Denise is an RGN and has been teaching specialist nursing for more than eight years.
The scope of nursing is widening, bringing with it opportunities to design and improve patient care using cost-effectiveness (CE) as a criterion. There are so many choices in healthcare these days, for products, services, and interventions; simply knowing what works is not enough to make wise choices.
CE information can shift resources to better interventions, resulting in better use of resources and lessening waste. Unlike 'cost-saving', cost-effectiveness estimates the relative value of the intervention by price and its healthcare benefits. It does not necessarily reduce cost; it is a ratio that proves whether or not the unit of benefit is big enough compared to cost.
Cost-effectiveness answers the question 'Is the test/product/procedure/program/technology worth it?' By translating certain parameters into economic terms, comparisons can be made between healthcare options and resources assigned or freed so that cost and quality care can be better balanced.
Interventions are assessed through an economic lens. Questions about cost, best price, and worth in terms of outcomes must be asked to assess the value of both the standard and new.
Outcomes are measured in natural units, for example: lives saved, quality-adjusted life years (QALY), disability-adjusted life-years (DALY), or disease prevented. Doing this evaluation before widespread practice implementation is the most economically efficient way. Bear in mind that short-term and long-term assessments may yield different results of cost worthiness. Once the information has been considered, cost-efficient strategies can be put in place.
Patient-centered care means the patient and their support are a respected and participating part of the care team. Empowered patients tend to be more compliant patients, who then make it easier to get accurate feedback on interventions. They bring personal knowledge that works with the scientific and administrative knowledge of the caregivers to guide decision-making.
The best patient-centered care must go beyond the metric of patient satisfaction and include objective improvement in clinical status. Care is organized around the patient experience from admission to discharge and, if necessary, followup. This method facilitates reductions in testing and referrals, decreased unnecessary use of services, better, more informed treatment choices, and increased client satisfaction. Patient-centered care's cost-effectiveness is shown in savings while delivering quality care and increasing staff and patient satisfaction.
Patient profiling facilitates a selection of targeted, more appropriate testing and management, rather than routine testing and treatments. Building such profiles requires educating nurses and doctors on choosing better questions and improving observation and listening techniques when interacting with patients.
Regular information sessions for clinical staff by laboratory staff on availability and suitability of tests also enables more cost-effective care. Nurses are well placed to contribute to these sessions because of their extensive interaction with patients and their families. However, the information needs to be read and assessed critically to be useful, accordingly information formats that comply with present-day scanning reading habits need to be designed. An opportunity for the field of nursing informatics.
Systems thinking involves working out the different elements of a process or organization and when, and how well, they interact. It provides solutions that may lead to domino-effect advancements through the system. Cost-effectiveness may be achieved by investing in standardizing processes, example in environmental services, and thereby reducing nosocomial infections. Care bundles such as those designed to reduce central line-associated bloodstream infections (CLABSI) can prove to be cost-effective by lowering bed days, releasing lab time and reagents, and improving patient health outcomes.
Auditing organizational and procedural systems may also help by showing where modifications would make these more valuable. For example, researching better screening techniques so that what comes into acute care actually requires acute care would pay off in freed staff, time, and other resources for more individualized, holistic patient care.
Evidence-based practice is about implementing the latest research and should also take into consideration the returns on the change and its relative value. Inclusion of CE values in proposed innovations improve credibility.
Implementers can learn from the earlier mistakes of others and adapt the practice to suit local setups.
Telehealth innovations such as telemonitoring of patient parameters, virtual patient visits, and dedicated helplines can show value in reduced necessity for in-person hospital visits, which opens up beds and improves patient hospital traffic. For example, its use in chronic heart failure cases has been shown to reduce mortality and repeat-hospitalizations. Technology can be used to coordinate or schedule procedures and therefore improve patient flow and care accessibility throughout the hospital.
Another way technology has shown its value is in nurse scheduling programs, which can factor in variables like staff skills, patient flow and volume, and use predictive analytics to match supply with demand in a standardized manner. Besides freeing staff for greater bedside presence, staff satisfaction increases, leading to greater staff retention.
Investing in staff education pays off in a wider skills bank, better usage of technologies and other resources, and higher quality care. It is also a significant factor in patient safety and in the success of innovations or new programs. Patient education improves their understanding of wellness, their disease condition and treatment, and enables them to make informed choices. All this saves and/or improves the quality of lives.
Cost-effectiveness (CE) is a ratio of intervention to outcomes. It gives information on relative value. It may not always result in reduced costs. Cost effective analysis is done using natural units for outcomes, such as lives saved, quality-adjusted life years (QALY), disability-adjusted life-years (DALY), and disease prevented.
Achieving efficient use of resources in acute care while providing safe, high-quality care may be done by:
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