In the United States, adverse drug events significantly contribute to hospital readmissions and are the leading cause of preventable patient harm that cost almost $3.5 billion every year. More than half of adverse drug events are preventable and can improve patient safety, health outcomes, patient experience and even save costs.
“Nationally, adverse drug events have been a focus of innovation programs such as the Hospital Engagement Network/Hospital Improvement Innovation Networks,” said Dr. Manjula Julka, vice president, clinical innovation, at the Parkland Center for Clinical Innovation in Dallas.
“Adverse drug events have been one of the most difficult areas to address and drive meaningful, sustainable improvement across the thousands of HEN/HIIN participants,” she said.
For timely identification and intervention, progressive hospitals began to engage pharmacy teams to offer a consult service, but few patients were being referred. The pharmacy teams were spending most of their time trying to identify high-risk patients instead of being able to focus on evaluation and intervention.
“To score a patient’s level of risk, PARADE captures a patient’s medical history, including medications and disease complexity, prior healthcare utilization, demographics and social determinants of health.”
Dr. Manjula Julka, Parkland Center for Clinical Innovation
“At Parkland, to increase the consult and intervention volumes, the pharmacy team built a homegrown, rules-based way of identifying hospitalized patients in addition to referrals from staff physicians,” Julka explained. “The program ran for a year. High-risk patients benefited by averting preventable adverse drug events, reducing length of stay in hospital and cost, but somehow this homegrown formula was also picking up a lot of low-risk patients as well.”
Parkland Hospital is a resource-crunched, safety net hospital that serves mainly under-insured and under-served populations with complex medical and socio-economic needs. It had only two pharmacy techs to support the program for more than 80,000 inpatients yearly and the more than 200 new admissions daily.
“It became obvious that the program was promising, but high-risk patient timely identification needed to be redesigned,” Julka said. “Simultaneously, some of the real-time predictive technology solutions were propelling other workflows and demonstrating success at this hospital. So, this intersection of constraint and collaboration with the Parkland Center for Clinical Innovation became an opportunity for creativity, resulting in a technology solution called PARADE.”
The Parkland Center for Clinical Innovation developed a predictive algorithm that identifies in real time which newly hospitalized patients may be at high risk for a preventable adverse drug event and help facilitates timely, pharmacy-led interventions to improve safety and outcomes.
“So if a pharmacist can do 8-14 consults a day, then this model can help them identify the right patients for the right care at the right time,” Julka noted. “Moreover, the hospital’s IT team collaborated to help integrate this risk score seamlessly into pharmacist’s view and we also provided top three variables and reasons contributing to increased risk just by hovering on the color-coded risk score (red/green/yellow).”
Pharmacists loved this sneak-peak feature that helped them save time and accommodate more consults, she added.
MEETING THE CHALLENGE
Designing a thinking framework and close collaboration with the pharmacy team from idea to implementation and beyond has been a key to success in addressing the problem, Julka said.
“I partnered with my data scientist colleague for the customer journey mapping exercise prior to an ideating session and that was very powerful,” Julka said.
“Numbers and data suddenly became meaningful in the contextual framework for the technology team,” she explained. “Open communication, quick iterations and testing new prototypes on historical data and subsequently real-time in silent mode before go-live were key to success.”
PARADE screens all adult patients at the point of hospitalization and flags high-risk individuals who can benefit from pharmacist intervention. The pharmacy team can see in their worklist which patients to consult first in addition to the doctor’s request. Due to the accuracy of the model and its help in making the pharm-tech effective and efficient, this is now a standard practice for daily operations.
“To score a patient’s level of risk, PARADE captures a patient’s medical history, including medications and disease complexity, prior healthcare utilization, demographics and social determinants of health,” Julka explained.
PARADE has helped prevent more than 2,000 adverse drug events for hospitalized patients, delivering a potential savings of more than $17 million by reducing readmissions and eliminating adverse drug events, Julka reported.
“During its two years of implementation at Parkland, the PARADE program has screened more than 87,000 patients, with 8,731 high-risk patients identified,” she said. “Of the high-risk patients, 16% received timely pharmacy intervention and more than 2,000 adverse drug events were prevented. For high-risk patients receiving a consult, the 30-day readmission rate was cut by 23.5%.”
ADVICE FOR OTHERS
“Technology solutions can only be as good as the users,” Julka advised. “It needs to be seamlessly integrated within existing workflows to be adopted successfully and for sustainability. In this case, it meant integration within the Epic EHR. Human-centered approach during development with end user input and patient impact were instrumental in sustained success since go-live two years ago.”
Staff continues to collaborate through listening, monitoring, analyzing and bilateral shared learnings, she added.
“Healthcare is at the brink of digital revolution,” she stated. “Physicians and patients are demanding more and more human-centered technology solutions like other more advanced industries: banking, airlines, etc. Whether predictive analytics or artificial intelligence or telehealth. Key elements should be front and center of every innovation: practical, impactful, ethical and secure.”
Technology and advanced analytics are not the complete solution, but enablers: Technology innovations have big responsibility to provide reliable solutions for doctors, nurses, pharmacists and community partners to empower better clinical decisions and engage every patient, she concluded.