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Emergency Medicine’s Newest Tool Assesses the Situation in a Single Glance

A Friday Story
By Professor Shlomo Mor-Yosef

Dear Friends,

Just as computers have appreciably changed our personal lives, their impact on the practice of medicine may be even more dramatic. Computers are commonplace in the operating room, in the admitting office, in the labs and by the bedside. They are essentials tools in sophisticated surgery, in the distribution of medication, in patient care and most certainly in the overall functioning of the large Hadassah University Medical Center. In our search to make these systems serve us better – and for new ways to make use of them – Hadassah's doctors are revolutionizing many aspects of medical care.

We all know that emergency rooms are in a constant state of flux – and that maintaining control of the situation poses a particular problem. The same is true in our Judy and Sidney Swartz Center for Emergency Medicine (CEM). Patients arrive at every hour of the day and night – soldiers and civilians, adults and children – many of them with complicated conditions. Our doctors and nurses cope with the ever-changing stream of patients as efficiently and immediately as time allows in normal times and during mass casualty events. Soon, a new and innovative computer program will give them greater control of patient flow and treatment, making a meaningful difference in this vital complex.

Before embarking on his medical career, Dr. Cobi Assaf, Chairman of the Department of Emergency Medicine, spent nine years researching the physiology of the brain at the Hebrew University-Hadassah Faculty of Medicine. "Our visual system gives us our picture of the world," he says. "Our eyes are our main sensory source of information. When we look at something, we immediately grasp it in three dimensions, in color and in high resolution. With one glance, the brain captures and absorbs the actual reality."

His understanding of how the brain perceives actual events was a major impetus for developing the new computer tool for the CEM. "When up and running, it will move us from working with one-dimensional lists to the real, three-dimensional world, in color and high resolution," Dr. Assaf explains. It presents a real time picture of the situation throughout the CEM and the status of the patients – day or night, on a quiet day or a hectic one.

Rather than walking from patient to patient with a clipboard in hand, the computer gives the CEM's management team both a comprehensive and detailed picture of the situation in the department at that moment – helping them identify bottlenecks so that patients are cared for in the most efficient manner. By zooming in, the head of the department, the head nurse – and even the head of the hospital – can immediately learn if and when a patient has been treated and what treatment has been administered. Whether they are sitting in their office or sitting in a meeting, they can react immediately and intervene to make sure that the department functions smoothly.

During a demonstration of the new program, it was easy to see how effective this will be. On the screen, the initial view of the CEM shows all the beds, color-coded to describe their status. The color on the edge shows how long the patient has been waiting to be seen; the color of the bed indicates the patient's situation. A double click on a bed allows the viewer to zoom in on a particular patient, see the condition of the patient and the progress of treatment. The color changes according to time that has elapsed, indicating whether the patient has been waiting for a few minutes or – as can happen on a busy day or night – a few hours. This time sensitive information will help the teams solve one of the major problems the management team encounters. The program also keeps a running tally of the number of patients received, discharged or admitted to one of the Medical Center's departments for further treatment.

This is how it will work. When a patient is admitted, a figure appears on the screen. When a doctor comes to the bed, the system responds. When doctors or nurses enter the vital data and send it to Machar, the Hebrew acronym for the Hadassah-designed 'Patient-Doctor-System,' the system responds again. Icons that describe the actual situation are imposed on the virtual bed, indicating which tests have been ordered and which have been completed. For example, when blood tests are ordered, a test tube appears on the screen. When the blood arrives at the lab the icon changes – and when the results are ready, a question mark appears on the icon to show the doctors they can access the information. If the results demand immediate attention, the icon flashes to show the situation is urgent. Other icons indicate other tests ordered or in progress – x-rays, electrocardiograms (EKG), CTs and ultrasound scans.

At every step of the way, in once glance, the management team can track the situation of an individual patient or the entire department and respond accordingly. Downplaying his own practical participation and intense interest in its success, Dr. Assaf is quick to credit two students from the Jerusalem College of Technology's Department of Technology Management and Marketing, who created the program for their senior project. Before graduating this summer, they will present the finished project to the faculty – and when it is approved, the CEM will have a new tool that can be adapted for use anywhere in the Medical Center.

Another new system takes advantage of the younger generation's familiarity with video games to teach medical students and residents how to cope with different situations in the emergency room.

The viewers enter this very serious game by analyzing the images representing doctors, nurses and patients that appear on the screen and responding to scenarios that reflect reality. Among the scenarios are interaction between a physician and a patient, a medical team and a patient, a team and group of patients or a team and the whole department. The challenge is to treat the patient or patients properly, make the best use of the medical personnel and ensure that the emergency room functions efficiently.

"This is the most complex part of the process," Dr. Assaf says. "Say a person arrives with chest pains. There can be 15 to 20 reasons for chest pains and an equal number of ways to respond." And respond they must, just as they will have to in real life.

Working together, Hadassah, IBM-Israel and the Technion are developing the concept. The Technion created a computerized simulator, IBM built the virtual game and HMO is working on the algorithms that present the scenarios, the instructions and the solutions – an immense and complicated challenge.

While some progress has been made, "the game" still faces some challenges, funding among them, but Dr. Assaf is hopeful this new tool will soon become part of emergency medicine training.

****

As we know, computers alone are simply machines that do the bidding of their users, yet with the right programs and in the right hands that have powerful potential. Hearing about these innovative approaches for the CEM – and elsewhere throughout our hospitals – I know you will be as impressed as I am with the creative minds of the men and women at our Medical Center who conceive and develop them, not for personal glory or financial reward, but out of their deep commitment to their patients and their profession.

Shabbat shalom,
Shlomo

Prof. Shlomo Mor-Yosef
Director General
Hadassah Medical Organization

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