IMProving Outcomes Related to Patients Through Advanced Nursing Technology (IMPORTANT)

Despite increasing healthcare costs in the United States, many patients continue to have poor health outcomes. In an effort to improve health quality while reducing costs, patient falls, hospital acquired infections (HAIs), and pressure ulcer injuries (PUIs) are no longer reimbursed by the Centers for Medicare & Medicaid Services. Research shows that increased nursing time with patients reduces risk of these adverse events, improves patient and nurse satisfaction, and decreases costs. Prior research also suggests that bedside shift reporting (BSR) and hourly rounding (HR) improve patient outcomes through increased nurse surveillance. Yet little research has assessed how or whether BSR and HR are completed.

New York-Presbyterian (NYP) has contracted with an outside vendor to pilot an innovative tool to increase nursing surveillance using BSR and HR. The tool’s technology includes wall-mounted hardware in the patient room with computer vision to provide constant surveillance of the patient room, a call-bell that operates via Wi-Fi, and companion software supplied via a mobile phone app that integrates these technologies. Color coded lights remind the nurse when BSR or HR has not been completed in a timely manner, and includes a call-bell system to provide alerts directly to nurses, allowing for more rapid responses.

In a preliminary study, a research team at Columbia University used a previously validated data collecting instrument to collect information about the activities routinely performed by nurses. Next, the surveillance tool was piloted to ensure it could collect the promised data and the variables requested, and the data would be reported in a format usable for the study. Results from the preliminary study showed that both BSR and HR improved after the tool was installed. For this current research, every interaction of every nurse with all patients at the bedside in two hospital units at a large urban hospital will be captured over a year-long period using the surveillance tool. Researchers will examine the data collected by the tool and determine the impact of technology-enabled BSR and HR on patient outcomes.

The aims of the current study are 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. 

This technology will potentially generate more comprehensive data on in-room patient mobility, positioning, and interaction with clinicians than other methods, making it possible to generate new knowledge about factors that influence patient outcomes. This study could also help establish a national standard for BSR and HR.