Virginia Commonwealth University Medical Center has spent the past 10 years implementing, adopting and optimizing its Cerner electronic health record system. Now, the Richmond, Va.-based organization is focusing on using the capabilities of the EHR to drastically reduce preventable patient harm.
"We've spent a decade laying the foundation, and getting the infrastructure in place," says Colin Banas, MD, CMIO of VCUMC. "And in the last four years we've started being able to leverage that foundational work to do some really cool stuff."
A safety-net hospital, VCUMC sees more than 35,000 inpatients per year and 500,000 outpatients in an attached ambulatory center. One of the organization's goals is to be "America's safest health system" and have all these patients experience no incident of preventable harm.
To this end, the hospital has developed several tools that use data from the EHR to help alert clinicians to emerging issues before they become incidents of patient harm. The safety dashboard for nurses is "a population health management tool at the hospital level," says Dr. Banas. The dashboard pulls information from the EHR system to give nurses an indication of which patients are high-risk for preventable harm, including those with fall risk, a need for physical restraints, or who currently have IV lines or surgical drains for example.
"They can see the status in real time of things we have declared institutional priorities," says Dr. Banas. "And those icons are actionable — they can bring up the dashboard, see the patients that have these issues that need to be addressed, and they can just click and address them."
The dashboard is particularly useful during handoffs and huddles, says Dr. Banas, as it allows a nurse to see real-time information about which patients are at risk for preventable harm. This can also be sorted by area of the hospital or care team. He says the dashboard is accessed hundreds of times a day by the hospital's nursing staff.
Since the implementation of the dashboard, VCUMC has seen a 50 percent reduction in patient falls with injury and a 50 percent reduction in hospital-acquired pressure ulcers. While an organizationwide focus on reducing these instances helped drive them down, Dr. Banas believes the nurses' use of the dashboard played a major role. "[The nurses] are so proud of how they used the dashboard to reduce falls and pressure ulcers," he says.
VCUMC has also developed early warning systems that continuously monitor patient conditions to alert clinicians to changes and trends before the problem becomes severe enough to trigger an alarm. The Medical Early Warning System and Pediatric Early Warning System are "dashboards that calculate in real time your ‘sickness score’, or how sick you are, using your vitals," says Dr. Banas. The dashboards then calculate an early-warning score to allow clinicians to intervene before a patient's condition reaches a critical state.
The dashboards have been particularly helpful for the hospital's rapid response team. "In the past, a patient would deteriorate, and the rapid response team would be called to come intervene. It was reactive," says Dr. Banas. "Now, the rapid response teams have iPads and laptops [with the dashboards] that refresh in real time, and they're actually able to go to the patients before they get called."
The dashboards, currently implemented across the system, have helped lead the hospital to a 30 percent reduction in cardiopulmonary arrests outside the intensive care unit, a 20 percent reduction in code blues outside the ICU and a 7 percent reduction in in-house mortality. These reductions have been accomplished by using the dashboards to "get patients interventions more quickly and ensure they get the appropriate level of care," says Dr. Banas.
These dashboards were both built on top of the EHR platform using a framework provided by Cerner. However, the inspiration for the dashboards came from the hospital's clinicians and the organization's overall mission to use all available resources to prevent patient harm and improve outcomes. "All this success, you can't attribute it all to IT," says Dr. Banas. "It starts with the people and their process. The technology is just the secret sauce you add in at the end."
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