Leading by Example: St. Jude Serves as a Model for Care Transformation
(4/02/2007)

How can health care organizations combine the science of patient care, computer science, and information science to give their clinical staff the tools to manage and communicate patient information in a meaningful way? Just ask the folks at St. Jude Medical Center (Fullerton, CA), a 359-bed facility that served as the pilot site for St. Joseph Health System's (SJHS) corporate-sponsored Care ReDesign project using the MEDITECH system. By undertaking a collaborative approach with multidisciplinary teams, St. Jude has stayed true to SJHS's project goals and serves as a great example of how hospitals can make specific process changes that yield far-reaching and tangible results.

"By participating in St. Joseph's Care ReDesign, we're not just implementing new technologies. Rather, we're taking a close look at all the services we provide for our patients, and completely rethinking how we can administer the best care in every situation," says Teresa Frey, RN and director of the clinical information services department. "By stepping back and reevaluating our overall approach, we're seeing huge patient safety improvements that wouldn't be possible with just a few isolated changes. It's been a true transformation for us."

Solid Focus, Teamwork Makes Project Possible
St. Jude shared a common focus with SJHS: to integrate information using I.T., while providing safety measures to reduce errors and facilitating improved staff productivity. But the hospital also had its own very specific goals in mind to improve the patient experience, as well as facilitate positive outcomes and financial stability. These goals included decreasing preventable medical errors and operational inefficiencies, providing real-time access to patient information, using automated technologies to redesign processes, aggregating information to support care improvement activities, and reducing patient wait times. A long list of challenges to undertake, admits Frey, but one that was possible thanks to strong leadership and teamwork.

"Our Care ReDesign team included nurse informaticists, physician liasions, and information service instructors to get this project off the ground," says Frey. "We relied on the input of physician champions and clinicians to help design patient care delivery decisions. This project was so large in scope, involving so many different technologies and caregivers, we couldn't be successful without having everyone on board."

Using Automation to Put Patient Safety First
One of the most important technological changes the site tackled was in the area of clinical documentation. By putting all documentation on-line, St. Jude was able to support a single integrated patient record, instantly accessible to all caregivers across disciplines, eliminating redundant data entry and the need to ask patients repeatedly for the same information. The site also implemented an Electronic Medical Record (EMR), so clinicians could immediately access information on patient progress over time. "We eliminated the time-consuming process of tracking down and searching manually through thick patient charts," says Frey. "Previously, documentation was kept separate by discipline and fragmented records were the norm. But now, all caregivers can be assured that they have easy access to the latest information, no matter when or where they need it."

The ability to safely deliver care from anywhere throughout the continuum was further enhanced by St. Jude's implementation of Computerized Physician Order Entry (CPOE) capabilities, which enabled clinicians to complete their orders from within the facility or from remote locations. "This technology also helps to prevent errors, as users can create legible, electronic orders that are instantly routed to all departments involved in the patient's care," says Frey. "CPOE also provides the physician with warnings for patient allergies, drug interactions, and contraindications, which is something that a handwritten order definitely cannot do."

St. Jude is also utilizing an Electronic Medication Administration Record (eMAR) to enhance medication safety by enabling caregivers to receive notifications and document medication administration electronically at the point of care. Likewise, bar code identification technology and bedside label printing is significantly improving patient safety by minimizing the chance for human error in patient identification and specimen labeling processes.

"Safe care and automation through technology really go hand-in-hand," says Frey. "For example, the ED Tracker helps us to facilitate better communication amongst our ER clinicians, while streamlining access to patient information and documentation routines. Meanwhile, the information contained within our on-line documentation allows us to automatically capture projected and retrospective acuity levels of our patients. And the list goes on from there. I.T. is allowing us to complete a lot of complicated processes in just a little time, while taking patient safety and quality to a whole new level."

Process Changes Produce both Clinical and Financial Results
St. Jude's results seem to confirm Frey's positive assessment of the site's progress. In the past three years since Care ReDesign began, the site has seen marked improvements in the area of patient safety, including better communication between caregivers, utilization of evidence-based medicine and best practice guidelines, and seamless reconciliation of patient medication lists between units and upon discharge. "Our updated falls documentation now reflects evidence-based practice, and new reporting tools now track why a patient fell, what the risk factors were, and which medication the patient received," says Frey. "We also have newly developed reports under a single desktop icon, for "hand-off" staff communication as shifts change. We're doing all we can to ensure the continuity and safety of the patient's care, no matter what the circumstances."

Care ReDesign has not only made a difference in St. Jude's patient care, but also in the hospital's financial health. Since the project began, St. Jude has seen a 3-5% increase in charge capture since automating charging with documentation, while significantly reducing batch rejects and chart deficiencies.

"Rethinking care processes using I.T. has made sense for us in every way - on both the clinical side and the business side," says Frey. "But it required a commitment - true care advancements could not be accomplished by our simply automating the paper medical record. We had to think outside the box and redesign the process, utilizing the MEDITECH system to support our goals. It's been a great experience for us, leading by example."

 

About St. Jude Medical Center
Established nearly 50 years ago by the Sisters of St. Joseph of Orange, St. Jude Medical Center (Fullerton, CA) ranks at the top of Orange County hospitals in patient satisfaction scores, medical outcomes, and state-of-the-art technology. St. Jude's physicians offer one of the nation’s highest board certification rates, while the hospital continues to be guided by the values of the Sisters: service, excellence, dignity, and justice.

During St. Jude's Care ReDesign project, St. Jude rethought how it could administer the best care in every situation using MEDITECH's HCIS. St. Jude has seen improvements in the areas of patient safety, including better communication between caregivers, utilization of evidence-based medicine and best practice guidelines, and seamless reconciliation of patient medication lists between units and upon discharge.

MEDITECH
Medical Information Technology, Inc.
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Westwood, MA 02090
781-821-3000
www.meditech.com