A co­or­di­nated ap­proach

Modern Healthcare - - Information Edge -

Dr. Larry Holder is the chief med­i­cal in­for­ma­tion of­fi­cer at Decatur (Ill.) Me­mo­rial Hos­pi­tal and physi­cian cham­pion of an award-win­ning health IT pro­gram. Holder, a hos­pi­tal­ist, came to Decatur in 2004 when it was well along on a health IT jour­ney that had be­gun in 1990. To­day, more than 75% of or­ders at Decatur are di­rectly en­tered by physi­cians into the hos­pi­tal’s com­put­er­ized physi­cian or­der en­try sys­tem.

While Holder is an in­di­vid­ual AMDIS award win­ner this year, Decatur Me­mo­rial also won Mod­ern Health­care’s third an­nual IT Case Study Con­test (July 4, p. 29). Both awards are based on a pro­ject to use adapted health IT and greater co­or­di­na­tion of hu­man re­sources to sharply im­prove per­for­mance on in­pa­tient glu­cose con­trol.

The pro­ject “took about a year and a half be­fore we started treat­ing pa­tients with it,” and ini­tially fo­cused on a dif­fer­ent, though re­lated, prob­lem, Holder says. “When this pro­ject ini­tially started, we were look­ing at ways to de­crease wound in­fec­tions,” he says, since there is a known cor­re­la­tion be­tween in­fec­tions and lack of glu­cose con­trol in di­a­bet­ics.

A his­toric im­ped­i­ment to im­prove­ment, how­ever, was the wide­spread re­liance on the tra­di­tional and yet out­moded and re­ac­tive “slid­ing scale” of in­sulin dosage based on blood glu­cose read­ings. Holder as­sem­bled a team of 23 staffers, from physi­cians and nurses to food ser­vice work­ers and a black belt in Six Sigma process im­prove­ment to de­velop a new and im­proved ap­proach for mon­i­tor­ing and med­i­cat­ing pa­tients.

Launched on the sur­gi­cal floor in De­cem­ber 2010, the pro­gram was rapidly rolled out to the rest of the hos­pi­tal by April. The IT end in­cluded de­vel­op­ment of a clin­i­cal de­ci­sion­sup­port tool to en­sure con­di­tion-re­lated pa­tient data reached the physi­cian, but also in­volved changes to the elec­tronic nurs­ing doc­u­men­ta­tion, phar­macy in­for­ma­tion, glu­cose mon­i­tor­ing and room ser­vice soft­ware sys­tems as well as req­ui­site re­port­ing tools.

The pay­off? For an ini­tial sam­pling of 75 pa­tients, glu­cose lev­els be­low 180 were main­tained by 81% of the pa­tients, com­pared with 72% in a pre-launch base­line. The tim­ing of glu­cose checks im­proved, too, with 80% oc­cur­ring within 30 min­utes of meal­time, up from a base­line of only 20%.


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