We want to pick-up from where we left off a couple weeks ago, which called attention to healthcare’s “Quiet Crisis” – a scenario in which clinical processes vary widely; are difficult to see into in near-real time; and, next to impossible to control and improve with EHR systems alone. One C-level clinician described the current state as ‘whack-a-mole’ healthcare. This environment is not conducive to clinical process control and improvement.
In my role as CMO at LogicStream Health, my team and I have been working with a Midwest academic medical center to tackle these challenges. The medical center recently directed its sepsis task force to implement a standardized care process to improve key outcomes. The group wasn’t seeing desired improvements which, in turn, motivated them to implement the LogicStream Health Clinical Process Improvement and Control software platform.
Here’s what they quickly discovered: Clinical alerts designed to notify nursing staff to the possible presence of sepsis were not being presented to the right user at the right place in the workflow to direct clinicians to make targeted interventions. The team quickly made changes that increased the specificity of the alert firing. This, in turn, quickly decreased alert fatigue by eliminating 150,000 alert firings per month. That’s 5,000 fewer alert firings EVERY SINGLE DAY resulting in a better care delivery experience for clinicians.
The team also quickly discovered wide variation in ordering habits in their provider groups. One target area for the sepsis task force was antibiotic utilization. In one example, they discovered a single physician who was ordering vancomycin at twice the rate of peers. Clinical leadership then provided targeted feedback to that physician regarding his practice patterns in the context of the peer group. This resulted in more uniform ordering and utilization of vancomycin. This physician’s ordering of vancomycin almost immediately fell in line with his peers, and has remained so in the almost one year since the feedback was given. Another concern of the sepsis team was inappropriate ordering of IV fluid resuscitation in sepsis patients. Again, they discovered unnecessary variation in ordering habits and identified exactly where to intervene. Within one week of targeting inappropriate ordering pathways, they realized a 50% improvement in appropriate fluid resuscitation.
Clinicians are hungry for this type of information. While we may be given information on our clinical outcomes, it is quite rare to be given meaningful feedback about our care processes and practice patterns in the context of our peer group and to actually see where and to what extent variability exists. I still remember the first time I presented similar information to a group of providers I was working with. It was a game changer to really see how much variation we had, even in areas where good evidence exists about best care. Instead of being a finger-pointing moment, it was an “a-ha” moment about why we weren’t achieving the results we wanted and got everyone asking, wow, why is it that we practice so differently? Studies on appropriate utilization of healthcare resources have demonstrated that interventions based on providing clinicians feedback on their habits in the context of their peer group are particularly effective in improving appropriate utilization and driving out unnecessary variation in care.
The team also discovered an expansive library of sepsis-related content in their EHR – much of which had not been updated or retired as new order sets, documentation templates, medications and other orderables were added. Clinician preferences and customization of order sets caused further variation. With capability for easy discovery and instant insight, the team cleaned up its sepsis-related EHR content and stopped inadvertently driving unnecessary care variation. Read more about this in the Sepsis Case Study you can download on this page.
Front-line clinicians now have powerful capability for highly actionable, instant insight enabling them to improve and better control vital processes for standardizing sepsis detection and care. Clinical process improvement and control is an important continuous feedback loop for caregivers desiring to make ongoing improvement. It is clearly must-have capability for clinicians working hard to reduce the impact of sepsis, and to improve patient care and reduce costs. Download the Sepsis Case Study now to better understand how your organization can improve its care delivery with Clinical Process Improvement and Control software from LogicStream Health.
Brita Hansen, M.D., is Chief Medical Officer of LogicStream Health. She began her career as an internal medicine hospitalist physician after receiving her undergraduate degree at NYU and her Doctorate of Medicine from the University of Minnesota School of Medicine. She served as Chief Health Information Officer for the Hennepin County Medical Center before joining LogicStream Health.
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