Take leap from manual to on-line data collection

Branches eliminated many differences

Two years ago, it started out as wishful thinking. So says Sally Welsh, MSN, RN, CNAA, director of quality management at CareOne, an affiliate of Memorial Medical Center in Savannah, GA. "We knew we were spending a lot of time doing manual data collection and tallying the information, and we wanted to free up the nurses’ time so we could do more performance improvement and team activities."

But moving from a manual to a computerized system would take two years for Welsh to complete. CareOne and its 40 branches are set to start computerized data collection in April — with a pilot project that will involve the quality managers. By the end of the year, Welsh says she hopes to be training field staff in the program.

"We will have much less in the way of limits in what we can do with our data," she says. "Now, we are only limited by time and imagination."

A year ago, CareOne started working in earnest toward computerized data collection.

The first step was for each group — home health, nursing, infusion, durable medical equipment (DME), etc. — to share the indicators they currently used. There were some major differences that Welsh knew had to be eliminated if CareOne was going to get the most out of a computerized system. "Home health benchmarked from branch to branch, but not with DME or infusion," she says. That made for some big differences in data collection tools.

For example, in home health offices, there were 12 questions relating to patient satisfaction. "But in DME, there were not. We decided there were five items that were common to all of the areas and started with that. Then each can add questions that meet their own needs." DME might add questions about whether the equipment was in good working order, but all would have questions on issues such as whether the patient was treated with respect.

In patient complaints, each one of the branches was sending in numbers to the corporate office, but they were using different forms. That, too, had to be changed. "We had to break complaints down by type of staff, by type of complaint. A lot of them just said that there were ‘clinical complaints,’ but we didn’t know what that meant. We had to include questions that gave us more information," she says.

Even instruction forms differed from branch to branch, she says, so such things as "sentinel events" were defined differently depending on what branch was involved. "We had no definition of a major injury. Is it one where the person seeks care from a doctor or hospital, or one that requires care? We had to set up parameters that were the same for all of us."

Initially, the group compared what was considered "major injury," she says, just to make sure there was agreement. Quality nurses then reviewed this with staff. But, Welsh says, there is still ongoing discussion on this matter.

Although it may seem daunting, Welsh says putting together a computer program was perhaps the easiest part of the project to date. She first met with the internal information systems personnel to determine what had to be done to create a good network. They needed to add some modems and improve memory capabilities on the office computers. Then the quality managers for each branch of CareOne and Welsh met with a consultant who would design the data collection program.

While aware that the Joint Commission on Accreditation of Healthcare Organizations has come out with a list of approved software vendors, Welsh says CareOne has not yet determined if it will seek approval for the new program. "We are still discussing that," she says.

"We told them what kinds of reports we wanted, what information we had now, and what information we would collect in the future," recalls Welsh. For instance, in the past, if staff tracked an occurrence such as a fall, there was limited detail available on the occurrence. "It was too time-consuming to sort through too much detail," she explains. The new program will allow secondary coding to be a factor in reports, which should provide a lot more information to Welsh and her staff.

She also indicated what kind of portability between reports she wanted. "We wanted to be able to look at an occurrence report, identify sentinel events, and then create a sentinel report without having to input the information all over again."

‘We never got to the resolution stage’

She also wanted to have automatic screen changes that would be triggered when certain information was entered. For example, if a patient had a positive culture for a urinary tract infection and had a Foley catheter, she wanted automatic screens that prompt staff to fill in when the catheter was last changed and by whom, so there would be more information on infection control. "I want to be able to track by staff, by patient, and by how long until it is resolved. Before, we just looked at infection rates each month, not patient care over time. We never got to the resolution stage." (See sample infection control screen, p. 48.)

The consultant provided a sample disk, and it was tried out by Welsh and the quality staff. They made further suggestions, and after just four such meetings, a program was completed. Total cost: less than $10,000, Welsh says.

Training in the program for quality managers and their secretaries started in late March, Welsh says. They will do trial runs on February data, although the nurses will continue to do manual tallies until CareOne is sure the program works. "There are four quality managers, and they will have a lot of work for a while," she says. "Before, all this used to be tallied at the branch level by the nurses."

Once all the kinks are worked out, Welsh will start rotating in nurses for training. "This is going to give them more time," she says. "Some are worried because they don’t have computer skills, but that’s why we are spending so much time doing trial runs, so it can be as easy as possible. We know that we will get more and better data from this. Unless there is some huge glitch, I know this will save time and money and will quickly pay for itself."