NURS FPX 6214 Assessment 4 Staff Training Session
Student Name Capella University NURS-FPX 6214 Health Care Informatics and Technology Prof. Name Date Staff Training Session Good morning, and welcome to today’s staff training session. Our focus is on the transformative potential of Remote Patient Monitoring (RPM) technology, using the Mayo Clinic as a case example. RPM enables healthcare providers to continuously monitor patient vital signs and treatment adherence remotely, allowing for timely interventions and proactive care. This technology has the potential to improve patient outcomes, enhance engagement, and optimize clinical workflows. However, implementing RPM involves challenges such as technical complexity, staff resistance, and privacy concerns. During this training, we will explore RPM’s scope, examine deployment requirements, and discuss its implications for nursing staff and healthcare systems. Purpose and Use of Remote Patient Monitoring What is the purpose of the technology? Remote Patient Monitoring (RPM) is a subset of telehealth designed to allow healthcare professionals to remotely track and manage patient health information. At the Mayo Clinic, RPM supports early detection of complications and chronic disease management by enabling continuous observation of patient vitals (Taylor et al., 2021). This facilitates timely interventions and improves care coordination. What are the benefits of the technology? Benefit Area Description Source Early Detection & Intervention RPM enables timely identification of health issues, allowing prompt responses. Alanazi & Daim, 2021 Operational Efficiency Automated data collection frees staff time to focus on direct patient care. Haddad et al., 2023 Patient Engagement Patients can access their own health data and communicate with providers, encouraging active participation. Haddad et al., 2023 What are the limitations of the technology? Limitation Area Description Source Technical Challenges Connectivity and interoperability issues may impede smooth RPM integration. Hamoud et al., 2022 Resistance to Change Staff may hesitate to adopt RPM due to workflow disruptions or unfamiliarity. León et al., 2022 Access Disparities Limited digital infrastructure in underserved populations may restrict RPM use. Omboni et al., 2022 Risks and Benefits of Remote Patient Monitoring What are the potential risks? While RPM can enhance care delivery, it poses risks including cybersecurity threats and potential breaches of patient data. Device malfunctions or inaccuracies may also compromise clinical decisions and patient trust (Singh et al., 2022; Rashidy et al., 2021). What are the benefits? Benefit Type Description Source Increased Access RPM lowers care barriers for patients in remote or underserved areas. Hayes et al., 2022 Chronic Disease Management Real-time monitoring allows early detection of complications, improving outcomes. Navathe et al., 2022 What are reasons for non-use? Barrier Explanation Source Lack of Personal Interaction Some providers worry RPM may weaken patient-provider rapport. Olivencia et al., 2022 Financial Constraints Initial setup costs and reimbursement challenges limit adoption. Abdolkhani et al., 2021 Cultural Resistance Professionals may prefer traditional in-person care over digital monitoring. Olivencia et al., 2022 Deployment Requirements for Remote Patient Monitoring What technology infrastructure and compatibility are required? Requirement Description Source Infrastructure Readiness Evaluating current systems ensures seamless integration with RPM. Lawrence et al., 2023 System Compatibility RPM devices and software must integrate with existing healthcare IT systems. Lawrence et al., 2023 What roles do staff members play? Successful RPM deployment requires clearly defined responsibilities. Project managers oversee activities, IT professionals handle integration and troubleshooting, and clinical trainers educate staff on device use and clinical application (Bove et al., 2021). What are nursing staff responsibilities? Nurses are central to patient education, assisting with device usage, interpreting monitoring data, and integrating RPM into daily routines for patients and caregivers (Rockwern et al., 2021). What knowledge gaps and uncertainties exist? Uncertainties may include patient adaptability, adequacy of technical support, and legal compliance. Continuous training, feedback collection, and evaluation mechanisms are necessary to address these gaps (Ruyobeza et al., 2022). Confidentiality and Privacy Safeguards in Remote Patient Monitoring What are the confidentiality challenges? Transmitting patient data digitally introduces privacy risks. Weak security measures, poor interoperability, or insufficient encryption may result in breaches (Ahmed & Kannan, 2021). What safeguards exist for RPM systems? Safeguard Function Source Data Encryption Secures patient information during transmission and storage. Jarrin & Parakh, 2021 Authentication Protocols Confirms user identity and prevents unauthorized access. Jarrin & Parakh, 2021 Regulatory Compliance Ensures adherence to HIPAA and other privacy