A new study finds that psychiatric disease and substance abuse are the top reasons for short-term rehospitalizations among non-Medicare patients.
A newly released analysis by researchers at Beth Israel Deaconess Medical Center shows that, when the rates, characteristics, and costs of hospital readmissions across all ages and insurance types are compared, non-Medicare patients account for nearly half of all 30-day readmissions. Psychiatric disease and substance abuse were the most common diagnoses associated with readmission among patients ages 18 to 64. Medicaid patients had very high rates of short-term readmissions across all age groups.
“As rehospitalization costs continue to rise, efforts to reduce hospital readmission rates have become a national health care priority,” says Robert Yeh, MD, MSc, MBA, senior author of the analysis and director of the Richard A. and Susan F. Smith Center for Outcomes Research in Cardiology at BIDMC in a news release. “With this analysis, we determined the specific causes of and the cost burdens associated with readmissions for patients of all ages and insurance coverage. We found there is tremendous potential to reduce readmissions by delivering targeted interventions for specific conditions within high-risk groups.”
Readmissions’ High Costs
The researchers evaluated data from the Nationwide Readmissions Database for patients over 18 years old who were hospitalized for any condition and discharged between January 2013 and November 2013. The patients were divided into age groups—18 to 44, 45 to 65, and 65 and older, and the data included discharges at more than 2,000 hospitals in 21 states.
The analysis found that out of the more than 12.5 million discharges evaluated, approximately 1.8 million patients were readmitted within 30 days. Medicare patients accounted for 56% of all readmissions. The readmissions translated to total annual hospital costs of $50.7 billion – Medicare readmissions resulting in a cost of $29.6 billion and non-Medicare in a cost over $21 billion in 2013.
“Our findings show that while Medicare readmissions represent more than half of all hospital readmissions, non-Medicare readmissions are frequent and make up a significant percentage and substantial cost,” says first author Jordan Strom, MD, research fellow at the center for research in a news release.
“We found that readmission among the non-elderly was most often driven by psychiatric and substance abuse problems, compared to the most common reasons for readmission in the elderly, which included pneumonia, heart failure and heart attack,” Strom adds.
As changes to national healthcare legislation are proposed, particularly those regarding Medicaid funding, the costs and causes of hospital readmissions should be considered.
“These findings clearly highlight the significant use of unplanned hospital-based care among younger patients, particularly among the Medicaid population,” Yeh says. “Therefore, any changes to Medicaid coverage will require alternative solutions to ensure that the current benefits can continue to be provided without creating financial catastrophe for these patients or the institutions that care for them.”
Despite their initial reason for hospitalization, diabetic patients with uncontrolled blood sugar are at risk for repeat admissions.
Diabetic patients with severe dysglycemia (uncontrolled high blood sugar or low blood sugar), are at increased risk for hospital readmission, despite their initial reason for hospitalization reports a new study in the Journal of General Internal Medicine.
When a team of researchers, examined the data of over 340,000 adult diabetic patients hospitalized between January 2009 and December 2014, they determined patients with diabetes are initially admitted to the hospital and experience unplanned readmissions for a wide range of reasons with heart failure being the most common.
Yet, once their initial condition was treated or stabilized, 10.8% were readmitted within 30 days of discharge and 2.5% of those readmissions were for dysglycemia regardless of the initial reason for hospitalization.
If their index hospitalization was also for severe dysglycemia, the risk of a recurrent episode requiring hospitalization was nearly nine times higher after a severe hyperglycemic event and five times higher after a severe hypoglycemic event. Patients between 18 and 44 years old were twice as likely to be readmitted for severe dysglycemia than older patients.
“We were especially concerned to find that, for patients whose index hospitalization was because of severe dysglycemia, if they were readmitted within 30 days, it was very likely to be for another dysglycemia event. Nearly 30% experienced back-to-back dysglycemia, rather than readmission for any other cause,” says the study’s lead author Rozalina McCoy, MD, an internal medicine physician and endocrinologist at Mayo Clinic in a news release.
Patient Education is Key to Prevention
Identifying patients at risk for readmission and intervening both during hospitalization and post-discharge can help prevent repeat hospitalizations, says McCoy.
“Severe dysglycemic events can be prevented with good diabetes outpatient care and careful discharge planning for diabetic patients who have been hospitalized for any reason ─ not just for severe hypoglycemia or hyperglycemia,” she says. “Inpatient diabetes education has been shown to reduce risk of readmission, as have medication reviews, care transition programs, and other efforts to incorporate diabetes care into discharge planning and post hospital follow-up.”
