1. E-Sign off Its importance and how to do it Created by Dr. Ruth Spearing for new RMOs joining the organisation

2. Background Previously paper resultsPreviously paper results Often late results e.g. swab/blood cultures/sensitivities came back after patient has left hospitalOften late results e.g. swab/blood cultures/sensitivities came back after patient has left hospital Difficult for the significance of results to be recognised without knowledge of the patientDifficult for the significance of results to be recognised without knowledge of the patient Meant that both the patient and the doctor was at riskMeant that both the patient and the doctor was at risk

3. History 2008 – group lead by clinicians requested all results become electronic and that paper results be phased out Wide consultation/ working group of RMOs/SMOs/Admin colleagues Came into place March 2009 Widely accepted as a major step forward HOWEVER – recently recognised lack of teaching of how to sign off and the expectations upon team members

4. How to do E-sign off Each day accept all results you are happy with and have actioned On joining a run it is essential that you know what the run wants you to sign off Should be clear in the induction information for the run - if not please feedback to us

5. Check what your team wants Most other teams want you to sign anything you feel comfortable with and to refer on the rest Surgeons generally don’t want histology signed Nephrology don’t want anything signed by RMOs!

6. Standard view of Concerto with unsigned results

7. Cumulative reports allow comparison to previous results

8. Click button to accept

9. You can always “Unaccept”

10. If unsure of significance, “Refer”

11. To ensure your older results are all checked you need “Clinician Enquiry” Important because e.g. sensitivities may change, blood cultures may become positive Some tests just take several days/weeks to come through

12. Clinician Enquiry button is down the side

13. At the beginning of each run set up your “Clinician Enquiry” Set up for the team or specific consultant Possibly also to have different saved searches for time periods – e.g. 24 hrs

15. Creating a pre-defined search

16. Enter Inpatient or Outpatient etc

17. Once set up, easy to search

18. Changing your routine screen to “cumulative” by clicking on Preferences on the Eclair page and then clicking on cumulative and then save.

20. Remember all results can be audited You must never look at results of patients whose care you are not involved with. You can lose your employment and your medical registration if you do. Make sure that you log out each and every time you walk away from the computer. It is easy to check who has previously looked at the results as shown on the next slide….

21. ….click on “Observation Details” and …..

22. ..then “Audit”. This will show who else has viewed the results.

23. Graph form can be valuable - click “Graph Report”

24. Final points Number of unsigned off results fed back to the CDs regularly. Results from ED follow the patient when admitted- other results don’t. Hope to get electronic ordering of lab and radiology and e-sign off for radiology in the not too distant future. Still concerns we aren’t doing e-sign off well enough as yet for e-ordering to be brought in.

25. Good Luck- Enjoy your time here An 8 minute video on Electronic Sign Off can be accessed from the CDHB Intranet: http://intraweb/custsup/eso/documents/WinkFile/eclair%20final.htm If you have concerns about e-sign off or anything – ask your other team members, CD or feel free to contact me at: ruth.spearing@cdhb.govt.nz