STAGE 7 SPOTLIGHT John Muir Health: Decreasing CAUTIs by 42%
All around the world, healthcare providers have turned to the HIMSS Analytics Electronic Medical Records Adoption Model (EMRAM) for guidance as they modernize their health information technology landscape. Modern HIT systems, paired with effective and innovative use of those systems, have a proven impact on the quality of care and the overall cost of care delivery, and can help with improving hospital operational efficiency.
The benefits of the EMRAM can be unique and varied across individual healthcare systems. As an example of the transformative power of the EMRAM, let's dive into the Stage 7 validation process at John Muir Health.
Based in San Francisco, California, John Muir Health (JMH) is a not-for-profit health system comprised of three hospitals, an inpatient/outpatient behavioral health services facility, five major outpatient centers and a physician network. JMH provides a full range of medical services, including imaging services, neurosciences, orthopedics, trauma, pediatrics and more.
When JMH began its journey toward EMRAM Stage 7 validation, catheter-associated urinary tract infection (CAUTI) standardized infection ratio (SIR) rates were too high in one of their acute care, inpatient medical centers. CAUTI prevention processes had been in place for a few years, but compliance monitoring for these processes was done manually through a weekly audit process. This process involved a trained clinical observer, called a Foley Friend. The Foley Friend stood by while nurses inserted intermittent or indwelling Foley catheters, and documented compliance data in the form of a free text comment in an additional flowsheet row.
Using this data, nursing leaders spent time performing laborious weekly audits — but an after-the-fact audit couldn't inform in-the-moment coaching and actionable feedback to prevent a CAUTI from the start. The nurses at JMH knew that early detection, intervention and improved clinical outcomes could only come with the ability to monitor and document this process in real time.
The EMRAM Implementation
To address this challenge, JMH acute care medical centers underwent a number of significant changes to their practice processes and EPIC electronic medical record usage. Working alongside informatics specialists, nursing clinicians, EPIC user-groups and quality/operations department leaders, a workgroup was formed and tasked with assessing the current policies, practices and evidence-based procedures for CAUTI prevention.
An additional Foley Friend flowsheet was built to be aligned with specific policy language regarding clinical practice, and a real-time monitoring dashboard was set up for more immediate practice interventions when necessary. Other practice changes included:
- Revision and simplification of CAUTI insertion and maintenance processes
- Revision of bladder-scanning protocols post Foley catheter removal
- Enhancements to documentation processes to facilitate charting
- Standardizing use of reports in Epic for more targeted monitoring
- Automated updates for catheter patient transfers and care touch points
... and more. As the new and revised processes and practices were captured in EPIC clinical workflows, administrators gave consistent and unwavering support of the implementation. Technology-related issues and concerns were addressed prior to go-live.
The CAUTI initiative at JMH is a great example of how data, knowledge and cross-functional experience can come together to drive a great outcome. During the post-implementation quarter reporting period, the CAUTI SIR rate decreased to .80, outperforming the benchmark of 1.0. Overall, CAUTI occurrences decreased by 42 percent.
The new processes and EPIC build not only prevented CAUTIs and improved patient outcomes overall, but also led to significant cost avoidance. Because the average cost of one CAUTI during hospitalization is $758, JMH was able to save approximately $22,000 in 2017.
“Our team has considerable experience, having implemented and supported Epic for more than three years, including through a double upgrade," said Jon Russell, CIO of JMH. "This experience however underscored that our data-driven approach, aligned informatics team, clinical operations partnership and support, and well-timed communication will drive solid patient results.”
JMH is just one of many healthcare organizations who have experienced the benefits of the EMRAM validation process. Like the team at JMH, healthcare organizations can use the EMRAM as a roadmap to make strategic technology investments that support their overarching goals, and to help with improving hospital operational efficiency.