IMProving Outcomes Related to Patients Through Advanced Nursing Technology (IMPORTANT)
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Digital nursing surveillance tools can enhance meaningful bedside interactions and improve patient care by leveraging the data to optimize nursing workflow, reduce nonnursing tasks, and boost nurse efficiency.
Project Details -
Completed
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Grant NumberR03 HS027006
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Funding Mechanism(s)
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AHRQ Funded Amount$96,297
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Principal Investigator(s)
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Organization
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LocationNew York CityNew York
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Project Dates04/01/2020 - 03/31/2023
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Technology
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Population
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Type of Care
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Health Care Theme
Despite rising healthcare costs in the United States, many patients experience poor health outcomes. To promote better health quality and reduce costs, the Centers for Medicare & Medicaid Services has stopped reimbursing for patient falls, hospital-acquired infections (HAIs), and pressure ulcers (PUIs). Research shows that increased nurse surveillance time, including bedside shift reporting (BSR), hourly rounding (HR), and other bedside interactions, reduces the risk of adverse events, improves satisfaction for both patients and nurses, and lowers costs. While BSR and HR are known to enhance patient outcomes, their implementation has been understudied.
Researchers previously used a validated instrument to gather information on nurses' routine activities and piloted a surveillance tool to confirm its data collection capabilities and format. The preliminary results showed improvements in BSR and HR after the tool's installation. The current research monitored every nurse-patient bedside interaction with a surveillance tool to assess the impact of technology-enabled BSR and HR on patient outcomes.
The specific aims of the research were as follows:
- Characterize nurse surveillance, including the frequency and duration of BSR and HR and other nurse interactions at the bedside.
- Compare BSR and HR pre- and post-implementation to assess the utility of a technology-assisted intervention to increase BSR and HR.
- Explore the relationships between technology-enabled BSR, HR, and other nurse interactions at the bedside and nurse-sensitive patient outcomes: patient falls, PUIs, and HAIs.
In this prospective cohort study, mounted hardware in the patient room provided surveillance of the nurses’ bedside presence. A Wi-Fi-enabled call bell alerted nurses directly when BSR or HR were overdue, and companion software supplied via mobile phone app integrated the technologies. The surveillance devices were installed in 32 beds in an acute care setting where they continuously tracked nurses’ and patients’ activities for 1 year. Nurses managed over seven patients per shift, spending approximately 9.39 minutes at the bedside per patient in a 12-hour shift, challenging previous studies’ findings of higher bedside time. Analyses also showed a 17.72 percent increase in BSR and a 17.58 percent increase in HR post-implementation of the surveillance devices, with a mean time of 69.5 seconds per HR and 50.1 seconds per BSR. Remote surveillance generates more comprehensive data on in-room patient mobility, positioning, and interactions with clinicians than other methods, making it possible to generate new knowledge about factors that influence patient outcomes. These findings underscore technology’s potential to improve patient care and nurse efficiency through the reduction of non-nursing tasks and redundant visits, and lay the groundwork for assessing the impact of similar technologies on nurse surveillance and nursing-sensitive patient outcomes.
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