UK Healthcare: Reclaiming 1,000+ Hours Per Year With Optimized Scheduling

UK HealthCare Hospitalist Division was spending substantial and costly time building provider schedules. As errors became commonplace and shift change approval rates plummeted, provider workload (and stress) was increasing. The hospitalist group recognized the need to address their complex provider scheduling demands with a more advanced solution: Optimized Scheduling powered by Lightning Bolt.

Key Results:

  • 82% reduction in time spent managing schedules.
  • Increased approval rate of time-off requests.
  • Better work-life balance and provider utilization.

Bon Secours Mercy Health: Combating the Opioid Crisis With PerfectServe

Fourteen private, church, university, and VA-based treatment centers were connected to Bon Secours Mercy Health through special read-only EHR access and PerfectServe’s advanced clinical communication solution. Treatment centers built on-call schedules within PerfectServe’s CC&C platform, which used intelligent routing to ensure that ED staff received timely responses.

PerfectServe helped Bon Secours Mercy Health achieve rapid rehabilitation referral through accurate and immediate communication between the ED clinical team and community-based treatment facilities. The initiative was a success, with a 50% increase in the number of patients in need receiving treatment, 36% decrease in overdose ED visits, and 34% decrease in opioid-related deaths.

Key Results:

  • Serviced the Only 3 Counties in Ohio to Decrease Opioid-Related Overdose Deaths in 2018
  • 4-Minute Average Patient Acceptance Response by Community Treatment Centers
  • Reduced Treatment Enrollment Timeline From 4-6 weeks to Hours
  • Significantly Improved Patients’ Likelihood of Therapy

Advocate Aurora Health: Streamlining Patient Transfers With PerfectServe

Advocate Aurora Health implemented PerfectServe’s CC&C solution systemwide as a core component of the Patient Command Center (PCC), a centralized hub that fosters the safe management and timely placement of patients across 3,500 total beds. Since launching in March of 2019, Advocate Aurora Health’s PCC has decreased “Ready to Move to Assigned Bed” time by 29%, expanded average capacity by 164 additional patients per month, and reached 89.8% acceptance for direct admissions.

Key Results:

  • Improved Patient Experience
  • Prevented Patient Leakage
  • Strengthened Patient Outcomes
  • Protected Organizational Revenue

Southwest Cancer Center: Reducing Answering Service Errors and Variable Costs in Group Practices With PerfectServe

Southwest Cancer Center reduced variable expenses and communication errors by replacing their live medical answering service with PerfectServe’s automated Answering Service solution with fixed-rate pricing, no hidden fees, and 24/7 dynamic routing and escalation capabilities. The center saved more than $1,000 per month while boosting provider satisfaction and patient experience by replacing their live medical answering service with PerfectServe’s Answering Service solution.

Key Results:

  • Reduced Patient Complaints
  • Increased Provider Satisfaction
  • Improved Patient Experience
  • Decreased Variable Expenses

Ridgeview Rehab Specialties department reduces no-show rate by 12.6% with automated text messages to patients

Problem

For years, Ridgeview Rehab Specialties was challenged with its no-show rate. Like patients at other medical organizations many of Ridgeview’s patients would forget about their appointments or experience last-minute conflicts and never reschedule.

After recording 6,264 rehab no-shows in 2016, leaders at Ridgeview explored ways to improve patient outreach and overall engagement without adding work for its staff.

Ridgeview realized that it could use new technology — specifically text messaging — to keep patients engaged and have fewer no-shows.

Results

Over a two-year period, Ridgeview Rehab Specialties used PerfectServe’s patient and family communication platform to reduce its no-show rate by 12.6%.

Generating an average of $175 per visit, Ridgeview Rehab Specialties reduced no-show rates by 792 visits, and estimates its total revenue recovery from 2016 to 2018 to be $138,600.

Other Ridgeview facilities are also using PerfectServe’s patient and family communications platform to reduce no-show rates, enhance patient engagement, reduce readmissions, gauge patient satisfaction and gather feedback from patients. As an organization, Ridgeview sends more than 235,000 messages to more than 100,000 patients each year to help them become more involved in their care and take charge of their health.

