Implementation of an Electronic Data Collection Tool to Monitor Nursing-Sensitive Indicators in a Large Academic Health Sciences Centre.

BACKGROUND: Monitoring the quality of nursing care is essential to identify patients at risk, measure adherence to hospital policies and evaluate the effectiveness of best practice interventions. However, monitoring nursing-sensitive indicators (NSI) is a challenge. Prevalence surveys are one method used by some organizations to monitor NSI, which are patient outcomes that are directly affected by the quantity or quality of nursing care that the patient receives. OBJECTIVE: The aim of this paper is to describe the development of an innovative electronic data collection tool to monitor NSI. METHODS: In the preliminary development work, we designed a mobile computing application with pre-populated patient census information to collect the nursing quality data. In subsequent phases, we refined this process by designing an electronic trigger using The Ottawa Hospital's Patient Safety Learning System, which automatically generated a case report form for each inpatient based on the hospital's daily patient census on the day of the prevalence survey. OBSERVATIONS: Both of these electronic data collection tools were accessible on tablet computers, which substantially reduced data collection, analysis and reporting time compared to previous paper-based methods. The electronic trigger provided improved completeness of the data. CONCLUSION: This work leveraged the use of tablet computers combined with a web-based application for patient data collection at point of care. Overall, the electronic methods improved data completeness and timeliness compared to traditional paper-based methods. This initiative has resulted in the ability to collect and report on NSI organization-wide to advance decision-making support and identify quality improvement opportunities within the organization.

Adverse events in patients with return emergency department visits.

OBJECTIVES: This study describes the proportion of emergency department (ED) returns within 7 days due to adverse events, defined as adverse outcomes related to healthcare received. DESIGN: Prospective cohort study. SETTING: We used an electronically triggered adverse event surveillance system at a tertiary care ED from May to June 2010 to examine ED returns within 7 days of index visit. PARTICIPANTS: One of three trained nurses determined whether the visit was related to index emergency care. For such records, one of three trained emergency physicians conducted adverse event determinations. MAIN OUTCOME MEASURE: We determined adverse event type and severity and analysed the data with descriptive statistics, χ(2) tests and logistic regression. RESULTS: Of 13,495 index ED visits, 923 (6.8%) were followed by ED returns within 7 days. The median age of all patients was 47 years and 52.8% were women. After nursing review, 211 cases required physician review. Of these, 53 visits were adverse events (positive predictive value (PPV)=5.7%, 95% CI 4.4% to 7.4%) and 30 (56.6%) were preventable. Common adverse event types involved management, diagnostic or medication issues. We observed one potentially preventable death and 58.5% of adverse events resulting in transient disability. The PPV of a modified trigger with a cut-off of return within 72 h, resulting in admission was 11.9% (95% CI 6.8% to 18.9%). CONCLUSIONS: Our electronic trigger efficiently identified adverse events among 12% of patients with ED returns within 72 h, requiring hospital admission. Given the high degree of preventability of the identified adverse events, this trigger also holds promise as a performance measurement tool.