Using electronic health records and nursing assessment to redesign clinical early recognition systems
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As health-care organizations transition from paper to electronic documentation systems, capturing the nursing assessment electronically can play a fundamental role in transforming health-care delivery. Especially in preventive health, electronic capture of nursing assessment, combined with vital sign-based monitoring, can support early detection of physiological deterioration of patients. While vital sign-based Early Warning Systems have the potential to detect signals of physiological deterioration, their clinical interpretation and integration into the workflow in hospital-based care setting remain a challenge. This study presents a clinical early recognition algorithm using electronic health records (EHRs) coupled with an electronic Nurse Screening Assessment (NSA) that targets various health assessment categories and its integration into the nursing workflow. Data was collected retrospectively from a single institution (N=2,405 visits). χ 2 tests showed significant differences between algorithms with and without NSA (P<0.01). This study provides a practical framework for facilitating the meaningful use of EHRs in hospitals.
Keywordsearly warning system nurse assessment physiological deterioration
This study was conducted collaboratively including the Value Institute (VI) Health Care Delivery Science (HCDS) Team and Christiana Early Warning System (CEWS) Team at Christiana Care Health System, Newark, DE.
- Bynd S, Sen A, Subbe C and Gemmell L (2004) Modified early warning score: one for all and A&E? British Journal of Anesthesia 92(4), 611P–612P.Google Scholar
- Centers for Medicare & Medicaid Services (CMS) (2015) The official web site for the medicare and medicaid electronic health records (EHR) incentive programs. [WWW document] https://www.cms.gov/Regulations-and-Guidance/Legislation/EHRIncentivePrograms/index.html?redirect=/ehrincentiveprograms (accessed 11 August 2015).
- Congressional Budget Office (2008) Evidence of the costs and benefits of health information technology. [WWW document] http://www.cbo.gov/sites/default/files/05-20-healthit.pdf (accessed 11 August 2015).
- Friedman CP, Wong AK and Blumenthal D (2010) Achieving a nationwide learning health system. Science Translational Medicine 2(57), 57cm29.Google Scholar
- Institute of Medicine (IOM) (2011) The Future of Nursing: Leading Change, Advancing Health. The National Academies Press, Washington DC.Google Scholar
- Kossman SP and Scheidenhelm SL (2008) Nurses’ perceptions of the impact of electronic health records on work and patient outcomes. CIN: Computers, Informatics, Nursing 26(2), 69–77.Google Scholar
- Leach LS and Mayo AM (2013) Rapid response teams: qualitative analysis of their effectiveness. AJCC 22(3), 198–209.Google Scholar
- Lewis SL, Dirksen SR, Heitkemper MM and Bucher L (2014) Medical-Surgical Nursing: Assessment and Management of Clinical Problems. Elsevier Health Sciences, St. Louis, MO.Google Scholar
- Moody LE, Slocumb E, Berg B and Jackson D (2004) Electronic health records documentation in nursing: nurses’ perceptions, attitudes, and preferences. CIN: Computers, Informatics, Nursing 22(6), 337–344.Google Scholar
- Payne TH et al (2015) Report of the AMIA EHR 2020 task force on the status and future direction of EHRs. Journal of the American Medical Informatics Association 1–11.Google Scholar
- Peberdy MA et al (2007) Recommended guidelines for monitoring, reporting, and conducting research on medical emergency team, outreach, and rapid response systems: an utstein-style scientific statement. A Scientific Statement from the International Liaison Committee on Resuscitation (American Heart Association, Australian Resuscitation Council, European Resuscitation Council, Heart and Stroke Foundation of Canada, InterAmerican Heart Foundation, Resuscitation Council of Southern Africa, and the New Zealand Resuscitation Council ...). Circulation 116(21): 2481–2500.Google Scholar
- Royal College of Physicians (2012) National early warning score (NEWS): Standardizing the assessment of acute illness severity in the NHS.London: Report of a working party.Google Scholar
- Schmid NA (1990) Reducing patient falls: a research-based comprehensive fall prevention program. Military Medicine 155(5), 202–207.Google Scholar
- Smith K, Smith V, Krugman M and Oman K (2005) Evaluating the impact of computerized clinical documentation. CIN: Computers, Informatics, Nursing 23(3), 132–138.Google Scholar
- Yakusheva O, Lindrooth R and Weiss M (2014) Nurse value‐added and patient outcomes in acute care. Health Services Research 49(6), 1767–1786.Google Scholar