Analytics boosts use of clinical best practices at Tampa General Hospital

This case study shows how clinicians reduced the number of orders for one specific test from roughly 90 per month to five – helping with antimicrobial stewardship along the way.
By Bill Siwicki
01:59 PM
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Tampa General Hospital at night exterior view

At Tampa General Hospital in Florida, analytics on orders and process workflows were hard to come by. Clinical and financial questions had to be answered by a custom report, some of which could take several days to produce. The data simply wasn't easily accessible, and each report would inevitably create more questions and more reports.

"For example, if I wanted to know how many cardiac stress tests were ordered in the last twelve months, I would have had to request a report," said Peter Chang, MD, chief medical informatics officer. "If numbers seemed too high, another report would have been required to determine which units they were being ordered from."

Yet another report would have been required if there was an irregularity, he added. For instance, if one-third of orders were originating from observation units that dealt with low-risk patients, Chang would like insight into which clinicians ordered stress tests most often.

On any given day, he could have 60-70 questions alone. This process placed an enormous burden on the business intelligence team, which had to endlessly produce report after report so that staff could continue improving hospital quality.

PROPOSAL

Chang and his team would use LogicStream's analytics software to improve compliance with sepsis protocols and identify and eliminate outdated order sets. The software would provide answers and insights in seconds rather than days or weeks.

MARKETPLACE

The market for analytics technology is vast. Vendors include 3M Health Information Systems, Acxiom, Arcadia Healthcare Solutions, Berg Analytics, Cerner, Change Healthcare, Definitive Healthcare, Enli Health Intelligence, Epic, Health Catalyst, IBM, Informatica, Medecision, Pieces Technologies, SAP America, Verato and Xifin.

MEETING THE CHALLENGE

Tampa General uses the analytics software primarily for clinical process improvement. The software allows staff to delve into ordering and workflow patterns and review data in near-real time. As a result, staff are able to improve lagging outcomes by implementing and managing leading process measures they have identified as best practices.

"Once we have built a process workflow in our electronic health record, we then are able to monitor clinician usage and compliance," Chang explained. "Our nurse managers, pharmacists and physician leaders are tasked with helping monitor and manage clinical staff."

LogicStream also can create and support a utilization management program, meaning hospital staff from information technology and clinical operations can use the software to keep a pulse on ordering and alerting trends.

For example, Tampa General ranks order sets based on how frequently they are used or not used and engages with clinicians to minimize any variability in the use of best practices.

"Once we have built a process workflow in our electronic health record, we then are able to monitor clinician usage and compliance. Our nurse managers, pharmacists and physician leaders are tasked with helping monitor and manage clinical staff."

Peter Chang, MD, Tampa General Hospital

The analytics helped the hospital comply with sepsis protocols. It provided the basis for thinking about how staff would manage sepsis in the hospital. Managing sepsis requires a clinician to first identify a septic patient and then initiate a treatment protocol at a specific time before the condition worsens.

To help identify patients, Tampa General created a sepsis alert order in its EHR. Using the analytics software, Tampa General was able to build the population of patients based on patients with a sepsis alert order. This population helps staff analyze how well clinical alerts were followed and if the correct orders from the suggested order set were used.

"For patients who do not have a sepsis alert order, we can review the sepsis screening best practice advisories to examine potential misses and reengineer our clinical alerts," Chang explained.

The software also allows staff to see individual response rates to clinical alerts and identify those who accept and react to alerts and those who ignore them. This provides staff with the information they need to council clinicians and enables insight into alert engagement so they can continuously refine alerts to prevent alert fatigue and workflow disruption.

"When we launch a new alert for any condition, we keep a close eye on it and regularly look for ways to adjust the parameters to ensure it has the desired effect," Chang said.

The analytics software also has helped Tampa General identify and eliminate outdated order sets. Although an order set may have been published, clinical care and guidelines can certainly change over time. Tampa General uses LogicStream to review the most popular order sets and analyze the ordering patterns from those order sets.

"We then can use our medical directors to create a review structure within their specialty to provide up-to-date modifications to order sets," Chang said.

"We also are able to examine order sets that are not frequently used to determine if they require modification or should be removed from production," he added. "We are currently in the process of developing a review structure across all specialties to help us expediently reach our quality goals – a feat that wouldn't have been possible just a couple of years ago."

RESULTS

"We've seen a significant increase in usage of the sepsis order set and compliance with orders placed," Chang reported. "Once we put the sepsis order panel into play, we saw and continue to see an upward trend in order set use and pathway adherence, driven primarily by the clinical alerts, meaning our strategy is having the desired effect."

Clinicians are responding to alerts in a timely manner and preventing septic patients from developing severe sepsis and as a result Tampa General is seeing a decline in sepsis mortality, Chang said.

This isn't the only sepsis initiative the hospitall has underway, so it's difficult to quantify LogicStream's direct impact on the performance, he emphasized. But what can be said with certainty, he said, is that the analytics software has had an impact on compliance and best practice utilization.

That said, Tampa General has gathered hard data that shows LogicStream has helped the hospital improve quality with Clostridium difficile (C. diff). There's an industrywide problem of over-diagnosing C. diff that stems from inappropriate test ordering, which generates false positives. Approximately 10 to 15 percent of the population is colonized with C. diff, who will test positive, despite having normal levels of the bacteria, Chang explained.

"Using LogicStream's software, we were able to identify and eliminate multiple versions of the C. diff order set, which allowed us to standardize the workflow very quickly and ensure appropriate utilization of lab tests," he said. "As a result, we decreased the number of test orders from roughly 90 per month to 5 per month. In one month, we reduced our C. diff rate by 50 percent, from an average of 0.876 to 0.4201 cases per 1,000 patient days."

This also supports Tampa General's antimicrobial stewardship efforts, since clinicians no longer are ordering antibiotics for false-positive cases.

ADVICE FOR OTHERS

"It's vitally important to make sure you have the process infrastructure set up to appropriately utilize the software," said Chang. "The technology can help uncover hard evidence that points to specific problems, but if your clinicians aren't empowered to do something about it, then the issues remain unresolved."

The biggest mistake Tampa General made was purchasing the software before the end users were ready to take action in the specific clinical areas, he added. Before implementing the technology, he advised, it's imperative to engage with clinical teams and ensure they are prepared to use the actionable data to effect positive and sustainable change.

Twitter: @SiwickiHealthIT
Email the writer: bill.siwicki@himssmedia.com