FOUR DOMAINS OF NURSING DATA

Many of the chapters in this text have discussed areas of importance for the nurse and nurse manager. Many of these areas of importance will be measured on a routine basis. And the nurse needs to be knowledgeable of the levels of performance in these key areas.

What are the uses of outcome information? Many individuals, especially in some health care organizations, believe that very little is done with all of the information that is collected on a daily basis. In organizations that have adopted a philosophy of organizational learning, outcome data are taken very seriously and used to drive improvement. These organizations have knowledge of their level of current performance on many levels. It is the nurse manager’s responsibility to have a working knowledge of the unit’s performance and to create an environment of continuous learning and improvement.

Nursing data fall into four domains (Table 12-1). Nurses need data to provide information about client care, provider staffing, administration of care and the organization, and knowledge-based research for evidence-based practice. Collecting specific sets of data related to each of these domains give nurses information about practice and its effectiveness.

USES OF OUTCOME INFORMATION

A tremendous amount of information is collected during a hospital stay. Much of these data are further analyzed and turned into information that assists the organization and nurse manager in evaluating levels of performance. The information can be used to drive organizational, departmental, unit-based, and individual improvements.

So, what are the uses for outcome information (adapted from The Urban Institute, 2004)?

THE CORE MEASURES

The patient care outcomes that are routinely collected vary from unit to unit and from institution to institution. There are nationwide measures, such as the National Patient Safety Goals and the Core Measures of The Joint Commission. These were discussed in Chapter 10. All institutions also collect information on infection rates. This information is required by both state and federal regulating agencies. Sometimes these measures are intertwined; one such example is the Core Measure of Pneumonia, which is also an infectious process. Infectious disease evidence shows two actions that result in lower mortality: administering antibiotics within 4 hours of admission and acting on the information obtained from blood cultures. By reviewing the levels of performance on these two “in-process” measures of caring for a patient with pneumonia (administering antibiotics within 4 hours of arrival and acting on information obtained from blood cultures), an organization may be able to improve their performance on the outcome for the care of the pneumonia patient.

In reviewing Figure 12-1, look at the performance of a particular hospital in the Core Measures for a patient with acute myocardial infarction. If you review the levels of performance for angiotensin-converting enzyme inhibitors (ACEIs) for left ventricular systolic dysfunction, you will see an improvement in performance from 2003 to 2006. You will also see improved performance for two of the other in-process measures for care of the patient with acute myocardial infarction: adult smoking advice/counseling and aspirin on arrival. Processes were created by the hospital based on performance in 2003 to make it easier to give aspirin on arrival, to give β-blockers, and to give smoking advice. This change in process led to the result of better performance in the following years. Also, it led to a lower length of stay for these patients.

Fiscal accountability by health care providers has become a theme in health care delivery systems; however, evaluation of outcomes on the basis of cost alone may minimize the importance of patient needs and the quality of the care delivered. Mechanisms related to resource identification and allocation has to be driven by internal data and information systems that consider all domains of hospital data: clinical, financial, administrative, and patient satisfaction data.

Also, many hospitals will have organization- and unit-specific dashboards that visually display current levels of performance on key indicators. For a further discussion of dashboards, go to Chapter 10.

PATIENT SATISFACTION REPORTS

One of the most common performance indicators reviewed by nurses on a routine basis is the patient satisfaction report. For this report, newly discharged patients are given a questionnaire that reflects their perception of the care received on the unit. The response to each of the questions provides data that are transformed into information that can be used by the nurse manager for improvement of care on the unit.

Data are collected routinely in a health care organization so that the organization can reflect on its performance and try to improve certain areas. The main purpose of data collection is to improve care to all individuals involved in the health care delivery. Let’s use the data set for patient satisfaction as a discussion point. Most nurses on units will tell you that patient satisfaction is one of the most important performance measures in an institution. You may say to yourself that the clinical outcome should be most important measure of performance, but patient satisfaction data really provide information on a variety of areas.

Common satisfaction data results in information about:

As you can see from these lists, the focus of patient satisfaction relies on providers going beyond the mechanical delivery of medical care to the delivery of a true health service.

DRIVING FORCES FOR INCREASING PATIENT SATISFACTION

The list of benefits of paying attention to patient satisfaction is long and extends to virtually every corner of the health care organization whether hospital, physician practice, home health, long-term care, and so forth. This makes sense, because the range of factors making up satisfaction is quite wide. With greater patient satisfaction comes the following benefits:

Clinical Benefits

• Greater patient trust and acceptance with treatment plans

• Increasing buy-in for treatment plans more quickly, making best use of scarce physician time

• Increasing trust, which allows caregivers to discover more factors that may affect the care needs of the patient

• Enhancing patient involvement in their own care through preventative measures, corrective measures, and so forth

Operational Benefits

• Driving efficiency into the organization by focusing on what works well with patients and eliminating what does not work well

• Cross-over trust is enhanced. For instance, a good experience in scheduling appointments can cross over into a better experience with the care provider. In addition, a good experience with the patient’s primary care physician can cross over into a more positive experience with specialists to whom the primary care physician has referred the patient.

• Increased internal support for other quality improvement efforts, such as timeliness improvement, care process improvement, etc.

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