优化使用电子病历系统,提高血液透析质量:回顾单个中心的经验。

Noémie Laurier, Jorane-Tiana Robert, Alexander Tom, Jerrica McKinnon, Nancy Filteau, Laura Horowitz, Murray Vasilevsky, Catherine Weber, Tiina Podymow, Andrey V Cybulsky, Rita S Suri, Emilie Trinh
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引用次数: 0

摘要

导言:血液透析终末期肾病患者管理的复杂性凸显了实施质量改进(QI)计划以提高患者安全和优先考虑以患者为中心的护理的重要性。为此,我们在三级学术中心成立了质量改进委员会,重点关注循证实践、以患者为中心的方法和成本效益。为了促进 QI 计划的顺利实施,我们充分利用了电子病历系统(EMR)的功能:本综述详细介绍了优化使用 EMR 系统以成功实施 QI 的有效策略。根据我们的经验,我们提供了可应用于其他 EMR 的详细描述和实用见解:创建一个安全、可访问的仪表板,提供有关质量指标的实时数据,是最显著的特点。该仪表板通过一种算法,将透析和医院 EMR 系统中的数据合并在一起。它的主要目的是简化高优先级患者的识别,加强团队沟通,促进质量指标的跟踪。此外,我们还将临床路径、核对表和标准化协议整合到肾脏 EMR 中,以确保质量改进干预措施的顺利实施。这些干预措施的显著例子包括增量血液透析方案、新的血液透析启动核对表、疫苗接种护理计划和个性化肾移植工作检查。事实证明,程序化的电子自动提醒在确保及时跟进指定任务方面非常有价值。此外,电子医疗记录仪还能根据特定药物类别生成病人名单,从而有助于优化用药和取消处方。最后,EMR 能够迅速生成具有特定特征的病人名单,这极大地促进了有针对性的 QI 干预:利用电子病历系统的功能对于加强血液透析患者的护理和实施有效的质量改进措施至关重要。
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Optimizing use of an electronic medical record system for quality improvement initiatives in hemodialysis: Review of a single center experience.

Introduction: The complexity of managing patients with end-stage kidney disease on hemodialysis underscores the importance of implementing quality improvement (QI) initiatives to enhance patient safety and prioritize patient-centered care. To address this, we established a QI committee at our tertiary academic center focusing on evidence-based practices, patient-centered approaches, and cost efficiency. To facilitate the seamless implementation of QI initiatives, we leveraged the capabilities of our electronic medical record (EMR) system.

Methods: This review details effective strategies for optimizing use of an EMR system to successfully implement QI efforts. Drawing from our experience, we provide detailed descriptions and practical insights that can be applied to other EMRs.

Findings: The creation of a secure and accessible dashboard, offering real-time data on quality metrics, stands out as the most notable feature. This dashboard operates through an algorithm that merges data from both our dialysis and hospital EMR systems. Its primary objectives are to streamline the identification of high-priority patients, enhance team communication, and facilitate tracking of quality indicators. Additionally, we integrated clinical pathways, checklists, and standardized protocols into the renal EMR to ensure smooth implementation of QI interventions. Notable examples of these interventions include an incremental hemodialysis protocol, a new hemodialysis start checklist, vaccination care plans, and personalized kidney transplant workups. Programmed electronic automatic reminders have proven invaluable in ensuring timely follow-ups of assigned tasks. The EMR has also contributed to medication optimization and deprescribing by generating patient lists based on specific medication classes. Finally, the EMR's capability to swiftly generate lists of patients with specific features has significantly facilitated targeted QI interventions.

Conclusions: Leveraging the capabilities of an EMR system can be crucial for enhancing care of hemodialysis patients and implementing effective QI initiatives.

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