Patient-level analysis of outcomes using structured labor and delivery data.

Area of Science:

• Nursing Informatics
• Health Services Research
• Clinical Nursing

Background:

• Computerized nurse documentation offers rich data for analyzing nursing care.
• Quantifying nursing care at the patient level is crucial for outcome research.
• Existing methods may not fully capture the nuances of nursing workload and patient care.

Purpose of the Study:

• To develop and evaluate methods for identifying associations between nursing care processes, patient attributes, and outcomes.
• To create patient-level and unit-level representations of nursing care using computerized documentation.
• To explore the relationship between quantified nursing care and labor durations.

Main Methods:

• Retrospective, descriptive analysis of documented nursing events for 900 Labor and Delivery patients.
• Development of two models to quantify nursing care: one based on nurse-patient census, the other on computerized documentation of patient load.
• Statistical analysis to identify relationships between nursing care scores and patient outcomes (labor duration).

Main Results:

• Significant relationships were identified between labor durations and nursing care scores derived from the second model (computerized documentation).
• The study demonstrated the feasibility of representing nursing care amount at the individual patient level.
• The second model, incorporating nurse-entered documentation, showed stronger associations with clinical outcomes.

Conclusions:

• Computerized nurse documentation can be effectively utilized to quantify nursing care at the patient level.
• Quantified nursing care scores derived from detailed documentation are associated with patient outcomes, such as labor duration.
• The proposed approach has broad applicability for analyzing the impact of nursing care on patient outcomes in various clinical settings.