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The Vanderbilt University Hospital heritage was influenced by the excellence of the Johns Hopkins era--by Osler, Halsted, Cushing, Brooks, and many others. Upon this strong origin, the neurosurgery department was built by Cobb Pilcher and perpetuated by William F. Meacham.
In July 1991, Vanderbilt University Medical Center (VUMC) initiated a fast track approach to the implementation of an Integrated Academic Information Management System (IAIMS). The fast track approach has four elements: 1) an integrated organizational structure combining various operational information management units and the academic informatics program into a single entity to enhance efficiency; 2) technology transfer and network access to remote resources in preference to de novo development; 3) parallel IAIMS planning and infrastructure construction; 4) restriction of the scope of the initial IAIMS to permit a manageable implementation project. The fast track approach is intended to provide a truly functional IAIMS within a time period (7 years) associated with other major construction projects such as the building of a replacement hospital.
In November 1993 The Vanderbilt University Hospital and Clinic (VUH/TVC) convened a 10-member Collaborative Organization Design (COD) team comprised of a multi-disciplinary team representing a diagonal slice through the organization. This team, lead by Gelinas * James, Inc. a consulting firm specializing in restructuring, was charged to develop, recommend, and implement a new organizational design that would promote stronger patient focus, increased efficiency, and lower cost. The COD process is structured to inspire and enable employees to rebuild their organization to respond to the challenges and opportunities that exist within their environment, to customer needs, and their own aspirations. This manuscript presents an overview of (1) the computer tools developed and/or employed to support the re-engineering process, and (2) the findings obtained as the work of patient care was defined and analyzed at VUH/TVC.
In November, 1993 The Vanderbilt University Hospital and Clinic (VUH/TVC) convened a 10-member Collaborative Organization Design (COD) team that represented a diagonal slice through the organization. This team, lead by Gelinas & James, an outside consulting firm, was charged to develop, recommend, and implement a new organizational design which would promote a stronger patient focus, increased efficiency, and lower costs. The COD process is structured to inspire and enable employees to rebuild their organization so that it can respond to the challenges and opportunities that exist within their environment, to customer needs, and their own aspirations. This manuscript describes several of the computer tools which were utilized in the definition and analysis of the work of patient care at VUH/TVC. Specific examples of the findings from this phase of the work are utilized to illustrate their use and value.
Vanderbilt University Medical Center is implementing an Integrated Advanced Information Management System (IAIMS) using a fast-track approach. The elapsed time between start-up and completion of implementation will be 7.5 years. The Start-Up and Planning phases of the project are complete. The Implementation phase asks one question: How does an organization create an environment that redirects and coordinates a variety of individual activities so that they come together to provide an IAIMS? Four answers to this question are being tested. First, design resources to be "scalable"--i.e., capable of supporting enterprise-wide use. Second, provide information technology planning activities as ongoing core functions that direct local efforts. Third, design core infrastructure resources to be both reusable and expandable at the local level. Fourth, use milestones to measure progress toward selected endpoints to permit early refinement of plans and strategies.
Fetal radiation dose estimates were calculated for women who received oral administrations of 59Fe at Vanderbilt University in the 1940's. A similar dosimetry analysis was performed by Dyer and Brill in 1972; the availability of recently developed physical models of the pregnant female at different stages of gestation and of a new kinetic model for iron metabolism afforded an opportunity to re-evaluate these doses. Radiation dose estimates for the fetus (and fetal liver in three cases) were calculated for a number of oral and intravenous studies using these new models and the available data about the original experiments. The total fetal doses do not appear to have exceeded a few hundred microgray (a few tens of millirad) for the majority of the study subjects. Considerable uncertainty exists, however, in the amount of activity administered to these subjects.
In a 1997 paper, Stabin et al. published estimates of the fetal radiation doses for women who received oral administrations of 59Fe at Vanderbilt University in the 1940's. These authors concluded that there was "considerable uncertainty... in the amount of radioactive material administered to these subjects." In an effort to quantify this uncertainty, the underlying factors in the input data used in the Stabin et al. dose estimates have been examined in detail. Such factors include (a) an absence of detailed information on, and discrepancies in, the amounts of 59Fe reported to have been administered; (b) the probability that the radioactive iron included 55Fe as well as 59Fe; (c) uncertainties as to the period of time that elapsed between the administration of the radioiron and the taking of the maternal blood samples, and the accompanying impacts of radioactive decay; (d) possible losses of 59Fe in the procedures used in preparing the blood samples; and (e) questions as to the reported efficiency of the counting equipment. Our principal conclusion is that, due to the significant uncertainties and the lack of key information, it is not possible to estimate the doses accurately. An ancillary conclusion, however, is that the doses were probably significantly higher than previously estimated. This latter possibility should be carefully considered by any investigators who subsequently seek to use these estimates to quantify the relationship between the doses to the fetus and the resulting health effects.
Cytogenetic records were examined from consecutive nononcology blood specimens from 2,821 patients referred for cytogenetic services to Vanderbilt University Medical Center, Nashville, Tenn, from January 1985 to December 1992. We grouped the records according to reasons for referral and diagnoses. The most common reasons for referral were history of multiple abortions/miscarriages (23.3%), possibility of chromosomal abnormality (18.8%), and possible presence of the fragile X syndrome (15.6%). Overall, 2,418 (85.7%) patients were found to have normal chromosomes, and 403 (14.3%) patients were diagnosed with a cytogenetic abnormality. For example, 20 (5.4%) of the 373 males referred for the fragile X syndrome, or 1.4% of all males (20 of 1,428) excluding those with ambiguous genitalia, were diagnosed with this syndrome while 8 (2.1%) of the 373 males had a chromosome abnormality other than the fragile X chromosome. In addition, 85 (70.2%) of 121 males referred for Down syndrome had this syndrome, and only 53 (40.8%) of 130 females referred for Down syndrome had this diagnosis. This study should assist physicians in middle Tennessee and surrounding areas by increasing their awareness of the types and frequencies of cytogenetic diseases and by providing figures for comparison with other regions of the country.
Work process redesign is an effective tool to assist laboratories in identifying areas for improvement. This article presents the experiences and results of Vanderbilt University Medical Center's Transfusion Service in undergoing a work process redesign project to reduce costs and increase growth potential. Opportunities for improvement were identified, and processes were redesigned to enhance efficiencies and increase workload capacity. Areas where opportunities for improvement were identified included work-flow, work process, personnel usage, task delegation, information transfer, physical layout, and communication. The thorough review and redesign of the work processes resulted in a greater demonstrated workload capacity of 381% for pretransfusion testing (antibody screens ABO/D typing, and immediate-spin crossmatches), using no additional FTEs.
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Vernon Wilson talks about definitions of health and measures of health, about leadership and credibility, democracy in decision-making, uses of power, and the process of delineating boundaries between managerial roles. He also describes how Vanderbilt Medical School entered the field of primary care medicine, a new direction for a school that has traditionally emphasized tertiary care.
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A computerized monitoring system utilizing touch screen input has been developed and tested at our university. Logical extensions of this technology include the development of a portable input device and the packaging of the physical system. Further extensions of this technology include, as necessary, the introduction of other monitoring modalities, such as respiratory and evoked potential data acquisition and analysis.
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