From the perspective of medical billing and coding companies, a critical illness or injury is one that acutely impairs one or more vital organ systems such that there is a high probability of imminent or life threatening deterioration in the patient’s condition. According to a recent report from www.healthaffairs.com, nurse-led innovation can improve critical care outcomes and hospital reimbursement. Clinical innovations drive efficient, effective, and patient-friendly care, and nurses are in the best position to deliver innovative solutions that are crucial to improve critical care.
The American College of Emergency Physicians (ACEP) defines critical care services as a physician’s “direct delivery of medical care for a critically ill or critically injured patient”. It involves decision making of high complexity to assess, manipulate, and support vital organ system failure and/or to prevent further life threatening deterioration of the patient’s condition. Examples of vital organ system failure include, but are not limited to: central nervous system failure, circulatory failure, shock, renal, hepatic, metabolic, and/or respiratory failure. Critical care nurses work with physicians to provide focused care for critically ill or unstable patients following extensive injury, surgery or life threatening diseases. The healthaffairs.com report says that nurses are ideally positioned to develop creative solutions that address hospital-acquired conditions and other pressing patient issues.
Innovations in health care are not easy. While medical treatments have advanced rapidly over the years, the industry is fraught with problems such as medical errors-reportedly the eighth leading cause of death in the United States-and spiraling costs, which are even weakening the foundations of the nation’s economy. Reports point out that nurses are the largest group of health professionals in the U.S., and managing them well and empowering them can lead to innovative solutions that improve patient outcomes.
According to healthaffairs.com, the financial challenges posed by the value-based care and reimbursement models, along with the uncertainty around the future of Affordable Care Act, underline the need to come up with creative solutions for hospital-acquired conditions (HACs) and other critical patient issues. As they work closely with patients, nurses can play a proactive role in initiating and dispersing innovative health care solutions. Leveraging nurse expertise has been found to:
- Improve patient safety and outcomes
- Enhance nurse satisfaction and staff retention
- Improve hospitals’ financial bottom line and work environments
Recognizing the untapped power of staff nurses, the American Association of Critical-Care Nurses (AACN) developed the AACN Clinical Scene Investigator (CSI) Academy to address the challenges of the current healthcare environment. The goals of the program include decreasing hospital-acquired conditions (HACs) and/or increasing patient/family satisfaction and staff communication and satisfaction. Specific topics addressed include change management, creativity and innovation, project development, improvement science, and sustainabilit-plus diffusion planning to help mitigate the barriers to practice, all with focus on the “how to” of creating change.
Employing strategies such as on-site workshops, webinars, and regular faculty-peer consultations in person, by phone, and via email, the program provides staff nurses with “the knowledge and support to guide and partner with peers and interdisciplinary team members in creating unit-based change that is scalable for maximum impact”.
The program’s outcomes are laudable. Using innovative approaches, 67 teams of nurses from nine United States regions have significantly improved patient outcomes while saving health care dollars to the tune of approximately $34 million. Noteworthy achievements, as listed by healthaffairs.com, include:
- More than 50% reduction in HACs, such as central line-associated blood stream infection, catheter-associated urinary tract infection, and ventilator-associated pneumonia
- More than 50% decrease in patient falls
- Nearly 50% decrease in pressure injuries
- Up to 40% reduction in CAM-ICU positive scores for delirium
- A one-day decrease in ventilator days
- A one-day reduction in overall hospital length of stay
In the wake of health care reform and the move towards value-based care, it is crucial to take advantage of such innovative approaches to improve efficiency and patient outcomes in health care delivery. With half of all adults in the United States having at least one chronic health condition, with one in four individuals having two or more, moving towards efficiency and patient outcomes in health care delivery is necessary. Partnering with an experienced medical billing company will allow clinicians to maximize revenue as they implement new care models.