Reports based on electronic health record data that is two months old is of limited value to nurses trying to manage pain in a cardiac unit. But a dashboard view of current patients, with the patients who have reported a pain level greater than 7 in red, provides an actionable snapshot to frontline managers that the EHR itself does not.
Speaking at the American Nursing Informatics Association 2015 Annual Conference in Philadelphia on April 25, nursing informatics leaders at 2,400-bed New York-Presbyterian Hospital described their early efforts to move from piles of static, dated reports to situational awareness tools.
This session describes the efforts of one hospital to develop a web-based application to assist frontline managers with managing quality outcomes on their care delivery units.
Rosemary Ventura, M.A., R.N., director of nursing informatics, explained the challenge the hospital was facing. She said the chief nursing officer and the CIO got together to ask some basic questions about reporting. “The CNO said we were drowning in reports. Patient care directors were getting 130 reports daily, monthly, and quarterly. It is almost impossible to analyze all that data and put a plan together,” she said. “None of it was in real time. The feedback she got was that the nurses couldn’t find anything in the EHR without hunting and pecking. “They wanted to tell that patient and unit story in a way they understand that doesn’t take half an hour.”
Daniel Sorbello, MPA, RN, program director in nursing informatics, said New York-Presbyterian chose to focus on pain management because its HCAHPS scores had been below national averages. “We knew we could do better,” he said. Using a visualization tool called Tableau, they piloted it in a medical cardiology unit. The system pulls HL7 messages for each action in the Allscripts Sunrise EHR, such as recording a pain assessment or re-assessment, and puts it in a dashboard view. A patient care director now can see if a pain reassessment is missing or if three patients on the unit have a pain score above 8. “Previously, without hunting and pecking in the EHR you would never know that,” Sorbello said.
Although it is still too early to tell if the tool has had a statistically significant impact, Sorbello said that the team believes it is helping staff have conversations with patients about pain expectations, and saw nice declines in patients reporting pain scores higher than 7. One patient care director said, “It provides a real-time unit snapshot. It was eye-opening to see the number of patients with pain greater than 7.”
Kimberly Baker, a manager on the data analytics team, said the hospital took a different approach with this project than it had traditionally. “Our previous approach for implementing things like this was that we tried to perfect it before we rolled it out. But the problem with that was that sometimes it was no longer relevant or people didn’t feel involved in the process,” she said. “With this project, we engaged nursing staff up front. They were straightforward with feedback, and we implemented changes on the fly.”
Next steps include applying the dashboards to other areas such as falls, pressure ulcers and use of restraints. They also plan to marry the real-time data with retrospective data, she said. “So on the same page the front-line staff can see who is in pain right now, but also look over the historical data for the quarter.
Ventura said the tool has to be useful for staff to drill down at the patient and unit level, but it also should be viewed in an executive portal. “The CNO needs to see if these initiatives are working, because we are spending a lot of time and money to develop them,” she said. “Are they making a difference? This was the first pilot. We need to learn how to react to the information and put a plan in place. We need to help people figure out what they are going to do with the information.”
