Truman Medical Centers shows how it used virtual observation to improve patient safety, reduced the 30-day readmission rate and promoted opioid stewardship. Only four other organizations have won the award twice.
By decreasing the 30-day readmission rate, promoting opioid stewardship and reducing patient falls, Cerner ITWorksSM client Truman Medical Centers (TMC), in Kansas City, Missouri, received its second HIMSS Enterprise Davies Award, one of the most prestigious awards in health care information technology.
The 2019 HIMSS Enterprise Davies Award honors organizations that utilize technology and health information to improve clinical care, patient outcomes and population health. Since the award started in 1995, only four organizations in the world have won it more than once.
“At Truman Medical Centers, we have always viewed health information technology as a strategic asset in helping our staff provide the best care possible,” said Mitzi Cardenas, executive chief administrative officer. “Being the fourth health system in the world to win the HIMSS Davies Enterprise Award twice is a testament to TMC’s commitment to ensuring our staff and students have the latest and greatest technology to meet the needs of the communities we serve.”
To be considered for the award, TMC leaders submitted three in-depth case studies showcasing their measurable and sustained improvements. Recordings of their presentations are posted here.
Using virtual observation to improve patient safety
With nationwide data showing 30-35% of patients who fall sustain an injury and the cost for each fall with injury at about $14,000,1 leaders at TMC implemented Cerner Patient Observer (CPO)™, a solution that tracks a patient’s movements and warns trained technicians when the patient is at risk of falling. TMC integrated CPO with CareAware Connect™, the solution nurses use for mobile messaging, directory and alerting functions. This allowed observation technicians to send alerts detected by CPO directly to a nurse’s phone. These improvements helped TMC reduce falls by more than 34%.2
"We try to create the best possible environment for our patients and caregivers," said Amy Peters, RN, MBA, chief nursing officer. "Reallocating additional patient care technicians from their primary jobs to one-on-one patient observation underutilized their skills and shortchanged our care teams. We needed a more predictable, efficient way to keep our patients safe."
TMC lowered sitter labor costs by allowing one technician to monitor up to 12 patients at a time. From February 2018-May 2019, the health system shifted 26,867 budgeted labor hours from patient sitting to clinical care.3
“Patient care technicians could focus on their jobs, which immediately eased nursing workloads,” said Angela Kline-Couch, RN, MBA, MSN, director of telemetry services. “As the project advanced, we began purposefully assigning patients with high observation needs to the pilot units. That really stretched the project's impact.”
In addition, technicians can communicate from their monitoring station to the patient’s room, using pre-recorded messages that play on speakers in the room, warning the patient they are at risk of falling.
Reduction in 30-day readmission rate
TMC introduced a new role called a transitional care pharmacist (TCP), who focused on patients at the highest risk of readmission. The TCP worked directly with patients to obtain a thorough medication history, optimize treatment, counsel on chronic disease states, and remove barriers to obtaining medications at discharge.
These interventions from the TCP led to a significant drop in the unplanned 30-day readmission rate. In fact, the rate was 65% lower for patients who had met with the TCP than the rate for the patients who didn’t.4
“When you combine excellent data that is utilized to create innovative IT patient care solutions with talented pharmacists, you get amazing outcomes,” said Joel Hennenfent, Pharm.D., MBA, BCPS, FASHP, chief pharmacy officer and associate administrator for laboratory and imaging.
TMC successfully reduced readmissions utilizing diagnosis codes in the electronic health record (EHR) to identify patients. These patients included those with heart failure, chronic obstructive pulmonary disease, pulmonary embolism or deep vein thrombosis.
“A patient with newly diagnosed heart failure was identified utilizing diagnostic codes. He reported he had stopped taking his medications as the cost had gone over $300 per month due to lack of prescription insurance,” said Blake Baumann Pharm.D., BCPS, clinical lead pharmacist transitional care. “Upon discharge, not only was he counseled on his new chronic disease state and medications, but we were able to help reduce his medication costs to less than $50 a month, which he stated was affordable.”
By reducing the 30-day unplanned readmission rate, TMC recognized a monthly cost avoidance of approximately $24,500.5
Promoting opioid stewardship
The CDC reports 115 Americans die each day from an opioid overdose. In Missouri, in 2016, the rate of opioid-related overdose deaths outpaced the national average with 15.9 deaths per 100,000 people, compared to a national average of 13.3.6
As health systems seek ways to battle the epidemic, a collaborative team at TMC undertook multiple initiatives to improve the use of opioids across the organization. The team began identifying patients at risk for opioid related complications, looking for ways to reduce unnecessary opioid prescribing, improving safety in opioid administration and increasing awareness of opioid use disorder.
“According to the CDC, 50 million Americans are living with chronic pain on a daily basis. We want to make sure we are treating pain appropriately but also keeping our patients safe at the same time,” said Joanne Hatfield, Pharm.D., BCPS, clinical lead pharmacist pain management. “We needed to make sure we were using opioids the right way and ensure our patients were educated about their risks.”
In one initiative, the pain management pharmacist provides inpatient and outpatient consultations with patients to help them develop a pain management plan and ensure their understanding of opioids. The pain management pharmacist averages three inpatient visits and eight outpatient appointments.
The TMC team implemented opioid stewardship strategies to minimize the use of intravenous opioids and encourage the use of oral alternatives. The TMC team has been able to show a trend toward a 22% reduction in average number of intravenous opioid orders per day.7
The pain management pharmacist also documents an average of 180 interventions per month with the providers accepting nearly all these recommendations to improve the safe use of opioids.
“Having a well-trained dedicated pharmacist focused on opioid stewardship and creating an innovative IT patient care solution are key strategies for approaching the opioid epidemic,” said Hennenfent.
This is the second HIMSS Enterprise Davies Award win for TMC. The organization won its first HIMSS Enterprise Davies award in 2014 after demonstrating a streamlined workflow that improved personalized care and reduced venous thromboembolisms and hospital-acquired pressure ulcers.
2 Comparing total medical-surgical and telemetry fall rate for August 2017 - January 2018 to rate for February 2018 - January 2019
3 Combining number of hours shifted per month from February 2018 - May 2019.
4 Comparing the average unplanned 30-day readmission rate from September 2017 to June 2018 of a control group of patients with the highest risk for readmission who were not seen by the TCP (28%) to the average readmission rate of a treatment group of patients with the highest risk for readmission who were seen by the TCP (10%).
5 Figuring in monthly readmission costs of $22,540 with assumptions including a five-day length of stay and 4.9 readmissions prevented per month, as well as hospital-acquired infections of $1,986.42.
7 Based on a trend line measured from January 2017 to May 2019 where the number of intravenous opioid orders per day dropped from 45 to 35.