Objectives Stated Given the obvious critical importance of the electronic and computerized systems for American ICUs, it is also essential to evaluate the related implications that eICUs will, or might, have on the development of the health care in the country. On the other hand, the evaluation of the potential implications of the very implementation of the eICU idea in the senses of associated costs, staff needed, training and education required is also essential. According to Oermann and Gaberson (2006, p. 3), evaluations can be formative and summative, and bot hof them fit into the following flow oft he project development:
Accordingly, this section will follow the above presented sequence of steps and place formative evaluation details before the finalizing steps taken in the process of the summative evaluation of the eICU implementation.
The very idea of the formative evaluation is the embodiment of the repeated assessment of the project development in its progress, and Oermann and Gaberson (2006) define it as “feedback…about…progress in meeting the objectives and developing competencies…It occurs throughout the…process and provides a basis for determining where further [changes are] needed” (p. 4). Accordingly, the formative evaluation of eICU can be carried out as a stage-based assessment of the pros and cons that a rather costly but still obviously necessary procedure displays (Mannion, 2009, p. 22). Drawing from this, there should literary be several formative evaluations, each corresponding to the stage of eICU implementation and assessment of its effectiveness.
The basic stages of the eICU implementation, as Oermann and Gaberson (2006) and Mannion (2009) argue, include the statement of objectives, assessment of needs, outlining the areas of implementation, assessment of costs, and the consideration of basic resources required in the aspects of staffing, training, and education. Another side of the formative assessment of eICU is data collection, which includes the combined Likert scale and narrative question methods, online and handwritten questionnaires, and the two-fold process of patient data collection (before and after eICU implementation).
Accordingly, the major implications of the above aspects for the formative evaluation of the eICU are as follows. First, the objectives and needs for the eICU implementation include the need to solve the nurse shortage problem and the associated increasing risk of health condition complications and mortality rates in U.S. intensive care units. Second, the major areas of implementation of eICU should be the remote health care facilities in which the nursing staff shortage and the time needed for intensivists to access require more time- and cost-effective ways to provide the necessary health care standards to patients. Third, costs and other resources needed for the implementation of eICUs in the USA should be regularly assessed against other ways to solve the nurse shortage issue, i. e. educating more nurses, recruiting non-experienced nurses, or using the services of ordinary physicians for ICUs.
Accordingly, the performance of eICUs implementers in each of the above aspects should be evaluated formatively, i. e. on the regular basis within the process of implementation. Oermann and Gaberson (2006) advocate the use of the combination of Likert scale and narrative question methods for this purpose (p. 26), while Mannion (2009) argues that online and handwritten questionnaires can both be effective because certain participants of the evaluation might lack computer experience necessary for filling out the exclusively online ones (p. 22). Finally, both Oermann and Gaberson (2006) and Mannion (2009) agree that it is essential to collect the required data at least twice, i. e. before and after the eICUs are implemented. For the purposes of formative evaluation, these data should be collected at least five times, i. e. after each stage of implementations.
Further on, the final stage of the evaluation process for every kind of activity, especially in the area of health care, is the summative evaluation defined as “evaluation provides information on the extent to which objectives were achieved” by Oermann and Gaberson (2006, p. 5). Accordingly, the summative evaluation is the final one, which sums up the results of the whole project, i. e. the eICU implementation in the discussed situation.
The basic stages of the summative evaluation should be the same as during the formative evaluation, with the addition of the procedures to sum up the results of the formative evaluation stages and the final evaluation of the achieved results as contrasted to the expected ones (Oermann and Gaberson, 2006, p. 244). Accordingly, the summative evaluation should have the clear success criteria according to which the relative and the actual effectiveness of eICUs should be measured. In the discussed situation, the major criteria for the performance success measurement are the rates of health conditions complications and mortality among ICU patients before and after the eICU implementation, as well as the funds saved, or wasted, in association with the eICUs.
The major implications of the summative evaluation for eICU project are expected to include the display of the effectiveness of the project as contrasted against its expected and forecasted results and against the current situation regarding the patients’ health care and cost-effectiveness of ICU functioning. Some of the criteria against which the effectiveness of the eICUs can be evaluated in a summative mode include the facts that:
- eICUs can save an average of 50,000 people annually (Mannion, 2009, p. 22);
- Mortality rates are reported to drop from 36% to 15% in ICU equipped by electronic monitoring systems (Mannion, 2009, p. 22);
- eICU systems can help save over $4 billion annually (Mannion, 2009, p. 22).
Drawing from this, the summative evaluation of the eICUs effectiveness can be carried out in two major planes. The first one touches upon the mortality rate decrease and cost-effectiveness improvement as assessed against current levels (identified through observations and questionnaire surveys), while the second plane will have the considerably scholarly nature and try to find out if the scholarly reported figures illustrating eICU associated improvements can actually be observed due to the use of Telemedicine.
Formative and Summative Evaluation
Thus, one can see that the division of the project evaluation process into two main stages, i. e. formative and summative evaluation, has considerable rationale behind it. Oermann and Gaberson (2006) and Mannion (2009) argument the need of these two evaluation stages by claiming that the formative evaluation allows tracing the project progress, while the summative evaluation allows summing the project up and assessing it as an effective or ineffective one against the clear success criteria. Since the eICU implementation presents such criteria, the use of the two above discussed evaluation stages is strongly desired for this process.
Mannion, A. (2009). The Electronic ICU. American Journal of Nursing, 109(11), 22.
Oermann, M. and Gaberson, K. (2006). Evaluation and testing in nursing education. Springer Publishing Company.