located on the Surgical Clinic Census and accesses the Approval queue for surgeons to approve or reject residents’ requests for surgery.
The New Case icon allows you to schedule a new case if you need to schedule multiple cases on the same patient.
Export allows the user to export the Census to a CSV file.
Worklist displays a list of unlocked forms or follow up items pending or needing additional attention. This is the same as the Pending Work Census.
Monitor allows the user to remotely access monitors that are used in the OR.
Print when selected on the OR Census, prints the census content displayed.
Refresh provides a refresh or update of the most up-to-date data.
VistA Web provides access to the web-based CPRS notes for the patient.
TRANSITION:
Let’s start with the Export icon and learn how to export your search results to be able to manipulate them in a spreadsheet.

8. Export to CSV
EXPLAIN:
As seen on the previous slide, the Export icon is available on the toolbars for the OR Census, Surgery Clinic and Misc Census.
The system allows patients to be exported from a search. Users with the appropriate Security rights are able to export the information to a CSV file.
For example, you can do a search for a list of patients meeting a certain criteria, then you can export that list, and pull it into Excel. Uses for an exported list include creating a patient list for the day for the surgeon or clinic, or managing and scheduling patients for surgery.
Once you select the Export icon, a dialog box displays allowing you to save the file to CSV format.
TRANSITION: Let’s look at some of the features of the Misc Census.

9. OR Census Navigation TRANSITION:
Nurses can also access OR Census. It defaults to display patients scheduled for surgery on the current date.
DISCUSS:
To display patients for a specific date census, select the From Date and the To Date in the date fields on which you wish to search. To retrieve all patients for a specific date, do not enter any information in the patient search text box. All patients that are scheduled for that clinic date displays.
To search for a specific patient, enter the last name in the Last Name field, and click Search. The other search options include specific personnel, such as attending, resident or anesthesiologist, as well as case number or room number.
Search fields can be used to limit the results seen in the OR Census display area. The more data entered in the search fields, the more focused the results. In order to search on the various roles (i.e. Surgeon, Anesthetist) these roles must have been assigned via the scheduling system. As users log in to the application, if they have been assigned one of the roles in the search area, their name defaults in the initial search. If the user has not been assigned to cases, they can select Clear and Search to remove the provider criteria.
Column headings include Name, OR Scheduled, Scheduled Time, SSN, DOB, Assigned Personnel (Anesthesiologist, CRNA, Resident, Surgeon), Preop Eval, Case Number, PAT Concerns, and Clinic Location. The columns can be sorted by double clicking the column header.

10. Miscellaneous Census EXPLAIN:
The Misc Census is also referred as the Waitlist Census. A patient is placed on the Miscellaneous/Waitlist Census when indicated for surgery and stays there until the surgery is performed. The census columns show the patient’s Name, DOB, Gender, SSN, which all come over from ADT.
Service connect is also from ADT, and may be Read Only.
Actions come from the Surgery H&P.
Complete writes back to the census when lab or other tests are completed.
Service refers to the surgical service.
Suspense pulls the last suspense for this patient.
DOL refers to Days on List, which starts with zero and shows how long the patient waited to have surgery.
The Status column contains statuses such as Surgery Indicated, Pending Request, and Pending Medical Clearance, if the surgery is delayed as a result of the patient not being medically ready. Currently DOL only stops when the patient is in the OR. The status, Clinic, is the initial status. All consults have an initial status of Clinic.
Discharged from service status displays when the patient is dismissed by the surgeon. Cancelled comes across cross from Clinical Documentation. Deceased comes across from ADT. Surgery Indicated shows whenever surgery is approved. Procedure Requests can be listed as Pending Approval, Approved Or Rejected.

11. Misc Census Search Fields
EXPLAIN:
The Misc Census is also referred as the Waitlist Census. A patient is placed on the Miscellaneous/Waitlist Census when indicated for surgery and stays there until the surgery is performed. The census columns show the patient’s Name, DOB, Gender, SSN, which all come over from ADT.
Service connect is also from ADT, and may be Read Only.
Actions come from the Surgery H&P.
Complete writes back to the census when lab or other tests are completed. Service refers to the surgical service.
Suspense pulls the last suspense for this patient.
DOL refers to Days on List, which starts with zero and shows how long the patient waited to have surgery.
The Status column contains statuses such as Surgery Indicated, Pending Request, and Pending Medical Clearance, if the surgery is delayed as a result of the patient not being medically ready. Currently DOL only stops when the patient is in the OR. The status, Clinic, is the initial status. All consults have an initial status of Clinic.
Discharged from service status displays when the patient is dismissed by the surgeon. Cancelled comes across cross from Clinical Documentation. Deceased comes across from ADT. Surgery Indicated shows whenever surgery is approved. Procedure Requests can be listed as Pending Approval, Approved Or Rejected.

