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By Sandra Marshall, RN, MSN, CCM, CPHRM
Senior Vice President, Organizational Effectiveness and
Clinical Outcomes
Covenant Health
Employing Innovative Solutions
Running an efficient, cost-effective healthcare enterprise in today's demanding environment is a constant challenge. Changing reimbursement rules for preventable readmissions and hospital-acquired conditions, as well as ever-escalating costs, make it more important than ever to improve clinical and operational performance, while delivering safe care that protects the bottom line.
At Covenant Health – East Tennessee's leading healthcare provider – we tackle these challenges daily. Our acute-care hospitals, outpatient clinics, and rehabilitation, cancer and homecare services are known for excellence, quality and value. But we can't afford to be complacent.
Six years ago, we turned to an integrated suite of technology solutions to help us fine-tune our processes and achieve sustainable gains. Here are some of the innovative ways we applied the technology to make it work for us.
Superior Case Management
One of our most unique achievements is improved case management functionality. Paper-based processes are now automated, including patient clinical reviews, payor information, documenting and tracking claims, workflow management and key departmental metrics. McKesson's Horizon Clinicals® integrated technology enables our case managers to automate all processes from admission through discharge. Eliminating redundant data entry and similar manual tasks has reduced the need for administrative support.
Our discharge planning process is much simpler and more efficient. We are able to release comprehensive, real-time patient information to home healthcare agencies and nursing facilities using McKesson's physician portal. With just the click of a mouse, our case managers can now do in seconds what used to take hours of printing, copying and faxing. As a result, patients are placed more quickly in the right setting.
Continuous Prevention Mode
Managing patients to the appropriate level of care in the appropriate time frame with appropriate documentation has yielded big dividends for us. We've significantly reduced hospital-acquired infections, never events, adverse drug events (ADEs) and length of stay (LOS). Care is safer because our clinicians focus on common points of treatment failure and work to prevent them in the first place.
For example, we use the alerts solution to embed evidence-based nursing practice tools such as the Braden Scale to predict pressure ulcer risk and the Hendrich II Model to identify patients at risk for falls. Nurses know which patients are vulnerable and go into prevention mode. For every case of ventilator-acquired pneumonia or decubitus ulcer we avoid, it's money saved to the bottom line.
Improved Documentation and Communication
Our clinical analytics tools aggregate data from multiple sources and transform it into actionable information. This has greatly improved clinical documentation. Case managers can view a comprehensive patient record and quickly see if updates are needed for proper reimbursement. Just this year, we saved more than $679,000 as part of our documentation improvement initiative.
The ability to view everything at once is key: One page tells us all we need to know about the patient. This enhances communication among team members, which is essential for fostering a culture of patient safety. For example, if a physician is called in the middle of the night, the nurse can quickly relay the patient history and get what's needed. In addition, linking the physician portal to the case manager's or the staff nurse's SBAR (Situation-Background-Assessment-Recommendation) gives physicians real-time vital signs and other critical information to manage their patients for that day.
Safer Patients
By using the appropriate tools and managing patients in a more effective manner, we have dramatically reduced our LOS from 7 days to 5.4 days in just one year. This is a huge improvement, which saves us $500 per patient per day and reaps big safety gains.
Our medication processes are safer too. Our bar-code medication administration solution has reduced ADEs to just 0.6 per 1,000 days, significantly below the Institute for Healthcare Improvement's benchmark of five per 1,000 days. Finding "near misses" via this solution has assisted us in implementing process improvements to prevent medication errors from reaching the patient.
Information technology has produced impressive gains in quality, efficiency and safety at Covenant Health. Our proactive, patient-centric approach and innovative delivery methods help us sustain these gains and support our mission to serve the community by improving quality of life through better health.
As Senior Vice President of Organizational Effectiveness and Clinical Outcomes for Covenant Health, Sandra Marshall's responsibilities include clinical quality, patient safety, physician credentialing, Investigational Review Board activities and case management. She also serves as its Chief Quality and Patient Safety Officer. Sandra has been a registered nurse for more than 25 years with the last 14 focused on improving clinical quality of care. She is a certified case manager and holds the distinction of being one of the first to be a certified professional in healthcare risk management. Sandra is a member of the American Organization of Nurse Executives and has served as the local chair of the Tennessee Organization of Nurse Executives of East Tennessee. She is a member of the American Society of Healthcare Risk Managers and the Case Management Society of America. She also serves on the Tennessee Hospital Association Quality Council.
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