Epic Optimization and Reporting

Integrates and translates nursing science in the adoption and innovation of technologies and analytics to drive and improve patient outcomes, care efficiencies and staff well-being.

What We Do

The Epic Optimization Reporting services yield a collaborative endeavor to facilitate an optimal user experience that enables the achievement of Stanford Health Care’s priorities and goals. Services include advising, consulting, and education on clinical informatics-related topics, providing analytics solutions and feasibility, building documentation tools clinicians love, and implementing Epic Optimization and external reporting.

Informatics Tools

Guiding Principles to Enhance/Change:

Guide care to enhance quality and safety, compliance, and patient experience
Add value and generate meaningful and useful information to create and capture evidence-based practice
Create a seamless workflow by generating a meaningful or necessary alert/response by another team member
Add value by creating a meaningful report that will enhance quality care and patient experience
Necessary for external reporting, regulatory compliance, billing or will it boost the organizational financial strength
Is nursing staff collection and entry of the information the best or only way to capture the information?

Nursing Design Principles

Workflow Analyzer

Used to compare efficiency by measuring clicks, keystrokes, screen-switches, and keyboard-mouse transitions.

It uses Keystroke Level Modeling (KLM) which is an industry standard technique in Human-Computer Interaction (HCI) for measuring the time needed to perform the mechanical actions in a workflow.

Nursing Analytics & Reporting 2022 Highlights

In 2022 the Nursing Analytics team completed 455 requests. The graph illustrates the breakdown of request types completed.

Some notable projects for 2022 that nursing analytics partnered with to support improved process, outcomes or efficiencies with data are:

-Pressure Injury Prevention for Tracheostomy Patients

-PRN Pain Meds Given per Indication

-Swallow Screening Optimization

-Nursing Workload Acuity Analysis

-Central line-associated bloodstream infections (CLABSIs) and central line utilization rates.

-HAPI data inquiry

-Falls Event Reporting

A goal of Nursing Analytics is to foster collaboration across all roles in the health care delivery teams, as this is essential for optimal patient outcomes. One example of such collaboration is the partnership with Specialty Practice Nursing to address the issue of HAPI events. HAPI stands for hospital-acquired pressure injury, which is a serious complication that can affect patients' quality of life and increase health care costs.

Together, Nursing Analytics and Specialty Practice Nursing developed a dashboard that allows them to monitor and track HAPI events, as well as to identify possible factors that contribute to them. One of the insights that they gained from the dashboard was that device-related HAPIs were more prevalent than other types of HAPIs, especially those caused by respiratory devices, arterial lines and orthosis devices. Chungmei Shih, DNP, Director Specialty Practice Nursing, and her team, used insights gathered from this data to implement interventions and best practices to prevent and reduce device-related HAPIs.

Some key interventions base on the insights:

•RT Gecko Pad trial completed, will implement house-wide to prevent Bipap mask-related HAPI

•OPL for management of orthosis devices

•Arterial line HAPI prevention

•Hovermat to Hoversling conversion

By the end of 2022, they observed a decrease in device-related HAPI events from 47 HAPI sites to 34 HAPI sites.

Building Tools Clinicians Love

The Observation Navigator

Objective:

Build care-focused documentation tool for Observation patient populations.

This project was led by one of our bedside staff from the Observation unit, Vi Van Nguyen, MSN, RN, CMSRN, Clinical Nurse IV, and now Unit Educator. With a very close guidance from our Informatics Nurse Specialist and highly supported by the unit leadership.

This approach is highly encouraged being a Magnet organization to promote and build staff to transformational leadership.

Staff Satisfaction

A priority outcome when developing or redesigning documentation, is have a happy end-user that will ultimately use the tool.

Studies have shown that EHR satisfaction and success was associated with job satisfaction when involving the end-user in the design and development process.

Building Tools Clinicians Love

The Swallow Safety

Objective:

Update and optimize swallow screen documentation workflow to align with clinical practice.

This project was led by one of our bedside staff from L5, Neuro/Stroke Unit, Noah Wachtel, BSN, RN, PCCN, Clinical Nurse IV. He is one of our Epic Optimization Coordinators, a frontline staff that is passionate in optimizing documentation tools clinicians use.

Figure 1. Represents pre-implementation task duration a staff would take to finish the swallow screen workflow. Whereas Figure 2, shows the dramatic reduction of the workflow duration post implementation of the optimized tool.

Building Tools Clinicians Love

Code Narrator Optimization

Objective:

Optimize and use Epic Code Narrator to document code events. Eventually retire the paper form documentation.

Led by Nursing Informatics Sr. Program Manager, Heidi Fronda, a team of bedside staff across the care areas, TDS analyst, Epic Educator, and Response Team gathered, reviewed workflows, identify requirements, and designed the tools that staff will use and be happy about.

To ensure efficiency, accuracy, and timeliness of code documentation during a code event, this Epic tool is undergoing an optimization and is now being piloted by Response Team and Emergency Department.

With Medical Emergency Response Committee (MERC) guidance, this optimization was established to improve and promote data elements relevant to the Get with the Guidelines (GWTG) regulatory and Advanced Cardiac Life Support (ACLS). Establishment of a real-time data capture during a code event promotes shareable information that guides the clinical team in their care during this life-threatening emergencies.

Image: Epic Educator, Ivan Canarecio, Sr. Clinical Informatics Analyst Aubrey HageMann, provided training on the Code Narrator to a group from of the Response Team that provided a real-time “iron out the kinks” workflow for the tool to be effective.

Submitted by:

Moses Albaniel BSN, RN Manager, Nursing Analytics & Reporting

Darvin Antonio, MSN, RN-BC, CPHQ Manager- Nursing Informatics

Thank you to the Epic Optimization & Reporting department for your ongoing exemplary professional practice and for sharing your Epic expertise as you work diligently to optimize workflows and implement electronic innovations for nursing!