Putting Data in Nurses' Hands

Gienna Shaw, for HealthLeaders Media , February 21, 2012

The assessment takes a nurse who is familiar with the system and its indicators about 20 seconds per patient.

Ultimately, the organization plans to automatically send the Cerner documentation system to the organization's QuadraMed indicators and classification system, saving nurses from having to enter the data twice.

That's one of the areas where nurse informatics can shine, Hebda says. An automated systems that asks nurses to enter the same piece of information numerous times "is clearly a waste of everyone's time," she says. "Nurses are already in short supply, and they know that this is a waste of their valuable time. And if you're already collecting the data once, then the screen capture should bring that information into other programs [and] automatically populate it everywhere."

Acuity data has led to significant staffing changes in several Mission Hospital departments. The surgical unit, for example, used workflow data to make the case for a dedicated discharge nurse who would work peak discharge hours: Monday through Friday from 8 a.m. to 4 p.m. 

That allows other nurses to focus on caring for new admissions, Shuford says, and "reduces the chance of error from interruptions." In fact, the surgical unit's readmission rates have decreased from 8.23% to 8.00%, although several initiatives were occurring during this time to reduce readmissions.

In the ED, acuity data was used to make the case for staggered shifts throughout the day with overlap at peaks in volume. Every unit management team has access to the data and can use it to make similar decisions about staffing and other solutions.

Prior to utilizing the acuity data to modify the staffing patterns, the ED provided staffing within the target range only 12.5% of the hours of the day. Since implementation of staggered staffing based on acuity data by hour of day and day of week, they are now providing staffing within the target range 54% of the hours of the day, Shuford says. They are continuing to adjust shift hours to further increase this percentage.

Putting data in plain view

The ability to view alerts and other clinical data in dashboard format also makes it easier for nurses to respond quickly "in a way that we were never able to do in the past," says Oklahoma Heart Hospital's Miller.

The MPages Web-based platform from Kansas City, MO–based Cerner helps keep track of vaccines, stroke indicators, aspirin on arrival, rehabilitation references, venous thromboembolism, restraints, and dietary needs, for example, arranging the information for nurses in an easy-to-read format.

"Most of the data is near real-time in that it is information about patients who are currently in the hospital. It's information about actions that we either have performed or need to perform on those patients," Miller says.

The organization also uses its EMR reports and dashboards to track progress toward goals such as CPOE use and meaningful use readiness.

"We had CPOE; we already had a lot of those meaningful use measures. But we really needed a way to track our percentages and look at that information in much greater detail to ensure we were really meeting the meaningful use standards," Miller says.

"I looked at all these meaningful use measures and I said, 'How are we ever going to know that we're doing all this?' I really have confidence when the CEO comes to me and says, 'Are we going to make meaningful use? Are we going to get a little bit of that EMR investment back so we can reinvest in other areas?' And I can say, 'Absolutely.' I know we're doing this and that we're doing the best job for our patients.

"That's why we started this process, but it really led us to this whole better way to consume information that is, we think, really going to revolutionize our area," Miller says. "This ability to build dashboards and to present data in much more than just lists but to be able to show it in dials, to be able to show it with more graphics, to be able to put that not only on a traditional interface, but put that into an iPhone or put that into an iPad—that ability to bring data out and provide that in a much more meaningful way—that's really changed the way we do business."

The data has also changed the way that the organization serves its patients.

"We are beginning to see information so much clearer than we could in the past. That's really been the innovator for us," Miller says. "We're really focused on making information more useable. And so I think for us we have the data and now we have the tools to present it. Really focusing on that usability engineering in everything we do is a big part of our strategy."

And that applies to both clinical information and business information. "Being able to use that more effectively to run our business is going to be very core to the future," Miller says. "The challenges of healthcare are so large … the ability to use data and information to help us chart the way and become more efficient, to find out ways to improve the cost or the value that we're delivering to that patient, is absolutely paramount."

This article appears in the February 2012 issue of HealthLeaders magazine.

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2 comments on "Putting Data in Nurses' Hands"

Jackie Larson - Avantas (2/22/2012 at 12:19 PM)
This article tackles a lot of issues. On one hand, it speaks to a greater issue of departmental silos. In my company's world of healthcare labor management we provide our clients with a lot of tools and dashboards to monitor staffing levels, productivity, etc., but sometimes these tools are used only by financial analysts, put into reports and are forgotten – not the point of having access to real-time data. The point of real-time data is to empower staff and managers to make adjustments to correct the course – before variances become trends that hurt the bottom line. To the point about making staffing recommendations for the next shift based on acuity, hospitals should already have the expansion and contraction capacity built into their contingency resources to account for normal fluctuations in volume or acuity. This really isn't an issue of needing a technology to tell you what you already know. It is an issue of having sound labor management plans that allow you to adjust, system-wide, to the ebb and flow of patient care. If your inpatient unit scheduling is based off accurate, census projections (predictive analysis), not budgeted census, your staffing levels will be more accurate to begin with, making those last minute acuity adjustments nonevents. Providing nurses with data is not hard to do. What a lot of organizations struggle with is empowering nurses to do something with the data they have access to.

Karen Hahn, MBA, BSN, RN (2/21/2012 at 12:01 PM)
This article further substatiates the nurses vital role as end users of EMR to the success of the organizations and meeting their goals and requirements for HIT .




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