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Hot topic, hot patato? Koen De Meester MScN, PHD Student Director of Nursing Antwerp University Hospital Teaching and research assistant University of.

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Presentatie over: "Hot topic, hot patato? Koen De Meester MScN, PHD Student Director of Nursing Antwerp University Hospital Teaching and research assistant University of."— Transcript van de presentatie:

1 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

2 I am a nurse, manager and do some research 1987: –Sint Elisabeth Instituut Leuven Gegradueerde Ziekenhuisverpleegkunde Kliniek Sint-Jan Brussel: –Geriatric Ward and Pneumology oncology UZA: Intensive care –banaba emergency and critical care –internal medicine –cardiac surgery –Resuscitation training officer ALS, AED In-Hospital UZA: –banaba care management –Ward leader Post Anaestetic Care Unit present UZA: –MScN –Director of nursing 12 wards present UA: –PhD student –Teaching and research assistant

3 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

4 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!

5 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

6 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 Onderwerp of naam Context Indicators?

7 FOD patiëntveiligheid pijler 3: indicatoren ontwikkelen kwaliteit en patiëntveiligheid Onderwerp of naam Context

8 Beleidsnota Vlaams minister Jo Vandeurzen Patiëntveiligheid Accreditering Meten van zorgresultaten Context What’s in the media?

9 Ziekenhuizen doorgelicht Knack 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?

10 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?

11 Vlaamse patiënt krijgt meer transparantie over kwaliteit ziekenhuizen Knack 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?

12 De specialisten dinsdag 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 plannen de Vlaamse private en openbare ziekenhuizen een website met de medische resultaten van elk Vlaams ziekenhuis. Context What’s in the media?

13 Voorbeelden websites Onderwerp of naam

14 Onderwerp of naam Voorbeelden websites

15 Quality management Indicators at three levels Strategic Tactic Operational

16 Quality management Measures in each improvement model

17 Quality management What to measure?

18 Quality management Nursing Executive Center The Data-Driven Nursing Enterprise: Leveraging Data to Advance Hospital Nursing Performance The Advisory Board Company 2007 What to measure?

19 Onderwerp of naam

20 Quality management How to measure? Nursing Executive Center The Data-Driven Nursing Enterprise: Leveraging Data to Advance Hospital Nursing Performance The Advisory Board Company 2007 Hope Hospital Information System Electronic 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

21 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?

22 Input and output data warehouse Purpose: managment debate at unit level Infrastructure: –Number of beds, occupancy –ADT index: Flow –Case mix –SOI Input: –Consumables –Investments

23 Input and output data warehouse Input: –Personnel: staff (nursing)hours per patient day (NHPPD) –Workhour scheduling –Sick leave Vacancies/ budget Turnover: attraction/ retention Overtime Education Meetings –Patient transport

24 Voorbeeld deel rapport intern patiëntentransport Onderwerp of naam

25 Input and output data 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

26 Input and output data 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)

27 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

28 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 ©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)

29

30 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?

31 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?

32 What needs the manager? Dashboard: –Makes follow-up easy –Evaluation –Tree or forest? Pre defined reports Annual Report

33 Example data from warehouse

34 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?

35 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

36 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


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