"We think it has a benefit for those highly acute patients who require fast decisions," he says. "This gives our physicians quicker access to information."
In addition, all of the nursing and ancillary service documentation is available to physicians electronically. "That makes our vital signs and patient physiologic data available in real time throughout the hospital and outside the hospital," Longhurst says. The availability of that information could have also contributed to the mortality reduction, he adds.
Real-time, automated clinical decision support
According to Longhurst, physician ordering drives half of the resources in LPCH. And, as one might expect, there can be variability in physician ordering practices even for similar diagnoses, such as the request for a blood transfusion.
Clinical resource management programs can focus on educating physicians about such variances by trying to get them to change their ordering habits; however, LPCH discovered that it can hardwire such changes into its CPOE system. Widen refers to this as "building a better mousetrap."
For example, LPCH has data about transfusion thresholds in children that suggest that hemoglobin over 7 g/dl does not require a transfusion. Longhurst says that, traditionally, it would take five to 10 years to disseminate those data to physicians to standardize the orders they place—and it still wouldn't always happen consistently.
Instead, the hospital hardwired it into its CPOE system. Now, a prompt in the form of a decision support tool will display at the point of care when a physician orders blood products on a patient who has hemoglobin over the threshold that is set in the system.