Abstract 3272: University Hospitals Stroke System Program (UH-SSP): Leveraging a System-wide CPOE Rollout to Drive Compliance with Best Practices for Stroke
INTRODUCTIONThe “meaningful use” of electronic medical records requires major shifts in physician behavior, considerable technical support, and substantial financial commitment in an era of shrinking reimbursement. Successful initiatives are widely adopted, simple to use, and multitask in their ability to guide best practices and capture regulatory documentation.
HYPOTHESIS A system-wide computerized patient order entry (CPOE) rollout can be leveraged to encourage use of a Stroke Orderset and increase compliance with best practices for stroke across a hospital system.
METHODS The UH-SSP developed a Stroke Orderset embedded with GWTG quality measures and smart reminders for omission of best practices. Implementation was phased in at four Stroke Center hospitals between December 2009 and October 2010. The Stroke Orderset was selected for provider CPOE training. Data from each hospital on Ischemic Stroke / TIA discharges, usage of the Stroke Orderset and compliance with measure #6: Discharge on Statin was collected and reviewed by the Stroke Quality Committee.
RESULTS Stroke Orderset usage relative to total Ischemic Stroke/ TIA discharges significantly increased at all system hospitals from 15-50% in the first quarter to a high of 35-100% over the next three quarters and was consistently high at 97-100% at UH-Case, where a CPOE had been in place since 1998 and all suspected strokes are admitted to an inpatient Stroke service. Compliance with measure #6 substantially increased at each system hospital: UH-Bedford from 77% to 100%, UH-Geauga from 50% to 89%, UH-Richmond from 51% to 72% (p=0.02) and remained high at UH-Case (97-100%) which led to GWTG Gold Plus and Silver Plus awards at two hospitals. Compliance with measure #6 correlated with Stroke Orderset use at UH-Bedford and UH-Richmond (Pearson coefficients of 0.65 and 0.98 respectively).
CONCLUSIONS The use of a standard Stroke Orderset increases compliance with best practices for stroke care. A hospital system-wide CPOE rollout was an opportunity for leveraging EMR training of community physicians to educate them on GWTG quality measures for stroke and make rapid changes in their behavior. By encouraging consistent use of a standard Stroke Orderset, any subsequent revisions will continue to update caregivers on current best practices and reinforce optimum patient care.
- © 2012 by American Heart Association, Inc.