standards. Jarrin & Parakh, 2021 What assumptions and considerations should be made? Effective safeguards rely on staff compliance, secure patient connectivity, and vendors maintaining high cybersecurity standards. The growing use of AI in RPM also raises ethical and privacy considerations (Jumreornvong et al., 2020; Mosnaim et al., 2020). Assessing the Effectiveness of Remote Patient Monitoring What are the short-term and long-term goals? Initially, RPM should enhance patient convenience, reduce travel, and improve satisfaction. Long-term goals include better chronic disease management, fewer hospital readmissions, and overall cost savings (Miranda et al., 2023; Rockwern et al., 2021). What post-implementation metrics should be tracked? Outcome Category Metrics Assessed Source Patient Satisfaction Convenience, ease of use, perceived quality of care. Tan et al., 2021 Clinical Effectiveness Changes in vitals, adherence, and disease progression. Olivencia et al., 2022 Operational Efficiency Resource utilization, workflow improvements, wait times. Bove et al., 2021 Financial Performance Cost savings, reduced admissions, RPM reimbursement. Ferreira, 2020 What measurement strategies are used? Method Purpose Source EHR Data Analytics Tracks patient outcomes and usage patterns. Makina et al., 2023 Surveys & Interviews Collects subjective feedback from staff and patients. Alanazi & Daim, 2021 Comparative Analyses Compares RPM results to traditional care models. Nittari et al., 2020 Cost-Benefit Studies Evaluates financial return on RPM investments. Muller et al., 2021 Ongoing Training and Technical Support for Remote Patient Monitoring What is the training scope? Staff training addresses both technical and clinical aspects. Technical training covers platform navigation and troubleshooting, while clinical modules focus on data interpretation and remote patient assessments. Ongoing learning is provided via webinars and e-learning platforms (Serrano et al., 2023; Hilty et al., 2021). What are the training objectives? Training aims to maintain competence, adapt to updates, and ensure privacy compliance. Refresher sessions close gaps and keep staff informed about new RPM system features (Steinberg et al., 2021). How are knowledge gaps identified
NURS FPX 6214 Assessment 3 Implementation Plan
Student Name Capella University NURS-FPX 6214 Health Care Informatics and Technology Prof. Name Date Assessment of Existing Telehealth Infrastructure St. Anthony Medical Center (SAMC) has implemented basic telehealth capabilities, yet the current infrastructure demonstrates limitations that affect both service quality and operational reliability. One primary concern is insufficient bandwidth, which is especially problematic during peak usage periods or in rural areas where internet connectivity is limited. These bandwidth constraints can cause latency and interruptions in real-time video consultations, undermining the effectiveness of synchronous remote care. Another challenge lies in system integration. Many patient monitoring devices are not fully compatible with the existing electronic health record (EHR) systems, impeding the seamless transfer of clinical data. This lack of interoperability can disrupt care coordination and reduce the efficiency of remote patient monitoring (RPM). In addition, outdated hardware and software create barriers to adopting newer telehealth technologies, further limiting the system’s adaptability. Compounding these technological issues are disparities in digital literacy among staff and patients, which can hinder effective use and reduce engagement (Lee et al., 2021). Addressing these challenges requires strategic upgrades to both hardware and software, including enhancements to network capacity, scalable equipment, and user-friendly, secure software platforms. Additionally, assessing system resilience, user satisfaction, and cybersecurity readiness is critical to ensure the infrastructure can support increased telehealth adoption while safeguarding sensitive patient data. Table 1: Key Infrastructure Limitations and Improvement Strategies Challenge Impact Proposed Solution Limited bandwidth Video lag, reduced user experience Expand network capacity and optimize data transmission Incompatible monitoring devices Disrupted EHR integration Implement interoperable devices and platforms Outdated hardware/software Cannot support new technologies Replace obsolete equipment and update software Training disparities Misuse or underuse of RPM tools Standardize staff and patient training Cybersecurity vulnerabilities Increased risk of data breaches Strengthen system security protocols and monitoring Assigning Tasks and Responsibilities Implementing RPM successfully at SAMC requires clear assignment of roles to ensure smooth deployment. The IT department is responsible for technical evaluation, identifying limitations, and executing system upgrades. This includes sourcing scalable solutions and ensuring integration with existing hospital systems. In cases where internal resources are insufficient, collaboration with external telehealth vendors can provide