1
|
McLean KJ, Haas M, Koenig J, Horvath M, Vigil M, Werner NE, Bishop L. "I'm dealing with a health care system that doesn't get it": Barriers and facilitators to inclusive healthcare for autistic adults. AUTISM : THE INTERNATIONAL JOURNAL OF RESEARCH AND PRACTICE 2024; 28:1382-1393. [PMID: 38469707 PMCID: PMC11132937 DOI: 10.1177/13623613241236380] [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] [Indexed: 03/13/2024]
Abstract
LAY ABSTRACT Research has suggested that autistic adults may have a bigger chance of having mental health and physical health conditions such as depression, anxiety, sleep disorders, diabetes, obesity, and heart problems than adults without autism. Unfortunately, the unique healthcare needs of autistic adults are often overlooked, so it is not clear why autistic adults have worse health or what can be done to improve it. This study wants to find out the challenges autistic adults experience in taking care of their health and in going to different doctors. Researchers interviewed autistic adults across the country about their healthcare experiences. The interviewed autistic adults told the researchers about the barriers (things that did not help) and facilitators (things that did help) that impacted whether they received the care they needed. The researchers then organized what they learned from the autistic adults into a model called the Systems Engineering Initiative for Patient Safety model of work system and patient safety. This model explains how different parts of a healthcare system (person, tasks, technology and tools, environment, and organization) interact with one another and impact the healthcare experiences and outcomes of the patients in their care, like autistic adults. Overall, this study advocates for a systems-level approach to improving the healthcare experiences of autistic adults and their health outcomes.
Collapse
Affiliation(s)
| | - Meghan Haas
- Sandra Rosenbaum School of Social Work University of Wisconsin-Madison, USA
| | - Jamie Koenig
- Sandra Rosenbaum School of Social Work University of Wisconsin-Madison, USA
- Waisman Center, USA
| | - Megan Horvath
- Sandra Rosenbaum School of Social Work University of Wisconsin-Madison, USA
| | - Mariah Vigil
- Sandra Rosenbaum School of Social Work University of Wisconsin-Madison, USA
| | - Nicole E Werner
- Department of Health and Wellness Design, Indiana University Bloomington, USA
| | - Lauren Bishop
- Sandra Rosenbaum School of Social Work University of Wisconsin-Madison, USA
- Waisman Center, USA
| |
Collapse
|
2
|
Whitaker Mhi M, Lester C, Rowell B. Handing Off Electronic Prescription Data From Prescribers to Community Pharmacies: A Qualitative Analysis of Pharmacy Staff Perspectives. J Patient Saf 2024:01209203-990000000-00221. [PMID: 38742931 DOI: 10.1097/pts.0000000000001244] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/16/2024]
Abstract
OBJECTIVES The aims of the study are to understand the process of how community pharmacies handle electronic prescriptions (e-prescriptions) and learn about different errors or potential errors encountered. METHODS Fifteen remote, semistructured interviews were conducted with community pharmacy staff. Interview analysis was done with two adapted Systems Engineering Initiative for Patient Safety methods to understand the workflow and an affinity wall, which led to key words that were tallied to understand the frequency of different issues. RESULTS Data entry in community pharmacies is a process that varies based on the different software platforms receiving e-prescriptions. Data entry of a medication product is typically a human-reliant process matching an e-prescription with an equivalent medication product. Current automated safety supports focus on matching the dispensed medication to the medication chosen at data entry. Substitutions may be required for a variety of reasons, however, pharmacists' comfort and permissions in doing so without provider involvement fluctuates. CONCLUSIONS Prescription errors remain that could be prevented with additional support at the data entry step of e-prescriptions. Few studies demonstrate where these errors originate and what role current technology plays in contributing to or preventing these errors. Future work must consider how these matches between prescribed medications and pharmacy fulfilled medications occur. There is a need to identify potential tools to support data entry and prevent medication errors.
Collapse
Affiliation(s)
- Megan Whitaker Mhi
- From the School of Information & School of Public Health, University of Michigan, Ann Arbor, Michigan
| | - Corey Lester
- College of Pharmacy, University of Michigan, Ann Arbor, Michigan
| | - Brigid Rowell
- College of Pharmacy, University of Michigan, Ann Arbor, Michigan
| |
Collapse
|
3
|
Segarra GC, Catchpole K, Rayo MF, Hegde S, Jefferies C, Woodward J, Taaffe K. Revealing complex interdependencies in surgical instrument reprocessing using SEIPS 101 tools. APPLIED ERGONOMICS 2024; 119:104307. [PMID: 38735234 DOI: 10.1016/j.apergo.2024.104307] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/18/2023] [Revised: 04/30/2024] [Accepted: 05/03/2024] [Indexed: 05/14/2024]
Abstract
Sterile Processing Departments (SPDs) must clean, maintain, store, and organize surgical instruments which are then delivered to Operating Rooms (ORs) using a Courier Network, with regular coordination occurring across departmental boundaries. To represent these relationships, we utilized the Systems Engineering Initiative for Patient Safety (SEIPS) 101 Toolkit, which helps model how health-related outcomes are affected by healthcare work systems. Through observations and interviews which built on prior work system analyses, we developed a SEIPS 101 journey map, PETT scan, and tasks matrices to represent the instrument reprocessing work system, revealing complex interdependencies between the people, tools, and tasks occurring within it. The SPD, OR and Courier teams are found to have overlapping responsibilities and a clear co-dependence, with critical implications for the successful functioning of the whole hospital system.
Collapse
Affiliation(s)
- Gabriel C Segarra
- Medical University of South Carolina, Charleston, SC, United States.
| | - Ken Catchpole
- Medical University of South Carolina, Charleston, SC, United States
| | | | | | | | - Jeffrey Woodward
- Medical University of South Carolina, Charleston, SC, United States
| | | |
Collapse
|
4
|
Glans A, Wilén J, Hansson B, Audulv Å, Lindgren L. Managing acoustic noise within MRI: A qualitative interview study among Swedish radiographers. Radiography (Lond) 2024; 30:889-895. [PMID: 38603992 DOI: 10.1016/j.radi.2024.04.002] [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] [Received: 02/09/2024] [Revised: 03/22/2024] [Accepted: 04/01/2024] [Indexed: 04/13/2024]
Abstract
INTRODUCTION Acoustic noise from magnetic resonance imaging (MRI) can cause hearing loss and needs to be mitigated to ensure the safety of patients and personnel. Capturing MR personnel's insights is crucial for guiding the development and future applications of noise-reduction technology. This study aimed to explore how MR radiographers manage acoustic noise in clinical MR settings. METHODS Using a qualitative design, we conducted semi-structured individual interviews with fifteen MR radiographers from fifteen hospitals around Sweden. We focused on the clinical implications of participants' noise management, using an interpretive description approach. We also identified sociotechnical interactions between People, Environment, Tools, and Tasks (PETT) by adopting a Human Factors/Ergonomics framework. Interview data were analyzed inductively with thematic analysis (Braun and Clarke). RESULTS The analysis generated three main themes regarding MR radiographers' noise management: (I) Navigating Occupational Noise: Risk Management and Adaptation; (II) Protecting the Patient and Serving the Exam, and (III) Establishing a Safe Healthcare Environment with Organizational Support. CONCLUSION This study offers insights into radiographers' experiences of managing acoustic noise within MRI, and the associated challenges. Radiographers have adopted multiple strategies to protect patients and themselves from adverse noise-related effects. However, they require tools and support to manage this effectively, suggesting a need for organizations to adopt more proactive, holistic approaches to safety initiatives. IMPLICATIONS FOR PRACTICE The radiographers stressed the importance of a soundproofed work environment to minimize occupational adverse health effects and preserve work performance. They acknowledge noise as a common contributor to patient distress and discomfort. Providing options like earplugs, headphones, mold putty, software-optimized "quiet" sequences, and patient information were important tools. Fostering a safety culture requires proactive safety efforts and support from colleagues and management.
Collapse
Affiliation(s)
- A Glans
- Department of Nursing, Umeå University, Umeå, Sweden; Department of Diagnostics and Intervention, Radiation Physics, Umeå University, Umeå, Sweden.
| | - J Wilén
- Department of Diagnostics and Intervention, Radiation Physics, Umeå University, Umeå, Sweden
| | - B Hansson
- Department of Clinical Sciences Lund, Diagnostic Radiology, Lund University, Lund, Sweden
| | - Å Audulv
- Department of Nursing, Umeå University, Umeå, Sweden
| | - L Lindgren
- Department of Nursing, Umeå University, Umeå, Sweden
| |
Collapse
|
5
|
Wenderott K, Krups J, Luetkens JA, Weigl M. Radiologists' perspectives on the workflow integration of an artificial intelligence-based computer-aided detection system: A qualitative study. APPLIED ERGONOMICS 2024; 117:104243. [PMID: 38306741 DOI: 10.1016/j.apergo.2024.104243] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Revised: 12/18/2023] [Accepted: 01/23/2024] [Indexed: 02/04/2024]
Abstract
In healthcare, artificial intelligence (AI) is expected to improve work processes, yet most research focuses on the technical features of AI rather than its real-world clinical implementation. To evaluate the implementation process of an AI-based computer-aided detection system (AI-CAD) for prostate MRI readings, we interviewed German radiologists in a pre-post design. We embedded our findings in the Model of Workflow Integration and the Technology Acceptance Model to analyze workflow effects, facilitators, and barriers. The most prominent barriers were: (i) a time delay in the work process, (ii) additional work steps to be taken, and (iii) an unstable performance of the AI-CAD. Most frequently named facilitators were (i) good self-organization, and (ii) good usability of the software. Our results underline the importance of a holistic approach to AI implementation considering the sociotechnical work system and provide valuable insights into key factors of the successful adoption of AI technologies in work systems.
Collapse
Affiliation(s)
- Katharina Wenderott
- Institute for Patient Safety, University Hospital Bonn, Venusberg-Campus 1, 53127, Bonn, Germany.
| | - Jim Krups
- Institute for Patient Safety, University Hospital Bonn, Venusberg-Campus 1, 53127, Bonn, Germany
| | - Julian A Luetkens
- Department of Diagnostic and Interventional Radiology, University Hospital Bonn, Germany; Quantitative Imaging Lab Bonn (QILaB), University Hospital Bonn, Germany
| | - Matthias Weigl
- Institute for Patient Safety, University Hospital Bonn, Venusberg-Campus 1, 53127, Bonn, Germany
| |
Collapse
|
6
|
Xiao Y, Fulda KG, Young RA, Hendrix ZN, Daniel KM, Chen KY, Zhou Y, Roye JL, Kosmari L, Wilson J, Espinoza AM, Sutcliffe KM, Pitts SI, Arbaje AI, Chui MA, Blair S, Sloan D, Jackson M, Gurses AP. Patient Partnership Tools to Support Medication Safety in Community-Dwelling Older Adults: Protocol for a Nonrandomized Stepped Wedge Clinical Trial. JMIR Res Protoc 2024; 13:e57878. [PMID: 38684080 PMCID: PMC11091807 DOI: 10.2196/57878] [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: 02/28/2024] [Revised: 03/20/2024] [Accepted: 03/23/2024] [Indexed: 05/02/2024] Open
Abstract
BACKGROUND Preventable harms from medications are significant threats to patient safety in community settings, especially among ambulatory older adults on multiple prescription medications. Patients may partner with primary care professionals by taking on active roles in decisions, learning the basics of medication self-management, and working with community resources. OBJECTIVE This study aims to assess the impact of a set of patient partnership tools that redesign primary care encounters to encourage and empower patients to make more effective use of those encounters to improve medication safety. METHODS The study is a nonrandomized, cross-sectional stepped wedge cluster-controlled trial with 1 private family medicine clinic and 2 public safety-net primary care clinics each composing their own cluster. There are 2 intervention sequences with 1 cluster per sequence and 1 control sequence with 1 cluster. Cross-sectional surveys will be taken immediately at the conclusion of visits to the clinics during 6 time periods of 6 weeks each, with a transition period of no data collection during intervention implementation. The number of visits to be surveyed will vary by period and cluster. We plan to recruit patients and professionals for surveys during 405 visits. In the experimental periods, visits will be conducted with two partnership tools and associated clinic process changes: (1) a 1-page visit preparation guide given to relevant patients by clinic staff before seeing the provider, with the intention to improve communication and shared decision-making, and (2) a library of short educational videos that clinic staff encourage patients to watch on medication safety. In the control periods, visits will be conducted with usual care. The primary outcome will be patients' self-efficacy in medication use. The secondary outcomes are medication-related issues such as duplicate therapies identified by primary care providers and assessment of collaborative work during visits. RESULTS The study was funded in September 2019. Data collection started in April 2023 and ended in December 2023. Data was collected for 405 primary care encounters during that period. As of February 15, 2024, initial descriptive statistics were calculated. Full data analysis is expected to be completed and published in the summer of 2024. CONCLUSIONS This study will assess the impact of patient partnership tools and associated process changes in primary care on medication use self-efficacy and medication-related issues. The study is powered to identify types of patients who may benefit most from patient engagement tools in primary care visits. TRIAL REGISTRATION ClinicalTrials.gov NCT05880368; https://clinicaltrials.gov/study/NCT05880368. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/57878.
Collapse
Affiliation(s)
- Yan Xiao
- College of Nursing and Health Innovation, University of Texas at Arlington, Arlington, TX, United States
- College of Engineering, University of Texas at Arlington, Arlington, TX, United States
| | - Kimberley G Fulda
- Department of Family Medicine and Osteopathic Manipulative Medicine and North Texas Primary Care Practice-Based Research Network (NorTex), University of North Texas Health Science Center, Fort Worth, TX, United States
| | - Richard A Young
- Family Medicine Residency Program, John Peter Smith Health Network, Fort Worth, TX, United States
| | - Z Noah Hendrix
- College of Nursing and Health Innovation, University of Texas at Arlington, Arlington, TX, United States
| | - Kathryn M Daniel
- College of Nursing and Health Innovation, University of Texas at Arlington, Arlington, TX, United States
| | - Kay Yut Chen
- College of Business, University of Texas at Arlington, Arlington, TX, United States
| | - Yuan Zhou
- College of Engineering, University of Texas at Arlington, Arlington, TX, United States
| | - Jennifer L Roye
- College of Nursing and Health Innovation, University of Texas at Arlington, Arlington, TX, United States
| | - Ludmila Kosmari
- College of Nursing and Health Innovation, University of Texas at Arlington, Arlington, TX, United States
| | - Joshua Wilson
- College of Liberal Arts, University of Texas at Arlington, Arlington, TX, United States
| | - Anna M Espinoza
- Department of Family Medicine and Osteopathic Manipulative Medicine and North Texas Primary Care Practice-Based Research Network (NorTex), University of North Texas Health Science Center, Fort Worth, TX, United States
| | - Kathleen M Sutcliffe
- Carey Business School, Johns Hopkins University, Baltimore, MD, United States
- School of Medicine, Johns Hopkins University, Baltimore, MD, United States
- Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, United States
- School of Nursing, Johns Hopkins University, Baltimore, MD, United States
| | - Samantha I Pitts
- School of Medicine, Johns Hopkins University, Baltimore, MD, United States
| | - Alicia I Arbaje
- School of Medicine, Johns Hopkins University, Baltimore, MD, United States
- Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, United States
| | - Michelle A Chui
- School of Pharmacy, University of Wisconsin-Madison, Madison, WI, United States
| | - Somer Blair
- Office of Clinical Research, John Peter Smith Health Network, Fort Worth, TX, United States
| | - Dawn Sloan
- Family Medicine Residency Program, John Peter Smith Health Network, Fort Worth, TX, United States
| | - Masheika Jackson
- Family Medicine Residency Program, John Peter Smith Health Network, Fort Worth, TX, United States
| | - Ayse P Gurses
- School of Medicine, Johns Hopkins University, Baltimore, MD, United States
- Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, United States
- Whiting School of Engineering, Johns Hopkins University, Baltimore, MD, United States
| |
Collapse
|
7
|
Elkefi S, Asan O. Validating the Effectiveness of the Patient-Centered Cancer Care Framework by Assessing the Impact of Work System Factors on Patient-Centered Care and Quality of Care: Interview Study With Newly Diagnosed Cancer Patients. JMIR Hum Factors 2024; 11:e53053. [PMID: 38656776 PMCID: PMC11079762 DOI: 10.2196/53053] [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: 09/24/2023] [Revised: 03/06/2024] [Accepted: 03/15/2024] [Indexed: 04/26/2024] Open
Abstract
BACKGROUND Patients with cancer who have recently been diagnosed have distinct requirements compared to cancer survivors. It is crucial to take into account their unique needs to ensure that they make informed decisions and are receptive to the care provided. OBJECTIVE This study suggested a framework titled Effectiveness of Patient-Centered Cancer Care that considers the needs of newly diagnosed patients with cancer and related work system factors. This study investigated how work system factors influence the perceptions of patient-centered care, quality of care, and associated outcomes among newly diagnosed patients with cancer. Patient-centered care is defined in terms of workload and communication considerations, whereas the quality of care is assessed through indicators such as trust in physicians, satisfaction with care, and perceptions of technology. METHODS This study used qualitative data collected through interviews with newly diagnosed patients with cancer (N=20) right after their first visits with their physicians. Thematic analysis was conducted to validate the 5 hypotheses of the framework, mapping the interactions among quality of care, patient-centered care, and work system factors. RESULTS We found that workload and patient-centered communication impact the quality of care and that the work system elements impact the patient-centeredness (workload and communication) and the quality of care (trust in physicians, satisfaction with care, and perception of technology use). CONCLUSIONS Qualitatively validating the proposed Effectiveness of Patient-Centered Cancer Care framework, this study demonstrated its efficacy in elucidating the interplay of various factors. The framework holds promise for informing interventions geared toward enhancing patients' experiences during their initial visits after diagnosis. There is a pressing need for heightened attention to the organizational design, patient processes, and collaborative efforts among diverse stakeholders and providers to optimize the overall patient experience.
