Reducing BPA Fatigue and Enhancing Workflow Efficiency: A DMAIC Approach

Clinical decision support tools, such as Best Practice Advisories (BPAs), are crucial in guiding healthcare staff toward timely, effective and safe patient care. However, irrelevant alerts can contribute to alert fatigue among clinicians.  UTHealth Houston’s (UTHH) Council that oversees the creation of new BPAs and evaluates the effectiveness of existing BPAs; evaluated the most ignored BPAs and identified the Link Encounter to Transitions Care Management (TCM) Episode BPA as the second most frequently ignored advisory, with a staggering 95.37% dismissal rate. This high rate of BPA cancellations raises concerns about its relevance, timing, and overall utility, potentially contributing to BPA fatigue among healthcare staff.  Through a comprehensive analysis utilizing a DMAIC approach, aimed at understanding the underlying factors contributing to the high dismissal rate of TCM BPA, UTHH was able to achieve a reduction of 69% in BPA firings and increase the acceptance rate by 1444.44%. 

Evaluate the appropriateness of the alert timing and targeted recipients and how to develop recommendations for enhancements.

Investigate the conditions which prompt a BPA to fire and weight the effectiveness of the EHR build.

Understand how to apply a DMAIC approach to addressing inefficiencies in the EHR.

Authors

Lindy Anderson-Papke, MHA, CLSSBB, PCMH CCE is the Executive Director of Clinic Operations Performance Improvement at UTHealth Houston.  She received her Bachelors from Texas A&M University in Sociology and her Masters in Health Care Administration from Texas Woman's University.  She leads the Operational Excellence arm of the Coordinated Operational and Clinical Help Team (COACH) that focuses on process improvement using Lean Six Sigma methodology at UTHealth Houston.  She also leads the Clinic Operations System Support Liaisons (COSSL) that provide at-the-elbow support for Epic to our provider and clinical staff end users.