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Please review our attached paper. We look forward to your feedback!

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Can Real-World Data Improve Health Outcomes?

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To maximise Real-World Data (RWD) potential and improve health outcomes and service delivery, stakeholders need to develop standards for data use and access. This video provides an overview of RAND Europe's assessment of the RWD landscape in Europe and exploration of options going forwards.

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Improving Healthcare Quality Outcomes through Data

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AMSURG leverages quality reporting from GI procedure data to improve healthcare outcomes, best practices and patient experience in collaboration with our physician partners. Insights from data will drive performance at AMSURG surgery and endoscopy centers, while quality reporting will keep payors and patients informed as the healthcare economy transforms from fee-for-service to fee-for-value.

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How Big Data Could Transform The Health Care Industry

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We will attach HERE a summary of everything discussed on our Padlet by Sunday (end of week 6).

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Florence Nightingale provided the first nursing look at EBP

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Florence Nightingale provided the first nursing look at EBP

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This poster was originally created by Emily for JU's NUR514 class and discuses how data leads to improved outcomes in regards to HPV vaccination rates for adolescent males.

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Using PICO(T) to build a research question

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Using PICO(T) to build a research question

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Note: some research questions add a "T" (for time frame) as well.

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This is my poster that I did in Nursing 514 class on probiotics.

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The Top Five Essentials for Outcomes Improvement

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The Top Five Essentials for Outcomes Improvement

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Check out this website, it's got some great information on using data to improve outcomes.
LINK: https://www.healthcatalyst.com/Outcomes-Improvement-Five-Essentials

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What do YOU think?

1. Have you ever collected data that resulted in helping to improve patient outcomes? If so, please provide a brief description of the project and your involvement.

1. Hi Emily and team. Yes, in my current role I often gather data to improve upon or support patient care. Sometimes the data is presented proactively and other times it is after a process or procedure in order to improve upon surgical times, shortening patient appointments, patient outcomes etc.

2. Do you use an evidence-based approach in your nursing practice? If so, do you find that using EBP is easy or hard to utilize in everyday practice?

1. Absolutely, we use evidence based practice only. It is essential when working with standard practice and EBP. When making recommendations to clinicians, surgeons and other medical team members, it is imperative to use EBP for multiple reasons including but not limited to reimbursement.

3.   If you had one process improvement project to work on at your current nursing position, what would it be? What method would you use to produce positive outcomes?(ie: PICO, FOCUS, PCDA, etc.)?
1.  That is a great question and one that I am not sure where to even start.  All of them have positive and negative aspects including training, staff acceptance and organization roll out and going live.   Sometimes the intangibles are the most difficult and most difficult to measure.
References:
Grove, S. K, Gray, J. R., & Burns, N. (2015). Understanding nursing research: Building an evidence-based practice (6th ed.). St Louis, MO: Saunders.

Melnyk, B. M., & Fineout-Overholt, E. (2015). Evidenced-based practice in nursing & healthcare (3rd ed.). Philadelphia, PA: Lippincott, Williams, & Wilkins.

Sewell, J. (2016). Informatics and Nursing: Opportunities and challenges (5th ed.). Philadelphia,  PA: Walters Kluwer.

Trina

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In response to the picture on “Biggest Challenges in Improving Patient Health Outcomes” while the main factor is hard to relate to my field of nursing specifically, in a previous class I spoke about how important public health is toward changing how our healthcare delivery system currently works. Toward preventing the illness from occurring before it turns into actually treating the illness. We as a healthcare system do not put enough focus or money into public health illness prevention, which with the current evidence-based practice data that we have, we should be able to know how to target the population specifically toward prevention rather than treatment. Again, great graphical representation on showing challenging areas toward improving patient outcomes.

Regards, Kaitlyn Morris

REPLY to Kaitlyn from EMILY:
Hi Kaitlyn: I totally agree with you that preventative medicine is so important and I wish it was more of a focus in today's healthcare. Baker (2017) wrote an excellent editorial that describes what nurses should do with their influence to help not only themselves, but also the nursing profession and their patients.

Baker defines influence as “the ability to affect actions, behaviors, and beliefs of others. It represents power, but for nursing, I believe that ‘power’ is enabled because of trust, not authority or obligation,” (2017, p. 10). We have all been professional nurses now for at least some amount of time, and all of you have most likely been asked a health-related question from your friends and/or family members, simply because they know you are a nurse.

According to Baker (2017), nurses need to use their knowledge (and the trust that society has in nursing) to influence “better health outcomes for individuals and communities – locally, nationally, and internationally,” (p. 11). Baker (2017) advises that nurses seize these opportunities as a way to promote population health by those seeking our input.

We can also use informative conversations with others we interact with in the community, such as in church or community service work as well. In addition to influencing our family and friends, Baker (2017) advises that nurses also use their influence to advocate with their local, state, or national legislators to be “powerful and productive,” (p.10). Nurses can influence legislative changes to improve the health of their community as well as volunteering their time to promote nursing and join professional nursing associations as well.

Reference:
Baker, K. (2017). Maximize your nursing influence. Gastroenterology Nursing., 40(1), 10-11. doi: 10.1097/SGA.0000000000000284

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1. Have you ever collected data that resulted in helping to improve patient outcomes? If so, please provide a brief description of the project and your involvement.

2. Do you use an evidence-based approach in your nursing practice? If so, do you find that using EBP is easy or hard to utilize in everyday practice?

3.  If you had one process improvement project to work on at your current nursing position, what would it be? What method would you use to produce positive outcomes?(ie: PICO, FOCUS, PCDA, etc.)?

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Great video! And great presentation this week Jan and Emily!