Collapse
Affiliation(s)
- Safa Elkefi
- School of Nursing, Columbia University, New York, NY, United States
| | - Onur Asan
- School of Systems and Enterprises, Stevens Institute of Technology, Hoboken, NJ, United States
| |
Collapse
|
8
|
Magerøy MR, Braut GS, Macrae C, Clay-Williams R, Braithwaite J, Wiig S. Leading Quality and Safety on the Frontline - A Case Study of Department Leaders in Nursing Homes. J Healthc Leadersh 2024; 16:193-208. [PMID: 38681135 PMCID: PMC11055517 DOI: 10.2147/jhl.s454109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2023] [Accepted: 03/30/2024] [Indexed: 05/01/2024] Open
Abstract
Purpose The role of healthcare leaders is becoming increasingly complex, and carries great responsibility for patients, employees, and the quality of service delivery. This study explored the barriers and enablers that department leaders in nursing homes encounter when managing the dual responsibilities in Health, Safety and Environment (HSE) and Quality and Patient Safety (QPS). Methodology Case study design with data collected through semi structured interviews with 16 department leaders in five Norwegian municipalities. We analyzed the data using qualitative content analysis. Results Data analysis resulted in four themes explaining what department leaders in nursing homes experience as barriers and enablers when handling the dual responsibility of HSE and QPS: Temporal capacity: The importance of having enough time to create a health-promoting work environment that ensures patient safety. Relational capacity: Relationships have an impact on work process and outcomes. Professional competence: Competence affects patient safety and leadership strategies. Organizational structure: Organizational frameworks influence how the dual responsibilities are handled. Conclusion Evidence from this study showed that external contextual factors (eg, legislations and finances) and internal factors (eg, relationships and expectations) are experienced as barriers and enablers when department leaders are enacting the dual responsibility of HSE and QPS. Of these, relationships were found to be the most significant contributor.
Collapse
Affiliation(s)
- Malin Rosell Magerøy
- SHARE- Centre for Resilience in Healthcare, Faculty of Health Science, University of Stavanger, Stavanger, Norway
| | - Geir Sverre Braut
- Department of Research, Stavanger University Hospital, Stavanger, Norway
- Department of Social Science, Western Norway University of Applied Sciences, Sogndal, Norway
| | - Carl Macrae
- SHARE- Centre for Resilience in Healthcare, Faculty of Health Science, University of Stavanger, Stavanger, Norway
- Centre for Health, Innovation, Leadership and Learning, Nottingham University Business School, Nottingham, UK
| | - Robyn Clay-Williams
- Australian Institute of Health Innovation. Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, New South Wales, Australia
| | - Jeffrey Braithwaite
- Australian Institute of Health Innovation. Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, New South Wales, Australia
| | - Siri Wiig
- SHARE- Centre for Resilience in Healthcare, Faculty of Health Science, University of Stavanger, Stavanger, Norway
| |
Collapse
|
9
|
Davoust M, Bazzi AR, Blakemore S, Blodgett J, Cheng A, Fielman S, Magane KM, Theisen J, Saitz R, Ventura AS, Weinstein ZM. Patient and Clinician Experiences with the Implementation of Telemedicine and Related Adaptations in Office-Based Buprenorphine Treatment During the COVID-19 Pandemic: A Qualitative Study. RESEARCH SQUARE 2024:rs.3.rs-4272282. [PMID: 38746460 PMCID: PMC11092823 DOI: 10.21203/rs.3.rs-4272282/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/16/2024]
Abstract
Background Deaths from opioid overdose have increased dramatically in the past decade, representing an epidemic in the United States. For individuals with opioid use disorder (OUD), agonist medications such as methadone and buprenorphine reduce opioid-related morbidity and mortality. Historically, the provision of buprenorphine treatment in office-based settings has relied on frequent in-person contact, likely influencing patients' access to and retention in care. In response to the COVID-19 pandemic, providers of office-based buprenorphine treatment rapidly adapted their care processes, increasingly relying on telemedicine visits. To date, relatively few prior studies have combined patient and clinician perspectives to examine the implementation of telemedicine and related care adaptations, particularly in safety-net settings. Methods Qualitative methods were used to explore clinician and patient experiences with telemedicine in an office-based buprenorphine treatment clinic affiliated with an urban safety-net hospital. From this clinic, we interviewed 25 patients and 16 clinicians (including prescribers and non-prescribers) to understand how telemedicine impacted treatment quality and engagement in care, as well as preferences for using telemedicine moving forward. Results Five themes regarding the implementation of telemedicine and other COVID-19-related care adaptations arose from patient and clinician perspectives: 1) telemedicine integration precipitated openness to more flexibility in care practices, 2) concerns regarding telemedicine-related adaptations centered around safety and accountability, 3) telemedicine encounters required rapport and trust between patients and clinicians to facilitate open communication, 4) safety-net patient populations experienced unique challenges when using telemedicine, particularly in terms of the technology required and the need for privacy, and 5) there is an important role for telemedicine in office-based buprenorphine treatment moving forward, primarily through its use in hybrid models of care. Conclusions Telemedicine implementation within office-based buprenorphine treatment has the potential to improve patients' engagement in care; however, our findings emphasize the need for tailored approaches to implementing telemedicine in office-based buprenorphine treatment, particularly within safety-net settings. Overall, this study supports the maintenance of changes to policy and practice that facilitate the use of telemedicine in office-based buprenorphine treatment beyond the COVID-19 public health emergency.
Collapse
Affiliation(s)
| | | | | | | | - Anna Cheng
- Boston University Chobanian & Avedisian School of Medicine
| | | | | | - Jacqui Theisen
- Boston University Chobanian & Avedisian School of Medicine
| | | | | | | |
Collapse
|
10
|
Scheer ER, Werner NE, Coller RJ, Nacht CL, Petty L, Tang M, Ehlenbach M, Kelly MM, Finesilver S, Warner G, Katz B, Keim-Malpass J, Lunsford CD, Letzkus L, Desai SS, Valdez RS. Designing for caregiving networks: a case study of primary caregivers of children with medical complexity. J Am Med Inform Assoc 2024; 31:1151-1162. [PMID: 38427845 PMCID: PMC11031225 DOI: 10.1093/jamia/ocae026] [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: 08/07/2023] [Revised: 01/21/2024] [Accepted: 02/01/2024] [Indexed: 03/03/2024] Open
Abstract
OBJECTIVE The study aimed to characterize the experiences of primary caregivers of children with medical complexity (CMC) in engaging with other members of the child's caregiving network, thereby informing the design of health information technology (IT) for the caregiving network. Caregiving networks include friends, family, community members, and other trusted individuals who provide resources, information, health, or childcare. MATERIALS AND METHODS We performed a secondary analysis of two qualitative studies. Primary studies conducted semi-structured interviews (n = 50) with family caregivers of CMC. Interviews were held in the Midwest (n = 30) and the mid-Atlantic region (n = 20). Interviews were transcribed verbatim for thematic analysis. Emergent themes were mapped to implications for the design of future health IT. RESULTS Thematic analysis identified 8 themes characterizing a wide range of primary caregivers' experiences in constructing, managing, and ensuring high-quality care delivery across the caregiving network. DISCUSSION Findings evidence a critical need to create flexible and customizable tools designed to support hiring/training processes, coordinating daily care across the caregiving network, communicating changing needs and care updates across the caregiving network, and creating contingency plans for instances where caregivers are unavailable to provide care to the CMC. Informaticists should additionally design accessible platforms that allow primary caregivers to connect with and learn from other caregivers while minimizing exposure to sensitive or emotional content as indicated by the user. CONCLUSION This article contributes to the design of health IT for CMC caregiving networks by uncovering previously underrecognized needs and experiences of CMC primary caregivers and drawing direct connections to design implications.
Collapse
Affiliation(s)
- Eleanore Rae Scheer
- Department of Systems and Information Engineering, University of Virginia, Charlottesville, VA 22904, United States
| | - Nicole E Werner
- Department of Health and Wellness Design, Indiana University School of Public Health-Bloomington, Bloomington, IN 47405, United States
| | - Ryan J Coller
- Department of Pediatrics, University of Wisconsin-Madison, Madison, WI 53792, United States
| | - Carrie L Nacht
- School of Public Health, San Diego State University, San Diego, CA 92182, United States
- Herbert Wertheim School of Public Health and Human Longevity Science, University of California San Diego, San Diego, CA 92093, United States
| | - Lauren Petty
- Department of Systems and Information Engineering, University of Virginia, Charlottesville, VA 22904, United States
| | - Mengwei Tang
- Department of Industrial and Systems Engineering, University of Wisconsin-Madison, Madison, WI 53706, United States
| | - Mary Ehlenbach
- Department of Pediatrics, University of Wisconsin-Madison, Madison, WI 53792, United States
| | - Michelle M Kelly
- Department of Pediatrics, University of Wisconsin-Madison, Madison, WI 53792, United States
| | - Sara Finesilver
- Department of Pediatrics, University of Wisconsin-Madison, Madison, WI 53792, United States
| | - Gemma Warner
- Department of Pediatrics, University of Wisconsin-Madison, Madison, WI 53792, United States
| | - Barbara Katz
- Family Voices of Wisconsin, Madison, WI 53705, United States
| | - Jessica Keim-Malpass
- Department of Pediatrics, University of Virginia, Charlottesville, VA 22903, United States
| | - Christopher D Lunsford
- Department of Orthopedics, Duke University, Durham, NC 27710, United States
- Department of Pediatrics, Duke University, Durham, NC 27707, United States
| | - Lisa Letzkus
- Department of Pediatrics, University of Virginia, Charlottesville, VA 22903, United States
| | - Shaalini Sanjiv Desai
- Department of Public Health Sciences, University of Virginia, Charlottesville, VA 22903, United States
| | - Rupa S Valdez
- Department of Systems and Information Engineering, University of Virginia, Charlottesville, VA 22904, United States
- Department of Public Health Sciences, University of Virginia, Charlottesville, VA 22903, United States
| |
Collapse
|
11
|
Al-Ghraiybah T, Lago L, Fernandez R, Sim J. Effects of the nursing practice environment, nurse staffing, patient surveillance and escalation of care on patient mortality: A multi-source quantitative study. Int J Nurs Stud 2024; 156:104777. [PMID: 38772288 DOI: 10.1016/j.ijnurstu.2024.104777] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Revised: 03/08/2024] [Accepted: 04/13/2024] [Indexed: 05/23/2024]
Abstract
BACKGROUND A favourable nursing practice environment and adequate nurse staffing have been linked to reduced patient mortality. However, the contribution of nursing care processes such as patient surveillance and escalation of care, on patient mortality is not well understood. OBJECTIVE The aim of this study was to investigate the effect of the nursing practice environment, nurse staffing, missed care related to patient surveillance and escalation of care on 30-day inpatient mortality. DESIGN A multi-source quantitative study including a cross-sectional survey of nurses, and retrospective data extracted from an audit of medical and admission records. SETTING(S) A large tertiary teaching hospital (600 beds) in metropolitan Sydney, Australia. METHODS Data on the nursing practice environment, nurse staffing and missed care were obtained from the nursing survey. Patient deterioration data and patient outcome data were collected from the medical and admission records respectively. Logistic regression models were used to examine the association between the nursing practice environment, patient deterioration and 30-day inpatient mortality accounting for clustering of episodes within patients using generalised estimating equations. RESULTS Surveys were completed by 304 nurses (84.5 % female, mean age 34.4 years, 93.4 % Registered Nurses) from 16 wards. Patient deterioration data was collected for 30,011 patient deterioration events and 63,847 admitted patient episodes of care. Each additional patient per nurse (OR = 1.22, 95 % CI = 1.04-1.43) and the presence of increased missed care for patient surveillance (OR = 1.13, 95 % CI = 1.03-1.23) were associated with higher risk of 30-day inpatient mortality. The use of a clinical emergency response system reduced the risk of mortality (OR = 0.82, 95 % CI = 0.76-0.89). A sub-group analysis excluding aged care units identified a 38 % increase in 30-day inpatient mortality for each additional patient per nurse (OR = 1.38, 95 % CI = 1.15-1.65). The nursing practice environment was also significantly associated with mortality (OR = 0.79, 95 % CI: 0.72-0.88) when aged care wards were excluded. CONCLUSIONS Patient mortality can be reduced by increasing nurse staffing levels and improving the nursing practice environment. Nurses play a pivotal role in patient safety and improving nursing care processes to minimise missed care related to patient surveillance and ensuring timely clinical review for deteriorating patients reduces inpatient mortality. TWEETABLE ABSTRACT Patient mortality can be reduced by improving the nursing practice environment & increasing the number of nurses so that nurses have more time to monitor patients. Investing in nurses results in lower mortality and better outcomes. #PatientSafety #NurseStaffing #WorkEnvironment #Mortality.
Collapse
Affiliation(s)
- Tamer Al-Ghraiybah
- School of Nursing, University of Wollongong, Northfields Ave, Wollongong, Australia; School of Nursing & Midwifery, Faculty of Health, University of Technology Sydney, Australia.
| | - Luise Lago
- Centre for Health Research Illawarra Shoalhaven Population, Innovation Campus, University of Wollongong, Australia.
| | - Ritin Fernandez
- School of Nursing and Midwifery, University of Newcastle, Newcastle, Australia.
| | - Jenny Sim
- School of Nursing, University of Wollongong, Northfields Ave, Wollongong, Australia; School of Nursing and Midwifery, University of Newcastle, Newcastle, Australia; School of Nursing, Midwifery & Paramedicine, Australian Catholic University, North Sydney, Australia.
| |
Collapse
|
12
|
Barton HJ, Maru A, Leaf MA, Hekman DJ, Wiegmann DA, Shah MN, Patterson BW. Academic Detailing as a Health Information Technology Implementation Method: Supporting the Design and Implementation of an Emergency Department-Based Clinical Decision Support Tool to Prevent Future Falls. JMIR Hum Factors 2024; 11:e52592. [PMID: 38635318 PMCID: PMC11066751 DOI: 10.2196/52592] [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: 09/11/2023] [Revised: 02/08/2024] [Accepted: 03/02/2024] [Indexed: 04/19/2024] Open
Abstract
BACKGROUND Clinical decision support (CDS) tools that incorporate machine learning-derived content have the potential to transform clinical care by augmenting clinicians' expertise. To realize this potential, such tools must be designed to fit the dynamic work systems of the clinicians who use them. We propose the use of academic detailing-personal visits to clinicians by an expert in a specific health IT tool-as a method for both ensuring the correct understanding of that tool and its evidence base and identifying factors influencing the tool's implementation. OBJECTIVE This study aimed to assess academic detailing as a method for simultaneously ensuring the correct understanding of an emergency department-based CDS tool to prevent future falls and identifying factors impacting clinicians' use of the tool through an analysis of the resultant qualitative data. METHODS Previously, our team designed a CDS tool to identify patients aged 65 years and older who are at the highest risk of future falls and prompt an interruptive alert to clinicians, suggesting the patient be referred to a mobility and falls clinic for an evidence-based preventative intervention. We conducted 10-minute academic detailing interviews (n=16) with resident emergency medicine physicians and advanced practice providers who had encountered our CDS tool in practice. We conducted an inductive, team-based content analysis to identify factors that influenced clinicians' use of the CDS tool. RESULTS The following categories of factors that impacted clinicians' use of the CDS were identified: (1) aspects of the CDS tool's design (2) clinicians' understanding (or misunderstanding) of the CDS or referral process, (3) the busy nature of the emergency department environment, (4) clinicians' perceptions of the patient and their associated fall risk, and (5) the opacity of the referral process. Additionally, clinician education was done to address any misconceptions about the CDS tool or referral process, for example, demonstrating how simple it is to place a referral via the CDS and clarifying which clinic the referral goes to. CONCLUSIONS Our study demonstrates the use of academic detailing for supporting the implementation of health information technologies, allowing us to identify factors that impacted clinicians' use of the CDS while concurrently educating clinicians to ensure the correct understanding of the CDS tool and intervention. Thus, academic detailing can inform both real-time adjustments of a tool's implementation, for example, refinement of the language used to introduce the tool, and larger scale redesign of the CDS tool to better fit the dynamic work environment of clinicians.