Solutions

After comparing vendors, Ridgeview Rehab Specialties chose to implement PerfectServe’s patient and family communication platform to improve patient engagement and reduce the no-show rate.

With PerfectServe, Ridgeview Rehab Specialties’ clinicians can send valuable appointment information to their patients via SMS, including:

  • Automated pre-encounter visit reminders, including scheduling and location details
  • On-demand messaging to alert patients of unexpected scheduling changes
  • Automatic recall messaging to request that patients rebook missed appointments
  • Automated patient experience and satisfaction surveys after an appointment

From a patient’s perspective, the secure text messages from Ridgeview Rehab Specialties are written clearly and it’s easy to respond. Staff using Perfect- Serve’s secure, web-based platform find it simple and intuitive. Clinicians log in on their desktops and have instant access to real-time data, including overall patient engagement dashboards and individual text message responses.

Since most of Ridgeview’s provider-to-patient text messages are automated — including visit reminders, rebooking messages and patient satisfaction surveys — staff don’t have to manually call every patient to remind him/her about upcoming appointments or rescheduling. Instead, they can focus efforts on the small percentage of patients who haven’t responded to text messages.

Ridgeview administrators use PerfectServe to see a global view of how patients are engaging with text messages including participation, response and click-through rates.

Learn More About Patient Engagement

Park Nicollet drops readmission rate by 32% with provider-to-patient text messages

After struggling to hit its readmission rate goals, Park Nicollet Methodist Hospital adopted a text-first approach to patient outreach for follow-ups that reduced readmissions and nurse workloads.

Problem

Readmission rates are a key factor in quality ratings and reimbursement levels, but lowering them can be a challenge.

While following up with patients post-discharge is a proven method of reducing readmission rates, getting in touch with patients over the phone is difficult and time-consuming. Park Nicollet’s nurses were spending a significant amount of time calling patients and leaving messages, but readmission goals still weren’t being met.

Joan Sandstrom, VP of primary care at Park Nicollet, knew a solution had to exist that was more efficient, allowed them to reach more patients and did not add to the nursing workload.

Solution

After searching for other patient engagement methods, Sandstrom and her team partnered with PerfectServe to implement an automated, text-first patient follow-up solution at Park Nicollet Methodist Hospital.

PerfectServe built a series of customized follow-up text messages that assess each patient’s risk for readmission. Rather than having nurses call each patient individually, the PerfectServe solution delivers this simple series of HIPAA secure text messages to medical patients automatically.

The PerfectServe online dashboard collects and analyzes every patient’s responses — and nonresponses — and automatically flags patients for follow-up. Nurses receive these notifications, which are then used to inform their patient engagement strategy.

With PerfectServe, nurses get a global view of how their patients are doing and how they should prioritize patients who need additional attention to reduce the likelihood of readmittance.

Results

Park Nicollet’s results showed that patients who received and responded to text messages were 32% less likely to readmit than those who were solely

contacted by phone. (These results are risk-adjusted to account for the relative complexity of each patient’s conditions.)

Overall, 70% of questions sent via text message received a response from patients, reducing the number of phone calls from nurses by 25%. PerfectServe made it possible to segment Park Nicollet’s patient population into risk categories, highlighting the 17% of cases that needed immediate follow-up.

These findings were presented at Park Nicollet Methodist Hospital’s monthly Readmission Council, and as a result of their success with PerfectServe, Park Nicollet elected to expand the solution to other hospitals in the system.

Piedmont Healthcare: Standardizing Physician Practice Communications With PerfectServe

Piedmont Healthcare implemented PerfectServe’s Answering Service solution as a means to consolidate third-party answering services inherited during expansion. By implementing PerfectServe’s Answering Service solution as the standard for Piedmont Healthcare’s 550+ physician group practices, Piedmont was able to consolidate its vendor footprint and reduce variable expenses resulting in a 21% cost decrease.

