1
|
Wash A, Moczygemba LR, Brown CM, Crismon ML, Whittaker TA. A narrative review of the well-being and burnout of U.S. community pharmacists. J Am Pharm Assoc (2003) 2024; 64:337-349. [PMID: 37967722 DOI: 10.1016/j.japh.2023.11.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Revised: 10/26/2023] [Accepted: 11/08/2023] [Indexed: 11/17/2023]
Abstract
OBJECTIVES The purpose of this narrative review is to summarize the literature on well-being and burnout among community pharmacists in the U.S. and provide recommendations for future research. METHODS Relevant literature was identified by searching PubMed for combinations of keywords such as "burnout" and "well-being" combined with "pharmacists." Titles and abstracts were reviewed for relevancy, and full text articles were reviewed when applicable. RESULTS While burnout is defined by its 3 core symptoms of emotional exhaustion, depersonalization, and low personal accomplishment, well-being is more challenging to define and measure, which has led to it being less studied. Community pharmacists faced high rates of burnout, low quality of life (QOL), and extreme fatigue prior to the COVID-19 pandemic, a situation that has likely only worsened. Factors such as workload, the type of community pharmacy, the level of education or training of the pharmacist, and stress may be some of the contributors to high rates of burnout. Clinician burnout may be related to high rates of mental health disorders seen in pharmacists, may impact patient safety and satisfaction, and may affect productivity and costs to employers and the healthcare system overall. There has been no research into interventions or strategies to support well-being and reduce burnout among community pharmacists, but having a workplace that is perceived as supporting well-being may have some impact. Recommendations for future research include the following: (1) define well-being, (2) explore why various factors support well-being or contribute to burnout, (3) determine the impact of community pharmacists experiencing well-being or burnout, and (4) develop strategies to support well-being and reduce burnout that are specific to community pharmacy. CONCLUSION There is a sparsity of evidence regarding community pharmacist well-being and burnout. Further research is needed to generate the evidence needed to support interventions that are specific to the unique work setting of community pharmacists.
Collapse
|
2
|
Bradley CJ, Kitchen S, Owsley KM. Much work to do about measuring work. J Natl Cancer Inst 2024; 116:194-199. [PMID: 38070483 PMCID: PMC10852620 DOI: 10.1093/jnci/djad258] [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] [Received: 08/31/2023] [Revised: 11/09/2023] [Accepted: 12/05/2023] [Indexed: 02/10/2024] Open
Abstract
Work ability is a critical economic and well-being indicator in cancer care. Yet, work ability is understudied in clinical trials and observational research and is often undocumented in medical records. Despite agreement on the importance of work from well-being, health insurance, and financial perspectives, standardized approaches for collecting, measuring, and analyzing work outcomes are lacking in the health-care setting. The necessary components for closing the gap in patient and caregiver employment research in health-care settings involve a common set of measures, including those that replace or translate generic measures of mental and physical functioning into work outcomes in observational and clinical trial research, standardized approaches to data collection and documentation, and the use of longitudinal data to understand the consequences of reduced work ability over time. We present a conceptual framework for the inclusion of work ability in outcomes research. We cover constructs for employment and work ability measurement that can be adopted in research, recorded as patient-level data, and used to guide treatment decisions. The inclusion of return to work and hours worked, productivity, and ability to perform in a similar job can support conversations that guide treatment decisions and minimize economic consequences. Our hope is that by considering impact on work ability, improved treatments will be developed, health inequities reduced, and resources directed toward aiding patients and their caregivers in balancing work and health demands.
