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Reducing C. diff cases and improving anti-microbial stewardship

We recently worked with a hospital in Newport Beach, California, U.S.A. to maximize Allscripts Sunrise capabilities for better outcomes. We formed an Outcomes Board with leaders from both entities representing clinical, financial and operational disciplines. The Outcomes Board sets goals, identifies anticipated returns on investment and develops metrics for performance improvements.

We’ve had some exciting results, improving early intervention for patients with Clostridium difficile (C. diff) and reducing risk of infection by converting patients from intravenous (IV) to oral (PO) medications.

Faster interventions for patients with C. diff

Physicians note that of all the common hospital-acquired infections in California, all of them are improving except for C.diff. Orange County has one of the highest rates of C. diff infections in the state.

The Outcomes Board targeted C.diff cases, with a goal of identifying patients sooner to help provide faster intervention, prevent transmission and reduce cost per case. Using a Medical Logic Module (MLM) within Sunrise, the hospital created documentation and automatic testing for C. diff when patients met predefined criteria.

The Outcomes Board adjusted cost-per-case measurements using Case Mix Index (CMI), which indicates the severity of cases. Within the first seven months of implementing the project, the organization recognized a 4.65% savings in CMI-adjusted cost per case.

The community is watching this initiative very closely. If this hospital can move the needle on C.diff, these are procedures that other organizations can apply with success, too. The hospital is sharing its progress with the California Department of Public Health collaborative on infectious disease.

Anti-microbial stewardship: IV to PO conversion

The hospital continuously works toward more effective and cost-efficient uses of medications. One consideration is whether clinicians should order intravenous (IV) or oral (PO) antibiotic therapies.

Many hospitalized patients receive IV-administered antibiotics, but they can create clinical challenges. For example, IV therapy increases the risk for catheter-related infections, which can lead to additional time in the hospital, sepsis and other complications. Oral medication alternatives can be just as effective as IV treatments and can reduce these clinical risks. They also reduce costs of IV sets and pumps, nursing and pharmacy personnel time.

According to the hospital’s Medical Director of Infection Prevention and Hospital Epidemiology, research shows 30% to 50% of patients receive unnecessary antibiotics, which contributes to rising bacterial resistance and C. diff rates. Converting medications from IV to PO helps improve patient safety.

The organization designed an MLM to alert clinicians placing IV orders for 15 antibiotics within the stewardship program. If patients also had diet orders, meaning patients are able to eat food, then the alert would recommend an oral medication. Another MLM reminded clinicians to change medications from IV to PO when placing a new diet order.

While the hospital had an IV to PO policy in place, it had very little impact until Sunrise helped make the conversion automatic. Now that the conversion occurs at the time of prescribing, it eliminates manual processes for both the physician and pharmacy.

The project started in spring of 2015, and the Sunrise MLMs triggered alerts for 170 cases during a seven-week period. In 149 of those instances, or 88% of cases, the physician converted the order from IV to PO, moving to a lower cost medication therapy that is equally effective. The estimated annualized cost savings per discharge is about 6.8%, after 4 months of data to date.

What’s next?

The hospital’s Outcomes Board continues to identify new projects with help and input from our Outcomes Collaboration program and onsite team members. Plans are under way to use Sepsis and ICU Delirium pathways, presented earlier this year in our program. Physicians report looking forward to undertaking new initiatives to improve patient safety with Sunrise.

Because with Sunrise, it’s possible to target patient safety initiatives specific to each organization. If you’re interested in learning more about successful workflows in Sunrise, join the conversation in our ClientConnect community today.


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