Problem: In striving for high reliability, hospital system stakeholders sought a shift from manual to electronic Lines, Drains, and Airways (LDAs) denominator reporting. Prior efforts to address LDA reconciliation gleaned qualitative data on barriers and best practices, but the organization lacked quantitative data measuring the facilities’ readiness to report electronically.
Measurement: The National Healthcare Safety Network (NHSN) requires no more than five percent difference between manual and electronic sources to adopt electronic reporting. The authors extracted daily device counts from electronic health record reports and an external audit database, merging data with a sophisticated data preparation tool to calculate percent difference.
Analysis: In collaboration with nursing and information technology, the authors conducted a targeted assessment of six units across two hospitals, evaluating two available manual processes. They compiled manual and electronic LDA denominator counts, calculating percent differences to measure readiness. Additional metrics clarified the feasibility of system-wide use of each manual process.
Implementation: Nurse-focused webinar trainings reinforced best practices for two manual procedures and the importance of accuracy and agreement of LDA counts captured manually and electronically. A director visited participating units to observe real-time procedures and identify barriers facing manual count entries by nurses. Data visualizations facilitated interpretation and dissemination of results.
Results/Discussion: Percent difference ranged from 46% to 72% between electronic and manual sources, revealing significant opportunities for improvement before transitioning to electronic reporting. Percent missing for manual entries ranged from one percent to 65% throughout the assessment period. Latent patient-level device discrepancies indicated training gaps to target for decreasing percent difference.
