Laurier Noémie, Robert Jorane-Tiana, Tom Alexander, McKinnon Jerrica, Filteau Nancy, Horowitz Laura, Vasilevsky Murray, Weber Catherine, Podymow Tiina, Cybulsky Andrey V, Suri Rita S, Trinh Emilie
Faculty of Medicine and Health Sciences, McGill University, Montreal, Quebec, Canada.
Research Institute of the McGill University Health Center, Montreal, Quebec, Canada.
Hemodial Int. 2025 Jan;29(1):74-82. doi: 10.1111/hdi.13178. Epub 2024 Oct 21.
The complexity of managing patients with end-stage kidney disease on hemodialysis underscores the importance of implementing quality improvement (QI) initiatives to enhance patient safety and prioritize patient-centered care. To address this, we established a QI committee at our tertiary academic center focusing on evidence-based practices, patient-centered approaches, and cost efficiency. To facilitate the seamless implementation of QI initiatives, we leveraged the capabilities of our electronic medical record (EMR) system.
This review details effective strategies for optimizing use of an EMR system to successfully implement QI efforts. Drawing from our experience, we provide detailed descriptions and practical insights that can be applied to other EMRs.
The creation of a secure and accessible dashboard, offering real-time data on quality metrics, stands out as the most notable feature. This dashboard operates through an algorithm that merges data from both our dialysis and hospital EMR systems. Its primary objectives are to streamline the identification of high-priority patients, enhance team communication, and facilitate tracking of quality indicators. Additionally, we integrated clinical pathways, checklists, and standardized protocols into the renal EMR to ensure smooth implementation of QI interventions. Notable examples of these interventions include an incremental hemodialysis protocol, a new hemodialysis start checklist, vaccination care plans, and personalized kidney transplant workups. Programmed electronic automatic reminders have proven invaluable in ensuring timely follow-ups of assigned tasks. The EMR has also contributed to medication optimization and deprescribing by generating patient lists based on specific medication classes. Finally, the EMR's capability to swiftly generate lists of patients with specific features has significantly facilitated targeted QI interventions.
Leveraging the capabilities of an EMR system can be crucial for enhancing care of hemodialysis patients and implementing effective QI initiatives.
管理接受血液透析的终末期肾病患者的复杂性凸显了实施质量改进（QI）举措以提高患者安全性并将以患者为中心的护理放在首位的重要性。为解决这一问题，我们在三级学术中心成立了一个QI委员会，重点关注循证实践、以患者为中心的方法和成本效益。为促进QI举措的无缝实施，我们利用了电子病历（EMR）系统的功能。
本综述详细介绍了优化EMR系统使用以成功实施QI工作的有效策略。借鉴我们的经验，我们提供了可应用于其他EMR的详细描述和实用见解。
创建一个安全且可访问的仪表板，提供质量指标的实时数据，是最显著的特点。该仪表板通过一种算法运行，该算法合并了我们透析和医院EMR系统的数据。其主要目标是简化对高优先级患者的识别，加强团队沟通，并便于跟踪质量指标。此外，我们将临床路径、检查表和标准化协议整合到肾脏EMR中，以确保QI干预措施的顺利实施。这些干预措施的显著例子包括递增血液透析方案、新的血液透析启动检查表、疫苗接种护理计划和个性化肾移植检查。程序化电子自动提醒在确保及时跟进分配的任务方面已证明具有重要价值。EMR还通过根据特定药物类别生成患者列表，为药物优化和减少用药做出了贡献。最后，EMR快速生成具有特定特征患者列表的能力极大地促进了有针对性的QI干预。
利用EMR系统的功能对于加强血液透析患者的护理和实施有效的QI举措可能至关重要。