This was such a good explanation of ways that data is used to improve patient outcomes. I especially liked the point where a simple implementation such as “all eyes on the screen” is being used in the operating room, where the doctor, anesthesiologist, nurses and I am sure technicians all help to the doctor to look for polyps. This is done to help the provider not miss anything, and I think that it is the epitome of teamwork and collaboration and through data collection a method as simple as this has shown to have positive patient outcomes. Again, great video.

Regards, Kaitlyn Morris

REPLY TO KAITLYN from EMILY:
Thanks for your positive feedback on the video. Your comment on the "all eyes on the screen" comment brings up a really important aspect of QI work.  Once the work is completed and shown to have positive results, it's extremely important to then ensure the new process will sustain the improvement and spread. If the specific aim was not met, it will be important to determine what the next steps will be to ensure continuous improvement.

The following information was taken from UWH’s Spread Strategy Roadmap revised 11/5/15:

Spreading an improvement means having the improvement widely adopted.

USEFUL FOR: Having a common language on how we refer to spreading improvements at UW Health. The roadmap provides clear steps regarding how to:

•Move beyond small tests of change,

•Pilot one or many successful changes from the test phase,

•Spread the improvement beyond the pilot phase, and

•Sustain the improvement by locking in the progress that has been made during the spread phase.

PREPARATION: The scope and scale of the improvement will determine the appropriate team members and decision-making body which will be engaged.

KEY TERMS:

Sites: May include physician, specialty, clinic, or multiple locations.

Test: The first phase of the spread process, and a critical step before pilot and spread. Testing involves taking a team through the FOCUS-PDCA improvement methodology and collecting data on a particular process improvement. The typical timeframe is 3-6 months to complete.

Pilot: The next phase after testing. The action one takes after testing has shown the change is positive and leads to improvement, but before spreading the change to other (broader) areas of the organization. Piloting takes the process improvement from the testing phase and expands the process improvement to a larger scale, but the change is still not adopted as a recognized standard. The time frame is dependent on the scope of the pilot. During the pilot, continue to apply FOCUS-PDCA, as your current state is the test and you will set a specific aim(s) to determine the success of the pilot (FOCUS).

Futhermore, your team will be planning & doing the pilot, checking the data, and determining next steps in act.

Spread: The final stage of implementing a change, and comes only after data collected during the testing and pilot phase has shown the change is positive. In this phase, the Steering Committee, Operations Committee, or other decision making body, is ready to accept the improvement as the new standard, and assign appropriate resources to support roll out across sites.

HOW IT WORKS: Similar to FOCUS-PDCA, it is crucial to identify the team members, establish a communication plan, and keep track of action items. Additional tools are identified on the roadmap that may be useful, such as the decision log.

KEY NOTE: Regardless of the scope and scale of the improvement, the same principles apply when planning to spread beyond small tests of change.

Sources:

Langley, Gerald et al. The Improvement Guide: A Practical Approach to Enhancing Organizational Performance. 2nd Ed. San Francisco: Jossey-Bass, 2009.

Massoud MR, Nielsen GA, Nolan K, Schall MW, Sevin C. A Framework for Spread: From Local Improvements to System-Wide Change. IHI Innovation Series white paper. Cambridge, MA: Institute for Healthcare Improvement; 2006

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1. Yes, I have collected data for various topics but mostly to determine if a procedure/policy/test was up to date. The latest one was in regards to blood sugar testing and accuracy of POC vs venous. When a sample was needed we would collect both and compare the data to see if there were any differences that were statistically significant. Another was collected data on our triage process and modifying the process to decrease patient wait times in our triage area in an attempt to increase satisfaction and safety of the patients while they were waiting to be seen by a provider.
2. In my current role, I really do not do much with regards to EBP as I am a nursing supervisor and have minimal patient care interactions. I occasionally will work in our float pool and utilize EBP in every patient interaction. We have sepsis protocols built into our EHR as one example.
3. For my nursing supervisor role, the one process improvement project I would work on would utilize a PDCA method. I would love to streamline the process for collecting staffing data and make it electronic where the Charge nurses could just update a spreadsheet or database and I could gather the data and call with questions. Currently everything is by phone and hand written with very little review (If any) being done. Having the data in a spreadsheet or a database would at least allow it to be tracked and determine which units were consistently requiring the use of the float pool for staffing or being adequately staffed without assistance. Either way, data is needed in order to make a informed decision instead of a knee-jerk reaction. As Sewell (2016) says, an organized method will be needed in order to know how the current process is in order to make changes and improve outcomes.

Sewell, J. (2016). Informatics and nursing: Opportunities and challenges (5th ed.). Philadelphia, PA: Walters Kluwer.

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This is a copy of a Powerpoint for NUR514. Jan and I actually worked together on this to complete a quality improvement project within our department that ended up quite successful results! You will have to download the file to view the "speaker notes" to give you more information/more thorough details.

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What do YOU think?

Fabulous job on your wall ladies, I love the color scheme.  The videos are really informative; I especially like the one on how big data could save your life.

1. Have you ever collected data that resulted in helping to improve patient outcomes? If so, please provide a brief description of the project and your involvement.

Yes is the short answer, in many ways over the years.  Currently I utilize data collection on a minute-by-minute basis.  What I mean by that is, we are constantly collecting metrics and information regarding patient throughput.  It is connected with arrival times in the ER, OR, PACU and their throughput to an in-patient bed.  We additionally capture all of the additional times in between, such as, bed requests, time delays, procedures prior to bed placement and the list goes on.  We are benchmarked by corporate office on division and corporate levels.  We receive daily feed back in a spreadsheet format showing how all of the related hospitals are doing.  The metric times are based on evidenced based practice (EBP) for patient outcomes.

1. Do you use an evidence-based approach in your nursing practice? If so, do you find that using EBP is easy or hard to utilize in everyday practice?

