Skip to Main Content
Skip Navigation Links
Magnet Logo

Nursing Excellence

The Online Newsletter for Children's Nurses
e-Edition, Issue 11 

Denise Zeitler


Processes and methods which support the sharing, receiving
and exchanging of ideas and information.

By Denise Zeitler, MBA, BSN, RN, NE-BC

Advanced Clinical Systems (ACS)
ACS Go-Live, Leveraging the “Team Huddle” on a Grand Scale


At Children’s Hospital the summer of 2011 was marked by the implementation of our Advanced Clinical Systems (ACS) project. ACS represents the organization’s transformation of the paper-based patient record to the electronic medical record. Depending on who you talk to, this project’s span extended over almost two years before the July 12 go-live. That go-live date was the first of many waves that proceeded over the summer and into the fall. Communication strategies were key to the successful transition.
Centralizing Our Communication
The magnitude of change for the clinical staff and physicians at the bedside was significant as every aspect of direct patient care was impacted as we moved from paper to electronic documentation. While the design and development of how registered nurses (RNs) and respiratory care practitioners (RCPs) documented seemed straight forward – here’s our flow sheet, here’s our policy – the reality of going live presented us with challenges that were difficult, if not impossible, to anticipate. In order to facilitate going live and respond to newly identified issues, we planned and deployed a centralized command center. The command center was the central hub for communication of issues, assessment of solutions, and distribution of education addressing rapid process improvement.

Look For the Red Shirts
With the command center as the hub for issue resolution, numerous clinical staff functioned as “superusers.” During the go-live, RNs and RCPs who had participated in additional training on the system, were assigned to each patient care department providing support to the staff on duty. They did not have direct patient care assignments at this time. This provided the clinical end-users with immediate hands-on support assisting with reinforcement of navigating the system, documenting care activities in the electronic medical record (EMR), and identification of new issues and communicating those issues to the command center. For the first two weeks, the command center remained open 24/7 with superusers staffed on all patient care units involved. Armed with wireless phones and wearing red shirts with blocked white lettering, “SUPER-USER.” on their backs, our superuser staff worked to assess and troubleshoot issues. When the issue was more significant, the superuser staff would call the command center and report the issue. The command center team would then work to resolve the issue.

Continuous Process Improvement – Leveraging the Team Huddle
Implementation of new processes required a willingness to continually reassess the situation or process, and make incremental changes to improve the overall process. From go-live, we had established a team huddle at the beginning and end of each shift. These huddles overlapped so that all the superusers could meet and hear what the experiences and observations had been for the prior shift. As issues were identified and solutions developed, the need for rapid education deployment became apparent. We quickly recognized the need to leverage our team huddle and within the first 24-48 hours added key times throughout the day when the team would come together, debrief and discuss the issues and the processes impacted by this new documentation tool. What added more value to the process is that we opened up the huddle to any leader, physician, or clinician who wanted to participate in the discussion and issue resolution. Issues identified in the morning would be worked on and resolved. The clinical education team would then develop education/communication tools which would then be shared at the huddle in the afternoon. Our superusers and other interdisciplinary team members would facilitate the communication by distributing the education materials and sharing with the clinical end-users. Those resource tools can always be found on the iCare page of our intranet.

We have operationalized the command center model through several project implementations over the last few years. Each time we make incremental improvements to our model and processes, our efforts further enhance communication and continuous process improvement. The magnitude of the ACS go-live required a large centralized hub to support the needs of the organization and the varied groups. However, as we moved to implement computerized provider order entry (CPOE), we modified our command center and rather than having the superusers report to a central place, we took the command center to the local departments. As each wave of providers went live with CPOE, we brought the command center to the department further improving our communication and rapid-cycle process improvement efforts. Feedback from our clinicians, physicians and information technology services (ITS) staff has been extremely positive and with each new project implementation we become more efficient.

In June 2012 Children’s will be upgrading Meditech to the next version of Client Server. This upgrade will allow us to implement new features and enhancements, improving our use of the EMR. While the magnitude of change will be significantly less than our summer 2011 go-live, you can expect that the command center will be operational and folks in red shirts will be out on the units ready to help!


In This Issue

Professional Practice

Professional Values

Theoretical Framework

Professional Practice


Collaborative Relationships

Care Delivery


Research / Evidence-Based Practice

Professional Development

Reward and Recognition