Partnership Uses IT to Improve Clinical Quality

Ben Cole, for HealthLeaders Media , June 16, 2009

The Knowledge-Based Nursing Initiative (KBNI)—a joint venture by Aurora Health Care, Cerner Corporation, and the University of Wisconsin-Milwaukee—will spread its vision to accelerate the use of evidence-based knowledge in nursing practice via technology during a visit to the United Kingdom this week.

The goal of the KBNI is to infuse research and other evidence-based nursing knowledge into nurses' workflow by facilitating clinical decision-making, populating data repositories as care is documented, and conducting analyses of the data in the repositories. Through these efforts, the KBNI hopes to improve the quality of patient care.

To date, the KBNI has completed "knowledge development" for 25 clinical health problems, such as risk for falls, infection control, and medication management. This knowledge development includes developing a series of interconnected, actionable, evidence-based clinical practice recommendations for assessments, diagnoses, interventions, and outcomes based on "analyzing and synthesizing the evidence through a search for relevant literature," according to the KBNI Web site.

"As the nurses use this, their data automatically gets transferred to a clinical data repository that we can then use while the patient is in the hospital or healthcare system, but also can be queried for reports," says Norma Lang, PhD, a co-principal investigator with the project. "The more you can pull standardized data to screen elements out electronically, the less demanding it is on people to do this manually."

In collaboration with the other partners, the recommendations are made executable within the information system to provide support for clinical decision-making. Last year, the recommendations for six clinical health problems were implemented at Aurora Health Care as a pilot test.

This week, Lang is in the United Kingdom meeting to present to the Royal College of Nursing and other UK health leaders about her work with KBNI. The quality issues that the KBNI tries to improve, such as decreasing falls and patient readmissions, are universal and best practices should be shared between countries, Lang says.

"We think we are really different, but people are people," says Lang, who is also an honorary Fellow of the Royal College of Nursing in London. "It's very good to share things across the water—I don't know if either country has the answer, but we can sure share a lot, we can learn from each other."

This type of information sharing was one of the premises on which the KBNI was founded: Partnerships between businesses, service organizations, and academia can accelerate quality and outcome improvement that would be difficult for one organization alone to achieve.

Lang says KBNI also was formed to help define nurses' contributions to patient care outcomes because they are able to determine what care contributes to the best results and how to implement these practices. With the rapid development of clinical health IT, nurses and their patients can benefit greatly from the best practices and evidence-based care that is developed through KBNI, Lang says.

"There was very little emphasis on nurses, and yet nurses are the ones who are actually using these systems 24 hours a day, seven days a week, and also nurses have the most complex information needs," Lang says.

And with nurses all over the world facing similar quality-related issues, Lang says she can definitely see knowledge-sharing practices used by KBNI spreading. While there are no immediate plans to spread the word apart from this week's trip to the UK, Lang says the KBNI's best practices has the potential to be implemented in hospitals all over the world.

"The needs are there all over, and actually in every language too," Lang says. "There is an incredible amount of interest, and I can see it building."

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Ben Cole is an associate online editor with HealthLeaders Media. He can be reached at

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