VigiLanz Supports Program that Reduces Rate of Acute-Kidney Injury

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.

 

Cincinnati Children’s: Ensuring Safe Antibiotic Utilization Among Pediatric Kidney Patients

Customer Profile

Ranked by U.S. News & World Report as one of the nation’s best children’s hospitals, the 629-bed Cincinnati Children’s Hospital Medical Center is a leading medical research institution and teaching hospital caring for children from across the globe. Established in 1883, the healthcare system’s 15,260 employees engage in 1.25 million patient encounters each year, including approximately 34,000 admissions and 103,000 emergency department visits.

Cincinnati Children’s comprises the Department of Pediatrics of the University of Cincinnati College of Medicine, offering comprehensive clinical services ranging from treatments for rare and complex conditions to well-child care. It is the third-highest recipient of research grants from the National Institutes of Health among pediatric institutions and is among just 7% of hospitals in the U.S. to have earned Magnet-designation (2013-2017) by the American Nurses Credentialing Center.

heartCINCINNATI CHILDREN’S WAS DETERMINED TO DECREASE PROLONGED USE OF VANCOMYCIN

Challenge

With a growing body of evidence associating acute kidney injury (AKI) with an increased risk for development of chronic kidney disease, end-stage renal disease and mortality, Cincinnati Children’s was determined to reduce rates of AKI among its pediatric inpatient population. Baseline data indicated that, on average, six inpatients each week developed AKI during or within a week of discontinuing a vancomycin course. Additional evidence also suggested that extended courses of vancomycin—which when used beyond four days for empiric courses creates potentially unnecessary exposure to a nephrotoxic medication—may have been unintended.

Thus, vancomycin utilization was a natural target as the healthcare system embarked upon its mission to reduce the risk of AKI in pediatric patients. Specifically, Cincinnati Children’s sought to:

  • Decrease episodes of acute kidney injury associated with vancomycin use.
  • Decrease vancomycin exposure.
  • Decrease prolonged courses of vancomycin.
  • Increase oversight and approval for prolonged vancomycin exposure.

Success would require a close partnership between pharmacists and physicians that would enable implementation of an innovative, multistep quality improvement program focused on reducing the risk of vancomycin-induced kidney injury in pediatric patients. It also necessitated implementation of surveillance, clinical decision support and reporting technology capable of triggering interventions and educating clinicians on best practices.

Solution

Integrated within an existing antimicrobial stewardship program (ASP) and AKI reduction efforts, a core team of pharmacists, physicians, the chief medical resident and a quality improvement expert identified key drivers and implemented interventions including standardized orders, improved medical record documentation and integration of new processes into normal workflow. This enabled a stepwise approach using “plan-do-study-act” cycles.

Cincinnati Children’s also deployed the VigiLanz ASP solution to automate key processes, including screening and monitoring patients. The cloud-based platform leverages data collected from Cincinnati Children’s electronic medical record, physician order entry, laboratory and pathology systems to monitor patients in real-time for drug interactions and ineffective or inappropriate antibiotics. When potential issues are identified, alerts are triggered to enable clinical pharmacists and other members of the care team to take appropriate action.

Outcomes

Leveraging VigiLanz helped Cincinnati Children’s to create a sustainable and scalable framework that guides appropriate and safe use of antimicrobials while also promoting the safe and effective use of other medications. By enabling the provision of enterprise-wide guidance on the use of vancomycin in a matter of minutes each day, the technology helped drive significant improvements. These included:

  • Decreasing AKI associated with vancomycin exposure to an average of 4 per week from a baseline average of 6 per week, with sustained efforts likely to prevent an estimated 100 cases of vancomycin-associated acute kidney injury per year.
  • Decreasing vancomycin exposure (days of therapy/1000 patient days) by 43%, putting Cincinnati Children’s below the 25th percentile from a baseline near the 50th percentile.
  • Decreasing instances of prolonged courses of vancomycin by 44% hospital-wide.
  • Increasing ASP/ID approval in courses of vancomycin greater than four days to an average of 95% from a baseline average of 53%.

Cincinnati Children’s efforts to reduce AKI were recognized by the Association of Health-System Pharmacists, which gave the health system its 2016 Award for Excellence in Medication Safety.

