How IT helped Christiana Care save $4.8M
The use of cardiac telemetry at Christiana Care Health System improved patient care and proved to be a boost for the Delaware hospital's bottom line as well, with $4.8 million dollars saved.
Christiana Care includes two hospitals with 1,100 patient beds, a home healthcare service, preventive medicine, rehabilitation services, a network of primary care physicians and a range of outpatient services. It is recognized as a regional center for excellence in cardiology, cancer and women's health services.
Christiana Care researchers reported the improved care and financial savings in JAMA Internal Medicine, published online Sept. 22.
How did Christiana do it? By integrating evidence-based guidelines on medication and telemetry use into Christiana Care's health information technology systems and equipping nurses with supportive tools, more effective care was delivered through the use of cardiac telemetry, lead author Robert M. Dressler, MD, vice chair of Christiana Care's Department of Medicine, concludes.
"This study is about providing the right care to the right patient at the right time," Dressler, who is also the director of patient safety and quality for Christiana Care's Department of Medicine, writes in the journal. "We focused on a national challenge that hospitals face and created an innovative system of care that enables us to be better stewards of our resources and provide care of greater value to our neighbors."
Cardiac telemetry is frequently used in caring for hospital patients with serious problems, Dressler explains. In cardiac telemetry, the heart rhythm of patients is tracked in real time through a medical device, and the information is relayed into remote computers that are monitored by medical staff. The cardiac monitor is designed to trigger an alarm when there's a concern – such as a prolonged stop in the heartbeat.
Cardiac monitoring is the standard of care in intensive care units. However, the appropriate delivery of that care is more challenging in units outside of ICUs, where some patients may be in need of cardiac monitoring while others may not, he further explains. Continuous telemetry monitoring outside of the ICU has been identified as one of "five things physicians and doctors should question" by the Society of Hospital Medicine's Choosing Wisely campaign. The campaign, which is aimed at promoting safe and suitable use of care, selected telemetry monitoring since it has been shown to be of limited benefit in the majority of patients with low risk heart problems.
Here is what Christiana Care did:
- Integrated guidelines on the use of telemetry by both the American College of Cardiology and the American Heart Association into its health IT systems to help doctors distinguish those patients who need cardiac monitoring from those who do not.
- Christiana Care clinicians and pharmacists also partnered to identify which medications necessitated cardiac telemetry monitoring and which ones did not.
- Nurses were given assessment tools to help them determine when cardiac telemetry monitoring could be discontinued safely.
- 47 percent decrease in the average duration of telemetry monitoring;
- 43 percent decrease in the number of telemetry orders;
- 70 percent reduction in telemetry use overall without any negative impact to patient safety.
"Historically, hospitals across the nation have struggled with how to most effectively use cardiac telemetry," Dressler said, in a press statement. "We hope this study sheds light on solutions that can help hospitals provide care of the best value to this population of patients."