Collapse
Affiliation(s)
- Hanna J Barton
- BerbeeWalsh Department of Emergency Medicine, University of Wisconsin-Madison, Madison, WI, United States
| | - Apoorva Maru
- BerbeeWalsh Department of Emergency Medicine, University of Wisconsin-Madison, Madison, WI, United States
| | - Margaret A Leaf
- Department of Information Services, UW Health, Madison, WI, United States
| | - Daniel J Hekman
- BerbeeWalsh Department of Emergency Medicine, University of Wisconsin-Madison, Madison, WI, United States
| | - Douglas A Wiegmann
- Department of Industrial and Systems Engineering, University of Wisconsin-Madison, Madison, WI, United States
| | - Manish N Shah
- BerbeeWalsh Department of Emergency Medicine, University of Wisconsin-Madison, Madison, WI, United States
| | - Brian W Patterson
- BerbeeWalsh Department of Emergency Medicine, University of Wisconsin-Madison, Madison, WI, United States
- Department of Industrial and Systems Engineering, University of Wisconsin-Madison, Madison, WI, United States
| |
Collapse
|
13
|
Guetterman TC, Manojlovich M. Grand rounds in methodology: designing for integration in mixed methods research. BMJ Qual Saf 2024:bmjqs-2023-016112. [PMID: 38575310 DOI: 10.1136/bmjqs-2023-016112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Accepted: 03/27/2024] [Indexed: 04/06/2024]
Abstract
Mixed methods research is a popular approach used to understand persistent and complex problems related to quality and safety, such as reasons why interventions are not implemented as intended or explaining differential outcomes. However, the quality and rigour of mixed methods research proposals and publications often miss opportunities for integration, which is the core of mixed methods. Achieving integration remains challenging, and failing to integrate reduces the benefits of a mixed methods approach. Therefore, the purpose of this article is to guide quality and safety researchers in planning and designing a mixed methods study that facilitates integration. We highlight how meaningful integration in mixed methods research can be achieved by centring integration at the following levels: research question, design, methods, results and reporting and interpretation levels. A holistic view of integration through all these levels will enable researchers to provide better answers to complex problems and thereby contribute to improvement of safety and quality of care.
Collapse
|
14
|
Will KK, Liang Y, Chi CL, Lamb G, Todd M, Delaney C. Measuring the Impact of Primary Care Team Composition on Patient Activation Utilizing Electronic Health Record Big Data Analytics. J Patient Cent Res Rev 2024; 11:18-28. [PMID: 38596347 PMCID: PMC11000700 DOI: 10.17294/2330-0698.2019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/11/2024] Open
Abstract
Purpose Team-based care has been linked to key outcomes associated with the Quadruple Aim and a key driver of high-value patient-centered care. Use of the electronic health record (EHR) and machine learning have significant potential to overcome previous barriers to studying the impact of teams, including delays in accessing data to improve teamwork and optimize patient outcomes. Methods This study utilized a large EHR dataset (n=316,542) from an urban health system to explore the relationship between team composition and patient activation, a key driver of patient engagement. Teams were operationalized using consensus definitions of teamwork from the literature. Patient activation was measured using the Patient Activation Measure (PAM). Results from multilevel regression analyses were compared to machine learning analyses using multinomial logistic regression to calculate propensity scores for the effect of team composition on PAM scores. Under the machine learning approach, a causal inference model with generalized overlap weighting was used to calculate the average treatment effect of teamwork. Results Seventeen different team types were observed in the data from the analyzed sample (n=12,448). Team sizes ranged from 2 to 5 members. After controlling for confounding variables in both analyses, more diverse, multidisciplinary teams (team size of 4 or more) were observed to have improved patient activation scores. Conclusions This is the first study to explore the relationship between team composition and patient activation using the EHR and big data analytics. Implications for further research using EHR data and machine learning to study teams and other patient-centered care are promising and could be used to advance team science.
Collapse
Affiliation(s)
| | - Yue Liang
- University of Minnesota, Minneapolis, MN
| | | | | | | | | |
Collapse
|
15
|
Liebzeit D, Geiger O, Jaboob S, Bjornson S, Strayer A, Buck H, Werner NE. Older Adults' Process of Collaborating With a Support Team During Transitions From Hospital to Home: A Grounded Theory Study. THE GERONTOLOGIST 2024; 64:gnad096. [PMID: 37436125 DOI: 10.1093/geront/gnad096] [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: 03/27/2023] [Indexed: 07/13/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Little is known about how older adults engage with multiple sources of support and resources during transitions from hospital to home, a period of high vulnerability. This study aims to describe how older adults identify and collaborate with a support team, including unpaid/family caregivers, health care providers, and professional and social networks, during the transition. RESEARCH DESIGN AND METHODS This study utilized grounded theory methodology. One-on-one interviews were conducted with adults aged 60 and older following their discharge from a medical/surgical inpatient unit in a large midwestern teaching hospital. Data were analyzed using open, axial, and selective coding. RESULTS Participants (N = 25) ranged from 60 to 82 years of age, 11 were female, and all participants were White, non-Hispanic. They described a process of identifying a support team and collaborating with that team to manage at home and progress their health, mobility, and engagement. Support teams varied, but included collaborations between the older person, unpaid/family caregiver(s), and their health care providers. Their collaboration was impacted by the participant's professional and social networks. DISCUSSION AND IMPLICATIONS Older adults collaborate with multiple sources of support and this collaboration is a dynamic process that varies across phases of their transition from hospital to home. Findings reveal opportunities for assessing individual's support and social networks, in addition to health and functional status, to determine needs and leverage resources during transitions in care.
Collapse
Affiliation(s)
- Daniel Liebzeit
- College of Nursing, The University of Iowa, Iowa City, Iowa, USA
| | - Olivia Geiger
- College of Nursing, The University of Iowa, Iowa City, Iowa, USA
| | - Saida Jaboob
- College of Nursing, The University of Iowa, Iowa City, Iowa, USA
| | | | - Andrea Strayer
- College of Nursing, The University of Iowa, Iowa City, Iowa, USA
| | - Harleah Buck
- College of Nursing, The University of Iowa, Iowa City, Iowa, USA
| | - Nicole E Werner
- School of Public Health, Indiana University-Bloomington, Bloomington, Indiana, USA
| |
Collapse
|
16
|
Dye ME, Runyan P, Scott TA, Dietrich MS, Hatch LD, France D, Alrifai MW. Small Patients but a Heavy Lift: Workload and Burnout of Advanced Practice Providers and Physicians in a Level IV Neonatal Intensive Care Unit. J Perinat Neonatal Nurs 2024; 38:192-200. [PMID: 38758274 PMCID: PMC11104510 DOI: 10.1097/jpn.0000000000000804] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/18/2024]
Abstract
OBJECTIVE This study explored the association between workload and the level of burnout reported by clinicians in our neonatal intensive care unit (NICU). A qualitative analysis was used to identify specific factors that contributed to workload and modulated clinician workload in the NICU. STUDY DESIGN We conducted a study utilizing postshift surveys to explore workload of 42 NICU advanced practice providers and physicians over a 6-month period. We used multinomial logistic regression models to determine associations between workload and burnout. We used a descriptive qualitative design with an inductive thematic analysis to analyze qualitative data. RESULTS Clinicians reported feelings of burnout on nearly half of their shifts (44%), and higher levels of workload during a shift were associated with report of a burnout symptom. Our study identified 7 themes related to workload in the NICU. Two themes focused on contributors to workload, 3 themes focused on modulators of workload, and the final 2 themes represented mixed experiences of clinicians' workload. CONCLUSION We found an association between burnout and increased workload. Clinicians in our study described common contributors to workload and actions to reduce workload. Decreasing workload and burnout along with improving clinician well-being requires a multifaceted approach on unit and systems levels.
Collapse
Affiliation(s)
- M. Eva Dye
- Monroe Carell Jr. Children’s Hospital at Vanderbilt, Nashville, TN
- Department of Pediatrics, Division of Neonatology, Vanderbilt University Medical Center, Nashville, TN
| | - Patti Runyan
- Monroe Carell Jr. Children’s Hospital at Vanderbilt, Nashville, TN
| | - Theresa A. Scott
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, TN
| | - Mary S. Dietrich
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, TN
- School of Nursing, Vanderbilt University, Nashville, TN
| | - L Dupree Hatch
- Monroe Carell Jr. Children’s Hospital at Vanderbilt, Nashville, TN
- Department of Pediatrics, Division of Neonatology, Vanderbilt University Medical Center, Nashville, TN
- Center for Child Health Policy, Vanderbilt University Medical Center, Nashville, TN
| | - Daniel France
- Department of Anesthesiology, Vanderbilt University Medical Center, Nashville, TN
- Center for Research and Innovation in Systems Safety, Vanderbilt University Medical Center, Nashville, TN
| | - Mhd Wael Alrifai
- Monroe Carell Jr. Children’s Hospital at Vanderbilt, Nashville, TN
- Department of Pediatrics, Division of Neonatology, Vanderbilt University Medical Center, Nashville, TN
- Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, TN
| |
Collapse
|
17
|
Jallow F, Stehling E, Sajwani-Merchant Z, Daniel KM, Fulda KG, Gurses AP, Arbaje AI, Xiao Y. Medication Management Strategies by Community-Dwelling Older Adults: A Multisite Qualitative Analysis. J Patient Saf 2024; 20:192-197. [PMID: 38372504 PMCID: PMC10963160 DOI: 10.1097/pts.0000000000001200] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/20/2024]
Abstract
OBJECTIVES Community-dwelling older adults taking 5 or more medications are at risk for medication-related harm. Managing multiple medications is a challenging task for patients and caregivers. Community-dwelling older adults self-manage their medications with minimal healthcare professional supervision. Although organizations, such as the Food and Drug Administration, often issue guidelines to ensure medication safety, how older adults understand and mitigate the risk of harm from medication use in the home environment is poorly understood. METHODS We conducted semistructured interviews with community-dwelling older adults 65 years and older who took 5 or more prescription medications to explore medication safety strategies they use. We also compared 2 organizations' medication safety guidelines for areas of concordance and discordance. RESULTS A total of 28 older adults were interviewed. Four overarching themes of medication management strategies emerged: collaborating with prescribers, collaborating with pharmacists, learning about medications, and safe practices at home. Study findings revealed that older adults followed some of the published guidelines by the 2 government organizations, although there were some areas of discord. Some of the strategies used were unintentionally against the recommended guidelines. For example, older adults tried weaning themselves off their medications without notifying their providers. CONCLUSIONS Older adults and their caregivers in our study used strategies different from those recommended by government organizations in managing medications to enhance drug safety. Patient-provider collaboration and positive patient outcomes can be improved by understanding and respecting strategies older adults use at home. Future studies must effectively incorporate older adults' perspectives when developing medication safety guidelines.
Collapse
Affiliation(s)
- Fatoumata Jallow
- University of Texas at Arlington, College of Nursing and Health Innovation, Arlington, Texas
| | - Elisa Stehling
- University of Texas at Arlington, College of Nursing and Health Innovation, Arlington, Texas
| | - Zara Sajwani-Merchant
- University of Texas at Arlington, College of Nursing and Health Innovation, Arlington, Texas
| | - Kathryn M. Daniel
- University of Texas at Arlington, College of Nursing and Health Innovation, Arlington, Texas
| | - Kimberly G. Fulda
- The University of North Texas Health Science Center, Department of Family Medicine and Osteopathic Manipulative Medicine. Fort Worth, TX; North Texas Primary Care Practice-Based Research Network (NorTex), Fort Worth, TX
| | - Ayse P Gurses
- Armstrong Institute Center for Health Care Human Factors, Johns Hopkins Medicine. Baltimore, Maryland
| | - Alicia I. Arbaje
- Armstrong Institute Center for Health Care Human Factors, Johns Hopkins Medicine. Baltimore, Maryland
- Division of Geriatric Medicine and Gerontology, Center for Transformative Geriatric Research, Johns Hopkins University School of Medicine, Baltimore, Maryland
- Department of Health Policy and Management, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland
| | - Yan Xiao
- University of Texas at Arlington, College of Nursing and Health Innovation, Arlington, Texas
| |
Collapse
|
18
|
Sutherland AB, Phipps DL, Grant S, Hughes J, Tomlin S, Ashcroft DM. Understanding the informal aspects of medication processes to maintain patient safety in hospitals: a sociotechnical ethnographic study in paediatric units. ERGONOMICS 2024:1-15. [PMID: 38557363 DOI: 10.1080/00140139.2024.2333396] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/06/2023] [Accepted: 03/17/2024] [Indexed: 04/04/2024]
Abstract
Adverse drug events (ADEs) are common in hospitals, affecting one in six child in-patients. Medication processes are complex systems. This study aimed to explore the work-as-done of medication safety in three English paediatric units using direct observation and semi-structured interviews. We found that a combination of the physical environment, traditional work systems and team norms were among the systemic barriers to medicines safety. The layout of wards discouraged teamworking and reinforced professional boundaries. Workspaces were inadequate, and interruptions were uncontrollable. A less experienced workforce undertook prescribing and verification while more experienced nurses undertook administration. Guidelines were inadequate, with actors muddling through together. Formal controls against ADEs included checking (of prescriptions and administration) and barcode administration systems, but these did not integrate into workflows. Families played an important part in the safe administration of medication and provision of information about their children but were isolated from other parts of the system.
Collapse
Affiliation(s)
- Adam B Sutherland
- Medicines Optimisation Research Group, School of Pharmacy & Medical Sciences, Faculty of Life Sciences, University of Bradford, Bradford, UK
- Division of Pharmacy & Optometry, School of Health Sciences, Faculty of Biology, Medicine & Health, University of Manchester, Manchester, UK
- NIHR Greater Manchester Patient Safety Research Collaboration, Manchester, UK
- Pharmacy Department, Royal Manchester Children's Hospital, Manchester University NHS Foundation Trust, Manchester, UK
| | - Denham L Phipps
- Division of Pharmacy & Optometry, School of Health Sciences, Faculty of Biology, Medicine & Health, University of Manchester, Manchester, UK
- NIHR Greater Manchester Patient Safety Research Collaboration, Manchester, UK
| | - Suzanne Grant
- Division of Population Health and Genomics, School of Medicine, University of Dundee, Dundee, UK
| | | | - Stephen Tomlin
- Children's Medicines Research & Innovation Centre, Great Ormond Street Hospital NHS Foundation Trust, London, UK
| | - Darren M Ashcroft
- Division of Pharmacy & Optometry, School of Health Sciences, Faculty of Biology, Medicine & Health, University of Manchester, Manchester, UK
- NIHR Greater Manchester Patient Safety Research Collaboration, Manchester, UK
| |
Collapse
|
19
|
Kristiansen PC, Bastien S, Debesay J, Fagernes M. How and why do healthcare workers use gloves in two Norwegian nursing homes? J Hosp Infect 2024; 146:134-140. [PMID: 38423133 DOI: 10.1016/j.jhin.2024.02.005] [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] [Received: 11/05/2023] [Revised: 02/14/2024] [Accepted: 02/15/2024] [Indexed: 03/02/2024]
Abstract
BACKGROUND Incorrect glove use can cause cross-contamination and healthcare-associated infections. Previous research has identified reasons for this, such as lack of indication, improper changing, and poor hand hygiene post use. Limited research has investigated the reasons behind healthcare workers' glove usage. AIM To develop an in-depth understanding of healthcare worker (HCW) attitudes and perceptions of glove use and to explore barriers and facilitators as well as compliance with national guidelines. METHODS A small-scale convergent-parallel mixed methods study design consisting of observations with focus group interviews (FGIs) by using the Systems Engineering Initiative for Patient Safety model (SEIPS). The study was conducted at two Norwegian municipal nursing homes in Oslo for two weeks in January-February 2023. FINDINGS Out of 73 observations, gloves were used in 67 episodes, not worn even if indicated in six observations, and were overused 16 times (21.9%). Lack of hand hygiene after glove removal was observed in 36 out of 67 instances (53.7%). Two FGIs disclosed that glove usage decisions are shaped by habits, knowledge, experience, and emotions linked to patient requirements, tasks, and glove type. Double gloves were used for self-protection and efficiency. Availability of gloves was a facilitator, while poor glove quality posed a barrier. CONCLUSION Despite HCWs' knowledge of glove guidelines, their attitudes did not consistently ensure compliance. This study underscores the need for targeted interventions to improve hand hygiene after glove removal, urging awareness of glove overuse to reduce infections, protect HCWs' skin, and promote sustainability.
