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Yavapai Regional Medical Center

Improved quality reporting is helping staff at Yavapai Regional Medical Center (YRMC) — a 206-bed, nonprofit community health system in Prescott, Arizona — work toward identifying sepsis at earlier stages.

The Cerner ITWorks℠ client has used a Cerner solution (eQualityCheck™) to pull quality report information from its electronic health record since 2013.

On Oct. 1, 2015, the Centers for Medicare & Medicaid Services (CMS) mandated data capture of a new sepsis quality measure. Hospitals and health care organizations needed to adjust workflows to successfully ensure sepsis data capture and find a way to determine and document “time zero” for sepsis.

In the past, YRMC physicians documented sepsis “time zero”1 in free-text notes, which forced quality abstractors to look for the information manually.

To automate this process, YRMC paired with Cerner’s quality reporting team to design, review and adjust the organization’s sepsis workflow.

Part of this new workflow incorporates alerts that fire based on the St. John Sepsis agent algorithm. Once the algorithm triggers, providers receive an “open chart” alert to prompt them to document the suspected source of infection on a PowerForm within the patient record.

The solution monitors patients for risk of sepsis, and an alert fires if there are two signs of systemic inflammatory response syndrome (SIRS) and one sign of organ dysfunction.

The quality reporting team’s efforts led to an increase from 50 to 85 percent in the ordering and collection of repeat lactate test results (if the initial lactate is greater than two).

‘Invaluable’ technology

YRMC identified a sepsis physician champion to help make design decisions and carry out the official rollout of the sepsis core measure workflow. During the May 2016 implementation, physicians received in-person training from super users as well as the Cerner team.

“Our entire team at YRMC found working with the Cerner quality reporting team to be invaluable,” said Vickie Jones, RN, clinical quality analyst, meaningful use coordinator.

In addition, the YRMC team trained providers and nurses who directly impact sepsis management. The team emphasized the importance of discreet and time-efficient documentation, and the training seems to have worked.

Additionally, from May 2016 to September 2016, YRMC increased the percentage of physicians performing documentation on a suspected source of infection by 210 percent. This improvement came, in part, from the feedback the quality reporting team at YRMC gained from elbow-to-elbow training on how best to enhance the alerts.

“Trying to connect all the pieces for this extremely complicated measure, including modifications to the standard recommendations to adapt to our provider’s preferences and workflow, would have been impossible without the help [from the Cerner quality reporting team],” Jones said.

Finally, the alerts providers now receive include reminders to use the sepsis PowerPlan™, Jones said. This prompt helped YRMC increase in sepsis PowerPlan compliance by 32 percent, during this same time period.

“Adoption of these plans is improving, and we expect that to be key in improving patient outcomes,” she said.

1SIRS, organ function and suspected source of infection

Watch the following videos about how other organizations are using the St. John Sepsis agent and to learn more about ITWorks

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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.