Study of Clinical Workflow and Information Flow of a Breast Care Unit

Introduction. The study of the clinical workflows and information flows in healthcare institutions is of vital importance to improve its effectiveness and efficiency. At Hospital São João, Oporto – Portugal, a Diagnostic Breast Unit (DBU) was recently created. The implementation of a new Electronic Patient Record (EPR) called Breast.Care triggered the need to better understand the DBU processes and suggest improvements. Aim. To describe clinical workflows and information flows in DBU, detect problems and propose solutions for better communication among different actors. Methods. The study started with a direct observation period with a total of 24 hours. The observed processes and flows were transcribed into free text and then into structured text, tables and Unified Modeling Language (UML) diagrams (activity and partition-activity). The structured text and diagrams were analysed to find possible improvements. Results. Seven main processes were identified representing how different actors (humans and computers) work together. Three communication process improvements between humans were detected (e.g. changing timing of patient data insertion to facilitate reading access to others), three human–machine improvements (e.g. changing computer medical forms) and one between machines (creating specific links between information systems). Discussion. Analysing workflow and information flow in DBU allowed the detection of communication problems and the improvement of those through changes in EPR and in DBU current