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Learning Objective 1: describe the patient factors and referral types used for decision support in the Electronic Health Record of hospitalized patients.
Learning Objective 2: describe the predictive factors that support nurse and automatic referral for nurse case management services decision support in the Electronic Health Record nursing admission history.
Methods: This descriptive, retrospective, cohort study employed a secondary analysis of nursing admission history and assessment data collected at two different time periods.
Results: Missing data in the pre-decision support group made analysis of the patient factors that predict nurse-referral for NCM impractical. In the post-decision support group, drug use positively predicted nurse-referral to NCM services indicating a subject is nearly three times as likely to be nurse-referred for NCM services. Use of community equipment and services positively predicted nurse-referral to NCM services indicating a subject who uses community equipment or services was nearly three times more likely to be nurse-referred for NCM services. In the post-decision support group, age group, greater than and equal to 70, positively predicted auto-referral to NCM services indicating a subject is nearly three times as likely to be auto-referred for NCM services if the subject’s age was 70 or greater. Overall functional status deficits were positively predictive of auto-referral to NCM services indicating subjects with overall functional status deficits were five times more likely to be auto-referred for NCM services in this period. Use of community equipment and services positively predicted auto-referral to NCM services indicating that a subject is nearly two and one-half times as likely to be auto-referred for NCM services.
Conclusion: Findings suggest the addition of auto-referral contribute to enhancing nursing decision support for NCM services referral. Future research is needed to facilitate reuse of clinical data for decision support. Recommendations for future research include continued investigation of patient factors in the EHR nursing admission history to determine potential predictors for early referral to NCM services.