Key Results:

  • Reduced Variable Expenses
  • Improved Clinical Efficiency
  • Increased Provider Satisfaction
  • Streamlined Patient Experience

PerfectServe helps hospital manage risk and improve patient safety

St. Rita’s Medical Center serves a 10-county area in northwestern Ohio and is the largest hospital in a 70-mile radius. Since 2005, the hospital has been using the PerfectServe clinical communications system to ensure that calls and messages route to the right clinicians at the right time, based on their workflow, call schedules, contact preferences and on the clinical situation.

Among St. Rita’s clinicians, PerfectServe processes about 180,000 clinical communications events annually. From these, PerfectServe provides analytics that enable detailed reporting about each contact event. This information gives St. Rita’s invaluable insights into its clinical communications processes and the outliers that increase risks.

Managing risk: Detailed documentation of communication events and timelines

PerfectServe eliminates the need for subjective interpretations when St. Rita’s must establish the steps and timeline of a communications process preceding an adverse event. Using PerfectServe Analytics, the hospital can quickly identify and drill into data that show:

  • The specific time each communication event was initiated
  • The originating department and number
  • The intended recipient
  • The actual recipient
  • The contact modality (e.g., cell phone, voice message, text message)
  • The length of the call
  • The time a specific call was answered and confirmation that the call was answered by a clinician (for calls that employ fail-safe contact processes)
  • The elapsed time to retrieve a voice message

The hospital uses these data when it investigates cases relating to quality or risk management. In fact, St. Rita’s decided to implement PerfectServe after it was unable to prove that one of its nurses had contacted a physician three times. The lack of documented evidence was a key factor in an unfavorable lawsuit that cost the hospital hundreds of thousands of dollars.

“PerfectServe is our ‘black box’ for communications that lets us piece together exactly what happened and when,” said Dr. Herbert Schumm, St. Rita’s Vice President of Medical Affairs. “Also, our physicians have become conscientious about being responsive, in part because they are aware that we automatically document the communications process.”

Safeguarding patients: Legibility of physician orders

At most hospitals, including St. Rita’s, the vast majority of physician orders are still written by hand. A recent report found that only 14 percent of all U.S. hospitals are entering at least 10 percent of orders electronically, which is the level of computerized physician order entry (CPOE) required to reach the federal government’s proposed standard for Stage 1 of meaningful use. The legibility of handwritten orders can be a problem that is more pervasive, and more of a threat to patient safety, than most hospitals realize.

In an article in Trustee® magazine,* an executive from The Joint Commission notes that his agency “almost always finds instances where handwriting is of poor quality.” According to the Agency for Healthcare Research and Quality, poor penmanship is responsible for an estimated 6 percent of all hospital medication errors.

To address this issue, St. Rita’s used PerfectServe to document and measure incidents of illegible handwriting. For defined periods of time, PerfectServe prompted callers to indicate when they were calling to clarify an illegible order.

The system captured data on where the order was received as well as who wrote it. PerfectServe compiled this information into reports for the Patient Safety Steering Committee at St. Rita’s.

“We sat down with about four or five doctors and showed them the number of calls that were made to clarify their orders,” said Dr. Schumm. “We also reminded them to use preprinted order sets whenever possible.”

The analysis showed that during the first three months of the study, an average of more than 80 calls per week were made to clarify orders. After discussion with some of the doctors, subsequent analyses indicated the average was 53, a drop of more than 40 percent.

improve patient safety

Improving clinical communications: Physicians’ responsiveness

According to The Joint Commission, communications breakdown is the single greatest contributing factor to sentinel events and delays in care in U.S. hospitals. St. Rita’s uses PerfectServe to track a key source for such breakdowns (i.e., physicians who do not respond to calls).

Of the hospital’s approximately 15,000 monthly communication events processed by PerfectServe, about 15 to 25 are directed to the PerfectServe Help Center to report a problem with a physician not responding. Dr. Schumm and the patient safety team use these reports as a way to open a constructive dialogue with physicians whose names repeatedly appear on this list.

“It really helps to have such clear, objective evidence for the physicians,” said Dr. Schumm. “Most of the time, showing them the reports is enough to prevent future incidents.”

