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Nursing Informatics Roundtable: Nursing Informatics Impact on Quality Care Delivery Session 411, March 7, 2018 Michelle R. Troseth, Co-Founder, MissingLogic, LLC, President, National Academies of Practice Nancy Beale, Vice President, Clinical Systems and Integration, NYU Langone Health Marie (Kim) Jordan, Senior Vice President, Patient Care Services & CNO, Lehigh Valley Health Network

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Page 1: Nursing Informatics Roundtable - 365.himss.org365.himss.org/sites/himss365/files/365/handouts/550381243/handout... · Nursing Informatics Roundtable: Nursing Informatics Impact on

Nursing Informatics Roundtable:Nursing Informatics Impact on Quality Care Delivery

Session 411, March 7, 2018

Michelle R. Troseth, Co-Founder, MissingLogic, LLC, President, National Academies of Practice

Nancy Beale, Vice President, Clinical Systems and Integration, NYU Langone Health

Marie (Kim) Jordan, Senior Vice President, Patient Care Services & CNO, Lehigh Valley Health Network

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Digital Transformation in Health:

Technology enabled care, health

promotion and disease prevention

that advances the quadruple aim.

PRODUCTIVITY

• Improve the clinician experience

LOWER COST

• Reduce the per capita cost of care

BETTER HEALTH

• Improve population health

BETTER CARE

• Improve the experience of care

Bodenheimer, T. & Sinsky, C. "From Triple to Quadruple Aim: Care of the patient requires care of the provider" Ann Fam Med Nov/Dec 2014, vol. 12 no. 6 673-576

US Health Strategy

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Digital transformation in the health industry

Creating more

personal computing

Reinventing

productivity and

business processes

Building the intelligent

cloud platform

ENGAGE PATIENTS

AND CUSTOMERS

EMPOWER CARE

TEAMS AND

EMPLOYEES

OPTIMIZE CLINICAL

& OPERATIONAL

EFFECTIVENESS

TRANSFORM

HEALTH

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HIMSS Nursing Informatics Roundtable: Nursing Impact on Quality Care Delivery

MODERATOR

Molly McCarthy, MBA, BSN, RN-BC

National Director, US Provider Industry, and Chief Nursing Officer

Microsoft US Health & Life Sciences

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Agenda

• Michelle Troseth- Finding the voice of leaders to magnify the impact of

technology in healthcare.

• Nancy Beale- Building a new clinical environment from the ground up,

involves changes to technology, practice and culture.

• Kim Jordan- Outcomes utilizing an electronic dashboard to manage

patient flow.

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Conflict of Interest

Nancy Beale

Marie (Kim) Jordan

Michelle Troseth

Have no real or apparent conflicts of interest to report.

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Learning Objectives

• Explain ways nurse leaders can impact technology and practice at

local, state and national levels.

• Identify key considerations to creating a digital patient care

environment.

• Detail processes of a daily leadership huddle that utilizes embedded

electronic health record analytics and real-time dashboard reports.

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Speaker Introduction

Michelle R. Troseth, Co-Founder, MissingLogic, LLC

President, National Academies of Practice

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About National Academies of Practice (NAP)NAP is a nonprofit organization founded in 1981 to advise governmental bodies on our healthcare system.

Distinguished practitioners and scholars are elected by their peers from fourteen different health professions to join the only interprofessional group of healthcare practitioners and scholars dedicated to supporting affordable, accessible, coordinated quality healthcare for all.

www.napractice.org

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• Audiology

• Dentistry

• Medicine

• Nursing

• Occupational Therapy

• Optometry

• Osteopathic Medicine

• Audiology

• Dentistry

• Medicine

• Nursing

• Occupational Therapy

• Optometry

• Osteopathic Medicine

14 Academies

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To accomplish great things, we must not only act, but also

D R E A MNot only plan, but also

B E L I E V E

~Anatole France

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Critical Polarities to Manage

• Standardized & Individualized Care

• Collaborative Practice & InterprofessionalEducation

• Practice & Technology

• Direct & Shared Decision-Making

• Individual & Team Competency

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Collaboration Leads to Impact• The National Academies of Practice (NAP) is now a key

stakeholder for the Office of the National Coordinator (ONC)

• NAP is a network organization for the National Academy of

Medicines (NAM) Action Collaborative on Clinician Well-

Being and Resilience

• The #NAPForum2018 is featuring Connie Delaney and

Rebecca Freeman as keynote speakers

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Collaboration Leads to Impact

• Get engaged! (volunteer and/or engage others)

• Stick to the greater purpose (listen, learn and advocate)

• Believe in the power of partnership (strengths & synergy)

• Celebrate your success along the way (Woo Hoo!)

