Specialists at Vanderbilt University Medical Center have teamed up with Epic to help reconfigure its EHRs to better manage intensive care unit delirium, an impaired cognition that results from various causes in ICU patients.

WHY IT MATTERS
Delirium in ICU patients, which is in many cases reversible, is associated with increased duration of mechanical ventilation, prolonged hospitalization and increased risk of mortality.

The update, called the ICU Liberation Bundle, allows clinicians to take a more holistic look at a patient, which includes delirium assessments throughout the day.

Ely noted the system build would allow for streamlined implementation and better compliance, which, according to more than 20,000 patients worth of data the health system has published, yields less time on the ventilator, shorter ICU stays, reduced costs and improved survival.

The bundle is one way to help health systems align and coordinate care, with a specific focus on delirium as a component of the overall care patients receive including sedation and pain medications, breathing machines, and mobilization.

The ICU Liberation Bundle will become a standard part of Epic's EHR system with the company's next software release in February 2020, and the company noted it is already available to Epic customers as an add-on.

THE LARGER TREND
The development of the bundle also included specialists from the University of Colorado, the University of California San Francisco and California-based Sutter Health, and is the result of more than two years of development.

According to the current guidelines for Pain, Agitation, Delirium, Immobility, and Sleep Disruption from the Society of Critical Care Medicine, it is "essential" to consider delirium management in the broader picture of ICU patient care.

ON THE RECORD
"The implications for patient outcomes are stark and so is the improvement opportunity," said Kevin Johnson, professor and chair of the Department of Biomedical Informatics and informatician-in-chief at VUMC, in a statement. "There's a vital role here for clinical information technology. We're very pleased that our colleagues at Epic have fully embraced this opportunity and are working closely with VUMC and others to promote and support new workflows in the ICU."

"New support from a major EHR company like Epic means that fewer patients stand to undergo ICU delirium and its harrowing consequences," E. Wesley Ely, professor of medicine and co-director of the Critical Illness, Brain Dysfunction, and Survivorship Center at VUMC, said in a statement.