Scenario A patient with community acquired pneumonia presents

19: 20 hrs, ED at UNMC, Omaha • 68 yo male smoker presents with

Summary @ 20: 14 hrs 68 Poor respiratory function, Fever, Anemia, r/o infection, Renal

Chest X-rays PA view of the chest shows dense opacity in the left lower

Chest X-rays The loss of the left hemidiaphragm ("silhouette sign") and preservation of the

MD records Problem, 20: 53 hrs The SAGE Engine is triggered by this event.

SAGE determines PSI Given new observations, SAGE then determines PSI score. Class: IV Score:

Three possible treatment outcomes. SAGE Guidelin e Engine PSI calculation uses record, labs, and

SAGE Guideline Logic in Protégé SAGE now ready to use PSI score to make

Choice is made to treat as Non-ICU inpatient. SAGE Guidelin e Engine PSI calculation

Inpatient Logic Now two actions to be taken: 1) JCAHO measures, 2) Admission orders.

CMS & JCAHO Specific Measures Clinicians are asked these questions since data not available

Blood Culture Timing Set up reminders. Has it been done?

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Scenario A patient with community acquired pneumonia presents to ER with cough and fever. Based on assessment, the patient is candidate for inpatient treatment.

19: 20 hrs, ED at UNMC, Omaha • 68 yo male smoker presents with 2 days of fever, chills, and productive cough. • Evaluation: Left lower rales consistent with pneumonia. • Orders in ER: CBC, Lytes, BUN, Cr and CXR. Pulse oximetry checked. Roger Dogeman, DOB 03/04/1938

Summary @ 20: 14 hrs 68 Poor respiratory function, Fever, Anemia, r/o infection, Renal insufficiency

Chest X-rays PA view of the chest shows dense opacity in the left lower lobe, consistent with pneumonia. PA

Chest X-rays The loss of the left hemidiaphragm ("silhouette sign") and preservation of the left heart border, indicates involvement of the left lower lobe and sparing of the lingula of the left upper lobe. Lateral

MD records Problem, 20: 53 hrs The SAGE Engine is triggered by this event.

Initial Medications List

Initial Problem List

PSI Inquiries

SAGE determines PSI Given new observations, SAGE then determines PSI score. Class: IV Score: 98 Mortality: 9. 5% Image from: Pneumonia Severity Index Calculator. December 2003. Agency for Healthcare Research and Quality. Rockville, MD. http: //pda. ahrq. gov/psicalc. asp

Three possible treatment outcomes. SAGE Guidelin e Engine PSI calculation uses record, labs, and clinician inputs. Outpatient Rx Non-ICU Admit

SAGE Guideline Logic in Protégé SAGE now ready to use PSI score to make triage recommendation.

Choice is made to treat as Non-ICU inpatient. SAGE Guidelin e Engine PSI calculation uses record, labs, and clinician inputs. Outpatient Rx Non-ICU Admit

Inpatient Logic Now two actions to be taken: 1) JCAHO measures, 2) Admission orders.

CMS & JCAHO Specific Measures Clinicians are asked these questions since data not available from EMR: Pneumococcal vaccination up to date? Influenza vaccination up to date? At risk for pseudomonas? Transferred from outside? Previous antibiotics for CAP prior to arrival? Blood cultures obtained prior to arrival? Comfort measures only?

Blood Culture Timing Set up reminders. Has it been done?

Antibiotic Timing

Pending Top Level Order Set

Top Level

Consults

Lab

Med Rx for Pneumonia