ten ways to make your alarm analytics count · sabermetrics . in baseball, batting average only...

Ten Ways to Make Your Alarm Analytics Count

by Kenny Schiff Founder & Managing Partner

T2 Technical Services | CareSight “Universal solutions have yet to be identified, but it is important for a hospital to understand its own situation and to develop a systematic, coordinated approach to clinical alarm system management.”

—The Joint Commission “With data collection, 'The sooner the better' is always the best answer.”

—Marissa Mayer, CEO, Yahoo “On average, people should be more skeptical when they see numbers. They should be more willing to play around with the data themselves.”

—Nate Silver “It’s not about the size of the data, it’s what we do with it.”

—Elizabeth McGlynn, Kaiser Permanente “Big Data is clearly where all the excitement and headlines are, but it’s the little data that is likely to have the most effect on our individual healthcare.”

—Dan Munro, Forbes © 2015 Schiff Partners, Inc. | CareSight.com 1

https://www.caresight.com/

Overview A lot has changed in the 10+ years that our team has been working with hospital customers on clinical communications and alarm solutions. Yet much also remains the same. Regardless of the size of the hospital or health system, we often see analytics as a checkbox that organizations tick when they buy applications rather than a central part of their decision making. While the last decade has consumerized data and brought it into a surprising array of uses in our personal lives (e.g., fitness trackers, 401K modelers, our Amazon order history), when it comes to hospital technologies, the data reporting tools are limited in what they deliver and hard to use. Indeed, while vendors talk up all the information that can be delivered during the sales process, there’s often a disconnect between the promise and reality. Part of the problem is that hospitals don’t know what to ask for. All too often customers will deploy with some basic reporting options provided by the manufacturer. Yet even with good reporting tools, customers are not optimizing their capabilities and utilizing the findings to become datadriven decision making organizations. That’s where this guide comes in.

© 2015 Schiff Partners, Inc. | CareSight.com 2


Whether you are doing due diligence for alarm management applications, new patient monitors, a new nurse call platform, or mobile voice technologies, trying to best leverage existing systems, or creating your own reporting tools, the steps outlined in this guide can help you optimize your data reporting and analytics. The Problem Quality management and risk management personnel, as well as nursing and other hospital administrators, need data from Nursing. Be it an investigation into a patientrelated incident, measuring the effectiveness of patient experience improvement initiatives, regular reporting on nurse responsiveness, measuring HCAHPS scores’ relationship to staffing and census, or any of a myriad of other requests, it’s very difficult for Nursing management to pull it all together. Organizations big and small have disparate information silos that make it very difficult to distill their organization’s key performance indicators into an easy to understand and complete picture. Nursing activities generate massive amounts of information. Within this constant data flow are crucial insights that can be used to improve quality, reduce risk, optimize processes, research incidents, and much more. The problem many hospitals face is turning that information into easyto understand, actionable data.



As you look to make sense of all the rich information that may be available, here are 10 tips for improving how you analyze and make use of that data.

1. Start with the end in mind. Do you have an accurate, realtime breakdown of physiological monitoring alarm traffic that segregates system alerts and truly critical alarms that should be responded to? Do you know how many nurse calls were triggered during last night’s overnight shift? What’s acceptable? Do you know what your HCAHPS score will look like in 6 months, or next year? If you are using mobile devices for alarm notification, how many alarms get escalated? Have you considered what a reasonable amount of interruptions an RN, PCT, or CNA should have during a 12hour shift (patient calls, voice calls, etc.)? Perhaps you have some targets in mind, but maybe you’re not sure?

● Before you make changes of any kind or start a new initiative, find a way to establish a baseline. If you have no tools in place, collect data manually.

● If you had a plan in place, how are you doing against that plan? Is it time to make adjustments?

● Can you look at the data shift to shift, week to week, month to month, unit against unit? Where do you think you need to be performance wise? Whether at a unit or



department or housewide level, your systems can lead you towards datadriven decision making.

2. Provide context for your analytics. When we first started working on measuring alarm behaviors, our thinking was relatively flat. We said to ourselves, let’s look at different physical locations and time slices (originally just days). What we came to understand is that only tells part of the story. It turns out that having a lot of alarms in a particular nursing unit tell us one thing. Having a lot of alarms, but also high census, tells another. Having a lot of alarms, high census, but low staffing, tell us yet another. Throw shifts into the mix and time of day, and you’re beginning to get a deeper sense of what’s going on. And that’s just scratching the surface.

● Look at possible intersections between your source data and other workflow elements and find ways to mingle them into your data views.

