Measuring the benefits and outcomes of cm: Clinical Pathways Trish White bn mn (dist)



Yüklə 1,34 Mb.
tarix26.05.2017
ölçüsü1,34 Mb.


Measuring the benefits and outcomes of CM: Clinical Pathways

  • Trish White BN MN (dist)

  • Nurse Practitioner: Adult Urology

  • Hawke’s Bay DHB

  • October 2005


Outcomes

  • Defined as the end result of a process, treatment or intervention

  • Traditionally mortality and morbidity – measures of clinical outcomes and physiology

  • Modern Parameters:

    • Physiological
    • Psychosocial (attitude, mood)
    • Behavioural (motivation)
    • Functional (ADL’s)
    • QOL (symptom control, well being)
    • Knowledge (medications, diet)
    • Financial (costs of care)
    • Satisfaction (patient, staff) (Kleinpell, 2003)


Why do it?

  • Improves standard of care

    • How good is the care we are providing?
    • Measures the benefit of care
    • Benchmarking
    • Promotes continuous quality improvements
  • Nurses should be critical thinkers

  • Clearly illustrates benefits of the role



How I measure outcomes….

  • Monthly report

    • Linked to Nursing Council competencies
    • Clinical data: number of pts seen in ward, OPD, home
    • Referral sources: Nurse, Urologist, GP, Hospice
    • Prevented admissions
    • Teaching sessions
    • Professional activities: presentations, publication, mentoring
  • Audits: readmissions, active review, day cases, blood transfusions, returns to OT

  • Clinical Pathways: variance monitoring reports

  • Research



Clinical Pathways

  • “Documentation of variance – key to improving patient outcomes”

    • Sheehan, Nursing Management, Feb 2002


Clinical Pathways: process

  • IT obtain patient data & enter onto Excel spreadsheet

  • Clinical audit of medical records

  • Manual input of clinical data into spreadsheet

  • Report generated

  • Analysis by me

  • Feedback to clinicians (nursing and medical) & discussion

  • Any changes put in place



Hyperemesis Gravidarum

  • Multidisciplinary CP implemented in 1999: input from nursing, dietitian & medical staff

    • HBDHB Quality Award, NZ Gynaecology Nurses Conference best paper 2002
    • Replaces daily flow chart
    • Ability to individualise


HG – Length of Stay



HG – Cost implications

  • Pre Clinical Pathway

      • $85,367 per annum
  • Post Clinical Pathway

    • $35 – 47,000 per annum
  • At best $50,000 saving per year



Readmissions

  • 25% of patients readmitted

  • Aggressive management for readmissions

    • NG feeding
    • Case coordination


Ethnicity: July 03 – Dec 04



HG – Clinical Indicators

  • Demographics

  • Nausea & Vomiting Day 2

  • Ketones Day 2

  • Ptyalism

  • NG feeding

  • CP completion rates: ED & ward

  • Potential to be used in PHC



TURP Data

  • Implemented as guideline in 1998

  • Variance Monitoring 2001

  • 2002

  • TURP volumes = 18.2% of surgery

  • 105 case weights = 28% of total contract



TURP - LOS



Clinical Indicators

  • Acute vs Elective

  • Admission DOS

  • CBI/MBI

  • Readmissions

  • Operating time



Benchmarking

  • Benchmarking – (ACHS) Australian Council Healthcare Standards

  • Each variance has between

  • 60 – 84 Health Care

  • organisations reporting

  • figures

  • Tissue weight, histology, blood

  • transfusions, operating time,

  • readmissions



Outcomes – Last report:

  • Reduced TURP LOS by 0.5 day

  • Plan to reduce readmissions in place

  • Frequency of postop blood tests reviewed

  • Difference in practice: CBI reviewed

  • Rate of DOS admissions discussed

  • HBDHB within Australasian benchmarks



Hysterectomy

  • Includes: vaginal, abdominal & laparoscopic

  • LOS further broken down by type of surgery & gynaecologist

  • Benchmarked with ACHS



Hysterectomy - LOS



Clinical Indicators

  • Demographics

  • Readmission rate

  • Admit DOS

  • Postop blood work

  • Intraoperative injury

  • IDC

  • Nausea & vomiting

  • Fever

  • Bowel function

  • CP completion rate



Outcomes – last report:

  • 2004-2005 for first time Laparoscopic Hysterectomy has shortest length of stay

  • IDC removal and patients tolerating diet on Day 1 improved

  • Fever rate >38 increased – no trend noted

  • HBDHB within ACHS benchmarks

  • Length of stay reducing

  • Readmission rate reduced



Conclusions

  • Clinical indicators selected on potential impact to quality of care and LOS

  • Little benefit having clinical pathways without a robust VM system

  • Clinical pathway an option even with different techniques between clinicians

  • Linking clinical outcomes with data

  • Provides a guideline for staff

  • Current method labour intensive

    • Future link to Trendcare, acuity system


CLINICAL PATHWAYS

  • SHOULD NOT REPLACE CLINICAL JUDGEMENT




Yüklə 1,34 Mb.

Dostları ilə paylaş:




Verilənlər bazası müəlliflik hüququ ilə müdafiə olunur ©azkurs.org 2020
rəhbərliyinə müraciət

    Ana səhifə