More than 600,000 Americans die of heart disease every year — one in every four deaths. As American Heart Month, in February, puts the national spotlight on this leading cause of death in the United States, essential hospitals are taking the lead to improve heart health through health information technology (IT).
Henry Ford Health System, in Detroit, set its sights on reducing one of the common causes of heart attack and stroke: venous thromboembolism (VTE), a blood clot that starts in the vein.
More than half of blood clots occurring after hospital discharge are linked to hospitalization or surgery. Research shows that 30 percent of patients who get blood clots in the hospital die within 30 days, and one in five have lifelong complications, according to Jack Jordan, director of performance excellence and quality at Henry Ford.
Hospital staff rely on clinical documentation to monitor quality, but existing measures have limitations. For example, an Agency for Healthcare Research and Quality patient safety indicator measures postoperative pulmonary embolism and deep vein thrombosis, focusing exclusively on surgical patients. Henry Ford staff wanted to reduce VTE incidences following hospital stays for all patients by expanding documentation to include nonsurgical discharges.
In late 2014, IT specialists, analysts, and clinicians developed a process to standardize preventive care through electronic health records (EHRs). An assessment tool, called the Padua score, calculates patients’ risk for blood clots and captures this risk in an EHR dashboard. The EHR dashboard also monitors whether patients receive anticoagulant medication, flags when patients have medical contraindications that might prevent them from taking the medicine, and tracks medication refusals and missed doses. Physicians and specialists receive a daily digest of case-specific data.
“You can help prompt someone to be thinking about avoiding a blood clot even though that’s not the primary reason someone’s here,” Jordan said. “Helping people reliably do those secondary kinds of issues they’re worried about in the hospital [is] one of the key kinds of strategies for quality that slip through the cracks.”
The real-time tracking system helps hospital staff stay ahead of quality measures and conduct root-cause analysis.
“You don’t have to wait for a bill to come back to know what was wrong with a patient in the hospital,” Jordan said. “The minute somebody puts a problem on the problem list, you can…categorize patients with that.”
Michelle Schreiber, MD, senior vice president and chief quality officer of Henry Ford Health System, said the initiative also focuses on educating nurses and patients to reduce missed doses of preventive treatment.
“We started examining the reasons why people weren’t getting their medications or they were actually getting blood clots, and one of the leading reasons—which really surprised us, quite honestly—is that patients were refusing their prophylactic medications,” Schreiber said. In response, the hospital developed an educational brochure for patients and switched to longer-lasting anticoagulant medication to reduce the number of shots patients needed.
The new protocols decreased avoidable missed or refused preventive care and quarterly VTE incidence by 50 percent annually. Henry Ford estimates the initiative saved $1.44 million in annual direct costs and up to $3 million in annual systemwide savings.
Henry Ford has expanded its health IT initiative to reduce catheter-associated urinary tract infections (CAUTI). The health system implemented EHR reminders to change catheters and order appropriate cultures, and trained clinicians to avoid giving unnecessary antibiotics. As a result, Henry Ford’s CAUTI rate decreased by 60 percent from 2015 to 2017 .
“Embedding this into the [EHR] really helps the workflow, helps embed this into something that becomes daily practice,” Schreiber says. “Everybody practices that way. You are always reminded of this.”
While sustaining this improvement over time might be difficult, Henry Ford’s leaders are up for the challenge.
“You always have to really keep up and continue re-educating, you have new people on staff, and I think that really is always the challenge,” Schreiber said.
The Healthcare Information and Management Systems Society (HIMSS) recognized Henry Ford with the 2017 HIMSS Enterprise Davies Award for its innovative use of health IT to improve patient outcomes.
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