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Lanocha N, Taub S, Webb JA, Wood M, Tate T. It Starts With a Story: A Four-Step Narrative-Based Framework for Serious Illness Conversations. J Palliat Med 2024; 27:1177-1183. [PMID: 38968377 DOI: 10.1089/jpm.2024.0088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/07/2024] Open
Abstract
Background: As a key component of advance care planning, serious illness conversations form a core intervention in palliative care. To achieve effective serious illness conversations, acknowledgment and inclusion of patient sense of self and identity are critical. However, no framework exists to describe how goals, values, and choices relate to patient identity. This conceptual gap hinders the advancement of palliative care education and practice. Objective: This philosophical investigation aimed to explicate two items: first, a novel conceptual framework for serious illness conversations; second, a structured approach to optimize these conversations within the palliative care clinical context. Methods: A philosophical and theoretical analysis was performed within an interdisciplinary context, by scholars in palliative care, medical humanities, philosophy, and bioethics. Key literature in psychology, qualitative research on the experience of serious illness, medical ethics, and choice architecture in medical decision-making were reviewed, and a structured conceptual and narrative analysis was performed. Results: An original and innovative identity-centered conceptual framework for serious illness conversations was developed. The framework consists of a four-step, reproducible approach: (1) attend to patient narrative identity, (2) identify values, (3) cocreate goals, and (4) actively promote choices. In short: attend, identify, create, and promote (AICP). Discussion: By using this conceptual framework and four-step approach, clinicians can accomplish goal-concordant serious illness care and build rich clinical relationships that foster trust and goodwill.
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Affiliation(s)
| | - Sara Taub
- Knight Cancer Institute, Portland, Oregon, USA
| | - Jason A Webb
- Oregon Health and Science University, Portland, Oregon, USA
- University of Oregon, Eugene, Oregon, USA
| | - Mary Wood
- University of Oregon, Eugene, Oregon, USA
| | - Tyler Tate
- Stanford University School of Medicine, Palo Alto, California, USA
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Privitera MR, Shanafelt TD. Strategic Allocation of a Finite Resource: Clinician Brain Power. Ann Intern Med 2024; 177:980-981. [PMID: 38885504 DOI: 10.7326/m24-0880] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/20/2024] Open
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Kissler MJ, Porter S, Knees M, Kissler K, Keniston A, Burden M. Attention Among Health Care Professionals : A Scoping Review. Ann Intern Med 2024; 177:941-952. [PMID: 38885508 DOI: 10.7326/m23-3229] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/20/2024] Open
Abstract
BACKGROUND The concept of attention can provide insight into the needs of clinicians and how health systems design can impact patient care quality and medical errors. PURPOSE To conduct a scoping review to 1) identify and characterize literature relevant to clinician attention; 2) compile metrics used to measure attention; and 3) create a framework of key concepts. DATA SOURCES Cumulated Index to Nursing and Allied Health Literature (CINAHL), Medline (PubMed), and Embase (Ovid) from 2001 to 26 February 2024. STUDY SELECTION English-language studies addressing health care worker attention in patient care. At least dual review and data abstraction. DATA EXTRACTION Article information, health care professional studied, practice environment, study design and intent, factor type related to attention, and metrics of attention used. DATA SYNTHESIS Of 6448 screened articles, 585 met inclusion criteria. Most studies were descriptive (n = 469) versus investigational (n = 116). More studies focused on barriers to attention (n = 387; 342 descriptive and 45 investigational) versus facilitators to improving attention (n = 198; 112 descriptive and 86 investigational). We developed a framework, grouping studies into 6 categories: 1) definitions of attention, 2) the clinical environment and its effect on attention, 3) personal factors affecting attention, 4) relationships between interventions or factors that affect attention and patient outcomes, 5) the effect of clinical alarms and alarm fatigue on attention, and 6) health information technology's effect on attention. Eighty-two metrics were used to measure attention. LIMITATIONS Does not synthesize answers to specific questions. Quality of studies was not assessed. CONCLUSION This overview may be a resource for researchers, quality improvement experts, and health system leaders to improve clinical environments. Future systematic reviews may synthesize evidence on metrics to measure attention and on the effectiveness of barriers or facilitators related to attention. PRIMARY FUNDING SOURCE None.
