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Children’s Hospital of Orange County

Children’s Hospital of Orange County earns coveted HIMSS Davies for care guidelines, early warning system and more

Children’s Hospital of Orange County (CHOC), a 279-bed children’s hospital in Orange County, California, earned one of the health information technology industry's highest accolades: the 2016 HIMSS Enterprise Davies Award.

CHOC received this prestigious award as a nod to the organization’s efforts to improve patient care.

HIMSS Davies winners are Stage 6 and 7 Electronic Medical Record Adoption Model organizations that improve patient outcomes using electronic health records (EHR) and information technology (IT) while achieving return on investment.

“CHOC has made significant investments in health information technology designed to enhance quality and patient safety — our highest priorities,” said James Cappon, MD, chief quality officer. “We designed and implemented our electronic health record (EHR) with a focus on improving care. Because building and using an effective EHR is not always easy, and is certainly expensive, it’s gratifying to see measurable improvement from our efforts and investments. Making kids’ care better — making kids’ lives better — is the ultimate outcome, and proves the value.

“Consistent with a movement within medicine of more transparency, a marvelous piece of the Davies Award is that our improvement stories, in great detail, are shared with the international IT quality and leadership community from which to learn, duplicate and even improve.”

CHOC’s Davies application required four case studies highlighting the organization’s key health IT (HIT) quality and patient safety successes. CHOC’s benchmark projects include reducing harm from catheter-associated urinary tract infections; centralizing human milk management and introducing bar-coding — basically, treating human milk like a medicine; adding embedded care guidelines to the EHR and implementing an early alert system for at-risk patients.

CHOC achieved remarkable results using embedded care guidelines to control patients’ asthma. Staff created an alert for patients with asthma who were not tied to a care plan. The alert triggered when patients were set for discharge before a care plan was created. After implementing this alert, average length of stay for CHOC patients with asthma dropped from 2.14 days in 2010 to 1.72 days in 2016 — a 19.6 percent reduction.

Asthma readmissions within 30 days post-discharge fell 59 percent from a mean of 1.7 per quarter (Q3 2010-Q4 2011) to 0.7 per quarter (Q1 2012-Q3 2015). This is directly correlated to increased use of evidence-based care guidelines and the increase in requiring a home management plan of care at the time of hospital discharge. Reducing readmissions created an estimated cost-avoidance of $624,000 annually.

“Our main goal that motivates everything we do is to keep children well, and those that are ill as well as they are able to be,” said William Feaster, MD, chief medical information officer.

CHOC also addressed how providers monitor patients identified as deteriorating. An electronic assessment tool, the pediatric early warning system (PEWS), uses information from patients’ EHRs to assess all children at risk for or at the earliest stages of deterioration. The care team can then provide more timely detection and interventions.

“We have probably eliminated as many as 373 cardiac arrests outside of the ICU, largely as a result of the PEWS,” said Feaster. “That’s a huge step in our ongoing mission to provide the best possible care for our patients.”

Combined with the implementation of a rapid response team — designed to empower nurses and other personnel to use objective measures to quickly escalate patient cases — PEWS helped reduce the non-ICU code rate from 0.8 to 0.1/1000 patient days between 2008 and 2009. This is due to the PEWS detecting deterioration earlier and avoiding the need for many emergency interventions, which helped sustain this low code rate for eight consecutive years, through 2016 (at the time of the award submission).

“We’ve gone up to 1,000 days without a code in non-ICU areas, which is simply remarkable — and not even the stuff of dreams not that many years ago,” said Cappon.

“It’s been really rewarding to go through the Davies process because you realize how much you actually have improved care through applying an electronic medical record to your practice,” said Feaster.

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Client outcomes were achieved in respective settings and are not representative of benefits realized by all clients due to many variables, including solution scope, client capabilities and business and implementation models.