Improving Patient Safety/Quality with Health Information Technology Implementation

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Project Details -
Completed

In an effort to improve patient safety and quality of care within our own facility, and to contribute to overall improvement of patient safety and quality of care in the health care industry, St. Joseph's primary goal was to implement an Epic system, in a clearly developed and documented manner benefitted other small hospitals. This project builded on research and discussion around patient safety and quality of care at our national Learning Lab held in Milwaukee in 2002. This Learning Lab was attended by nationally recognized patient safety leadership representing leaders from organizations active in patent safety. Community-wide diffusion of the Epic system began at our current small hospital as the lead partners and transferred to our new facility upon completion of construction and extend to multiple clinic sites, a community retail pharmacy, a new residential hospice facility and an 18-bed skilled nursing sub-acute care facility. We documented our safety-driven design principles and discussed the role Epic has in meeting these design principles, either directly or indirectly. Further, we designed around precarious events, specifically medication errors, by identifying the prevalence of medication errors, near misses and preventable adverse drug events in our current manual patient record and with our community partners systems and then again after Epic is implemented. We measured the length of stay, cost per case-mixed adjusted DRG and customer satisfaction in the old system and then again after Epic was implemented. Finally, we developed and document a clear health IT implementation report that can be utilized by AHRQ, other small community hospitals, and research organizations.

John Reiling, President and CEO of SynergyHealth
On Aug. 7, 2005, St. Joseph's Community Hospital in West Bend, Wis., transformed itself, opening a brand-new 80-bed facility designed around patient safety and supported by a centralized IT system that will help the hospital prevent errors and improve patient care.

"The key concept is to automate where possible," says John Reiling, president and CEO of SynergyHealth, the regional health system that includes St. Joseph's, and principal investigator for the AHRQ grant that is funding implementation of the new IT system. "By using technology in lieu of human intervention, error rates will be lower, if the technology is done well."

Inspired by the Institute of Medicine's groundbreaking 1999 report, "To Err is Human," Reiling has made patient safety the hospital's guiding mantra. St. Joseph's is a nonprofit, acute care hospital with more than 6,100 admissions a year. In 2000, hospital leaders recognized that their original facility, which opened in 1930, could not meet future needs. They decided to rebuild on a new site.

Two years later, Reiling convened a "national learning laboratory" in West Bend, attracting leaders in health care quality and patient safety from around the country, to discuss the relationship between facility design and quality of care. As a result of that meeting, Reiling and his colleagues developed a plan for designing a hospital around a specific set of safety-focused principles, including better visibility of patients to staff, increased patient involvement with care, reduced staff fatigue, automation where possible, and standardization.

The safety team at St. Joseph's also targeted specific adverse events for prevention through better design. These included: operative and post-operative complications and infections, medication errors, patient falls, wrong-site surgeries, and MRI hazards.

Reiling knew that the new hospital would need a strong, centralized IT system to support its ambitious goals for improving patient safety. West Bend Clinic, the multi-specialty physician group with which St. Joseph's is affiliated, was already using the Epic system. After researching their options, hospital leaders decided on Epic as well, creating an integrated system across the organization to lower the risks of human error and adverse events.

Implementation of the new system began in early 2005, with the creation of a Master Person Identifier for the SynergyHealth system, which, in addition to the hospital and its affiliated clinics, will include a sub-acute care facility and a new residential hospice. Scheduling, pharmacy, and medication administration are all being automated and centralized under Epic. In addition, patients will be able to access portions of their medical records from home or from their bedsides as inpatients.

Because most of St. Joseph's physicians were already using Epic on an outpatient basis, they were familiar with the system. However, not all physicians are consistent in their use of the system, and opportunities for improvement remain.

With the opening of the new hospital, St. Joseph's is poised to demonstrate the impact of both Epic and the design principles on a range of outcomes, such as patient satisfaction, length of stay and cost per discharge, as well as on each of the adverse events targeted for prevention. Studies based on each design principle are being conducted to measure the effect on these key outcomes and adverse events.

Looking ahead, Reiling says: "Using IT to improve safety and quality is critical and will be a fundamental element to deliver safe and high quality care into the future."