Dr. Arnoldas Giedrimas leverages Epic technology to quickly identify possible bacteremia infection in ICD patients

FALL RIVER, Mass. — Southcoast Health announced today that Dr. Arnoldas Giedrimas, MD, an electrophysiologist and Epic physician champion at Southcoast Health, created an alert in Epic that helps identify potential bacteremia in patients with an Internal Cardiac Device (ICD).

Dr. Giedrimas recognized the difficulty of identifying when bacteremia is related to a patient’s ICD, because different members of the care team hold different pieces of a patient’s health puzzle. Delays in identifying device-related bacteremia can have a significant effect on the patient’s care. While antibiotic treatment might make it seem like the infection has been eliminated, the source of the infection remains in the patient’s body, causing the infection to return. The patient might have multiple courses of treatment before the ICD is identified as the problem.

From lessons learned from an internal case study, Dr. Giedrimas thought there must be a way to have the system put the pieces together sooner and automatically notify him, saving the care team the detective work.

Dr. Giedrimas worked with a team to develop a rule that looks for both an ICD and a positive bacteremia lab result in the patient’s chart. When these criteria are met, a BestPractice Advisory (BPA) In Basket message is sent to Dr. Giedrimas about the patient, ICD, and lab result. He then follows up with the care team to determine if the bacteremia is caused by the ICD, and if so, a lead extraction can be promptly performed.

Before implementing this workflow, Southcoast Health checked about one patient per month for possible device-related bacteremia. In the first four months of having the workflow live, Dr. Giedrimas was notified about 20 patients who fit the rule’s criteria. After nine and a half months, 46 In Basket message notifications had been sent. Four of those patients had a lead extraction, greatly reducing their risk of re-hospitalization, misdiagnosis, or unnecessary treatment.

The simplicity and flexibility of this workflow’s build means that it could easily be used to identify other possible device-, implant-, or transplant-related infections as soon as they are documented in a patient’s chart.