Yes, we utilize Epic and they have the EBP guidelines built in, they pop-up as alerts for staff as they are progressing through their charting.  The pop-up box has a link and can direct the staff into the chart to enter the specific information that has been flagged.   It is a simple system to utilize but requires a lot of configuration when we require an additional guideline to be added.

1.  If you had one process improvement project to work on at your current nursing position, what would it be? What method would you use to produce positive outcomes? (i.e.: PICO, FOCUS, PCDA, etc.)?

Well, I will be honest, I am not familiar with FOCUS, that will take some research, but I have had positive outcomes with the other two methods.  I would actually say that my utilization for PICO has been related to finding the correct information and evidence to present to whichever team or board for a related project.  The information I then utilized in the format of plan-do-check-act (PCDA) model.  I think that having the evidence to support the project can ensure a larger grasp of the concept and engage staff (or whoever) at an earlier stage.  We are currently working on a process of improvement for our throughput times.  We have recently (2017), moved to utilizing iPhones for each nurse (these have a multiple functionalities), I can text or call the charge RN for a bed and staff can receive a direct call from the ER or PACU, cutting out delays related to calling the floor.  If the nurse receiving the patient is busy, they can indicate that on the phone, the ER nurse can text that the patient is ready and floor nurse can call as soon as she is available.  We also have a system in place where if the floor nurse is going to be tied up for a while the charge nurse will receive the patient and get them settled.  This is an ongoing cycle and we review it every month with metrics of how our times are, any feedback from staff and we work on optimization of the actual flow process.

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1. Have you ever collected data that resulted in helping improve patient outcomes? Provide brief description.
a. Yes currently I collect data to monitor the affect of "Battlefield Accupuncture". This is a program for patients who have pain. Its most effective with patient that have pain in their lower extremities and some back pain. The needles are small gold metal colored that resembles a thumbtack which are pushed in around the outer aspect of the ear. Data is collected each day for a week. To assure treatment, needles must be counted daily and documented. The patient will be evaluated to determine effectiveness of pain. This treatment has reduced the administration of PRN's to the patient using Battlefield Accupuncture.
2. Do you use an evidence based approach in your nursing? Do you find using EBP easy or hard to utilize in everyday practice? Evidence based is used in my nursing practice it is the standard used to perform procedure to our patients. Nurse educators in-service staff on new changes for care provided to continue improvement practices.
3.If you had one process improvement project to work on  what would it be? What method would you use to produce positive outcomes?
a. One project I would work on is nurse/patient ratio which has a lot to do with staffing. My method to use is PCDA.

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I definitely think that information is powerful in a process such as this

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1. Have you ever collected data that resulted in helping to improve patient outcomes? If so, please provide a brief description of the project and your involvement. At my previous hospital I was involved in implementing QBL (quantitative blood loss) versus EBL (estimated blood loss), where we the nurse actually weighed the blood loss after each delivery to get a more accurate measurement of postpartum bleeding. It was very interesting to see how inaccurate EBL actually is and then to improve patient outcomes by providing appropriate postpartum care considering the true quantitative blood loss

2. Do you use an evidence-based approach in your nursing practice? If so, do you find that using EBP is easy or hard to utilize in everyday practice?
Yes, we use an evidence based approach on my nursing floor. All of the policies and procedures that our providers and nurses practice are based off of EBP, as this in my opinion provides the safest, proven patient care. I think that it is easy to utilize EBP in everyday practice as we want the best for our patients so regardless of the extra steps this may sometimes require, if it means an improved patient outcome it is definitely worth it. I have also on numerous occasions justified my rationale to a provider for not wanting to do a certain procedure for a patient due to EBP, and once the provider has read the article they are majority of the time influenced as to their plan of care. Therefore, EBP in my workplace is definitely utilized in everyday practice and very beneficial.

3. If you had one process improvement project to work on at your current nursing position, what would it be? What method would you use to produce positive outcomes?(ie: PICO, FOCUS, PCDA, etc.)? I would use the PICO method to address when the appropriate time is to use internal monitors on a laboring patient. So often, our learning residents insert internal monitors because they visualize a Category II tracing, they are not seeing the contraction pattern as well as they would like etc. All reasons that do not require the use of internals. Internal monitoring drastically increases the risk for infection along with other risk factors that when not deemed necessary should not be used, period. Therefore, I would like to do a process improvement project on this topic, among many others.

Again, great presentation this week and very though provoking questions.

Regards, Kaitlyn Morris

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This paper accompanied the Powerpoint that we've also attached from a group project in JU's NUR514. It goes in to a little more depth than the Powerpoint, for anyone interested in learning more about this process.

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Best Practices for improving flow and care of pediatric patients in the ED is a great PDF. It addresses a lot of the information that we are reviewing this week and it also sings true to my current position and daily focus. It can be extremely challenging to balance what is best for the patient as evidenced by best practice and what you can actually accomplish with your resources at hand in a timely evidenced based manner. This PDF looks at guidelines, patient flow, lean methodology, pathways and innovative staffing and performance measures.

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Week 6_ Response # 1 to Mrs. Pittsley and Mrs. Simmonsen

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Week 6_ Response # 1 to Mrs. Pittsley and Mrs. Simmonsen