Collapse
Affiliation(s)
- Cathy J Bradley
- Department of Health Systems, Management, and Policy, Colorado School of Public Health, Aurora, CO, USA
- University of Colorado Comprehensive Cancer Center, Aurora, CO, USA
| | - Sara Kitchen
- Department of Health Systems, Management, and Policy, Colorado School of Public Health, Aurora, CO, USA
| | - Kelsey M Owsley
- Department of Health Policy and Management, Fay W. Boozman College of Public Health, Little Rock, AR, USA
- Winthrop P. Rockefeller Cancer Institute, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| |
Collapse
|
3
|
Steffey MA, Griffon DJ, Risselada M, Buote NJ, Scharf VF, Zamprogno H, Winter AL. A narrative review of the physiology and health effects of burnout associated with veterinarian-pertinent occupational stressors. Front Vet Sci 2023; 10:1184525. [PMID: 37465277 PMCID: PMC10351608 DOI: 10.3389/fvets.2023.1184525] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2023] [Accepted: 06/19/2023] [Indexed: 07/20/2023] Open
Abstract
Chronic workplace stress and burnout are serious problems in veterinary medicine. Although not classified as a medical condition, burnout can affect sleep patterns and contributes to chronic low grade systemic inflammation, autonomic imbalance, hormonal imbalances and immunodeficiencies, thereby increasing the risks of physical and psychological ill health in affected individuals. Cultural misconceptions in the profession often lead to perceptions of burnout as a personal failure, ideas that healthcare professionals are somehow at lower risk for suffering, and beliefs that affected individuals can or should somehow heal themselves. However, these concepts are antiquated, harmful and incorrect, preventing the design of appropriate solutions for this serious and growing challenge to the veterinary profession. Veterinarians must first correctly identify the nature of the problem and understand its causes and impacts before rational solutions can be implemented. In this first part of two companion reviews, burnout will be defined, pathophysiology discussed, and healthcare and veterinary-relevant occupational stressors that lead to burnout identified.
Collapse
Affiliation(s)
- Michele A. Steffey
- Department of Surgical and Radiological Sciences, School of Veterinary Medicine, University of California, Davis, Davis, CA, United States
| | - Dominique J. Griffon
- Western University of Health Sciences, College of Veterinary Medicine, Pomona, CA, United States
| | - Marije Risselada
- Department of Veterinary Clinical Sciences, College of Veterinary Medicine, Purdue University, West-Lafayette, IN, United States
| | - Nicole J. Buote
- Department of Clinical Sciences, Cornell University College of Veterinary Medicine, Ithaca, NY, United States
| | - Valery F. Scharf
- Department of Clinical Sciences, North Carolina State University College of Veterinary Medicine, Raleigh, NC, United States
| | | | | |
Collapse
|
4
|
Lloyd S, Long K, Probst Y, Di Donato J, Oshni Alvandi A, Roach J, Bain C. Medical and nursing clinician perspectives on the usability of the hospital electronic medical record: A qualitative analysis. HEALTH INF MANAG J 2023:18333583231154624. [PMID: 36866778 DOI: 10.1177/18333583231154624] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/04/2023]
Abstract
BACKGROUND Electronic medical records (EMRs) have been widely implemented in Australian hospitals. Their usability and design to support clinicians to effectively deliver and document care is essential, as is their impact on clinical workflow, safety and quality, communication, and collaboration across health systems. Perceptions of, and data about, usability of EMRs implemented in Australian hospitals are key to successful adoption. OBJECTIVE To explore perspectives of medical and nursing clinicians on EMR usability utilising free-text data collected in a survey. METHOD Qualitative analysis of one free-text optional question included in a web-based survey. Respondents included medical and nursing/midwifery professionals in Australian hospitals (85 doctors and 27 nurses), who commented on the usability of the main EMR used. RESULTS Themes identified related to the status of EMR implementation, system design, human factors, safety and risk, system response time, and stability, alerts, and supporting the collaboration between healthcare sectors. Positive factors included ability to view information from any location; ease of medication documentation; and capacity to access diagnostic test results. Usability concerns included lack of intuitiveness; complexity; difficulties communicating with primary and other care sectors; and time taken to perform clinical tasks. CONCLUSION If the benefits of EMRs are to be realised, there are good reasons to address the usability challenges identified by clinicians. Easy solutions that could improve the usability experience of hospital-based clinicians include resolving sign-on issues, use of templates, and more intelligent alerts and warnings to avoid errors. IMPLICATIONS These essential improvements to the usability of the EMR, which are the foundation of the digital health system, will enable hospital clinicians to deliver safer and more effective health care.