“…We believe we can decrease the potential downside by choosing antibiotics that are likely to be just as effective but have less risk of increasing antibiotic resistance,” said David Haslam, M.D., an infectious disease specialist who joined Cincinnati Children’s specifically to launch its ASP initiative. “…Some hospitals just say ‘you can’t use that drug.’ Our approach will be ‘you might want to consider [another drug].’ We hope physicians will view this as bringing a lot of potential benefit.”– Silva, Mary. “Finding the Balance.” Research Horizons. Winter 2014.

How Orlando Health Deploys Predictive Analytics to Fight Sepsis

As a result of the prevalence of sepsis in the healthcare setting and new reimbursement models that reward value and outcomes, many health systems and hospitals are looking for ways to take full advantage of all technological resources available in order to protect patients and reduce costs by working to properly manage and prevent sepsis.

While CMS assesses hospital performance by monitoring 30-day readmissions following hospitalizations for heart attack, heart failure, chronic obstructive pulmonary disease and pneumonia, none of these conditions take the same toll on hospitals and their patients in terms of readmissions as sepsis, according to a recent study published in JAMA. In the study, researchers found sepsis — a condition caused by the body’s immune response to life-threatening infection — accounted for 12.2 percent of readmissions, followed by 6.7 percent for heart failure, 5 percent for pneumonia, 4.6 percent for COPD and 1.3 percent for heart attack.

During a Jan. 26 webinar sponsored by VigiLanz — a provider of real time intelligence and predictive analytics — and hosted by Becker’s Hospital Review, Eric Rose, Pharm. D, manager in corporate clinical decision support at Orlando (Fla.) Health, Adam Klass, chief technology officer with VigiLanz, and Bart Abban, PhD, director of analytics and data science with VigiLanz, discussed the development of predictive models for sepsis risk and how such models can improve outcomes by alerting physicians to the early signs of sepsis and enabling them to intervene sooner.

The VigiLanz intelligence platform conducts automated, continuous surveillance to provide clinicians with solutions and insights in real time to ensure adherence to best practices, increase patient safety and improve reimbursement.

“We’re a layer that sits on top of the EMR and really our goal is to drive all of the value out of all of that great data that’s in the EMR and really affect patient care in real time,” said Mr. Klass during the webinar.

The VigiLanz platform is designed to deliver clinicians predictive analytics tailored to a hospital’s patient population. Patient attributes like age, clinical history, comorbidities and lab results can be continuously introduced into the model. The VigiLanz model also analyzes the potential effects of a patient’s unique history and attributes on their clinical outcomes.

Additionally, models are constructed from the ground up through collaboration between the VigiLanz team and the hospital, tested against a hospital’s historical data and validated within a staging environment.

“We have a very collaborative process between your experts and the VigiLanz team,” said Dr. Abban, during the discussion. “Based on the literature available, we’ve built great base models. When we begin working with [a hospital’s] team, we look at the important differences that are in your institution, things that might impinge on the foundational models and we incorporate those into the models.”

The pilot model designed to predict the risk of sepsis in patients at Orlando Health — a six-campus health system with 1,700 beds and a Level I trauma center — involves a multi-layer process. First, efforts are made to accurately identify patients already presenting sepsis upon admission. Second, patient data like vital signs, microbiology and clinical history are entered into the model. Then the platform conducts a clinical evaluation and attributes a sepsis risk score to the patient. Based on the score, hospitals can decide when medical interventions are warranted and more effectively triage the patient population.

At Orlando Health, the VigiLanz model has a positive sepsis predication rate of 70 percent and has been particularly well received in the med-surgery units.

Additionally, Orlando Health’s Dr. Rose and the VigiLanz team were able to establish more accurate time frames for organ dysfunction pertaining to sepsis. According to Dr. Rose, the newly established time frames “helped us very quickly tighten up the predictive power of the algorithm.”

“It’s really been a pleasure to partner with them [VigiLanz] on this new venture in predictive analytics,” said Dr. Rose.

To view the webinar, click here.

Article reposted with permission from Becker’s Healthcare. See the original here.