Evidence-Based Practice Case Study: Uab's Internal Medical System

On average, the guides took 27 minutes to complete. As the results indicate, Hospital A has not implemented some of the recommended practices in the following guides: Computerized Provider Order Entry with Decision Support, Patient Identification, and Test Result Reporting. The total number of these practices are 16 which accounts for 10% of the total recommended practices. Also, there is a number of practices that has been implemented partially in some areas in hospital A. These practices fall into the following guides: Computerized Provider Order Entry with Decision Support, Clinician Communication, High Priority Practice, Organizational Responsibilities, and system interfaces which account for 11% of the total recommended practices. The only guides that hospital A is fully complied with are Contingency Planning and System Configuration guides. The total number of practices that have been fully implemented across all guides is 125 which represent 79% of the total recommended practices.

Maggie Gill started her career with Memorial University Medical Center (MUMC) in 2004 as the VP of managed care and finance. In 2005, she became MUMC's COO, and then in 2011, she was named CEO and president by the board of directors, once they realized that the ideal candidate for the position, one who had experience in both finance and operations, was already employed by the health care facility.

The physicians will have the role as the promoter; they need to make sure the patients have this information, and they understand what they are reading. The physicians have to be on board and encourage all the staff to support this process change to continue to grow and meet the needs of our patients. The providers are pivotal to this process change because they have the power to help the process along or hinder it. The providers would have a great interest in this project to ensure we are utilizing evidence-based practice and meeting our patient’s needs.

The health coach performs multiple activities that currently require the coach to manual pull data from the electronic medical record, EHR. With this redesigned approach the health coach would no longer complete chart reviews as the EHR that is currently used throughout the clinics have a patient manager section that includes all of the information that is being manual extracted for the chart reviews. Also, instead of the health coach manually pulling data, such as who has been in the ER five or more times in the past year, set up a report that will run automatically on a monthly basis for the coach to review. Finally, the health coach is currently pulling the data on hospital discharges manually on a daily basis. In this process the health coach opens all of the charts of the patients that were discharged the prior day to determine who the patients primary care provider (PCP) is and

Forty-eight consenting patients were drawn from patients admitted to an inpatient medical-surgical unit. Requirements were length of stay of at least 3 days; age 18 or older; medical order for ambulation; oriented to time, person, and place; the ability to leave their hospital room; and able to ambulate with the assistance of up to two people. After the 48 patients were chosen, a computer randomization program selected the patients that would be in the ambulation program and those who would receive usual care. 26 patients were assigned to usual care and 22 were assigned to the ambulation program (Tedore et al., 2016.)

My background includes 10 years of working in a hospital setting. I started out as a unit clerk at Midwest Regional Medical Center and was promoted to Charge Auditor Supervisor during my employment. I was responsible for correcting any mistakes on patient’s charts before the account was sent to the billing department. I gained experience as a clinic representative for St. Anthony Oncology Clinic. I was responsible for scheduling patients for appointments, treatments, and tests; and served as a liaison between patient and all medical staff.

Each hospital or healthcare facility requires that every physician seeking privileges go through an extensive credentialing process before being able to schedule procedures or operations at their facility. Often though, when a physician is consulted, time is of the essence, and in the in-house

Id. Providers who ensure exact descriptions of the level of service performed can prevent level of service coding errors. Likewise, providers should not be careless when linking diagnosis and procedure codes, both need to be present in order to determine if the procedure is medically necessary. Making every effort to code to the highest level of specificity and it is recommended that staff check the alphabetical index of the ICD-9 book for patient’s conditions. Id. Additionally, providers should avoid using signs and symptoms to describe a medically necessary procedure or services provided when the diagnosis is not apparent and the chief medical complaint should always be documented. Id. Determining whether to code the office visit as a consult or a referral can be perplexing for providers. When it is a consulting visit, the patient is normally required to revisit their primary care physician, and if medical care is provided to the patient, the visit is a referral and should be billed as a new patient. Id. The unbundling of multiple component services and billing, intentionally or not, is considered fraudulent or reckless to all payers. Finally, providers should periodically review diagnosis, service, and procedure codes documentation with office

After working in an emergency department for eight years you get to know the “frequent flyer”. These are the patients that come in multiple times a month for either the same thing or a variety of chief complaints. The true reason for their visit is usual non-medical and so they are discharged after there symptoms have been addressed. For this reason they are placed in medical surgical beds in order to conserve resources.

Clinical staff contributed to restrictive patient flow second to subjective treatment routines and subjective diagnostic and discharge patterns. Subjective diagnostic patterns created different workflow demands on Microbiology, Radiology, and Respiratory departments. Because each patient was subjected to different diagnosis, based upon subjective assessments by clinical staff, different patient flow patterns emerged. Simultaneously each shift of clinicians had a varying diagnostic wait time, treatment time, and time to discharge. Thus, the effectiveness and experience of clinical staff is directly related to their speed and accuracy of assessment, treatment, and discharge routines.

Numerous legal issues can surface when scheduling patient appointments. For example, when the initial telephone call is received from a primary care provider (PCP) or specialist’s office, a scheduler must register the patient by creating an electronic health record (EHR) in the health information technology (HIT) system of the healthcare provider where the patient is being referred. This is necessary because healthcare providers are transitioning from paper medical records to electronic health records. EHRs contain the personal demographic information necessary to identify the patient, which improves patient safety and reduces the potential for medical errors, which is a serious issue in healthcare. EHRs are also a convenient, one-stop shop

The physician’s tasks throughout the shift are focused on rounding (seeing patients), and entering patient information into the DC Navigator. The physician starts rounding at the start of the shift.Although the order in which the patients are seen varies depending on the physician, the sickest patients generally have the highest priority. In between morning rounding, generally at a time between 8:45 AM to 9:15 AM, the MFH physician meets with one of two discharge planners and a social worker for an average of 19 minutes to discuss the discharge and overall status of all the patients assigned to them. The physician continues rounding until all of the patients are seen. Before seeing each patient, the physician does some, none, or all of the

Evidence based medicine is utilizing the most accurate and current scientific research to guide the case management of clients in conjunction with the clinical experience of the treating practitioner. It also takes into account the patients individual circumstances, their treatment expectations, viewpoints, values and choices.

As many know there is a difference between inpatient facility and a physician’s office. First notable difference it the type of care that is provided and the setting in which care is provided. In addition to the level of care provided there is a difference in the paperwork and the names of the paper work are different (Gartee, 2011). Although there is a difference in the names of the documents used to collected medical information this information is essential to both care providers within outpatient and inpatient settings. They need to use this information to make management decisions in how they will proceed in providing patient care (Bhatia, 2015).

When I took part in an externship at Texas Health Presbyterian Hospital at Dallas during my junior year, I was fascinated by the hospital’s ability to care for patients in light of spiraling costs in healthcare. In the back of my mind, I began to wonder: How do clinical settings operate on a daily basis? What administrative factors diminish the quality of care for patients? Questions such as these inspired me to further my knowledge of healthcare delivery as a graduate student at Cambridge University.