Holyoke employed a multi-pronged approach that improved target attainment rates by nearly 30%
Holyoke Medical Center (HMC) is an independent community hospital serving the healthcare needs of people in central and western Massachusetts. Founded in 1893 as a 40-bed hospital, HMC has grown to be a 219-bed facility with more than 1,600 employees. HMC’s clinical team includes more than 330 physicians and consulting staff.
HMC was focused on performance improvement initiatives related to target exposure measures when dosing patients with vancomycin, an antibiotic widely used in hospitals to treat infections. Vancomycin exposure under the target range for individual patients may not be effective in treating infections, while exposure above the target range can cause acute nephrotoxicity and acute kidney injury (AKI), leading to worsening (and sometimes fatal) patient conditions, longer hospital stays, and higher costs of care. Nearly a half-million patients are impacted by AKIs in the U.S. each year, adding $4.7 billion to $24.0 billion to the nation’s annual healthcare spending, research shows.
While trying to maintain a balance between optimized use of vancomycin and patient safety, HMC historically used a more conservative vancomycin dosing approach. HMC began using InsightRX’s Nova precision dosing platform in 2020, but it wasn’t until the spring of 2023 that the hospital conducted a deep analysis of target attainment data from the InsightRX Apollo analytics dashboard. Leveraging HMC’s own data gleaned from InsightRX Apollo, clinical pharmacists identified target attainment for vancomycin dosing as an area for improvement.
Education and a new pharmacokinetic model
HMC leaders were confident in the InsightRX platform, but concluded they weren’t fully leveraging the solution, especially the data available in Apollo. To better understand the specific challenges with vancomycin target attainment, the InsightRX clinical team met with HMC staff over several weeks to discuss their data, find realistic avenues for improvement, and develop quality metrics for tracking performance. Working with the InsightRX team, HMC tested several different dosing models before settling on the newer default model that better reflected its patient population and improved target attainment scores.
Most importantly, in addition to modifying the dosing model, the hospital worked on building a collaborative and data-driven culture. They regularly shared target attainment data at clinical and pharmacy staff meetings and sought feedback from clinicians about other ways to improve dosing performance. HMC leaders ensured InsightRX vancomycin target attainment data was a constant topic across hospital divisions and a daily part of conversations among pharmacists (including an ED pharmacist), ICU physicians, and other clinicians.
InsightRX Apollo demonstrates results
With InsightRX Apollo data at their fingertips to enable their data-driven approach, HMC proceeded to measure changes in target attainment rates after modifying its vancomycin dosing model and providing staff education. They compiled and compared InsightRX Apollo data from 514 patients receiving vancomycin doses between Jan. 1 and May 21, 2023, prior to implementing the new approach, with data from 176 patients who received vancomycin treatments between May 22 and Sept. 21, after the changes.
The data revealed that among all patients in both cohorts, target attainment rates were higher for patients receiving vancomycin doses after the new education and use of a newer model were implemented. Specifically, this approach produced a higher attainment rate for patients within 24-to-48 hours after dosing (40% versus 28%, a 43% improvement). Similarly, target levels were attained in 67.4% of patients receiving more than 48 hours of therapy, versus 59.4% of patients prior to the new approach, a 13% improvement. Overall, average target attainment rates over the entire course of therapy increased from 36.0% to 46.7%, a 29.7% improvement.
Conclusion
Using InsightRX Apollo analytics data and a combination of pharmacist feedback and increased awareness, HMC achieved significant, measurable improvement – nearly 30% – in average target attainment. Supported by InsightRX solutions, this was driven primarily by more conscious selection of regimens, aided by the use of a pharmacokinetic model that is better suited to its patient population.
HMC’s experience demonstrates the importance of data and analytics to support a multi-pronged approach to performance improvement. HMC’s success in improving vancomycin target attainment rates resulted from a combination of identifying a more population-appropriate dosing model, HMC’s efforts to educate staff about optimized use of the InsightRX dosing and analytics platform, and the hospital’s ability to create a data-driven and patient-centric culture.
This case highlights best practices for other hospitals seeking to improve their vancomycin target attainment rates: Leverage your technology’s clinical services, optimize the platform for your population, educate and involve your clinical staff, and cultivate a data-driven culture.