specialized expertise. Clinical leaders play a critical role in selecting appropriate monitoring devices and incorporating them into patient care protocols, ensuring that technology complements rather than disrupts workflows (Smuck et al., 2021). Training coordinators develop and deliver educational programs for both staff and patients, focusing on operational proficiency and digital literacy to minimize resistance and maximize technology adoption. Data analysts continuously monitor system performance and outcomes, providing actionable insights for improvement. External consultants may also be engaged to offer independent evaluations, further ensuring the RPM deployment remains efficient and evidence-based. Structured role delineation promotes accountability and supports a sustainable telehealth program. Table 2: Assigned Responsibilities for RPM Implementation Role Responsibility Additional Support IT Department System upgrades, cybersecurity, integration External telehealth IT consultants Clinical Team Leaders Device selection, integration into clinical workflows Coordination with training staff Training Coordinators Staff and patient education Third-party training providers Data Analysts Monitor outcomes, evaluate system performance External evaluation consultants Implementation Schedule, Training, Collaboration, and Evaluation The deployment of RPM at SAMC will follow an eight-month phased approach to minimize service disruption. Phase 1 (Months 1–2) focuses on evaluating and upgrading the infrastructure. Phase 2 (Months 3–4) involves pilot testing RPM with select patient groups. Phase 3 (Months 5–6) provides comprehensive training for all staff, while Phase 4 (Months 7–8) launches full hospital-wide implementation, retiring outdated systems once readiness is confirmed. Training will be tailored according to staff roles. Clinical staff will learn to interpret remote patient data and manage virtual interactions, IT personnel will focus on maintenance and troubleshooting, and administrative staff will handle system operations and documentation. Training methods include live demonstrations, printed guides, and pre/post-assessment evaluations to ensure skill acquisition (Farias et al., 2020). Collaboration and early engagement of both providers and patients are essential to adoption. Educational sessions and interactive demonstrations address concerns about technology complexity and data privacy. Adopting a transformational leadership approach, which emphasizes vision, empowerment, and team cohesion, supports smooth implementation (Deveaux et al., 2021). Regular feedback loops post-deployment ensure ongoing optimization. After deployment, initial workflow slowdowns are expected as staff acclimate to the new system; efficiency will improve as familiarity grows and automated processes are integrated. Maintenance will include scheduled software updates, hardware checks, and cybersecurity audits. Success will be evaluated using key performance indicators (KPIs) such as clinical outcomes, user satisfaction, workflow efficiency, cost-effectiveness, and system reliability (Vindrola-Padros et al., 2021). Table 3: RPM Implementation Timeline and Evaluation Metrics Phase Timeline Key Activities Phase 1: Infrastructure Months 1–2 Upgrade bandwidth, replace outdated hardware/software Phase 2: Pilot Testing Months 3–4 Deploy RPM with select users, collect usability feedback Phase 3: Training Months 5–6 Conduct hands-on training sessions for staff and patients Phase 4: Full Rollout Months 7–8 Retire legacy systems, expand RPM hospital-wide Evaluation Criteria Measurement Method Clinical outcomes Hospital readmission rates, early interventions User satisfaction Surveys, focus groups Workflow efficiency Time-motion studies, system logs Cost-effectiveness ROI analysis, reduction in in-person visits System reliability Downtime reports, technical incident tracking Conclusion The structured implementation of RPM at SAMC represents a proactive strategy for improving patient care and operational efficiency. Careful assessment of infrastructure, strategic task delegation, and a phased rollout plan ensure that the initiative is comprehensive and sustainable. Emphasis on staff education, stakeholder engagement, and leadership support builds confidence and promotes adoption. By monitoring outcomes and incorporating feedback, SAMC can refine RPM practices over time, establishing a robust framework for patient-centered, technology-enabled care. References Deveaux, D. B., Kaplan, S., Gabbe, L., & Mansfield, L. (2021). Transformational leadership meets innovative strategy: How nurse leaders and clinical nurses redesigned bedside handover to improve nursing practice. Nurse Leader, 20(3), 290–296. https://doi.org/10.1016/j.mnl.2021.10.010 Farias, F. A. C. de, Dagostini, C. M., Bicca, Y. de A., Falavigna, V. F., & Falavigna, A. (2020). Remote patient monitoring: A systematic review. Telemedicine and E-Health, 26(5), 576–583. https://doi.org/10.1089/tmj.2019.0066 NURS FPX 6214 Assessment 3 Implementation Plan Lee, W. L., Lim, Z. J., Tang, L. Y., Yahya, N. A., Varathan, K. D., & Ludin, S.
