Hot topic, hot patato?

Koen De Meester MScN, PHD Student

Director of Nursing Antwerp University Hospital

Teaching and research assistant University of Antwerp

Key Care Quality Indicators using Hospital Information Systems and

Electronic Healthcare Records

I am a nurse, manager and do some research• 1987:

– Sint Elisabeth Instituut Leuven Gegradueerde Ziekenhuisverpleegkunde• 1987 - 1989 Kliniek Sint-Jan Brussel:

– Geriatric Ward and Pneumology oncology• 1989 -2000 UZA: Intensive care

– banaba emergency and critical care– internal medicine– cardiac surgery– Resuscitation training officer ALS, AED In-Hospital

• 2000 - 2006 UZA: – banaba care management– Ward leader Post Anaestetic Care Unit

• 2007- present UZA:– MScN – Director of nursing 12 wards

• 2010 - present UA:– PhD student– Teaching and research assistant

Overview

• Context

• Quality management

• Input and output: Data warehouse

• What’s in it for the nurse?

• What needs the manager?

• What needs the researcher?

• Summerized

Context

L’évaluation de la qualité des soins et de la performance de notre système de santé est au coeur de l’actualité. A cette fin, l’utilisation rationnelle d’indicateurs pertinents reste toujours un défi à relever. Dans le cadre limité du monde hospitalier et à partir de leur expérience de terrain, nos orateurs s’attacheront à montrer comment un système d’information hospitalier (HIS) et, en particulier, le dossier patient informatisé peut actuellement aider à construire, enregistrer ou analyser des indicateurs de qualité des soins.

Zorgefficiëntie en zorgkwaliteit alsook de evaluatie er van staan brandend actuele ontwerpen. Vooral het rationeel gebruik van pertinente en betrouwbare indicatoren blijft een uitdaging. De sprekers zullen, op basis van hun eigen ervaring, aantonen hoe een ziekenhuis informatiesysteem (ZIS) en meer bepaald het elektronisch medisch dossier (EMD) kunnen aangewend worden voor identificatie, registratie en analyse van kwaliteitsindicatoren betreffende de zorg.

There is a lot in it! Good work! High expectations!

Context• Evaluation

– Quality of care (system)– Performance of care (system)

• Challenge– Rational use of indicators– Reliable indicators– Indisputable indicators

• Hope– Hospital Information System– Electronic Patient Record (Medical ea)

• Key Care Quality Indicators– Identification– Registration– Analysis

Definition of quality?

In its seminal 2001 report, Crossing the Quality Chasm: A New Health System for the 21st Century, the IOM defined quality as

"the degree to which health services for individuals and populations increase the likelihood of desired health outcomes and are consistent with current professional knowledge.“

authors used the definition to create STEEEP, i.e., all health care should be

– Safe

– Timely

– Effective (outcome)

– Efficient (proces)

– Equitable

– Patient-centered

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Context

Indicators?

FOD patiëntveiligheid pijler 3:

indicatoren ontwikkelen kwaliteit en patiëntveiligheid

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Context

Beleidsnota Vlaams minister Jo Vandeurzen

• Patiëntveiligheid

• Accreditering

• Meten van zorgresultaten

Context

What’s in the media?

Ziekenhuizen doorgelichtKnack 23 februari 2011

Prof Arthur Vleugels:• “wij weten niet wat de kwaliteit van onze ziekenhuizen is”• “We lopen achter op kwaliteitsmeting”• “De ziekenhuiswet van 1963 zegt niets over de processen

en er zijn geen criteria over het resultaat van de zorg.”

Prof Lieven Annemans:• “minder dan 3% van het budget naar informatie en

communicatie technologie tov 4 tot 6% in andere sectoren”

• “ … het bord schoonvegen want we hebben echt een geïnformatiseerd zorgsysteem nodig.”

Context

What’s in the media?

Indicatoren mbt de kwaliteit van de verpleegkundige activiteit

3 maart 2011 Brussel

Federale Raad

voor de kwaliteit van de verpleegkundige activiteit:– Pijn– Decubitus– Fixatie– Ondervoeding

Context

What’s in the media?

Vlaamse patiënt krijgt meer transparantie over kwaliteit ziekenhuizenKnack woensdag 01 juni 2011 om 14u26

(Belga) De Vlaamse patiënt moet meer transparantie krijgen over de kwaliteit

van de ziekenhuizen. Dat is het doel van het protocol "Kwaliteitsindicatoren Vlaamse Ziekenhuizen" dat Vlaams minister van Welzijn en Volksgezondheid Jo Vandeurzen (CD&V) woensdag met diverse spelers uit de Vlaamse gezondheidszorg ondertekende. Het finale doel is het verhogen van de kwaliteit van de zorg voor de patiënten.

Vlaams Agentschap Zorg en Gezondheid

Context

What’s in the media?

