Wednesday, December 15, 2010

Falls and HIT Polic Committee Measure Concepts

Yes, the title gives it away this is a serious one. I read recently on a blog that the HIT Policy Committee is creating “measure concepts” that will be applied into meaningful use standards. At the very bottom – in fact the last one listed – is "Measures of fall events and screening". While we each are passionate about one item or another on that list, I believe there is some low hanging fruit that could easily be picked off and taken care of quickly AND provide the hospital with real “meaningful” savings.

The tricky thing about falls is that you are dealing with a patient. Patient’s actions, movements, attitudes, and even behaviors are a challenge to categorize into the neat and tidy little boxes that EMR vendors need to have strong governance in documentation standards. That’s a mouthful that says patients don’t follow the rules. The key is to look at the patterns of patient behaviors, staff behaviors, and other key dynamic factors then balance them with some static information. That is where you will find the answer to identifying Key Performance Indicators that link to predictive modeling for falls.

I know, I know you have never heard me use so many $20 words in one sentence. The answer is all ready there in the data. Think of it like seeing a Picasso – some people look at a Picasso and see random shapes, meaningless strange pictures and some people look at it and can interpret a story. I see the story in regards to the data surrounding falls. I had a great experience the other day with a hospital that “got it”. While I presented the data and our assumptions on the patient behaviors and indicators the staff filled in their specifics surrounding the staff’s behaviors. We see the same thing in the data – over and over again. We see the story.

This data should be in the Medical Record, it should be part of meaningful use standards, and it is part of the patient experience in the hospital. This is low hanging fruit – as my dad would say “easy pickins” – a real problem that is solvable.

I believe the key to reducing falls in a hospital lies in the ability to categorize, capture, and document the behaviors and actions. Believe me there are consistencies that we can currently identify. You just have to know where to look.

1 comment:

  1. Kourtney,
    Very thoughtful blog post. I agree that it is important for caregivers to be aware of high risk patients, which is why multidisciplinary and Schwartz rounds are absolutely necessary. I do think that standards can address some of the issues involved with high risk patients by easing the process, but I don’t think standards alone can solve the problem of patient safety altogether. You’re spot on, ‘Data should be in the medical record”, but I’m seeing more and more hospitals ill equipped in resources and tools to populate the record. Often the record is duplicated between departments and disciplines, which results in fragmentation of care and the inability to quantify outcomes. And most of the data entered into an EHR system is typically done by nursing. At a time patient acuities are rising and the need for qualified nurses increasing, nurses are finding that they are spending more time recording data and later entering into the EMR at the cost of direct patient care. Hospitals are navigating towards device integration as a first step to get vital data into the record. Little argument can be made that it directly affects the quality of the record in a positive way. If you pair the standards you described with automated documentation in conjunction with alerts, then you start to transform care. Caregivers can be ahead of the game, in which they are alerted before an event occurs. They will be able to prevent falls from happening - and I think you’re right, the answer is in the data. And, the documentation supporting it, is a simply by-product of providing care. It’s really important for nurses to understand technologies like this can lead to safer, higher quality of care. Thoughts?


Thanks for Posting on Clinical Transformation!

Kourtney Govro