Since PerfectServe collects communications process information automatically, nurses do not have to “tattle” on doctors who do not always respond in a timely manner. This not only relieves nurses of an uncomfortable task, but also enables St. Rita’s to avoid adversarial situations that can undermine nurse-physician relationships.

*Glabman, Maureen. “Death by Handwriting,” Trustee®, October 2005.

Addressing clinical communications security with PerfectServe

Healthcare leaders are increasingly concerned about the security of clinical communications in their organizations. The enhanced HIPAA enforcement environment, a number of well-publicized breaches and settlements and a simultaneous increase in the use of asynchronous electronic communication in the clinical environment — specifically text messaging — have made the issue top-of-mind for many leaders. They are concerned about the potential dangers of the transmission of protected health information (PHI) without adequate safeguards; the risk of privacy and security breaches that may result in adverse legal and financial consequences; and the loss of patient trust and reputation in the marketplace.

The recent uptick in the use of text messaging for clinical communications has resulted in a greater focus on the security of text messages sent via mobile devices. While secure text messaging is an important aspect of clinical communications security, simply addressing the security of text messaging leaves organizations vulnerable to breaches in other modes of communication, such as voice messages and texts sent from mobile carrier websites, Web-based paging applications, call centers, answering services and hospital switchboards.

PerfectServe is a communications system that stores data on a secure server, rather than on individual devices, thus maintaining the security of messages sent via the system, no matter which mode of communication is used. This success story describes how two healthcare organizations have implemented PerfectServe to address their need for a secure, comprehensive communications system.

St. John Providence Health System

According to Mike Burke, HIPAA privacy officer for the health system, the need to address the security of clinical communications recently became increasingly clear. “It became apparent over the past two years that more physicians wanted to communicate with other caregivers by electronic means,” he says. Physicians were finding the communications process inefficient and cumbersome when they needed to contact another physician after a consultation or after test results were posted to the electronic medical record — for example, when a consultant wanted to report their findings quickly to a primary care physician. According to Burke, “The physicians were specifically asking about text messaging from their mobile phones.”

A loss highlights security needs

In 2010, the health system experienced the loss of a portable device. Since the loss, the organization has solidified its security processes, including the training of physicians and other staff about the need to ensure that PHI is communicated in an encrypted manner across secure networks. Because of this attention, physicians were cognizant of the security requirements but were struggling to communicate clinical information in a manner that was both secure and efficient. “Our physicians were aware of the need to send encrypted messages and were looking for a way to do this safely.”

The organization had implemented PerfectServe in 2007 to facilitate communication between the system’s staff and individual physicians. In September 2013, the health system added a PerfectServe module to ensure secure direct communication between physicians. The calling physician can access PerfectServe via a smartphone or by dialing a toll-free number, which allows him or her to bypass answering services, front office staff and switchboards to quickly contact colleagues for real-time discussions of patient care issues. If the receiving physician is unavailable, the calling physician can leave a secure, HIPAA-compliant voice message, which the recipient will receive immediately or at a predefined future time.

According to Burke, the implementation process went smoothly: “Once the physicians realized how easy it was to use PerfectServe, they began signing up to access the application. To date, about 1,000 physicians have signed on for the voluntary service. Adoption at all five hospitals has been more rapid than expected. Physician leaders at our hospitals have been happy with PerfectServe and have been really helpful in getting the message out to other physicians.”

Reduced frustration and a market advantage

Since implementation of PerfectServe, Burke has seen a reduction in the frustration level of physicians regarding clinical communication. He has also found that implementation has reduced a major area of personal concern for him. “My goal is to make patient information as secure as possible. What keeps me up at night is portable devices — they are prevalent, and it’s really difficult to make sure that all devices on our campus are secure. PerfectServe helps address this worry.”

Burke also believes that implementing PerfectServe has provided the organization with a market advantage. “We want to make practicing at our organization as easy as possible. Having a common communication system between all five of our hospitals makes it more convenient for physicians to care for their patients at the hospitals within our organization.”

