Clinical Redesign: MRSA Optimization

From the 2019 HVPAA National Conference

Ms. Crystal Clemons (Yale New Haven Health), Dr. Sonali Advani (Yale University), Mr. Michael Aniskiewicz (Yale New Haven Health), Dr. Brittany Branson (Yale University), Ms. Piper Brien (Yale New Haven Health), Ms. Cheryl Brophy (Yale New Haven Health), Ms. Suzanne Dahlbery (Yale New Haven Health), Ms. Michelle DeWitt (Yale New Haven Health), Ms. Iyanna Fairweather (Yale New Haven Health), Ms. Ann Marie Figoras (Yale New Haven Health), Dr. Alana Hall (Yale New Haven Health), Ms. Jodi Katz (Yale New Haven Health), Dr. Marie Landry (Yale New Haven Health), Dr. Richard Martinello (Yale New Haven Health), Mr. Robert Malone (Yale New Haven Health), Ms. Maureen Owen (Yale New Haven Health), Dr. Vivek Parwani (Yale University), Dr. David Peaper (Yale University), Mr. Thom Saxa (Yale), Ms. Emily Scarpetti (Yale New Haven Health), Mr. Mark Sevilla (Yale New Haven Health), Dr. Marc Shapiro (Yale University), Ms. Linda Sullivan (Yale New Haven Health), Dr. Andrew Ulrich (Yale University)

Background

Previously diagnosed MRSA patients are not being re-tested for continued presence of MRSA upon subsequent arrivals to the Emergency Department (ED).  As such, many patients continue to be placed on unnecessary contact precautions.

Objective

In an effort to improve the value of care delivered to patients, a Clinical Redesign team was created to focus on removing MRSA contact precautions from patients who were inappropriately designated as requiring continued precautions.

Methods

The team focused on the following interventions to in order to achieve their objective: 1. Developed reports to identify the MRSA isolation population, 2. Implemented new criteria/policy for MRSA testing (Infection Prevention intervention prior to this project), 3. Implemented 24/7 ability to remove contact precautions (Partnership with Bed Management), 4. Implemented Epic Utility, 5. Implemented use of rapid MRSA testing, and 6. Create a best practice alert (BPA) to fire for remaining MRSA isolation patients within the ED upon inpatient admission. The BPA encourages providers to order the rapid MRSA test to assist with proper contact precaution status and bed placement.

Results

Prior to the Epic Utility, there were over 17,000 patients with a MRSA isolation reason attached to their medical record. Upon review of reports created by the Joint Data Analytics Team, the project team was able to identify over 8,000 patients who no longer met criteria to have a MRSA isolation reason. The Utility was executed and a total of 8,162 patients were removed from MRSA isolation. Since the Utility was run, an additional 3,474 patients have been removed from MRSA isolation.

Conclusions

Through a series of specific interventions the team was able to significantly reduce the number of patients with MRSA precautions, allowing for more accurate medical records. The rapid MRSA test also has potential to improve ED LOS and allow for appropriate bed placement.

Clinical Implications

The collaborative work of this project team can be leveraged for other populations and isolation reasons across the Health System to ensure accurate patient information within our electronic medical record. The project directly reduces environmental waste and personal protective equipment expenditures.

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