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Measuring and improving the quality of health care delivery is one of the most critical challenges facing health care clinicians and decision-makers. In the Canadian province of Ontario, a task force recommended the capture of information reflecting nurses’ contributions to patient care; specifically, clinical outcomes. The Health Outcomes for Better Information and Care (HOBIC) initiative was established to identify nursing-sensitive outcomes and processes for their capture in electronic health records and subsequent extraction to centralized databases.
HOBIC introduced a systematic structured language to patient assessments for a suite of evidence-based clinical outcomes: functional status, readiness for discharge, symptoms (pain, nausea, fatigue, dyspnea), safety outcomes (falls, pressure ulcers. This information is abstracted with ADT (admission, discharge, transfer) information, to a real time database that, as of January 2015 houses over 1,000,000 assessments from more than 185 organizations across Ontario.
This presentation will describe the background to this initiative and the approach to collecting this dataset at the point of care. One of the key goals of this work is to engage nurses and nurse leaders in realizing the benefits of standardized clinical outcomes information to inform quality patient care. Through the electronic collection of the standardized clinical outcomes at the point of care, nurses, nurse executives, researchers and policy makers are provided with real time information. Examples of how nurses and leaders in health care organizations are using the HOBIC information to assess performance within units and organizations to facilitate quality patient care will be presented.
As part of this initiative, researchers have access to an aggregate database of standardized clinical information. Current efforts are focused on linking this dataset with other datasets, and exploring the ability of this suite of standardized clinical information to predict the need for alternate level of care status and length of stay for patients that are admitted to acute care. Initial research findings have been shared with clinicians, challenging them to think about their practice with a goal of better preparing patients to manage their self care on discharge from acute care.
To advance clinical practice it is essential that data be collected in a format that allows for sharing of data between clinicians, within organizations and across clinical borders to facilitate transitions and support quality patient care. Collection of data in a standardized format and the active engagement of clinicians is and will continue to be essential to transforming healthcare in Canada. With an increasing focus on professional and financial accountability it is important that nurses are able to demonstrate the impact of their practice on patient outcomes within the healthcare system. This initiative is leading the way by providing nurses with evidence-based information to evaluate the impact of their practice.