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Good evening Mrs. Pittsley and Mrs. Simmonsen, thank you for your Padlet presentation on “Using Data to Improve Outcomes.”  It was informative, creative and well organized.  In regards to your first question, at my place of employment we are currently conducting a research project that involves collecting data of patients who smoke nicotine-based products and are planning to have spine surgery.  This data is expected to be collected over the course of one year.  The clinic staff nurses are required to assess smoking tobacco products status for each patient that comes for an appointment visit.  My participation in the project is as a staff nurse contributing to collect the data during the assessment process and to evaluate the intervention methods currently used by the institution’s healthcare team.  The aim of this research study is to find out which smoking cessation intervention methods have a greater rate of success to improve patient compliance outcomes.
In reference to your second question, a change in how nursing conducts the central line dressing changes in my current place of employment was highly influenced by the evidence-based practice (EBP) research data reviewed.  It was noted through this EBP research that having a bundle that included all the supplies necessary to perform a central line dressing change did help to reduce the infection rate.  As noted by Holt et al. (2016), “registered nurses can help prevent Central Catheter Associated Bloodstream Infections (CLABSIs) by keeping track of bundle compliance” (p. 53).  I use the central line bundle as part of my daily nursing care practice.  It has helped to reduce the time I spend doing this procedure, which is important when you are working in a fast pace clinic.  In my opinion, evidence-based practice research is a positive influence to nursing care practice, if implemented appropriately.
It has been quite interesting to see that there is a lack of evidence-based practice research related to nursing order entry in the outpatient clinics using the electronic medical record (EMR) system.  In the outpatient clinics, once an order is place in the EMR, it cannot be released until the provider signs off the order.  This is a concern for the senior nursing care team when policies and procedures are not in place to define the extent of nursing order entry in the outpatient clinics.  The issue is that in the outpatient clinics time frame to sign off the orders by the provider affects patient waiting time creating pressure on the nursing staff.  This is why is important for healthcare organizations to keep up their nursing policies and procedures with the advancement in technology to maintain scope of practice guidelines.  The fact that there is a lack of research on this topic brings to mind what are the actual practices in many healthcare organizations regarding this nursing matter.  Therefore, I will use the PICO format to create the hypothesis and the quantitative method to conduct the research.

References

Holt, S., Thompson-Brazill, K. A., Sparks, E. R., & Lipetzky, J. (2016). Treating central catheter-associated bacteremia due to methicillin-resistant staphylococcus aureus: Beyond vancomycin. Critical Care Nurse, 36(4), 46-57. doi:10.4037/ccn2016475

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Hello Team,How do we make informed and judicial practice and management about patients, disease systems and such. Extensive work and research in the area of evidence based medicine, which propagate and advice for improved and excellent patient outcomes, by informing clinical practice, medical modalities, treatment plans and with relevant research which contribute evidence base data. Guidelines for best practice should be comprehensive and simple enough to follow. To ascertain what is known fact about the relationship between patient experience measures and initiatives for patients designed data must be provided to improve care. It is critical to identify how public health policy and medical practices can encourage patient valued outcomes in healthcare systems. The continues process of evidence based medical and nursing practice is mainly based and dependent on outcomes assessment, measurements, and positive outcome resolutions. These data sources have become more readily available for collection, as information technology advanced.When I look at improving patient’s outcomes, I realized that nurses staffing is a great example of positive patient’s outcomes,” each additional patient per nurse was associated with 5% lower odds of surviving to discharge”, (Wallis, 2016).ReferenceWallis, L. (2016). Data again show nurse staffing improves outcomes in a variety of settings. AJN, American Journal of Nursing, 116(3), 14-14. doi:10.1097/01.NAJ.0000481262.56623.10Manny

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Hello Team,How do we make informed and judicial practice and management about patients, disease systems and such. Extensive work and research in the area of evidence based medicine, which propagate and advice for improved and excellent patient outcomes, by informing clinical practice, medical modalities, treatment plans and with relevant research which contribute evidence base data. Guidelines for best practice should be comprehensive and simple enough to follow. To ascertain what is known fact about the relationship between patient experience measures and initiatives for patients designed data must be provided to improve care. It is critical to identify how public health policy and medical practices can encourage patient valued outcomes in healthcare systems. The continues process of evidence based medical and nursing practice is mainly based and dependent on outcomes assessment, measurements, and positive outcome resolutions. These data sources have become more readily available for collection, as information technology advanced.When I look at improving patient’s outcomes, I realized that nurses staffing is a great example of positive patient’s outcomes,” each additional patient per nurse was associated with 5% lower odds of surviving to discharge”, (Wallis, 2016).ReferenceWallis, L. (2016). Data again show nurse staffing improves outcomes in a variety of settings. AJN, American Journal of Nursing, 116(3), 14-14. doi:10.1097/01.NAJ.0000481262.56623.10Manny

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Great job this week!  Big data, machine learning, and predictive analytics are my favorite informatics topics!  Things are ever-changing with this healthcare trend.  For example, big data has expanded from 3 to 4 V’s (volume, velocity, variety, and veracity) (IBM, 2014). You did a great job summarizing this week’s topic for the class.

As a nurse informaticist, I do this a lot as part of my job.  One of my favorite projects was programing our EMR with predictive analytics to determine a patient’s risk for hypoglycemic episodes during their hospitalization.  Working with a well-respected Diabetologist and his team, alongside biostatisticians, this was a great project.  I really enjoyed seeing the different variables and their weight into the algorithm.  Building it into our EMR was no easy feat, but after we worked out the kinks, it was great to see that it was truly catching patients at high risk and the team was able to intervene earlier and prevent a potential hypoglycemic episode.

I use EBP in almost every project.  Our health system’s philosophy is that all scales used must be evidence-based.  Therefore, I am responsible to ensure any and all requests are supported by research and EBP and are applicable to the population for which we will implement.  For example, we had a request to add pH levels for gastric contents as a verification of proper placement. Four of the five hospitals opposed the change, but we needed to review the literature to determine if it was a valid method.  After reviewing, it was found this was no longer current practice for multiple reasons and not only did we not build the request, that hospital needed to create education surrounding new methods for gastric tube placement verification.

Moving five hospitals to one EMR creates a lot of opportunity for improvement.  One process improvement project that would serve our organization well is definition and standardization of standards of care.  For example, only one hospital tracks all patients’ intake and output.  The other hospitals require provider’s order to track a patient’s I/O.  Additionally, every hospital has their own “per routine” for vital signs.  So, at one hospital that might be every eight hours on a med-surg unit and at another it could be every four.  Using the FOCUS-PCDA with lean methodologies, this process could be greatly improved for our clinicians and patients.

