Sourcebook : 10.3 Systems That Help Manage Improvement : 10.3.3 Case Study - VITAS Healthcare

Patients in the hospice system operated by VITAS Healthcare of Miami self-report pain in an automated record-keeping system that clocks visits to patients by physicians, nurses, home health aides, and social workers. Although the computerized system does not replace paper medical records, it does serve as a real-time tool for tracking and changing patient care.

Teams use the Missoula-VITAS Quality of Life Index to track patient-reported information on five dimensions of experience: symptoms, functional status, interpersonal relationships, emotional well-being, and transcendence. A patient might categorize pain at a level 2 or 3; however, the team might notice during the chart review that after the patient is bathed, pain scores jump to a 6. The team would then work with the patient to take additional medication an hour before the visit.

Using the system, staff can respond quickly to patient and family needs. Each team, which includes about 12 employees assigned to 40 to 60 patients, has almost instant access to patient records. Using electronic links to local vendors, staff can quickly order medications, durable medical equipment, and so on. Similarly, when a patient dies, the system faxes vendors to pick up equipment from the patient's home, a process that saves families the burden of making such arrangements.

The computerized system now contains approximately 100,000 records and, at any given time, is tracking almost 5,000 active records. VITAS uses the data to examine severity of illness, admissions and deaths, patient demographics, staff turnover rates, staffing ratios, length of visits and stay, the diagnostic mix of patients in a team, and continuity of care.

The information is reported in easy-to-read charts to the right, displaying patient status and progress.

Employees who visit a patient can either phone in data about the visit (including information for their own time sheets) or enter it via keyboard. Phone-in reports are usually done the day of the visit and can track clinical data such as pain severity. Other reports, such as bereavement visits, are usually entered into the computer within a week of the visit.