Analytics A Decision Making Tool for Hospitals. Rick Skinner Chief Information and Technology Officer University of Virginia Health System

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1 Analytics A Decision Making Tool for Hospitals Rick Skinner Chief Information and Technology Officer University of Virginia Health System

2 Academic medical center, ter.ary care facility Located in Charlo5esville, Virginia 550 beds divided into: Adult hospital Children s hospital Rehabilita.on hospital Transi.onal care hospital 1500 physician faculty prac.ce School of Medicine School of Nursing 80+ remote clinics/sites

3 So many reports, so li0le 1me (and so li0le good data)

4 For clinical quality reporting alone: 483 clinical quality metrics reported anywhere from daily to quarterly, most reported in at least two different versions (regulatory and operational) to more than one regulatory body Add to that: Financial Human Resources Patient experience Supply chain etc. And to that: School of Medicine University Physicians Group School of Nursing etc. And we haven t even talked about Analytics yet!

5 The Data Improvement Cycle THE CAUTI example We want to improve our catheter associated UTI performance But wait, the performance informa.on we have gets reported back to us with a 90+ day lag.me Okay, let s do our own repor.ng, aver all we have an EMR But wait, we insert Foley catheters oven.mes without an order and/or documenta.on can be in many different places/forms in the chart Hmmm. We ll have to come up with standard documenta.on and retrain everyone to enter it the same way. Okay, now we know who has a Foley, and whether it has been in for more than 4 days, what next? We know daily bathing with Chlorhexidine soap reduces incidence of UTI, so let s develop a protocol requiring that, and also design the documenta.on to automa.cally let us know if it s been done. Lets also fire a BPA if the Foley is in more than 4 days. Wow, an 18% reduc.on in CAUTI in 3 months! Now only 482 indicators to go

6 The EMR is cri1cal The Sepsis BPA - an Epic alert Early iden.fica.on and interven.on in Sepsis pa.ents can be aided by Epic alerts and the MET team. UVA has developed an Epic- based interven.on to ensure the iden.fica.on and.mely treatment of sep.c pa.ents. The alert will help you to: provide early goal directed therapy within the 1 st hour complete the evidence- based Sepsis Resuscita.on Bundle within 6 hours On all adult Acute Care units, a red BPA (Best Prac.ce Advisory) fires when a pa.ent meets all 4 criteria for Systemic Inflammatory Response Syndrome (SIRS) Temp <= 36 or >=38.3 (in past 24 hours) HR > 90 (most recent) Respiratory rate > 20 (most recent) or PaCO2<32 (most recent in last 24 hours) WBC > 12k or < 4k or Bands > 10% (most recent in last 24 hours) The BPA fires for any RN, PCA, PT/OT, Pharmacist or LIP who opens the paaent s chart, aler.ng him/ her that the pa.ent is at risk for Sepsis Sepsis BPA - RN 6 of 16

7 Responding to the Sepsis BPA Pa.ents for whom the BPA fires are at risk for Sepsis and early interven.on must be started right away Immediate ac.on must be taken: Nurses receiving the BPA are directed to call MET to the bedside immediately LIPs should open the Sepsis Order Set directly from the BPA, to begin treatment LIPs should also call the MET team for help with early intervention items The MET team will respond, contact the primary team and bedside RN and begin a Sepsis alert if indicated Treatment of poten.ally sep.c pa.ents will be administered in an immediate and standardized way; comparable to calling a code REMINDER: this may occur for any pa.ent, at any.me- be prepared for the MET team to show up at your pa.ent s bedside and begin the Sepsis Alert at any.me! Sepsis BPA - RN 7 of 16

8 The RN Sepsis BPA: Sepsis BPA - RN 8 of 16

9 Not just sta1s1cs but why

10 And it gets complicated quickly! 100% 90% 80% 70% 60% 50% 40% 30% 20% 10% 0% Indwelling Catheter Point Prevalence Survey- Acute & CriAcal Care Catheter secured to body No dependent loops in drainage tubing Drainage tubing secured Drainage bag off floor Urine bag less than 2/3 full Documenta.on: Nursing assessment of need discussion w/ LIP documented every shiv? Documenta.on: Daily care with 2% CHG bag bath wipes provided q24? Documenta.on: Best prac.ces for maintenance care every shiv? Order review: 2% CHG ordered for pa.ent on MAR? Q Acute (22) Q Cri.cal (38) Q Acute (29) Q Cri.cal (36) Q Acute (32) Q Cri.cal (40)

11 And finally, Popula1on Health Culpeper Charlo5esville

12 Cost and Quality % of total 100% 80% 60% 40% 20% 0% Highest- Cost PaAents: UAlizaAon ProporAons Cost ED IP LOS visits stays Top 10% Top 5% Top 1% 10/12 09/13 ACO As % of MC volume In pa.ent 4,062 13% Out pa.ent 132,840 18%

13 Ques.ons?