Listening to our end users and working to improve efficiencies for them is another way we focus on continuous improvement.
Our Documentation Advancement Resource Team (DART) continues to work across specialties to streamline documentation and make the EHR experience more personal.
The team introduced the Workflow MPage and Dynamic Documentation (DynDoc). IT worked directly with the primary care providers to produce a more efficient and pleasant EHR experience.
As each provider proceeds through their customized specialty workflow, the page connects with DynDoc. This link allows clinicians to complete nearly all required documentation as a byproduct of the notes they make during the patient’s appointment.
Those providers who were willing to take the leap into a new documentation platform have seen dramatic decreases in after-hours documentation time as well as time spent per note while maintaining patient volumes.
Documentation time per patient decreased by a range of 18.3% to 46.7% across various groups, including family medicine, internal medicine and urology.
These efficiencies reduce the time doctors spend documenting outside hours, giving them more time with their families. The early adopters are down 43%, and family medicine providers decreased off hours documentation time by 57%
The DART team will continue to work with other specialty groups to achieve similar outcomes.
In an academic inpatient institution, the physician directly responsible for patient care changes frequently. Call schedules and whiteboards fall short of keeping this information patient-centric with timely and quick accessibility. Valuable patient care time is too often spent in search of “Who is the doc right NOW?”.
To solve this problem, the team searched for the source of truth to identify the inpatient primary contact, and implemented “Physician Handoff with Primary Contact” across the enterprise.
This PI-LDP project team’s goal is to reduce 30-day, all-cause admissions by facilitating the initiation of Congestive Heart Failure (CHF) care and the transition process for patients with CHF as early as possible in their hospital stay.
A retrospective study showed 70% of patients with CHF were identified later in their inpatient stay — and some were identified at discharge.
To better care for CHF patients, we need to help clinicians identify patients with this condition sooner in the hospital stay. Thus, our team refined our decision support tool so that it correctly identified more than 85% of patients with CHF, resulting in a 50% decrease in CHF readmissions.
This team developed tools to improve admission documentation.
After we completed the pilot phase of the new order set, the O:E mortality for stroke improved to 0.66, down from 1.02.
The number of queries sent to residents from coders asking for more information also dropped significantly, from a monthly average of seven to three, indicating that the residents were capturing more of the necessary information upfront.
Sepsis is the leading cause of hospital mortality. Sepsis diagnoses are present in 40% of MU Health Care’s mortalities and we are at the Vizient top-quartile performance for sepsis observed to expected (O:E) mortality for the quarter ending June 30, 2017.
A cross-functional team comprised of physicians, Office of Clinical Effectiveness, and IT are collaborating on these key focus areas and closely monitoring outcomes to drive toward our aim of top-decile performance for sepsis O:E mortality.
Technology and access to data were identified early on as an opportunity for improvement. Therefore, we implemented the following changes:
- Deployed Sepsis Alerts throughout the health system
- Deployed clinical decision support embedded in the EHR
- Standardized protocols and documentation within the EHR
- Created robust data repository related to sepsis that can be mined for outcomes and performance improvement initiatives
Standardization of care and access to data results in improvements in bundle compliance with a corresponding reduction in mortality.
We are developing a tool that will give providers sepsis treatment real-time bundle compliance, directly within their workflow. The Sepsis Team is developing dashboards to give ED and inpatient providers information to retrospectively analyze the care they provide.
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