In the 3/20/13 New York Times piece called, The Future Face of Healthcare, Reporter Reed Ableson reports that over the last five or so years, Kaiser has been “using the information to identify those doctors or clinics that excel in certain areas, as well as those in need of improvement. The organization has also used the records to change how it delivers care, identifying patients at risk for developing bed sores in the hospital and then sending electronic alerts every two hours to remind the nurses to turn the patients. The percentage of patients with serious pressure ulcers, or bed sores, dropped to well under 1 percent from 3.5 percent”.
This sounds like a great idea and great results, but I have a few questions and thoughts to share.
I wonder, what was the underlying problem? Were nurses “forgetting” to turn patients or too busy to make it happen every two hours or perhaps something else? If forgetting was the problem, then a reminder might be just the ticket. But if under staffing was the problem then isn’t this type of intervention more likely to shift priorities towards patient turns, contribute to supportive research, exacerbate a problem elsewhere,(a dressing that doesn’t get changed, handwashing that is postponed, or pain medication is delayed), and keep the underlying problem of understaffing hidden? In a world where everything is critical or at least urgent, it may be difficult to see how such an intervention impacts all care, especially if we are only looking at one result!
How Nurse & Nurse Assistant Staffing Impacts Quality & Safety: Part I-Bed Sores offers more insight about the problem.
I am also concerned about adding another ‘alarm’ or beep to nurses as this article portrays! I hate to be critical of positive results, but would like to understand them better before rushing out and implementing the new system. What do you think?