We all know clinicians have a critical job of making care decisions. However, data can provide support in the decision making process in better aligning resources, skills and competencies around individual patient care. A key to delivering the highest quality, patient-centered care is measuring acuity ─ or the severity of a patient's illness and the level of attention or service they will need from professional staff. Research shows that quantifying clinical data using the electronic health record (EHR), nursing taxonomy and computer algorithms enables clinicians to leverage rapid documentation analysis and more objective and accurate acuity calculations.
In this Q&A, two Intermountain Healthcare leaders, Trevor Hightower, RN, MSN, Clairvia Solutions analyst, and Karla Ure, RN, MSN, Clairvia Acuity clinical informatics analyst, discuss the value of leveraging evidence – specifically outcomes-driven acuity data — to drive better patient care.
Q: What’s unique about using outcomes-driven data in providing a reliable acuity score?
Karla: One of the biggest factors that make outcomes-driven data unique is that it’s objective and doesn’t leave room for loose interpretation around determining acuity scores. Outcomes-driven data is also measurable. If you have two hospital units that are charting using the same outcome set, they’ll get the exact same acuity results. That’s important when you’re benchmarking and comparing how different units are doing. We’ve become more aware of the importance of minimum basic charting standards for accuracy as we use technology for data intake. The technology looks back at 24 hours of data to give a more holistic view of all the outcomes, which is helpful if, for example, a shift nurse isn’t able to chart everything in real time.
Trevor: Outcomes-driven data gives us targets that are tested, credible and published. This allows us to use evidence-based practice and create a holistic picture of the patient that captures all aspects of what’s going on with their health.
Q: You represented Intermountain on a nursing pediatric acuity council that focused on using outcomes-driven acuity technology to advance evidence-based practice. Can you explain your roles on the council and why this collaboration of acuity and pediatric clinical leaders was so important?
Trevor: Karla and I participated on the council to collaborate with other healthcare organizations around pediatric outcomes including newborn, postpartum and behavioral health. We volunteered to pilot the postpartum and newborn outcomes at Intermountain to see what worked and what didn’t and then bring our data back to the group. It’s important that we collaborate with other health systems on a regular basis because it gives us a chance to share lessons learned and best practices. We can do so much more when we’re all working together toward a common goal.
Q: Can you explain the impact that an interoperable outcomes-driven acuity system has on the overall nursing documentation process?
Karla: One impact is more appropriate documentation. We’d found in the past that the charting standards were not aligned, and now thanks to technology at our fingertips, our nurses are taught proper documentation at the forefront. The technology allows us to analyze how other units are doing against each other, which helps with sharing best practices that lead to good charting and good acuities. Also, if you’re looking to benchmark across health systems, it’s nice to have a set standard that’s applicable to the majority of systems. When the outcomes are specialized for each system, you don’t have that comparison value.
Trevor: Through using an outcomes-driven acuity system, we were able to identify that our documentation had room for improvement. Previously, nurses were afraid to chart abnormal patient outcomes because that would influence the acuity scores in a way that made them feel like they weren’t doing their job of helping patients get better. Now, they’re empowered to reflect their patient’s condition more accurately without the concern of triggering falsely high acuity scores.
Q: The nursing pediatric acuity council resulted in a pilot project around expanding newborn and post-partum acuity outcome sets. Why was the pilot an important piece of the overall project?
Trevor: When we started discussing the newborn and post-partum outcome sets, we were eager to get a more accurate picture of the patients. Through the pilot process, we had to make numerous adjustments to the outcome sets to allow for more collaboration with the nursing acuity council. We were able to look at how we can have a more well-rounded picture of the patient by adding more and better data. This pilot process also enabled us to work closer with the staff at the bedside level and gain their confidence in the Clairvia℠ system.
Q: What were some of the most useful results and outcomes from the pilot program, and how will these guide your work moving forward?
Karla: With the pilot program, we had the opportunity to chart documentation standards against three different hospitals: small, medium and our large Intermountain system. We were able to better align the documentation standards because we had to consider how hospital population size affects acuity. As a result, we now have more appropriate acuity levels and a drop in the overall average score which is really good. Perhaps, most importantly, the program motivated us to better educate our Intermountain staff around documentation and acuity.
Trevor: This whole process highlighted the importance of collaboration. Whether that’s with other health systems, your health IT partner, nursing leadership or bedside nurses, getting everyone on the same page and working together is crucial for any organization that wants success with using outcomes-driven data for better evidence-based care.
Intermountain is a user of the Cerner Clairvia solution. This outcomes-driven acuity technology (compatible with many types of EHRs) leverages outcomes, interventions and observations to create a custom workload calculation based on each patient's clinical condition. Learn more here.
Cerner is the creator of the nursing acuity council that is focused on using outcomes-driven acuity technology to advance evidence-based practice.