KishHealth System

KishHealth System is a community-owned health system in the DeKalb, Illinois area that includes 98-bed Kishwaukee Hospital, an acute care facility, and 25-bed Valley West Hospital, a critical access hospital. In addition, the health system provides hospice, home health, behavioral health and cancer care services and serves the local community with almost 39,000 ED visits and about 8,300 admissions each year.

An inefficient system for communicating patient-specific information

According to Michael Kulisz, Jr., DO,chief medical officer of the health system, physicians were finding it difficult to efficiently and securely communicate patient-related information. For example, when a physician requested a consult from a specialist via the computerized physician order entry (CPOE) system, he or she might also text the consultant with a specific question. In order to comply with HIPAA privacy regulations, however, both physicians had to exclude specific patient information. This process, and any follow-up discussions after the consultation, often required one or more telephone calls to communicate patient-specific information — which frequently resulted in callbacks and phone tag. In addition to the lack of direct information exchange, the process was frustrating for physicians and slowed patient flow through the hospital. Health system leaders realized that the organization needed a platform for securely communicating PHI between physicians.

In June 2013, the health system implemented PerfectServe at both hospitals. According to Kulisz, the implementation process was relatively painless. “There is a learning curve, but once physicians are trained, they really like the system. Uptake and use have been more rapid than we had expected.”

A secure platform plusa streamlined process for direct conversations

In addition to providing a secure platform for clinical communications that includes PHI, PerfectServe has decreased the number of calls required by a physician trying to track down a colleague for a direct conversation. Utilization has grown over time as a greater number of physicians exchange more specific information than they could communicate safely on an unsecure network. Kulisz believes that having a secure platform is an essential ingredient for success. “With so many devices and modes of communicating, it’s easy to misstep. It’s important to have a strong information structure to alleviate that risk.”

Conclusion

Compliance with HIPAA privacy and security regulations has become a priority for healthcare organizations. The use of text messaging highlights the importance of a secure platform for all modes of clinical communications.

St. John Providence Health System in Detroit and KishHealth System in DeKalb have implemented PerfectServe to successfully streamline communication between physicians and ensure a secure environment for the efficient exchange of PHI and other clinical information.

Rapid team notification accelerates treatment at St. John Hospital

Stroke occurs frequently in the United States, with almost 800,000 people suffering a new or repeat stroke each year. It is a common cause of death in this country and a major cause of disability.

Timely treatment of acute ischemic stroke has been shown to significantly reduce disability and mortality.

In-hospital mortality was significantly lower among acute stroke patients who were treated with intravenous tissue plasminogen activator (tPA) within 60 minutes of ED arrival, compared with those who were treated after more than 60 minutes.

A recent study found no benefit to tPA when administered 4.5 hours or more after symptom onset; beyond this time point, the risks associated with the therapy may outweigh the potential benefits.

Current treatment recommendations emphasize the need for rapid evaluation and treatment of patients presenting with symptoms of acute stroke.
Joint American Heart Association/American Stroke Association guidelines call for interpretation of the CT scan within 45 minutes of ED arrival and treatment initiation within 60 minutes.

Few organizations are currently able to meet these challenging goals. To assist in achieving them, in 2000 the Brain Attack Coalition recommended the development of primary stroke centers to deliver standardized acute stroke care.

As of January 2011, there are more than 800 certified primary stroke centers across the country. (7) Experts have identified key elements of these focused treatment centers that are associated with improved outcomes.

These elements include certification by an independent entity and identification of an acute stroke team that can be mobilized to the bedside within 15 minutes of patient presentation.

However, operationalizing a coordinated rapid team response on a 24/7/365 basis can be a daunting administrative task and a significant barrier to providing timely acute stroke treatment.

Staff at St. John Hospital & Medical Center (SJHMC) have built a reliable process for rapidly evaluating and treating patients with acute stroke — and have seen their door-to-treatment times decline steeply and the number of patients treated with tPA increase substantially. Single-call notification of the acute stroke team with PerfectServe is central to this process.

Closing the gaps in acute stroke care

A member of the St. John Providence Health System, SJHMC is a 772-bed acute care hospital located in Detroit.