Collapse
Affiliation(s)
- Sheree Lloyd
- Australian Institute of Health Service Management, 3925University of Tasmania, Hobart, TAS, Australia
| | - Karrie Long
- 90134The Royal Melbourne Hospital, Parkville, VIC, Australia
| | - Yasmine Probst
- 8691University of Wollongong, Wollongong, NSW, Australia
| | - Josie Di Donato
- 1969Queensland University of Technology (QUT Online), Brisbane City, QLD, Australia
| | | | | | | |
Collapse
|
5
|
Lindsay M. A shared governance approach to nursing documentation redesign using Kotter's change management model. Nurs Manag (Harrow) 2023; 54:14-20. [PMID: 36854001 DOI: 10.1097/01.numa.0000919064.29246.6b] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/02/2023]
Affiliation(s)
- Mary Lindsay
- Mary Lindsay is the associate chief nursing officer, Heart Services at Duke University Hospital in Durham, N.C. She's also responsible for patient care services departments, Respiratory Therapy, Cardiopulmonary Rehabilitation, and Pulmonary Function Testing Lab
| |
Collapse
|
6
|
R Gowda N, Satpathy S, Singh AR, Behera SD. The Holy grail of healthcare analytics: what it takes to get there? BMJ LEADER 2022; 6:286-294. [PMID: 36794609 DOI: 10.1136/leader-2021-000527] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2021] [Accepted: 01/10/2022] [Indexed: 11/04/2022]
Abstract
BACKGROUND Indian healthcare is rapidly growing and needs efficiency more than ever, which can be achieved by leveraging healthcare analytics. National Digital Health Mission has set the stage for digital health and getting the right direction from the very beginning is important. The current study was, therefore, undertaken to find what it takes for an apex tertiary care teaching hospital to leverage healthcare analytics. AIM To study the existing Hospital Information System (HIS) at AIIMS, New Delhi and assess the preparedness to leverage healthcare analytics. METHODOLOGY A three-pronged approach was used. First, concurrent review and detailed mapping of all running applications was done based on nine parameters by a multidisciplinary team of experts. Second, capability of the current HIS to measure specific management related KPIs was evaluated. Third, user perspective was obtained from 750 participants from all cadres of healthcare workers, using a validated questionnaire based on Delone and McLean model. RESULTS Interoperability issues between applications running within the same institute, impaired informational continuity with limited device interface and automation were found on concurrent review. HIS was capturing data to measure only 9 out of 33 management KPIs. User perspective on information quality was very poor which was found to be due to poor system quality of HIS, though some functions were reportedly well supported by the HIS. CONCLUSION It is important for hospitals to first evaluate and strengthen their data generation systems/HIS. The three-pronged approach used in this study provides a template for other hospitals.
Collapse
Affiliation(s)
- Naveen R Gowda
- Hospital Administration, All India Institute of Medical Sciences, New Delhi, Delhi, India
| | - Sidhartha Satpathy
- Hospital Administration, All India Institute of Medical Sciences, New Delhi, Delhi, India
| | - Angel Rajan Singh
- Hospital Administration, All India Institute of Medical Sciences, New Delhi, Delhi, India
| | - S D Behera
- Director General, Armed Forces Medical Services, New Delhi, Delhi, India
| |
Collapse
|
7
|
Determining the requirements of a medical records electronic deficiency management system: a mixed-method study. RECORDS MANAGEMENT JOURNAL 2022. [DOI: 10.1108/rmj-02-2022-0004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Purpose
Despite the presence of electronic medical records systems, traditional paper-based methods are often used in many countries to document data and eliminate medical record deficiencies. These methods waste patient and hospital resources. The purpose of this study is to evaluate the traditional deficiency management system and determine the requirements of an electronic deficiency management system in settings that currently use paper records alongside electronic hospital information systems.
Design/methodology/approach
This mixed-method study was performed in three phases. First, the traditional process of medical records deficiency management was qualitatively evaluated. Second, the accuracy of identifying deficiencies by the traditional and redesigned checklists was compared. Third, the requirements for an electronic deficiency management system were discussed in focus group sessions.
