Minimizing waste through ongoing process improvements is not new to healthcare. Actions such as improving scheduling methods, enhancing revenue cycles and identifying patient flow bottlenecks, have been used to make operational tasks more efficient.
But what about clinical outcomes themselves? Given that there are often significant inefficiencies in clinical workflows, looking at processes within this context could help improve outcomes while also lowering costs.
Blood pressure (BP) measurement often provides an ideal starting place to eliminate inefficiencies toward realizing better outcomes and lowering costs.
Better BP: Better Outcomes and Lower Costs
Of all vital signs, BP measurement has perhaps the strongest connection to point of care diagnosis, patient risk stratification and medication dosing. These three critical factors of care management are essential to precise decision-making tied to better outcomes.
In order to properly diagnosis and treat hypertension–a major risk factor for coronary heart disease, stroke and renal failure–caregivers need to obtain accurate BP measurements, both current and trending. It is also important to detect small differences in BP readings in the treatment of patients with diabetes and renal diseases, making accurate trending data and standardized protocols critical.
In 2017, the American Heart Association (AHA) and the American College of Cardiology updated guidelines for the detection, prevention, management and treatment of abnormally elevated BP. The new guidelines lower the traditional definition of hypertension to account for complications that can occur with lower BP readings and to allow for earlier intervention. With more than 30 million more people now classified as hypertensive, the difference between “normal” and hypertensive is less. This means the risk of false-positives is higher.
Vital Signs Acquisition and Greater Connectivity
BP measurement continues to be one of the most inconsistently performed tests in clinical environments. According to the AHA, numerous surveys have shown that physicians and other healthcare providers rarely follow established AHA guidelines for proper BP measurement; however, when they do, the readings correlate more closely with objective BP measures than those readings taken not following the guidelines.
It is also generally accepted among thought leaders that when different caregivers acquire a BP measurement on the same patient, their results can be quite different.
When connected, caregivers can take vital signs, review results and seamlessly import information to an electronic medical records (EMR) system. Additionally, the automation made possible by connected vital signs acquisition facilitates the repeatable adherence to a health system’s clinical guidelines for proper BP measurement techniques to achieve more accurate, consistent and reliable BP readings for all patients.
This is evident with the addition of a connected examination chair that can be used to position patients in accordance with AHA and American Medical Association guidelines for proper BP measurement. Caregivers are set-up to easily achieve more accurate, consistent and comparable BP readings.
Short-Term and Long-Term Benefits
Eliminating waste and optimizing BP acquisition delivers a number of short-term benefits. One direct benefit gained when a true resting BP is recorded, which is almost always lower, is that clinicians are more likely to achieve performance goals for the Merit-Based Incentive Payment System (MIPS) score by meeting the quality metrics tied to BP. Other indirect, short-term benefits include fewer labs to review, fewer medication-related issues for patients with questions about their condition, and less time spent by the care team coordinating care and educating patients. Finally, when patients observe their clinical team performing BP acquisition the proper way, in a careful and precise manner, their experience and confidence can support better outcomes.
Long-term benefits offered by this approach are even more appealing. Improper clinical risk stratification of patients results in expensive resource consumption that may be of low value-add to improve outcomes. Opportunity costs associated with low value-add visits tie up room, staff and appointment times that could be better used for sick and acute patients. This could result in patients going to emergency rooms, urgent care or waiting longer to be seen by a clinician, which can result in a worsening of the clinical condition. In other words, with fewer false-positive diagnoses of elevated BP conditions, resources would be freed up to tackle problems for higher risk patients who could benefit from the intervention.
Healthcare organizations continue to use ongoing process improvements to realize significant operational efficiency gains. By taking a similar approach with clinical workflows, starting with BP acquisition, steps can be taken that will help improve clinical outcomes and lower costs.
Thomas D. Schwieterman, MD, MBA, is the Vice President, Clinical Affairs and Chief Medical Officer of Midmark Corporation.