Northwestern Memorial Hospital is one of six national participants in a pilot study that will test whether operable lung cancer patients have better outcomes by hardwiring data systems to reduce medical error and sticking to best practice standards.
The 18-month trial, co-sponsored by the Commission on Cancer and the Society of Thoracic Surgeons, will study clinician consistency in delivering 38 evidence-based best practice elements of care from the time of referral through their surgical admission and concluding with a plan for follow-up and continued cancer surveillance.
Monitored care elements include appropriate pre-surgical imaging, medication choice, dose and timing, patient counseling regarding smoking cessation and defining expectations of a patient's involvement in their own care.
The study centers on assessing whether better outcomes and fewer complications can be achieved by applying systems engineering principles to the plan of care and then leveraging the electronic health record to provide rapid feedback regarding how well it worked, according to Malcolm DeCamp, MD, Northwestern's chief of the division of thoracic surgery.
"Errors in healthcare are more common than errors in many industries such as manufacturing or commercial air travel," said DeCamp, who is also a professor of surgery at Northwestern University's Feinberg School of Medicine. "With shift changes, holidays and overwhelmed staff, a medication dosage might not be given at the correct time one day, or a critical respiratory treatment may be omitted by a cross-covering therapist."
ProvenCare calls attention to such possible errors by tracking the documentation already performed by medical staff in the electronic health record, he said. For example post-operative pain is assessed on a 0 to 10 scale by the nursing staff at least every four hours. These pain scores are recorded in the vital signs area of the record and any score greater than three mandates an intervention (change in medication and/or dose) with a follow-up pain assessment in the next hour. As the record is electronic, the original pain score, the intervention and reassessment are date and time stamped when entered.
At Northwestern, the data warehouse generates a ProvenCare "electronic report card" combining and analyzing both out-patient and in-patient records. It verifies when and how often each care element was completed and more importantly flags episodes where the best-practice standard was not met. The tally, which can be updated daily, is often a wake-up call for clinicians about consistency in routine, says DeCamp.
"ProvenCare methodology will allow us to rapidly identify potential problems electronically and provide timely feedback to the care team," said DeCamp. "That way, we can constantly be aware of and fix minor slips before there's a compounded affect. It's a bit like simple rocket science after blast-off. If the rocket is a bit off course you can correct it pretty easily. But if you wait too long to address it, it could crash jeopardizing the entire mission. ProvenCare is a system that allows for constant and early course correction."
At the conclusion of the trial, outcomes from the six centers participating will be compared with those from non-participating centers that already report results to the National General Thoracic Database. Based on results, ProvenCare could lead to improved care for all patients with operable lung cancer.
