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Increasing e-prescribing may improve hospital metrics

Hospital-wide initiatives and interventions to improve e-prescribing rates of discharge prescriptions led to increased e-prescribing among residents and hospitalists, which may have an impact on hospital metrics like meaningful use, according to recently published data in Pediatrics.

“The present study highlights the importance of engaging front-line providers such as residents and hospitalists in initiatives involving their workflows,” Jennifer Fuchs, MD, of the department of pediatric hospital medicine, Texas Children’s Hospital, Houston, and colleagues wrote. “Although these providers may not be directly eligible for incentive programs, their actions directly affect hospital metrics. Our study shows that [quality improvement] methods can help identify barriers to resident e-prescribing and implement changes to overcome them.”

Before the study, median e-prescribing occurrence was 7.4% on the pediatric hospital medicine service, which is below standards, according to researchers.

They conducted surveys and focus groups of pediatric residents and patient families to determine barriers to e-prescribing. With those data, they generated interventions that included provider education and changes to electronic health record workflow. The goal was to increase e-prescribing rates to 40% (level one standards) within 6 months and sustain it through the following academic year. They compared three periods: a baseline of 30 weeks (July 1, 2014 to Jan. 25, 2015); implementation of the interventions (Jan. 26 to June 28, 2015) and sustainability (June 29 to Dec. 31, 2015).

During the course of the study, 6,148 discharge prescriptions were ordered: 3,430 (56%) were written before any of the interventions were implemented.

An education bundle intervention that included a tutorial presented at a resident conference, prescription resource tip sheets and monthly email reminders, was implemented from Jan. 26 to March 29, 2015 and led to an increase in e-prescribing frequency to 23.4%.

From March 30 to June 28, 2015, EHR interventions were implemented. These included the input of a patient’s preferred pharmacy at registration, updating the EHR for residents to assign an authorizing attending provider, and making e-prescribing the default method of prescription. These interventions led to an e-prescribing frequency to 48.9%, which was sustained over the next 6 months, even after a new intern class began.

Post-hoc analysis showed significant differences between groups, indicating each phase was distinctly different than from the others. There was no difference in e-prescribing occurrence between postintervention and sustainability periods, according to researchers. There was no difference in the occurrence of e-prescribing throughout the study when data from an outpatient resident clinic was scrutinized.

“Residency is a time to teach best practices so residents are better equipped to be independent practitioners (and potentially future eligible providers) upon graduation,” the researchers wrote. “As bedside providers in many institutions, they have a unique and often overlooked perspective about daily care workflows — and excellent ideas on how to improve them,” Fuchs and colleagues wrote. – by Janel Miller

Disclosure: The researchers report no relevant financial disclosures.