Barnes-Jewish Medical Center – St. Louis, MO
As the largest hospital in Missouri, Barnes-Jewish Hospital at Washington University Medical Center has been delivering exceptional quality care since 1996 when The Barnes Hospital and the Jewish Hospital of St. Louis merged. Ultimately, BJC HealthCare was formed which is one of the nation’s largest health-care organizations. Currently, BJH has 1,167 staffed beds, and perform 1,200 to 1,500 PCI procedures annually. They have been on the U.S. News and World Report honor roll of America’s Best Hospitals for 24 years and were ranked#15 in the Heart and Vascular Program in that same report.
In keeping up with traditions of delivering exceptional quality care, BJH recognized that by risk stratifying their patient population they could better support treatment decisions and improve patient outcomes. As part of the shift to delivering precision medicine, BJH implemented ePRISM in 2013, and have been improving results in their cath lab since. By incorporating the ACC’s certified risk models through the ePRISM platform, Barnes Jewish hospital saw improvements in several areas including reduced PCI bleed rates, reduced acute kidney injury, and reduced rates of inappropriate PCI’s. Barnes also implemented a same-day discharge program based on patient’s risk factors and collaborative decision making, that has lead to extreme cost savings.
A combination of physician commitment and implementation of ePRISM helped BJH build a more patient-centered approach to healthcare, which has significantly reduced complication rates, improved revenue, and created a foundation for value-based care. Read more about their success below.
When implementing ePRISM, Barnes-Jewish Hospital customized the eLUMEN output screen to include their own protocols based on risk. By providing a treatment pathway based on a patient’s risk, health systems can more accurately ensure proper treatment and resource utilization. For Barnes-Jewish, it virtually eliminated the risk-treatment paradox and helped the team improve outcomes, cutting bleeding and AKI events by more than half.
The example in figure 1 shows an ePRISM output screen similar to the output screen at Barnes-Jewish hospital. These outputs are displayed on the boom in the cath lab during the procedure to assist in real-time decision making, to ensure high-quality care.
By implementing a contrast limit based on risk, acute kidney injury rates steadily decreased over time. AKI events can lead to unnecessary and damaging costs to a health care system, specifically under bundled payments. Since implementing this strategy, Barnes has positioned themselves very near the top 90th percentile and are prepared to succeed in value-based care.
Similar results were seen in PCI bleeding events. If the patient has a high risk for a bleed, Barnes-Jewish protocol suggests recommended bleeding avoidance strategies. By displaying the patient’s risk factors on the screen during the procedure, decisions can be made in real-time to assure the patient receives the highest quality care and avoids complications.