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Putting Data in Nurses' Hands

Gienna Shaw, for HealthLeaders Media, February 13, 2012
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The system allows nurses to not only spend more time at the bedside but also respond to patients more quickly, says Janet Fundaro, APRN-CNP, chief nursing officer. And the facility's EMR allows nurses to perform documentation faster, as well. She encourages nurses to document in the room while they're with the patient. It's more efficient and accurate, and also presents a chance to talk to and educate the patient about his or her care.

"That does help with our patient satisfaction because of the quality and quantity of time," Fundaro says.
Integration with the organization's EMR is another important piece of the alerting system. "Inside our EMR, we have multiple alerts that are designed to really help stay ahead of all the factors that may contribute to the overall care of that patient," Miller says. Alerts automatically generated from EMR data include risk for infections, falls, out-of-range lab values, and more.

"We try to make our alerts as automated as we can because that's where you can get value," Miller says. "The No. 1 [advantage] is to be able to take care of the patient in any kind of critical situation as quickly as possible … to respond to that patient and provide whatever they need as quickly as possible."

The organization plans to expand its mobile alerting system. "We're looking at integrating more of our EMR alerts that today go to them in the charts and instead send those to the smartphone," Miller says.

Assessing acuity

At the 624-staffed-bed Mission Hospital in Asheville, NC, nurses use informatics to classify the acuity of every patient on every unit every day. That data tells them how many hours of care each patient will need so that they can deploy staff accordingly.

"You can look at the acuity of every patient every day," says Brenda Shuford, RN, management systems coordinator. "The nurse on the unit providing the care to the patient that day goes in and does what we call a classification of her patients. So there are certain indicators that are weighted based on how valuable they are in translating the needs of the patient into their hours of care that were needed for the day … Once they get all the patients on that unit classified, they're able to run a report and see what kind of staffing recommendations they're going to need for the next shift."

When Shuford was a nurse manager in the pediatric ICU, she instinctively knew that although the number of patients in any given unit didn't change dramatically over time, the severity of illness did. "And the staffing—hiring and change of mix—had not kept current to the patient changes," she adds.

But when Shuford asked for more RNs and a change in skill mix on the units, the answer was no. Budgets are created based on patient days and because the historic data on patient days hadn't changed, neither would the nursing staff configuration or budget.

Using an acuity system by Reston, VA–based QuadraMed when she became management system coordinator, Shuford and her team tracked patient data for two years and ultimately convinced finance leaders to create parallel budgets—one based on acuity system data and one based on historical data.
It turned out the acuity assessment–based budget and the historical budget weren't so different. The former would save the organization just one half of a full-time equivalent position. But although staff levels stayed more or less the same, nurses are now deployed where they are most needed each day.

"It really did show … the units that were overstaffed and the units that were understaffed," Shuford says.

"We knew the nurses knew what staff they needed. They just needed some way to prove that. And the QuadraMed system gave that opportunity to prove that. Nurses really know from being there a few hours what the flow of patients is and how sick they are and whether they've got the right number of staff. Being able to respond and get the finance end of the healthcare business to understand and see that nurses need to be in charge of that was an issue. But with this system we were really able to accomplish that," Shuford says.

Better deployment of resources had an impact on satisfaction, as well.

"We increased not only our staff satisfaction, which had been really low in the pediatric ICU because of the feeling of being overworked, but also patient and family satisfaction," Shuford says. "Before we got the additional staffing, I had numerous conversations with families who were disgruntled that their child did not get the care that they needed at the time that they needed it—it wasn't a timely response."

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