Known for its centers of excellence in neurosciences, cardiology, oncology and several other clinical areas, the hospital was in the process of preparing for The Joint Commission certification as a primary stroke center in 2009.

Carrie Stover, MSN, NP-C, director of neuroscience for the St. John Providence Health System, was charged with reconfiguring the program to meet certification standards.

Along with a multidisciplinary team of physicians and other staff from neurology, the ED and neurosurgery, Stover identified single-call team notification as an important priority.

“We were looking for a mechanism to contact both the neurologist and the neuroendovascular physician at the same time. We realized that PerfectServe — which we were in the process of setting up for all providers — would let us alert more than one person at a time, provide a backup, and track calls.”

According to Stover, there were a number of shortcomings in the acute stroke treatment process prior to the overhaul.

“We had no system for escalation or backup if the neurologist didn’t call back quickly. We had to update the on-call list in the ED continually. The neurologists couldn’t easily tell if an incoming call was routine or related to a stroke. We couldn’t track calls. And we didn’t have a mechanism for easily tracking patients who were evaluated for acute stroke but discharged with a different diagnosis.”

Paul A. Cullis, MD, chiefof neurology and director of the stroke program at the hospital, recalls that identifying the correct physician to contact was a major issue.

“The ED staff never knew who was on call. The schedule wouldn’t get disseminated properly or got lost. A few times, the wrong physician was contacted because the staff was looking at the schedule for the correct month but from a previous year. Nobody knew who to contact, when, how, why and where. Sometimes a particular neurology group might be assigned to take stroke calls, but until you called their answering service, waited on hold and finally spoke with someone, you wouldn’t know who was on call that day. It was a major bottleneck.”

According to Robert B. Dunne, MD, vice chief of the emergency department, the lack of an automated escalation system for callbacks added extra work for the ED physician.

“We had written policies on escalation, but they were all driven by physicians in the ED. I might become busy, then remember that the neurologist I paged 25 minutes ago hadn’t called back. The clerk would try him again and then the next neurologist on the list. A busy ED physician shouldn’t have to remember that.”

Dunne also points to challenges with collecting and extracting data regarding calls and call times, difficulty altering the call schedule (a task requiring 5 to 10 phone calls to inform others of the change), and delays in treatment initiation due to a lack of timely communication. He also saw a great deal of variability in the timeliness of treatment.

“If the ED physician was very motivated and the ED wasn’t too busy, he or she could make the calls, set up the CT scan and speak with the radiologist. But the ED physician had to create the protocol on the fly every time. A problem in any one of those steps could cause a delay.”

Launching a team-based approach

The planning group at St. John Hospital listed several priorities for the future treatment program: a dedicated neurologist on call for acute stroke, integration with the interventional group and the radiology department and a simple team communication system that would be consistent 24/7, yet easily updated by users.

The group chose PerfectServe because of its successful use in other clinical areas within the medical center.

After getting commitment from the neurology groups regarding a call system for acute stroke and achieving buy-in from primary care physicians that the designated on-call neurologist would be contacted for acute stroke patients, the group launched the treatment program, which was dubbed “Code Stroke.”

The group initiated a weekly meeting to review data and identify bottlenecks in the system. Over time, they honed the process into a highly efficient system.

Implementing a standardized process

Acute stroke treatment is now a standardized process, based on reliable, rapid team notification.

The ED staff makes a single call to PerfectServe; the on-call schedules are automatically analyzed and the appropriate team members are identified.

The entire acute stroke care team is contacted simultaneously based on the individual preferences of team members and the specific rules established for the team.

Because team members are immediately aware of the reason for the call, they respond quickly. If needed, repeat call backs and escalation occur automatically.

Users can easily change the call schedule via phone, Web and mobile apps. Changes are reflected in real time.

Moreover, the new process eliminated the need for ED staff to refer to printed schedules because the schedules are built into the PerfectServe platform, and messages route automatically to the appropriate clinician.

Finally, team members can easily track and analyze call times and patient data. Using these data, the team can identify and address areas of concern to drive continuous process improvement.