NURS FPX 6214 Assessment 2 Stakeholder Meeting
Student Name Capella University NURS-FPX 6214 Health Care Informatics and Technology Prof. Name Date Stakeholder Meeting Greetings everyone, I am ________, and I welcome you to this presentation. Today, I will discuss the stakeholder meeting essential for integrating a telehealth counseling program into existing services at St. Anthony Medical Center (SAMC). This meeting is a pivotal step in ensuring that the program is efficiently adopted and meets the needs of rural students. Stakeholder Meeting Overview The ongoing evolution of healthcare technology has made digital tools critical in delivering modern healthcare services. This presentation examines the implementation of a telehealth counseling program at SAMC, designed to improve mental health access for rural students. The success of this initiative depends on active participation from IT specialists, clinical staff, administrators, and patients (Rural Health Information Hub, 2024). The program aims to enhance care quality and accessibility, with its effectiveness measured by patient satisfaction, operational efficiency, cost management, and clinical outcomes. Key Stakeholders Involved Successful integration of a telehealth counseling program requires coordination among multiple stakeholders, each contributing to secure, compliant, and effective service delivery. Information Technology (IT) Team The IT team is responsible for designing the technological framework, ensuring secure integration between telehealth solutions and existing hospital systems. Their duties include maintaining HIPAA-compliant infrastructure, implementing data encryption, providing secure video conferencing, and supporting electronic hospital systems. IT staff conduct regular cybersecurity assessments to mitigate potential vulnerabilities (Haleem et al., 2021). Clinical Staff (Nurses and Mental Health Providers) Clinical staff deliver virtual counseling to rural students and ensure that telehealth services align with clinical standards and usability requirements. They are responsible for maintaining therapeutic interactions, safeguarding patient privacy, and accurately documenting digital sessions. Administrative Leaders Administrators manage funding allocation, ensure project alignment with organizational objectives, oversee vendor relationships, and maintain compliance standards. They assess the financial viability of telehealth services while monitoring operational integration (Haleem et al., 2021). Rural Student Population (End Users) Rural students, as end users, must be considered during platform selection and service design. Factors such as digital accessibility, privacy concerns, and communication preferences influence adoption and equitable care delivery. Areas of Uncertainty Stakeholder meetings should address four key challenges: Challenge Description Regulatory Requirements Ensuring HIPAA compliance and adherence to state/federal telehealth regulations Technical Stability Guaranteeing secure, reliable technology with minimal disruptions Student Digital Literacy Ensuring end users can access and effectively use telehealth services Data Protection & User Training Maintaining confidentiality and educating staff/patients on secure system use Proactive planning for these areas is critical to delivering a safe and sustainable telehealth program. Scheduled Stakeholder Meeting The stakeholder meeting is scheduled to integrate the telehealth counseling program for rural students at SAMC. Key objectives include evaluating system compatibility, security measures, HIPAA compliance, and staff training requirements. Attendance is required from IT personnel, clinical staff, administrators, and school representatives to provide feedback on project progress (Houser et al., 2023). Meeting Details: Agenda The meeting will address the following key points: Successful adoption depends on stakeholder understanding of how the telehealth system improves patient care and organizational efficiency. Impact on Patient Care Telehealth counseling will significantly enhance access to mental healthcare for rural students by eliminating geographical and provider availability barriers. Students will receive timely support without long-distance travel, promoting privacy, convenience, and timely intervention. These improvements encourage help-seeking behavior, supporting academic performance and overall well-being (Ezeamii, 2024). Remote counseling also optimizes organizational practices by enabling counselors to serve students efficiently from multiple locations. This system increases the reach of specialized mental health services, improving outcomes and satisfaction for both students and staff. Standards for Assessing Organizational Effectiveness The program’s success will be evaluated through multiple criteria: Assessment Element Measurement Method Reduced Travel & Barriers Tracking student access to mental health sessions Session Volume Monitoring number of telehealth appointments conducted Student Satisfaction Surveys evaluating usability, privacy, and engagement Academic & Health Outcomes Comparing mental health status and academic performance before and after program launch Operational Savings Measuring staff