was assembled to identify an appropriate solution to speed up and centralize the order-set development process, ensure that the latest evidence was attached to CDS and advance the practice of EBM. The obvious starting point was the ICU.
Advanced technology overcomes challenges Sibley initiated a six-month pilot in early 2011 wherein
paper-based order sets used in the ICU and joint-replacement program were converted to ProVation Order Sets, powered by UpToDate Decision Support. In addition to a robust project- management function that accelerates the development cycle, the electronic order-set solution features direct links to sup- porting medical evidence and an automated maintenance tool to ensure that the order sets stay current. Most importantly, the software’s interfaces allow for fast deployment into the hospital’s CPOE system. Though a fully automated interface with any system is impossible, order-set tools with customizable interfaces make it easier to upload approved order sets into the CPOE system with limited manual intervention.
A key element to the successful rollout and implementa- tion of the order-set technology was the identifi cation of physician champions to oversee the process. Due to physi- cian time constraints, as well as the need for consensus going forward, Sibley determined it would be impossible to have mass involvement. Thus, a limited committee structure was established to ensure that the program could move forward as smoothly as possible. Physician champions and subject- matter experts were identifi ed in the targeted clinical areas to facilitate this process.
Once rolled out, order sets successfully served as a crucial checklist in the ICU to make sure nothing was missed or overlooked. The department staff was also able to draw on the integrated evidence to implement more effi cient programs. For example, in Sibley’s prior ICU admission orders, a pre- printed order set existed that listed an option for “stress ulcer prophylaxis.” This created a situation where the majority of patients admitted to the ICU were placed on prophylaxis, often including patients at low risk for developing stress ulcers. This created higher costs for the hospital as patients were often continued on prophylaxis until discharge from the hospital. That order set was revised based on the template available within ProVation Order Sets and linked to evidence provided by UpToDate to support the change in prophylaxis orders. This changeover has created a more effective and cost-effi cient process.
As part of the ICU pilot, Sibley was also able to imple- ment a nutrition order set that did not previously exist. Prior to the availability of order sets, a nutrition consult had to be obtained before enteral nutrition could be initiated. Now, clinicians feel much more comfortable implementing nutri- tion support in a more timely fashion. UpToDate has been widely embraced, and the physician community has gained a great deal of confi dence in the
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evidence provided. Direct links to UpToDate are provided for much of the order-set content, allowing physicians to quickly and easily click through to the supporting evidence to see the rationale behind the order set. This is especially valuable when the order set represents a change in typical practice patterns.
The extent to which Sibley’s medical staff has embraced order sets and CPOE has far exceeded the initial expecta- tions. When a new process is carefully thought out and well executed, the physician community is much more likely to embrace its benefi ts going forward. For example, the hos- pital’s ICU admission order set ultimately went from one page to fi ve, but the end result has been the execution of more effi cient and effective patient care alongside improved workfl ows.
By leveraging advanced order-set technology coupled with evidence-based decision support in the ICU, Sibley has been able to standardize care on a high level. This suc- cessful effort positions the organization to raise the bar on patient quality and places it at the forefront of the national healthcare movement.
HMT EDITORIAL OPPORTUNITY
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