Jefferson Regional Medical Center Raises Standard of ICU Care

Silos of paper-based information used to inhibit the flow of vital data as patients moved from one care venue to another at JRMC. But in a strategic move to connect care teams, streamline care processes and create an integrated EMR for every patient, in 2002 the hospital began a phased implementation of Sunrise Clinical Manager™, Eclipsys’ advanced patient information system. JRMC has successfully implemented interdisciplinary documentation in units throughout the organization, including nursing, Occupational Therapy, Physical Therapy, Respiratory Therapy, Dietary, Pastoral Care and Discharge Planning.

As part of its initiative to link documentation in the ED, ICUs and medical-surgical units, JRMC focused on deploying electronic documentation and eMARs in its four ICUs (medical, surgical, coronary and cardio-vascular). In November 2005, three of the hospital’s four ICUs went live on Sunrise Critical Care™, which enhances the value of Sunrise Clinical Manager for intensive care clinicians with customizable flowsheets and clinical decision support. It was, in effect, the beginning of the end of the nurse’s paper tri-fold note and medication administration form in the ICUs, and another major step in JRMC’s move toward a fully integrated, enterprise-wide health information system.

The Benefits
With Sunrise Clinical Manager as the foundation for its EMR strategies, JRMC is improving patient safety and enhancing the effectiveness of its critical care teams.

Documentation is intensive in the hospital’s ICUs, with up to 16 nurses at a time performing assessments and charting vital signs. Sunrise Critical Care’s customizable flowsheets and device interfaces help reduce the time nurses spend documenting care so they can spend more time providing it. “Nurses no longer have to write in times and draw arrows and dots to enter vitals. And the information is more accurate,” says Leah Wright, ICU nurse manager at JRMC.

The system’s flexibility has also helped the team customize reports for various workflows. “Every healthcare provider and every site has slightly different workflow needs,” says Andy Jenkins, Clinical Application Systems manager at JRMC. “Sunrise Critical Care allows us to implement decisions about how to display clinical data depending on the needs of our clinicians.”

Handoffs between departments are also smoother and safer thanks to comprehensive information in the enterprise EMR. One of the best examples is the transfer of patients to the ICU from JRMC’s emergency department, which uses Eclipsys Sunrise Emergency Care™. “We now get complete patient information from the ER on a medical screening form at the bedside,” Wright says.

In addition, the hospital’s rapid response teams are using Sunrise Critical Care’s alerting capabilities to increase their ability to intervene within the “window of opportunity” — the six to eight hours when rapid therapeutic intervention can save lives.

“The goal is to help patients early, before they deteriorate,” Wright continues. “We now have eight months of data with these reports and we’re definitely seeing fewer code blues on the floor. Patients are coming from the medical-surgical units to the ICU without deteriorating, and this has helped decrease their length of stay in the ICU. We are definitely benefiting from that.”

Implementation of the eMAR is also helping improve patient safety and reduce errors in the ICUs. All pharmacy data now flows automatically into the eMAR, which is displayed and charted at the bedside and available to all clinicians. “We’ve only scratched the surface, but all of us feel that the Eclipsys system has already raised the standard of care for nursing in the hospital,” Wright says. “That’s a very positive result.”

“Sunrise Clinical Manager is a robust and configurable system that provides us with a structure and serves as a solid base from which to build. We have been able to configure this system to not only fit, but to enhance, our clinical ‘practice.’ And the more we use it, the more we’ve seen the endless possibilities for improving clinical outcomes and operational efficiencies,” said Thomas Harbuck, executive vice president of JRMC.