efficiency and cost-effectiveness Scalability Evaluating ability to extend services in the future (Orsolini et al., 2021) Outcome Metrics Patient Satisfaction Feedback from students will measure program success, focusing on counseling quality and platform usability. Monitoring technology-related issues informs future improvements and enhances engagement and adherence to care plans (Morelli et al., 2024). Improved Patient Outcomes Telehealth counseling aims to improve mental health and reduce academic or professional absences. SAMC will analyze student mental health and academic performance data pre- and post-implementation, enabling early intervention and reducing emergency care requirements. Reduced Healthcare Costs Remote services lower costs associated with transportation, in-person visits, and no-shows. Evaluating program savings versus traditional care highlights the financial benefits of telehealth deployment. Operational Efficiency Efficiency metrics include session scheduling, access to patient files, and counselor-student interactions. Optimized workflows reduce administrative burdens, enabling counselors to focus on care delivery while supporting more students without compromising service quality (Morelli et al., 2024). Assessing the Quality of Current Data Successful telehealth implementation requires high-quality data: Data Aspect Key Focus Data Completeness Ensure patient records are fully documented to prevent care gaps (Appleton et al., 2021) Data Accuracy Correct inaccuracies and outdated entries to support proper diagnosis and treatment Data Security Evaluate current methods, identify vulnerabilities, and enhance encryption and privacy protocols System Compatibility Ensure seamless integration with existing EHR systems to maintain operational stability Ensuring Patient Privacy and Confidentiality Telehealth services must comply with HIPAA standards to protect student health information. SAMC should implement access controls, authentication protocols, and staff training programs on data privacy and electronic system security. Adherence to these protocols safeguards confidentiality and builds trust (HHS, 2022). Steps and Timeline for Implementation The following phased approach will guide implementation: Step Description Duration Define Requirements Identify program needs, system components, and integration goals 2 months Vendor Selection Compare vendors for solutions and pricing 1 month Design & Configure Customize platform and train staff 2 months Test & Validate Conduct security and functionality testing 3 months Deployment Staged rollout with continuous monitoring 2 months The total projected timeline is 10 months, contingent on
NURS FPX 6214 Assessment 1 Technology Needs Assessment
Student Name Capella University NURS-FPX 6214 Health Care Informatics and Technology Prof. Name Date Technology Needs Assessment St. Anthony Medical Center has undertaken a strategic initiative to implement Remote Patient Monitoring (RPM) to modernize patient care and leverage technology for improved health outcomes. Conducting a detailed technology needs assessment was crucial to uncover clinical inefficiencies, evaluate resource allocation, and ensure compliance with legal and ethical standards. This systematic evaluation provided evidence-based insights into patient care requirements and confirmed the necessity of RPM to address care gaps. By prioritizing both patient safety and data privacy, the hospital established a secure framework for managing patient information while enhancing the delivery of care. This assessment not only addressed current technological needs but also laid the groundwork for sustainable improvements in institutional operations and long-term health outcomes. Table 1: Key Components of the RPM Needs Assessment Component Purpose Outcome Identification of Care Gaps Identify gaps in chronic disease management Highlighted the need for RPM for patients with CHF Resource Evaluation Assess technological infrastructure and staffing Determined RPM feasibility and staff training requirements Regulatory Compliance Check Ensure compliance with HIPAA and state regulations Confirmed adherence to telehealth data security standards Patient Data Security Review Safeguard sensitive patient information Implemented encryption and multi-factor authentication protocols Strategic Alignment Align RPM with organizational mission Positioned RPM to support long-term care delivery improvements Relevance and Importance of a Needs Assessment Why is a technology needs assessment necessary for RPM implementation? The introduction of RPM at St. Anthony Medical Center was guided by a comprehensive needs assessment, ensuring alignment with both organizational priorities and patient population characteristics. Chronic disease prevalence, frequent hospital readmissions, and resource optimization were key factors influencing the assessment. Insights from this process directed investments toward robust infrastructure, staff education, and monitoring tools designed to support patients with long-term health conditions (Lawrence et al., 2023). Collaboration among diverse stakeholders played an integral role in the assessment process. Nurses, physicians, administrative leaders, and patient