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Affiliation(s)
- Mark J Kissler
- Division of Hospital Medicine, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado (M.J.K., S.P., M.K., A.K., M.B.)
| | - Samuel Porter
- Division of Hospital Medicine, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado (M.J.K., S.P., M.K., A.K., M.B.)
| | - Michelle Knees
- Division of Hospital Medicine, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado (M.J.K., S.P., M.K., A.K., M.B.)
| | - Katherine Kissler
- College of Nursing, University of Colorado Anschutz Medical Campus, Aurora, Colorado (K.K.)
| | - Angela Keniston
- Division of Hospital Medicine, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado (M.J.K., S.P., M.K., A.K., M.B.)
| | - Marisha Burden
- Division of Hospital Medicine, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado (M.J.K., S.P., M.K., A.K., M.B.)
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Biederman S, Sadr N, Qayyum R. Improving Interdisciplinary Communication on an Academic Hospitalist Service: A Quality Improvement Project. J Healthc Qual 2024; 46:65-71. [PMID: 37820056 DOI: 10.1097/jhq.0000000000000411] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/13/2023]
Abstract
ABSTRACT Effective communication is essential for quality patient care, and paging remains among the most common forms of communication despite the introduction of secure texting platforms. The goal of this project was to use quantitative and qualitative analyses of paging to guide improvements in paging best practices. A retrospective analysis of pages sent over a 7-day period was completed, characterizing the volume, content, and effectiveness of pages both preintervention and 3-month postintervention. The content of each page was categorized into laboratories, medications, vital signs, diet, patient assessment/clinical change, pain, or miscellaneous/other. Effectiveness was based on the following five critical elements: (1) two patient identifiers, (2) the sender's name, (3) the sender's callback number, (4) priority or acuity of the page, and (5) patient-care concern. Pages were considered successful if they contained all the five essential elements. The preintervention results guided interventions. Of 3,483 included pages, 1,806 and 1,677 were sent during the preintervention and postintervention periods, respectively. Adherence to all essential paging elements increased from 15.2% to 40% ( p < .001). The largest deficiency was labeling the urgency of a page, which increased from 31.6% to 51.9% ( p < .001). Quantitative and qualitative analyses of pages effectively guided this project to increase the standardization of paging.
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Solebo AL, Hysi P, Horvat-Gitsels LA, Rahi JS. Data saves lives: optimising routinely collected clinical data for rare disease research. Orphanet J Rare Dis 2023; 18:285. [PMID: 37697298 PMCID: PMC10496203 DOI: 10.1186/s13023-023-02912-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Accepted: 09/06/2023] [Indexed: 09/13/2023] Open
Abstract
Necessity driven organisational change in the post-pandemic landscape has seen health care providers adopting innovations to manage and process health data. These include the use of 'real-world' datasets of routinely collected clinical information, enabling data-driven delivery. Rare disease risks being 'left-behind' unless our clinical and research communities engage with the challenges and opportunities afforded by the burgeoning field of health data informatics. We address the challenges to the meaningful use and reuse of rare disease data, and, through a series of recommendations around workforce education, harmonisation of taxonomy, and ensuring an inclusive health data environment, we highlight the role that those who manage rare disease must play in addressing them.
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Affiliation(s)
- Ameenat Lola Solebo
- Population, Policy and Practice Research and Teaching Department, Great Ormond Street Institute of Child Health, University College London, 30 Guilford Street, London, WC1N 1EH, UK.
- Ulverscroft Vision Research Group, Great Ormond Street Institute of Child Health, University College London, London, UK.
