As an M.D. and geriatrician, Dr. Zachary Palace is hyper aware of the importance of patient data as it relates to effective care plans and health outcomes.
In his role at Hebrew Home at Riverdale, which is part of the RiverSpring Living campus in the Bronx, New York, Dr. Palace oversees care for hundreds of skilled nursing residents. In this Clinical Dashboard interview, Dr. Palace shares the data points he would like to see on his ideal clinical dashboard, as well as who in the organization can best use this information and how the clinical care plan can improve as a result.
What are the three most important data points that you would want to see each day on your ideal clinical dashboard and why?
Heart rate, respiratory rate, pulse oximetry. These metrics help the clinician identify residents who are at increased risk of clinically deteriorating. As a geriatrician, I have spent much of my career working on reducing avoidable hospitalizations, and one of the most challenging areas is identifying the patients who are developing the earliest signs and symptoms of sepsis so that treatment can be initiated sooner. Early recognition of changes in heart rate and respiratory rate guide the clinician to further assess the patient for an acute change in status. Recognizing these changes can also help identify other factors affecting the patient, including exacerbation of pain in a patient unable to verbalize their complaints. Recognizing patients with oxygen desaturations can trigger an assessment for patients developing acute respiratory changes in status. If the patient isn’t actively coughing or complaining of shortness of breath, these early warning signs can be missed.
How would your ideal clinical dashboard drive patient care decisions?
When the clinician receives this relevant data on the clinical dashboard, this can trigger the clinician to assess the patient and [potentially] order further diagnostic studies and treatment. This can often address the underlying problem and avoid clinical declines that may necessitate a hospital transfer.
How would the ideal clinical dashboard help optimize reimbursement?
Maintaining patients in the facility is good for the facility’s census and a win-win for the patient and the facility.
How can the clinical dashboard improve staffing efficiency?
Nursing is tasked with many roles, including medication administration, administering treatments, and clinical documentation. The presence of a clinical dashboard that pushes this information out to clinicians saves nursing time from having to communicate and reach out to the clinician for every abnormal data point collected.
How would you like to see the clinical dashboard integrated with predictive analytics tools?
As we move into the era of AI, machine learning will help assist with predictive analytics that can incorporate other patient data, including blood sugar and significant changes in weight to help improve the predictive value of the clinical dashboard alerts.
Besides yourself, what are the most important roles in your organization to also have access to the clinical dashboard?
Medical director, medical staff, and director of nursing and nursing administrator on duty would be the key players to obtain these alerts.
What would you do to improve the collection of patient health data?
Collection of vital signs data, blood glucose monitoring electronically that automatically uploads to the EMR would allow for more efficient processing of data. At present, continuous glucose monitoring devices are not approved for use in the SNF, yet in the community this is information which is so readily available to patients. Incorporating CGM into the SNF would be a tremendous game changer from the perspective of patient comfort and safety (i.e. no fingersticks) and clinicians having much more readily accessible actionable information about patients developing extreme swings in their blood glucose levels.
