Throughout my career, I’ve helped numerous hospitals build new technology solutions.
When implementing these systems, organizational leaders always hope their clinicians will embrace the new tools and drive benefits for patients and their hospital.
Most of the solutions I have implemented have focused on transforming patient care through the implementation of evidence-based content, including evidence-based plans of care and order sets. These solutions have been designed to standardize and improve the quality of patient care and safety, reduce the cost of avoidable adverse events, and create more efficient workflows.
Similar solutions have been widely adopted across the nation’s hospitals: according to the ASHP National Survey of Pharmacy Practice in Hospital Settings: Prescribing and Transcribing - 2016, 96 percent of hospitals now use computerized prescription order entry (CPOE) systems that include clinical decision support tools.
Despite widespread adoption, few hospitals have the right tools in place for measuring the impact of these systems on mortality rates, lengths of stays, readmissions, hospital-acquired infections and other metrics. In fact, many organizations can’t definitely articulate which, if any, of their clinicians are actually using evidence-based plans of care and order sets.
Over the last two decades, hospitals have invested millions in advanced systems designed to drive better clinical and financial outcomes. We’ve come a long way, but isn’t it time for hospital leaders to find out if their clinicians have indeed come to use these solutions effectively so that we can measure their clinical and financial impact?
Why evidence-based care matters
In aviation, aerospace, and many other industries, standardization has been the go-to first step toward decreasing adverse outcomes, eliminating waste, and achieving high reliability. In aviation, for example, standardization efforts have led to a decrease in annual fatalities, from 450 casualties/year 20 years ago to 250/year more recently, despite a doubling of total flight hours.
Numerous studies have also found that standardization of medical care improves clinical outcomes, patient safety, and possibly costs. One way to create standardization is through the use of evidence-based order sets and plans of care. Evidence-based order sets and care plans guide providers to follow interventions that have been proven to drive the best outcomes and reduce unwarranted care variations that may lead to harm, waste staff time, and even impact the organization financially.
Unfortunately, despite the known benefits of evidence-based care solutions, many hospitals have failed to realize their full potential because of poor adoption by clinicians.
The implementation of standards vs. actual standards adoption
While working with hospitals to optimize their use of health IT solutions, one question that often arises is whether or not the organization truly benefits from order sets and plans of care, especially in light of the significant time and financial resources required for implementation. Sometimes the answer is (painfully) obvious: despite the availability of standardized, evidence-based order sets, a hospital may have created hundreds of order sets –many of which may or may not be evidence-based—because each physician prefers to follow his or her own care routine.
Sometimes clinicians avoid using the hospital’s standardized order sets because the order sets don’t work well with physician workflows. Other times doctors choose not to use order sets because they don’t want to be “told” how to practice medicine. Still others believe these tools add to the many administrative burdens of delivering patient care.
Some organizations are stricter than others by restricting the use of provider-specific order sets and mandating the use of standardized order sets, with possible exceptions based on the individual health and care needs of each patient.) Regardless of how stringent a hospital may be in terms order set adherence, organizations rarely know if clinicians are indeed following plans of care unless they intentionally measure activity, either with analytics or the manual review of patient charts.
Measurement matters
Measuring clinician adherence to evidenced-based care practices is the first step in evaluating whether or not specific interventions are resulting in the intended results. Ideally organizations need to assess adherence by setting, department, patient appropriateness, and individual clinician to truly understand what is actually happening and to calculate the real consequences.
If evidence-based practices are not being followed, hospital leaders can then proactively communicate back to the front lines and engage providers to drive changes in behavior and modify workflows to encourage adherence and ultimately better outcomes. Organizations should then continuously monitor practice patterns to gauge the ongoing success of improvement campaigns.
With insight into how physicians are using evidence-based care guidelines, hospitals are better positioned to track the impact of their activities and take action as necessary to advance superior patient care and optimal financial outcomes.
About the Author
Staci Porter, MSN, RN, is a senior clinical strategist at Zynx Health. In this role, she supports the planning, development, and maintenance of clinical decision support across the care continuum. Prior to joining Zynx Health, Porter’s clinical background was in labor and delivery, postpartum, lactation, and the Level II Nursery. After helping a unit switch to computerized documentation and bar-coded medication administration, she transitioned to the clinical informatics department. There, she was instrumental in the development and implementation of the conversion to the electronic health record, including order sets and plans of care, utilizing Zynx evidence-based templates to optimize clinical decision support. Impressed with the width and depth of Zynx Health solutions, she joined Zynx, where she can help empower hospitals to measurably improve the safety, efficiency, and quality of care nationwide. She earned a BS from Brown University and an MSN from Excelsior College; she received her RN degree from Great Bay College and is ANCC board-certified in informatics nursing.