representatives were actively engaged throughout the planning and evaluation stages. Their collective input revealed assumptions about available support systems, clarified shared goals, and ensured that RPM implementation would meet the unique needs of the patient population. This collaborative approach improved the likelihood of successful adoption and ensured high-quality, continuous care delivery (Williams et al., 2021). Table 2: Stakeholder Contributions to RPM Implementation Stakeholder Group Role in Needs Assessment Benefit to RPM Deployment Clinical Staff Identified patient care priorities Enabled tailored RPM care protocols Administrative Teams Evaluated financial and strategic fit Ensured budget alignment and sustainability IT Professionals Reviewed technical infrastructure Facilitated secure integration with EHR and telehealth systems Patients Provided feedback on usability Supported adoption of user-friendly technology Regulators Ensured compliance with healthcare policies Promoted ethical and legal RPM implementation Critical Issues in Nursing Care Affecting Patient Outcomes How does RPM impact nursing care and patient outcomes? RPM enhances nursing practice by providing real-time patient data, allowing nurses to tailor care plans and adjust interventions as conditions change. This is especially significant for patients managing chronic illnesses such as congestive heart failure. Remote monitoring encourages patient engagement in self-care, improving adherence to treatment regimens, reducing complications, and enhancing patient satisfaction. These benefits also contribute to decreased healthcare costs (Mhanna et al., 2021). Operationally, RPM streamlines workflows by automating routine data collection, freeing nursing staff to focus on direct patient care. This efficiency is particularly valuable in rural or underserved areas, expanding access to high-quality care. Early identification of clinical deterioration in post-discharge patients helps prevent readmissions and allows timely interventions before conditions escalate (Muller et al., 2021). Safety Requirements and Regulatory Considerations What regulatory and safety requirements must RPM meet? Implementing RPM requires adherence to safety protocols and regulatory standards. The hospital conducted a detailed assessment to ensure compliance with HIPAA and other state mandates governing patient data protection. Interoperability standards, such as FHIR, were reviewed to enable seamless integration of RPM platforms with existing electronic health records, facilitating better communication across care teams (Alverson, 2020). Financial and operational considerations were addressed through an evaluation of Centers for Medicare & Medicaid Services (CMS) reimbursement guidelines, ensuring long-term sustainability. To reduce potential risks from telehealth errors or cybersecurity incidents, St. Anthony Medical Center instituted proactive risk management strategies, including system audits, incident response plans, and ongoing staff training (Gadzinski et al., 2020). Patient Confidentiality and Privacy Protections How is patient data privacy maintained in RPM? Maintaining patient confidentiality is central to the deployment of RPM. The hospital implemented strict security measures, including encryption, access controls, and two-factor authentication, in accordance with HIPAA regulations (Kovac, 2021). These protections are essential to preserving patient trust in digital health technologies. Cybersecurity measures include real-time threat monitoring and incident detection tools, reducing the risk of unauthorized access. Staff receive continuous training on digital safety protocols, and frequent security audits ensure that privacy practices remain robust and adaptable to emerging threats (Kim et al., 2020; Alenoghena et al., 2023). Impact of Stakeholders and Users’ End Who are the key stakeholders in RPM implementation, and how do they influence outcomes? Successful RPM adoption depends on the active participation of both internal and external stakeholders. Internally, care providers, IT teams, and administrative leaders evaluate the feasibility, integration, and security of RPM within the hospital’s operational and financial frameworks. Externally, patients, vendors, regulators, and community organizations provide insight into ethical, social, and usability considerations (Talwar et al., 2023). Resistance to change among healthcare professionals is a potential barrier, often stemming from concerns over job security or autonomy. The hospital addressed these challenges through training, transparent communication, and inclusive planning. Leadership’s emphasis on collaboration fostered buy-in and minimized workflow disruption, positioning stakeholders as champions of RPM and supporting the hospital’s patient-centered, technologically advanced vision (Harris et al., 2021; Pierre, 2024). Conclusion The implementation of Remote Patient Monitoring at St. Anthony Medical Center illustrates a strategic and evidence-based approach to healthcare innovation. By conducting a comprehensive needs assessment, engaging stakeholders, and adhering to regulatory and safety standards, the hospital has strengthened patient outcomes and