- Great Ormond Street Hospital for Children, NHS Foundation Trust, London, UK.
| | - Pirro Hysi
- Population, Policy and Practice Research and Teaching Department, Great Ormond Street Institute of Child Health, University College London, 30 Guilford Street, London, WC1N 1EH, UK
- Section of Ophthalmology, School of Life Course Sciences, King's College London, London, UK
- Department of Twin Research and Genetic Epidemiology, School of Life Course Sciences, King's College London, London, UK
| | - Lisanne Andra Horvat-Gitsels
- Population, Policy and Practice Research and Teaching Department, Great Ormond Street Institute of Child Health, University College London, 30 Guilford Street, London, WC1N 1EH, UK
- Ulverscroft Vision Research Group, Great Ormond Street Institute of Child Health, University College London, London, UK
| | - Jugnoo Sangeeta Rahi
- Population, Policy and Practice Research and Teaching Department, Great Ormond Street Institute of Child Health, University College London, 30 Guilford Street, London, WC1N 1EH, UK
- Ulverscroft Vision Research Group, Great Ormond Street Institute of Child Health, University College London, London, UK
- Great Ormond Street Hospital for Children, NHS Foundation Trust, London, UK
- Institute of Ophthalmology, University College London and NIHR Moorfields Biomedical Research Centre London, London, UK
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Xia Y, Geng M, Chen Y, Sun S, Liao C, Zhu Z, Li Z, Ochieng WY, Angeloudis P, Elhajj M, Zhang L, Zeng Z, Zhang B, Gao Z, Chen X(M. Understanding common human driving semantics for autonomous vehicles. PATTERNS (NEW YORK, N.Y.) 2023; 4:100730. [PMID: 37521046 PMCID: PMC10382946 DOI: 10.1016/j.patter.2023.100730] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/24/2022] [Revised: 12/05/2022] [Accepted: 03/20/2023] [Indexed: 08/01/2023]
Abstract
Autonomous vehicles will share roads with human-driven vehicles until the transition to fully autonomous transport systems is complete. The critical challenge of improving mutual understanding between both vehicle types cannot be addressed only by feeding extensive driving data into data-driven models but by enabling autonomous vehicles to understand and apply common driving behaviors analogous to human drivers. Therefore, we designed and conducted two electroencephalography experiments for comparing the cerebral activities of human linguistics and driving understanding. The results showed that driving activates hierarchical neural functions in the auditory cortex, which is analogous to abstraction in linguistic understanding. Subsequently, we proposed a neural-informed, semantics-driven framework to understand common human driving behavior in a brain-inspired manner. This study highlights the pathway of fusing neuroscience into complex human behavior understanding tasks and provides a computational neural model to understand human driving behaviors, which will enable autonomous vehicles to perceive and think like human drivers.
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Affiliation(s)
- Yingji Xia
- Institute of Intelligent Transportation Systems, College of Civil Engineering and Architecture, Zhejiang University, Hangzhou 310058, China
| | - Maosi Geng
- Institute of Intelligent Transportation Systems, College of Civil Engineering and Architecture, Zhejiang University, Hangzhou 310058, China
- Polytechnic Institute & Institute of Intelligent Transportation Systems, Zhejiang University, Hangzhou 310015, China
| | - Yong Chen
- Institute of Intelligent Transportation Systems, College of Civil Engineering and Architecture, Zhejiang University, Hangzhou 310058, China
| | - Sudan Sun
- School of Medicine, Zhejiang University, Hangzhou 310058, China
| | - Chenlei Liao
- Institute of Intelligent Transportation Systems, College of Civil Engineering and Architecture, Zhejiang University, Hangzhou 310058, China
| | - Zheng Zhu
- Institute of Intelligent Transportation Systems, College of Civil Engineering and Architecture, Zhejiang University, Hangzhou 310058, China
- Alibaba-Zhejiang University Joint Research Institute of Frontier Technologies, Hangzhou 310027, China
- Zhejiang Provincial Engineering Research Center for Intelligent Transportation, Hangzhou 310058, China
| | - Zhihui Li
- School of Transportation, Jilin University, Changchun 130022, China
| | - Washington Yotto Ochieng
- Department of Civil and Environmental Engineering, Imperial College London, South Kensington Campus, London SW7 2AZ, UK
| | - Panagiotis Angeloudis
- Department of Civil and Environmental Engineering, Imperial College London, South Kensington Campus, London SW7 2AZ, UK
| | - Mireille Elhajj
