Transcript PowerPoint-presentatie

Key Care Quality Indicators using
Hospital Information Systems and
Electronic Healthcare Records
Hot topic, hot patato?
Koen De Meester
MScN, PHD Student
Director of Nursing Antwerp University Hospital
Teaching and research assistant University of Antwerp
I am a nurse, manager and do some research
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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
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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
There is a lot in it! Good work! High expectations!
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.
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
Context
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)
Indicators?
– Efficient (proces)
– Equitable
– Patient-centered
Onderwerp of naam
Context
FOD patiëntveiligheid pijler 3:
indicatoren ontwikkelen kwaliteit en patiëntveiligheid
Onderwerp of naam
Context
What’s in the media?
Beleidsnota Vlaams minister Jo Vandeurzen
• Patiëntveiligheid
• Accreditering
• Meten van zorgresultaten
Context
What’s in the media?
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?
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 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?
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 2012-2013 plannen de Vlaamse private en
openbare ziekenhuizen een website met de
medische resultaten van elk Vlaams ziekenhuis.
Voorbeelden websites
http://www.ziekenhuizentransparant.nl
http://www.leapfroggroup.org/cp
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Voorbeelden websites
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Quality management
Indicators at three levels
• Strategic
• Tactic
• Operational
Quality management
• Measures in each improvement model
Quality management
• What to measure?
Quality management
• What to measure?
Nursing Executive Center
The Data-Driven Nursing Enterprise: Leveraging Data to Advance Hospital Nursing Performance
The Advisory Board Company 2007
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Quality management
• How to measure?
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
Nursing Executive Center
The Data-Driven Nursing Enterprise: Leveraging Data to Advance Hospital Nursing Performance
The Advisory Board Company 2007
Quality management
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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 output
data warehouse
Purpose: managment debate at unit level
• Infrastructure:
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Number of beds, occupancy
ADT index: Flow
Case mix
SOI
• Input:
– Consumables
– Investments
Input and output
data warehouse
Input:
– Personnel:
• staff (nursing)hours per patient day (NHPPD)
– Workhour scheduling
– Sick leave
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Vacancies/ budget
Turnover: attraction/ retention
Overtime
Education
Meetings
– Patient transport
Voorbeeld deel rapport intern patiëntentransport
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Input and output
data warehouse
Output:
– Patient satisfaction
– Delivered care: nursing and medical
• MVG/MZG/MKG
– KCE points
• Facturation
– Patient outcomes
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Nursing Outcomes
Complications
Nosocomial infections
Serious Adverse Events:
– CA, Readmission ICU, Failure to rescue
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)
What’s in it for the Nurse?
• Patient safety and reliability of care
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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
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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)
What’s in it for the Nurse?
• Decision support
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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 needs the manager?
• Evaluation
– Quality of care (system)
– Performance of care (system)
• Challenge
Remember this one?
– Rational use of indicators
– Reliable indicators
– Indisputable indicators
• Hope
– Hospital Information System
– Electronic Patient Record (Medical ea)
• Key Care Quality Indicators
– Identification
– Registration
– Analysis
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