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Automating Infection Control

February 24, 2010
by Daphne Lawrence
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For a small community hospital, leveraging a component of the existing EMR had surprising results

Leaders in healthcare IT innovation are often large academic medical centers with access to great resources. In these changing times, however, small community hospitals are finding ways to harness the power of IT to not only improve patient care, but also to help protect and bolster their bottom lines. For these hospitals, it's more than prestige is at stake. With heavy competition for admissions, it is a case of outright survival. One such hospital is 220-bed Chester County Hospital in West Chester, Pa. Located near Philadelphia, which is also home to many large academic medical centers, Chester faced the need to stand out.

Michael barber
Michael Barber

“We needed to distinguish our hospital from other hospitals both locally and regionally so we created our own “Hospital of Distinction” campaign,” says COO Michael Barber. “Our goal was to distinguish ourselves from a quality and safety perspective.” And for Chester, an innovative approach to automating the infection control process that would improve patient outcomes was the jumping off point to earning that distinction. Using an existing module of Malvern, Pa-based Siemens Soarian enterprise EMR that it already had, Chester utilized business process management (BPM) to automate its clinical processes for infection control notification in order to improve patient care outcomes for Methycillin-resistant Staphylococcus aureus (MRSA) as well as compliance for Centers for Medicare and Medicaid Services (CMS, Baltimore) core measures. This was done with no investment other than the time of its dedicated staff.

The foundation of BPM, widely used in industries other than healthcare, is similar to other quality performance methodologies though technology is its key enabler. But BPM goes a step further by stating that this approach can be supported, or enabled, through technology. In Chester's case, a BPM engine that is part of its Soarian system automates and manages the workflow changes. “It came with the product but people didn't know what to do with it; they were using it as a glorified rules engine,” says Vice President of Information Technology, Ray Hess, referring to Soarian. “One of the things I find frustrating with my peers is that we look at what we can't do rather than what we can do,” he says. “In this case, there was functionality that we said we can leverage in a different way.”

BPM automation evaluates workflow processes, targets with the goal of decreased variation in the execution of each process step, decreases in missed or delayed steps, fewer errors, more timely completion of the process, decreased workload for the staff and ultimately improved outcomes. But hospitals have traditionally lagged behind other industries in its use because of the unique nature of healthcare. “BPM is a niche in the IT industry that allows you to put processes in the system and allows the system to manage and direct the process,” says Hess. “It's very popular in many other industries, but you don't see a whole lot in acute healthcare environments because of the complexities of the processes we are trying to automate.”

At Chester, the processes they wanted to automate were in the department of infection control. “Infection control has been a major hot button for years,” says Hess. “We had a group working on it and were having a hard time getting our arms around because of all the handoffs.”

Although Chester's Infection Control team met regularly, Hess says that no matter how much they honed the process, they didn't get the desired results. “We had a good flowchart of the process, but it was dependent on multiple people doing the right thing,” says Hess. “For example, all it took to throw a wrench into the workflow was one unit secretary who didn't order an isolation cart.”

The hospital found it had anywhere from eight to 12 manual processes every time it tried to put a patient into isolation (see sidebar.) “If any of those didn't happen you would be at risk,” notes Hess. Automating the management of those manual processes came from using Chester's existing Siemens BPM engine to improve two Soarian-driven workflows - Bed Management and Infection Control. The goal was to automate the manual steps within the process of identification, notification and tracking of patients with infectious diseases. The Chester team built the automated process themselves and then showed it to Siemens.

Chester's Steps for Automating its Infection Control Process

  • Evaluate patients for a history or MRSA at all points of entry

  • Pre-Admission Testing; Ambulatory Care Unit; Cath Lab; Emergency Department and Inpatient Admission

  • Notify nursing staff in each area of positive history

  • Notify nursing bed manager on all admissions for appropriate placement

  • Change the isolation flag in the system

  • Write a clinical note into the medical record

  • Check for recent positive MRSA tests

  • Order isolation kit from central

  • Notify nursing staff to (collect) a MRSA screen if no recent positive results

  • Evaluate microbiology results for new MRSA positives and alert if unknown

  • Maintain /update the MRSA history database

  • Listen for negative screens, calculate if the patient may be able to come out of isolation and notify the staff and bed manager

  • Notify infection control

  • Notify housekeeping that the room is “isolation clean” on patient transfer/discharge

  • If no history, assess patient for “high risk” MRSA status