No matter the initial reason for hospitalization, McCoy encourages healthcare providers of hospitalized diabetic patients to develop discharge plans that include follow-up with their primary care provider immediately after discharge. They should also discuss the reasons for the patient’s hospitalization and diabetes management.
“The hospital follow-up visit allows patients and their providers to discuss the reason for hospitalization, any medication changes, their ability to take care of themselves at home, and potential ways to prevent readmission if problems arise in the future,” she says. “It also provides an opportunity to review the patient’s diabetes management plan and blood sugar levels.”
Nurse leaders can foster acceptance of evidence-based practice by providing RNs with a process to question changes.
Change is good. But it can also be hard.
This is often the case when nursing procedures are updated to align with evidence-based practice. For all the potential EBP has to improve patient care and outcomes, nurses may still dig in their heels and balk at doing things differently than the way they've always been done.
So what's the secret to getting RNs to embrace EBP? Let them challenge it, says Alison Mason, MS, RN, national director, quality informatics, at Englewood, Colorado-based Catholic Health Initiatives.
"What I tell people when I do implementations with them is, if people want to challenge a procedure, I welcome that because that is a way of engaging a nurse and looking at evidence and understanding how leveled evidence works," she says.
Practice Must Align with Evidence
Mason speaks from experience. As part of her role at CHI, she focuses on using evidence-based resources and electronic systems, including those for physicians, nurses, and pharmacists, to affect change and support practice.
Over the years, she has brought number of facilities (CHI operates in 17 states and comprises 104 hospitals; community health-services organizations; accredited nursing colleges; home-health agencies; living communities; and other facilities and services along the care continuum) into the EBP-fold.
"Evidence-based practice was one of our destination metrics that was determined a decade ago," she says. "My goal is to help our facilities align with EBP and to help them analyze data in order to meet metrics that we have set as an organization around quality initiatives."
As one would expect, when new facilities come on board, there can be resistance to doing things differently.
"When you're onboarding somebody new, sometimes they'll say, 'That's not how we do it here.' [But] how you insert a nasogastric tube in Lexington, Kentucky should be same way you do it in Tacoma, Washington," Mason says.
"The expectation is that they will align with the evidence and the [electronic EBP] resource that we use."
EBP Challenges Encourage Critical Thinking
If a nurse takes issue with a standardized procedure, he or she may engage in the challenge process.
"I encourage them to look at it, I encourage them to then go back and, if they want to challenge something there's a form that they have to fill out that is very specific about what it is they have an exception with," Mason explains.
The nurse must provide citations and resources to support the challenge and Mason does an initial review of the challenge.
"If the level of evidence is below the level of evidence used to define the electronic procedure I go back to them and explain that their challenge doesn't have the same rigor of evidence that was used to develop the procedure," she says.
"And I explain, if they still want to carry this forward, the type of evidence they need to find."
This includes explaining the scale CHI uses to determine strength of evidence.
"It's a way of pulling nurses into understanding leveled evidence and how it applies to practice," she says.
Mason also includes the nurse on any communication she has with the vendor regarding the challenge.
"I always copy them if I push this forward to the editor at the vendor for review," she says.
"I copy them so that they're aware that they're being listened to and they're involved in the discussion and the decision."
While it takes time and effort, Mason says encouraging rather than dissuading nurses' challenges to EBP is a positive thing.
"It's challenging sometimes but I think very beneficial for our end users, for our clinicians," she says. "What I have found is that because they see that we're open to pushing their challenges forward if they provide the evidence to support their claim, they really are more accepting then of any kind of changes that may occur."
Looking beyond general statistics can lead to better design of policies related to end-of-life care among oncology patients, researchers say.
Nuances among patient populations are not reflected in Medicare policies regarding cancer patients’ end-of-life care, finds a new study led by Harvard Medical School researchers and published in the July issue of Health Affairs.
Currently, Medicare policies on cancer patients’ end-of-life care are based on general statistics like average survival time and treatment costs. The study found that the dominant end-of-life care settings for patients with lung cancer—home, inpatient facility, hospice, or intensive care—showed variations in survival time, expenses, number of hospitalizations, and length of palliative care.
“Medicare policies for cancer care ought to be designed with diversity in mind. There is no average patient,” study senior investigator Laura Hatfield, an associate professor of health care policy at Harvard Medical School, says in a news release.
