The Center for Evidence-based Practice (CEP) leads the integration of the best available evidence into institutional decision making, with the goal of strengthening the quality, safety, and value of care for patients. CEP’s multidisciplinary team includes research analysts, clinical liaisons, librarians, and administrators who collaborate to perform systematic reviews, translate evidence into practice contributing to the design of clinical decision support, and educate staff and faculty on evidence-based practice in domains across the health system.
CEP uses applied health informatics to help clinicians provide evidence-based treatment at the right moment in care. One example of CEP’s informatics-informed work is in Penn Pathways: evidence-based care algorithms that help physicians make well-informed decisions based on the best possible information on a given topic.
By incorporating the most up-to-date evidence for a particular clinical condition, pathways provide trusted guidance to care providers as they make a diagnosis or decide the next steps in care for a patient.
One of the 350 pathways CEP has developed reminds providers in hospital settings when a patient’s urinary catheter should be removed or changed. When catheters remain in place for too long, they can cause Catheter-Associated Urinary Tract Infections (CAUTIs). CAUTIs cause unnecessary pain and discomfort for patients and often require treatment by antibiotics. They are also a major quality and safety adverse indicator for hospitals—a high number of CAUTIs is a red flag for other health risks to patients.
The CEP team worked closely with Penn Medicine’s Clinical Effectiveness and Quality Improvement (CEQI) group to identify the problem of CAUTIs and come up with an informatics-informed solution to reducing these hospital-acquired infections. To create this pathway, the CEP team first looked at the evidence on the use of catheters in hospital-based patients to find the optimal time to remove the catheter and prevent CAUTI in a patient.
Next, through a collaboration with the Chief Medical Information Officer (CMIO) and Information Services (IS) teams, they integrated specific advice about appropriate duration of catheter use into the electronic health record, PennChart. This clinical decision support pathway required a provider to specify why the catheter was needed—the indication. Based on the indication chosen, the pathway then alerted the provider to reassess the need for the catheter if it had not been removed within the recommended timeframe. With the pathway in place, 15% of the reminders resulted in the physician ordering the catheter to be removed, and subsequently the number of CAUTIs declined.
The Center for Evidence-based Practice is excited to be involved in the Center for Applied Health Informatics, and is eager to collaborate with other Center groups on high impact health system projects. One goal is that by working together, CEP and the Center can reduce—and someday eliminate—the gap between evidence and practice, an ongoing and as yet unsolved challenge in health care. Their partnership may allow for novel ways to more seamlessly integrate evidence-based pathways into the EHR, in a way that makes following pathway guidance natural and simple for clinicians.
Lastly, the Center may bring about new ways of assessing provider satisfaction and patient outcomes when pathways are used. In so doing, CEP and the Center for Applied Health Informatics can help Penn Medicine move further in its journey toward becoming a High Reliability Organization.