December 12: Today on TownHall Jake Lancaster, Chief Medical Information Officer at Baptist Memorial Health Care talks with Nancy Engeman, Quality Outcomes Coordinator at Golden Valley Memorial Healthcare. They discuss the demanding role of a Quality Outcomes Coordinator, involving the ultimate challenge of providing standard care for every patient despite variables such as experience levels of nurses and doctors or frequency of procedures. How does technology, particularly systems like surveillance, assist in standardizing workflow and better patient care? How might transitioning from traditional paper to digital processes transform healthcare? How does real-time monitoring of patient metrics allow for immediate interventions, advancing patient results beyond current nationwide standards in areas such as maternal care? Nancy also reflects on the challenges and final triumphs of change management during the implementation of surveillance.
Read more about Golden Valley’s success using MEDITECH’s Surveillance solution to reduce
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Today on This Week Health.
I call it when you peek under the covers and find out that three months ago you didn't do so well. What you really want to do is to move it right to the bedside and how can you affect change immediately at the time that the patient is experiencing it versus digging through a chart and abstracting it and then reporting it.
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Hey everybody, I'm Jake Lancaster, an internal medicine physician and the chief medical information officer for Baptist Memorial Healthcare based out of Memphis, Tennessee. And today I'm excited to be with Nancy Ingeman.
Did I say that correctly? That's
correct. Nancy, welcome to the program. Can you tell us a little bit about yourself and what you
Sure. I've been a nurse since 1990. I started in critical care and after 32 years, I've spent 25 years in some form of quality and performance improvement. I've gone across couple of different hospitals. One was a 700 bed hospital, and this current facility that I've been at for 18 years is a 50 bed hospital in rural America, south of Kansas City.
You've had a tremendous amount of experience, and we uh, Really am looking forward to diving into this conversation about quality and the systems that you use to support it. A lot of people don't know of what a quality director does and all the things they're responsible for. Can you tell us just a little bit about the role and what you've been doing over the years?
Well, I think that even people in healthcare aren't really sure what quality does. Some of the responsibilities that I've taken on is to. Assure that we can provide the standard of care consistently for every patient, every encounter, every nurse, and every provider, which is a pretty big bill to fill.
You think of your experience that you have brand new providers, brand new nurses, you have your experienced front, and you got to consider how can you make that equal. For a patient experience for every single encounter a patient has with healthcare moving into the technical phase and having computers and the power behind computers, we've really been able to roll a lot of quality measures into patient care through standardizing our workflow.
Yeah, so for a long time quality I guess was on paper and still is, you know, I work close with our quality director and there does seem to be a lot of manual abstraction and things like that. How have you all been using technology to simplify that process and streamline it?
Oh, my goodness. The manual process and the paper process was daunting.
You just literally had to memorize everything, and then if you had something that you didn't do very frequently, say you only did a procedure once every nine months, and you weren't, you've done it 25 times, but it's been nine months since you've done it. Having everything on paper is really difficult.
We have actually transitioned all of our policies and protocols electronically. And one of the things that we've been working on over the last six or seven years is implementing those protocols into our work list. And now since we surveillance, we have the ability to attach that protocol directly to an alert that goes to the nurse at the bedside, and they can see that protocol right there and verify that they're on the right path.
So going, moving from paper to an electronic process has been a huge win. Yeah,
tell me a little bit more about that program. So you said it was surveillance?
Tell me more. Yeah, so, surveillance, we've been using some form of electronic surveillance for well, we've been going on 12 years now, and so anytime that you have a specific response that you're looking for, say you're looking for a blood pressure parameter, and when the computer receives that value, then it will send us a notification, if you will, that a patient qualified, and that lets us know that it needs further review to evaluate that patient.
Surveillance is a lot to get everybody's head around until you've had any experience with it, but just knowing. That something's out there searching for an abnormal that needs me to take action on it is really what surveillance is all about. We've been able to use surveillance over the past 12 years to we started using it with infection prevention.
Our infection preventionist can see immediately. What type of organism needs to be reported to the state, reported to the provider we can look for if it's a specific organism and what kind of antibiotic they are on to help drive changes in care at the time of receiving data versus when a provider makes rounds the following day.
Or it's sitting on a desk. We've seen the paper process. Your alert is this piece of paper that I set on your desk. You were supposed to see it. And this way we have a couple of different ways that we can farm that data through surveillance. So it's a pretty powerful tool.
A lot of organizations wait to see, I guess, at the end of the quarter or end of the year when Medicare tells them how they did on certain surgical site infections or CLABSI's, CAUTI's, etc. It sounds like you're able to move that forward in time, so you're knowing in real time, hey, this is a risk, we need to intervene sooner.
