The VA Hospitalist group carries 2 acute patients and 8 patients that they have determined are "non-acute" -- usually these patients are awaiting placement.
1. Considering the protocol you are developing: identify the process and outcome indicators associated with the program and briefly describe an approach to measuring each.
Process Indicators: hospitalists use of an order to the likes of "do not perform night time vitals between 2200-0600". We can measure this process indicator in two ways. We can perform a qualitative method in which we discuss with the hospitalists if they are taking into account whether the low risk patient would be harmed or receive no benefit from the night time vitals when they write orders.
Outcome Indicators: % low risk patients with nighttime vitals; % patients that did not have nighttime vitals that were transferred to the ICU
We can quantitatively measure this by doing a chart review. Ideally, we would have a risk calculator that would ID those at high risk and low risk for deterioration in the hospital and then measure the % of low risk patients that are receiving nighttime vitals.
2. Define one or more “intermediate” outcome measures (reflecting changes in environment, organizational culture, systems of care, patient or public behavior, and/or clinician behaviors) that can inform you about the mechanism by which your intervention achieves its downstream effect on health inform you about the acceptability of your intervention
clinician behavior: this can also be measured as discussed above with a qualitative method to evaluate whether the clinician individualizes care by taking into account a patient's risk/benefit from night time interventions.
staff behavior: whether there is an order indicating avoiding night time vitals and whether it was performed anyway by the night staff will evaluate whether the staff is recognizing the importance of individualizing care to that patient.