Survival Times Differ
To identify care patterns, investigators analyzed Medicare claims from 1995 to 2009 for more than 14,000 patients with extensive stage small-cell lung cancer, and compared the time patients spent in each care setting from diagnosis to death relative to patients’ overall survival time.
For example, while the average survival time for patients with small-cell lung cancer is eight to 12 months, many patients have much shorter life expectancies. Patients who spent most of their time in inpatient and ICU settings had an average survival time of one month, and patients in the hospice group had a survival time of around four months. Patients who spent the most time at home had an average survival time of 10 months.
The researchers’ model classifies patients with the same diagnosis into smaller groups with similar characteristics, which the authors hope can be used to inform tailored healthcare coverage options and provide better individualized care.
The authors say that their findings do not indicate that healthcare settings necessarily played a role in different survival times. Rather, the purpose of classifying patients in subgroups was to give policymakers better information about variation in patients’ outcomes and healthcare needs
“If a patient has only one month to live, then policies should ensure that their care includes more rapid decision making and advanced care planning,” Hatfield said.
Giving nurses time to connect with why they chose to be nurses can stop burnout before it begins.
Burnout is more than just being overworked. It's a response to chronic workplace stressors that leaves workers experiencing one or more of the following components: emotional exhaustion, cynicism, and inefficacy.
Unfortunately, nurses often experience higher rates of burnout than other healthcare workers.
A 2011 study by nurse researchers at the University of Pennsylvania School of Nursing found that 34% of nurses scored higher than the average for healthcare workers on the Maslach Burnout Inventory emotional exhaustion subscale.
But Page West, RN, MHA, MPA, senior vice president and chief nursing executive at Dignity Health is working to change that by helping the organization's nurses cultivate resilience.
"I look at resilience as the prevention of burnout. If we focus on resilience and figuring out what is that magic piece of work that allows nurses or providers to keep in touch with their heart and soul, then we don't reach the burnout phase," West says.
"It's the antidote really, if you will, for burnout."
Time to Reconnect
Most nurses go into nursing because they want to make a difference in people's lives. But that goal can get lost among the intensity and chaos of a typical day.
It's for this reason that West advocates for building in time for nurses to reconnect with the reasons they went into the profession in the first place.
"We need to continue to build processes and time into the work day for the nurses to be able to connect their heart and their mind. To allow them to have some moments for reflective pause that get them through the day rather than just having to do task after task after task," she says.
For example, at Dignity there is time built into the end of a code blue for nurses to pause and reflect on the life that was lost.
"The nurses just take a second, instead of going back to their assignment, to reflect on the life that they just lost and honor it as well as taking a moment to reflect among the team about what just happened," West says.
"They allow themselves to get [centered], to grieve for a minute if they need to, to listen to each other, to thank each other for what they've done."
Outside some patient rooms there is a picture of a hand that says, "Stop and reflect."
"It's a visual reminder to reflect on what it is you're about and what it is you want to do for this patient," she says.
Work-life, Personal-life Benefit
Giving nurses more control over their work environment also helps prevent burnout, says West.
"One of the things we learned is that they'd like to have a "weather report" so each unit knows what's going on in the rest of the hospital," she says.
"So if they're going to get five admissions, they understand the reason they're getting them is because their sister unit is either full or doesn't have enough staff. It helps them to connect as the larger team."
At Dignity Mercy San Juan, connection between teammates is encouraged through reflective huddles.
"When they're feeling stressed, [the nurses] can call a quick huddle and they all talk about what's making them unhappy at that moment and what they can do to help each other get over it so they can change the emotion and tide of the way a unit is going," West says.
The nurses have responded positively to the resilience training work, she says.
"[They talk] about what a difference it has made in their life—both in their quality of work-life and in their persona- life. They feel more rested when they go home and interact with their families," she says.
"I see in their eyes, when they think about the profound difference they have made even in one life during a shift, there's just joy that comes over them, this sense of peace. It's that fulfillment of why you go into nursing in the first place which is to make a difference in the lives of our patients and each other."
Nurse leaders pushing for nurses to obtain BSNs need to understand that college debt can slow nurses' academic progression, and has negative implications for those on a leadership track.
Students are graduating from college with significant amounts of educational debt—in 2015 the average student borrowerhad $30,100 in loans upon graduation—and a recently published study finds that nurses are no different.
When Jan Jones-Schenk, DHSc, RN, NE-BC, national director for the college of health professions at Western Governors University, surveyed 1,299 working nurses for the study, 62% of the respondents reported they had prior college debt.
