The Nursing Information Technology Innovation Award
Health Data Management Magazine, April 1, 2008
When Jennifer Dunscomb, R.N., arrived at Columbus (Ind.) Regional Hospital to begin her shift one morning, she used her handheld computer to make an extraordinary difference in the treatment of a patient.
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As she scrolled through the data, “I could tell that this one patient could be in trouble,” she recalls. “When I went up to the nursing floor to ask about that patient, the nurse there said she noticed something was wrong, but couldn’t tell what the problem was.”
Dunscomb’s computer displayed trending data that seemed to indicate the patient had internal bleeding. Upon further investigation, clinicians discovered that, indeed, the patient had a bleeding ulcer and “was on the edge of starting to deteriorate.” But that never happened, thanks to the computer alert that enabled clinicians to take prompt treatment steps.
The nurse executive calls the software that caught the problem “our guardian angel system.”
Columbus Regional Hospital has earned Health Data Management's third annual Nursing Information Technology Innovation Award in recognition of its groundbreaking early detection efforts. The hospital’s alert program uses the Clinical Xpert CareFocus system from Thomson Healthcare, Stamford, Conn. The software is a module within the Clinical Xpert Navigator system (formerly Mercury MD), which gives clinicians access to information culled from numerous hospital information systems.
Keeping Patients Local
A 225-bed community hospital in rural southeastern Indiana, Columbus Regional faced the challenge of persuading residents of the 10-county region that they don’t have to drive to Indianapolis, Louisville or Cincinnati to receive top-notch care. So the hospital’s leadership launched many efforts aimed at improving the quality of care.
One important early step was using Clinical Xpert Navigator to give both physicians and nurses rapid, wireless access to a wealth of clinical information. Caregivers use any brand of PDA to gain real-time access to demographics, medication histories, test results, vital signs, radiology and other reports and more.
“The ease of access and consolidated nature of the data on one small screen is much better than trying to hunt for information in our electronic medical records,” says Diana Boyer, the hospital’s CIO. “It gives clinicians a concise report and calls up their patient lists for them.”
Clinicians use the software to call up data from clinical documentation systems from McKesson Corp., San Francisco, and a laboratory system from Cerner Corp., Kansas City, Mo., among others.
Once clinicians became accustomed to having this easy access to data to support their treatment decisions, the hospital took the important step of devising ways to use the data to create structured alerts for patients with risks of complications.
The CareFocus module is designed to enable hospitals to write specific reports, such as queries for which patients are taking one aspirin a day as part of a heart regimen. In addition, however, it enables the creation of profiles that caregivers can use to automatically screen inpatient data to identify those with various conditions.
Warning Profiles
Columbus Regional has created a general early warning system to detect potential problems in all hospitalized patients, as well as narrower profiles to detect patients with high risk of developing congestive heart failure and sepsis, a whole-body inflammatory state caused by infection.
This year, the hospital hopes to add profiles for those at risk of pressure ulcers, among others.
So far, the results have been impressive. From 2005 to 2007, the hospital achieved these improvements from using the software and taking other action, such as creating a rapid response team:
* A 15.6% decrease in mortality rate per 1,000 inpatient discharges;
* A 13% reduction in cardiac and respiratory arrests for all inpatients;
* A 22% reduction in cardiac/respiratory arrests outside critical care;
* A 38% reduction in intensive care unit mortality for patients transferred from medical/surgical units with a diagnosis of sepsis;
* A 35% increase in the number of congestive heart failure patients receiving interventions as recommended by the Centers for Medicare & Medicaid Services; and
* A 115% increase in calls to the hospital’s new rapid response team for critical care support and assessments.
“We’re now better able to recognize patients at high risk of complications,” says Shannon Page, R.N., a case manager and critical care clinical data coordinator. Case managers more frequently serve as mentors to other nurses, using the data to help improve the care delivered, she adds.
Building Alerts
To create the alerts using CareFocus, nurses at the hospital used national studies and other sources to identify good indicators of potential complications and other problems to include in the computerized profiles.
The Web-based profiles feature a drag-and-drop interface that enables users to define filters, such as specific combinations of lab values and vital signs, explains Will Moye, product manager for Thomson Healthcare. The profiles can even be tied to the identification of specific words or phrases in the electronic record, he adds.
Working with the I.T. department to build the automated profiles, the nurses refined the indicators after initial tests yielded results that were too broad and failed to pinpoint high-risk patients, Page explains. “It took a lot of trial and error with moving one variable out and trying another one,” she says.
Once the profiles were refined, nurses who are specialists, case managers, or members of the rapid response team began using them daily to automatically identify potentially high-risk patients in the areas where they worked.
The system, however, can’t do all the work.
“It still takes a level of expertise to sort through the information it pulls,” Dunscomb says. “We have to analyze whether the patients identified have problems or are in need of action.”
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