Findings
Problems in the traditional system include inadequate guidelines, incomplete procedures for evaluating sheets and subsequent delays in activities. Problems also included the omission of some vital data elements and a lack of feedback about the documentation deficiencies of each documenter. There was a significant difference between the mean number of deficiencies identified by traditional and redesigned checklists (p < 0.0001). The authors proposed an electronic deficiency management system based on redesigned checklists with improved functionalities such as discriminating deficiencies based on the documenter’s role, providing systematic feedback and generating automatic reports.
Originality/value
Previous studies only examined the positive effect of audit and feedback methods to enhance the documentation of data elements in electronic and paper medical records. The authors propose an electronic deficiency management system for medical records to solve those problems. Health-care policymakers, hospital managers and health information systems developers can use the proposed system to manage deficiencies and improve medical records documentation.
Collapse
|
8
|
Lederman A, Lederman R, Verspoor K. Tasks as needs: reframing the paradigm of clinical natural language processing research for real-world decision support. J Am Med Inform Assoc 2022; 29:1810-1817. [PMID: 35848784 PMCID: PMC9471702 DOI: 10.1093/jamia/ocac121] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2022] [Revised: 06/06/2022] [Accepted: 07/04/2022] [Indexed: 12/13/2022] Open
Abstract
Electronic medical records are increasingly used to store patient information in hospitals and other clinical settings. There has been a corresponding proliferation of clinical natural language processing (cNLP) systems aimed at using text data in these records to improve clinical decision-making, in comparison to manual clinician search and clinical judgment alone. However, these systems have delivered marginal practical utility and are rarely deployed into healthcare settings, leading to proposals for technical and structural improvements. In this paper, we argue that this reflects a violation of Friedman's "Fundamental Theorem of Biomedical Informatics," and that a deeper epistemological change must occur in the cNLP field, as a parallel step alongside any technical or structural improvements. We propose that researchers shift away from designing cNLP systems independent of clinical needs, in which cNLP tasks are ends in themselves-"tasks as decisions"-and toward systems that are directly guided by the needs of clinicians in realistic decision-making contexts-"tasks as needs." A case study example illustrates the potential benefits of developing cNLP systems that are designed to more directly support clinical needs.
Collapse
Affiliation(s)
- Asher Lederman
- Faculty of Engineering and IT, School of Computing and Information Systems, University of Melbourne, Melbourne, Australia
| | - Reeva Lederman
- Faculty of Engineering and IT, School of Computing and Information Systems, University of Melbourne, Melbourne, Australia
| | - Karin Verspoor
- STEM College, School of Computing Technologies, RMIT University, Melbourne, Australia
| |
Collapse
|
9
|
Wurster F, Fütterer G, Beckmann M, Dittmer K, Jaschke J, Köberlein-Neu J, Okumu MR, Rusniok C, Pfaff H, Karbach U. The Analyzation of Change in Documentation due to the Introduction of Electronic Patient Records in Hospitals-A Systematic Review. J Med Syst 2022; 46:54. [PMID: 35781136 PMCID: PMC9252957 DOI: 10.1007/s10916-022-01840-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2022] [Accepted: 05/31/2022] [Indexed: 11/29/2022]
Abstract
The major impact on healthcare through the ongoing digital transformation and new technologies results in opportunities for improving quality of care. Electronic patient records (EPR) are a substantial part in this transformation, even though their influence on documentation remains often unclear. This review aims to answer the question of which effect the introduction of the EPR has on the documentation proper in hospitals. To do this, studies are reviewed that analyze the documentation itself, rather than merely conducting interviews or surveys about it. Several databases were searched in this systematic review (PubMed including PubMed, PubMed Central and Medline; PDQ Evidence; Web of Science Core Collection; CINHAL). To be included, studies needed to analyze written documentation and empirical data, be in either German or English language, published between 2010 and 2020, conducted in a hospital setting, focused on transition from paper-based to electronic patient records, and peer reviewed. Quantitative, qualitative and mixed methods studies were included. Studies were independently screened for inclusion by two researchers in three stages (title, abstract, full text) and, in case of disagreement, discussed with a third person from the research team until consensus was reached. The main outcome assessed was whether the studies indicated a negative or positive effect on documentation (e.g. changing the completeness of documentation) by introducing an EPR. Mixed Methods Appraisal Tool was used to assess the individual risk of bias in the included studies. Overall, 264 studies were found. Of these, 17 met the inclusion criteria and were included in this review. Of all included studies, 11 of 17 proved a positive effect of the introduction of the EPR on documentation such as an improved completeness or guideline adherence of the documentation. Six of 17 showed a mixed effect with positive and negative or no changes. No study showed an exclusively negative effect. Most studies found a positive effect of EPR introduction on documentation. However, it is difficult to draw specific conclusions about how the EPR affects or does not affect documentation since the included studies examined a variety of outcomes. As a result, various scenarios are conceivable with higher or reduced burden for practitioners. Additionally, the impact on treatment remains unclear.
