Data for Nurses

Understanding and Using Data to Optimize Care Delivery in Hospitals and Health Systems

Molly McNett

• Publisher: Academic Press
• Year: 2019
• Print ISBN: 9780128165430
• eBook ISBN: 9780128172780
• Topic: Biological Sciences
• Subtopic: Biotechnology
• Index: Biological Sciences

Data for Nurses: Understanding and Using Data to Optimize Care Delivery in Hospitals and Health Systems provides information for nurses on how to work with data to effectively evaluate and improve care delivery for patients. Quality, benchmarking, and research data are increasingly used to guide care in hospitals and health systems, and nurses are expected to actively use this information to identify interventions to optimize outcomes and meet reporting and financial targets. However, not all nurses receive formal training on data utilization, making interpretation and application of the different types of data difficult.This book provides information on topics such as benchmarking and reportable indicators, financial metrics, quality improvement, research, and implementation science, with applications to nursing practice. Important information on protective measures to guarantee integrity and security of personal patient data is also included.The book is a valuable resource for nurses and other healthcare professionals who require a basic understanding of key principles of data utilization in order to increase engagement in evidence-based practices, quality improvement, and mandatory reporting of key indices.- Explains the differences between research data and quality improvement data- Provides examples of project design, data usage, data storage and data dissemination- Presents tables and figures that highlight mandatory reporting and how to correctly interpret and track information when making decisions about care delivery

Chapter One

Introduction: Why data matter

Molly McNett The Helene Fuld Health Trust National Institute for Evidence-Based Practice in Nursing & Healthcare, College of Nursing, The Ohio State University, Columbus, OH, United States

Abstract

Data have historically driven both advancements and reforms in healthcare delivery. Nurses have been at the forefront of many of these changes in healthcare, and were early adopters of data as a mechanism to drive improvements in care. Nurses remain key stakeholders for data utilization in current healthcare environments. This chapter reviews the evolution of healthcare delivery, with a focus on data and the critical role of nurses as key stakeholders and change agents utilizing data to improve care delivery and patient outcomes.

Keywords

Evidence-based practice; Quality improvement; Research; Healthcare change; Nursing education

Contents

• Data and nurses
• Data in healthcare
• Historical evolution of healthcare and the role of data
  • Early beginnings: Florence Nightingale
  • Advances in the early 1900s
  • Period of growth: The mid-1900s
  • Evolution and expansion: Late 1900s–2000s
• Recent healthcare changes and the role of data
• Conclusion
• References

Data and nurses

Healthcare delivery has always been influenced by data. Typically, the scientific method comes to mind when referencing data in healthcare; specifically, data used to generate new knowledge and guide technological, biomedical, and pharmaceutical advances. These advances then impact care delivery in health systems. Unfortunately, it takes up to 15–20 years for this new knowledge to translate into actual practice, and equally as long to evaluate if implementation of these new advances impacts health outcomes and care processes.¹ However, there are other types of data in healthcare that are equally important as research data, and have shaped care delivery and nursing practices for decades. These include quality data, financial data, benchmarks, and nursing sensitive indicators. These types of data have shaped evolution of healthcare since its earliest stages.^{2, 3} Regardless of the type or size of a healthcare delivery system, nurses continue to remain a core component of care delivery in almost all settings around the globe. As such, they are in an optimal position to critically analyze these distinct types of data, assess applicability to practice, and evaluate outcomes immediately in real time. Nurses remain key stakeholders of data utilization in all healthcare settings.

Despite the key role nurses have in integrating data in their daily practice, several reports indicate nurses may lack a solid understanding and application of data utilization in practice, specifically with evidence-based practice, research, and quality improvement activities.^{4, 5} Recent estimates on nurse competency for evidence-based practice and integration of data into daily care decisions demonstrate significant deficiencies not only in the United States, but on an international level as well.^4–8 Integration of evidence-based practice, and data in general includes the ability to perform a literature search, understand and interpret findings from research, determine applicability of research findings to practice, understanding the differences between quality improvement and research, and the ability to accurately collect, interpret, and disseminate data.⁵

Information on evidence-based practice has been integrated into most educational nursing programs.⁹ Nursing students are taught methods of inquiry and how data can be used to guide nursing practice. However, continued application of this content as nurses begin practicing in the healthcare setting is often scattered or infrequent.⁵ There is often substantial variation in how health systems educate their nurses about current evidence-based practices within their organizations, and how ongoing application of this knowledge and data utilization is communicated to practicing nurses.^10–12 Particularly for experienced nurses, many have never received formal training on the diverse types of data, methods for data acquisition, evaluation, interpretation, or application to practice. Nurses must remain knowledgeable not only of new advances in their specialty, but of the increasing ways in which data guide their practice and delivery of care.

