About COST2CARE
One of the greatest challenges to health care systems today is the rapidly increasing proportion of older people (>65 years) accessing healthcare in acute hospitals. The OECD predicts that the proportion of the population aged >65 years will rise from 17.4% in 2017 to 27.1% by 2050, placing their care management high on the agenda of clinicians and policy makers. The largest group of patients in acute hospitals in Ireland and elsewhere is that of older people, accounting for half of all hospital bed days. While these patients require acute nursing care for their presenting condition, they often simultaneously require a level of fundamental care to address other needs related to advancing age, or the presence of co-morbidities. If this care is missed or incomplete, patients are at high risk of experiencing complications which are often associated with extended lengths of stay or reduced function on discharge. Ultimately, these complications are high-cost events, both financially, to the health service, and in human costs to the patient and caregiver.
In Ireland Hospital In-Patient Enquiry (HIPE) is the principal source of national data on discharges from acute hospitals, through which demographic, clinical and administrative data on discharges from, and deaths in, acute public hospitals nationally are collected. To date nursing sensitive adverse events are largely invisible in reports generated from HIPE and it is likely that this reflects a lack of understanding of the potential of routinely available discharge data as a source of important patient safety data. In the COST2CARE project researchers intend to mine the national HIPE data for national rates of four nursing sensitive adverse events (pneumonia, delirium, urinary tract infections and pressure injuries) and to verify the accuracy of the data through an extensive retrospective chart review in one model four hospital. These four events, described as Failure to Maintain events are known to occur when fundamental nursing care is missed.
Using ICD10 data and rates of occurrence verified through chart review the research team hope to calculate the cost to the Irish health service by examining length of stay, and other variables associated with cost of illness calculations. The project offers a smart, scalable and sustainable solution to a contemporary healthcare challenge, and enables opportunities for benchmarking and quality improvement initiatives in Ireland and potentially globally.
Simultaneous surveys of both nurses and patients in one hospital using validated instruments will enable the team to examine the human cost of missed care in acute hospitals.
COST2CARE Objectives
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To determine prevalence in Ireland of four common nursing sensitive adverse events in older adults (>65 years)
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To estimate the prevalence, contributing factors, and impact of missed nursing care in an Irish healthcare setting, and how it is experienced by both nurses and patients.
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To determine the cost associated with nursing sensitive adverse events and missed nursing care.
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To promote the recording and reporting of these nursing sensitive events in hospital discharge data
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To promote the measurement of Missed Nursing Care as a quality and safety measurement to stakeholders, including policy makers, health care providers, professional bodies, clinicians and patients.
