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Enhancing Nursing Workforce Indicators: Insights from the May 2009 Sustainability Webcast

The Nursing Workforce Sustainability Group held a webcast on May 1, 2009, focusing on the release and review of performance indicators. Key topics included the interpretation of data, updates on individual reports, and preparations for the September meeting. The discussion covered "Raw Indicators" and the evolution to "Standardised Indicators," including HRT adjustments based on extensive data analyses from 2004 to 2007. Attendees analyzed risk factors for comparative subgroups across hospitals, emphasizing better data integrity and adapting strategies for effective nursing workforce management.

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Enhancing Nursing Workforce Indicators: Insights from the May 2009 Sustainability Webcast

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  1. Nursing Workforce Sustainability Group Webcast 1 May 2009

  2. Webcast Agenda • Release of Individual reports • Review of indicators and how to interpret • Brief review of data • Review agenda for September meeting • Survey Development

  3. Review of Indicators: Changes and Updates • Previously: • “Raw indicators” and “Standardised” indicators” • Raw Indicators • Based on the Coding Rules for Adverse Outcomes developed by Needleman et al. (2002) • Additional New Zealand/Australian Coding adjustments developed by Barbara McCloskey, RN, DNSc • Standardised • HRT adjustments applied over top of the Needleman adjustments

  4. Data Dictionary • Same data dictionary as October 2008 meeting

  5. Data Dictionary

  6. Data Dictionary

  7. Data Dictionary

  8. Data Dictionary

  9. Data Dictionary

  10. Data Dictionary

  11. “Raw Indicators” now “Needleman Care Indicators” • N1.01-N.1.16 • No definitional difference from October meeting • All measures exclude: • LOS less than 1 and greater than 90 days • Age less than 18 • MDC 14 (Obstetrics) • MDC 15 (Newborn) • MDC 19 (Mental Illness) • MDC 20 (Substance Abuse) • Error DRGs 9

  12. “Standardised Indicators” now “HRT Standardised Indicators” • N 2.01-N 2.16 • Index rates established based on 3 yrs of data (Dec 2004-Dec 2007) • 100% = Dec 2004 – Dec 2007 average • Index compared to observed in 2008 Jan-June • Expected vs. Actual • 6 risk factors considered

  13. HRT Standardised Indicators Risk Factors • Principal Diagnosis Chapter (ICD-10) • Age Group • Gender • Emergency / Elective • Complexity • Acute Transfer In / Other • Grouped-average stratification approach used • i.e. Diseases of the nervous system (G00-G99), age 50-64, Female, Emergency, Complex, Not acute transfer • Rates in each of these subgroups are compared at each hospital

  14. HRT Standardised Indicators • Relative rate of expected vs. actual • >100%: higher than expected rate • <100%: lower than expected rate

  15. Impact of changes • No longer “Double controlling” • 2 separate data sets • Needleman set supported by literature • Obstetric patients now included in HRT data set, as are • MDC 15 (Newborn) • MDC 19 (Mental Illness) • MDC 20 (Substance Abuse)

  16. Brief Review of Data

  17. N1.02, N2.02, N3.02 UTI Exclusions • Primary diagnosis of • N390, T835 (UTIs) • A40* - A41* (Sepsis) • A499 (Bacterial infection, unspecified) Inclusions • N390, T835 (UTIs)

  18. N1.02 UTINeedleman Indicator 8.2% 14.1%

  19. N1.02 UTI Needleman Indicator • Exclusions • LOS <1 and >90 days • Age less than 18 • MDC 14 (Obstetrics) • MDC 15 (Newborn) • MDC 19 (Mental Illness) • MDC 20 (Substance Abuse) • Error DRGs 9

  20. N2.02: UTIHRT Standardised Indicator

  21. N2.02 UTI HRT Standardised Indicator • Standardisations • Principal Diagnosis Chapter (ICD-10) • Age Group • Gender • Emergency / Elective • Complexity • Acute Transfer In / Other

  22. N1.01 vs. N2.01UTI Comparison Needleman Indicators Eagle, Polaris, Jaguar, Athene HRT Standardised Indicators

  23. N1.13, N2.13, N3.13Failure to Rescue Exclusions Primary diagnosis of • Hospital-Acquired Pneumonia • Shock or Cardiac Arrest • Upper Gastrointestinal Bleeding • Hospital-Acquired Sepsis • Deep Venous Thrombosis Inclusions • Hospital-Acquired Pneumonia • Shock or Cardiac Arrest • Upper Gastrointestinal Bleeding • Hospital-Acquired Sepsis • Deep Venous Thrombosis • + Discharge of Death

  24. N1.13 Failure to RescueNeedleman Indicator

  25. N1.13 Failure to RescueNeedleman Indicator • Exclusions • LOS <1 and >90 days • Age less than 18 • MDC 14 (Obstetrics) • MDC 15 (Newborn) • MDC 19 (Mental Illness) • MDC 20 (Substance Abuse) • Error DRGs 9

  26. N2.13 Failure to RescueHRT Standardised Indicator

  27. N2.13 Failure to RescueHRT Standardised Indicator • Standardisations • Principal Diagnosis Chapter (ICD-10) • Age Group • Gender • Emergency / Elective • Complexity • Acute Transfer In / Other

  28. Failure to Rescue Comparison Needleman Indicators Tiger, Achilles, Scorpio, Athene HRT Standardised Indicators

  29. 3-4 September Meeting • Novotel Brisbane (200 Creek Street, Brisbane) • October 2008 Topic: Attracting, Recruiting, and Retaining Gen X and Y nurses • Gen X Guest Speaker

  30. 3-4 September Meeting • Add small profile of each participating hospital • # of beds • Location • Specialty • Anything else?

  31. 3-4 September Agenda • September Topic Choices • Strategies for a Part-time workforce • Phased Retirement • Strategies for retaining retirement age nurses • A hospital without agency/Reducing reliance on agency nurses • Other choices?   • Guest Speaker? • Site visit?

  32. Survey Development • Feedback from previous meeting • Shortened/streamlined survey • Focus on relationship of variables • Impact of: • Post-graduate Qualifications • Turnover • Skill-mix • % full time • Length of service • Resignation rate …on each of 16 indicators

  33. Survey Development • Impact on each of 16 indicators • Which data set to use? • Set of questions relating to topic chosen

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