2014 HIMSS Davies Enterprise Award of Excellence recipient St. Clair Hospital, an independent, 328-bed acute care facility that provides advanced, high quality health care to more than 500,000 residents of southwestern Pennsylvania, realized a broad range of significant benefits through the use of information technology while serving a patient population that includes the largest ratio of Medicare patients in the United States.
Davies Clinical Value case study for St. Clair Hospital demonstrating how St. Clair used Health IT to reduce hospital acquired C. diff infections, improve inpatient care for diabetic patients and increase the number of at risk patients that received pneumonia vaccinations.
Through better use of the integrated EHR, Patient Accounting and Scheduling systems, the Hospital was able to generate incremental net revenue improvements over each prior year, through advancements in recovery of underpayments, increases in collections, and reduced denials. Due to the incremental nature of the gains, the overall cumulative benefit from the FY07 – FY14 period is $64M. This also increased operating margins from 4% to 6%, while generating a hard ROI of $89,000000 in 7 years.
St. Clair hospital used IT improvement efforts designed to support for patient registration process changes, the implementation of the ED Status Board and associated analytics, CPOE, electronic documentation, and an electronic bed management system. In the first year after the system changes were implemented, a reduction of waiting room times from 49 minutes to 4 minutes was achieved. In that first year St. Clair's emergency department saw a decrease in the time to see a physician from 76 minutes to 28 minutes. Since those initial improvements, St. Clair's ED has observed a one-hour reduction was achieved in the time from entry into the system to discharge from the ED.
Using a dual bar-code and RFID scanner for use in the mobile device coupled with changes in nursing workflow, over 1,100 avoidable errors have been prevented, including three most serious preventable errors: Med Not Ordered for Patient, Med Discontinued by Physician, and Wrong Patient Scanned, a total of 4,168 avoidable medication administration errors were prevented.
St. Clair Hospital established a PRISM (Physician Resource Information System Management) Committee to review analytics to identify the source of most medication errors. After identifying that inaccurate medication start times lead to most of the avoidable errors, St. Clair developed an EHR-enabled Anti-Infective Auto-Scheduling Decision Tree workflow that reduced medication errors. The Decision Tree reduced the average number of daily CPOE medication orders with missing start times by almost 500%.