Collapse
Affiliation(s)
- P C Kristiansen
- Infection Prevention Nurse, MPH, Nursing Home Agency, Oslo Municipal, Oslo City, Norway; Department of Public Health, Science Faculty of Landscape and Society, Norwegian University of Life Sciences (NMBU), Aas, Norway.
| | - S Bastien
- Department of Public Health, Science Faculty of Landscape and Society, Norwegian University of Life Sciences (NMBU), Aas, Norway
| | - J Debesay
- Department of Nursing and Health Promotion, Faculty of Health Sciences, OsloMet, Oslo, Norway
| | - M Fagernes
- Department of Antimicrobial Resistance and Infection Prevention, Norwegian Institute of Public Health (NIPH), Oslo, Norway
| |
Collapse
|
20
|
Yusof MM, Takeda T, Shimai Y, Mihara N, Matsumura Y. Evaluating health information systems-related errors using the human, organization, process, technology-fit (HOPT-fit) framework. Health Informatics J 2024; 30:14604582241252763. [PMID: 38805345 DOI: 10.1177/14604582241252763] [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: 05/30/2024]
Abstract
Complex socio-technical health information systems (HIS) issues can create new error risks. Therefore, we evaluated the management of HIS-related errors using the proposed human, organization, process, and technology-fit framework to identify the lessons learned. Qualitative case study methodology through observation, interview, and document analysis was conducted at a 1000-bed Japanese specialist teaching hospital. Effective management of HIS-related errors was attributable to many socio-technical factors including continuous improvement, safety culture, strong management and leadership, effective communication, preventive and corrective mechanisms, an incident reporting system, and closed feedback loops. Enablers of medication errors include system sophistication and process factors like workarounds, variance, clinical workload, slips and mistakes, and miscommunication. The case management effectiveness in handling the HIS-related errors can guide other clinical settings. The potential of HIS to minimize errors can be achieved through continual, systematic, and structured evaluation. The case study validated the applicability of the proposed evaluation framework that can be applied flexibly according to study contexts to inform HIS stakeholders in decision-making. The comprehensive and specific measures of the proposed framework and approach can be a useful guide for evaluating complex HIS-related errors. Leaner and fitter socio-technical components of HIS can yield safer system use.
Collapse
Affiliation(s)
- Maryati Mohd Yusof
- Faculty of Information Science and Technology, Universiti Kebangsaan Malaysia(UKM), Bangi, Malaysia
| | - Toshihiro Takeda
- Department of Medical Informatics, Graduate School of Medicine, Osaka University, Osaka, Japan
| | - Yoshie Shimai
- Department of Medical Informatics, Graduate School of Medicine, Osaka University, Osaka, Japan
| | - Naoki Mihara
- Medical Informatics & Systems Management, Hiroshima UniversityHospital, Hiroshima, Japan
| | - Yasuhsi Matsumura
- National Hospital Organization, Osaka National Hospital, Osaka, Japan
| |
Collapse
|
21
|
Wild KT, Rintoul N, Hedrick HL, Heimall L, Soorikian L, Foglia EE, Ades AM, Herrick HM. Delivery Room Resuscitation of Infants with Congenital Diaphragmatic Hernia: Lessons Learned through Video Review. Fetal Diagn Ther 2024:000538536. [PMID: 38531327 DOI: 10.1159/000538536] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2024] [Accepted: 03/22/2024] [Indexed: 03/28/2024]
Abstract
INTRODUCTION Delivery room (DR) interventions for infants with congenital diaphragmatic hernia (CDH) are not well described. This study sought to describe timing and order of DR interventions and identify system factors impacting CDH DR resuscitations using a human factors framework. METHODS Single center observational study of video recorded CDH DR resuscitations documenting timing and order of interventions. The team used the Systems Engineering Initiative for Patient Safety (SEIPS) model to identify system factors impacting DR resuscitations and time to invasive ventilation. RESULTS We analyzed 31 video recorded CDH resuscitations. We observed variability in timing and order of resuscitation tasks. The 'Internal Environment' and 'Tasks' components of the SEIPS model were prominent factors affecting resuscitation efficiency; significant room and bed spatial constraints exist, and nurses have a significant task burden. Additionally, endotracheal tube preparation was a prominent barrier to timely invasive ventilation. CONCLUSION Video review revealed variation in event timing and order during CDH resuscitations. Standardization of room set-up, equipment, and event order and reallocation of tasks facilitate more efficient intubation and ventilation, representing targets for CDH DR improvement initiatives. This work emphasizes the utility of rigorous human factors review to identify areas for improvement during DR resuscitation.
Collapse
|
22
|
Lamé G, Liberati EG, Canham A, Burt J, Hinton L, Draycott T, Winter C, Dakin FH, Richards N, Miller L, Willars J, Dixon-Woods M. Why is safety in intrapartum electronic fetal monitoring so hard? A qualitative study combining human factors/ergonomics and social science analysis. BMJ Qual Saf 2024; 33:246-256. [PMID: 37945341 PMCID: PMC10982615 DOI: 10.1136/bmjqs-2023-016144] [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: 03/21/2023] [Accepted: 09/16/2023] [Indexed: 11/12/2023]
Abstract
BACKGROUND Problems in intrapartum electronic fetal monitoring with cardiotocography (CTG) remain a major area of preventable harm. Poor understanding of the range of influences on safety may have hindered improvement. Taking an interdisciplinary perspective, we sought to characterise the everyday practice of CTG monitoring and the work systems within which it takes place, with the goal of identifying potential sources of risk. METHODS Human factors/ergonomics (HF/E) experts and social scientists conducted 325 hours of observations and 23 interviews in three maternity units in the UK, focusing on how CTG tasks were undertaken, the influences on this work and the cultural and organisational features of work settings. HF/E analysis was based on the Systems Engineering Initiative for Patient Safety 2.0 model. Social science analysis was based on the constant comparative method. RESULTS CTG monitoring can be understood as a complex sociotechnical activity, with tasks, people, tools and technology, and organisational and external factors all combining to affect safety. Fetal heart rate patterns need to be recorded and interpreted correctly. Systems are also required for seeking the opinions of others, determining whether the situation warrants concern, escalating concerns and mobilising response. These processes may be inadequately designed or function suboptimally, and may be further complicated by staffing issues, equipment and ergonomics issues, and competing and frequently changing clinical guidelines. Practice may also be affected by variable standards and workflows, variations in clinical competence, teamwork and situation awareness, and the ability to communicate concerns freely. CONCLUSIONS CTG monitoring is an inherently collective and sociotechnical practice. Improving it will require accounting for complex system interdependencies, rather than focusing solely on discrete factors such as individual technical proficiency in interpreting traces.
Collapse
Affiliation(s)
- Guillaume Lamé
- Laboratoire Génie Industriel, CentraleSupélec, Gif-sur-Yvette, France
- Department of Public Health and Primary Care, THIS Institute (The Healthcare Improvement Studies Institute), University of Cambridge, Cambridge, UK
| | - Elisa Giulia Liberati
- Department of Public Health and Primary Care, THIS Institute (The Healthcare Improvement Studies Institute), University of Cambridge, Cambridge, UK
| | | | - Jenni Burt
- Department of Public Health and Primary Care, THIS Institute (The Healthcare Improvement Studies Institute), University of Cambridge, Cambridge, UK
| | - Lisa Hinton
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | | | | | - Francesca Helen Dakin
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Natalie Richards
- Department of Public Health and Primary Care, THIS Institute (The Healthcare Improvement Studies Institute), University of Cambridge, Cambridge, UK
| | - Lucy Miller
- University Division of Anaesthesia, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Janet Willars
- Department of Health Sciences, University of Leicester, Leicester, UK
| | - Mary Dixon-Woods
- Department of Public Health and Primary Care, THIS Institute (The Healthcare Improvement Studies Institute), University of Cambridge, Cambridge, UK
| |
Collapse
|
23
|
Dubé M, Martel J, Kumagai J, Suddes M, Cullen J, Laberge J. Applying Human Factors and Systems Simulation Methods to Inform a Multimillion-Dollar Healthcare Decision. HERD-HEALTH ENVIRONMENTS RESEARCH & DESIGN JOURNAL 2024:19375867241229078. [PMID: 38439644 DOI: 10.1177/19375867241229078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/06/2024]
Abstract
PURPOSE This article describes a case study of a collaborative human factors (HF) and systems-focused simulation (SFS) project to evaluate potential patient and staff safety risks associated with a multimillion-dollar design and construction decision. BACKGROUND The combined integration of HF and SFS methods in healthcare related to testing and informing the design of new environments and processes is underutilized. Few realize the effectiveness of this integration in healthcare to reduce risk and improve decision-making, safety, design, efficiency, patient experience, and outcomes. This project showcases how the combined use of HF and SFS methods can provide objective evidence to help inform decisions. METHODS The project was initiated by a healthcare executive team looking for an objective, user informed analysis of a current connector passageway between two existing buildings. The goal was to understand the implications of keeping the current route for simultaneous use for public and patients service flow versus building and financing a new passageway for separate flow and transport. An interprofessional team of intensive care unit professionals participated in two simulations designed to test the current connector. A failure mode and effects analysis and qualitative debrief feedback was used to evaluate risks and potential failures. RESULTS The evaluation resulted in data that enabled informed executive decision making for the most effective, efficient, and safest option for public, staff, and patient transport between two buildings. This evaluation resulted in the decision to go forward with building a multimillion-dollar new connector passageway to improve integrated care and transport.
Collapse
Affiliation(s)
- Mirette Dubé
- Alberta Health Services, Foothills Medical Centre, Calgary, Alberta, Canada
| | - Jessica Martel
- Alberta Health Services, Foothills Medical Centre, Calgary, Alberta, Canada
| | - Jason Kumagai
- Alberta Health Services, Foothills Medical Centre, Calgary, Alberta, Canada
| | - Michael Suddes
- Alberta Health Services, Foothills Medical Centre, Calgary, Alberta, Canada
| | - Janice Cullen
- Alberta Health Services, Foothills Medical Centre, Calgary, Alberta, Canada
| | - Jason Laberge
- Alberta Health Services, Foothills Medical Centre, Calgary, Alberta, Canada
| |
Collapse
|
24
|
Parker SH, Jesso MN, Wolf LD, Leigh KA, Booth S, Gualandi N, Garrick RE, Kliger AS, Patel PR. Human Factors Contributing to Infection Prevention in Outpatient Hemodialysis Centers: A Mixed Methods Study. Am J Kidney Dis 2024:S0272-6386(24)00626-7. [PMID: 38447708 DOI: 10.1053/j.ajkd.2023.12.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Revised: 12/18/2023] [Accepted: 12/23/2023] [Indexed: 03/08/2024]
Abstract
RATIONALE & OBJECTIVE Infection prevention efforts in dialysis centers can avert patient morbidity and mortality but are challenging to implement. The objective of this study was to better understand how the design of the work system might contribute to infection prevention in outpatient dialysis centers. STUDY DESIGN Mixed methods, observational study. SETTING & PARTICIPANTS Six dialysis facilities across the United States visited by a multidisciplinary team over 8 months. ANALYTICAL APPROACH At each facility, structured macroergonomic observations were undertaken by a multidisciplinary team using the SEIPS 1.0 model. Ethnographic observations were collected about staff encounters with dialysis patients including the content of staff conversations. Selective and axial coding were used for qualitative analysis and quantitative data were reported using descriptive statistics. RESULTS Organizational and sociotechnical barriers and facilitators to infection prevention in the outpatient dialysis setting were identified. Features related to human performance, (eg, alarms, interruptions, and task stacking), work system design (eg, physical space, scheduling, leadership, and culture), and extrinsic factors (eg, patient-related characteristics) were identified. LIMITATIONS This was an exploratory evaluation with a small sample size. CONCLUSIONS This study used a systematic macroergonomic approach in multiple outpatient dialysis facilities to identify infection prevention barriers and facilitators related to human performance. Several features common across facilities were identified that may influence infection prevention in outpatient care and warrant further exploration.
Collapse
Affiliation(s)
| | | | | | | | - Stephanie Booth
- Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Nicole Gualandi
- Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Renee E Garrick
- New York Medical and Westchester Medical Center, Valhalla, New York
| | - Alan S Kliger
- Department of Medicine, Section of Nephrology, School of Medicine, Yale University, New Haven, Connecticut
| | - Priti R Patel
- Centers for Disease Control and Prevention, Atlanta, Georgia
| |
Collapse
|
25
|
Ji W, Liu H, Pan K, Huang R, Xu C, Wei Z, Wang J. Knowledge mapping analysis of safety ergonomics: a bibliometric study. ERGONOMICS 2024; 67:398-421. [PMID: 37288996 DOI: 10.1080/00140139.2023.2223788] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Accepted: 06/06/2023] [Indexed: 06/09/2023]
Abstract
Although a significant attention, the field of safety ergonomics has not yet been systematically profiled based on recent studies. To fully understand the current research status, basis, hotspots, and development trends in the field, 533 documents from the Web of Science core database were used for knowledge mapping analysis by the bibliometric method. The study found that the USA is the top country in publications, and Tehran University is the institution with the highest number of publications. Ergonomics and Applied Economics are the authoritative safety ergonomics journals. Through co-occurrence and co-citation analysis, current safety ergonomics research is focussed on healthcare, product design, and occupational health and safety. The keyword timeline view indicates that the main research paths are occupational health and safety, and patient safety research. The analysis of burst keywords shows that safety ergonomics research in management, model design, and system design areas are research frontiers in the field.Practitioner summary: This paper presents a knowledge mapping of safety ergonomics research through bibliometric analysis. The research results show the research status, research hotspots, and research frontiers in the field of safety ergonomics, which provides a direction for other scholars to quickly understand the development of this field.
Collapse
Affiliation(s)
- Wenjing Ji
- College of Quality and Safety Engineering, China Jiliang University, Hangzhou, China
| | - Hui Liu
- College of Quality and Safety Engineering, China Jiliang University, Hangzhou, China
| | - Kai Pan
- College of Quality and Safety Engineering, China Jiliang University, Hangzhou, China
| | - Rui Huang
- College of Quality and Safety Engineering, China Jiliang University, Hangzhou, China
| | - Chang Xu
- College of Quality and Safety Engineering, China Jiliang University, Hangzhou, China
| | - Ze Wei
- College of Quality and Safety Engineering, China Jiliang University, Hangzhou, China
| | - Jianhai Wang
- College of Quality and Safety Engineering, China Jiliang University, Hangzhou, China
| |
Collapse
|
26
|
McKinley LL, Goedken CC, Balkenende EC, Hockett Sherlock SM, Knobloch MJ, Bartel R, Perencevich EN, Reisinger HS, Safdar N. Using a human-factors engineering approach to evaluate environmental cleaning in Veterans' Affairs acute and long-term care facilities: A qualitative analysis. Infect Control Hosp Epidemiol 2024; 45:351-359. [PMID: 37873620 DOI: 10.1017/ice.2023.226] [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: 10/25/2023]
Abstract
BACKGROUND Environmental cleaning is important in the interruption of pathogen transmission. Although prevention initiatives have targeted environmental cleaning, practice variations exist and compliance is low. Evaluation of human factors influencing variations in cleaning practices can be valuable in developing interventions to standardized practices. We conducted a work-system analysis using a human-factors engineering (HFE) framework to identify barriers and facilitators to environmental cleaning practices in acute and long-term care settings within the Veterans' Affairs health system. METHODS We conducted a qualitative study with key stakeholders at 3 VA facilities. We analyzed transcripts for thematic content and mapped themes to the HFE framework. RESULTS Staffing consistency was felt to improve cleaning practices and teamwork. We found that many environmental management service (EMS) staff were veterans who were motivated to serve fellow veterans, especially to prevent infections. However, hiring veterans comes with regulatory hurdles that affect staffing. Sites reported some form of monitoring their cleaning process, but there was variation in method and frequency. The EMS workload was affected by whether rooms were occupied by patients or were semiprivate rooms; both were reportedly more difficult to clean. Room design and surface finishes were identified as important to cleaning efficiency. CONCLUSION HFE work analysis identified barriers and facilitators to environmental cleaning. These findings highlight intervention entry points that may facilitate standardized work practices. There is a need to develop task-specific procedures such as cleaning occupied beds and semiprivate rooms. Future research should evaluate interventions that address these determinants of environmental cleaning.
