Patient Condition Surveillance Tool: Identifying at-risk patients to minimize negative nurse-sensitive outcomes

Purpose:
By using a pt condition tool that synthesizes existing electronic medical record data (nursing assessment, nursing daily pt documentation, pt vital signs, and lab values), staff nurses can identify pts at potentially higher risk for adverse nurse sensitive outcomes and early decline in condition.

Significance:
Nurse sensitive outcomes can be impacted by understanding the patients at risk based on their pt condition score.Through early identification, at risk patients can receive alternative interventions in order to reduce deterioration of their condition and decrease risk of hospital acquired infections.

Strategy and Implementation:
Initally a tool was piloted and later adopted that used the EMR data found in the documentation of nursing assessments, vital signs, and laboratory values to create a single score reflecting overall patient condition. It is displayed graphically in the EMR and is updated each hour that new data becomes available. Of the 26 variables comprising the score, those originated in documents completed by nursing staff are particularly important in determining a patient's score. Staff use the tool to detect subtle changes in patient condition and deviation from the expected clinical trajectory and to intervene early when deterioration becomes evident. Through evaluation of patients scores for specific populations and time frames, correlations were made between scores and key hospital acquired infections. In collaboration with our Decision Support and Finance department partners, we are exploring the value of the tool in terms of its impact on a variety of nurse sensitive outcomes.

Evaluation:
Having demonstrated an association between patient condition scores and hospital length of stay, we established the existence of a relationship of the scores to development of hospital acquired infections. The consistent use has also enhanced interdisciplinary communication assuming less pt errors.

Implications for Practice:
Early identification of pts at risk for developing an infection while hospitalized has the potential to positively affect the health of patients and of hospitals. By impacting both pt outcomes and organizational financial measures an organization is able to become or remain a destination hospital.