- Department of Civil and Environmental Engineering, Imperial College London, South Kensington Campus, London SW7 2AZ, UK
| | - Lei Zhang
- Alibaba Group, Hangzhou 310052, China
| | | | | | - Ziyou Gao
- School of Traffic and Transportation, Beijing Jiaotong University, Beijing 100044, China
| | - Xiqun (Michael) Chen
- Institute of Intelligent Transportation Systems, College of Civil Engineering and Architecture, Zhejiang University, Hangzhou 310058, China
- Alibaba-Zhejiang University Joint Research Institute of Frontier Technologies, Hangzhou 310027, China
- Zhejiang University/University of Illinois Urbana-Champaign (ZJU-UIUC) Institute, Zhejiang University, Haining 314400, China
- Zhejiang Provincial Engineering Research Center for Intelligent Transportation, Hangzhou 310058, China
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Tate T, Clair J. Love Your Patient as Yourself: On Reviving the Broken Heart of American Medical Ethics. Hastings Cent Rep 2023; 53:12-25. [PMID: 37092648 DOI: 10.1002/hast.1470] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/25/2023]
Abstract
This article presents a radical claim: American medical ethics is broken, and it needs love to be healed. Due to a unique set of cultural and economic pressures, American medical ethics has adopted a mechanistic mode of ethical reasoning epitomized by the doctrine of principlism. This mode of reasoning divorces clinicians from both their patients and themselves. This results in clinicians who can ace ethics questions on multiple-choice tests but who fail either to recognize a patient's humanity or to navigate the ethical quandaries into which they are frequently thrown. Drawing on personal experience as well as the philosophical work of Augustine of Hippo, Simone Weil, and Iris Murdoch, we propose a novel ethical approach grounded in a conception of neighbor love, specifically, the virtue of love understood as attention to a sufferer's humanity. We conclude with five practical recommendations for reimagining medical ethics education oriented around the virtue of love.
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Burden M, Patel M, Kissler M, Harry E, Keniston A. Measuring and driving hospitalist value: Expanding beyond wRVUs. J Hosp Med 2022; 17:760-764. [PMID: 35652672 PMCID: PMC9545401 DOI: 10.1002/jhm.12849] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2021] [Revised: 04/17/2022] [Accepted: 05/02/2022] [Indexed: 11/25/2022]
Affiliation(s)
- Marisha Burden
- Division of Hospital MedicineUniversity of Colorado School of MedicineAuroraColoradoUSA
| | - Moksha Patel
- Division of Hospital MedicineUniversity of Colorado School of MedicineAuroraColoradoUSA
| | - Mark Kissler
- Division of Hospital MedicineUniversity of Colorado School of MedicineAuroraColoradoUSA
| | - Elizabeth Harry
- Division of Hospital MedicineUniversity of Colorado School of MedicineAuroraColoradoUSA
| | - Angela Keniston
- Division of Hospital MedicineUniversity of Colorado School of MedicineAuroraColoradoUSA
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Closer to or Farther away from an Ideal Model of Care? Lessons Learned from Geographic Cohorting. J Gen Intern Med 2022; 37:3162-3165. [PMID: 35415791 PMCID: PMC9005021 DOI: 10.1007/s11606-022-07560-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Accepted: 03/30/2022] [Indexed: 11/18/2022]
Abstract
Geographic "cohorting," "co-location," "regionalization," or "localization" refers to the assignation of a hospitalist team to a specific inpatient unit. Its benefits may be related to the formation of a team and the additional interventions like interdisciplinary rounding that the enhanced proximity facilitates. However, cohorting is often adopted in isolation of the bundled approach within which it has proven beneficial. Cohorting may also be associated with unintended consequences such as increased interruptions and increased indirect care time. Institutions may increase patient loads in anticipation of the efficiency gained by cohorting-leading to further increases in interruptions and time away from the bedside. Fragmented attention and increases in indirect care may lead to a perception of increased workload, errors, and burnout. As hospital medicine evolves, there are lessons to be learned by studying cohorting. Institutions and inpatient units should work in synergy to shape the day-to-day work which directly affects patient and clinician outcomes-and ultimately culminates in the success or failure of the parent organization. Such synergy can manifest in workflow design and metric selection. Attention to workloads and adopting the principles of continuous quality improvement are also crucial to developing models of care that deliver excellent care.
