Enterprise Care Coding & Documentation
Enterprise Care Coding and Documentation
Recognizing the need to create purposeful engagement between clinical and financial data, coding and documentation, Avera developed the Enterprise Care Coding and Documentation Steering Committee to review, select and endorse system level projects that have the potential to have wide spread impact in the areas of quality of patient care, cost of care, coding opportunities, documentation improvement and workflow enhancement.
The committee hands said work to a core ECCD committee who execute analytics on the topic and prepare stakeholders for receiving handoffs of performance improvement activities. Each project is evaluated by an analytics sprint where opportunities are identified in the areas of care, coding and documentation. In addition, metrics and potential strategic initiatives are uncovered. Analytic sprints are followed by a close working relationship with identified project leaders and stakeholders as the handoff results in system wide performance improvement efforts.
ECCD Projects in process include:
- Transfusion Reduction
- Discharge Disposition
- Colon Surgery Bundle (Surgical Site Infection Prevention)
- Major Bowel
- OB C-section
Sepsis is a time-critical emergency just like trauma, acute myocardial infarction and stroke. It has been identified nationally that only one third of patients received appropriate care for sepsis. (Reference: Minnesota Hospital Association, Lead Edge Advanced Practice Topic (LEAPT))
Multiple projects have occurred throughout Avera to improve quality. Our goal was to create a multidisciplinary team from across the Avera system to identify and implement key elements of care delivery for septic patients. After initial analysis, four interventions were identified:
- Nurse driven screening protocol.
- Physician order sets for three hour and six hour bundle.
- Transfer Trigger Tool.
- Education/Seeing Sepsis: Saves Lives and 100-100-100 rule sepsis awareness education.
The project goal is to collaborate with multiple disciplines, providers, and facilities throughout Avera to implement a nurse driven screening protocol and other clinical IT alerts to identify sepsis patients early, to standardize the care sepsis patient receive with physician order sets using the Surviving Sepsis Guidelines, and to ultimately improve the outcomes for the sepsis patients at Avera.
Avera Health System Antibiotic Stewardship program started April of 2012. The group led by Dr. Nazir Board Certified Infectious Disease Physician and Brad Laible Infectious Disease Trained Pharmacist consisted of physicians, pharmacists, Infection Control and Quality from three sites. Avera McKennan, Avera St. Luke’s and Avera Marshall started to look at ways to reduce resistance in gram negative organisms. This group expanded to Avera Sacred Heart, Avera Queen of Peace and Avera St. Mary’s with the implementation of the Fluoroquinolone Reduction Project.
Fluoroquinolones are among the most commonly prescribed antimicrobial agents for adults in the United States.1 These agents generally have a broad spectrum of activity, convenient dosing, and provide the opportunity for simple conversions from intravenous to oral administration with near equal bioequivalency.2 The addition of generic fluoroquinolones to discounted pricing lists at many pharmacies has added the benefit of low cost in comparison to some alternative agents. As with all antimicrobials, overuse of these agents has consequences. Development of fluoroquinolone resistance among Enterobacteriaceae and Pseudomonas aeruginosa has proven significant, with rates of resistance rising in relationship to increased fluoroquinolone utilization. Fluoroquinolone use is a major factor for Clostridium difficile associated diarrhea.
The project included a comprehensive review of order sets and actively making changes to provide alternatives to fluoroquinolones for inpatient antimicrobial therapy. The order sets were set up so that the first line drug was at the top of the list and fluoroquinolones were either removed or moved to the bottom of the order set. The project also involved education of medical staff about resistance and an audit and feedback approach to prescribing.