Relationship Between Nursing Documentation and Patients' Mortality

Patterns of additional data that nurses document in the EHR to highlight concerning patient changes are not explicitly evident to other members of the care team.

“As part of surveillance, nurses document additional data in the EHR to highlight concerning patient changes, but the patterns of these additional data are not explicitly evident to other members of the care team12,13.”

The team has published on statistically significant signals detected in nursing data using this metadata modeling approach since 2012, demonstrating its resilience as EHR functionality and documentation policies change over time and across multiple sites.

“Our team has published on statistically significant signals detected in nursing data using this metadata modeling approach since 2012 (refs. 13,21), demonstrating its resilience, first, as EHR functionality and documentation policies change over time and across multiple sites.”

CONCERN EWS's methodological choices, including robust modeling of temporal data patterns and use of nursing assessment and observational data, allowed it to have accurate and robust predictive power and sufficient lead time to alter a patient's clinical trajectory.

“Several methodological choices allowed CONCERN EWS to have accurate and robust predictive power and sufficient lead time to alter a patient’s clinical trajectory as we observed in this trial, including: (1) robust modeling of temporal data patterns40–42 (for example, time of day, day of week and patient hospital day) for health care processes (for example, nurses’ surveillance and medication”

CONCERN EWS overcomes the limitations of physiological measurements by leveraging nursing surveillance patterns and an existing expert knowledge base.

“By leveraging nursing surveillance patterns rather than physiological measures10,44, CONCERN EWS overcomes the limitations of physiological measurements8 and leverages an existing expert knowledge base: nurses’ autonomous decisions to take greater action and document more observations or notes than mandated by policy in direct response to concerning changes in a patient’s clinical state10,13.”

Nurses play an important role in collecting data that might eventually be used by AI tools.

“Nurses play an important role in collecting data that might be eventually used by AI tools, as evidenced by work that has linked the nature and patterns of nursing documentation practices with patients' mortality (Collins et al., 2013).”

CONCERN leverages evidence that nurses alter their documentation behavior or use selected language in their narrative notes when they are concerned about a patient's changing clinical state.

“As such, it leverages evidence that nurses alter their documentation behavior or use selected language in their narrative notes when they are concerned about a patient’s changing clinical state [21-24].”

Lack of shared team situational awareness delays medical interventions.

“Unfortunately, when there is a lack of shared team situational awareness, medical interventions are delayed10,12–14.”