12. Status Options EXPLAIN: Patients can be searched for by status:
Acton Required - Items required for clearance for surgery display on the MISC Census under the Actions column. Use the Update link to update the case. Days on List continues.
Canceled - Stops counting Days on List. Cancelled status comes from Clinical Documentation or Scheduler.
Canceled Pending Reschedule - When a case is cancelled in Scheduler, and Return to Misc Census is selected from the cancel case window. This option is used to mark a patient for further workup.
Clinic - all consults have an initial status of Clinic.
Completed - Cases fall off the Misc Census but can be searched for when needed
Deceased comes across from ADT.
Discharged from service status displays when the patient is dismissed by the surgeon.
Surgery Indicated shows whenever surgery is approved. Procedure Requests can be listed as Pending Approval, Approved Or Rejected.
TRANSITION: Let’s look at how to put a case back on the Misc census if it needs to be cancelled.

13. Miscellaneous Census Options
EXPLAIN:
Search for patients in the same way as for the Surgical Consult Census, using the To and From Date fields, and selecting a Unit. Once the patient list displays, click to show the dropdown options. The Surgical Readiness Status form is one of the Options available.
This may be a new and different business process. Often this function has been performed by carrying a notebook with entries on every patient. For many Care Coordinators, the Waitlist Census and Surgical Readiness Status forms are the only things they see. This is often used only by nurses and care coordinators.
The Facilitator or Care Coordinator fills out the Surgical Readiness Status form. Patient wait times begin being calculated when surgery is indicated and in order to prevent excessive wait times, it is important to monitor the issues preventing surgery and keep it on schedule.
Wait times can be placed in suspense from any patient decision not to have or to delay surgery. The patient can have up to three instances where the surgery is placed into suspense, after that the surgery is rescheduled.
The Surgical Readiness Status form is usually for whomever has the task of monitoring the waitlist to ensure that patients are medically ready for surgery.
TRANSITION:
Let’s look at how to access a patient’s Labs from within SQWM.

14. Lab Interface EXPLAIN:
The Labs link on the Documentation dropdown provides access to labs ordered for the patient. This link is also available on the Documentation dropdown in OR Census, Surgery Clinic Census, and on the Forms toolbar. Click Labs and the Labs module displays.
Labs can be searched for by selecting groups, time frames, and priorities. The different parameters available when you view Labs include Groups, Priority, Time Span, Time Compression and Microbiology.
Groups: Use the dropdown menu under Groups to change the type of lab that you are viewing.
Priority: Choose from All, Typical or Critical.
Time Span: When you view the labs, the time span defaults to three days. You can choose a different time span by clicking on the dropdown under Time Span. Your choices range from Today to No Limit.
Time Compression: You can choose None, Day, or Week from the Time Compression dropdown menu.
If you wish to also see Microbiology, click the box underneath Microbiology. A checkmark displays and Microbiology is included in the labs.
There are also Defaults and Search buttons.
Defaults: Click on the Defaults icon to return the choices to default, which are Default, Typical, Three Days, None and no Microbiology.
Search: Allows to search for a specific result.
TRANSITION: In addition to accessing Labs, you can also access CPRS from within SQWM.

15. Access CPRS from within SQWM
EXPLAIN:
After you execute a search and the patient list displays, select a patient and click to display documentation options, as seen previously.
Select the CPRS link to access a patient’s CPRS record.
TRANSITION:
Let’s look at how to access the Surgical Readiness Status form.

16. EXPLAIN:
After you execute a search and the patient list displays, select a patient and click to display documentation options, as seen previously. Select the Surgical Readiness Status option.
The form selection dialog box displays. The Date and Time defaults to the date and time the form is launched. This can be altered prior to opening the form.
The Datacopy option is the default. It is recommended to leave this option checked so that information pre-populates or flows into the forms.
This allows any information documented in the previous forms to flow into the current form if they are similar.
TRANSITION:
Next, let’s look at information available in the form banner.

17. Patient Banner EXPLAIN:
The patient banner that displays at the top of the form contains important information on the selected patient that can be seen with higher visibility.
Information is populated from documentation within the form or from scheduled case information. After charting, click the Refresh icon to display the information documented on the form in the banner.
Information displayed can include:
Name, Date of Birth, Gender, MRN, Scheduled Procedure, and Allergies.
Additional banner information displays by clicking the red box at the far right of the banner.
The form header displays the form name, date and time when the form was initiated, and the name of the user who launched the form.
TRANSITION:
Let’s look at the form toolbar and the function of each icon.

18. Forms Toolbar EXPLAIN:
The toolbar icons for the various forms include:
Back is used to return to the previous page displayed.
Logout is used to change users without exiting the application.
The Labs icon provides access to labs ordered for the patient.
Conversion is a conversion tool that can be used to convert between units of measure such as weight, temperatures and length.
Procedures launches the folders for the Procedure Note templates.
Census returns the user to the census from the current page.
WorkList displays a list of unlocked forms or follow up items pending or needing additional attention. This is the same as the Pending Work Census.
Risk Calc is a risk calculator available that calculates the risks from surgery for the patient.
Transmit transmits the form to CPRS.
Edit controls whether a form can be viewed or edited. If you have edit privileges, it defaults to Edit mode.
Print prints the contents of the form displayed.
Refresh provides a refresh or update of the most up-to-date data.
The Expand icon opens all panels within the form displayed.
Collapse returns the panels to their closed positions.
New Form allows the user to select a new form to complete.
Click the down arrow at the end of the toolbar to display additional toolbar icons.
Add Variable allows you to add additional parameters to a form.
Open Form opens the form for editing.
Modify allows someone with edit privileges to modify data that was entered incorrectly.
Delete removes information if it was entered in the wrong place, for example.
TRANSITION: Next, let’s look at how to access previous SQWM notes.