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Chen Y, Adler-Milstein J, Sinsky C. Measuring and Maximizing Undivided Attention in the Context of Electronic Health Records. Appl Clin Inform 2022; 13:774-777. [PMID: 35790200 PMCID: PMC9371726 DOI: 10.1055/a-1892-1437] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Affiliation(s)
- You Chen
- Dept. of Biomedical Informatics, Vanderbilt University, nashville, United States
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Kissler MJ, Kissler K, Porter SC, Keniston A, Jankousky K, Burden M. Concepts and metrics of clinician attention: a scoping review protocol. BMJ Open 2022; 12:e052334. [PMID: 35697461 PMCID: PMC9196160 DOI: 10.1136/bmjopen-2021-052334] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2021] [Accepted: 04/28/2022] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION There is growing emphasis on the importance of both the cognitive and behavioural phenomenon of attention for clinicians engaged in patient care. Aspects of attention such as cognitive load, distraction and task switching have been studied in various settings with different methodologies. Using the protocol described here, we aim to systematically review the medical literature in order to map the concept of attention and to synthesise diverse concepts and methods under the broader category of research focused on 'attention'. METHODS AND ANALYSIS Following the methodology described by the Joanna Briggs Institute and Arksey and O'Malley, our scoping review conducts an iterative search of Cumulative Index of Nursing and Allied Health Literature (CINAHL), Medline (PubMed) and EMBASE (Ovid). An initial limited search based on key concepts and terminology will generate relevant articles which in turn will be mined for additional keywords and index terms to guide a formal literature search. Our multidisciplinary team will extract data into a matrix, including a small random sample of the same studies (to ensure concordance), and present the results in a descriptive narrative format. ETHICS AND DISSEMINATION As a secondary analysis, our study does not require ethics approval, and we will ensure that included studies have appropriate approval. We anticipate results will identify diverse ways of conceptualising clinician attention and will provide a foundation for developing additional metrics and study methods to optimise attention in the clinical environment. We will disseminate results through journals and conferences and coordinate with colleagues doing work in adjacent fields.
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Affiliation(s)
- Mark J Kissler
- Division of Hospital Medicine, University of Colorado - Anschutz Medical Campus, Aurora, Colorado, USA
| | - Katherine Kissler
- College of Nursing, University of Colorado - Anschutz Medical Campus, Aurora, Colorado, USA
| | - Samuel C Porter
- Division of Hospital Medicine, University of Colorado - Anschutz Medical Campus, Aurora, Colorado, USA
| | - Angela Keniston
- Division of Hospital Medicine, University of Colorado - Anschutz Medical Campus, Aurora, Colorado, USA
| | - Katherine Jankousky
- Department of Medicine, University of Colorado - Anschutz Medical Campus, Aurora, Colorado, USA
| | - Marisha Burden
- Division of Hospital Medicine, University of Colorado - Anschutz Medical Campus, Aurora, Colorado, USA
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Sinsky CA. 2021 E/M Coding Change: Making Sense of Unexpected Findings. Ann Intern Med 2022; 175:602-603. [PMID: 35188787 DOI: 10.7326/m22-0355] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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Keniston A, Patel V, McBeth L, Bowden K, Gallant A, Burden M. The impact of surge adaptations on hospitalist care teams during the COVID-19 pandemic utilizing a rapid qualitative analysis approach. Arch Public Health 2022; 80:57. [PMID: 35177114 PMCID: PMC8851813 DOI: 10.1186/s13690-022-00804-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2021] [Accepted: 01/17/2022] [Indexed: 11/25/2022] Open
Abstract