Data in healthcare

Care in hospitals is increasingly directed by data. In the United States, the Institute of Medicine (IOM) published an influential report highlighting the tremendous gap existing between knowledge generated from research and quality data, and actual care delivery in healthcare systems.¹³ As a result, the past decade has been inundated with substantial shifts in care delivery both in the United States (US) and on an international level. Healthcare delivery models have integrated numerous regulatory and accreditation requirements, with mandatory data reporting and alignment with preestablished benchmarks as central core components.

Nurses are not immune to these shifts in care delivery. As the largest component of any hospital workforce, and present at all points-of-care delivery, nurses play an integral role in impacting quality outcomes and delivery of care based on evidence and best practices.^{14, 15} In order to have a solid understanding why data matter, nurses need to appreciate the historical development of data in healthcare, and specifically their role in these developments, in order to have an appreciation for the current landscape.

Historical evolution of healthcare and the role of data

Early beginnings: Florence Nightingale

Nurses were at forefront of using data to advocate for change to improve safety and efficiency within hospitals.^{16, 17} As early as the mid-1800s, Florence Nightingale emerged as a nursing leader during her tenure in the Crimean War from 1854 to 1856; however, her career after the war focused on healthcare reform, specifically meticulous record keeping providing evidence and rationale for improvements in sanitary conditions for care of soldiers. Florence had utilized data and figures she had accumulated during the war to demonstrate the primary predominance of disease was the main cause of death during the war, rather than actual war injuries.^{16, 17} Integrating statistical models, she used these data to make projections about continued poor outcomes among soldiers unless radial changes were made to improve their living conditions. She also used the data as rationale to establish basic standards of hygiene in all hospitals, including structural changes to improve ventilation, contain waste disposal, ensuring access to clean water sources, and improving disinfection practices for bedding and equipment. She encouraged hospitals to keep track of these changes, and record observations with compliance, current practices, and associated outcomes. She remained an advocate for improved hygiene practices, natural ventilation, and access to natural light for hospitalized patients, much of which remain priority agents even today in current design concepts. Florence Nightingale’s early efforts to improve standards of healthcare delivery using data provided a substantial foundation for continued healthcare growth.^{16, 17}

Advances in the early 1900s

In the early 1900s, a British physician built upon initial work by Nightingale and began to apply an outcomes-based model to healthcare delivery.² Earnest Codman collected data on patient progress throughout hospitalization to identify trends in outcomes. He used these data to aid in future decision making when managing patients with similar maladies. Data collected included information about intervention effectiveness, reasons why a certain procedure was unsuccessful, and potential sources of error that could be corrected with future patients. He then partnered with an American physician colleague, Edward Martin, and the two began to advocate for general standards in hospitals based on these data to evaluate quality of hospital processes and care delivery. They formed an initial group of physicians to formally establish The American College of Surgeons, and proposed five basic standards for all hospitals.¹⁸ These standards included: (1) Identification of a definitive group of hospital staff; (2) Establishment of basic credentials and requirements for hospital staff; (3) Hospital staff adopt rules and regulations, including regular meetings to evaluate department specific data and outcomes at specific intervals; (4) Accurate and complete recording and storage of patient data and medical records; (5) Ensuring availability of diagnostic and therapeutic modalities with adequate supervision.¹⁸ These standards incorporated requirements for data collection and sto...

Table of contents

• Cover image
• Title page
• Table of Contents
• Copyright
• Contributors
• Chapter One: Introduction: Why data matter
• Chapter Two: Quality and benchmarking data in health systems
• Chapter Three: Research data in hospitals and health systems
• Chapter Four: Financial data in hospitals and health systems
• Chapter Five: Evaluating data to guide care delivery: Quality improvement methods and implementation science
• Chapter Six: Protecting the data: Security and privacy
• Chapter Seven: Determining the dissemination plan: Internal and external considerations
• Chapter Eight: International perspectives on data
• Index