More than 39% of those with debt said their debt ranged from $1 to $24,999 while 23.5% reported debt greater than $25,000. Approximately one-third of the respondents said they had no prior college debt.
"Some had debt as high as $100,000, and 7% reported debt greater than $50,000. That's a lifetime of debt," Jones-Schenk says.
The study also found that educational debt influences nurses' decisions about academic progression.
"The data showed that most of the people who have an education plan are going to go on, and they have debt," she says.
"But if they have more than $10,000 in college debt they're going to delay their educational advancement so they're not going to go on as quickly."
Debt's Influence on Education Decisions
When the National Academy of Medicine (formerly the Institute of Medicine) report, "The Future of Nursing: Leading Change, Advancing Health," was released in 2010, it had very specific recommendations on the educational preparation of RNs.
The report called for 80% of nurses to hold a baccalaureate degree by 2020, and for the number of nurses with doctorate degrees to double during that time as well.
It also called upon healthcare organizations to encourage nurses with associate's and diploma degrees to enter baccalaureate nursing programs within 5 years of graduation, and for accredited nursing schools to ensure that at least 10% of all baccalaureate graduates enrolled in master's or doctoral program within 5 years of graduation.
"We all understand the basis of that," Jones-Schenk says. "But I do think that nurse leaders may not understand that while they may offer tuition reimbursement or other incentives for their staff, they may not be aware of the current level of debt those people have already."
While nurses with ADNs may want to obtain BSNs, they may already carry a large amount of educational debt from their associate's degree program.
"Because I do have students in all 50 states, I was seeing programs where students were coming to me with an associate degree and it seemed like their college debt was already pretty high," she says of her inspiration for the study. "Some of the associate degree programs were at $60,000."
Financial Knowledge Needed
Jones-Schenk says good financial mentoring is one way to help nurses keep their educational debt in check.
"If [students] are eligible for federal financial aid or state financial aid, without good counseling they may take the maximum amount of eligibility. But they may not need all that," she says.
"In our university, we have a specific initiative called 'the responsible borrowing initiative.' We counsel students about how much borrowing they really need and not to over-borrow… so they're going to be able to go on without that debt as a barrier."
Nurses should also look at the overall cost of a program, even if a college or university is offering a discount to their employer.
"'If you're saying, 'Well, I'm going to go to the school that offers the 20% tuition discount vs. one that offers a 5% discount,' that percentage of discount is meaningless. What matters is the ultimate cost to the student," Jones-Schenk says.
"That's where I think a lot of people get hung up. They think they're going to go to a school because they offer a 20% discount, but the ultimate cost to the student is still $30,000 grand to the student vs. $10,000 [with a smaller discount]."
Responsibility for minimizing debt shouldn't be placed entirely on the student. Jones-Schenk says low-interest rate loans and loan forgiveness programs are tools that could help defray educational debt.
"Nurse leaders, people in higher education, the government and other individuals who have an interest in healthcare are all worried about healthcare costs," she says.
"This is part of it as well. I would hope that we would take a serious look at the cost of higher education and its value and contribution to the health of the nation."
Nursing organizations advocate for rehabilitating rather than punishing nurses experiencing substance use disorder.
The American Association of Nurse Anesthetists is endorsing a new position statement that advocates for an alternative-to-discipline approach for nurses and nursing students with substance use disorder.
The position statement also says drug diversion for personal use should be considered a symptom of a serious but treatable disorder rather than strictly as a crime.
“It’s about education for prevention and fair handling when it happens,” says Lynn Reede, DNP, MBA, CRNA, FNAP, AANA senior director of professional practice. “Education raises awareness and understanding, and at the same time decreases the stigma related to the disease. Treatment of substance use disorder helps keep patients and healthcare professionals safe.”
Recovery is the Goal
A disciplinary approach to impaired practice or drug diversion involves due process with a state board of nursing and suspension or revocation of a nurse’s professional license. There is no offer of a recovery program and the nurse may be terminated and legal charges can be filed.
Through an alternative-to-discipline program, a nurse does not practice for a specific time while undergoing treatment and establishing sobriety and recovery program. He or she may undergo psychiatric evaluations, specialized treatment like one-to-one therapy and support groups, and random drug screens. A return-to-work agreement is created and often involves a reduction in hours, limited shifts, and restrictions in assignments with continued treatment and monitoring for periods of up to three to five years. Restrictions are lifted as the nurse demonstrates he or she is making progress.
