nursing informatics roundtable -...
TRANSCRIPT
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
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
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
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
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.
Conflict of Interest
Nancy Beale
Marie (Kim) Jordan
Michelle Troseth
Have no real or apparent conflicts of interest to report.
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.
Speaker Introduction
Michelle R. Troseth, Co-Founder, MissingLogic, LLC
President, National Academies of Practice
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
• Audiology
• Dentistry
• Medicine
• Nursing
• Occupational Therapy
• Optometry
• Osteopathic Medicine
• Audiology
• Dentistry
• Medicine
• Nursing
• Occupational Therapy
• Optometry
• Osteopathic Medicine
14 Academies
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
Critical Polarities to Manage
• Standardized & Individualized Care
• Collaborative Practice & InterprofessionalEducation
• Practice & Technology
• Direct & Shared Decision-Making
• Individual & Team Competency
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
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!)
Thank you
Nancy Beale, MSN, RN-BC
Vice President
Clinical Systems and Integration
• 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
What problem are you trying to solve?
• Lead time
• RFP Process
• Key stakeholder involvement
• Emerging technology
Selecting the Technology
Partnership with key leadership
• C-Suite
• Nursing leadership
• Clinical Department leaders
• Key stakeholders and point of care collaborators
Engaging Stakeholders
• 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
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
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
Thank you
Speaker Introduction
Marie (Kim) Jordan
Senior Vice President, Patient Care Services & CNO
Lehigh Valley Health Network
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
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
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
“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
How IT was Used
Metrics: Discharge Efficiencies
34
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
How IT was Used
Metrics: Emergency Department Pull Times
36
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
How IT was Used
Metrics: Intra-Unit Transfers
38
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
Thank you
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
Thank You
Reception immediately following.
Complimentary food and beverage provided.
Thank you to our conference and NI Roundtable supporter.