Australia’s first fully integrated digital hospital used health information technology to help return thousands of nursing hours to bedside care, reduce hospital-acquired pressure injuries, decrease adverse drug events due to medication omissions, and standardize care to reduce length of stay for orthopedic patients.
The historic electronic health record (EHR) implementation at St Stephen’s Hospital in Hervey Bay, Australia, once again received international recognition. Not only was the UnitingCare Queensland facility recently named as the first hospital in Australia to earn HIMSS Analytics Stage 7 validation, as tracked by the Electronic Medical Record Adoption Model, it is also the first hospital in Australia to win the coveted HIMSS Davies Enterprise Award.
The Davies Award is widely regarded as one of the most prestigious in health information technology (HIT) and is reserved for organizations that leveraged HIT to show significant and sustained improvements to patient outcomes and clinical workflows. Care teams at St Stephen’s used device integration, barcode medication administration and standardized care plans to increase time at the bedside for nurses, avoid hospital-acquired injuries, improve medication variance and reduce length of stay.
“Everyone involved with St Stephen’s is pleased and proud to accept the HIMSS Davies Award of Excellence,” said Madonna Bowers, acting general manager and director of clinical services. “As the first fully integrated digital hospital in Australia, health information and technology has been a cornerstone to our success in providing excellent and safe care to our patients and the community.”
St Stephen’s submitted three in-depth case studies that showcase their success. Recordings of their presentations are posted here.
Creating an integrated environment
The opening of St Stephen’s digital facility provided an opportunity for care redesign in multiple areas. The digital hospital’s focus went beyond the EHR and included a scalable platform that improved data access by creating a fully integrated care environment.
This new level of middleware integration resulted in seamless communication between the EHR, medical devices and care team communications, enabling near real time monitoring, clinical decision support tools, care plans, electronic room signage and enhanced patient engagement.
The biomedical device integration automated many manual processes, which freed-up nurses to spend approximately 2,800 more hours at the bedside.1
Additionally, St Stephens integrated Camera Capture™, an application that allows clinicians to take pictures of wounds and upload them directly into the record. This enabled nurses to more accurately monitor deterioration and progress of pressure injuries, and the rate of hospital-acquired pressure injuries fell 40% over two years.2
“Device connectivity has made life easier for all of our clinicians both in and outside the hospital,” said Larnie Wright, RN, assistant director of nursing. “It is very open and visible no matter where you are.”
Reducing medication administration variance
Switching from paper to a fully digital environment also enabled St Stephen’s to improve the variance in its medication process. By implementing a closed loop electronic medication management process with barcode medication administration (BCMA), clinicians could track and verify each step of the process.
“Reliable data provides greater visibility and helps us improve our clinician’s and patient’s hospital experience,” said Joanne Hayden, BSc (Hons), BPharm, clinical informaticist. “Add to this the clinical decision support tools and we can help prevent medication errors in near real time.”
With an increase in computerized provider order entry (CPOE) adoption and the utilization of BCMA, St Stephen’s realized an estimated 69% decrease in adverse drug events due to medication omissions.3
Standardizing orthopedic care
St Stephen’s set out to minimize variation among the high number of retirees in the region who require hip and knee procedures. As one of the highest diagnosis-related groups for the system, this orthopedic population provided a significant opportunity to improve both clinical and financial outcomes.
Through careful planning, engaged governance and process improvement, St Stephen’s embedded best practice care recommendations into the EHR digital forms. These forms, known internally as medical power plans, provided clinicians with the ability to individualize diagnoses and problem-driven plans of care, including multidisciplinary clinical pathways and care protocols.
Nurses incorporated electronic interdisciplinary plans of care to drive standardized nursing goals which further minimized the variation of care. After thorough testing and a committed focus on decreasing length of stay (LOS), the standardization paid off.
“Through our governance structure, we utilized data and documentation to standardize care delivery,” said Bowers. “As we continued the education and redevelopment of our plans of care, our average LOS decreased from 3.02 days to 1.6 days.”4
1 Comparing a pre-go-live time to capture vital signs of 5 minutes to a post-go-live time to capture vital signs of 2 minutes 7 seconds and using the number of admission days from Nov 2015 to Oct 2016 of 14,587 with the assumption that vital signs are taken four times a day.
2 Comparing a pre-go-live annual rate of hospital-acquired injuries of 44% measured during fiscal year 2014 to a post-go-live annual rate of 26% measured during fiscal year 2016.
3 Comparing the estimated number of adverse drug events due to medication omissions that would have occurred in the paper environment to the actual number of errors that occurred in the digital environment between July 2018 and April 2019. The expected number of errors is estimated using the organization’s paper environment error rate, measured from July to September 2014.
4 Comparing a pre-go-live average length of stay for orthopaedic patients measured across 2014 to a post-go-live average length of stay for orthopaedic patients measured across 2018.