Alternative-to-discipline programs make it easier for impaired nurses, including nurse anesthetists, to step away from work while they receive treatment, says the AANA in a news release.
“An ATD approach gives Certified Registered Nurse Anesthetists and student registered nurse anesthetists three opportunities: 1) To enter treatment to address their addiction, 2) To work toward lifelong sobriety, and 3) When possible, their eventual return to the workplace,” says Linda Stone, DNP, CRNA, chair of the AANA peer assistance advisors committee.
Healthcare providers should exercise caution when prescribing antibiotics as adverse drug reactions can extend hospital stays and increase emergency department visits.
Antibiotics can be an important part of a patient’s treatment plan, but healthcare providers should be mindful that the drugs do not come without risks, write authors of a new study published in JAMA Internal Medicine.After examining medical records of 1488 patients, researchers at The Johns Hopkins Hospital found that 20% of hospitalized patients who received at least 24 hours of antibiotic therapy developed antibiotic-associated adverse drug events. Additionally, 20% of adverse drug effects were attributable to antibiotics prescribed for conditions that did not warrant the use of antibiotics.
The study’s authors stress that healthcare providers need to be judicious when prescribing antibiotics to reduce the occurrence of adverse drug events.
“Too often, clinicians prescribe antibiotics even if they have a low suspicion for a bacterial infection, thinking that even if antibiotics may not be necessary, they are probably not harmful,” says Pranita Tamma, MD, MHS, assistant professor of pediatrics and director of the Pediatric Antimicrobial Stewardship Program at The Johns Hopkins Hospital in a news release. “But that is not always the case. Antibiotics have the potential to cause real harm to patients. Each time we think to prescribe an antibiotic, we need to pause and ask ourselves, ‘Does this patient really need an antibiotic?’”
Adverse Drug Effects Prolong Hopsital Length of Stay
Between September 2013 to June 2014, researchers reviewed medical records of patients admitted to the general medicine services at The Johns Hopkins Hospital. Patients were followed for 30 days after hospital discharge to determine the likelihood of an adverse reaction to antibiotics and to identify how many adverse reactions could be prevented by eliminating unnecessary antibiotic use. They were observed for up to 90 days for the development of Clostridium difficile infection and for development of new multidrug-resistant infections.
In addition to finding that 20% of patients experienced one or more antibiotic adverse effect, researchers also found that antibiotic side effects increased by 3% for each additional 10 days of antibiotic therapy. The most common side effects experienced were gastrointestinal, kidney, and blood abnormalities. A total of 4% and 6% of patients developed C. difficile infections and potential multidrug-resistant organism infections. No deaths were attributed to any antibiotic side effects in this study
The researchers say 24% of patients had prolonged hospital stays; 3% percent experienced additional hospital admissions; 9% required additional ED or clinic visits; and 61% needed additional diagnostic tests due to adverse drug effects.
Adverse drug reactions in general are a serious and costly problem. The CDC estimates that each year adverse drug events cause more than 1 million ED visits and 280,000 hospitalizations and contribute to an additional $3.5 billion in medical costs of annually.
Clinical outcomes and teamwork suffer when healthcare providers exhibit rude or uncivil behavior. Vanderbilt University Medical Center has developed a process for resolving disruptive behavior among clinicians.
Rudeness by medical teams causes problems that go beyond hurt feelings, suggest two studies published in the journal Pediatrics.
Researchers have found that rudeness can negatively affect:
Diagnostic and intervention parameters
Team processes such as workload sharing, helping, and communication
Diagnostic and procedural performance scores
Researchers say that rudeness alone explained nearly 12% of the variance in diagnostic and procedural performance.
"We do this work for Vanderbilt nurses and physicians, but we also have several sites around the country where we support their work in terms of processing their data and providing analysis and training of their leaders on how to address professionals who are associated with more than their fair share of, as we occasionally call them 'disturbances in the force'," he says.
These disturbances can include interactions with patients, colleagues, or staff members.
"If you have a nursing professional who has encountered a surgeon who, every time she brings up the surgical time-out, the surgeon says, 'No, we're on the same page let's just proceed,' she may not bring it up the next time," says Cooper.
One of the center's goals is to prevent this type of behavior from becoming a pattern.
"We work really hard to try to prevent physicians, advanced practice nurses, and other professionals from having the really unfortunate consequences of having these patterns develop, including malpractice suits and harassment suits," he says.
Respect is a Shared Value
Everyone has an off day here and there so it's important to look at data to see if particular patterns are emerging.