Collapse
Affiliation(s)
- Linda L McKinley
- William S. Middleton Memorial Veterans' Hospital, Madison, Wisconsin
| | - Cassie C Goedken
- Center for Access and Delivery Research and Evaluation (CADRE), Iowa City, Iowa
- Iowa City VA Health Care System, Iowa City, Iowa
| | - Erin C Balkenende
- Center for Access and Delivery Research and Evaluation (CADRE), Iowa City, Iowa
- Iowa City VA Health Care System, Iowa City, Iowa
- Carver College of Medicine, University of Iowa, Iowa City, Iowa
| | - Stacey M Hockett Sherlock
- Center for Access and Delivery Research and Evaluation (CADRE), Iowa City, Iowa
- Iowa City VA Health Care System, Iowa City, Iowa
- Carver College of Medicine, University of Iowa, Iowa City, Iowa
| | - Mary Jo Knobloch
- Center for Access and Delivery Research and Evaluation (CADRE), Iowa City, Iowa
- Carver College of Medicine, University of Iowa, Iowa City, Iowa
| | - Rosie Bartel
- Patient-Centered Outcomes Research Institute (PCORI), Washington, DC
| | - Eli N Perencevich
- Center for Access and Delivery Research and Evaluation (CADRE), Iowa City, Iowa
- Iowa City VA Health Care System, Iowa City, Iowa
- Carver College of Medicine, University of Iowa, Iowa City, Iowa
| | - Heather S Reisinger
- Center for Access and Delivery Research and Evaluation (CADRE), Iowa City, Iowa
- Iowa City VA Health Care System, Iowa City, Iowa
- Carver College of Medicine, University of Iowa, Iowa City, Iowa
- Institute for Clinical and Translational Science, Iowa City, Iowa
| | - Nasia Safdar
- William S. Middleton Memorial Veterans' Hospital, Madison, Wisconsin
- University of Wisconsin-Madison, Madison, Wisconsin
| |
Collapse
|
27
|
Leon C, Hogan H, Jani YH. Identifying and mapping measures of medication safety during transfer of care in a digital era: a scoping literature review. BMJ Qual Saf 2024; 33:173-186. [PMID: 37923372 PMCID: PMC10894843 DOI: 10.1136/bmjqs-2022-015859] [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: 12/21/2022] [Accepted: 10/04/2023] [Indexed: 11/07/2023]
Abstract
BACKGROUND Measures to evaluate high-risk medication safety during transfers of care should span different safety dimensions across all components of these transfers and reflect outcomes and opportunities for proactive safety management. OBJECTIVES To scope measures currently used to evaluate safety interventions targeting insulin, anticoagulants and other high-risk medications during transfers of care and evaluate their comprehensiveness as a portfolio. METHODS Embase, Medline, Cochrane and CINAHL databases were searched using scoping methodology for studies evaluating the safety of insulin, anticoagulants and other high-risk medications during transfer of care. Measures identified were extracted into a spreadsheet, collated and mapped against three frameworks: (1) 'Key Components of an Ideal Transfer of Care', (2) work systems, processes and outcomes and (3) whether measures captured past harms, events in real time or areas of concern. The potential for digital health systems to support proactive measures was explored. RESULTS Thirty-five studies were reviewed with 162 measures in use. Once collated, 29 discrete categories of measures were identified. Most were outcome measures such as adverse events. Process measures included communication and issue identification and resolution. Clinic enrolment was the only work system measure. Twenty-four measures captured past harm (eg, adverse events) and six indicated future risk (eg, patient feedback for organisations). Two real-time measures alerted healthcare professionals to risks using digital systems. No measures were of advance care planning or enlisting support. CONCLUSION The measures identified are insufficient for a comprehensive portfolio to assess safety of key medications during transfer of care. Further measures are required to reflect all components of transfers of care and capture the work system factors contributing to outcomes in order to support proactive intervention to reduce unwanted variation and prevent adverse outcomes. Advances in digital technology and its employment within integrated care provide opportunities for the development of such measures.
Collapse
Affiliation(s)
- Catherine Leon
- Department of Health Services Research and Policy, London School of Hygiene & Tropical Medicine, London, UK
| | - Helen Hogan
- Department of Health Services Research and Policy, London School of Hygiene & Tropical Medicine, London, UK
| | - Yogini H Jani
- Department of Practice and Policy, University College London School of Pharmacy, London, UK
- Centre for Medicines Optimisation Research and Education, University College London Hospitals NHS Foundation Trust, London, UK
| |
Collapse
|
28
|
Wong AH, Nath B, Shah D, Kumar A, Brinker M, Faustino IV, Boyce M, Dziura JD, Heckmann R, Yonkers KA, Bernstein SL, Adapa K, Taylor RA, Ovchinnikova P, McCall T, Melnick ER. Formative evaluation of an emergency department clinical decision support system for agitation symptoms: a study protocol. BMJ Open 2024; 14:e082834. [PMID: 38373857 PMCID: PMC10882402 DOI: 10.1136/bmjopen-2023-082834] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2023] [Accepted: 01/31/2024] [Indexed: 02/21/2024] Open
Abstract
INTRODUCTION The burden of mental health-related visits to emergency departments (EDs) is growing, and agitation episodes are prevalent with such visits. Best practice guidance from experts recommends early assessment of at-risk populations and pre-emptive intervention using de-escalation techniques to prevent agitation. Time pressure, fluctuating work demands, and other systems-related factors pose challenges to efficient decision-making and adoption of best practice recommendations during an unfolding behavioural crisis. As such, we propose to design, develop and evaluate a computerised clinical decision support (CDS) system, Early Detection and Treatment to Reduce Events with Agitation Tool (ED-TREAT). We aim to identify patients at risk of agitation and guide ED clinicians through appropriate risk assessment and timely interventions to prevent agitation with a goal of minimising restraint use and improving patient experience and outcomes. METHODS AND ANALYSIS This study describes the formative evaluation of the health record embedded CDS tool. Under aim 1, the study will collect qualitative data to design and develop ED-TREAT using a contextual design approach and an iterative user-centred design process. Participants will include potential CDS users, that is, ED physicians, nurses, technicians, as well as patients with lived experience of restraint use for behavioural crisis management during an ED visit. We will use purposive sampling to ensure the full spectrum of perspectives until we reach thematic saturation. Next, under aim 2, the study will conduct a pilot, randomised controlled trial of ED-TREAT at two adult ED sites in a regional health system in the Northeast USA to evaluate the feasibility, fidelity and bedside acceptability of ED-TREAT. We aim to recruit a total of at least 26 eligible subjects under the pilot trial. ETHICS AND DISSEMINATION Ethical approval by the Yale University Human Investigation Committee was obtained in 2021 (HIC# 2000030893 and 2000030906). All participants will provide informed verbal consent prior to being enrolled in the study. Results will be disseminated through publications in open-access, peer-reviewed journals, via scientific presentations or through direct email notifications. TRIAL REGISTRATION NUMBER NCT04959279; Pre-results.
Collapse
Affiliation(s)
- Ambrose H Wong
- Yale New Haven Health System, New Haven, Connecticut, USA
- Department of Emergency Medicine, Yale School of Medicine, New Haven, Connecticut, USA
| | - Bidisha Nath
- Department of Emergency Medicine, Yale School of Medicine, New Haven, Connecticut, USA
| | - Dhruvil Shah
- Department of Emergency Medicine, Yale School of Medicine, New Haven, Connecticut, USA
| | - Anusha Kumar
- Department of Emergency Medicine, Yale School of Medicine, New Haven, Connecticut, USA
| | - Morgan Brinker
- Department of Emergency Medicine, Yale School of Medicine, New Haven, Connecticut, USA
| | - Isaac V Faustino
- Department of Emergency Medicine, Yale School of Medicine, New Haven, Connecticut, USA
| | - Michael Boyce
- Yale New Haven Health System, New Haven, Connecticut, USA
| | - James D Dziura
- Department of Emergency Medicine, Yale School of Medicine, New Haven, Connecticut, USA
- Department of Biostatistics, Yale School of Public Health, New Haven, Connecticut, USA
| | - Rebekah Heckmann
- Yale New Haven Health System, New Haven, Connecticut, USA
- Department of Emergency Medicine, Yale School of Medicine, New Haven, Connecticut, USA
| | - Kimberly A Yonkers
- Department of Psychiatry, University of Massachusetts System, Worchester, Massachusetts, USA
| | - Steven L Bernstein
- Department of Emergency Medicine, Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire, USA
| | - Karthik Adapa
- Carolina Health Informatics Program, University of North Carolina System, Chapel Hill, North Carolina, USA
| | - Richard Andrew Taylor
- Yale New Haven Health System, New Haven, Connecticut, USA
- Department of Emergency Medicine, Yale School of Medicine, New Haven, Connecticut, USA
| | - Polina Ovchinnikova
- Department of Biostatistics, Yale School of Public Health, New Haven, Connecticut, USA
- Section of Biomedical Informatics and Data Science, Yale School of Medicine, New Haven, Connecticut, USA
| | - Terika McCall
- Department of Biostatistics, Yale School of Public Health, New Haven, Connecticut, USA
- Section of Biomedical Informatics and Data Science, Yale School of Medicine, New Haven, Connecticut, USA
| | - Edward R Melnick
- Yale New Haven Health System, New Haven, Connecticut, USA
- Department of Emergency Medicine, Yale School of Medicine, New Haven, Connecticut, USA
| |
Collapse
|
29
|
Hernandez SE, Solomon D, Moon J, Parmasad V, Wiegmann D, Bennett NT, Ferren RS, Fitzsimmons AJ, Lepak AJ, O'Horo JC, Pop-Vicas AE, Schulz LT, Safdar N. Understanding clinical implementation coordinators' experiences in deploying evidence-based interventions. Am J Health Syst Pharm 2024; 81:120-128. [PMID: 37897218 DOI: 10.1093/ajhp/zxad272] [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: 10/24/2023] [Indexed: 10/29/2023] Open
Abstract
PURPOSE The fluoroquinolone restriction for the prevention of Clostridioides difficile infection (FIRST) trial is a multisite clinical study in which sites carry out a preauthorization process via electronic health record-based best-practice alert (BPA) to optimize the use of fluoroquinolone antibiotics in acute care settings. Our research team worked closely with clinical implementation coordinators to facilitate the dissemination and implementation of this evidence-based intervention. Clinical implementation coordinators within the antibiotic stewardship team (AST) played a pivotal role in the implementation process; however, considerable research is needed to further understand their role. In this study, we aimed to (1) describe the roles and responsibilities of clinical implementation coordinators within ASTs and (2) identify facilitators and barriers coordinators experienced within the implementation process. METHODS We conducted a directed content analysis of semistructured interviews, implementation diaries, and check-in meetings utilizing the conceptual framework of middle managers' roles in innovation implementation in healthcare from Urquhart et al. RESULTS Clinical implementation coordinators performed a variety of roles vital to the implementation's success, including gathering and compiling information for BPA design, preparing staff, organizing meetings, connecting relevant stakeholders, evaluating clinical efficacy, and participating in the innovation as clinicians. Coordinators identified organizational staffing models and COVID-19 interruptions as the main barriers. Facilitators included AST empowerment, positive relationships with staff and oversight/governance committees, and using diverse implementation strategies. CONCLUSION When implementing healthcare innovations, clinical implementation coordinators facilitated the implementation process through their roles and responsibilities and acted as strategic partners in improving the adoption and sustainability of a fluoroquinolone preauthorization protocol.
Collapse
Affiliation(s)
- Sara E Hernandez
- School of Pharmacy, University of Wisconsin-Madison, Madison, WI, USA
| | - Demetrius Solomon
- Department of Industrial and Systems Engineering, University of Wisconsin-Madison, Madison, WI, USA
| | - Jukrin Moon
- School of Pharmacy, University of Wisconsin-Madison, Madison, WI, USA
| | - Vishala Parmasad
- School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI, USA
| | - Douglas Wiegmann
- Department of Industrial and Systems Engineering, University of Wisconsin-Madison, Madison, WI, USA
| | - Nick T Bennett
- Antimicrobial Stewardship Program, Saint Luke's Health System, Kansas City, MO, USA
| | - Ryan S Ferren
- University of Texas Medical Branch, Galveston, TX, USA
| | - Alec J Fitzsimmons
- Department of Medical Research, Gundersen Health System, La Crosse, WI, USA
| | - Alexander J Lepak
- School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI, USA
| | - John C O'Horo
- Mayo Foundation for Medical Education and Research, Rochester, MN, USA
| | - Aurora E Pop-Vicas
- School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI, USA
| | - Lucas T Schulz
- Department of Pharmacy, University of Wisconsin Health, Madison, WI, USA
| | - Nasia Safdar
- School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI, USA
| |
Collapse
|
30
|
McCormack C, Savoy A, Mathew A, Gilmore AM, Cottingham E, Sangani A, Caldwell B, Holden RJ, Weiner M. Characterizing barriers to closing cross-institutional referral loops: Workflow and information flow analysis. APPLIED ERGONOMICS 2024; 115:104177. [PMID: 38016271 PMCID: PMC10863302 DOI: 10.1016/j.apergo.2023.104177] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Revised: 10/28/2023] [Accepted: 11/09/2023] [Indexed: 11/30/2023]
Abstract
The specialty referral process consists of primary care clinicians referring patients to specialty consultants. This care transition requires effective care coordination and health information exchange between care teams; however, breakdowns in workflow and information flow impede "closing the referral loop" and delay or prevent referrers from receiving the consultant's "visit notes," particularly in cross-institutional referrals. This study aimed to describe and map the referral process as it occurs in clinics and identify and characterize work system barriers affecting its performance. Referrers and consultants were interviewed about their perceived workflows, barriers, and clinical outcomes to inform a workflow analysis.
Collapse
Affiliation(s)
| | - April Savoy
- Purdue School of Engineering and Technology, Indiana University-Purdue University Indianapolis, Indiana, USA; Regenstrief Institute, Inc., Indianapolis, IN, USA; Center for Health Information and Communication, Department of Veterans Affairs, Veterans Health Administration, Health Services Research and Development Service CIN 13-416, Richard L. Roudebush VA Medical Center, Indianapolis, IN, USA.
| | - Anna Mathew
- Purdue School of Engineering and Technology, Indiana University-Purdue University Indianapolis, Indiana, USA; Regenstrief Institute, Inc., Indianapolis, IN, USA
| | | | | | - Amee Sangani
- Regenstrief Institute, Inc., Indianapolis, IN, USA; Indiana University School of Medicine, Indianapolis, IN, USA
| | - Barrett Caldwell
- Purdue University School of Industrial Engineering, West Lafayette, IN, USA
| | - Richard J Holden
- Regenstrief Institute, Inc., Indianapolis, IN, USA; Indiana University School of Medicine, Indianapolis, IN, USA; Indiana University School of Public Health-Bloomington, Bloomington, IN, USA
| | - Michael Weiner
- Regenstrief Institute, Inc., Indianapolis, IN, USA; Center for Health Information and Communication, Department of Veterans Affairs, Veterans Health Administration, Health Services Research and Development Service CIN 13-416, Richard L. Roudebush VA Medical Center, Indianapolis, IN, USA; Indiana University School of Medicine, Indianapolis, IN, USA
| |
Collapse
|
31
|
Healey J, Hignett S, Gyi D. A day in the life of a home care worker in England: A human factors systems perspective. APPLIED ERGONOMICS 2024; 115:104151. [PMID: 37992651 DOI: 10.1016/j.apergo.2023.104151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Revised: 10/02/2023] [Accepted: 10/08/2023] [Indexed: 11/24/2023]
Abstract
The delivery of home care in England is explored with respect to (a) the work system (b) the barriers that challenge worker performance, and most importantly (c) whether these barriers impact the quality and safety of the care received by older adults. Data were collected using surveys and interviews with home care workers (n = 11). The analysis used two validated Human Factors and Ergonomics (HFE) models to map the data which identified three key performance barriers; (1) time factors, (2) organisational practices, and (3) job design. Adaptive behaviour was identified as being routine to manage time barriers, which resulted in trade-offs between care outcomes (delivery), quality and safety standards and work-related quality of life. The findings make an important contribution to the limited research literature on home care work by highlighting the opportunity for an HFE systems perspective to provide a novel approach for both understanding home care and building better home care systems.
Collapse
Affiliation(s)
- Jan Healey
- School of Design and Creative Arts, Loughborough University, Epinal Way, Loughborough, Leicestershire, England, LE11 3TU, United Kingdom.
| | - Sue Hignett
- School of Design and Creative Arts, Loughborough University, Epinal Way, Loughborough, Leicestershire, England, LE11 3TU, United Kingdom.
| | - Diane Gyi
- School of Design and Creative Arts, Loughborough, United Kingdom.
| |
Collapse
|
32
|
Magerøy MR, Macrae C, Braut GS, Wiig S. Managing patient safety and staff safety in nursing homes: exploring how leaders of nursing homes negotiate their dual responsibilities-a case study. FRONTIERS IN HEALTH SERVICES 2024; 4:1275743. [PMID: 38348403 PMCID: PMC10860424 DOI: 10.3389/frhs.2024.1275743] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/15/2023] [Accepted: 01/19/2024] [Indexed: 02/15/2024]
Abstract
Objective Within healthcare, the role of leader is becoming more complex, and healthcare leaders carry an increasing responsibility for the performance of employees, the experience and safety of patients and the quality of care provision. This study aimed to explore how leaders of nursing homes manage the dual responsibility of both Health, Safety and Environment (HSE) and Quality and Patient Safety (QPS), focusing particularly on the approaches leaders take and the dilemmas they face. In addition, we wanted to examine how leaders experience and manage the challenges of HSE and QPS in a holistic way. Design/setting The study was designed as a case study. Data were collected through semi structured individual interviews with leaders of nursing homes in five Norwegian municipalities. Participants 13 leaders of nursing homes in urban and rural municipalities participated in this study. Results Data analysis resulted in four themes explaining how leaders of nursing homes manage the dual responsibility of HSE and QPS, and the approaches they take and the dilemmas they face: 1.Establishing good systems and building a culture for a work environment that promotes health and patient safety.2.Establish channels for internal and external collaboration and communication.3.Establish room for maneuver to exercise leadership.4.Recognizing and having the mandate to handle possible tensions in the dual responsibility of HSE and QPS. Conclusions The study showed that leaders of nursing homes who are responsible for ensuring quality and safety for both patients and staff, experience tensions in handling this dual responsibility. They acknowledged the importance of having time to be present as a leader, to have robust systems to maintain HSE and QPS, and that conflicting aspects of legislation are an everyday challenge.