19. Access Previous SQWM Notes
EXPLAIN:
Any notes previously entered in SQWM can be accessed by selecting the Open Form icon.
A dialog box displays with a list of any previously documented forms. Select the appropriate form to open and view previously documented information.
TRANSITION:
Next let’s look at how to enter data in the form.

20. Enter Data in the Form EXPLAIN:
The form is made up of panels. The panels group assessment information. The Patient Information panel reflects information that was captured through the scheduling process and automatically populates the form when launched. Any updates made to that information outside the form do not update a form that is already launched.
You can expand a panel by clicking the + on the left side of the page. You can collapse a panel by clicking the -. You can also use the expand and collapse icons in the toolbar.
The forms also allow you to select from a list of common data, shortening the amount of time you spend documenting and standardizing the documentation. To enter data using the lists, click the parameter to be assessed. The list of items for this parameter display. Select the appropriate item from the list. If the choice you want is not available, you can enter free text data.
Within Normal Limits (WNL) is configured for each panel where applicable. The WNL button when selected charts the appropriate verbiage to indicate a normal assessment for that section. The data can be changed once WNL has been documented. No Change (NC) displays next to the WNL button only when more than one form has been documented. The No Change feature is used to pull information from like forms. To document, select the + sign in front of the panel description to expose the objects available for charting. The objects may allow for a single selection of answers or multiple selections, date/time formatting or free text fields.
Some objects may group several related objects. The user may chart a portion or all components in the grouping. Other objects have a waterfall effect where once the first selection is made subsequent details are requested.

21. Surgical Readiness Status Form
EXPLAIN:
When a user finishes documenting a form, to lock it and allow for it to be transmitted, the user clicks Sign Off.
A Password Required prompt displays. The user can certify the document or cancel out if more information needs to be charted.
TRANSITION:
Now let’s practice what we learned.

22. Practice – Surgical Readiness Status
Patient B is having knee surgery. The surgical procedure is 29883, Arthroscopy, Knee, Surgical w/ Meniscus Repair Medial & Lateral, right laterality. The provider ordered a Chem 7 and an EKG for this patient. You enter these tests in the Surgical Readiness form, check their status, and mark the tests as completed.
ASSIST:
Move around room providing assistance as necessary.
ASK:
What questions do you have about documenting a Surgical Readiness Form?
INSTRUCT:
Directions to complete the exercise.
Log in to SQWM Documentation.
Select Misc Census.
Click Patient B.
Click Surgical Readiness Status form.
Enter relevant data.
Click Back to go back to the census.

23. Review We have covered the following topics:
Access and navigate windows for Surgery Clinic Census, OR Census, and Misc Census
Access and complete the Surgical Readiness Status Form
REVIEW:
In this section, we learned how to Log in, access and navigate in the Surgery Clinic Census, OR Census, and Misc Census. We discussed how to search for patients,.
ASK:
What step must you perform first to enable patients to display on the census?
(First select a Unit from the Unit dropdown.)
We discussed how to complete the Surgical Readiness Status form.
What questions do you have about any of those processes?

24. Real World Scenario
Patient C had a left shoulder arthroscopy with subacromial decompression. He had an infraclavicular brachial plexus block with continuous catheter placement in holding. He received 3 mg of Versed for the block. Use the information on your handout to document the following form for this patient: Surgical Readiness Status form.
ASSIST:
Move around room providing assistance as necessary.
ASK:
What questions do you have about entering an information in a Surgical Readiness Form?
INSTRUCT:
Directions to complete the exercise.
Log in to SQWM Documentation.
Select the appropriate Census.
Find the Patient.
Click the appropriate form.
Enter relevant data.
Click in the Sign area and then in “I have reviewed form.”
Enter password
Click OK.
Click Back to go back to the census.

25. Questions? Session Wrap-Up ASK:
How are patients moved from the Waiting Room to the Exam Room in Preop Clinic?
How do you access VASQIP forms?
What two census’ are typically used?
Ask for any questions on the exercises. Are there any steps or processes that are unclear?
DISCUSS:
Any outstanding questions from the parking lot?

26. Help Desk and References
Two methods of entering a service request
eService - low priority ticket
Phone – critical, high, medium, low priorities
Press 4 for Surgery Quality and Workflow Management, then
Press 4 to speak to technical support
SQWM Training SharePoint Site:
EXPLAIN
There are two methods of entering a service request, eService and by phone. Additional training information can be found at the SQWM Training SharePoint Site.

27. Course Evaluation EXPLAIN:
Your input and feedback is greatly appreciated.
Direct students to End of Course Evaluation location.