At the recent APIC conference in Philadelphia, attendees heard from Jennifer Boe, BSN, RN, PHN, CIC, an infection preventionist at Children’s Minnesota, and Joe Kurland, MPH, CIC, an infection preventionist and vaccine specialist at Children’s Minnesota, about how their hospital helped quell a measles outbreak in their community in 2017.
If you missed the presentation, here’s your chance to view it. You’ll learn what led to the outbreak, how the hospital responded, and lessons learned that could benefit your own health system.
Health providers across the country must react quickly and proactively if an outbreak occurs in their area, but it’s not an easy undertaking.
Although measles was declared eliminated in the United States in 2000, measles is still endemic in many areas of the world. Public health officials and healthcare providers know that a new measles outbreak in the U.S. could ignite at any moment when communities of susceptible individuals combine with easily accessible, rapid international travel. This is the situation in several jurisdictions, where recent outbreaks have resulted in the largest number of confirmed measles cases the U.S. has seen in 25 years, according to the CDC.
Clinics, hospitals, and healthcare systems across the country must be prepared to act quickly if an outbreak occurs in their area, but it’s not an easy undertaking.
Just before the conference, we caught up with them to learn more about their story what they’ll be presenting during their session.
VigiLanz: How did the measles outbreak develop in your community? What type of situation was your hospital facing?
Boe and Kurland: We have a large, vibrant Somali community here in Minnesota, centered in the Twin Cities metro area, and they frequently travel to places where measles is endemic. Back in 2004, the MMR vaccination rate for the Somali-Minnesotan community was about 92 percent. Around 2006, and in response to the Somali community’s perception of increased and disproportionate rates of autism without a known cause, the community was subjected to targeted anti-vaccine messaging. As a result, the MMR rate among Somali-Minnesotan children plummeted to a low of 42 percent. With low community immunity and frequent international travel, it was only a matter of time until we had an outbreak. Our first measles case occurred in March 2017 in a Somali-Minnesotan child, and we knew immediately that we would be seeing many more cases. At Children’s Minnesota, we ended up testing 275 patients for measles between April and August. At the end of the outbreak, Minnesota had 75 confirmed cases, and Children’s had cared for 52 of them, including 22 inpatient hospitalizations.
“With low community immunity and frequent international travel, it was only a matter of time until we had an outbreak.”
VigiLanz: What were some of the first things you did to address the problem?
Boe and Kurland: Because of the low community immunity, we knew this was a public health emergency. We activated our hospital incident command system (HICS), and it was “all hands on deck.” We collaborated with our state health department, developed phone banks and a measles hotline, and prepared the emergency departments and clinics to rapidly identify and isolate suspect cases. Our infection prevention team had to reprioritize our normal work and resources in order to accommodate this outbreak response. This included rotating call every 24 hours and assigning one team member to other high-priority daily work.
VigiLanz: What role did VigiLanz play in supporting your efforts?
Boe and Kurland: VigiLanz helped ensure that no suspect cases being tested for measles slipped through the cracks. For example, we ask providers to contact us whenever they consider ordering a measles test for a patient. At the height of the outbreak when we were testing so many patients, we found that we weren’t being notified 100 percent of the time. We worked with our VigiLanz support team member to create a new rule, which alerted us whenever a measles test was ordered. VigiLanz was able to implement this new alert for us within one day of us requesting it. Knowing about suspect cases ahead of time ensured we were in the loop, and it allowed us to identify potential exposures so we could rapidly respond if the measles test was positive. Another VigiLanz rule alerted us if a known case or exposed patient returned to our organization for care.
VigiLanz: What is one thing you will discuss during your session that you think health systems would really benefit from hearing more about?
Boe and Kurland: During our session, we’ll also discuss our exposure reduction interventions that were implemented during the outbreak, as well as our post-exposure response plan, including prophylaxis and prioritization of exposed individuals. We will also share a checklist to help organizations improve their preparedness and plan their response to a measles outbreak. Finally, we will hold a Q&A after the session, and we are excited to talk to other infection preventionists and providers about unique challenges at their health systems and share thoughts on how they might be addressed.
Patient safety problems, from hospital-acquired infections to medical errors, occur much too frequently. This year,800 hospitals will incur reimbursement penalties from Medicare because of high rates of infections and patient injuries, and a recent Johns Hopkins study found that medical errors are the third leading cause of death in the U.S. after heart disease and cancer.
Hospitals Fight Back Against the Opioid Epidemic With VigiLanz
The opioid epidemic is one of the most challenging safety problems hospitals face, and VigiLanz is helping address it. The technology alerts physicians and pharmacists if a safety issue arises, such as if a patient is prescribed multiple opioids or has been taking an opioid longer than recommended.
Houston Methodist hospital is using VigiLanz to identify duplicate opioid orders and high use areas. In a recent study, the hospital found that opioid alerts triggered by VigiLanz led to the discontinuation of one or more opioids 53% of the time.
VigiLanz Supports Innovative New Approach at Cincinnati Children’s Hospital
Nephrotoxic medications are critical for many patients. Unfortunately, they can also sometimes lead to acute-kidney injury in pediatric patients. To address this problem, Cincinnati Children’s Hospital Medical Center created a complex algorithm to identify patients at risk. The program has led to a 40 percent reduction in AKIs.
VigiLanz supports the program by monitoring patient datawith a complex set of exposure criteria and alerting providers in near real-time if a patient has been exposed to nephrotoxins. It also lets providers know if injury occurs.
