To improve patient outcomes, University of Missouri Health Care (MU Health Care) staff set a goal of lowering congestive heart failure (CHF) readmissions by 5 percent. The electronic health record (EHR) intervention project proved so successful, the Cerner ITWorks℠ client cut readmission numbers by nearly a third.
“Quality improvement has been part of MU Health Care for 15 years,” said Thomas Selva, MD, chief medical information officer. “The most successful IT-related readmission interventions are clinician-led and IT-enabled.”
An interdisciplinary team of MU Health Care staff, which included Tiger Institute team members, designed and implemented the readmissions project in June 2016. The project received the MU Health Care Chief Executive Officer award, which recognizes innovative solutions to complex problems.
The improvement team worked with cardiologists and other key stakeholders to build tools and develop an algorithm within the EHR to lower readmissions.
This work led to more than a 32 percent reduction in congestive heart failure readmission.1
The algorithm digs through EHR data, comparing information from the current admission and the patient’s medical history to determine if the patient may have CHF. If the algorithm identifies the patient, it prompts several possible actions.
For example, in some cases, a physician receives an alert informing him or her the patient potentially suffers from heart failure.
In most instances, however, when a patient is identified with heart failure, the provider does not receive an alert. To remove ordering burden and alert fatigue, the algorithm automatically fires certain tasks to appropriate care team members. For example, it prompts nurses to take daily weight and inputs and outputs, patients to view CHF-related videos and the pharmacy and nutrition teams to perform specific tasks. The cardiac rehabilitation team — Fit for Life — also receives tasks for education and outpatient cardiac rehabilitation.
“Communication between teams is vital,” said S. Hasan Naqvi, MD, associate chief medical officer. “Using technology allows us to increase communication, better assess patients, and ultimately, make significant improvements in patient outcomes.”
Team members also educated nurses, dieticians, pharmacists and Fit for Life staff members. Projects like this, where IT staff are embedded within clinical performance improvement teams, led IT staff to score a survey with high marks. This contributed to Healthcare IT News naming MU Health Care one of 2017’s Best Hospital IT Departments. Bryan Bliven, chief information officer and Tiger Institute executive director, attributed the success of the project to the combination of the robust IT solution with the diligent work of MU Health Care clinicians.
“Implementing appropriate data analytics was crucial to measuring and maintaining progress,” said Bliven. “We had to anticipate the effects of the project on the staff’s workflow.”
1Comparing 24 percent from October 2014 – May 2016 to 16 percent from June 2016 – December 2017