Service recording of care services

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Service recording in nursing care ( LEP ) was defined for nursing in the 1980s at the Cantonal Hospital St. Gallen and the University Hospital Zurich as a method for computer-aided statistical recording and presentation of nursing services in the inpatient and outpatient area. The software is distributed and further developed by LEP AG , which emerged from the original developer groups, and is used both for service accounting, quality assurance and cost transparency. The method is mainly used in Switzerland, but is also used in Germany and Austria.

history

The procedure for recording services in nursing is a typical adaptation of activity-based costing according to the proposal by Robert S. Kaplan and W. Bruns in 1987. A recording of all nursing activities to justify later billing was therefore not intended either by Kaplan or in Switzerland. In the initial definition, the procedure falls into the category of modeling concepts for post-accounting cost accounting in business administration.

At the end of the 1980s and the beginning of the 1990s, the St. Gallen Cantonal Hospital and the University Hospital Zurich, initially independently of each other, but later partly together and in cooperation with the Interdisciplinary Research Center for Health St. Gallen and scientists from the Sociological Department of the University of St. Gallen, the Methods for recording process costs PAMS (patient expenditure measurement system) and SEP-USZ (system for recording care expenditure at the University Hospital Zurich) developed. These concepts followed the development of information technology and cost modeling in production technology from the mid-1980s. A modeling for the development of the performance structures was not yet connected with this.

Since around 2005, a variety of concepts supported by mobile communication for recording all outpatient care activities on patients / patients has been new. This means that activity-based costing is continued for authentic cost recording in the sense of activity-based accounting . Similar solutions for use in healthcare facilities can only be seen in the beginning.

development

From 1995 the two developer groups merged, the two methods were standardized and were given the designation Performance recording in nursing . From 1995 the method was also used outside the two hospitals; In 1996, 21 institutions implemented LEP. So that the further development was possible independently of the two original hospitals, the company LEP-AG was founded in 2000, the stock corporation achieved a turnover of around 1.3 million francs in 2007. The main shareholder of LEP AG is the St. Gallen Cantonal Hospital.

distribution

In 2008 the LEP method was used in 160 institutions in German- and French-speaking Switzerland , 50 companies in Germany and 5 in Austria . In addition to the LEP method for the care of another collection engine that was physiotherapy work develops, the name on LEP Nursing why (Engl. For maintenance ) has been expanded.

features

The LEP is an instrument for recording care services with a retrospective focus for inpatient acute care. It records what services were actually provided, i.e. the nursing activities carried out . A prospective application would theoretically be possible and advisable.

LEP distinguishes between activities that can be assigned to individual patients (direct care activities) and all other activities, for example ward maintenance or management work (indirect care activities). The direct care activities are recorded electronically as continuously as possible by the caregivers using a list of 56 tasks, each with one to four characteristics, which are also referred to as effort levels. In LEP parlance, each expression is referred to as a variable. These are divided into the types of information variables and maintenance variables. The variables of both types are again arranged in variable groups. The group classification is used to provide an orderly overview of the variables and, in addition to faster assignment during acquisition, supports a condensed evaluation of the data.

Information variables

Information variables are used for re-identification and the repeated description of the patient's status, so no time values ​​are stored in them. The information variables are divided into the groups “master data”, “status variables” and “additional information about the patient”.

  • The master data is used to identify the patient so that the services recorded with LEP can be clearly assigned to the respective patient. In order to enable a link with in-house administration systems, the content of the master data such as age, gender, etc. must be defined specifically for the company. Master data also contain information about the type of stay as well as admission, transfer and discharge.
  • The state variables describe characteristics about the patient's situation, such as hearing and / or language problems or disorientation, which are recorded by the nursing staff during the nursing history or in nursing practice. They serve to assess the plausibility of the recorded services and explain, for example, why a patient incurs more effort.
  • The supplementary information about the patient contains further general information that is not directly related to care goals or measures, but is of interest from an operational point of view, such as resuscitation, operation day or death. Furthermore, they enable the description of patient conditions in an intensive care unit, such as hemodialysis or special monitoring. Own company-specific variables can be added.