Avoid adverse events, prevent and control infections and outbreaks, and promote opioid stewardship
Far too many patients are harmed due to medical errors and other safety issues. In fact, medical errors are the third leading cause of death in the United States. VigiLanz is helping hundreds of hospitals improve patient safety in several ways, including assisting with adverse event avoidance, infection and outbreak control, and opioid stewardship. Learn more about how three hospitals are using clinical surveillance technology to improve in these areas.
The Unforgivable Metric: Avoidable Patient Errors…
…and What Hospitals Can Do About Them
Patients go to the hospital for healing, but despite the best intentions of clinical staff, far too many patients experience unintended harm.
The numbers are staggering. Medical errors are the third leading cause of death in the United States after heart disease and cancer. Today alone, 1,000 people will die because of a preventable hospital error.
Check out our short infographic to learn how real hospitals are using clinical surveillance to turn the tide against medical errors and other patient safety issues.
Data can help physicians and pharmacists make smarter patient care decisions, but the way in which physicians receive that data plays a huge role in whether the information drives higher-value care.
Physicians benefit most from data that is:
Easily integrated into their workflows; and
Targeted to their specific needs at that moment in patient care.
Many health systems are struggling to meet these three objectives. In fact, turning data into actionable information is the most pressing health IT challenge healthcare organizations face, according to a recent survey of 100 healthcare executives by Managed Healthcare Executive.
At HIMSS 2019, Nicholas Desai, MD, system chief medical information officer at Houston Methodist, shared how his organization is addressing this challenge.
Houston Methodist—which is made up of seven hospitals, eight emergency care centers, and a large network of more than 6,700 affiliated physicians and 675 employed primary care and specialty physicians—recently embarked on a 90-day pilot to test how integrating clinical alerts into its EMR workflow could help physicians and pharmacists make more cost-effective, higher quality care decisions.
About 130 clinicians and 38 pharmacists were involved in the pilot, said Desai, during his presentation at the VigiLanz booth on Wednesday, February 13.
The alerts were pulled from a variety of sources, including Houston Methodist’s own data and data from its partners, such as VigiLanz. The alerts were integrated into the EMR workflow via IllumiCare’s Smart Ribbon.
“The ribbon is an executable file that sits right on top of our [EMR]. It aggregates data and everything right from our [EMR], but the best part is it pulls it all together in one place,” said Desai. “I can call it up when I want it, I can force it to be passive or active.”
Two Tips for Effective Alert Integrations
When integrating alerts into the EMR, consider passive and active alerts that you want to make front and center. For example, if there are five drugs your organization is watching and monitoring closely, consider how you can use alerts to highlight those as top of mind for clinicians.
Bring various stakeholders to the table to help determine what type of alerts and data should be integrated. For example, if your organization’s PDMP task force is involved, it might reveal that integrating PDMP-related reports is key.
The results of the pilot are impressive. The organization was able to shift the cost curve within the 90-day mark about $107,000, said Desai.
“Overall, we believe that in 2019, for this hospital, we have an opportunity of 4.5 percent reduction in our costs, which will lead to between $1.7 million and $2.8 million, just for one hospital,” he said. “As an organization, it’s upwards of what appears to be closer to in the ballpark of $18 [million], $19 [million], $20 million dollars.”
Desai said the VigiLanz alerts in the Smart Ribbon are also extremely helpful to pharmacists, because they can see alerts directly in the EMR without needing to go into the VigiLanz app to view them.
“The reality here is we’re giving [clinicians] tools and working with partners like VigiLanz and Illumicare to really bring together the efficiency tools that our providers need,” said Desai. “That’s what matters.”
Perhaps most importantly, clinicians responded very favorably to the integrated alerts. “Seventy-two percent of doctors, at the end of our pilot said, ‘This is not just valuable, finally you’re giving me a tool that is meaningful,’” said Desai. “In every one of those conversations, cost was important, but not the only reason why they liked the tool. What they liked about it was that this allowed them to see things in a more holistic view in one place.”
This post has been updated from a post previously published on February 28, 2019.
High Impact, High Reward: Hospitals Reap Cost, Quality Benefits from Clinical Surveillance
Real Hospitals Share Clinical Surveillance Benefits
As hospitals incorporate clinical surveillance into more patient care areas, the impact on quality, costs, and the bottom line is growing. More than 90 percent of hospital executive respondents to a recent survey said clinical surveillance improves care quality. Nearly 80 percent said it has an ROI.
Here’s your chance to learn more about the ROI three hospitals have experienced (including for one hospital, more than $100,000 in savings just in the emergency department alone).
The following is an excerpt from Pharmacy Practice News. For more information about the collaboration between VigiLanz and Cincinnati Children’s to reduce AKI, please read our press release and learn more about the solution that is functional and customizable for any hospital, regardless of EMR platform.
Dubbed NINJA, or Nephrotoxic Injury Negated by Just-in-time Action, a new solution enables real-time identification and monitoring of pediatric patients at risk for acute kidney injury (AKI) from exposure to nephrotoxic drugs.
So far, the program appears to be putting a significant dent in the problem—a greater than 40% reduction in AKI, which the authors contend has reached epidemic proportions in the nation’s hospitals.
Nephrotoxic medication exposure is one of the most common causes of AKI in children. “We know that children need nephrotoxins. These are lifesaving medications,” said Stuart L. Goldstein, MD, the director of the Center for Acute Care Nephrology at Cincinnati Children’s Hospital Medical Center and primary developer of NINJA. “But children should only get the nephrotoxic medications they need for the duration they need them.