Collapse
Affiliation(s)
- Florian Wurster
- Faculty of Human Sciences & Faculty of Medicine and University Hospital Cologne, Institute of Medical Sociology, Health Services Research, and Rehabilitation Science, University of Cologne, Cologne, Germany.
| | - Garret Fütterer
- Faculty of Human Sciences & Faculty of Medicine and University Hospital Cologne, Institute of Medical Sociology, Health Services Research, and Rehabilitation Science, University of Cologne, Cologne, Germany
| | - Marina Beckmann
- Faculty of Human Sciences & Faculty of Medicine and University Hospital Cologne, Institute of Medical Sociology, Health Services Research, and Rehabilitation Science, University of Cologne, Cologne, Germany
| | - Kerstin Dittmer
- Faculty of Human Sciences & Faculty of Medicine and University Hospital Cologne, Institute of Medical Sociology, Health Services Research, and Rehabilitation Science, University of Cologne, Cologne, Germany
| | - Julia Jaschke
- Center for Health Economics and Health Services Research, University of Wuppertal, Wuppertal, Germany
| | - Juliane Köberlein-Neu
- Center for Health Economics and Health Services Research, University of Wuppertal, Wuppertal, Germany
| | - Mi-Ran Okumu
- Faculty of Human Sciences & Faculty of Medicine and University Hospital Cologne, Institute of Medical Sociology, Health Services Research, and Rehabilitation Science, University of Cologne, Cologne, Germany
| | - Carsten Rusniok
- Faculty of Human Sciences & Faculty of Medicine and University Hospital Cologne, Institute of Medical Sociology, Health Services Research, and Rehabilitation Science, University of Cologne, Cologne, Germany
| | - Holger Pfaff
- Faculty of Human Sciences & Faculty of Medicine and University Hospital Cologne, Institute of Medical Sociology, Health Services Research, and Rehabilitation Science, University of Cologne, Cologne, Germany
| | - Ute Karbach
- Faculty of Human Sciences & Faculty of Medicine and University Hospital Cologne, Institute of Medical Sociology, Health Services Research, and Rehabilitation Science, University of Cologne, Cologne, Germany
| |
Collapse
|
10
|
Atashzadeh‐Shoorideh F, Monjazabi F, Fathollahzadeh E, Parastoo O. The obstacles to nurses being present with patients. Nurs Open 2021; 8:1115-1124. [PMID: 34482655 PMCID: PMC8046123 DOI: 10.1002/nop2.723] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2020] [Revised: 10/04/2020] [Accepted: 11/05/2020] [Indexed: 11/24/2022] Open
Abstract
AIM The aim of the present research was to investigate the obstacles, which prevent nurses being present with patients. BACKGROUND It is vital for nurses to be able to spend time with patients for an accurate assessment of patients' needs to take place and to allow patients to express their concerns. The factors, which prevent nurses spending time with patients, are still unclear. METHOD Data were collected using semi-structured interviews with thirty-five participants, including the nurses and physicians from educational hospitals of Tehran. The analysis was performed through the conventional content analysis. To achieve accuracy and trustworthiness of the data, the Lincoln and Guba criteria were used. RESULT The results of the study can be summarized as: "conflict between human considerations and bureaucratic structure," "failure to meet basic needs," "the personal and interpersonal aspects of caring" and "safety in caring context." CONCLUSION To ensure high-quality care, it is important to understand more fully the factors that prevent nurses spending time with patients. Interventions are needed to allow nurses to spend more time with the patients. IMPLICATION FOR NURSING MANAGEMENT Health service managers should consider that the intrinsic motivation of nurses is to care for patients. They can increase the presence of nurses at patients' bedside and improve care quality by creating an attractive working environment, appreciating nurses' values, paying attention to their opinions and establishing professional communication based on mutual respect.
