St. Clair Hospital | Davies Enterprise Award

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.

  • 100% of at-risk in-patients have received pneumonia vaccinations since December, 2012
  • Using clinical analytics, St. Clair identified all patients who experienced hyperglycemic episodes of greater than 180 mg/dl and severe hypoglycemia less than 70 mg/dl. In March, 2011, the incidence of hyperglycemia was 659 per 1,000 patient days. Hypoglycemia incidence was 55 per 1,000 patient days. It was clear that there was room for improvement. With physician engagement, a standardized, evidence-based subcutaneous order set was implemented, accompanied by a revised hypoglycemia protocol. Three years later, in March, 2014, the rate of hyperglycemic episodes dropped to 416 per 1,000 patient days. A refocus of hypoglycemia resulted in revised data collection for severe hypoglycemia, now defined as a blood sugar less than 40 mg/dl. In 2014, the rate of severe hypoglycemic episodes fell from 4.6 to a low of 1.86 per 1,000 patient days. To support this initiative, St. Clair staff implemented an automatic order set that triggers a HgbA1c test for any patient that doesn't have a record of a HgbA1C test within the last 90 days.
  • In order to reduce C Diff infections, St. Clair implemented a probiotic automatic order as a standard part of antibiotic ordering. Following implementation of the protocol in December of 2013, St Clair reduced C-Diff incidents by 50%.
  • Prior to June of 2014, the daily rate of missing start times reported was averaging over 4.5 per day. Through carefully designed clinical decision support, the system now auto-schedules some medications. This new logic was activated in June 2014 and for the first 6 weeks the number of reported CPOE medication start time errors has decreased to less than 0.088 per day.
  • By developing and deploying a dual scanning technology, barcode and RFID, to facilitate change management and technology adoption by nursing personnel and real time automated charting of medication administration into the electronic medication administration record, St. Clair Hospital has avoided 1,100 errors per year on average since 2004.

Clinical Value

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.

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Return on Investment

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.

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Emergency Room Patient Flow

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.

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Innovative use of Bar Code Administration

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.

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CPOE-Enabled Reduction in Medication Errors

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%.

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