Reference

IBM. (2014). The four V’s of big data. Retrieved from http://www.ibmbigdatahub.com/infographic/four-vs-big-data

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This is a nice picture to summarize the 4 V's of big data
Volume: the amount of data
Velocity: the analysis and speed of data exchange
Variety: the many forms of data (structured vs. unstructured data)
Verocity: the accuracy of data

Big data affords researchers the opportunity to data mine numerous variables and use machine learning without hypothesis.  This method allows all variables to be included, rather than limited by a researcher’s educated assumption of data that will find patterns or relationships.   Belle et. al (2015) analyzed that development of new knowledge is often constrained by prior knowledge that has not utilized high-dimensional time series data.  Comprehensive approaches give context to systems regarding patient conditions.  Studying the correlations of data can encourage and support improved patient care models.

Reference
Belle, A., Thiagarajan, R., Roroushmehr, S. R., Navidi, F., Beard, D. A., & Najarian, K. (2015, July 2). Big data analytics in healthcare. Biomedical Research International, 2015(16), 1-16. http://dx.doi.org/10.1155/2015/370194

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Great job! Excellent, interesting, and informative resources!

1. Working in the ED we are constantly working on data collection to improve our processes and patient outcomes. Currently I am involved in data collection for the sepsis patients (includes patient presentation time, alert from EMS or walk in, time labs/blood cultures obtained and sent, time IVF bolus and antibiotics initiated, etc... The patient is then followed throughout their hospital course to determine outcome. A second initiative we are currently working on is door to needle for the Neurointervention lab for our stroke patients. Our new goal is to get appropriate candidates to the NI lab in less than 45 minutes. We have just begun to work on breaking down the current practices and rebuild new ones to make this happen to improve patient outcomes.
Lastly, CAUTI is a big initiative everywhere. So we have stopped placing foley catheters in the ED unless absolutely necessary for retention or blockage. We wait for the pt to be admitted and move to their inpatient room to have them placed if ordered.

2. Our education department and team sees EBP as the foundation of any changes we consider making. It is the basis for our sepsis and stroke initiatives. As soon as there is new evidence that a change in practice may improve outcomes - our physicians are the first to bring it to the forefront and discuss with nursing ways to make it happen. We are able to pull data from our EPIC charting system and other data tracking systems that our health system utilizes. Sometimes we have to ask for help in developing new reports to get the data we are looking for but with EBP to back us up - it is usually pretty easy to get the help we need!

3. My biggest passion right now is patient throughput for admitted patients. Over the years I have watched the slow rise in boarding patients in the ED. Some days it feels like a battle just trying to get a patient to the floor from delays in housekeeping, transport, giving report, testing, addressing incorrect orders, etc... I would utilize Plan-Do-Check-Act and the Lean methodology. These have been extremely successful in the past for me and when you bring multiple disciplines and stakeholders together it tends to help build relationships and understanding as to the hurdles we each face. This allows for open discussion and collaboration to fix the issue rather than just "telling" people what to do. It increases buy-in and overall chances of success and sustainability.

Thank you all for a well written paper and excellent questions for discussion!

Kathye

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This week I learned that using research in medicine began in the early 19th century in France and England, with physicians using statistics to help them interpret patient’s treatment responses. (Sewell, 2017). Data analysis remains the driving force of evidence base practice. Each part of the health care system needs to be improved systematically to improve services to patients and patient outcomes. Involving patients in research is a way to collect high quality data, especially if the measures of collection are kept very simply and patient friendly; such as surveys. Meaningful outcomes can be accomplished routinely if feedback is used; if the data collected is implemented into patient-focused improvements. Data matters and it supports change; that’s how important research in every facet of healthcare is.ReferencesCurrow, D., Allingham, S., Yates, P., Johnson, C., Clark, K., & Eagar, K. (2015). Improving national hospice/palliative care service sumptom outcomes systematically through point-of-care data collection, structured feedback and benchmarking. Support Care Center, 23(5), 307-315.Sewell, J. (2016). Informatics and Nursing: Opportunities and challanges (5th ed.). Philadelphia, PA: Walters Kluwer.

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This week I learned that using research in medicine began in the early 19th century in France and England, with physicians using statistics to help them interpret patient’s treatment responses. (Sewell, 2017). Data analysis remains the driving force of evidence base practice. Each part of the health care system needs to be improved systematically to improve services to patients and patient outcomes. Involving patients in research is a way to collect high quality data, especially if the measures of collection are kept very simply and patient friendly; such as surveys. Meaningful outcomes can be accomplished routinely if feedback is used; if the data collected is implemented into patient-focused improvements. Data matters and it supports change; that’s how important research in every facet of healthcare is.ReferencesCurrow, D., Allingham, S., Yates, P., Johnson, C., Clark, K., & Eagar, K. (2015). Improving national hospice/palliative care service sumptom outcomes systematically through point-of-care data collection, structured feedback and benchmarking. Support Care Center, 23(5), 307-315.Sewell, J. (2016). Informatics and Nursing: Opportunities and challanges (5th ed.). Philadelphia, PA: Walters Kluwer.

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Carol Guimaraes

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Intel's white paper on healthcare (2015), addresses delivering a specific platform for healthcare transformation but addresses many of the issues that we are discussing this week. In addition, they look at waste and inefficiencies in healthcare, variations in clinical treatment and fragmented care being responsible for 20-40% of the rising healthcare costs. Having platforms that integrate technology, simplify and utilize the data provide "continuous improvements in quality and efficiency."

