Averting Risk through Effective Population Management Strategies

This was accomplished by altering emergency department order sets to address specific diagnostic and treatment protocols. Specifically, we used information provided by Centers for Disease Control (CDC), and state and local health departments to identify specific treatment procedures and processes that aligned with regional requirements and needs. This information was then used to update the applicable order set, alerting clinicians when TB screening tests were appropriate and guiding them toward appropriate treatment based on whether an identified patient had active or latent phase TB.

The addition of pre-checked diagnostic testing in evidence based order sets ensured that our team was fully compliant with the recommended guidelines for patients who exhibited nonspecific symptoms. Isolation management strategies were immediately employed for all high-risk patients to keep exposure to a minimum during the diagnostic testing.

As of mid-June 2013, we were managing 45 active TB patients and 350 latent phase patients. This long-term treatment effort—something that is often impossible with the transient homeless population—is possible thanks to a collaborative effort under the coordination of the Kane County Health Department, Illinois Department of Public Health and the CDC. Since the outbreak began, the CDC has made site visits to Kane County on two occasions, providing oversight to ensure that regulatory guidelines are being met and industry best practices followed.

It took a collaborative effort to address the long-term PHM aspects of the TB outbreak, but it was the availability of evidence-based order sets that drove the point-of-care actions needed to identify and treat infected patients and bring down the risk of broader contamination both within the hospital and across the community at large.

Conclusion

The federal government is taking action to address inefficiencies and the need for higher quality in healthcare. CDS technology provided at the point of care has been identified as a critical component to meeting these goals. 

Of six major focus areas identified by the government that attribute to significant losses in healthcare, three—accounting for 50 percent of total losses—can effectively be addressed with evidence-based order sets at the point of care:

• Missed opportunities for care;
• Preventable harm; and
• Unnecessary or duplicated of services

Rush-Copley was able to address all three of these areas and deploy an effective PHM strategy during the recent TB outbreak through use of ProVation Order Sets. It is a clear demonstration of the critical role point-of-care strategies play in addressing the deficiencies that exist in the healthcare system.

Diane Homan, M.D. is the Vice President of Quality and Patient Safety Officer with Rush-Copley Medical Center.