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Trends in ICU Quality After Implementation of an Electronic Health Record FREE TO VIEW

Virginia Flatow; David Eshak, MD; Nadezhda Ibragimova, DO; Celia Divino, MD; Bridget Twohig, MS; Adel Bassily Marcus, MD; Roopa Kohli-Seth, MD
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Mount Sinai Scool of Medicine, Mt Sinai NY, New York, NY

Chest. 2015;148(4_MeetingAbstracts):477A. doi:10.1378/chest.2251945
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SESSION TITLE: Process Improvement in Obstructive Lung Disease Education, Pneumonia Readmissions and Rapid Response Systems I

SESSION TYPE: Original Investigation Poster

PRESENTED ON: Wednesday, October 28, 2015 at 01:30 PM - 02:30 PM

PURPOSE: Health information technology, and specifically the electronic health record (EHR), is increasingly viewed as a means to provide more coordinated, patient-centered care. There is enormous ongoing investment in EHR development. Few studies consider the impact of EHRs on quality of care in the intensive care unit (ICU) setting. We assessed the trend of key quality measures in a surgical intensive care unit (SICU) following implementation of the Epic EHR system in a large tertiary hospital.

METHODS: A retrospective chart review was undertaken to record quality indicators for all patients admitted to the SICU between January 1, 2009 and December 31, 2013 (3,742 patients). Data was segregated between patients admitted to the SICU two years before (Jan. 1, 2009 to Dec. 31, 2010) and two years after (Jan 1, 2012 to Dec. 31, 2013) EHR implementation. Data from the twelve-month period of transition to EHR was excluded (Jan. 1, 2011 to Dec. 11, 2011). We collected length of stay, mortality, central line associated blood stream infection (CLABSI) rates, Clostridium difficile (C. diff.) colitis rates, readmission rates, and number of coded diagnoses. To control for variation in the patient population over time, the case mix indexes (CMIs) and Acute Physiology, Age, Chronic Health Evaluation (APACHE) II scores were also analyzed. Data was analyzed with IBM’s SPSS Statistics.

RESULTS: There was no significant difference in length of stay, C. diff. colitis, readmission rates, or case mix index (CMI) before and after EHR. After EHR implementation, the rate of central line blood stream infection (CLABSI) per 1000 catheter days was 85% lower (2.16 vs 0.39; RR, 0.18; 95% CI, 0.05 to 0.61, p < .005), and SICU mortality was 28% lower (12.2 vs 8.8; RR, 1.35; 95% CI, 1.06 to 1.71, p < .01). Moreover, after EHR there was a significant increase in the average number of coded diagnoses from 17.8 to 20.8 (p < .000).

CONCLUSIONS: After EHR implementation, there was no significant difference in multiple key quality of care indicators in the SICU. There were significant reductions in CLABSI rates and SICU mortality. Ongoing quality improvement endeavors may explain the changes in CLABSI and mortality, but these trends invite further study of the possible impact of EHRs on quality of care in the ICU.

CLINICAL IMPLICATIONS: Considering the large investment into electronic health records and the high costs associated with ICU care, it’s important to develop EHRs that improve ICU quality of care.

DISCLOSURE: The following authors have nothing to disclose: Virginia Flatow, David Eshak, Nadezhda Ibragimova, Celia Divino, Bridget Twohig, Adel Bassily Marcus, Roopa Kohli-Seth

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