Improving patient outcomes

There are known knowns. These are things we know that we know. There are known unknowns. That is to say, there are things that we know we don’t know. But there are also unknown unknowns. There are things we don’t know we don’t know

Donald Rumsfeld’s comments on the presence, or otherwise, of weapons of mass destruction may have passed into folklore but they do encapsulate the dilemma facing anyone who seeks to move away from the tendrils of speculation and into a position of certainty.  Particularly so in the field of research where some studies result in ground breaking initiatives whilst others merely confirm unproven but seemingly obvious theories.

For example, a Europe-wide study into nursing practices has shown that a combination of nurse education levels and patient/nurse ratios can have an impact on patient outcomes.  Whilst the initial reaction to this report may be to dismiss it as stating the obvious, an already known known; studies such as these are invaluable in both proving the theory and in quantifying the extent of the problem.

So whilst we may have thought that we knew increasing the workload of nurses may lead to poorer patient care, a study which concludes that increasing a nurse’s workload by one patient is associated with a 7% increase in patient deaths can only serve to sharply focus the attention.    The report also concludes that in return for a 10% increase in nurses with degrees the risk of patient deaths falls by 7%; something which will be of comfort in the UK where with effect from 2013 all new nurses have to be educated to degree level.

Those working within the healthcare profession have always “known” that the more patients presenting for treatment equals the less time available for each patient and consequently the more likely that symptoms may be missed and care not be provided to the standards expected.  But studies such as this one highlight the effect of time and patient pressure.  For some the solution will be to educate further, to take on more staff; but when budgets are tight that is not always possible.  Finding ways to work smarter, to automate, to outsource the routine, to free up time for patients is the way forward.

Before this study we knew that time and education equalled improved outcomes but we didn’t know to what extent.  Now this part of the health service puzzle has moved from a known unknown into a known known and that has planning implications for all who practice healthcare and want to maximise patient outcomes.