Cedars-Sinai Medical Center

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A BI-WEEKLY PUBLICATION FROM THE CEDARS-SINAI CHIEF OF STAFF Feb. 15, 2013 | Archived Issues

Update for Physicians: Monthly Improvements to CS-Link

Earlier this month, several improvements were added to CS-Link™. This document highlights the key improvements providers will benefit from and experience with these additions.

Expansion of the CS Medicine RBC Transfusion Advisory Pilot

A new advisory pilot began in December in 4SW and 4SE and is being expanded housewide except for ED, OR, and Procedure Areas.

The advisory displays if a packed red blood cell (pRBC) transfusion is ordered on a patient whose most recent hemoglobin is greater than seven (or greater than eight, for patients with cardiovascular disease documented on the Problem List), or if no hemoglobin results are available within past three days.

The most recent hemoglobin and hematocrit results, and a link to blood transfusion guidelines will be displayed in the advisory.

Refer to Job Aid CCST 0022 for more detail around this advisory.

This improvement:

  • Enables providers to adhere to best practice guidelines
  • Enhances patient safety by encouraging judicious use of blood transfusions

Expansion of Duplicate Lab Order Advisory

CS Medicine and the Lab Department have identified commonly ordered labs that generally should not be ordered more than once a day. About 200 labs were identified initially. An additional 140 labs have been identified for use of this advisory to alert providers if one of these labs has already been recently resulted when ordering.

The advisory has already been in place for labs such as CBC, CMP, BMP, lipid panels, HbA1C and hepatitis C viral loads. The advisory fires if you try to order one of those tests within eight hours of a prior one being completed.

This improvement will:

  • Enhance patient safety
  • Improve patient satisfaction (fewer sticks)
  • Reduce lab costs

Duplicate Neuro Imaging Advisory

CS Medicine and Radiology would like to reduce unnecessary imaging orders by expanding the use of the duplicate procedure advisory to include CT Brain and MRI Brain orders.

An advisory will fire on any patient located in the 4NW Stroke Unit when a physician attempts to place any CT Brain or MRI Brain order that has already occurred within the past 24 hours.

This improvement will:

  • Reduce costs
  • Provide an opportunity to intervene proactively before a duplicate order is placed and potentially reduce callbacks from Radiology and Nursing

New Consult to Patient Relations Order

A consult to patient relations order will be added in production in February.

When this order is placed, patient relations will be notified via an in-basket message that can be seen by users in the patient relations pool.

This improvement:

  • Enhances communication between providers and patient relations.

Improvements specific to Emergency Department

  • Releasing 30 additional Notewriter HPI Smartforms to make additional HPI templates available
  • Modifications to the Existing Patient Summary Report:
    • Following the CS-Link upgrade in October, the ED Orders section started to display Override Cabinet Pulls for medications removed from the Pyxis.
    • Since ED is not set up for Pyxis overrides, the display of these orders were represented as duplicates; this issue has been resolved.

Other general changes to CS-Link

  • Platelet Advisory Pilot: CS-Medicine is creating an advisory to notify users that they may be ordering an inappropriate platelet transfusion. This advisory is in accordance with the platelet transfusion guidelines outlined by the CS-Medicine Transfusion Committee and will be piloted on 4SW, 4SE and 4NW (neuro).
  • Expansion of Inter-facility Transfer Workflow: For ISP patients on any Med Surg floor (with the exception of 7SW), nurses will now document the Inter-Facility Transfers to accepting facility using the Inter-Facility Transfer template, located within the Discharge Navigator.
  • Malignant Hyperthermia Banner: Anesthesia recognized a need for an order for "Malignant Hyperthermia" which would generate a patient summary banner similar to the "Difficult Airway" order.
  • Changes to Pneumococcal Vaccine Screen: Changing the custom list options for Pneumovax Indications to "Chronic heart/lung disease, renal disease, metabolic disease (i.e. D.M.), or prior splenectomy" and Removing thyroid problems as an example for metabolic diseases as it is not a CDC or TJC indication.
  • Ultrasound Guided IV Insertion Order Inactivated: Order was specific to the procedure center.