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1.     During my time as a labor nurse in NJ, my hospital participated in an AWHON study on postpartum hemorrhage. We collected data related to estimating vs. quantifying blood loss, making sure to accurately quantify blood loss from all deliveries. We also recorded postpartum hemorrhage rates and treatment. The data was only a small part of the entire study, however the experience of collecting it and participating in the study was memorable. The goal was to help re-define a postpartum hemorrhage, and to move towards quantifying rather than estimating blood loss following delivery for more accuracy and safety for patients. Also, a hemorrhage cart, a standardized cart with medical equipment for a hemorrhaging mother (much like a code cart) was to be developed and utilized. Finally, a grading rubric for assessing hemorrhage risk was to be completed. Patients fell into green, yellow, or red categories on our tracking board for low, medium or high risk. This visual tool assisted the unit by increasing awareness of our patient population and risk factors in one glance. The rubric was completed at admission, and then before delivery and after delivery, as the patient’s risk status would change with addition of medications, time spent in labor, or delivery trauma.

2.     I do utilize evidence based practice in my nursing care. The challenge with EBP is that it needs to be supported by hospital policy and provider decisions. Sometimes the two lag behind the current evidence, and effort needs to be made to stay current.

3.     I would use the PICO method to explore rupture of membranes for labor augmentation. During my care, I see many providers elect to artificially rupture membranes on patients who are still in very early stages of labor with a goal to augment labor progress. With ruptured membranes and poorly engaged presenting part, risks increase for cord prolapse and infection. I would really like to explore the evidence on the risks vs. benefits and efficacy of this practice.

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Wylie & Davies (2015) provide a very interesting discussion about using data warehousing for epidemiological reasons. The discussion centers around epidemiology, but also includes a discussion about antibiotic resistance and the potential of utilizing data warehousing for improving outcomes.

The interesting part for me was the tangent where they discussed the most challenging aspect they felt was obtaining informed consent. If the patient’s data was not able to be specifically linked to them, and with how hospitals already gather data…. Is a specific consent for this type of database needed? Or does a blanket consent to treat cover consent for their data (not personal information) to be collected for the benefit of greater good?

Wyllie, D., & Davies, J. (2015). Role of data warehousing in healthcare epidemiology. Journal Of Hospital Infection, 89(4), 267-270. doi:10.1016/j.jhin.2015.01.005

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This week is proving to be another interesting week of learning and a wealth of knowledge! As I intentionally dig into the search for data driven outcomes, it is difficult to choose among some of the topics. Attached is a study regarding improved outcomes for Magnet designated hospitals over Non- Magnet hospitals. However, it also reports that a non-Magnet hospital that later becomes a Magnet hospital does not show improvement just with the designation.

The point made by the article is that Magnet status may be recognizing hospitals that are already achieving excellence - and the designation itself does not lend to improving outcomes in lower performing hospitals.

Most articles are all about how the data shows improvement. I chose this article for the study that shows the positive outcome as well as the data presented in keeping the study honest. If all you read was the title - you would miss the honest reflection that a designation alone does not prove excellence. (Don't misinterpret me - I believe that Magnet status helps to drive systems to a higher standard and has many excellent benefits and principles!)

While data can be used to improve outcomes, it can also be used to show an honest reflection of the current state and that has added value too!
Thanks,
Kathye

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Hospitals In 'Magnet' Program Show Better Patient Outcomes On Mortality Measures Compared To Non-'Magnet' Hospitals. - PubMed - NCBI

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Health Aff (Millwood). 2015 Jun;34(6):986-92. doi: 10.1377/hlthaff.2014.0793. Comparative Study; Research Support, N.I.H., Extramural

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Found this great little summary about nursing and informatics. We all know we have an important job, but sometimes we forget the global impact we make in healthcare. When we thinking of benefits, most often we think of patient outcomes. Another important aspect is reducing cost. A lot of what we do and how we interact with technology avoids errors and increases productivity. This prevents waste and costs that are most likely not to be reimbursed.

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Nursing is increasingly becoming as "high tech" as it is a "high touch" profession. Today's nurses have more technology at their disposal than any nurses ever before, and as one might expect, it's considerably improving patient care.

One area where nurses are putting technology to use is in informatics. Officially known as the study of information, in the world of health care, health informatics is the management of health information. Using electronic medical records, devices that collect health information electronically, and other electronic information standards, health informatics nurses are responsible for managing, interpreting, and communicating the data that comes in and out of health care facilities, all with one primary purpose: Improving the quality of patient care.

But how does that happen, specifically? How are nurses using informatics as a way to improve the care they - and their colleagues - provide to patients? As it turns out, there are several key ways that informatics is part of that effort.
Improved Documentation
Documentation has long been considered an important part of the nursing profession, but it's more vital than ever to the delivery of quality care. While the theory and practice of nursing, the standards of nursing practice, legal and ethical considerations, and other points that are taught in advanced nursing programs all influence the practice of nursing, it's information, and specifically, electronic documentation, that is having the greatest influence on modern nursing.

Modern nursing care is driven by individual patient needs and history - information that is collected and organized in electronic patient records. By documenting a patient's condition, and sharing that information electronically, nurses are able to more effectively manage care, and by extension, improve the quality of that care.

A great deal of documentation takes place automatically thanks to connected devices, which collect specific information in real time and transmit it to patient records. By looking at the documentation of a patient's condition over time, nurses can make better decisions about how to provide care and when changes or adjustments need to be made.
Reduced Medical Errors
Patient safety is a primary concern of any health care provider, and nurses are often on the front lines of ensuring that their patients are kept safe and preventing medication errors, misdiagnoses, falls, and other problems. Health informatics provides important data that can prevent these errors; for example, an electronic record can provide information about a possible dangerous medication interaction or allergy that might not otherwise be immediately apparent. Armed with data, nurses can make quick decisions that keep their patients safe.