"We assess and analyze various sources of data, including patient complaints and staff complaints, to [identify] those professionals who are associated with a disproportionate share of those data points," Cooper says.
"Ninety-seven percent of professionals won't have significant amounts of trouble, but those small numbers that do create a whole lot of disturbance."
Over a 25-year period, which ended in 2015, fewer than 2% of all physicians practicing were responsible for half of all malpractice dollars paid out, researchers have found.
At Vanderbilt, physicians and APRNs are made aware of individual complaints just so they are aware one was received.
When they develop a pattern, a trained peer messenger takes them aside and says, 'I'm here as your peer today. I'm part of our professionalism committee. I just wanted to let you know that for some reason, your practice appears to be associated with more patient complaints than your colleagues.'"
"What we find is that 80% of the time, they'll self-correct," Cooper says.
For those who don't self-correct, a conversation is then had between the provider and someone at a higher level of authority.
"Even those folks that rise up to the authority-level conversation that haven't [already] self-corrected, about 60% of those end up self-correcting," he says.
Perhaps this success is due to the way the message is delivered.
"By sharing information with them in a non-judgmental way, you can really turn things around for them. The ripple effects for that individual and their coworkers and their patients is really phenomenal," Cooper says.
"There has to be a shared vision and values that aren't just around being the best. It's very important to have aspirational goals, but also that we will treat our colleagues with respect.
After incorporating machine learning technology into its fall prevention program, El Camino Hospital significantly improved fall rates.
Identifying patients who are risk for falling is a key component in traditional fall prevention programs. However, successfully reducing falls requires interventions that go beyond simply acknowledging risk factors.
El Camino Hospital, a 446-bed, two-hospital health system located in Silicon Valley, California, has added a high-tech twist to its fall prevention program and significantly improved fall rates.
"We had fall rates that were beyond the benchmark," says the organization's Chief Nursing Officer Cheryl Reinking, RN, MS, NEA-BC. "We're a Magnet hospital, so we like to stay in the top quartile or the top decile. It's important to us not only for that reason, but also for patient safety."
The organization leveraged its Silicon Valley location and worked with Qventus (formerly analyticsMD), a neighboring technology firm, to help it incorporate machine learning and prescriptive analytics into its fall prevention program.
"We explained our problem to them: There's all this data, we screen our patients, we do all these things, and we're still having falls—more than we want to have, and more than the benchmark," Reinking says. "They said to us, 'We think we can help you.'"
And Qventus has. Six-months after the hospital began incorporating the prescriptive analytics technology, fall rates dropped by 39%.
The Data Goldmine
Medicare patients make up about half of El Camino's patient population and often have multiple comorbidities which, in addition to age, put them at risk for multiple adverse events, not just falls.
Keeping track of which issue needs immediate attention can be a challenge.
"Nurses have lots of alarms, lots of data coming at us from all different directions. We do lots of mini risk assessments on our patients. We screen them for their risk of DVT, their risk for falls, their risk for infections, and on and on," Reinking says.
"When our patients are at high risk for so many things, it's hard to pull out those threads that are most important at the time."
This is where prescriptive analytics has helped. The technology takes data from multiple sources, including the EMR, call lights, and bed alarms, and can identify if a patient's risk for a fall is escalating.
"It can tell you a lot of things about your patients' behavior," She says. "It shows us how many times the patient has set off the bed alarm, how many times the patient has pulled the alarm in the bathroom, how many times the patient has put on the call light."
Reinking explains that the technology takes data from these multiple sources and analyzes it to predict which patient is a fall risk in that moment. When a patient gets to a certain threshold, the system sends an alert to the nurse via the Vocera badge system.
"Then the nurse knows there is something going on with this patient right now, and he or she needs to get in there, or send the CNA in there to look at the patient," she says.
The nurse can then determine if the patient needs to be moved to someplace in clearer view of the staff, if camera monitoring is necessary, or if a family member needs to be called.
"The nurses have been able to do further assessments and try to prevent a fall before it even happens, or even gets close to happening," Reinking says.
The technology has been successful in helping reduce falls at El Camino, and, although it's not the only tool used to keep patients safe, Reinking says it is something she encourages other nurse leaders to consider.
"A lot of our systems hold data elements that you may never have thought could help achieve improved outcomes. When you have someone who can really help you, from a technology standpoint, understand what [data is] there and how it could help you—it's eye opening," she says.
"We had this valuable data there that we never dreamed could help us in this way. You have to think outside the box sometimes."