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The Rounds

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Reducing Bias in Medicine: Changes to eGFR calculations
As of January 3, 2023, Harris Health has taken a significant step to remove race from the calculation of patient renal function via estimated glomerular filtration rate (eGFR). 
 
Harris Health recently adopted the non race-based calculation (CKD EPI refit) recommended by a joint task force of the National Kidney Foundation and American Society of Nephrology, and now eGFR results will be reported without any race qualifiers. The new calculation has been found to have acceptable performance characteristics and does not disproportionately affect any one group of individuals.
 
Historically, there was data to suggest that Black/African American patients have a higher level of creatinine due to muscle mass, diet and other factors. Creatinine is an important value to calculate an estimated renal function so eGFR values were reported separately for African American and Not African American patients. Subsequent analysis has shown this disproportionately negatively impacted African American patients and contributed to systematic racial bias in medicine.
 
Special thanks to the collective efforts of physician and operational leaders from laboratory, nephrology, IT and informatics to support our commitment to evidence-based medical care and to taking action to address systematic racial bias in medicine.

 
Don’t Wait To Escalate
Harris Health is raising awareness around the importance of Rapid Response Team activation and ICU transfer as a critical safety initiative. The content from this newly developed flier may be printed for your regular use, and is included here for reference.
 
Call the Rapid Response Team (*37800) for:
  • Acute change in pulse, blood pressure, respiratory status or mental status
  • Acute or significant bleeding
  • Signs and symptoms of stroke
  • New, repeated or prolonged seizures
  • New onset chest pain
  • Failure to respond to treatment for an acute symptom or problem, such as chest pain refractory to nitroglycerine
  • Staff, patient and/or family feel immediate intervention is indicated 
Request ICU Admission for:
  • Critically ill, unstable patients in need of intensive treatment and monitoring that cannot be done outside the ICU
  • Patients who require intensive monitoring and may potentially need immediate interventions
Prompt activation of Rapid Response or request for ICU admission saves lives.

 
VTE Prophylaxis Orderset Embedded into Designated Admission and Post-Operative Ordersets
VTE risk assessment (and reassessment) is important to ensure we address preventable complications. Surgical post-operative ordersets and additional admission ordersets will be updated Monday, Jan. 23 to ensure VTE risk is integrated into existing workflows. Leveraging Epic to assess renal function and weight/BMI, the dose and medications for VTE prophylaxis will be customized for the patient and make it easier for clinicians.
 
For additional information, please refer to this attached overview. 

 
Informatics Update 
  1. Epic Downtime
  2. Update to Patient Education Order Panel to include “CHF Education/Navigator Consult” 
  3. Inpatient Transthoracic Echo Order appropriately showing up in Active Orders
  4. MRSA Decolonization Protocol Orders in ICU Admission Order Sets
  5. Update Order Sets with updated TEG order
  6. Skipping eGFR Ordering for IV Contrast Studies 
Clinical Documentation Improvement Tip – Pathology
Best Documentation Practices: 
  • Review pathology report diagnoses and acknowledge the diagnoses within the medical record if in agreement.
  • Document the diagnosis throughout the medical record if report is available by discharge. 
  • It is considered appropriate and compliant to make addendums to encounters related to post discharge pathology results for accurate code and DRG assignment.  
Simple Documentation Example:
45 y/o female with PMHx of abnormal uterine bleeding, colon cancer, and DM presents for palliative surgery for bilateral adnexal masses. 

CMS DRG: 742 Uterine and Adnexa Procedures for Non-Malignancy with CC/MCC 
Weight: 1.7181 
Reimbursement: $10,235.56 
Average LOS: 3.8
Geometric Mean LOS: 2.8 
Severity of Illness: 2
Risk of Mortality: 2 

​Advanced Documentation Example:
45 y/o female with PMHx of abnormal uterine bleeding, colon cancer, and DM presents for palliative surgery for metastatic adenocarcinoma to bilateral adnexa.  
 
CMS DRG: 737 Uterine and Adnexa Procedures for Ovarian or Adnexal Malignancy with CC 
Weight: 2.0581 
Reimbursement: $12,269.56 
Average LOS: 4.9
Geometric Mean LOS: 4.2 
Severity of Illness: 2
Risk of Mortality: 2
Remember to clinically validate your diagnosis within the medical record with justifiable, supported clinical criteria. See examples in attached reference sheet.
 
Physician Kudos 
Exceptional feedback from our patients about our doctors
 
Shalini Vaid Jha, MD 
Rheumatology
Smith Clinic
Baylor College of Medicine
 
"Dr. Jha is an AMAZING doctor and her team follows. She’s the best that Harris Health has, and the best I have ever been seen by. She has a bedside manner that all doctors should have. There aren't enough words of how grateful I am for her and her team. She is professional, caring, knowledgeable, quick and VERY RESPECTFUL with me and her team. She is a blessing. Thank you, Smith Clinic."

 
Derek Matthew Nusbaum, MD
Medicine IMU / 6D 
Ben Taub Hospital
Baylor College of Medicine
 
"Dr. Derek, the oncology team and the palliative care team helped us better understand the process. They helped us understand my mother's health situation and to make the decisions that are best for her."

 
Michael W. Van Meter, MD
Emergency Center
Lyndon B. Johnson Hospital
McGovern Medical School at UTHealth 
 
"My loved one was seen at LBJ, several days ago, and Dr. Warren really was a life saver."

 
Thank you for your service!