In fact, in a study by the Agency for Healthcare Research and Quality (AHRQ), a majority of nurses reported that when they have access to EHRs, they have fewer problems with getting patients ready for discharge, fewer medication errors, and better quality of care. And when it comes to transfers between departments, nearly 15 percent of the nurses surveyed reported that information was more likely to be shared and less likely to "fall between the cracks" when electronic systems are used.
Reduced Costs
Medical errors cost nearly $40 billion every year, and many of those errors are preventable with informatics. Not only does information provide nurses with alerts to avoid errors, it also helps to automate certain tasks, both improving nurse productivity and preventing some of the costs associated with health care.
Improved Coordination of Care
Nurses are often called upon to help coordinate the care of their patients. This often means relaying information from physicians, therapists, pharmacy, billing, and more, both during care and at discharge. Without all of the necessary information, patient care could suffer. Informatics improves the coordination of this information, allowing nurses to give their patients all of the information they need, improving both outcomes and the satisfaction with care.

While there are some who criticize the use of informatics and technology to help manage care, arguing that it makes health care more impersonal, with the provider-patient relationship being replaced with data and algorithms, there is actually overwhelming evidence that informatics actually improves care. Nurses who are trained in this technology and how to best incorporate data into their workflow are often more productive and able to provide better care than ever before.

by Scott Rupp advanced nursing programs, coordination of care, health informatics nurses, healthcare informatics, patient safety

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How Nurses Are Using Health Informatics to Improve Patient Care

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Nursing is increasingly becoming as "high tech" as it is a "high touch" profession. Today's nurses have more technology at their disposal than any nurses ever before, and as one might expect, it's considerably improving patient care. One area where nurses are putting technology to use is in informatics.

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Week 6_Response # 2 to Mrs. Pittsley and Mrs. Simmonsen

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Week 6_Response # 2 to Mrs. Pittsley and Mrs. Simmonsen

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The video you posted titled “Can Real World Data Improve Health Outcomes?” was informative, educational and new knowledge for me.  It was interesting to see how this company Rand Europe describes healthcare as an ecosystem consisting of real time measurements (medical devices), medical records, hospital data, data from payers and economic-social indicators.  The utilization of these healthcare ecosystem’s components are categorized as big data, which contributes to research that leads to the development of medical treatment interventions that help to improve patients’ health outcomes.  The video identifies four distinctive barriers that limit access to the real world data for use.  These barriers are quality-content of data, methods for analyzing-linking data, data governance-data sharing, and concern over privacy.  Even though new medical technology offers many opportunities to improve patient care interventions, it is interesting to see that policies and procedures have not kept up with it.  These barriers challenges are happening at the local, national and international level as it is presented in this video.  The biggest challenge presented in this video is finding the balance of diminishing the barriers to access and usage of real world data.  In nursing, the major challenge is using the technological data available to improve patient care interventions, without infringing the patients’ rights to privacy.  According to Sewell (2016), “because data are readily available in healthcare settings today, nurses have an obligation to use them responsibly” (p. 374).  As patients’ advocates, we nurses need to be knowledgeable of the worldwide changes happening in healthcare.  This is to ensure that patients’ rights are not disregarded to pursue the rapid implementation of new medical technological innovations.  Nursing needs to be actively involved in all aspects of policy-procedure development at the local, national and international level.
References
Sewell, J. (2016). Informatics and research. In Informatics and Nursing: Opportunities and Challenges (5th ed., pp. 373-386). Philadelphia, PA: Wolters Kluwer

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I really enjoyed the video on "Big Data" and found this to be very interesting. Upon doing further research, I found an article by Harrington (2017) that described it in more detail. There are 4 components to Big Data: volume, variety, velocity, and veracity.

The goal of big data is to assist in making better, faster and more accurate decisions. The article also describes "dark data" which is data that is collected through text, wearable sensors, audio recordings, and even images.

For nursing the true goal is to recognize the value of data collected and utilize it to improve patient outcomes.

I remain technologically challenged and articles such as this one are written in such a way that I can have a better understanding of what these terms mean. I am unable to link it to this pallet - but if you search on the Jacksonville Library site under CINAHL you should be able to find it. (and it is only 4 pages long...)

Thank you for a great discussion this week and presenting new ideas to explore and learn from!
Kathye

Harrington, L. (2017). New Data of the Digital Age: Big, Dark, and Deep. AACN Advanced Critical Care, 28(3), 239-242. doi:10.4037/aacnacc2017954

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Great job on this week's topic.  Your paper was amazing...well-articulated and full of valuable information!
The Joint Commission (JC) specifies standards for preventing indwelling catheter-associated urinary tract infections (CAUTI).  An element of performance is to “measure and monitor prevention processes and outcomes in high-volume areas by selecting measures using evidence-based guideline or practices, having a consistent method for medical record documentation, monitoring compliance, and evaluating the effectiveness of prevention efforts” (The Joint Commission, 2016).

Currently, our medical facility is collecting data on insertion and maintenance of indwelling foley catheters on all units.  As a charge nurse in the Emergency Department, I am required to document the insertion and maintenance of all catheters within the unit on an online Joint Commission survey during my shift.  We must double check the physician order or appropriate reason for foley (urinary retention, bladder irrigation, or for strict and accurate intake and output recordings, etc.), perform hand hygiene prior to insertion, perform proper perineal care prior to insertion, and ensure aseptic technique.  The surveillance of this criteria leads to improvement of patient outcomes.

Reference:

The Joint Commission. (2016). Requirements for the Catheter-Associated Urinary Tract Infections (CAUTI) National Patient Safety Goal for Hospitals. The Joint Commission.

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Big data model improves

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Credit: Shutterstock/Yale University

More than half of hospital deaths in the United States are related to severe infections, or sepsis. Yale researchers developed a prediction model, drawing on "big data" about local patients and using machine-learning methods, that proved better at identifying at-risk patients than existing clinical practices.

