Customized Clinical Decision Support Improves Outcomes

Background and Challenge

University Medical Center – Southern Nevada (UMC) is a nonprofit, government hospital in Las Vegas. As Nevada’s only Level I Trauma Center, designated pediatric trauma center, burn care center, and center for transplantation, UMC is critical in caring for the sickest and most underserved communities in Las Vegas.

A year after going live on Epic on an accelerated schedule, UMC needed to stabilize core workflows to ensure clinical scalability and financial success. Clinical leadership had little time to focus on critical nursing documentation improvement, implementing newer features, or experimenting with predictive analytics, all of which had the potential to save even more lives at UMC and more time for nursing staff. UMC sought a partner that could provide the perfect blend of leadership guidance, clinical expertise, and skilled support while maintaining focused governance to align scope and goals.

Solution

An integrated team of Tegria clinical documentation experts and experienced managed services analysts conducted an assessment and prioritized initiatives for the engagement, including:

• Creating operational and technical solutions for disease-specific programs
• Developing real-time patient safety monitoring methodologies to promote better outcomes and reduce penalties
• Improving documentation efficiency and regulatory metric workflows and reporting

Tegria experts helped to create end-to-end workflows and toolsets that use Epic’s Sepsis Predictive Model to reduce end-user alert fatigue and clinician frustration. Separate, tailored solutions for adults and pediatrics now provide real-time analysis of patients’ risk scores and recommend follow-up actions as necessary. Tegria also worked with UMC’s trauma services team on a toolset that allows nursing informaticists to quickly track key aspects of patient care related to stroke and chest pain, as well compliance for specific regulatory guidelines.

Web-based dashboards were created to help UMC leadership guide the organization’s most critical decisions using data on quality metrics, patient throughput, revenue, and patient outcomes. UMC prioritized additional dashboards to allow bed planners, case management users, and hospital leadership to monitor patient throughput and review metrics related to occupancy rates, environmental services requests, and time spent in observation. The increased visibility helps with bed management and highlights bottlenecks in the system.

Patient safety indicators (PSI) and hospital acquired conditions (HAC) system lists were implemented in Epic to enable review of patient safety events in real time. Improving PSI and HAC rates should enhance patient safety and reduce payer penalties. Mapping and build related to electronic clinical quality measures (eCQM) also were updated to provide accurate reflections of performance through Epic reporting on all measures.

“At one glance, we can see compliance from staff on VAE bundle, weaning, charting, and billing compliance. It is very comprehensive and has cut down hours of work that we were doing previously looking in multiple charts to find this data,” said Alicia Jones, UMC Director, Respiratory Services. “We are also able to get more reliable vent days data – without spending hours manually gathering the data.”

The project also revealed that UMC’s ED Facility Charge Calculator (FCC) was not correctly calculating ED Level of Care charges. The FCC was rebuilt to facilitate faster and more accurate charging for ED patients by defining appropriate charging methods.