UAE Ministry of Health and Prevention - Excellence in Innovation in Government
Company: Ministry of Health and Prevention
Company Description: The UAE Ministry of Health and Prevention is responsible to enhance community health by providing comprehensive, innovative, and fair healthcare services as per international standards, and performing its role as a regulator and supervisor of the healthcare sector in the UAE. The Ministry vision is to have an effective and sustainable Healthcare System for a happy society.
Nomination Category: Company / Organization Categories
Nomination Sub Category: Award for Excellence in Innovation in Government - Organizations with 100 or More Employees
Nomination Title: Stroke Golden Hour
Background
The stroke patient journey is complex, which begins from ascertaining patient eligibility, then guiding the care provider to order relevant Lab tests, CT Head, ECG and other interventions. All the above should ideally be achieved within 60 minutes of patient’s arrival to the ED (recommended standard).
As this process is highly protocolized, a health IT solution was required which will guide clinicians to provide this urgent care in a safe way and as per clinical evidence. The aim was to save as much time as possible by automating most of the workflow and standardizing the stroke pathway. This initiative falls in line with the ministry’s strategy to provide comprehensive and innovative healthcare services, develop health information systems, and implement evidence-based patient safety standards. Moreover, it serves the UAE national agenda indicators in reducing Cardiovascular Disease Mortality by 25% by 2021.
Aim
The Hospital Sector division at the Ministry of Health & Prevention, UAE (MOHAP) desires to utilize Clinical Analytics, Clinical Decision support and Evidence Based Medicine in reducing the morbidity and mortality from Ischemic stroke. Our objective was to save as much time as possible by automating most of the workflow and standardizing the Stroke pathway which include pre-Hospital phase, In- Hospital phase and Post discharge phase. This would be achieved by establishing new, innovative Stroke IT solution that is patient centered, evidence based, efficient and cost effective. we decided to Build the solution inside the electronic medical record as an agent for change and instrument of support for physicians to provide this urgent care in a safe and timely manner.
Method (IT Solution)
Our team put together a carefully choreographed solution for maximum impact, maintaining utmost standards of Patient Safety. After studying evidence-based practice guidelines, performance indicators and best practices, we managed to propose workflow changes, system configurations and other technical aspects which helped us streamline the process. We then used techniques of Clinical automation and allocative efficiency (shifting some reparative tasks from physicians to Nurses) to create overall agility and efficiency in the workflow. Finally, application of Lean thinking allowed us to remove duplicate or non-essential steps from the workflow with the sole aim to reduce door to needle time.A comprehensive analysis of current state and workflow was carried out by Stroke committee in order to develop evidence-based Stroke workflow.We used EMR functionality and solutions to cover the flow of events after a suspected stroke patient contacts the ED.
Innovative Ideas in the solution:
-Pre alert Stroke notification and EMS system integration into EMR
-Automated Clinical Rules to order laboratory investigations as well order Urgent CT Head
-System adding appropriate diagnosis on patient record.
-21 point Check list, which looks back into patient record and highlight contraindication to thrombolysis.
-Pre-agreed therapy plans for Thrombolysis developed with Pharmacy department.
-Auto Calculation of required dosage.
-Translate clinical evidence-based guidelines into computer understandable binary logic.
-Introduction of VR assisted physiotherapy solution for stroke patients
Results
As a result of this implementation, we were able to achieve a reduction in door-to- needle time from an average of 94.2 minutes to 52.76 minutes (43% reduction) across all MOHAP facilities. In addition, post implementation results showed 46% reduction in door to CT time and 59% reduction in door to ECG time. The first pilot hospital (Obaidallah) has achieved remarkable reduction in Door to needle from 70 min to 30 min. In addition, Obaidallah hospital won the ESO angel awards – Platinum and Diamond category for achieving excellence in stroke care. Facilities Thrombolyzed Twice as number of Patients due to increased screening and were able to achieve >85% compliance of all Stroke Measures set by World Stroke Organization. This is a significant contributor towards reducing mortality & morbidity due to stroke