Currently, emergency physicians can use simple calculators or point- scoring systems known as clinical decision rules to determine which hospitalized patients might die from sepsis. However, these methods often fail to identify patients most at risk because they are based on limited information, derived from models that are unable to capture the complexity of data, and developed using different patient populations.

The new model developed by researchers at Yale School of Medicine and the University of Washington uses a large amount of data collected in electronic health records of local patients. Known as random forest modeling, the method draws on and learns from patient data to make predictions. Their big-data method outperformed existing models and has the potential to correctly classify an additional 200-300 patients per 5,000 with severe sepsis.

"By using the machine-learning technique and incorporating a large amount of variables-over 500-we created a model that has the potential to better predict sepsis mortality in patients admitted to the hospital," said Dr. R. Andrew Taylor, assistant professor of emergency medicine and first author on the study. Having proved the concept, Taylor and his colleagues hope to test the model in real-time with patients in New Haven while also promoting the big-data approach. "Our goal is to make patients' data work for them and create learning health systems where predictive models are developed and ultimately applied to improve patient care," he said.

The study published on this month in Academic Emergency Medicine.

More information: R. Andrew Taylor et al. Prediction of In-hospital Mortality in Emergency Department Patients with Sepsis: A Local Big Data Driven, Machine Learning Approach, Academic Emergency Medicine (2015). DOI: 10.1111/acem.12876

Provided by: Yale University

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Big data model improves prediction of key hospital outcome

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More than half of hospital deaths in the United States are related to severe infections, or sepsis. Yale researchers developed a prediction model, drawing on "big data" about local patients and using machine-learning methods, that proved better at identifying at-risk patients than existing clinical practices.

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The concept of communication is critical when discussing patient care delivery.  Research has been conducted on various communication tools to examine their effectiveness within clinical environments.  The Agency for Healthcare Research and Quality (AHRQ) and the Department of Defense (DoD) have developed an evidenced-based program for optimal team functioning called TeamSTEPPS (AHRQ, 2016).  Our hospital uses the TeamSTEPPS approach to improve teamwork and communication skills, create a culture of safety, and improve quality and clinical performance.

The TeamSTEPPS initiative takes a team approach to implementing Strategies and Tools to Enhance Performance and Patient Safety (Plonien & Williams, 2015).  TeamSTEPPS is based on four core competencies: communication, leadership, situation monitoring, and mutual support.  We attempt to utilize multiple tools as emphasized by TeamSTEPPS on a daily basis including huddles, debriefs, SBAR, assertive statement scripts, and closed-looped communication. If utilized correctly, this approach enhances patient quality outcomes.  TeamSTEPPS has proven effectiven in reducing patient safety issues (Stevens, 2013).  Teamwork always makes the dream work!

References:

AHRQ. (2016, September). TeamSTEPPS. Retrieved from Agency for Healthcare Research and Quality: https://www.ahrq.gov/teamstepps/instructor/index.html

Plonien, C., & Williams, M. (2015). Stepping Up Teamwork via TeamSTEPPS. AORN Journal.

Stevens, K. R. (2013). The Impact of Evidence-Based Practice in Nursing and the Next Big Ideas. The Online Journal of Issues in Nursing.

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Week 6_Response # 3 to Mrs. Pittsley and Mrs. Simmonsen

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Week 6_Response # 3 to Mrs. Pittsley and Mrs. Simmonsen

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The graphic outline you posted titled “The biggest challenges in improving patient health outcomes” shows the statistics of factors affecting the quality and efficiency of care.  These factors influence patient health outcomes and financial costs in healthcare.  In the United States, the healthcare system faces crucial challenges that distinctly indicate the need for continues reform.  This graphics reflects that disease prevention is still not a priority in the healthcare delivery system in the United States.  Increase emphasis is made on treating illnesses and not preventing them, which leads to higher healthcare cost for Americans than any other country worldwide.  Healthcare organizations can take into consideration the data indicated in this graphic to help decrease cost by providing preventive medicine interventions to improve patient health status outcomes.  As noted by Sewell (2016), “In this data-rich healthcare environment, the need to turn data into usable information is imperative” (p. 373).  One intervention that can help to increase the delivery of preventive medicine by healthcare institutions is allowing medical personnel to go out into the communities.  This exposure to the needs of the community serve can help healthcare organizations develop programs that will increase knowledge of diseases processes, healthy habits that will prevent illnesses or its deteriorations and increase patients’ engagement to their healthcare.  Through these programs, the healthcare team can provide the time that may not be given to patients in the healthcare setting to answer questions or concerns about their health.

References

Sewell, J. (2016). Informatics and research. In Informatics and Nursing: Opportunities and Challenges (5th ed., pp. 373-386). Philadelphia, PA: Wolters Kluwer

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This is an excellent question because it’s so easy to get caught up in the everyday bustle of work, do your job, and then go home.  However, taking the extra time to contribute to process improvement initiatives on your unit can pay major dividends for the nursing profession and the patient quality outcomes on your unit. As you know, many emergency departments are over- utilized for non-emergent issues.  At my previous medical facility, we had a “triage to clinic” policy in the Emergency Department.  This policy would allow us to send non-emergent and primary care issues to the appropriate clinics for further evaluation after triage was completed.  When I arrived at my current facility, I realized that triaging to a clinic was not a practice.  Since I have been in the workplace, I have adapted to not having the ‘triage to clinic’ option, but if given the opportunity I would work on making this happen.  The increasing patient volumes that occur from non-emergent issues lead to overcrowding and an increased risk for patient safety issues.

I would utilize the Plan, Do, Check, Act (PDCA) quality improvement methodology because it’s a short but effective way to implement process changes.  This method includes the steps to plan, carry out the plan, review and analyze results, and act based on the results. The PDCA method is a cycle that has no end meaning it can be repeated over and over for continuous process improvement until the goal is accomplished.