Coordination considerations of healthcare information technology.

While health information technology (HIT) may be designed to support specific tasks the integrated nature of healthcare delivery often requires HIT to play various coordination roles. While studies have shown that coordination issues with HIT can cause adverse impacts there is little research that has looked at the specific types of coordination that HIT need to support. This paper uses a longitudinal study of a perioperative information system to identify and discuss different categories of HIT coordination. The findings can help the design and evaluation of HIT to support the coordination needs of healthcare delivery.

Practice changes to improve delivery of surgical antibiotic prophylaxis.

Timely administration of appropriate antibiotics preoperatively can decrease the incidence of surgical site infection. We evaluated compliance with quality indicators in the delivery of antimicrobial surgical prophylaxis at The Ottawa Hospital and assessed the impact of a change to the hospital's Surgical Prophylaxis Policy. An audit in 2002 revealed improvement was necessary in the timing of preoperative doses, dosing for patients with a high body mass index, and intra-operative redosing. As a result, a multidisciplinary group was formed and a new surgical prophylaxis policy was approved. The policy included administration of preoperative doses by the anesthesiologist, and an automatic substitution for higher doses of antibiotics for select patients. This practice change resulted in significant improvements to the preoperative timing and dosing in subsequent audits. A mechanism to address intra-operative redosing will be implemented.