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

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Although healthcare costs in the United States rank among the highest in the world, critical health outcomes rank lower than other high resource countries. In an effort to improve healthcare quality and concomitantly reduce costs, Congress identified certain serious and expensive but preventable hospital acquired conditions such as patient falls, pressure ulcer injuries (PUI) and hospital acquired infections (HAI), that would no longer be reimbursed by Centers for Medicare and Medicaid Services. These preventable adverse events have been linked with nursing time with patients. Nurses play a critical role in preventing adverse outcomes by quickly identifying patients at risk, evaluating the extent of these risks, and acting upon the changing status of the patient, a process termed “nurse surveillance.” Hence, nurses are key contributors to overall patient surveillance and safety. The Joint Commission recommends that the nurses give report at the patient bedside, termed “bedside shift report” (BSR), to reduce errors and improve continuity of care; hourly rounds (HR) are also recommended to reduce falls; both of these measures contribute to nurse surveillance of patients, but their relationship to patient outcomes remains understudied. NewYork-Presbyterian, a large academic health system, is piloting an innovative technology called “iN,” to improve BSR and HR through the use of color-changing lights and integrated mobile app to remind nurses when these activities have not been completed. This technology uses a combination of mounted hardware in the patient room with obfuscated computer vision to provide constant surveillance of the patient room and companion software supplied via a mobile phone app that integrates these technologies. This novel intervention to increase BSR and HR by nurses, which generates detailed process data, offers an unprecedented opportunity to gain a complete understanding of all activities that take place at the bedside and yet has not yet been studied to characterize nurse surveillance or to assess associations with related patient outcomes. The IMProving Outcomes Related to patients Through Advanced Nursing Technology (IMPORTANT) study will characterize nurse surveillance and its influence on patient falls, HAI, and PUI to generate new knowledge about factors that influence these nurse-sensitive patient outcomes. Using the dataset built in this study that will integrate data from the iN device, electronic health record, staffing and census data, and hospital reported quality measures on falls, HAI and PUIs, this prospective cohort study design will use descriptive statistics and a Cox-proportional hazard model to characterize nurse surveillance and the contribution of BSR and HR to nurse surveillance to generate predictive indicators of these nurse-sensitive outcomes (falls, PUIs HAIs), which can be used to identify intervention targets. The IMPORTANT study addresses AHRQ’s specific priorities to conduct “Research to improve health care patient safety,” and “Harness data and technology to improve healthcare quality and patient outcomes and to provide a 360-degree view of the patient” and will address AHRQ priority populations of the those with multiple chronic conditions, minorities, and women.