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Thank you

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Nancy Beale, MSN, RN-BC

Vice President

Clinical Systems and Integration

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• Five inpatient hospitals:

• Tisch Hospital

• Rusk Rehabilitation

• NYU Langone Orthopedic Hospital

• NYU Langone Hospital - Brooklyn

• Hassenfeld Childrens Hospital

• Locations in:

• New York City’s five boroughs

• Long Island

• New Jersey

• Westchester, Putnam, and Dutchess

counties

• Affiliation with

• Winthrop University Hospital

Over 300 ambulatory sites

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What problem are you trying to solve?

• Lead time

• RFP Process

• Key stakeholder involvement

• Emerging technology

Selecting the Technology

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Partnership with key leadership

• C-Suite

• Nursing leadership

• Clinical Department leaders

• Key stakeholders and point of care collaborators

Engaging Stakeholders

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• Development in progress

• Ensuring development adjustments meet requirements

• Fluid technology marketplace – leadership changes

and acquisitions

• Fully understanding the impact to practice

Emerging Technology Challenges and Opportunities

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Important role of training and understanding at all levels

• Training requirements - collective impact

- Clinical Competency training

- Software training

• Foundational understanding of the technology

• Complexity>Simplicity

Balancing Technology in the Care Environment

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Early Tests of Change

• Pilot and full roll-out where possible

- Refine the end product

- Refine the training approach

• Minimize the amount of change at one time

• Thoughtful integration of technology

Incremental Change: Where Possible

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Thank you

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Speaker Introduction

Marie (Kim) Jordan

Senior Vice President, Patient Care Services & CNO

Lehigh Valley Health Network

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About Lehigh Valley Health Network

Heath system located in Northeast Pennsylvania:

• 8 Networked Hospital Campuses

• 1 Children’s Hospital

• 160+ Physician Practices

• 17 Community Clinics

• 22 Health Centers

• 16 ExpressCARE Locations

• 45 Rehab Locations

• 81 Testing and Imaging Locations

• 18,000+ Employees

• 2,005 Physicians

• 834 Advanced Practice Clinicians

• 4,208 Registered Nurses

• 69,346 Admissions

• 274,879 ED Visits

• 1,838 Acute Care Beds

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The LVHN Daily Huddle: Background

LVHN Facility Overview

Cedar Crest site has 686 staffed beds

• 7 high level units

• 16 medical surgical and low level units

• 6 pediatric and perinatal units

Average Movement

• 80 Adult and pediatric operating room patients

• 90 ED admits

• 100-160 discharges

• 50 transfers between units

• 230 beds cleaned

LVHN Huddle Background

Response to increased length of stay

(LOS)

Challenge of constant patient movement

Ambulances being directed to other

hospitals

Over 1300 diversion hours for FY 2015

Admitted patients being held in ED

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Purpose: What is the LVHN Huddle?Purpose: To enhance patient flow and improve patient experience

Challenges:

Consistent occupancy greater than 90%

Balance competing demands

Strategy: daily huddle with leadership from across the facility

Focus on patient flow and metrics

Transparency of data

Real-time problem solving

Huddle Members:

Clinical unit leadership

Physician leadership

Departments: Case management, radiology, respiratory, engineering, clinical

engineering, environmental services, security

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“Before” Manual and Paper-Based

• Before electronic dashboard

“Bedboard” huddle with units to review census

Manually collected data

• Leadership huddle without an electronic dashboard

FY 2016 decrease diversion 80%

All data manually gathered

Transcribed into software for trending

No real time details

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How IT was Used

Metrics: Discharge Efficiencies

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Metric: % Discharge Orders by 11:00 am• Prior to dashboard, unable to measure

• Discharge orders placed early = Early discharges

• Early discharges = Early open beds

• Early open beds = Patients not waiting in ED for a bed

• 32% improvement in orders placed by 11 am

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How IT was Used

Metrics: Emergency Department Pull Times

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Metric: Emergency Department Pull Times• ED Pull time - how soon patients make it to inpatient bed

• Lower ED Pull times = less time patients spend waiting in the ED to go to inpatient bed

• 28.8% improvement

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How IT was Used

Metrics: Intra-Unit Transfers

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Metric – Intra-Unit Transfers

• Intra-unit transfers free up beds in critical care for patients in the ED or OR

• Lower intra-unit transfer times = less time patients spend waiting in the ED or PACU to

go to inpatient bed

• 41.4% improvement

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Thank you

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Questions Michelle R. Troseth

Co-Founder, MissingLogic, LLC, President, National Academies of Practice

Nancy Beale

Vice President, Clinical Systems and Integration, NYU Langone Health

Marie (Kim) Jordan

Senior Vice President, Patient Care Services & CNO, Lehigh Valley Health Network

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Thank You

Reception immediately following.

Complimentary food and beverage provided.

Thank you to our conference and NI Roundtable supporter.