Collapse
Affiliation(s)
- Malin Rosell Magerøy
- SHARE – Centre for Resilience in Healthcare, Faculty of Health Science, University of Stavanger, Stavanger, Norway
| | - Carl Macrae
- SHARE – Centre for Resilience in Healthcare, Faculty of Health Science, University of Stavanger, Stavanger, Norway
- Centre for Health, Innovation, Leadership and Learning, Nottingham University Business School, Nottingham, United Kingdom
| | - Geir Sverre Braut
- Department of Research, Stavanger University Hospital, Stavanger, Norway
- Department of Social Science, Western Norway University of Applied Sciences, Sogndal, Norway
| | - Siri Wiig
- SHARE – Centre for Resilience in Healthcare, Faculty of Health Science, University of Stavanger, Stavanger, Norway
| |
Collapse
|
33
|
Zhou Q, Liu J, Zheng F, Wang Q, Zhang X, Li H, Tan L, Luo W. Nurses' preferences for interventions to improve infection prevention and control behaviors based on systems engineering initiative to patient safety model: a discrete choice experiment. BMC Nurs 2024; 23:29. [PMID: 38200529 PMCID: PMC10777601 DOI: 10.1186/s12912-024-01701-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Accepted: 01/01/2024] [Indexed: 01/12/2024] Open
Abstract
BACKGROUND The evidence of preferences for infection prevention and control (IPC) intervention from system perspective was lacked. This study aimed to elicit nurses' preferences for the intervention designed to improve IPC behaviors based on the Systems Engineering Initiative to Patient Safety (SEIPS) model using Discrete Choice Experiment (DCE). METHODS A DCE was conducted among nurses who were on active duty and willing to participate from July 5th to 10th, 2021 in a tertiary hospital in Ganzhou City, Jiangxi Province, using convenience sampling. A self-administered questionnaire included scenarios formed by six attributes with varying levels based on SEIPS model: person, organization, tools and technology, tasks, internal environment and external environment. A conditional logit and latent class logit model were performed to analyze the data. RESULTS A total of 257 valid questionnaires were analyzed among nurses. The results from the latent class logit model show that nurses' preferences can be divided into three classes. For nurses in multifaceted-aspect-preferred class (41.9%), positive coefficients were obtained in those six attributes. For person-preferred class (19.7%), only person was positively significant. For environment-preferred class (36.4%), the most important attribute were tasks, tools and technology, internal environment and external environment. CONCLUSIONS This finding suggest that nurses have three latent-class preferences for interventions. Multifaceted interventions to improve IPC behaviors based on the SEIPS model are preferred by most nurses. Moreover, relevant measured should be performed targeted the latent class of person-preferred and external-environment-preferred nurses.
Collapse
Affiliation(s)
- Qian Zhou
- Department of Hospital Infection Management, Wuhan Children's Hospital (Wuhan Maternal and Child Healthcare Hospital), Tongji Medical College, Huazhong University of Science and Technology , No.100 Xianggang Rd, Wuhan, Hubei Province, China
| | - Junjie Liu
- School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Feiyang Zheng
- School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Qianning Wang
- School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Xinping Zhang
- School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Hui Li
- Children's Oncology Department, Wuhan Children's Hospital (Wuhan Maternal and Child Healthcare Hospital), Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Li Tan
- Department of Hospital Infection Management, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, No.1095 Jie Fang Avenue, 430030, Hankou, Wuhan, China.
| | - Wanjun Luo
- Department of Hospital Infection Management, Wuhan Children's Hospital (Wuhan Maternal and Child Healthcare Hospital), Tongji Medical College, Huazhong University of Science and Technology , No.100 Xianggang Rd, Wuhan, Hubei Province, China.
| |
Collapse
|
34
|
Sidhu R, Turnbull D, Haboubi H, Leeds JS, Healey C, Hebbar S, Collins P, Jones W, Peerally MF, Brogden S, Neilson LJ, Nayar M, Gath J, Foulkes G, Trudgill NJ, Penman I. British Society of Gastroenterology guidelines on sedation in gastrointestinal endoscopy. Gut 2024; 73:219-245. [PMID: 37816587 PMCID: PMC10850688 DOI: 10.1136/gutjnl-2023-330396] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Accepted: 09/06/2023] [Indexed: 10/12/2023]
Abstract
Over 2.5 million gastrointestinal endoscopic procedures are carried out in the United Kingdom (UK) every year. Procedures are carried out with local anaesthetic r with sedation. Sedation is commonly used for gastrointestinal endoscopy, but the type and amount of sedation administered is influenced by the complexity and nature of the procedure and patient factors. The elective and emergency nature of endoscopy procedures and local resources also have a significant impact on the delivery of sedation. In the UK, the vast majority of sedated procedures are carried out using benzodiazepines, with or without opiates, whereas deeper sedation using propofol or general anaesthetic requires the involvement of an anaesthetic team. Patients undergoing gastrointestinal endoscopy need to have good understanding of the options for sedation, including the option for no sedation and alternatives, balancing the intended aims of the procedure and reducing the risk of complications. These guidelines were commissioned by the British Society of Gastroenterology (BSG) Endoscopy Committee with input from major stakeholders, to provide a detailed update, incorporating recent advances in sedation for gastrointestinal endoscopy.This guideline covers aspects from pre-assessment of the elective 'well' patient to patients with significant comorbidity requiring emergency procedures. Types of sedation are discussed, procedure and room requirements and the recovery period, providing guidance to enhance safety and minimise complications. These guidelines are intended to inform practising clinicians and all staff involved in the delivery of gastrointestinal endoscopy with an expectation that this guideline will be revised in 5-years' time.
Collapse
Affiliation(s)
- Reena Sidhu
- Academic Department of Gastroenterology, Royal Hallamshire Hospital, Sheffield, UK
- Department of Infection, Immunity & Cardiovascular Disease, The University of Sheffield, Sheffield, UK
| | - David Turnbull
- Department of Anaesthetics, Royal Hallamshire Hospital, Sheffield, UK
| | - Hasan Haboubi
- Department of Gastroenterology, University Hospital Llandough, Llandough, South Glamorgan, UK
- Institute of Life Sciences, Swansea University, Swansea, UK
| | - John S Leeds
- Hepato-Pancreato-Biliary Unit, Freeman Hospital, Newcastle upon Tyne, UK
- Newcastle University Population Health Sciences Institute, Newcastle upon Tyne, UK
| | - Chris Healey
- Airedale NHS Foundation Trust, Keighley, West Yorkshire, UK
| | - Srisha Hebbar
- Department of Gastroenterology, University Hospital of North Midlands, Stoke-on-Trent, Staffordshire, UK
| | - Paul Collins
- Department of Gastroenterology, Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK
| | - Wendy Jones
- Specialist Pharmacist Breastfeeding and Medication, Portsmouth, UK
| | - Mohammad Farhad Peerally
- Digestive Diseases Unit, Kettering General Hospital; Kettering, Kettering, Northamptonshire, UK
- Department of Population Health Sciences, College of Life Science, University of Leicester, Leicester, UK
| | - Sara Brogden
- Department of Gastroenterology, University College London, UK, London, London, UK
| | - Laura J Neilson
- Department of Gastroenterology, South Tyneside District Hospital, South Shields, Tyne and Wear, UK
| | - Manu Nayar
- Hepato-Pancreato-Biliary Unit, Freeman Hospital, Newcastle upon Tyne, UK
- Newcastle University Population Health Sciences Institute, Newcastle upon Tyne, UK
| | - Jacqui Gath
- Patient Representative on Guideline Development Group and member of Independent Cancer Patients' Voice, Sheffield, UK
| | - Graham Foulkes
- Patient Representative on Guideline Development Group, Manchester, UK
| | - Nigel J Trudgill
- Department of Gastroenterology, Sandwell General Hospital, West Bromwich, UK
| | - Ian Penman
- Centre for Liver and Digestive Disorders, Royal Infirmary Edinburgh, Edinburgh, Midlothian, UK
| |
Collapse
|
35
|
Haylor H, Sparkes T, Armitage G, Dawson-Jones M, Double K, Edwards L. The process and perspective of serious incident investigations in adult community mental health services: integrative review and synthesis. BJPsych Bull 2024:1-13. [PMID: 38174424 DOI: 10.1192/bjb.2023.98] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2024] Open
Abstract
AIMS AND METHOD Serious incident management and organisational learning are international patient safety priorities. Little is known about the quality of suicide investigations and, in turn, the potential for organisational learning. Suicide risk assessment is acknowledged as a complex phenomenon, particularly in the context of adult community mental health services. Root cause analysis (RCA) is the dominant investigative approach, although the evidence base underpinning RCA is contested, with little attention paid to the patient in context and their cumulative risk over time. RESULTS Recent literature proposes a safety-II approach in response to the limitations of RCA. The importance of applying these approaches within a mental healthcare system that advocates a zero suicide framework, grounded in a restorative just culture, is highlighted. CLINICAL IMPLICATIONS Although integrative reviews and syntheses have clear methodological limitations, this approach facilitates the management of a disparate body of work to advance a critical understanding of patient safety in adult community mental healthcare.
Collapse
Affiliation(s)
- Helen Haylor
- First Response Crisis Service, Bradford District Care NHS Foundation Trust, UK
| | - Tony Sparkes
- Faculty of Management, Law and Social Sciences, University of Bradford, UK
| | - Gerry Armitage
- Research and Development Department, Bradford District Care NHS Foundation Trust, UK
- Faculty of Health Studies, University of Bradford, UK
| | - Melanie Dawson-Jones
- Library and Health Promotion Resources Centre, Bradford District Care NHS Foundation Trust, UK
| | - Keith Double
- Patient and Carer Experience and Involvement Team, Bradford District Care NHS Foundation Trust, UK
| | - Lisa Edwards
- Faculty of Health Studies, University of Bradford, UK
| |
Collapse
|
36
|
Oh S, Sang E, Stawnychy MA, Garren P, You SB, O'Connor M, Hirschman KB, Hodgson N, Cranston T, Jablonski J, O'Brien K, Newcomb M, Spahr M, Bowles KH. Application of a Human Factors and Systems Engineering Approach to Explore Care Transitions of Sepsis Survivors From Hospital to Home Health Care. HUMAN FACTORS 2024:187208231222399. [PMID: 38171592 DOI: 10.1177/00187208231222399] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/05/2024]
Abstract
STUDY AIM This study aims to describe the transition-in-care work process for sepsis survivors going from hospitals to home health care (HHC) and identify facilitators and barriers to enable practice change and safe care transitions using a human factors and systems engineering approach. BACKGROUND Despite high readmission risk for sepsis survivors, the transition-in-care work process from hospitals to HHC has not been described. METHODS We analyzed semi-structured needs assessment interviews with 24 stakeholders involved in transitioning sepsis survivors from two hospitals and one affiliated HHC agency participating in the parent implementation science study, I-TRANSFER. The qualitative data analysis was guided by the Systems Engineering Initiative for Patient Safety (SEIPS) framework to describe the work process and identify work system elements. RESULTS We identified 31 tasks characterized as decision making, patient education, communication, information, documentation, and scheduling tasks. Technological and organizational facilitators lacked in HHC compared to the hospitals. Person and organization elements in HHC had the most barriers but few facilitators. Additionally, we identified specific task barriers that could hinder sepsis information transfer from hospitals to HHC. CONCLUSION This study explored the complex transition-in-care work processes for sepsis survivors going from hospitals to HHC. We identified barriers, facilitators, and critical areas for improvement to enable implementation and ensure safe care transitions. A key finding was the sepsis information transfer deficit, highlighting a critical issue for future study. APPLICATION We recommend using the SEIPS framework to explore complex healthcare work processes before the implementation of evidence-based interventions.
Collapse
|
37
|
Sick-Samuels AC, Koontz DW, Xie A, Kelly D, Woods-Hill CZ, Aneja A, Xiao S, Colantuoni EA, Marsteller J, Milstone AM. A Survey of PICU Clinician Practices and Perceptions regarding Respiratory Cultures in the Evaluation of Ventilator-Associated Infections in the BrighT STAR Collaborative. Pediatr Crit Care Med 2024; 25:e20-e30. [PMID: 37812030 PMCID: PMC10756695 DOI: 10.1097/pcc.0000000000003379] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/10/2023]
Abstract
OBJECTIVES To characterize respiratory culture practices for mechanically ventilated patients, and to identify drivers of culture use and potential barriers to changing practices across PICUs. DESIGN Cross-sectional survey conducted May 2021-January 2022. SETTING Sixteen academic pediatric hospitals across the United States participating in the BrighT STAR Collaborative. SUBJECTS Pediatric critical care medicine physicians, advanced practice providers, respiratory therapists, and nurses. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS We summarized the proportion of positive responses for each question within a hospital and calculated the median proportion and IQR across hospitals. We correlated responses with culture rates and compared responses by role. Sixteen invited institutions participated (100%). Five hundred sixty-eight of 1,301 (44%) e-mailed individuals completed the survey (median hospital response rate 60%). Saline lavage was common, but no PICUs had a standardized approach. There was the highest variability in perceived likelihood (median, IQR) to obtain cultures for isolated fever (49%, 38-61%), isolated laboratory changes (49%, 38-57%), fever and laboratory changes without respiratory symptoms (68%, 54-79%), isolated change in secretion characteristics (67%, 54-78%), and isolated increased secretions (55%, 40-65%). Respiratory cultures were likely to be obtained as a "pan culture" (75%, 70-86%). There was a significant correlation between higher culture rates and likelihood to obtain cultures for isolated fever, persistent fever, isolated hypotension, fever, and laboratory changes without respiratory symptoms, and "pan cultures." Respondents across hospitals would find clinical decision support (CDS) helpful (79%) and thought that CDS would help align ICU and/or consulting teams (82%). Anticipated barriers to change included reluctance to change (70%), opinion of consultants (64%), and concern for missing a diagnosis of ventilator-associated infections (62%). CONCLUSIONS Respiratory culture collection and ordering practices were inconsistent, revealing opportunities for diagnostic stewardship. CDS would be generally well received; however, anticipated conceptual and psychologic barriers to change must be considered.
Collapse
Affiliation(s)
- Anna C Sick-Samuels
- Department of Pediatrics, Johns Hopkins School of Medicine, Baltimore, MD
- Department of Hospital Epidemiology and Infection Control, Johns Hopkins Hospital, Baltimore, MD
| | - Danielle W Koontz
- Department of Pediatrics, Johns Hopkins School of Medicine, Baltimore, MD
| | - Anping Xie
- Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD
- Armstrong Institute of Patient Safety and Quality, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Daniel Kelly
- Division of Medical Critical Care, Department of Pediatrics, Boston Children's Hospital, Boston, MA
- Department of Pediatrics, Harvard Medical School, Boston, MA
| | - Charlotte Z Woods-Hill
- Division of Critical Care Medicine, The Children's Hospital of Philadelphia, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA
- The Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA
| | - Anushree Aneja
- Department of Pediatrics, Johns Hopkins School of Medicine, Baltimore, MD
| | - Shaoming Xiao
- Department of Pediatrics, Johns Hopkins School of Medicine, Baltimore, MD
| | - Elizabeth A Colantuoni
- Department of Biostatistics, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD
| | - Jill Marsteller
- Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD
- Armstrong Institute of Patient Safety and Quality, Johns Hopkins University School of Medicine, Baltimore, MD
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD
| | - Aaron M Milstone
- Department of Pediatrics, Johns Hopkins School of Medicine, Baltimore, MD
- Department of Hospital Epidemiology and Infection Control, Johns Hopkins Hospital, Baltimore, MD
| |
Collapse
|
38
|
Haimovich AD, Shah MN, Southerland LT, Hwang U, Patterson BW. Automating risk stratification for geriatric syndromes in the emergency department. J Am Geriatr Soc 2024; 72:258-267. [PMID: 37811698 PMCID: PMC10866303 DOI: 10.1111/jgs.18594] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Revised: 08/11/2023] [Accepted: 08/19/2023] [Indexed: 10/10/2023]
Abstract
BACKGROUND Geriatric emergency department (GED) guidelines endorse screening older patients for geriatric syndromes in the ED, but there have been significant barriers to widespread implementation. The majority of screening programs require engagement of a clinician, nurse, or social worker, adding to already significant workloads at a time of record-breaking ED patient volumes, staff shortages, and hospital boarding crises. Automated, electronic health record (EHR)-embedded risk stratification approaches may be an alternate solution for extending the reach of the GED mission by directing human actions to a smaller subset of higher risk patients. METHODS We define the concept of automated risk stratification and screening using existing EHR data. We discuss progress made in three potential use cases in the ED: falls, cognitive impairment, and end-of-life and palliative care, emphasizing the importance of linking automated screening with systems of healthcare delivery. RESULTS Research progress and operational deployment vary by use case, ranging from deployed solutions in falls screening to algorithmic validation in cognitive impairment and end-of-life care. CONCLUSIONS Automated risk stratification offers a potential solution to one of the most pressing problems in geriatric emergency care: identifying high-risk populations of older adults most appropriate for specific GED care. Future work is needed to realize the promise of improved care with less provider burden by creating tools suitable for widespread deployment as well as best practices for their implementation and governance.
