To integrate an auto-notification system into clinical workflow, so timely communication of sentinel events (elective surgery, hospital admission, or ER visit) in immunosuppressed rheumatic disease patients happened by design.
We developed an algorithm that triggered auto-notification within the electronic medical record to rheumatology when a patient experienced a sentinel event. A telephone encounter was created that included event type, baseline therapy, and event date. This was forwarded to the rheumatologist, who recorded guideline-driven recommendations and returned it to nursing. Instructions were included to communicate recommendations to the patient, inpatient rheumatology team, or other clinician. This was studied over four months at a multi-specialty medical practice in Central Pennsylvania. Primary outcomes were percentage of total notifications, notifications by sentinel event type where a change in care plan was recommended, as well as percentage of time where rheumatologists were notified of sentinel events, compared to prior to the intervention. Secondary outcomes were staff work effort.
240 notifications were received - 57% for elective surgeries, 39% for ER visits, and 4% for admissions. The need for change in care plan was only 17% for ER visits but was 25% for hospital admissions and 44% for elective surgeries. The percentage of time rheumatologists were notified of events increased from 57.6% to 100%. The average number of messages received per week was 2.2, requiring a weekly average of 13 minutes of work per physician.
We developed an easy, well-received process that "hardwires" rheumatologist notification sentinel events to facilitate timely care.