A Decision support system (DSS) for municipal nurses encountering health deterioration among older people

Abstract

BackgroundThis study is part of a larger project called ViSam and includes testing of a decision support system developed and adapted for older people on the basis of M (R) ETTS (Rapid Emergency Triage and Treatment System). The system is designed to allow municipal nurses to determine the optimal level of care for older people whose health has deteriorated. This new system will allow more structured assessment, the patient should receive optimal care and improved data transmission to the next caregiver.MethodsThis study has an explanatory approach, commencing with quantitative data collection phase followed by qualitative data arising from focus group discussions over the RNs professional experience using the Decision Support system. Focus group discussions were performed to complement the quantitative data to get a more holistic view of the decision support system.ResultsUsing elements of the decision support system (vital parameters for saturation, pain and affected general health) together with the nurses' decision showed that 94 % of the older persons referred to hospital were ultimately hospitalized. Nurses felt that they worked more systematically, communicated more effectively with others and felt more professional when using the decision support system.ConclusionsThe results of this study showed that, with the help of a decision support system, the correct patients are sent to the Emergency Department from municipal home care. Unnecessary referrals of older patients that might lead to poorer health, decreased well-being and confusion can thus be avoided. Using the decision support system means that healthcare co-workers (nurses, ambulance/emergency department/district doctor/SOS alarm) begin to communicate more optimally. There is increased understanding leading to the risk of misinterpretation being reduced and the relationship between healthcare co-workers is improved. However, the decision support system requires more extensive testing in order to enhance the evidence base relating to the vital parameters among older people and the use of the decision support system.

Ambulante Notfallversorgung von Pflegeheimbewohner: Ein Status Quo aus pflegerischer Sicht

“…Die Kommunikation zwischen den Pflegekräften und den heimversorgenden Ärzten könnte durch den Einsatz von Triage-Systemen verbessert werden. Dabei werden neben den Vitalparametern die Angabe von Schmerzen und die Einschätzung des allgemeinen Gesundheitszustands durch die Pflege zur Einstufung der Dringlichkeit der ärztlichen Versorgung eingesetzt [13]. Zudem konnte in Studien die Anzahl an vermeidbaren stationären Einweisungen durch den Einsatz von Triage-System verringert werden [13,14].…”

“…Dabei werden neben den Vitalparametern die Angabe von Schmerzen und die Einschätzung des allgemeinen Gesundheitszustands durch die Pflege zur Einstufung der Dringlichkeit der ärztlichen Versorgung eingesetzt [13]. Zudem konnte in Studien die Anzahl an vermeidbaren stationären Einweisungen durch den Einsatz von Triage-System verringert werden [13,14]. Trotz der positiven Ergebnisse werden Triage-Systeme in der Pflege bisher überwiegend in Notaufnahmen eingesetzt [15].…”

Decision-makers and mediators in a home healthcare digitisation process: nurses’ experiences of implementation and use of a decision support system

“…fever). The last page provides information about how to report to the emergency department (Situation, Background, Assessment and Recommendation [SBAR]) and includes a text box for the nurse's notes (Kihlgren et al, 2016). The DSS is paper-based.…”

“…New ways of working with common decision support systems (DSS) and other digitised tools are expected to assist this collaboration. A common understanding of and approach to structural assessment could enhance the way that DSS are worked within each organisation, which in turn could support a more accessible, efficient and safe way of working together across the care organisations (Kihlgren, Svensson, Lovbrand, Gifford, & Adolfsson, 2016). This study focuses on the implementation of a new DSS that is being introduced into home healthcare as part of a new way of collaborating between different healthcare organisations.…”

“…It is based on Rapid Emergency Triage and Treatment System (Kihlgren et al, 2016). Kihlgren et al (2016) found that working with the DSS results in the most appropriate transfer of older people with deteriorating health from their homes to the emergency department. However, knowledge about the use of pre-hospital assessment tools such as DSS is still considered to be insufficient among home care nurses.…”