The Story
Health First, named one of the "Most Wired Hospitals" for three consecutive years, has long championed the goal of patient-centric care. With its legacy documentation system, the organization struggled to meet patient-safety goals and allied-care workers had trouble coordinating patient care at its three hospitals: Cape Canaveral Hospital, Holmes Regional Medical Center and Palm Bay Community Hospital.

Seeking to improve Joint Commission compliance and interdisciplinary collaboration, and reduce duplicate charting, Health First engaged Eclipsys professional services and implemented Knowledge-Based Charting™. The solution's 190 evidence-based clinical practice guidelines support the full scope of practice for nursing and allied-care professionals. With the patient-centric, interdisciplinary documentation system, caregivers can work more efficiently as a team, with a more complete understanding of patient situations. Health First has improved its outcomes in quality and efficiency as well as its compliance with The Joint Commission and National Database of Nursing Quality Indicators.

Building Interdisciplinary Dialogue
Prior to activation, each of Health First's three hospitals worked closely with Eclipsys to engage caregivers, analyze and standardize its care practices and customize clinical content. Consultants from the Eclipsys Clinical Practice Model Resource Center™ led the organization in the creation of interdisciplinary partnership councils. With the councils, caregivers defined their own scope of practice, gained an understanding of the scope of other disciplines and cultivated stronger collaboration between units and departments.

"The councils helped us establish an interdisciplinary dialogue so we could work together to improve processes," said Janice McCoy, MSN, RN, CNAA, vice president, Patient Care Services and chief nursing officer. "They helped us realize we were all part of the same team."

Looking Beyond the Task at Hand
Health First went live with Knowledge-Based Charting at its three hospitals between November 2005 and November 2006. According to Judy Gizinski, MPH, RHIA, vice president of Information Services, charting is now more comprehensive and patient-focused. "The focus is on the patient rather than the task," said Gizinski. "Caregivers document what they see and do for the patient instead of documenting something because it was time to do that task."

Nurses now document care in real time at the bedside. "We're moving away from nurses writing notes, sticking them in their pocket and trying to remember to get to them later," said McCoy. "They enter the information when they gather it, and the rest of the team has access to it right away."

Joint Commission Patient-Safety Standards
Knowledge-Based Charting provides a content-rich profile that Health First uses to meet the growing emphasis on patient-centric care. Caregivers can see elements of care for each patient along with appropriate guidelines that explain the latest proven techniques. "The Joint Commission wants to see individualized care plans, and Knowledge-Based Charting is perfect for that," said McCoy. In addition, mandatory assessments help identify patients susceptible to falls and other hazards so the care team can take preventive action.

The patient record now includes narrative notes from multiple disciplines, including notes on appetite, mood, and other markers. The interdisciplinary approach provides caregivers a global view that extends beyond the confines of traditional silos of care. A recent Joint Commission review found no RFIs (requirements for improvement) for any patient-safety goals.

The Benefits
Across its three hospitals, Health First uses Knowledge-Based Charting to eliminate duplicate documentation, save time and enhance communication throughout the interdisciplinary care team. "Knowledge-Based Charting enables caregivers to understand each other's scope of practice," said McCoy. "It helps each caregiver become a more valuable member of the team."

Health First tried for years to reduce patient falls and pressure ulcers, with only modest success. However, it made significant improvements using Knowledge-Based Charting mandatory assessments. At Cape Canaveral Hospital, patient fall rates decreased 58 percent five months post implementation, and 92 percent one year after the activation. Nearly all duplicate documentation has been eliminated and incidence of hospital-acquired pressure ulcers went down 55.4 percent and remained at that level for the two years since activation. Throughout this period, the hospital maintained a zero percent pressure ulcer rate for wound sweep.

Meanwhile, clinicians have responded positively to Knowledge-Based Charting, and patient satisfaction is improving as well. "Clinicians can now see care across the continuum," said Gizinski. "The charting is more accurate, the physician has a clearer picture of care events, and the nurse has more time to spend with the patient."

About Health First
Three not-for-profit hospitals - Cape Canaveral Hospital in Cocoa Beach, Holmes Regional Medical Center in Melbourne, and Palm Bay Community Hospital in Palm Bay - form the core of Health First's family in Brevard County on Florida's Space Coast. Other services include outpatient care; the county's only trauma center; home care; specialized programs for cancer, diabetes, heart, stroke, and rehabilitative services; central Brevard's largest medical group; three fitness centers; and Medicare Advantage, commercial POS, and commercial HMO health plans.

About Knowledge-Based Charting
Knowledge-Based Charting is an interdisciplinary, pre-configured clinical documentation solution that integrates over 20 years of proven, evidence-based content into daily clinical processes. It offers seamless integration of embedded content within the context of individualized patient information. Based on a professional interdisciplinary practice framework, Knowledge-Based Charting is designed to prevent or manage potential patient complications while increasing patient and clinician satisfaction.

About Eclipsys
Eclipsys is a leading provider of advanced integrated clinical, revenue cycle, and access management software, clinical content and professional services that help healthcare organizations improve clinical, financial, operational and client satisfaction outcomes.