Background Hospital systems have rapidly adapted to manage the influx of patients with COVID-19 and hospitalists, specialists in inpatient care, have been at the forefront of this response, rapidly adapting to serve the ever-changing needs of the community and hospital system. Institutional leaders, including clinical care team members and administrators, deployed many different strategies (i.e. adaptations) to manage the influx of patients. While many different strategies were utilized in hospitals across the United States, it is unclear how frontline care teams experienced these strategies and multifaceted changes. As these surge adaptations likely directly impact clinical care teams, we aimed to understand the perceptions and impact of these clinical care and staffing adaptations on hospitalists and care team members in order to optimize future surge plans. Methods Qualitative, semi-structured interviews and focus groups with hospitalist physicians, advanced practice providers (APPs), and hospital nursing and care management staff at a quaternary academic medical center. Interviews focused on the impact of COVID-19 surge practices on the following areas: (1) the experience of clinical care teams with the adaptations used to manage the surge (2) the perception and experience with the communication strategies utilized (3) the personal experience with the adaptations (i.e. how they impacted the individual) and (4) if participants had recommendations on strategies for future surges. We utilized rapid qualitative analysis methods to explore themes and subthemes. Results We conducted five focus groups and 21 interviews. Three themes emerged from the work including (1) dynamic clinical experience with a lot of uncertainty, (2) the importance of visible leadership with a focus on sense-making, and (3) the significant emotional toll on care team members. Subthemes included sufficient workforce, role delineation and training, information sharing, the unique dichotomy between the need for flexibility and the need for structure, the importance of communication, and the emotional toll not only on the provider but their families. Several recommendations came from this work. Conclusions COVID-19 surge practices have had direct impact on hospitalists and care team members. Several tactics were identified to help mitigate the many negative effects of COVID-19 on frontline hospitalist providers and care teams. Supplementary Information The online version contains supplementary material available at 10.1186/s13690-022-00804-7.
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Affiliation(s)
- Angela Keniston
- Division of Hospital Medicine, University of Colorado School of Medicine, Aurora, USA
| | | | - Lauren McBeth
- Division of Hospital Medicine, University of Colorado School of Medicine, Aurora, USA
| | - Kasey Bowden
- Division of Hospital Medicine, University of Colorado School of Medicine, Aurora, USA
| | - Alexandra Gallant
- Division of Hospital Medicine, University of Colorado School of Medicine, Aurora, USA
| | - Marisha Burden
- Division of Hospital Medicine, University of Colorado School of Medicine, Aurora, USA.
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Yager J, MacPhee ER, Ritvo AD, Salamander RM. Thirty-Minute Psychiatric Management Visits in Academic Medical Centers: Framing and Exploring Distinct Clinical-Educational Social Processes. J Nerv Ment Dis 2022; 210:77-82. [PMID: 35080517 DOI: 10.1097/nmd.0000000000001460] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
ABSTRACT To address high clinical demand and manage workflow, some university-based practice settings are tending to replace traditional hour-long outpatient appointments with 30-minute psychiatric management visits, which must comply with multiple regulatory requirements for documentation and billing. This care model can significantly shape the culture of psychiatric treatment and education. Based on the limited published literature on this topic and pooled experiences of faculty, residents, and administrators, this article offers observations and raises questions concerning 1) clinical, educational and administrative benefits, limitations, and challenges for conducting 30-minute psychiatric visits in training contexts; 2) how administrative impositions affecting resident and faculty time and attention impact clinical encounters; 3) how various teaching settings manage regulatory requirements differently; and 4) considerations for education needs and opportunities, research gaps, and policy implications. Quality of care and education could be improved by judicious overhaul of administrative requirements to minimize burdens offering little clinical or educational value.
