I watched the small baby lay silently sleeping, his little body propped up in a full-sized hospital bed, dwarfed by monitors and machines and bags of medications that looked as benign as pure spring water and yet I knew were controlling most of his bodily functions including this induced sleep. His peaceful demeanor seemed so incongruous to the palpable intensity of everything around him. Despite the alarms, incessant beeping, murmur of voices and general hubbub of the ICU, he went on sleeping, utterly oblivious. In this environment, where every organ’s function is externalized and micro-managed down to each breath and each heartbeat, all medical decisions take on heightened scrutiny.
It is not hard to imagine why functional and technical measures were developed to assess patient outcomes and cost for each of these critical decisions, and how important it is to analyze those metrics to ensure these babies survive the next minute, hour, day.
We can estimate the cost of this baby’s hospitalization, but how do we measure the value?
When Jennifer Baird, PhD, MSW, RN, set out to study best practices in nursing in the pediatric intensive care unit (PICU), she didn’t know where the project would take her. “I intentionally left it open-ended,” she explains. “It was essentially an ethnographic study; I observed interactions between nurses and families over the course of a year, and also interviewed them separately.”
Baird, who is finishing up her Harvard-Wide Pediatric Health Services Research Fellowship at Boston Children’s Hospital, conducted her research in 2013 at a hospital in the Los Angeles, California area. Even though it wasn’t an explicit question, every single family brought up the subject of nursing continuity. “There was a story there,” says Baird, who published her findings this spring in Nursing Research, “And I needed to follow it.”
The story turned out to be complicated. …Read More
Hospitals, doctors and the health care system as a whole have become ever more focused on measuring the quality of the care patients receive. And with good reason: as the system leans ever more towards tying reimbursements to quality, everyone recognizes that you can’t improve quality if you’re not measuring it.
Of the many ways one can look at quality in an inpatient setting, patient experience has earned a lot of attention. Hospitals, payors, survey vendors and government agencies are spending millions to develop, deploy and analyze tools like the adult and child Hospital Consumer Assessment of Healthcare Providers and System (HCAHPS) surveys, which give voice to patients and their concerns about the care they receive.