Collapse
Affiliation(s)
- Adrian D Haimovich
- Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | - Manish N Shah
- BerbeeWalsh Department of Emergency Medicine, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
| | - Lauren T Southerland
- Department of Emergency Medicine, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Ula Hwang
- Geriatric Research, Education and Clinical Center, James J. Peters VAMC, Bronx, New York, USA
- Department of Emergency Medicine, Yale School of Medicine, New Haven, Connecticut, USA
| | - Brian W Patterson
- BerbeeWalsh Department of Emergency Medicine, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
- Department of Industrial and Systems Engineering, Department of Biostatistics and Medical Informatics, University of Wisconsin-Madison, Madison, Wisconsin, USA
| |
Collapse
|
39
|
Smith-Millman M, Daniels L, Gallagher K, Aspinwall S, Brightman H, Ubertini G, Borrero GU, Palmo L, Weinstock P, Allan C. Hazard Assessment and Remediation Tool for Simulation-Based Healthcare Facility Design Testing. HERD-HEALTH ENVIRONMENTS RESEARCH & DESIGN JOURNAL 2024; 17:287-305. [PMID: 37545401 DOI: 10.1177/19375867231188151] [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: 08/08/2023]
Abstract
OBJECTIVES To develop an objective, structured observational tool to enable identification and measurement of hazards in the built environment when applied to audiovisual recordings of simulations by trained raters. BACKGROUND Simulation-based facility design testing is increasingly used to optimize safety of healthcare environments, often relying on participant debriefing or direct observation by human factors experts. METHODS Hazard categories were defined through participant debriefing and detailed review of pediatric intensive care unit in situ simulation videos. Categories were refined and operational definitions developed through iterative coding and review. Hazard detection was optimized through the use of structured coding protocols and optimized camera angles. RESULTS Six hazard categories were defined: (1) slip/trip/fall/injury risk, impaired access to (2) patient or (3) equipment, (4) obstructed path, (5) poor visibility, and (6) infection risk. Analysis of paired and individual coding demonstrated strong overall reliability (0.89 and 0.85, Gwet's AC1). Reliability coefficients for each hazard category were >0.8 for all except obstructed path (0.76) for paired raters. Among individual raters, reliability coefficients were >0.8, except for slip/trip/fall/injury risk (0.68) and impaired access to equipment (0.77). CONCLUSIONS Hazard Assessment and Remediation Tool (HART) provides a framework to identify and quantify hazards in the built environment. The tool is highly reliable when applied to direct video review of simulations by either paired raters or trained single clinical raters. Subsequent work will (1) assess the tool's ability to discriminate between rooms with different physical attributes, (2) develop strategies to apply HART to improve facility design, and (3) assess transferability to non-ICU acute care environments.
Collapse
Affiliation(s)
| | - Lorraine Daniels
- Enterprise Project Management Office, Boston Children's Hospital, MA, USA
| | - Katie Gallagher
- Enterprise Project Management Office, Boston Children's Hospital, MA, USA
| | - Sarah Aspinwall
- Cardiovascular Program, Nursing Patient Services, Boston Children's Hospital, MA, USA
| | - Howard Brightman
- Enterprise Project Management Office, Boston Children's Hospital, MA, USA
| | - Gina Ubertini
- Cardiovascular Program, Nursing Patient Services, Boston Children's Hospital, MA, USA
| | | | - Lobsang Palmo
- Immerisve Design Systems, Boston Children's Hospital, MA, USA
| | - Peter Weinstock
- Immerisve Design Systems, Boston Children's Hospital, MA, USA
- Department of Anesthesia, Pain, and Critical Care Medicine, Boston Children's Hospital, MA, USA
- Department of Pediatrics, Harvard Medical School, Boston Children's Hospital, MA, USA
| | - Catherine Allan
- Immerisve Design Systems, Boston Children's Hospital, MA, USA
- Department of Pediatrics, Harvard Medical School, Boston Children's Hospital, MA, USA
- Division of Cardiac Intensive Care, Department of Cardiology, Boston Children's Hospital, MA, USA
| |
Collapse
|
40
|
Papautsky EL, Abdulbaseer U. Capturing the Work of Patients' Family Members in the Medical Intensive Care Unit Using Naturalistic Observations. HERD-HEALTH ENVIRONMENTS RESEARCH & DESIGN JOURNAL 2024; 17:84-91. [PMID: 37553816 DOI: 10.1177/19375867231190620] [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: 08/10/2023]
Abstract
BACKGROUND The contributions of cognitive and behavioral work of patients' family members in intensive care units remain largely unrecognized. OBJECTIVE The objective of this study was to develop a framework of outwardly observable family work, with specific focus on describing the physical space. METHODS We conducted approximately 50 hrs of naturalistic observations of family activities on a medical intensive care unit (MICU) at a large, Midwestern teaching hospital. RESULTS We created a framework of activities that include requesting, receiving, or delivering either information or action, along with examples. Further, we identified clinician and staff roles with whom families interact and characterized the physical spaces in which interactions take place. CONCLUSIONS Knowledge contribution is a proposed framework of family activities in the MICU. It has the potential to guide and be further described by future research and to inform development of human-centered family-facing interventions to support cognitive and behavioral cognitive and behavioral work.
Collapse
|
41
|
Wooldridge AR, Carayon P, Hoonakker P, Hose BZ, Shaffer DW, Brazelton T, Eithun B, Rusy D, Ross J, Kohler J, Kelly MM, Springman S, Gurses AP. Team Cognition in Handoffs: Relating System Factors, Team Cognition Functions and Outcomes in Two Handoff Processes. HUMAN FACTORS 2024; 66:271-293. [PMID: 35658721 PMCID: PMC11022309 DOI: 10.1177/00187208221086342] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
OBJECTIVE This study investigates how team cognition occurs in care transitions from operating room (OR) to intensive care unit (ICU). We then seek to understand how the sociotechnical system and team cognition are related. BACKGROUND Effective handoffs are critical to ensuring patient safety and have been the subject of many improvement efforts. However, the types of team-level cognitive processing during handoffs have not been explored, nor is it clear how the sociotechnical system shapes team cognition. METHOD We conducted this study in an academic, Level 1 trauma center in the Midwestern United States. Twenty-eight physicians (surgery, anesthesia, pediatric critical care) and nurses (OR, ICU) participated in semi-structured interviews. We performed qualitative content analysis and epistemic network analysis to understand the relationships between system factors, team cognition in handoffs and outcomes. RESULTS Participants described three team cognition functions in handoffs-(1) information exchange, (2) assessment, and (3) planning and decision making; information exchange was mentioned most. Work system factors influenced team cognition. Inter-professional handoffs facilitated information exchange but included large teams with diverse backgrounds communicating, which can be inefficient. Intra-professional handoffs decreased team size and role diversity, which may simplify communication but increase information loss. Participants in inter-professional handoffs reflected on outcomes significantly more in relation to system factors and team cognition (p < 0.001), while participants in intra-professional handoffs discussed handoffs as a task. CONCLUSION Handoffs include team cognition, which was influenced by work system design. Opportunities for handoff improvement include a flexibly standardized process and supportive tools/technologies. We recommend incorporating perspectives of the patient and family in future work.
Collapse
Affiliation(s)
- Abigail R. Wooldridge
- Department of Industrial and Enterprise Systems Engineering, University of Illinois at Urbana-Champaign
| | - Pascale Carayon
- Wisconsin Institute for Healthcare Systems Engineering, University of Wisconsin–Madison
- Department of Industrial and Systems Engineering, University of Wisconsin – Madison
| | - Peter Hoonakker
- Wisconsin Institute for Healthcare Systems Engineering, University of Wisconsin–Madison
| | - Bat-Zion Hose
- Department of Anesthesiology and Critical Care at the Perelman School of Medicine, University of Pennsylvania
| | | | - Tom Brazelton
- University of Wisconsin School of Medicine and Public Health, Madison, WI
| | - Ben Eithun
- University of Wisconsin School of Medicine and Public Health, Madison, WI
| | - Deborah Rusy
- University of Wisconsin School of Medicine and Public Health, Madison, WI
| | - Joshua Ross
- University of Wisconsin School of Medicine and Public Health, Madison, WI
| | | | - Michelle M. Kelly
- University of Wisconsin School of Medicine and Public Health, Madison, WI
| | - Scott Springman
- University of Wisconsin School of Medicine and Public Health, Madison, WI
| | - Ayse P. Gurses
- Center for Health Care Human Factors, Armstrong Institute for Patient Safety and Quality, Schools of Medicine, Bloomberg School of Public Health and Whiting School of Engineering, Johns Hopkins University, Baltimore, MD
| |
Collapse
|
42
|
Park K, Moon W. Review of Qualitative Research Methods in Health Information System Studies. Healthc Inform Res 2024; 30:16-34. [PMID: 38359846 PMCID: PMC10879827 DOI: 10.4258/hir.2024.30.1.16] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2023] [Revised: 11/05/2023] [Accepted: 12/10/2023] [Indexed: 02/17/2024] Open
Abstract
OBJECTIVES The aim of this study was to review hospital-based health information system (HIS) studies that used qualitative research methods and evaluate their methodological contexts and implications. In addition, we propose practical guidelines for HIS researchers who plan to use qualitative research methods. METHODS We collected papers published from 2012 to 2022 by searching the PubMed and CINAHL databases. As search keywords, we used specific system terms related to HISs, such as "electronic medical records" and "clinical decision support systems," linked with their operational terms, such as "implementation" and "adaptation," and qualitative methodological terms such as "observation" and "in-depth interview." We finally selected 74 studies that met this review's inclusion criteria and conducted an analytical review of the selected studies. RESULTS We analyzed the selected articles according to the following four points: the general characteristics of the selected articles; research design; participant sampling, identification, and recruitment; and data collection, processing, and analysis. This review found methodologically problematic issues regarding researchers' reflections, participant sampling methods and research accessibility, and data management. CONCLUSIONS Reports on the qualitative research process should include descriptions of researchers' reflections and ethical considerations, which are meaningful for strengthening the rigor and credibility of qualitative research. Based on these discussions, we suggest guidance for conducting ethical, feasible, and reliable qualitative research on HISs in hospital settings.
Collapse
Affiliation(s)
| | - Woojong Moon
- School of Nursing, Hanyang University, Seoul, Korea
| |
Collapse
|
43
|
Jimenez YA, Hill S, Lewis S, Abu Awwad D. Infection prevention and control in CT Part 2: Radiographers' and radiology nurses' perceptions of high-risk scenarios contributing to non-adherence to IPC protocols. Radiography (Lond) 2024; 30:265-273. [PMID: 38035444 DOI: 10.1016/j.radi.2023.11.014] [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] [Received: 08/04/2023] [Revised: 10/27/2023] [Accepted: 11/14/2023] [Indexed: 12/02/2023]
Abstract
INTRODUCTION Adherence to standard and transmission-based precautions in the computed tomography (CT) setting is central to effective infection prevention and control (IPC), yet there is limited evidence about medical imaging (MI) professionals' self-reported predictors of IPC breaches. This is the second of a two-part series on IPC in the CT setting. Part 1 reported on Australian baseline data relating to intravenous contrast media administration and power injectors. Part 2 presents Australian radiographers' and radiology nurses' perceptions of clinical situations that reduce adherence to standard and transmission-based precautions in CT. METHODS A self-administered survey was distributed to Australian radiographers and radiology nurses working in CT. Responses to an open-ended question "If I was to not adhere to the standard and transmission-based precautions in the CT department, it is most likely when …" was analysed using inductive coding for themes, followed by deductive analysis mapped to the Systems Engineering Initiative for Patient Safety (SEIPS) model. RESULTS Study participants (n = 136) were radiographers (n = 119; 87.5%) and nurses (n = 17; 12.5%). 'Four themes were derived from the inductive analysis: (1) high-risk working conditions, (2) compliance with good practice, (3) attitudes and practice, and (4) quality of communication. Deductive analysis, using the SEIPS domains revealed that predominant issues related to 'Tasks' (43.7%) and 'Organisation' (30.6%) followed by issues related to 'Person' (16.9%), 'Tools and technology' (6.9%) and 'Environment' (1.9%). CONCLUSION Multi-faceted pressures on radiology staff may compromise adherence to standard and transmission-based precautions in CT. Task difficulty, time pressures whilst undertaking tasks, and reduced staffing could lead to lower adherence to standard and transmission-based precautions. IMPLICATIONS FOR PRACTICE Future studies that focus on evaluation of 'Tasks' and 'Organisation' domains of the SEIPS model may provide further insights to non-adherence behaviours in MI.
Collapse
Affiliation(s)
- Y A Jimenez
- Faculty of Medicine and Health, Discipline of Medical Imaging Science, Susan Wakil Health Building (D18), Western Avenue, University of Sydney, NSW 2006, Australia.
| | - S Hill
- Faculty of Medicine and Health, Discipline of Medical Imaging Science, Susan Wakil Health Building (D18), Western Avenue, University of Sydney, NSW 2006, Australia
| | - S Lewis
- Faculty of Medicine and Health, Discipline of Medical Imaging Science, Susan Wakil Health Building (D18), Western Avenue, University of Sydney, NSW 2006, Australia. https://twitter.com/@SarahLewisUSYD
| | - D Abu Awwad
- Faculty of Medicine and Health, Discipline of Medical Imaging Science, Susan Wakil Health Building (D18), Western Avenue, University of Sydney, NSW 2006, Australia
| |
Collapse
|
44
|
Watterson TL, Stone JA, Kleinschmidt PC, Chui MA. CancelRx case study: implications for clinic and community pharmacy work systems. BMC Health Serv Res 2023; 23:1360. [PMID: 38057835 PMCID: PMC10698877 DOI: 10.1186/s12913-023-10396-9] [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: 04/25/2023] [Accepted: 11/29/2023] [Indexed: 12/08/2023] Open
Abstract
BACKGROUND Medication prescribing and discontinuation processes are complex and involve the patient, numerous health care professionals, organizations, health information technology (IT). CancelRx is a health IT that automatically communicates medication discontinuations from the clinic electronic health record to the community pharmacy dispensing platform, theoretically improving communication. CancelRx was implemented across a Midwest academic health system in October 2017. The health system also operates 15 outpatient community pharmacies. OBJECTIVE The goal of this qualitative study was to describe how both the clinic and community pharmacy work systems change and interact over time regarding medication discontinuations, before and after CancelRx implantation. APPROACH Medical Assistants (n = 9), Community Pharmacists (n = 12), and Pharmacy Administrators (n = 3), employed by the health system were interviewed across 3-time periods between 2017 and 2018- 3-months prior to CancelRx implementation, 3-months after CancelRx implementation, and 9-months after CancelRx implementation. Interviews were audio recorded, transcribed, and conducted a hybrid analysis with deductive content analysis following the Systems Engineering Initiative for Patient Safety (SEIPS) framework and inductive analysis to capture additional codes and themes. KEY RESULTS CancelRx changed the medication discontinuation process at both clinics and community pharmacies. In the clinics, the workflows and medication discontinuation tasks changed over time while MA roles and clinic staff communication practices remained variable. In the pharmacy, CancelRx automated and streamlined how medication discontinuation messages were received and processed, but also increased workload for the pharmacists and introduced new errors. CONCLUSIONS This study utilizes a systems approach to assess disparate systems within a patient network. Future studies may consider health IT implications for systems that are not in the same health system as well as assessing the role of implementation decisions on health IT use and dissemination.
Collapse
Affiliation(s)
| | - Jamie A Stone
- University of Wisconsin-Madison School of Pharmacy, Madison, WI, 53704, USA
| | | | - Michelle A Chui
- University of Wisconsin-Madison School of Pharmacy, Madison, WI, 53704, USA.
| |
Collapse
|
45
|
Keating JA, Parmasad V, McKinley L, Safdar N. Integrating infection control and environmental management work systems to prevent Clostridioides difficile infection. Am J Infect Control 2023; 51:1444-1448. [PMID: 37329984 PMCID: PMC10773464 DOI: 10.1016/j.ajic.2023.06.008] [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: 04/25/2023] [Revised: 06/04/2023] [Accepted: 06/05/2023] [Indexed: 06/19/2023]
Abstract
Effective infection prevention and control within health care settings requires collaboration and coordination between infection control and environmental management teams. However, the work systems of these teams can be difficult to integrate despite their shared goals. We provide results from a qualitative study of Clostridioides difficile infection prevention in Veterans Affairs facilities regarding challenges in coordination between these teams and opportunities to improve coordination and maximize infection prevention activities.