Collapse
Affiliation(s)
- Foroozan Atashzadeh‐Shoorideh
- Department of Psychiatric Nursing and ManagementSchool of Nursing & MidwiferyShahid Beheshti University of Medical SciencesTehranIran
| | - Fatemeh Monjazabi
- Department of Medical‐Surgical NursingSchool of Nursing & MidwiferyShahid Beheshti University of Medical SciencesTehranIran
| | | | - Oujian Parastoo
- Department of Pediatric NursingSchool of Nursing & MidwiferyShahid Beheshti University of Medical SciencesTehranIran
| |
Collapse
|
11
|
Tremoulet PD, Shah PD, Acosta AA, Grant CW, Kurtz JT, Mounas P, Kirchhoff M, Wade E. Usability of Electronic Health Record-Generated Discharge Summaries: Heuristic Evaluation. J Med Internet Res 2021; 23:e25657. [PMID: 33856353 PMCID: PMC8085750 DOI: 10.2196/25657] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Revised: 02/11/2021] [Accepted: 03/16/2021] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Obtaining accurate clinical information about recent acute care visits is extremely important for outpatient providers. However, documents used to communicate this information are often difficult to use. This puts patients at risk of adverse events. Elderly patients who are seen by more providers and have more care transitions are especially vulnerable. OBJECTIVE This study aimed to (1) identify the information about elderly patients' recent acute care visits needed to coordinate their care, (2) use this information to assess discharge summaries, and (3) provide recommendations to help improve the quality of electronic health record (EHR)-generated discharge summaries, thereby increasing patient safety. METHODS A literature review, clinician interviews, and a survey of outpatient providers were used to identify and categorize data needed to coordinate care for recently discharged elderly patients. Based upon those data, 2 guidelines for creating useful discharge summaries were created. The new guidelines, along with 17 previously developed medical documentation usability heuristics, were applied to assess 4 simulated elderly patient discharge summaries. RESULTS The initial research effort yielded a list of 29 items that should always be included in elderly patient discharge summaries and a list of 7 "helpful, but not always necessary" items. Evaluation of 4 deidentified elderly patient discharge summaries revealed that none of the documents contained all 36 necessary items; between 14 and 18 were missing. The documents each had several other issues, and they differed significantly in organization, layout, and formatting. CONCLUSIONS Variations in content and structure of discharge summaries in the United States make them unnecessarily difficult to use. Standardization would benefit both patients, by lowering the risk of care transition-related adverse events, and outpatient providers, by helping reduce frustration that can contribute to burnout. In the short term, acute care providers can help improve the quality of their discharge summaries by working with EHR vendors to follow recommendations based upon this study. Meanwhile, additional human factors work should determine the most effective way to organize and present information in discharge summaries, to facilitate effective standardization.
