Translating Evidence Into Practice Benchmarking

Translating Evidence Into Practice

Benchmarking is a processes where businesses compare their best practices to those of like businesses and find ways to improve overall. While working at a hospital in Scottsdale, I encountered benchmarks being put into action. In an attempt to improve patient care, the hospital began studying night time best nursing practices. Prior to the benchmarking, it was common practice at the hospital to make full vital and treatment rounds during the nighttime and daytime. While this ensured the utmost in care for patients, it interrupted many patients' ability to sleep. The hospital began receiving negative comments about evening rounds from patients, so the benchmark study began.

Nighttime practices of other hospitals were researched and compared to those of the hospital I was at. The hospital decided to redesign the nighttime rounds and redefine how often certain patients must be monitored. For those patients that were low to no risk, late night monitoring could be withheld at the request of the patient. The results of this study found an increased satisfaction for patients and improved survey scores.

This practice did, however, take time and work to implement. As stated in the Benson article, proper benchmarking requires teamwork with very knowledgeable members enacting the changes. For this clinical change, physicians in all specialties from pediatrics to geriatrics were consulted along with long-standing nurses and other staff. Additionally, a specific question was added to the patient surveys to obtain feedback from patients.

The changes were for the most part positive for patients, but the changes were very difficult for the staff. It required nighttime nursing staff to learn a new patient room coding system (created by management) and consistently follow this system, only visiting certain nighttime patients. This also made the morning rounds more difficult as certain nighttime processes had to be completed during a much busier time. After a month of the new system, the hospital staff adjusted and patients showed greater satisfaction. Overall, I felt it was a success.

Benson, HR (1994). An Introduction to Benchmarking in Healthcare. Radiol Manage, 16(4), 34-9.

Question 3

The issue of non-compliance with patients is resulting in alarming re-hospitalization rates as well as poor patient outcomes. In an attempt to reduce the amount of non-compliant patients, a groundbreaking 1976 study attempted to reduce the amount of non-complaint hypertension patients through an improved exam-room decorum. Instead of the doctor simply identifying symptoms and writing a prescription, half the patients had longer visits with doctors where they were educated on their condition and allowed to share their feelings and concerns. In the educated group of this study, 61% of patients took their medication as prescribed. In the control group who experienced a standard physician visit, only 32% followed the doctor's recommendations and took their medication as prescribed.

Researchers on this study followed a Stetler, Iowa, Rosswurm & Larrabee model. They identified the problem of non-compliance among hypertension patients and began collecting data based on how patients interacted with their physicians. The conclusion was quickly reached that there was not enough open communication. The intervention then used was simply getting physicians to communicate better with half of the patients using techniques including symptomatic education, education on medications, listening and responding to patient concerns, and allowing the patient to fully describe their condition, concerns, and questions.