Healthcare System Leverages Tech Innovation to Improve Patient Care

By Matt Phillion

Phoenix Children’s, one of the largest pediatric health systems in the U.S., has developed a culture of building innovative programs that enhance and improve patient safety efforts across the system. Recent developments include:

• The Phoenix Children’s Clinical Nurse Attending Program, which places seasoned nurses in supervisory consulting roles to help identify and address issues as early as possible
• WATCHER, a digital surveillance program that uses a predictive algorithm and patients’ EMRs to alert clinicians when a hospitalized child is at risk of deterioration, allowing providers to escalate care before an emergency arises and ensuring their most vulnerable patients receive the care they need quickly
• A malnutrition app developed in-house that uses an AI-driven algorithm to sift through hospital medical records to identify and flag pediatric patients who are at a high risk of malnutrition

“A core value of our leadership team is that our people have the freedom to explore and be innovative,” says Dr. Kelly Kelleher, Chief Quality and Safety Officer and Associate Chief Medical Officer with Phoenix Children’s. “That’s evident in the fact we have clinicians in this organization who are also experts in technology, which helps bridge the gap between the technology piece and the clinical piece.”

Having those dual experts makes it easier to reach those staff and leaders who can help bring those new, innovative ideas to fruition, explains Kelleher.

“Phoenix Children’s is a fairly young health system, but we have grown significantly to meet the needs of this fast-growing community. We’ve had to be nimble,” explains Kelleher. “If we didn’t have a process or solution for something clinical, and technology could help, our team has moved quickly to create it.”

That nimbleness has allowed leadership and technology to move quickly, Kelleher says.

“We’ve had some setbacks, but we never lost that continuous improvement mentality, so we have been able to work through those to really improve the safety and care of our patients as well as our communication and implementation processes.”

Choosing the right targets for improvement

Phoenix Children’s takes a risk-based approach to look at areas that have the potential for the most harm, or where harm is occurring most frequently, when determining where to put effort into technological improvements like these, Kelleher explains.

“Before developing the WATCHER dashboard and the Clinical Nurse Attending program, we had been concerned about sepsis. We wanted to intervene sooner to prevent sepsis and ensure the safest outcome for our patients,” she says. “We analyzed five years of data on clinical deterioration and identified the point of their care that would be the best time to catch their deterioration so we could intervene.”

Today, the Clinical Nurse Attending Program has 12 clinical nurse attendings working across all major hospital departments, including the ED and neonatal intensive care unit.

“One solution that has worked well to address sepsis is the clinical nurse attending program, which places highly skilled nurses in our units with the main responsibility of advocating for the patients,” says Kelleher. “These roles are solely patient-facing, and we designed their days to identify the sickest patients, visit them first, interact with the care team, and continue to escalate as needed to make sure the patient stays safe. These nurses are in a unique position to interface with our executive team and they have the support to escalate concerns until they get the response they need.”

Meanwhile, since implementing the WATCHER digital surveillance system, Phoenix Children’s has identified more than 200 children in need of a higher level of care, prompting their immediate transfer to the ICU. Clinical teams are intervening more than 50% of the time following an alert, and there has been only one preventable code event in the organization’s acute care units since implementation.

“It’s a tiered alerting system. As patients become clinically less stable, WATCHER alerts the bedside staff, operationalizing a different response around each tier. As the patient deteriorates clinically, the responses become increasingly intense,” says Kelleher. “Initially it brings a nurse and clinical supervisor to the bedside, then an attending, and finally a rapid response team with critical care expertise.”

Tech’s direct role in safety

Additionally, Phoenix Children’s looked for ways to work with their information technology team to improve care. This is where their AI-driven malnutrition app came into play. Of the pediatric patients flagged by the app as at risk for malnutrition, between 60% to 80% of those patients were positively diagnosed with malnutrition after a nutritional consult and were immediately put on a treatment plan.

“We scan the EHR for growth data, and with the details we get, such as height, weight and information from nutritionists. The malnutrition app has identified numerous patients who were malnourished who might otherwise have flown under the radar,” says Kelleher.

Choosing which areas technology additions can help is a group effort, Kelleher says.

“We’re still on our journey. Since we started out 40 years ago as a small community hospital, relationships have been critically important to our organization. We’re now a quaternary health system, but we still have that small-town feel where everyone knows everyone, and that’s been really helpful as we value local champions,” says Kelleher. “If you see a problem, speak up, and if you have an idea to fix it, even better.”

Leadership is embedded in the units and ask questions and encourage curiosity around ways to overcome daily obstacles.

“If you are interested in creating change, our leadership is eager to listen to and act upon ideas from frontline staff,” says Kelleher.

She relates a story during Quality Day, Phoenix Children’s annual day to celebrate quality improvement work across the system. The health system’s chief medical information officer attends every year, and not long ago an ICU physician was presenting on cardiac arrest and outcomes data. That IT leader was in the audience, stood up during Q&A and said: “I can help with that.”

“In less than 18 hours he created an entire dashboard to pull data elements for their project to make it easier for that team to review, survey, and learn from their data,” says Kelleher. “We are so fortunate that our culture encourages a willingness to engage with us to develop innovative tools that improve patient care.”

In a world where healthcare organizations are constantly pitched new technology, having a strong IT department who know the tech well and can innovate can go a long way, says Kelleher.

“We’re able to develop a lot of the technology we need on our own and design it in a way that is most effective for our patient population. WATCHER is a good example of that,” she says.

Another example is an app that allows for at-home monitoring for patients with cleft lip or palate.

“We feel strongly that children thrive in their routine. Since many of our patients live an hour or more away from us, one of our plastic surgeons spent a lot of time developing an app that allows patient families to enter data at home that we can track,” Kelleher says. “That means kids can thrive at home in their routine, but also allows us to quickly learn, for example, if a child is falling off their growth chart and needs to come see us sooner.”

This is not to say that the organization hasn’t partnered with technology vendors on occasion, but they feel very fortunate that they have the skill and expertise in house to do things locally.

“We’re very mindful about determining the true value of an app or dashboard before introducing new tech,” says Kelleher.

To find success, multidisciplinary collaboration is key, Kelleher notes.

“Building those relationships and having transparency around what is working and what is not is extremely important,” she says. “We try to have good collaboration, be very transparent, be inquisitive, and also be quick to change when things aren’t going the way we want them to.”

The organization is now spending a lot of effort in diagnostic accuracy and how they might use AI to make things like documentation easier and more efficient to enhance its EHR.

“There’s so much data and power within the EHR, and we rely on our dual clinical and technology experts to help us operationalize what we want in terms of improving patient care,” says Kelleher.

Kelleher credits their IT team with exceptional work in these innovative advancements.

“Where we are getting it right is that IT is so willing to partner, innovate and step into the work. They’re integrated in everything we do,” says Kelleher. “They are a big help with improving finance systems and patient access, but they give equal time and effort to the clinical side, and that’s a true testament to leadership’s philosophy.”

Matt Phillion is a freelance writer covering healthcare, cybersecurity, and more. He can be reached at matthew.phillion@gmail.com.