Right, right. So, we've certainly been part of that process. And when you, I call it when you peek under the covers and find out that three months ago you didn't do so well. What you really want to do is to move it right to the bedside and how can you affect change immediately at the time that the patient is experiencing it versus digging through a chart and abstracting it and then reporting it.
So we've been able to move our measures to 100 percent compliant, if you will, meaning that every patient Who had that experience that needed that treatment that we can get that treatment started within the guideline of when you wanted it to occur. For instance, if a patient is a pregnant mom is having a high blood pressure issue, and you want to get treatment within an hour, we can actually start treatment within 📍 30 minutes.
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Wow. And so that's fantastic for the patient. Yeah,
There's been several news stories and reports about how poorly in the United States we do with maternal care. So tell us more about how you're using the Meditech surveillance program to focus on
that. So, we started working on those processes back about 10 years ago when Missouri had a hospital engagement network.
Where we worked on protocols, order sets but we never could get any lift off the ground to get it implemented every patient, every time until we got surveillance and even at that point. The nursing staff felt that it was going to be something that just took more away from them and didn't really comprehend the power that it could do for them.
And so a couple of years ago, Joint Commission made it a requirement to participate, and we got the green lights. Let's go ahead and build this. And so, so we did. We started with something that we call a newborn high risk. And it's identifying moms whose babies may be at higher risk for experiencing low blood sugars.
And so we built that profile and very quickly was very responsive. Previously, they wouldn't know whether they were supposed to monitor a patient for 12 hours or 24 hours. And immediately going live with surveillance, it was able to identify for them that this patient needed to be monitored for 12 or 24 hours.
And so when joint commission made it a requirement for, hospitals in the United States to address. Maternal issues of hemorrhage and high blood pressure. We were really able to move quickly because we had all the background completed and what we did was we put the protocol right there with the alert, so when the nurse keys in that the blood pressure was 160 over 110, it'll send them an alert, and then they can select different actions for how they report it, what their next step is going to be for treating that patient.
So, the previous surveillance that we had you had to actually tap into that surveillance. You had to stop what you were doing and sign on. Yeah. And with having surveillance as part of the medical record. We can do everything from right there while we're at the bedside. Use it as a resource to find out what our next steps are.
Our order set has allowed us to pre approve, if you will, a treatment plan. So a medication that you were going to want to consistently use for high blood pressure would be already on the medication administration record so that staff could just go to the record. And get it ready versus the 45, it's about a 45 minute to validate, verify, and go through all of the checks and prechecks to get it on a patient's MAR.
So, when the patient comes in, we load that into their record as this is possibly something they may need because they've had. experience with high blood pressure or in the clinic we've identified that they might be at risk for hemorrhage. And so those types of things are initiated on arrival when the patient comes in.
that, it sounds amazing. And you mentioned that, some of the nurses were a little apprehensive when you were discussing going live with this. How did you go forward with change management and get that executive buy in that you need for a program like this?
I got super lucky when we started in 2018 we were building Expanse and I was very excited about surveillance.
I kept talking to every leader I could find. About the power of what it could do for us, and we had a director in physical therapy that identified a gap in care for patients who had higher levels of pain when they came in for therapy, they weren't getting documentation that therapy was modified.
And so we built a profile for him, and he shared it with everybody, how quickly they went from being incredibly low compliance, like in the 20s, to being 90 percent to 100 percent compliant within 90 days. And literally in the one month of them just getting those notifications of, did you modify? Your treatment plan, you just saw this spread that just shot up into the air to where they were 90 to 100 percent compliant.
So that was something that we were able to utilize and share that they were able to share that it was a very simple process. Nice.
And so you've done some amazing work. You've, you've expanded this into many different areas of quality improvement. What's next for you?
wHat is next?
We are working on you know, anything that is low volume, high risk is a target for me. I scour news articles, if you will, of events that happen at other hospitals when A hospital accidentally gave the cronium instead of Versed to a patient. We immediately started working the process and identifying, could this happen here?
We have a challenge with a treatment protocol on electrolyte replacement for potassium and magnesium. And your redraw is either two hours, four hours, or six hours. And that's where we kind of get into the mud. Is different. The staff being able to differentiate when they need to check, recheck the lab, and so many things are automated that they just.
I just think that it's automatically happening, so that is one of the things that we are currently working on. We're working on some new things up in the birthing center for neonatal abstinence. billirubin checks and making sure that all of the things that need to be done get done timely for those patients.
So, birthing centers had so much fantastic results that they're now looking for more things to do. So they'll. Definitely be keeping us busy.
Well, that is, yeah, that is certainly true. Certainly true here as well. Well, Nancy, thank you so much for your time today. Sounds like you're doing some very exciting work.
And you have some great tools that you're able to use. And thank you again for everybody listening. And again next week.
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