● To borrow the language of modern baseball, think sabermetrics. In baseball, batting average only tells you so much. Similarly the cumularative number of alarms per day is also a flat kind of measure. Whereas alarms per hour per patient per staff member tells you a much richer story.

● In hospitals, there’s a literal night and day difference to the rhythm of activities. Making your dashboards and


http://en.wikipedia.org/wiki/Sabermetrics


reporting shift centric can go a long way to improving their validity.

3. Don’t rely purely on history. As a supporting service provider, we’re often called to the table to help in the investigation of incidents or “events.” It’s not unusual for us to get call from a customer needing backup data for a particular date and time, regarding a particular unit, and regarding particular staff members. Because there may be legalities involved in this type of work, looking at history is critical, and traditional reporting can go a long way to establishing what happened or didn’t happen. But what if you could collapse down the lag between when something happened and insights regarding the conditions that caused it? What if you could look at your data from a predictive analysis standpoint and do what’s necessary from a prevention standpoint?

● Look for correlation opportunities. For example, patients getting out of a bed or chair, who are not responded to quickly, are likely to lead to falls. We’ve observed that there’s often a direct correlation between certain nursecall alarming behavior and falls. Matching up your falls incidence database with your fallsrelated nurse calls (Bed Exit, Toilet, etc.) can lead to tweaks in managing your nursing teams.

● For customer using mobile technology for the delivery of alarms to caregivers, customers may want to look at



distraction factors. While alarm fatigue is an understood problem that all organizations are trying to mitigate, staff who receive text messages and voice calls in addition to alarms are going to have significant “attention” challenges that can impact both care quality and safety. Providing a reporting fabric that looks at all of these dimensions can provide an organization with a much better framework for adjusting staffing levels, communication policies, and other work factors.

4. Drill down into the data. Early in in our development of CareSight, we met with a Director of Quality to review some dashboards and reports that we were working on. Several of our scorecards and dashboards had comparative measures that looked at averages (e.g., alarms per patient per shift). We thought we brought him some really great information. And we had. But it was only part of the story. The Director of Quality lives and breathes reams of quantitative data about all aspects of hospital operations. And he reminded us of the inherent fluctuation in staffing, census, and activity that vary based on time of day or season. So our ability to provide useful analytics needed to allow users to visualize those variations so that they could have the proper perspective.



● Averages are useful, but remember outliers can skew averages, and you need to periodically drill down into data to get a feel for its validity.

● Hospital activities show rhythmic time variation, so it’s useful to look at frequency distribution to see peaks and valleys based on time of day or shift.

● As much as possible, it’s important to compare like information to like information. Make sure to look at data from different time periods that have the same factors in play (e.g., seasons, census, and staffing levels).

5. Make data accessible to the people who need it. In the old days, data reporting was the province of the back office and someone would need to run a report for you. For many key players within a hospital organization, that data is still unreachable or held hostage, by organizational bottlenecks, governance issues, staffing issues, or a lack of adequate means of collection and presentation. Even if someone has an appetite or need for data, she may have no means of getting it. Now imagine what life would be like if hospital staff could access that data directly—the many benefits of having instant access to critical care data. For example, an assistant nursing manager, nursing manager, or nursing supervisor could instantly see the quality and efficiency of nurse interactions with patients and alarms.



We’re not advocating overwhelming already overburdened staff with data overload. However, properly tuned updates, summaries, and trending data can help those in managerial roles support their hunches, validate their concerns, and assist them as they push towards meeting goals.

● Liberate the data and put it in the hands of those on the line. Don’t assume that upper management is your only key audience for summarized and comparative data. The people closest to the actual work maybe the most powerful audience.

● Many reporting applications have seatbased licensing, preventing availability beyond a certain amount of users. Look for technologies that open the door for many different roles without significant financial burden.

6. Give staff access to critical data anywhere, any time. Having analytics tools that align with contemporary work styles and the realtime nature of hospital work is an absolute best practice. The best performers in your organization aren’t bound by shift, locale, or desktop PC. Instead you will find those stars starting or ending their days at home, or continuing their efforts on laptops, tablets, or smartphones.

● Consider displaying key metrics in real time and on large screens in key locations throughout the facility. Sharing key measures and progress towards them can create organizational focus.



● Analytics applications that require installable software or significant training are likely to be underutilized and their potential insights inaccessible. Web or mobilebased tools that are accessible both inside and outside the hospitals will likely encourage usage and provide better return on investment.

