It’s a fact: Evidence-based medicine is improving the quality and consistency of clinical care. While uniformly applying clinical data to medical practice and carefully tracking metrics requires great effort, the rewards are even greater in terms of better patient outcomes, better use of resources and balancing of costs. Two leading cardiac care facilities show how it’s done in treating acute myocardial infarction and more.
Healthcare technology plays an important role in the cardiac care process; however, improving cardiac care hinges on multiple inputs. True improvements in clinical outcomes require systematic changes in order to standardize processes to ensure that all patients receive high-quality and consistent clinical care. Similarly, hospitals can minimize the possibility of human error by implementing redundancy strategies to ensure that all patients receive appropriate tests, procedures and follow-up.
Take for example the common scenario of acute myocardial infarction (AMI) detection. Physicians can vary in the marker level used to launch the AMI order set, resulting in variability or delays in treatment. A standard cutoff—one derived from evidence-based data—levels the playing field. Another common process prone to human error is administration of aspirin and beta blockers at admission. Appropriate administration of meds is linked to positive outcomes, but the full regimen requires a precisely timed mix of medication. A standard order set helps ensure compliance and boosts patient outcomes.
Such changes not only improve clinical care but also can boost the bottom line by eliminating duplicative and unnecessary tests. These types of strategies form the heart of evidence-based medicine, which seeks to more uniformly apply clinical data to medical practice.
Driving change in the mega-enterprise
Institutions around the country are turning to evidence-based medicine to improve cardiac care. Banner Health System in Phoenix, Ariz., is one of the nation’s largest and most complex healthcare systems. It comprises 20 hospitals across multiple states. Its mission is guided by a commitment to high-quality patient care, and each chief medical officer assumes principle responsibility for the quality of care in the “home” institution. In addition, the enterprise is focusing on four major quality initiatives: AMI, heart failure, surgical quality improvement and pneumonia and preventative health.
The system chose its quality initiatives for two reasons, says Mark Starling, MD, medical director of Banner Heart Hospital in Mesa, Ariz. The Centers for Medicare and Medicaid Services (CMS) requires hospitals to track these areas, and equally important, says Starling, patients have better outcomes if these metrics are met. For AMI patients, Banner Health System decided to focus on several key metrics including administration of aspirin and beta blockers at arrival and discharge. Greater compliance with these metrics correlates with lower AMI mortality, according to The Duke Clinical Research Institute.
The AMI team focused on designing both system-wide and site-specific processes to guarantee that Banner Health System provides high-quality care to AMI patients. For example, the initiative team developed a standardized order set to use throughout the hospital system when a patient presents to the ED with chest pain. The order set lays the groundwork for a consistent, reliable sequence of care. At the same time, it can be adapted to individual site needs. Equally important,it establishes a framework as Banner Health heads toward computerized physician order entry (CPOE) in the EMR for AMI cases.
The next initiative is an admission order set with a care mapping process. “Care mapping ensures that heart attack patients get every item they require—from diet to medications to assessments and lab tests,” says Starling. The health system built redundancy into the care mapping process, with each department checking on various steps in the process. If one department forgets to administer aspirin, the next player can handle the missing piece via the admission order set or cath lab documentation system.
The new processes have been in place only a few months, so the health system does not yet have hard data; however, in the second half of 2007, more than 95 percent of AMI patients received appropriate care at all 20 facilities.
Banner Health System also established processes to allow hospitals to learn from each other. For example, after one