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Your secret weapon against infection: Clinical process improvement

Posted by Dr. Brita Hansen on Jun 21, 2018 12:45:00 PM
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In the battle against infection, we all need a clear line of defense. abandoned-ancient-architecture-200x300Healthcare-associated infections (HAIs), such as Clostridium difficile (C. diff) and catheter-associated urinary tract infections (CAUTI), take a heavy toll on patient outcomes, length of stay, Medicare reimbursements and more. They are formidable adversaries causing problems throughout hospitals and health systems. Thankfully, health systems have a secret weapon that can make a major dent in infection rates. Hospitals around the country are reducing infections through clinical process improvement. They accomplish this by streamlining workflows to remove unnecessary variation and ensure best practices are followed.

Reducing patient infection rates is crucial because the negative impact of conditions like CAUTI and C. diff is staggering. CAUTI is the most common type of HAI, accounting for more than 30% of HAIs. Each year, 560,000 cases of CAUTI cost health systems approximately $500 million, and that’s just the direct cost of treating CAUTIs. That doesn’t factor in penalties and missed revenues from Medicare reimbursements, meaning the cost most likely exceeds $1B per year. CAUTI increases morbidity and mortality with an estimated 13,000 attributable deaths annually, adds an average of two to four days to length of hospital stay and results in unnecessary antimicrobial use. The good news is that up to 69% of CAUTI may be prevented by following evidence-based strategies.

C. diff infections are another significant concern. C. diff is the most common infectious cause of healthcare-associated diarrhea and a significant factor leading to morbidity, mortality and increased length of stay among hospitalized patients. The cost of inpatient C. diff infections has been estimated to be $3,006 to $15,397 per episode. And again, this cost only represents the direct cost of treating the episode of C. diff and does not account for the larger impact on organizational reputation and reimbursement rates. For all these reasons, healthcare systems need to reduce C. diff infection rates and can do so by addressing patient risk for infection, deploying appropriate infection control measures and addressing the increasing problem of inappropriate C. diff testing and over-diagnosis. Fortunately, evidence-based guidelines can be deployed to guide appropriate testing and minimize false positive rates which drive over-reporting of C. diff cases, diversion of needed infection prevention and quality improvement resources, and unnecessary treatment. Historically, the difficulty has been ensuring care processes in place are aligned with current testing guidelines and workflow best practices.

During the Association for Professionals in Infection Control and Epidemiology (APIC) 2018 conference held June 13 to 15 in Minneapolis, my colleagues and I had the opportunity to interact with infection preventionists and learn more about their challenges and opportunities. APIC brings together more than 4,500 infection prevention professionals to learn, share and connect. What we heard was no surprise: Reducing infection rates continues to be a top priority for health systems across the country. The point was hammered home in the ‘Poster’ section of the exhibit hall. Multiple approaches were highlighted that targeted CAUTI, C. diff and CLABSI. Do you know what they seemed to have in common? Multi-disciplinary teams performing chart review after the fact to determine how to improve. Imagine if software was available that could take all that research, compile it into the best practices that have been proven at health systems across the country, and guide you on upstream workflow recommendations for clinicians to make the best thing the easy thing for them to do during care delivery.

Here’s what we told the infection preventionists gathered at APIC: We can help. The LogicStream Health CAUTI and C. diff solutions help healthcare organizations reduce CAUTI and C. diff rates by ensuring clinical teams are following best-practice care protocols based on CDC guidelines. These solutions guide health systems in adjusting electronic health record (EHR) content and workflows so they are aligned with current evidence-based strategies. This drives appropriate care standards, then maintains the workflow over time to ensure it remains up-to-date and provides surveillance tools to ensure clinical staff are following the approved processes. Essentially it’s a surveillance tool for your EHR that fixes problems upstream, in the workflow, rather than the last-minute or retrospective-style surveillance tools available to look back on what went wrong after it’s already too late. More specifically:

  • CAUTI: The LogicStream Health CAUTI prevention solution supports clinical staff in making determinations about when and how to insert, maintain and remove urinary catheters using core prevention strategies. This includes inserting catheters only for appropriate indications, leaving them in place only as long as needed, ensuring they are properly inserted and maintained, following proper hygiene precautions, etc., and documenting those actions.
  • C. diff: Our C. diff infection reduction solution helps health systems decrease C. diff infection rates by focusing on three key areas:
    • Minimizing patient risk for infection
    • Infection control and preventing spread of C. diff infection
    • Appropriate testing to minimize false positives

Reducing infection rates is a daunting task. Clinical process improvement is the key to standardize workflows, encourage adoption and improve outcomes. Around the country, hospital systems are using LogicStream Health solutions to achieve significant results, including:

  • 50% reduction in C. diff infection rate
  • Reduction in ordering of C. diff testing and inappropriate provider ordering habits (decrease from average of 90 incorrect order paths per month to less than five per month)
  • 75% reduction in average catheter hours per hospital encounter
  • 30% reduction in CAUTI rate

Learn more about these results and how our infection prevention solutions can work for you by downloading the CAUTI or C. Diff solutions overview documents below.

Download the CAUTI Overview Download the C. Diff Overview

Brita Hansen, MD, FACP is an internal medicine physician and clinical informaticist practicing in Minneapolis, Minn. She is Chief Medical Officer at LogicStream Health. Prior to joining LogicStream, she served in various leadership roles in clinical operations, quality and clinical informatics in the health system setting for over a decade, most recently serving as Chief Health Information Officer at Hennepin Healthcare in Minneapolis.

Topics: Quality & Safety

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Brita Hansen, MD, is Chief Medical Officer at LogicStream Health. Dr. Hansen is also a practicing internal medicine hospitalist and has served as a healthcare system executive, most recently as Chief Health Information Officer at Hennepin County Medical Center in Minneapolis. Dr. Brita’s Blog covers a range of topics, including:

  • Appropriate Utilization
  • Clinician Engagement
  • Clinical Process Performance & Improvement
  • Healthcare Information Software & Technology
  • EHR Optimization
  • Clinical Decision Support
  • Healthcare Patient Safety & Quality

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