New Epic EHR software update to target ICU delirium

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A new software release by Epic Systems planned for next month is intended to help clinicians prevent delirium in intensive care unit patients by using a clinical protocol.

The protocol—called the ICU Liberation Bundle—is the basis for the Epic software update and in February will become a standard part of the vendor’s electronic health record system. In the meantime, it is available to Epic’s customers as an add-on.

E. Wesley Ely, MD, professor of medicine and critical care at Vanderbilt University Medical Center, was the principal investigator for a project sponsored by the Society of Critical Care Medicine to improve patient outcomes in U.S. hospitals by leveraging the ICU Liberation Bundle.

“New support from a major EHR company like Epic means that fewer patients stand to undergo ICU delirium and its harrowing consequences,” says Ely, co-director of VUMC’s Critical Illness, Brain Dysfunction and Survivorship Center. “This Epic Foundation System build allows streamlined implementation and better compliance, which, according to more than 20,000 patients’ worth of data we’ve published, yields less time on the ventilator, shorter ICU stays, reduced costs and improved survival.”

“We worked closely with Wes Ely’s team both to design what these workflows would look like in Epic and to craft recommendations to help hospitals operationalize this way of doing things in the ICU,” says Jeff Wolanin, lead of the Epic Foundation System. “We feel very passionate that this clinical program not only saves lives but also improves the quality of people’s lives post-ICU.”

VUMC and other medical centers that assisted Epic on the project are using the EHR system update and associated ICU workflows.

The Society of Critical Care Medicine’s ICU Liberation Bundle is designed to improve patient outcomes and reduce the risk of long-terms consequences that arise from the harmful effects of pain, agitation, sedation, delirium, immobility and sleep disruption.

“Studies have shown that implementing ventilator weaning protocols, maintaining light levels of sedation, and preventing and managing delirium can improve patient outcomes,” according to the Society of Critical Care Medicine. “Early mobilization and family engagement also play a key role in reducing long- and short-term consequences of an ICU stay. The greatest benefit occurs when these interventions are combined.”

“What this bundle does is stop people from just looking at one organ at a time,” adds Ely. “It takes the overall person and says, ‘This is a whole human being, and we’re going to pay attention to how their brain is working, and their liver and lung and kidney, all at once. And we’re going to wake them up, we’re going to get them out of the bed, we’re going to walk them.’ It makes us take a step back and help people avoid injury that might otherwise occur in intensive care."

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