Evidence-based protocols drive quality improvement

By Joanne Finnegan

The following is an excerpt from an article published in FierceHealthcare's eBook "Systemwide Transformations that Improve Healthcare Quality and Efficiency." Download the eBook here to read more.

In a new and evolving healthcare market that rewards efficiency and quality care, hospitals must find a way to streamline their systems to put forth better results for patients and more savings for their organizations.

One way to accomplish this is by focusing on evidence-based care protocols--the clinical care recommendations supported by the best available evidence in the clinical literature.

Although there may be 200 ways to do something, in some cases clinicians have strong evidence that reveals the best way to do it, says David J. Ballard, M.D., Ph.D., chief quality officer for Baylor Scott & White Health, a not-for-profit healthcare system based in Dallas that includes 46 hospitals and more than 500 patient care sites. For instance, Baylor implemented a standardized heart failure order set, which has the potential, if it were deployed across the country, to save $2 billion in annual hospital costs and prevent 1,500 in-hospital deaths annually.

Intermountain Healthcare and Geisinger Health System have similar success stories. By implementing evidence-based protocols at their organizations, Intermountain, a non-profit health system based in Salt Lake City that includes 22 hospitals, saw its caesarean section rates drop below the national average. Geisinger, a physician-led system based in Danville, Pennsylvania, that is comprised of a 1,000-member multi-specialty group practice, seven hospital campuses, two research centers and a 448,000 health plan, boasts a 67 percent decline in operative mortality for patients undergoing elective coronary artery bypass.

The use of evidence-based protocols results in two major benefits: better care for patients and savings for organizations. In almost all cases, higher quality costs less, says Brent C. James, M.D., executive director of Intermountain's Institute for Health Care Delivery Research, which teaches healthcare leaders about clinical quality improvement. Intermountain can also document that it saves more than 1,000 lives per year as a result of evidence-based protocols, he says.

Evidence-Based Protocols: First Steps

One of the best ways for healthcare leaders who want to implement consensus-based practices is to talk to organizations that have already done so, says Glenn D. Steele, Jr., M.D., Ph.D., president and CEO at Geisinger.

Whether it's the best practice for how to treat an array of health problems--hearts, hips, knees or gastric bypass--there are two outcomes: better results for patients and significantly decreased costs for organizations, Steele says. It also requires changing the behavior of those involved in the caregiving process.

However, once you can show better outcomes for a group of patients through consensus-based practice, you will get buy-in from healthcare professionals, he says. Healthcare organizations can start by choosing areas of care where they will have the highest probability of success.

Brett Stauffer, M.D., Baylor's director of clinical decision support, says another early step in the process is for organizations to identify the problems they want to address. For example, Baylor clinicians were concerned about over-sedation of patients given narcotics after surgery.

Baylor decided the problem resulted from the way staff used patient-controlled analgesia (PCA) pumps. The system looked at what tools it could develop to solve the problem and brought together patient safety, surgical and pain medicine specialists. They put together a PCA order set, which was built into its EMR. The final step was to evaluate the effectiveness of those steps. Baylor monitored the results and found a reduction in sedation events. 

That one example gets replicated over and over to solve other problems, Stauffer says. For instance, Baylor implemented a standardized heart failure order set, which, if it were deployed across the country, could save $2 billion in annual hospital costs and prevent 1,500 in-hospital deaths annually, Ballard says. Implementation of a pneumonia order set resulted in one in-hospital death averted for every 30 patients compared to patients with no order set, he says. In other words, every 30 times the order set was used, it saved a life.

James cautions that Intermountain's protocols and guidelines aren't meant to fit every patient or take the place of a physician's judgment. "The guideline is not a cookbook," he says. "It doesn't step between the clinician and the patient."

To read the rest of this story and other articles, download FierceHealthcare's free eBook, "Systemwide Transformations that Improve Healthcare Quality and Efficiency."