Top 5 videos from HIMSS17

Top 5 videos from HIMSS17

Community hospitals share Davies-worthy success stories

'High-quality care doesn't have to cost more'
By Mike Miliard
06:42 PM
hospital building

Few organizations better understand how to use health IT to improve care and lower costs more than small community hospitals. At HIMSS15 on Tuesday, two recent Davies Award winners offered case studies on how their advanced use of electronic health records has helped them bolster both patient safety and the bottom line.

One of those was St. Joseph, Michigan-based Lakeland Regional Health System, which, thanks to rigorous adherence to clinical decision support and close analysis of outcome data, managed to drive significant decreases in its sepsis mortality rates.

Starting with implementation of its EHR, Lakeland was able to enact a "two-step process to improve early recognition of sepsis and act on it," said Robert Nolan, DO, director of Lakeland's St. Joseph emergency department.

Sepsis, which costs 200,000 lives and $17 billion each year, is a critical danger, and early detection of symptoms is all-important. It has a 10- to 30-percent mortality rate, and patients who survive need long and costly ICU stays.

Recognizing this, Lakeland undertook an initiative to leverage its IT systems to help improve those numbers, hoping to "impact survivability without letting costs go through the roof," said Nolan.

The aim was to "try to make this a much more transparent diagnosis, early on after the patient arrives at the emergency department," he said, building capabilities within Lakeland's IT system that could track four critical variables – heart rate, white blood cell count, respiratory rate, temperature – and "alert the nurse and the provider to the potential of sepsis and then trigger, at the tail end, some early goal-directed therapies."

But technology was only part of the equation. After its EHR go-live, Lakeland formed a multi-disciplinary sepsis committee with ED nurses and physicians, intensive care teams, pharmacists, performance support and analysts, said Karen Kaminski, RN, EHR Senior Analyst at Lakeland.

The group set its sights on sepsis workflow within the ED, collaborating to establish a workflow within the EHR that would recognize and treat potential septic patients as early as possible.

Prior to the EHR implementation and the new committee, "most of our processes and communication were on paper," said Kaminski. Perhaps not coincidentally, "we did have above-average mortality rate."

That rate dropped almost immediately after go-live, she said. Lakeland also experienced a 0.8-day reduction length of stay. And it gained the ability better monitor not only sepsis, but also stroke and trauma patients.

Best of all, it proved that "high-quality care doesn't have to cost more," said Kaminski.

With the implementation of order sets and pre-checks, there's a risk of overuse – that "people will be trained like mice to keep pushing the button and order a lot of unnecessary tests," said Nolan.

"One of the things we're most proud of is that not only did we save lives and improve the quality of care, but that extra care that probably didn't need to happen didn't come to fruition."

By getting the insights to treat patients much earlier, he said, "rather than letting them languish for six or eight hours before that a-ha moment comes," the sepsis initiative has saved 94 lives in the past two and a half years.