Collapse
Affiliation(s)
- Julie A Keating
- William S. Middleton Memorial Veterans Hospital, Madison, WI; Division of Infectious Disease, Department of Medicine, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI
| | - Vishala Parmasad
- Division of Infectious Disease, Department of Medicine, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI
| | - Linda McKinley
- William S. Middleton Memorial Veterans Hospital, Madison, WI
| | - Nasia Safdar
- William S. Middleton Memorial Veterans Hospital, Madison, WI; Division of Infectious Disease, Department of Medicine, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI.
| |
Collapse
|
46
|
Schiff E, Propst EJ, Balakrishnan K, Johnson K, Lounsbury DW, Brenner MJ, Tawfik MM, Yang CJ. Pediatric Tracheostomy Emergency Readiness Assessment Tool: International Consensus Recommendations. Laryngoscope 2023; 133:3588-3601. [PMID: 37114735 PMCID: PMC10710770 DOI: 10.1002/lary.30674] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Revised: 02/17/2023] [Accepted: 03/07/2023] [Indexed: 04/29/2023]
Abstract
OBJECTIVE To achieve consensus on critical steps and create an assessment tool for actual and simulated pediatric tracheostomy emergencies that incorporates human and systems factors along with tracheostomy-specific steps. METHODS A modified Delphi method was used. Using REDCap software, an instrument comprising 29 potential items was circulated to 171 tracheostomy and simulation experts. Consensus criteria were determined a priori with a goal of consolidating and ordering 15 to 25 final items. In the first round, items were rated as "keep" or "remove". In the second and third rounds, experts were asked to rate the importance of each item on a 9-point Likert scale. Items were refined in subsequent iterations based on analysis of results and respondents' comments. RESULTS The response rates were 125/171 (73.1%) for the first round, 111/125 (88.8%) for the second round, and 109/125 (87.2%) for the third round. 133 comments were incorporated. Consensus (>60% participants scoring ≥8, or mean score >7.5) was reached on 22 items distributed across three domains. There were 12, 4, and 6 items in the domains of tracheostomy-specific steps, team and personnel factors, and equipment respectively. CONCLUSIONS The resultant assessment tool can be used to assess both tracheostomy-specific steps as well as systems factors affecting hospital team response to simulated and clinical pediatric tracheostomy emergencies. The tool can also be used to guide debriefing discussions of both simulated and clinical emergencies, and to spur quality improvement initiatives. LEVEL OF EVIDENCE 5 Laryngoscope, 133:3588-3601, 2023.
Collapse
Affiliation(s)
- Elliot Schiff
- Albert Einstein College of Medicine, Bronx, New York, USA
| | - Evan J Propst
- Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Karthik Balakrishnan
- Lucile Packard Children's Hospital, Stanford University School of Medicine, Palo Alto, California, USA
| | - Kaalan Johnson
- Department of Otolaryngology - Head and Neck Surgery, University of Washington/ Division of Pediatric Otolaryngology - Head and Neck Surgery, Seattle Children's Hospital, Seattle, WA, USA
| | - David W Lounsbury
- Albert Einstein College of Medicine, Bronx, New York, USA
- Department of Otorhinolaryngology-Head and Neck Surgery, Montefiore Medical Center, Bronx, New York, USA
| | - Michael J Brenner
- Department of Otolaryngology-Head and Neck Surgery, University of Michigan Medical School, Ann Arbor, Michigan, USA
| | | | - Christina J Yang
- Albert Einstein College of Medicine, Bronx, New York, USA
- Department of Otorhinolaryngology-Head and Neck Surgery, Montefiore Medical Center, Bronx, New York, USA
| |
Collapse
|
47
|
Savoy A, Khazvand S, Mathew A, Gilmore AM, Cottingham E, Sangani A, Weiner M, Damush TM. Consultants' and referrers' perceived barriers to closing the cross-institutional referral loop, and perceived impact on clinical care. Int J Med Inform 2023; 180:105265. [PMID: 37913622 PMCID: PMC10863292 DOI: 10.1016/j.ijmedinf.2023.105265] [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: 06/14/2023] [Revised: 09/17/2023] [Accepted: 10/15/2023] [Indexed: 11/03/2023]
Abstract
BACKGROUND Cross-institutional (external) referrals are prone to communication breakdowns, increasing patient safety risks, clinician burnout, and healthcare costs. To close these external referral loops, referring primary care physicians (PCPs) need to receive patient information from consultants at different healthcare institutions. Although existing studies investigated the early phases of external referral loops, we lack sufficient knowledge about the closing phases of these loops. This knowledge could allow health care institutions to improve care coordination and rates of closed referral loops by implementing socio-technical interventions for patient information exchange throughout a referral loop. Human factors engineering (HFE) provides a systematic approach to advance our understanding of barriers perceived by physicians. Using HFE, our objective was to characterize referring and consulting physicians' barriers to closing referral loops and implications for care. METHODS This qualitative cross-sectional study included semi-structured interviews with referrers and external consultants. We used the Systems Engineering Initiative for Patient Safety 2.0 framework to conduct rapid qualitative analyses, determining perceived barriers and related implications. Main measures were consultants' and referrers' perceptions of, and experiences with, barriers to external referrals. RESULTS Six referring PCPs and 12 consultants participated from two healthcare systems and four medical specialties. Physicians perceived three main barriers in external referrals: receipt of excessive and unnecessary faxed documents, missing or delayed documentation, and organizational policies regarding information privacy interfering with closing the loop. Compared to internal referrals, physicians reported increased staff burden, patient frustration, and delays in diagnosis with external referrals. Consultants reported the ability to provide the same level of care to patients with internal or external referrals. However, consultants described communication breakdowns that prohibited confirmation of follow-up plan retrieval, initiation, or effectiveness. CONCLUSION Physicians reported technological and organizational barriers to closing cross-institutional referral loops. Promises of HIE technology for external referrals have not fully materialized. Among physicians and patients, retrieval and exchange of medical information increases perceived workload, burden, and frustration. These increases are not accurately captured by traditional organizational metrics. This study provides evidence that informs future human factors engineering research to address perceived barriers and guide future HIE design or implementation.
Collapse
Affiliation(s)
- April Savoy
- Purdue School of Engineering and Technology, Indiana University - Purdue University, 799, W Michigan St, Indianapolis, IN 46202, United States; Center for Health Information and Communication, Department of Veterans Affairs, Veterans Health Administration, Health Services Research and Development Service CIN 13-416, Richard L. Roudebush VA Medical Center, 1481, West Tenth St, Indianapolis, IN 46202-2884, United States; Regenstrief Institute, Inc., 1101 W 10(th) St, Indianapolis, IN 46202, United States.
| | - Shirin Khazvand
- Regenstrief Institute, Inc., 1101 W 10(th) St, Indianapolis, IN 46202, United States; School of Science, Indiana University Purdue University, 402 North Blackford St., LD 222, Indianapolis, IN 46202, United States
| | - Anna Mathew
- Purdue School of Engineering and Technology, Indiana University - Purdue University, 799, W Michigan St, Indianapolis, IN 46202, United States
| | - Alexis Marcum Gilmore
- Regenstrief Institute, Inc., 1101 W 10(th) St, Indianapolis, IN 46202, United States
| | - Elizabeth Cottingham
- Regenstrief Institute, Inc., 1101 W 10(th) St, Indianapolis, IN 46202, United States
| | - Amee Sangani
- Regenstrief Institute, Inc., 1101 W 10(th) St, Indianapolis, IN 46202, United States; Indiana University School of Medicine, 635, Barnhill Dr, Indianapolis, IN 46202, United States
| | - Michael Weiner
- Center for Health Information and Communication, Department of Veterans Affairs, Veterans Health Administration, Health Services Research and Development Service CIN 13-416, Richard L. Roudebush VA Medical Center, 1481, West Tenth St, Indianapolis, IN 46202-2884, United States; Regenstrief Institute, Inc., 1101 W 10(th) St, Indianapolis, IN 46202, United States; Indiana University School of Medicine, 635, Barnhill Dr, Indianapolis, IN 46202, United States
| | - Teresa M Damush
- Center for Health Information and Communication, Department of Veterans Affairs, Veterans Health Administration, Health Services Research and Development Service CIN 13-416, Richard L. Roudebush VA Medical Center, 1481, West Tenth St, Indianapolis, IN 46202-2884, United States; Regenstrief Institute, Inc., 1101 W 10(th) St, Indianapolis, IN 46202, United States; Indiana University School of Medicine, 635, Barnhill Dr, Indianapolis, IN 46202, United States
| |
Collapse
|
48
|
Page B, Irving D, Amalberti R, Vincent C. Health services under pressure: a scoping review and development of a taxonomy of adaptive strategies. BMJ Qual Saf 2023:bmjqs-2023-016686. [PMID: 38050158 DOI: 10.1136/bmjqs-2023-016686] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Accepted: 11/07/2023] [Indexed: 12/06/2023]
Abstract
OBJECTIVE The objective of this review was to develop a taxonomy of pressures experienced by health services and an accompanying taxonomy of strategies for adapting in response to these pressures. The taxonomies were developed from a review of observational studies directly assessing care delivered in a variety of clinical environments. DESIGN In the first phase, a scoping review of the relevant literature was conducted. In the second phase, pressures and strategies were systematically coded from the included papers, and categorised. DATA SOURCES Electronic databases (MEDLINE, Embase, CINAHL, PsycInfo and Scopus) and reference lists from recent reviews of the resilient healthcare literature. ELIGIBILITY CRITERIA Studies were included from the resilient healthcare literature, which used descriptive methodologies to directly assess a clinical environment. The studies were required to contain strategies for managing under pressure. RESULTS 5402 potential articles were identified with 17 papers meeting the inclusion criteria. The principal source of pressure described in the studies was the demand for care exceeding capacity (ie, the resources available), which in turn led to difficult working conditions and problems with system functioning. Strategies for responding to pressures were categorised into anticipatory and on-the-day adaptations. Anticipatory strategies included strategies for increasing resources, controlling demand and plans for managing the workload (efficiency strategies, forward planning, monitoring and co-ordination strategies and staff support initiatives). On-the-day adaptations were categorised into: flexing the use of existing resources, prioritising demand and adapting ways of working (leadership, teamwork and communication strategies). CONCLUSIONS The review has culminated in an empirically based taxonomy of pressures and an accompanying taxonomy of strategies for adapting in response to these pressures. The taxonomies could help clinicians and managers to optimise how they respond to pressures and may be used as the basis for training programmes and future research evaluating the impact of different strategies.
Collapse
Affiliation(s)
- Bethan Page
- Department of Experimental Psychology, University of Oxford, Oxford, UK
- Cicely Saunders Institute, King's College London, London, UK
| | - Dulcie Irving
- Department of Experimental Psychology, University of Oxford, Oxford, UK
| | - Rene Amalberti
- Foundation for Industrial Safety Culture, FONCSI, Toulouse, France
| | - Charles Vincent
- Department of Experimental Psychology, University of Oxford, Oxford, UK
| |
Collapse
|
49
|
Mehta J, Williams C, Holden RJ, Taylor B, Fowler NR, Boustani M. The methodology of the Agile Nudge University. FRONTIERS IN HEALTH SERVICES 2023; 3:1212787. [PMID: 38093811 PMCID: PMC10716213 DOI: 10.3389/frhs.2023.1212787] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/30/2023] [Accepted: 11/10/2023] [Indexed: 02/01/2024]
Abstract
Introduction The Agile Nudge University is a National Institute on Aging-funded initiative to engineer a diverse, interdisciplinary network of scientists trained in Agile processes. Methods Members of the network are trained and mentored in rapid, iterative, and adaptive problem-solving techniques to develop, implement, and disseminate evidence-based nudges capable of addressing health disparities and improving the care of people living with Alzheimer's disease and other related dementias (ADRD). Results Each Agile Nudge University cohort completes a year-long online program, biweekly coaching and mentoring sessions, monthly group-based problem-solving sessions, and receives access to a five-day Bootcamp and the Agile Nudge Resource Library. Discussion The Agile Nudge University is evaluated through participant feedback, competency surveys, and tracking of the funding, research awards, and promotions of participating scholars. The Agile Nudge University is compounding national innovation efforts in overcoming the gaps in the ADRD discovery-to-delivery translational cycle.
Collapse
Affiliation(s)
- Jade Mehta
- Center for Health Innovation and Implementation Science, School of Medicine, Indiana University, Indianapolis, IN, United States
| | - Christopher Williams
- Center for Health Innovation and Implementation Science, School of Medicine, Indiana University, Indianapolis, IN, United States
- Sandra Eskenazi Center for Brain Care Innovation, Eskenazi Health, Indianapolis, IN, United States
- Department of Health and Wellness Design, School of Public Health - Bloomington, Indiana University, Bloomington, IN, United States
| | - Richard J. Holden
- Center for Health Innovation and Implementation Science, School of Medicine, Indiana University, Indianapolis, IN, United States
- Department of Health and Wellness Design, School of Public Health - Bloomington, Indiana University, Bloomington, IN, United States
- Department of Medicine, School of Medicine, Indiana University, Indianapolis, IN, United States
- Center for Aging Research, Regenstrief Institute, Inc, Indianapolis, IN, United States
| | - Britain Taylor
- Center for Health Innovation and Implementation Science, School of Medicine, Indiana University, Indianapolis, IN, United States
- Center for Aging Research, Regenstrief Institute, Inc, Indianapolis, IN, United States
| | - Nicole R. Fowler
- Center for Health Innovation and Implementation Science, School of Medicine, Indiana University, Indianapolis, IN, United States
- Sandra Eskenazi Center for Brain Care Innovation, Eskenazi Health, Indianapolis, IN, United States
- Department of Medicine, School of Medicine, Indiana University, Indianapolis, IN, United States
- Center for Aging Research, Regenstrief Institute, Inc, Indianapolis, IN, United States
| | - Malaz Boustani
- Center for Health Innovation and Implementation Science, School of Medicine, Indiana University, Indianapolis, IN, United States
- Sandra Eskenazi Center for Brain Care Innovation, Eskenazi Health, Indianapolis, IN, United States
- Department of Medicine, School of Medicine, Indiana University, Indianapolis, IN, United States
- Center for Aging Research, Regenstrief Institute, Inc, Indianapolis, IN, United States
| |
Collapse
|
50
|
Gifford A, Butcher B, Chima RS, Moore L, Brady PW, Zackoff MW, Dewan M. Use of design thinking and human factors approach to improve situation awareness in the pediatric intensive care unit. J Hosp Med 2023; 18:978-985. [PMID: 37792360 DOI: 10.1002/jhm.13216] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Revised: 09/11/2023] [Accepted: 09/16/2023] [Indexed: 10/05/2023]
Abstract
BACKGROUND Optimal design of healthcare spaces can enhance patient care. We applied design thinking and human factors principles to optimize communication and signage on high risk patients to improve situation awareness in a new clinical space for the pediatric ICU. OBJECTIVE To assess the impact of these tools in mitigating situation awareness concerns within the new clinical space. We hypothesized that implementing these design-informed tools would either maintain or improve situation awareness. DESIGN, SETTINGS, AND PARTICIPANTS A 15-week design thinking process was employed, involving research, ideation, and refinement to develop and implement new situation awareness tools. The process included engagement with interprofessional clinical teams, scenario planning, workflow mapping, iterative feedback collection, and collaboration with an industry partner for signage development and implementation. INTERVENTION Improved and updated communication devices and bedside mitigation plans. MAIN OUTCOME AND MEASURES Process metrics included individual and shared situation awareness of PICU care teams and our patient outcome metric was the rate of cardiopulmonary resuscitation (CPR) events pre- and post-transition. RESULTS When evaluating all patients, shared situation awareness for accurate high-risk status improved from 81% pre-transition to 92% post-transition (p = .006). When assessing individual care team roles, accuracy of patient high-risk status improved from 88% to 95% (p = .05) for RNs, 85% to 96% (p = .003) for residents, and 88% to 95% (p = .03) for RTs. There was no change in the rate of CPR events following the transition.
Collapse
Affiliation(s)
| | - Bain Butcher
- College of Design, Art, Architecture, and Planning, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Ranjit S Chima
- Department of Pediatrics, College of Medicine, University of Cincinnati, Cincinnati, Ohio, USA
- Division of Critical Care Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Lindsey Moore
- Pediatric Intensive Care Unit, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Patrick W Brady
- Department of Pediatrics, College of Medicine, University of Cincinnati, Cincinnati, Ohio, USA
- James M. Anderson Center for Health Systems Excellence, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
- Division of Hospital Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Matthew W Zackoff
- Department of Pediatrics, College of Medicine, University of Cincinnati, Cincinnati, Ohio, USA
- Division of Critical Care Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Maya Dewan
- Department of Pediatrics, College of Medicine, University of Cincinnati, Cincinnati, Ohio, USA
- Division of Critical Care Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
- James M. Anderson Center for Health Systems Excellence, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
- Division of Biomedical Informatics, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| |
Collapse
|