Maintenance variables

For each LEP variable there is normally a variable name, description, examples, possible comments and instructions as well as a time value. The fair value was determined with care experts on the basis of estimates in such a way that it reflects the time that trained and experienced people need on average to carry out the activity in an appropriate quality. This includes the preparation, implementation and post-processing or disposal of the material, as well as any necessary communication and documentation regarding the activity, provided that it is within the usual framework. In addition to the normal case described above, there are additional information variables that document certain patient conditions; However, no current value is stored for this - the information is only intended to facilitate the interpretation of the evaluations.

Those activities that do not show any characteristics, but to which a base time value is assigned, are also dealt with in particular. The time actually used is recorded in units of the base value. Experience has shown that this type of activity was chosen when the time expenditure is extremely variable or when several patients are recipients of a single care service at the same time, for example during employment and leisure activities in a group.

The maintenance variables are arranged in fourteen groups. Since certain activities or characteristics only occur in certain departments, each station compiles a catalog of variables that is valid for it from the overall list. The indirect care activities are determined purely by calculation from the percentage difference between the staff times and the direct care activities.

In the development of LEP the link between the variables and the International Classification of Nursing Practice should (ICNP, dt. International Classification for Nursing Practice ), a classification system that the reference terminology for the acquisition of nursing diagnoses contains (nursing phenomena), nursing procedures and care results, guaranteed become. A field test in 2002 showed basic compatibility. Further information about the achieved status of the modeling, the work preparation and the cost efficiency is not available.

Forms of use

LEP is used to plan, control and evaluate nursing work for nursing itself; Creation of transparency towards non-nursing areas - inside and outside of companies; Calculation of establishment plans; Creation of cost transparency, for example for calculating case costs similar to Diagnosis Related Groups (DRG diagnosis-related case groups ) or as a basis for billing; Database for nursing research .

LEP serves to standardize the health system and has significantly influenced the introduction of the flat rate per case . The recording of nursing services is carried out for several reasons:

  • Cost transparency - In the sense of a total cost approach, all services can be allocated to the patient and diagnosis.
  • Justification of costs to customers (patients, represented by the respective insurance carriers).
  • Profitability comparisons of departments or clinics.
  • Quality control.
  • Risk Management - exclusion of organizational failure through documentation of all care services.

All care services are recorded using forms, online or with mobile computers. The LEP data are usually evaluated using a networked PC , on a server in the background or on mainframe computers. In order to optimize the processes on the respective wards, the data is ideally available online in the ward room.

It should be noted critically that health and recovery are highly individual aspects. By recording individual services, standardization (e.g. for the duration of a care unit ) is favored. Problems also arise in the recording of special patient groups, for example people suffering from dementia , whose care can hardly be standardized.

literature

  • A. Brosziewski, U. Brügger: On the scientific nature of measuring instruments in health care: Using the example of the LEP method , in: Pflege 2000/14, pages 59-66.
  • Virginia K. Saba, Kathleen Ann McCormick: Essentials of computers for nurses: informatics for the new millenium , McGraw-Hill, 2000, University of Michigan, ISBN 0071349006
  • Walter Schär, Manfred Haubrock: Nursing informatics in clinical practice , Elsevier, Urban & FischerVerlag, 2003, ISBN 3437267809

Web links

Individual evidence

  1. Service modeling (PDF; 2.2 MB)
  2. ^ Walter Schär, Manfred Haubrock: Nursing informatics in clinical practice , Elsevier, Urban & FischerVerlag, 2003, Chapter 4.4, pages 76-77, ISBN 3437267809
  3. a b Markus Löliger: A success story - born in the St. Gallen Cantonal Hospital. In: St. Galler Tagblatt from October 20, 2008
  4. Waste without modeling  ( page no longer available , search in web archivesInfo: The link was automatically marked as defective. Please check the link according to the instructions and then remove this notice. (PDF; 178 kB)@1@ 2Template: Toter Link / www.ipa.fraunhofer.de  
  5. ^ Walter Schär, Manfred Haubrock: Nursing informatics in clinical practice , Elsevier, Urban & FischerVerlag, 2003, chapter 4.4, pages 78, ISBN 3437267809
  6. ^ Andreas Lauterbach: Nursing Informatics in Europe , BoD, 2003, pages 227–232, ISBN 3833000171
  7. Manfred Borutta, Gerd Palm, Joachim Lennefer: People with dementia: work steps for performance-based care rates. Vincentz Network GmbH & Co KG, 2004, pages 62-64, ISBN 3878704909