Monthly Archives: February 2019

Feb 21

Managing Emergency Department Overcrowding With NEDOCS

2/21/19 | Delivering Results

Managing Emergency Department Overcrowding With NEDOCS

In collaboration with Cerner’s Emergency Medicine group, Tiger Institute developed the National Emergency Department Overcrowding Score (NEDOCS) component for display on the ED Real Time Dashboard. The NEDOCS algorithm provides an overcrowding score based on factors in the ED, including number of waiting patients, free beds, and ED patients on ventilators — among others.

By sending alerts to providers and hospital administration, staff can mitigate the factor(s) contributing to department overcrowding, and to get patients seen and moved to the appropriate level of care more quickly.

Our development work is available to the broader Cerner ED Dashboard client base, and as such, the NEDOCS component and alerting system now provide value to more than 15 health systems.

Feb 7

Making Surgery Easier for Patients and Families

2/7/19 | Delivering Results

Making Surgery Easier for Patients and Families

Team InteGrated Enhanced Recovery (TIGER) is a new protocol, which helps MU Health Care better prepare patients, shorten hospital stays, make pain more manageable, and reduce direct costs associated with radical cystectomy (a procedure where surgeons remove all or part of the bladder.) Because of the protocol’s success, the team is adapting it to impact other kinds of surgical procedures.

Tiger Institute associates and MU Health Care staff members built new tools in the EHR to track patients’ progress and lay out a daily care plan. A nurse navigator helps guide each patient along all steps of his or her surgery — from preparation to post-operation.

Improved pain management

The TIGER protocol encourages preemptive pain medications and informs patients about alternatives to narcotics for pain management.

Three days after the operation, patients in traditional care used a total median of 413 morphine milligram equivalents (MME), while those using the TIGER protocol had a median of 275 MME.

Shorter length of stay

Improved care plans, fewer drugs and other improvements helped patients spend less time in the hospital. Those who experienced the normal procedure had an average length of stay (ALOS) of 10.5 days. However, those who used the TIGER program had an ALOS of only six days.

Patients didn’t realize they were going home four days sooner,” said Mark Wakefield, MD, associate chief medical officer. “They were better prepared for surgery, more engaged in their own recovery, had less post-operative pain, and returned to a better condition sooner after surgery.

A reduced length of stay, along with fewer drugs and other items related to surgeries, helped reduce the median cost of a cystectomy surgery by 25%.

Similar work continues to improve other major surgical cases, such as liver or pancreas resections, colon surgeries and lung surgeries. These teams have already started developing protocols and are in various stages of implementation.