As we assume greater financial risk for care delivery through value-based purchasing and non-reimbursement for preventable readmissions and hospital-acquired conditions, it becomes more important than ever to deliver optimum care. In our quest for improvement at Eisenhower Medical Center (EMC), we understand that real-time feedback at the bedside supports the care team’s efforts to improve patient satisfaction and outcomes.
To accomplish our goals, better frontline visibility of patient status and immediate feedback about evidence-based best practices is a necessity. Having enhanced visibility is even more imperative since many of these practices include time-based tasks.
Narrowing the Focus
Because EMC serves an older patient population (average age of 67), it is common for patients to have multiple co-morbidities, making for complex care needs. With the overarching goal of improved outcomes as a guide, we identified our top priorities. We opted to focus on staff adherence to best-practice quality bundles for prevention of ventilator-associated pneumonia (VAP) as well as stroke core measure compliance.
Getting the Green Light
Working with longtime partner McKesson, we implemented a quality monitoring solution to provide bedside clinicians with real-time, at-a-glance status of their compliance with EMC’s best practices for VAP and stroke care. By indicating which tasks are due “before it’s too late,” the tool helps caregivers manage priorities more effectively.
By extracting and analyzing data in real time from the patient’s electronic health record (EHR), the quality monitor makes EHR information visible to the entire care team. That information may include orders, results, care team documentation and other data essential to delivering safe, high-quality, evidence-based care.
With just a quick look at the electronic stop light board, the care team knows which patient care tasks have been satisfied, which still need to be met, which time-based tasks are in danger of being missed, and in which order they should perform the tasks. This tool helps lift the burden of having to remember everything that should be done.
Seeing is Believing
With the support of the quality monitor’s ease of use, simplicity of format and integration with existing workflow, our caregivers are delivering impressive results. Since implementation in 2011, EMC has:
- Reduced VAP rates by 33%
- Improved and expanded our stroke program with an innovative, highly evolved interactive form to help sustain success.
- Achieved a highly successful stroke recertification through Joint Commission
- Achieved unprecedented collaboration between physicians and staff, and respiratory therapy and nursing for the VAP bundle, and between physical therapy and nursing for the stroke bundle.
- Elevated adherence to evidence-based practice by helping bedside clinicians with workflow and time management for a quality measure.
We also saw some unexpected benefits. With the satisfaction of real-time, publicly visible feedback (green check marks), and even some friendly competition, nurses have an incentive to improve compliance. This feedback results in charting as care is delivered, which leads to workflow efficiency and increased EHR data accuracy.
Vision for the Future
Our leadership understands that use of healthcare analytics at the bedside helps empower caregivers to provide optimal care and helps drive meaningful and measurable improvement. We will continue to look for opportunities to expand our use of real time, at-a-glance tools to improve the care provided to our patients.
EMC’s Results of Implementing Bedside Quality Monitoring Solution
- Exceeded our initial goal of decreasing the VAP rate by 20%, achieving a 33% reduction instead.
- Increased use of prophylactics for deep vein thrombosis (DVT)
- Increased administration of cholesterol-reducing medications to stroke patients
- Achieved 90% or better compliance with stroke core measures.