Process analysis of the patient pathway for automated data collection: an exemplar using pituitary surgery

Abstract

IntroductionAutomation of routine clinical data shows promise in relieving health systems of the burden associated with manual data collection. Identifying consistent points of documentation in the electronic health record (EHR) provides salient targets to improve data entry quality. Using our pituitary surgery service as an exemplar, we aimed to demonstrate how process mapping can be used to identify reliable areas of documentation in the patient pathway to target structured data entry interventions.Materials and methodsThis mixed methods study was conducted in the largest pituitary centre in the UK. Purposive snowball sampling identified frontline stakeholders for process mapping to produce a patient pathway. The final patient pathway was subsequently validated against a real-world dataset of 50 patients who underwent surgery for pituitary adenoma. Events were categorized by frequency and mapped to the patient pathway to determine critical data points.ResultsEighteen stakeholders encompassing all members of the multidisciplinary team (MDT) were consulted for process mapping. The commonest events recorded were neurosurgical ward round entries (N = 212, 14.7%), pituitary clinical nurse specialist (CNS) ward round entries (N = 88, 6.12%) and pituitary MDT treatment decisions (N = 88, 6.12%) representing critical data points. Operation notes and neurosurgical ward round entries were present for every patient. 43/44 (97.7%) had a pre-operative pituitary MDT entry, pre-operative clinic letter, a post-operative clinic letter, an admission clerking entry, a discharge summary, and a post-operative histopathology pituitary multidisciplinary (MDT) team entries.ConclusionThis is the first study to produce a validated patient pathway of patients undergoing pituitary surgery, serving as a comparison to optimise this patient pathway. We have identified salient targets for structured data entry interventions, including mandatory datapoints seen in every admission and have also identified areas to improve documentation adherence, both of which support movement towards automation.

Mapping patient education encounters in elective surgery: a cohort study and cross-sectional survey

“…Recently, Hanrahan et al has used process mapping to comprehensively define the preoperative, perioperative and postoperative pathways for patients undergoing transsphenoidal surgery. 12 In the paper, they identified that pituitary ward round entries, pituitary clinical nurse specialist ward round entries and pituitary MDTs were critical data entry points that could be used for automated data entry. Our study builds on this previous work by investigating the educational resources that patients use before spinal surgery.…”

“…The process map was validated using a methodology described by Hanrahan et al . 12 The EHR of patients that presented with degenerative spinal disease (DSD) and were managed surgically between January and July 2022, at a tertiary-academic single centre in the UK was used. A sample size of 50 patients was chosen as it was deemed adequate to gain an in-depth understanding of the patient pathway.…”