Management within our department and hospital leaders are constantly communicating with our team members, reporting new data and processes we adopt because of the interventions our department documents daily. Before this week’s assignment, I never linked the connection between informatics and the many ways it is incorporated into our department. For example, as discussed in a resource provided in this week’s lesson, “MCG produces evidence-based clinical guidelines and software and is widely used in the US, UK, and Middle East” (Nagle, L. et al., 2017). We utilize MCG daily when completing initial and concurrent stay reviews for patients admitted for observation and inpatient status in our facilities. MCG does assist with determining the correct class status and preventing the delay of discharges. Avoiding the delay of discharges is stressed in our department and to our physicians. “Delayed discharge was associated with mortality, infections, depression, reductions in patients’ mobility and their daily activities. The qualitative studies highlighted the pressure to reduce discharge delays on staff stress and interprofessional relationships, with implications for patient care” (Rojas-García, A. et al., 2018). Therefore, data tools we utilize in our department to guide clinical decisions can easily apply data to practice to promote knowledge formation and problem-solving, resulting in improved outcomes for the facility and the patients we serve. NURS 5051 NURS 505/6051 Application of Data to Problem-Solving
The hypothetical scenario that I present to this NURS 5051 NURS 505/6051 Application of Data to Problem-Solving discussion is the instance of electronic notifications to decrease the chances of miscommunication or lack of communication between physicians and the Utilization Review Nurses. Mainly working on the weekends, I often witnessed where sent communication to the physician communicating the request to change a patient from observation to inpatient status was missing. This communication issue often results in three to four-day observation admissions when the goal is to have inpatient status if the patient exceeds a two-midnight admission. When completing chart reviews, the chart contains the information of the payor type and the expected length of stay. Rather than relying on the UM nurse to review the observation admissions to determine the correct status, this scenario introduces the ideal the computer system would generate an automatic notification to the physician to request an Inpatient order based on those criteria methods. I agree that “Sophisticated protocols can be developed related to both routine and alert information, thereby more effectively organizing communications with physicians, nurses, and caregivers” (McGonigle and Mastrian, 2017, p.380). Developing a protocol to automatically set up notifications to the physicians of the request to consider entering an inpatient order for patients meeting criteria could prevent lengthy observation admissions and decrease the chances of miscommunication with the UM department and the physician, especially when understaffed the weekends and holidays. NURS 5051 NURS 505/6051 Application of Data to Problem-Solving
As mentioned, I continue to be amazed by the processes our virtual facility utilizes to record the interventions for each case, applying that data to determine the effectiveness of the outcome. With our advanced technology capabilities, I see this scenario having excellent results that could easily be incorporated into daily practice and monitored to determine the effectiveness of decreasing lengthy observation admissions and communication errors between providers. Data collection could occur by requiring the doctor to respond to the notification with yes, an inpatient order was entered or not, and the outcome was the patient remained observation status after receiving the notification. Collecting responses to determine how many times the physician entered an inpatient order in response to the notification would be a way to determine the percentage of correct status cases before implementing the notification process. The increased incidence of inpatient orders entered could positively impact the number of avoidable long observation admissions. I can see the ability of my nursing supervisor to monitor the responses from the physicians and the occurrence of lengthy observation cases, which are monitored already. Tracking the outcome of this intervention leading to an inpatient order entered as a response from the physician could lead to knowledge formation to determine if this is a method to improve communication and to serve as a reminder to physicians as they enter the patients’ charts admitted as observation status in our facilities.
References
McGonigle, D., & Mastrian, K. G. (2017). Nursing informatics and the foundation of knowledge (4th ed.). Burlington, MA: Jones & Bartlett Learning.
Nagle, L., Sermeus, W.& Junger, A. (2017). Evolving Role of the Nursing Informatics Specialist. In J Murphy, W. Goosen, & P. Weber (EDS.), Forecasting Competencies for Nurses in the Future of Connected Health (212-221). Clifton, VA: IMIA and IOS Press. NURS 5051 NURS 505/6051 Application of Data to Problem-Solving Retrieved from https://several.unil.ch/resource/several:BIB_4A0FEA56B8CB.P001/REF
Rojas-García, A., Turner, S., Pizzo, E., Hudson, E., Thomas, J., & Raine, R. (2018, February). Impact and experiences of delayed discharge: A mixed-studies systematic review. Health expectations: an international journal of public participation in health care and health policy. Retrieved November 30, 2021, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5750749/.