De specialistendinsdag 25 januari 2011 om 11u48

Alle Vlaamse ziekenhuizen willen tegen 2013 een website realiseren waarop burgers de kwaliteit van de geleverde zorg kunnen vergelijken.

Tegen 2012-2013 plannen de Vlaamse private en openbare ziekenhuizen een website met de medische resultaten van elk Vlaams ziekenhuis.

Context

What’s in the media?

Voorbeelden websites

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http://www.leapfroggroup.org/cp

http://www.ziekenhuizentransparant.nl

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Voorbeelden websites

Quality management

Indicators at three levels• Strategic• Tactic• Operational

Quality management

• Measures in each improvement model

Quality management• What to measure?

Quality management

Nursing Executive CenterThe Data-Driven Nursing Enterprise: Leveraging Data to Advance Hospital Nursing PerformanceThe Advisory Board Company 2007

• What to measure?

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Quality management• How to measure?

Nursing Executive CenterThe Data-Driven Nursing Enterprise: Leveraging Data to Advance Hospital Nursing PerformanceThe Advisory Board Company 2007

HopeHospital Information SystemElectronic Patient Record (Medical ea)

Need for • strong ICT department• good ICT tools• strong Business Intelligence cell• good input

rubbish in = rubbish out nothing in = nothing out

Quality management

• How to analyse and interpret?

• Data correct?

• Does it measure what you want to know?

• Good description of the indicator

• What’s the target KPI?

Input and outputdata warehouse

Purpose: managment debate at unit level

• Infrastructure:– Number of beds, occupancy– ADT index: Flow– Case mix– SOI

• Input:– Consumables– Investments

Input and outputdata warehouse

Input: – Personnel:

• staff (nursing)hours per patient day (NHPPD)– Workhour scheduling– Sick leave

• Vacancies/ budget• Turnover: attraction/ retention• Overtime• Education• Meetings

– Patient transport

Voorbeeld deel rapport intern patiëntentransport

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Input and outputdata warehouse

Output:– Patient satisfaction– Delivered care: nursing and medical

• MVG/MZG/MKG– KCE points

• Facturation

– Patient outcomes• Nursing Outcomes• Complications• Nosocomial infections• Serious Adverse Events:

– CA, Readmission ICU, Failure to rescue

Input and outputdata warehouse

• Data at hand in multiple ICT applications

• Difficult to extract, not impossible

• Correct definition of indicator– After multidisciplinair consult

• Strong Business Intelligence Cell

• Strong ICT department

• Good ICT tool (f.i. Cognoss)

What’s in it for the Nurse?

• Patient safety and reliability of care– Number of patient observations– MRSA– Pressure Sores– Falls

• Patient satisfaction• Staf wellbeïng• Care efficiency (new to measure)

– Direct patient care time – Number of patients goïng home safe and on time

What’s in it for the Nurse?

Patient records of lower quality showed more unintentional harm

M.C. de Bruijne , M. Zegers ,L.H.F. Hoonhout ,C. Wagner Onbedoelde schade in Nederlandse ziekenhuizen: Dossieronderzoek van ziekenhuisopnames in 2004 ISBN 978-90-6905-845-0 ©2007 EMGO Instituut en NIVEL

Nurses and doctors have to put their actions in the record! Point of care registration Easy to access Easy to use No extra clerical work to get Indicators Wants electronic patient record that supports good nursing

care not good financing alone (MVG/MZG)

• Decision support– Aggregated scoring systems– Nutrition screening– Risk for Falls– Risk for pressure sores– Delirium

• For management – Annual Report & Feedback– Joint decision making– At this point nurses are not used to data or

indicators regarding their quality of work

What’s in it for the Nurse?

What needs the manager?• Evaluation

– Quality of care (system)– Performance of care (system)

• Challenge– Rational use of indicators– Reliable indicators– Indisputable indicators

• Hope– Hospital Information System– Electronic Patient Record (Medical ea)

• Key Care Quality Indicators– Identification– Registration– Analysis

Remember this one?

What needs the manager?

• Dashboard: – Makes follow-up easy– Evaluation– Tree or forest?

• Pre defined reports

• Annual Report

Example data from warehouse

What needs the manager?

• Analysis: – What does the indicator means?

• Interpretation only possible by meeting the stakeholders

• Peer review, benchmarking– Are the indicators the same and reliable?

What needs the researcher?

Research on nursing conditions in cases of Serious Adverse Events on general wards

• Data not always ready to use• Problem of diversity in measurements difficult

to compare• Problem of accessibility

– f.e. multi-center studies• Quantification of information in patient records• Data extraction• Merging data

Summarized

– Brief overview– Complex, indicators in

• different levels• different goals

– Standardisation of indicators if possible– Helps to objectivate

• Supports dialogue between frontline and management

• Supports improvement

– A long way to go for al parties involved