7. Automate your reporting data. For 20 years the mantra for hospitals has been performance improvement through process automation and workflow refinement. Whether you are working from a Deming perspective or are a Six Sigma black belt, the common wisdom is that if you study a process carefully enough, you can tweak it to get improved results. Nothing can dampen these type of improvement efforts more than not having data available to benchmark, review, or model results. It is not uncommon for analytics systems to require significant manual efforts to trigger, update, collate, and combine data to make it useful for daily review, your next committee meeting, or annual review. We have seen many customers put significant effort into extracting data from multiple systems, only to plunk it into Excel so that they could manipulate it to their liking.

● Once you understand your output and presentation requirements, put in place mechanisms that can deliver the data in a standardized and consistent fashion.



● The holy grail is no manual intervention whatsoever, or to do as little data massaging as necessary.

● Hospitals are realtime organizations, and the various staff who will consume the data will have little patience for oldfashioned lengthy report runs. Look for tools that can deliver complex results quickly.

8. Make data easy to access. Over the years, I keep coming back to a great book on web design called Don’t Make Me Think! by Steve Krug. You may wonder what this has to do with alarm analytics, but I would suggest more than you think. The basic premise of the book is that regardless of the potential benefit of a website, if it’s hard to use, the customer will quickly leave. While staff members may have no choice regarding the use of a particular analytics tool or the data it presents, its impact to the organization is likely to be severely diminished if it’s dense, difficult to navigate, and requires too much effort. We’ve built off that premise and extended it to the actual data that’s presented to the user. If it takes too much effort to figure out what’s important, users will move on and abandon it.

● Distill when you can and provide toplevel macro indicators that invite the user to explore and drill down if they need more details.

● Organization leaders may not have the patience for the nittygritty and will prefer the stoplight version of the


https://www.sensible.com/dmmt.html


universe (red=bad, yellow=pay attention but not urgent, green=good).

● Custom reporting will always be necessary, but the more daytoday core templates you have the better, along with the least amount of predefined filters necessary.

● When possible, steer clear of proprietary databases and tools that are sealed and don’t offer opportunities to manipulate data.

9. Double check and validate results. One of our customers had an initiative in place to measure turnover time in their operating rooms. As part of a renovation process, they installed bed ready/needs cleaning stations in each of the operating rooms, and assigned notifications from those alarms to be sent to the Environmental Services teams to turnover the rooms. The OR and Environmental Services managers soon began receiving daily chronological reports about the bed readiness of each of the rooms and didn’t pay much attention to the data. At some point, however, someone decided to take a close look at the reports. It turned out that that the data didn’t look like what was happening in the actual operating rooms. The underlying system was sending out false notifications without anyone catching it.

● If the results seems off, they may indeed be off. There could be an underlying reporting or data process



assumption that was not properly calibrated. So be prepared to investigate the originating system for flaws.

● Make sure that someone deeply familiar with the workflow or originating devices looks at the results and validates them early on, but comes back and checks them periodically.

10. Revisit your processes regularly. Recently we were asked by a customer to make modifications to how alarms were escalated from one caregiver role to another. The customer had made a considerable investment in designing the original workflow, rolled it out, but hadn’t revisited it for a couple of years. While the organization initially made a good show regarding measuring the effectiveness of its initiative, focus quickly turned to other activities. When we were brought back into the conversation, it was based on nursing leadership’s gut feeling that something was off about escalations. The immediate impact of the modification in the escalation process was that an already overburdened role went from receiving 0 alarms in a given shift to receiving hundreds. The situation was quickly deemed intolerable. Fortunately, this time around, we were able to show the negative impact of the new escalation procedure and, in time, management requested that the change be rolled back.



● If you have a hunch, dig into the available data and see whether there’s data to support it. This is obviously a no brainer, but my story is fairly common.

● With the right mindset, even an organization without sophisticated tools can become data driven.

● An organization that has the right tools can be results driven and make crisper decisions with more certainty.

About CareSight Developed by T2 Technical Services, a Connecticutbased healthcare communications specialist, CareSight is the culmination of 12 years of ongoing work with customers on clinical alarm integration, mobile communications, and nursing analytics. CareSight’s mission is to break down the barriers between technology platforms and organizational silos, placing easytouse, actionable analytics in the hands of care managers, patient experience executives, quality and risk professionals, and hospital leadership. Led by healthcare industry veterans Kenny Schiff and Bill Sterling, CareSight leverages their many years of experience with hospital customers and their work at and with RaulandBorg, Vocera Communications, Ascom, Connexall, and Extension Healthcare. For additional information about CareSight, contact us at 888.427.2215 or via email at [email protected]


https://caresight.com/

mailto:[email protected]


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