CONCERN Initiative Leverages Nursing Expertise into Patient Predictive Models, Receives Funding

Nurse expertise includes the ability to pick up cues about patients’ health from subtle changes in behavior and appearance, but these observations often get missed or under-analyzed within the electronic health record (EHR).

The CONCERN Initiative, a multi-hospital system effort led by the Columbia University Irving Medical Center (CUIMC), will leverage that expertise with artificial intelligence to create prediction models that can improve patient outcomes through the CONCERN Initiative.

CONCERN (COmmunicating Narrative Concerns Entered by RNs) is a predictive tool that extracts nurses’ expert and knowledge-driven behaviors within patient health records and transforms them into observable data that support early prediction of organ failure or other critical conditions in hospitalized patients.

CUIMC is partnering with three hospital systems — Mass General Brigham (MA), Vanderbilt University Medical Center (TN), and Washington University School of Medicine/Barnes-Jewish Hospital (MO) — to test the effectiveness of the CONCERN implementation toolkit, developed to support large-scale adoption of the tool.

This initiative recently received funding from the American Nurses Foundation (the Foundation) through the Reimagining Nursing Initiative.

Learn more about the Concern initiative on the Reimagining Nursing Initiative homepage

Sarah Rossetti

“CONCERN shows what nurses already know: Our risk identification is not simply a subjective clinical hunch,” said Sarah Rossetti, Assistant Professor of Biomedical Informatics and Nursing at Columbia. “We’re demonstrating that nurses have objective, expert-based knowledge that drives their practice, and we’re positioning nurses as knowledge workers with tremendous value to the entire care team.”

ABOUT THE CONCERN INITIATIVE

Annually, more than 200,000 patients die in U.S. hospitals from cardiac arrest and over 130,000 patients’ deaths are attributed to sepsis. Many of these deaths could be preventable if patients who are at risk are detected earlier. Prior work from the CONCERN team found that nursing documentation within EHRs contains information that could contribute to early detection and treatment, but these data are not being analyzed and exposed by EHRs to clinicians to initiate interventions quickly enough to save patients.

CONCERN shows what nurses already know: Our risk identification is not simply a subjective clinical hunch. We’re demonstrating that nurses have objective, expert-based knowledge that drives their practice, and we’re positioning nurses as knowledge workers with tremendous value to the entire care team.

Sarah Rossetti

The research team defined a new source of predictive data by analyzing the frequency and types of nursing documentation that indicated nurses’ increased surveillance and level of concern for a patient. These data documented in the 48 hours preceding a cardiac arrest and hospital mortality were predictive of the event. While clinicians strive to provide the best care, there is a systematic problem within hospital settings of non-optimal communication between nurses and doctors leading to delays in care for patients at risk. Well-designed and tested EHRs are able to trend data and support communication and decision making, but too often fall short of these goals and actually increase clinician cognitive load through fragmented information displays, “note bloat,” and information overload.

Substitutable Medical Applications & Reusable Technologies (SMARTapps) using Fast Health Interoperability Resource (FHIR) standard allow for open sharing and use of innovations across EHR systems. The aim of the CONCERN Initiative is to design and evaluate a SMARTapp on FHIR used across multiple large academic medical centers that exposes to physicians and nurses the predictive data source from nursing documentation to increase care team situational awareness of at-risk patients to decrease preventable adverse outcomes.

ABOUT THE REIMAGINING NURSING INITIATIVE

The American Nurses Foundation Reimagining Nursing Initiative announced May 24 that it is funding 10 bold ideas developed and led by nurses to transform nursing for improved health access, care, and outcomes for all. The pilots impact more than 20 states, covering diverse urban and rural regions. Collectively, the pilots have the potential to improve the lives of millions of nurses and the many people in their care.

The Foundation is awarding $14 million over three years to the 10 pilots to test new ideas and solutions. The Foundation’s goal is to then support those that demonstrate success to scale. By nurturing these ideas and enabling successful ones to scale, the Foundation hopes to disrupt – for the better – long-standing practices that leave nurses under-developed, under-utilized, and under-appreciated.

For more information on the Initiative and to explore each of the pilots, please visit: https://www.nursingworld.org/rninitiative.