Improving Cardiac Care by Standardizing Patient Records

Title:
Improving Cardiac Care by Standardizing Patient Records

Hospital:
Washington Hospital Center; Washington, D.C.

Goal:
Standardizing the language used on records of heart failure patients with left ventricular systolic dysfunction (LVSD) to improve consistency and accuracy.

Innovation:
The Heart Failure Performance Improvement team implemented a new process to classify LVSD patients’ condition and symptoms.

Result:
By using the consistent language on patients’ cardiac care reports, physicians were able to form sound patient care decisions based on the modernized process to categorize patient information. Additionally, the hospital’s abstractors were able to easily find information to support AMI-3, HF-3 and HF-4 core measures.

Institution:
Washington Hospital Center
110 Irving St. NW
Washington, D.C. 20010
P: (202) 877-7000

From the C-Suite:
“It is imperative that all physicians treating patients ‘speak the same language’. When a patient is seen by multiple physicians, it is critical that the patient’s medical history is clear and understandable. By standardizing the way patient’s cardiac reports are worded, our team has been able to implement an effective intervention that helps physicians form accurate care decisions.”


Elizabeth Wykpisz
Chief Nursing Officer


Profile:
Washington Hospital Center is the largest private hospital in the nation's capital with 926 licensed beds offering primary, secondary and tertiary health care services to adult and neonatal patients.

Clinical Areas Affected:

  • Heart and Vascular Institute

Staff involved:

  • Cardiologists
  • Medical Records Office

Timeline:
It took less than two months for the initial problem to be discovered and an executive decision to be made on the new system.

Contact:
Elizabeth Wykpisz
Chief Nursing Officer
Elizabeth.Wykpisz@MedStar.Net
P: (202) 877-7000

Innovation Implementation:
Washington Hospital Center’s vision is to be the leader in providing safe, effective and efficient care to patients in the Washington Metropolitan Area. For patients suffering from heart failure, it is critical that they are provided with care decisions based on the most accurate information.

In 2007, physicians treating heart failure patients noticed that there was inconsistent terminology used to describe patients’ symptoms and conditions. Some physicians used numerical values like one or 10, and others used qualitative values like high or low. The physicians presented their concerns to the medical director of the Heart Failure Unit who then broached the physicians’ concerns at a meeting with the Heart Failure Performance Improvement Team. The Improvement Team decided inconsistent language use on patient records was an urgent issue and quickly implemented a new system to categorize patient information.

The Heart Failure Performance Improvement Team decided to meet and hash out a new system to record patients’ symptoms and conditions at their monthly meeting. Once they decided to record patients’ conditions using a numerical scale, the recommendation was passed along to the medical director, who in turn e-mailed the entire Heart Failure Unit and the hospital’s abstractors in the medical records office about the new system.

Advice and lessons learned:

  1. Keep it simple. Design a system that is easy to follow for new or visiting physicians.
  2. Make sure the effort is driven by senior leaders. Without full participation and approval by top leadership, new systems cannot be implemented quickly.
  3. Craft a plan to track the effectiveness of the new system early on. In hindsight, we should have set up a process to track whether the new system was being used appropriately and whether it had any quantitative results on patient care.
  4. Identify patients concurrently versus retrospectively. Since existing patient records are already coded, we felt it would be easier and more cost-effective to implement the new system for new patients.

Cost/benefit:
Since the hospital didn’t need to alter original patient records, there was no cost involved. The hospital anticipates the benefit will be an overall improvement in the quality of heart failure patient care.