Bringing Consistency to the 9-Month Episode of Care
To hardwire this particular best practice, the electronic health record tracks all C-sections throughout the system, along with the gestational age of the baby and the reason for the C-section. If by chance an indication shows up in the system for an elective C-section prior to 39 weeks, a red flag alerts the senior obstetricians to contact the delivering physician in real time to review, Nash says. For the past two years, Geisinger's elective delivery rate prior to 39 weeks has been zero.
The order sets embedded into the health record are meant to support and remind physicians about the benchmarks of care, but not to bog down workflow. One revamp they call the "Result Consult" allows the physician to divide all of the different lab and radiology work by weeks of pregnancy. So a physician can simply check if a patient at 20 weeks has had all of the recommended studies, and if not to order them according to the timeline. If an opportunity is missed, then the alert reminds the physician at the next visit that the recommended care is overdue but still within the time window to correct, Cassagnol says.
"Hard stops"—orders that a physician has to click though in the course of the patient encounter—are built into the health record selectively, Mateer says.
"We also have what are called best-practice alerts for certain high-importance areas, such as receiving Rh immune globulin for our pregnant patients who are Rh-negative," Mateer says. "If something has not been completed at a particular point in the pregnancy, an alert will come up at the very top of the patient encounter. Then a drop box will allow you to complete that in a very easy, timely fashion. We didn't want to have best-practice alerts for every component because that can get overwhelming if you have a hard stop to every component of care, but for certain crucial areas of care we felt that hard stops were beneficial and would then be harder for a physician to miss."
HealthLeaders Media LIVE from Geisinger: Women's Health Leadership Discover how Geisinger Health System used its ProvenCare model to streamline perinatal care, created stronger patient engagement and communication, and drove better outcomes for both safety and quality.
This article appears in the July/August issue of HealthLeaders magazine.
Jim Molpus is Leadership Programs Director of HealthLeaders Media.
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