February 3, 2006

Upgrade streamlines admission order sets

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C. Wright Pinson, M.D.

Upgrade streamlines admission order sets

Last month, approximately 60 newly packaged sets of physicians' evidence-based admission orders were linked to Admission Wizard, the information systems tool that doctors use when they initiate care for patients in Vanderbilt hospitals.

“The complexity of diagnostic and therapeutic options for treatment of medical problems can often be daunting,” said Chief of Staff Allen B. Kaiser, M.D. “This upgrade helps make the route to best practice that much clearer for our physicians by delivering evidence-based guidelines to them in the form of electronic order sets at the inception of hospital care.”

Each evidence-based order set is keyed to a medical condition, disease or major surgical procedure. When the user selects a hospital unit for the patient, Admission Wizard automatically pulls up relevant sets of admission orders.

“Standardization of practice according to the best evidence is a keystone for quality,” Kaiser said. “Though some patients may fall partly outside the scope of standardized treatment plans, we need our physicians to use the new order sets whenever they apply.”

While order sets were being linked to Admission Wizard, work was nearing completion on a new information systems tool that practice groups will use to get immediate data showing how consistently their physicians use order sets.

Electronic order sets have become the prime instrument of Vanderbilt's evidence-based medicine initiative. About 90 order sets have been written under the initiative, which began 16 months ago. The order sets are written by multi-disciplinary teams assigned by Vanderbilt practice groups. The core of each team typically includes one or more attending physicians, a pharmacist, residents and clinical fellows, a nurse and a social worker.

“Our emphasis now is on encouraging and tracking the use of evidence-based order sets in the hospital,” said Chief Medical Officer C. Wright Pinson, M.D., M.B.A. “This evidence-based care program is vital to improving the quality, safety, cost and ultimately the value of the care that we provide to our patients. We're out to ensure that day-to-day clinical practice is aligned with the best available medical evidence. This is an important operational management tool of our performance improvement, quality and safety program strategy overall.”

Internal consultants for evidence-based medicine assist each team to create order sets, and a VUMC librarian is available to search out evidence. As an additional resource, teams can use a Web-based subscription service that provides summaries of medical evidence.

The editor for electronic order sets became Web-based last summer, and since then teams have been able to load new order sets onto the system and test them without having to go through systems programmers. Teams can also link evidence from the medical literature directly to order sets.

Jack Starmer, M.D., assistant professor of Biomedical Informatics, coordinates systems development to support implementation of evidence-based order sets and clinical pathways. Other leaders for the EBM initiative include Bill Anderson, M.D., with Vanderbilt Medical Group administration, and Assistant Vice-Chancellor Nancy Lorenzi, Ph.D.