Results

By deploying the new process, the team was able to reduce on-call neurologist response time by 90 percent, from 22 to 2 minutes.

before after perfectserve

Using the revised process, SJHMC staff administered tPA to three times more patients with acute ischemic stroke in 2010 compared to 2009.

ischemic stroke improvements

The process also reduced the door-to-CT completion time by 41 percent, from 78 to 46 minutes.

door-to-CT completion time

During this study period, the number of patients with acute stroke remained relatively flat.

number of acute stroke patients

Reaping the rewards of rapid team notification

With the new process in place, the St. John Hospital team has achieved a significant reduction in the time to treatment for acute stroke patients.

Neurologists on call for acute stroke respond to the ED call in an average of two minutes, down from an average of 22 minutes.

“Because the notification is immediate and because the neurologist knows the call is coming from the ED, they respond quickly. I rarely get backup calls anymore because the notification system works so well,” says Cullis.

The door-to-CT completion time averaged 78 minutes before the notification system was implemented. That number is now 46 minutes.

Although the number of patients diagnosed with acute ischemic stroke has remained stable, the number who receive tPA has increased substantially, according to Dunne.

“We were below the national average before, and now we’re way above average — and getting better all the time.”

Using call tracking to improve data collection

The team’s ability to collect data regarding patients evaluated for acute stroke also improved.

According to Stover, the process increased by 25 percent the number of patients with stroke-like symptoms who are tracked in the system.

“We can now easily identify patients who presented with symptoms of stroke but were discharged with a different diagnosis. Before, we could only easily track patients with a discharge diagnosis of stroke. It gives us a much bigger pool from which to identify trends, barriers and opportunities to improve.”

According to Dunne, the ability to capture data is important to The Joint Commission stroke certification process.

“The Joint Commission wants to see that we’ve collected 95 percent or more of the data, not 70 percent. Using PerfectServe we’re able to get these numbers in an automated fashion in very close to real time.”

The findings of the St. John Hospital team were presented at the Society of Academic Emergency Medicine’s national meeting in Boston in June 2011 and at the Michigan State Medical Society Quality Symposium in Novi, Michigan in October 2011.

The team plans to continue identifying and improving delays in tPA administration time, develop a database for objective outcomes analysis of National Institutes of Health stroke scores at admission and discharge and improve outreach to community hospitals for patients needing interventional treatment via telemedicine.

Dunne sees the benefits of the new program for both patients and physicians. “The notification system has made the management of stroke easier for the ED doctor, which is great for patients. It reduces the frustrations of the ED physician and frees him or her up to care for patients. We have a really busy and fast-growing emergency department, so it’s important that we have a system that works well forus.”

Stover agrees. “PerfectServe really helped us to affect a practice change, making treatment better and safer for patients and easier for ED staff.”

Cullis recalls the importance of rapid treatment for a particular patient. “We had a patient who came in recently with a lack of blood supply to his brain stem — a very important part of the brain. He was treated quickly and effectively and is going to walk out of the hospital almost completely normal because of the speed of the treatment.”

He credits the PerfectServe notification system as being an essential factor in the team’s ability to treat patients quickly.

“The slogan we like to use in treating stroke is ‘time is brain.’ Cells are dying at a prodigious rate for every minute that you don’t do something, and it’s important to intervene quickly. PerfectServe helps us do that and has become an important part of our acute stroke treatment program.”

References

  1. Lloyd-Jones D, Adams RJ, Brown TM, Carnethon M, Dai S, De Simone G, et al. Executive summary: heart disease and stroke statistics—2010 update: a report from the American Heart Association. Circulation. 2010;121:948–954.
  2. Kochanek K, Xu J, Murphy SL, Minino AM, Kung H-C. Deaths: Preliminary data for 2009. National Vital Statistics Report. 2011;59:1–51.
  3. Fonarow GC, Smith EE, Saver JL, Reeves MJ, Bhatt DL, Grau-Sepulveda MV,et Timeliness of tissue-type plasminogen activator therapy in acute ischemic stroke: patient characteristics, hospital factors, and outcomes associated with door-to-needle times within 60 minutes.Circulation.