For the last two and a half years, Texas Health Resources (THR), an integrated delivery system in North Texas, has been focusing on “hardwiring” evidence-based best practices into the processes of all 14 of its hospitals. At HIMSS17 in Orlando next week, THR officials will present lessons learned from their “Reliable Care Blueprinting” effort. In this HIMSS preview, Healthcare Informatics spoke with Joni Padden, nursing informatics specialist, about her upcoming Feb. 20 presentation with Ferdinand Velasco, M.D., senior vice president and chief health information officer.
THR developed Reliable Care Blueprinting as it sought to improve care processes such as handling sepsis, Padden said. “It takes a given clinical process and looks for an evidence base and ways to hardwire the parts of that process that can be hardwired,” Padden said, “so that for every patient every time and at every facility we are always doing the right thing.”
The 14 hospitals have had internal quality staff working on projects, she noted, but previously there was not a structural way to take best practices, either from its own facilities or from the evidence in literature, and apply them across the system. “We also wanted to find a way to make this cost-efficient and cost-effective,” she said.
The Reliable Care Blueprinting process first involves a design phase. The design teams are multidisciplinary and include physicians, front-line nursing staff, and pharmacists — everybody in the process is represented on the design team. After the deployment, there is a sustainment phase. “We have learned that once you have deployed something, often you have to go back and make adjustments. For sepsis, we might have new guidelines come out,” she said.
THR uses tiered dashboards to track progress on metrics. “We have process measures to make sure the process is working as intended,” Padden explained, “but we also have outcome measures that we are looking at. You have to make sure those are lining up.”
Padden said THR learned early on that it had to have an informaticist on the design teams. “With the EHR, we want to make sure we support the clinical practice these teams are designing and that we will be able to provide the different metrics they are looking at,” she added. So the design is done in tandem with the IT analyst work.
“We don’t want the tail to wag the dog — we don’t want the EHR to drive what the teams are doing, but we do want to make sure what the teams are doing the EHR can support,” she said.
Padden noted that THR is already seeing impressive gains in some outcome measures. When its clinicians use the sepsis module and order set, THR is seeing a 4 percent reduction in sepsis mortality. When its clinicians use the catheter-associated urinary tract infection (CAUTI) workflow, it is seeing a greater than 15 percent reduction in CAUTI rates.
She stressed that the transformation work is not easy. “This is a disruption to the staff. We are taking them out of their old way of doing things. We try very hard to make it easy for them to do, but any change is difficult at the beginning. We do a lot of work on training, support and education as these modules go live.”
Padden said she is excited about the Reliable Care Blueprinting program. “The impact we have managed to have is refreshing. I come from a background in critical care, where research would normally take 17 years to get from evidence to the bedside. We have had evidence come out in the last year that we are already getting to the bedside and seeing it improve patient care.”