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Affiliation(s)
- Joel Yager
- Department of Psychiatry, University of Colorado School of Medicine, Anschutz Medical Campus, Aurora, Colorado
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Gonzalez-Jaramillo V, Guyer J, Luethi N, Sobanski P, Zbinden R, Rodriguez E, Hunziker L, Eychmüller S, Maessen M. Validation of the German version of the needs assessment tool: progressive disease-heart failure. Health Qual Life Outcomes 2021; 19:214. [PMID: 34488787 PMCID: PMC8419951 DOI: 10.1186/s12955-021-01817-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2021] [Accepted: 07/03/2021] [Indexed: 12/14/2022] Open
Abstract
Background The Needs Assessment Tool: Progressive Disease-Heart Failure (NAT: PD-HF) is a tool created to assess the needs of people living with heart failure and their informal caregivers to assist delivering care in a more comprehensive way that addresses actual needs that are unmet, and to improve quality of life. In this study, we aimed to (1) Translate the tool into German and culturally adapt it. (2) Assess internal consistency, inter-rater reliability, and test–retest reliability of the German NAT: PD-HF. (3) Evaluate whether and how patients and health care personnel understand the tool and its utility. (4) Assess the tool’s face validity, applicability, relevance, and acceptability among health care personnel. Methods Single-center validation study. The tool was translated from English into German using a forward–backward translation. To assess internal consistency, we used Cronbach´s alpha. To assess inter-rater reliability and test–retest reliability, we used Cohen´s kappa, and to assess validity we used face validity. Results The translated tool showed good internal consistency. Raters were in substantial agreement on a majority of the questions, and agreement was almost perfect for all the questions in the test–retest analysis. Face validity was rated high by health care personnel. Conclusion The German NAT: PD-HF is a reliable, valid, and internally consistent tool that is well accepted by both patients and health care personnel. However, it is important to keep in mind that effective use of the tool requires training of health care personnel. Supplementary Information The online version contains supplementary material available at 10.1186/s12955-021-01817-6.
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Affiliation(s)
- Valentina Gonzalez-Jaramillo
- Institute of Social and Preventive Medicine (ISPM), University of Bern, Bern, Switzerland. .,Graduate School for Health Sciences, University of Bern, Bern, Switzerland.
| | - Jelena Guyer
- Department of General Surgery, Spital Emmental, Burgdorf, Switzerland.,Faculty of Medicine, University of Bern, Bern, Switzerland
| | - Nora Luethi
- University Center for Palliative Care, Inselspital, University Hospital Bern, University of Bern, Bern, Switzerland.,Department of Emergency Medicine, Inselspital, University Hospital Bern, University of Bern, Bern, Switzerland
| | - Piotr Sobanski
- Palliative Care Unit and Competence Centre, Department of Internal Medicine, Spital Schwyz, Schwyz, Switzerland
| | - Rut Zbinden
- Faculty of Medicine, University of Bern, Bern, Switzerland
| | | | - Lukas Hunziker
- Department of Cardiology, Inselspital University Hospital Bern, Bern, Switzerland
| | - Steffen Eychmüller
- University Center for Palliative Care, Inselspital, University Hospital Bern, University of Bern, Bern, Switzerland
| | - Maud Maessen
- Institute of Social and Preventive Medicine (ISPM), University of Bern, Bern, Switzerland.,University Center for Palliative Care, Inselspital, University Hospital Bern, University of Bern, Bern, Switzerland
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Ventres WB, Frankel RM. Personalizing the BioPsychoSocial Approach: "Add-Ons" and "Add-Ins" in Generalist Practice. Front Psychiatry 2021; 12:716486. [PMID: 34899410 PMCID: PMC8652412 DOI: 10.3389/fpsyt.2021.716486] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Accepted: 10/26/2021] [Indexed: 11/13/2022] Open
Abstract
Generalist practitioners often find interacting with patients deeply satisfying and joyful; they also experience encounters that are challenging and complex. In both cases, they must be aware of the many issues that affect the processes and outcomes of patient care. Although using the BioPsychoSocial approach is an important, time-tested framework for cultivating one's awareness of patients' presenting concerns, recent developments suggest that additional frames of reference may enhance communication and relationships with patients. In this article, we describe several additions to the BioPsychoSocial approach, considerations we call "add-ons" and "add-ins". We invite generalist practitioners and, indeed, all health care practitioners, to consider how they can improve their ongoing care of patients by personalizing these and other additions in their day-to-day work with patients.
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Affiliation(s)
- William B Ventres
- Department of Family and Preventive Medicine, University of Arkansas for Medical Sciences, Little Rock, AR, United States
| | - Richard M Frankel
- Regenstrief Institute, Indiana University School of Medicine, Indianapolis, IN, United States
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