Collapse
Affiliation(s)
- Patrice D Tremoulet
- Department of Psychology, Rowan University, Glassboro, NJ, United States.,Device Evaluation, ECRI, Plymouth Meeting, PA, United States
| | - Priyanka D Shah
- Device Evaluation, ECRI, Plymouth Meeting, PA, United States
| | - Alisha A Acosta
- Department of Biochemistry, Rowan University, Glassboro, NJ, United States
| | - Christian W Grant
- Department of Psychology, Rowan University, Glassboro, NJ, United States
| | - Jon T Kurtz
- Department of Computer Science, Rowan University, Glassboro, NJ, United States
| | - Peter Mounas
- Department of Biological Sciences, Rowan University, Glassboro, NJ, United States
| | - Michael Kirchhoff
- Department of Emergency Medicine, Cooper Medical School, Rowan University, Camden, NJ, United States
| | | |
Collapse
|
12
|
Kasamatsu TM, Nottingham SL, Eberman LE, Neil ER, Welch Bacon CE. Patient Care Documentation in the Secondary School Setting: Unique Challenges and Needs. J Athl Train 2020; 55:1089-1097. [PMID: 32966580 DOI: 10.4085/1062-6050-0406.19] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
CONTEXT Athletic trainers (ATs) recognize patient care documentation as an important part of clinical practice. However, ATs using 1 electronic medical record (EMR) platform reported low accountability and lack of time as barriers to documentation. Whether ATs using paper, other EMRs, or a combined paper-electronic system exhibit similar behaviors or experience similar challenges is unclear. OBJECTIVE To explore ATs' documentation behaviors and perceived challenges while using various systems to document patient care in the secondary school setting. DESIGN Qualitative study. SETTING Individual telephone interviews. PATIENTS OR OTHER PARTICIPANTS Twenty ATs (12 women, 8 men; age = 38 ± 14 years; clinical experience = 15 ± 13 years; from National Athletic Trainers' Association Districts 2, 3, 6, 7, 8, 9, and 10) were recruited via purposeful and snowball-sampling techniques. DATA COLLECTION AND ANALYSIS Two investigators conducted semistructured interviews, which were audio recorded and transcribed verbatim. Following the consensual qualitative research tradition, 3 researchers independently coded transcripts in 4 rounds using a codebook to confirm codes, themes, and data saturation. Multiple researchers, member checking, and peer reviewing were the methods used to triangulate data and enhance trustworthiness. RESULTS The secondary school setting was central to 3 themes. The ATs identified challenges to documentation, including lack of time due to high patient volume and multiple providers or locations where care was provided. Oftentimes, these challenges affected their documentation behaviors, including the process of and criteria for whether to document or not, content documented, and location and timing of documentation. To enhance patient care documentation, ATs described the need for more professional development, including resources or specific guidelines and viewing how documentation has been used to improve clinical practice. CONCLUSIONS Challenges particular to the secondary school setting affected ATs' documentation behaviors, regardless of the system used to document care. Targeted professional development is needed to promote best practices in patient care documentation.
Collapse
|
13
|
Shah T, Kitts AB, Gold JA, Horvath K, Ommaya A, Frank O, Sato L, Schwarze G, Upton M, Sandy L. Electronic Health Record Optimization and Clinician Well-Being: A Potential Roadmap Toward Action. NAM Perspect 2020; 2020:202008a. [PMID: 35291737 PMCID: PMC8916811 DOI: 10.31478/202008a] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2023]
|
14
|
Gowda NR, Kumar A, Arya SK, H V. The information imperative: to study the impact of informational discontinuity on clinical decision making among doctors. BMC Med Inform Decis Mak 2020; 20:175. [PMID: 32723340 PMCID: PMC7388506 DOI: 10.1186/s12911-020-01190-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2019] [Accepted: 07/16/2020] [Indexed: 11/16/2022] Open
Abstract
Background Informational discontinuity can have far reaching consequences like medical errors, increased re-hospitalization rates and adverse events among others. Thus the holy grail of seamless informational continuity in healthcare has been an enigma with some nations going the digital way. Digitization in healthcare in India is fast catching up. The current study explores the components of informational continuity, its impact on clinical decision-making and captures the general perception among the doctors towards a digital solution. Methods Cross-sectional study with snowball sampling. A survey questionnaire was developed and validated through a pilot study, then circulated through online platforms. Responses from doctors were obtained through an online Google form for a period of 3 months and analyzed using SPSS 20. The categorical variables were analyzed using Chi-square test. Results 1413 responses were obtained through a national level survey. Respondents were from a wide range of work experiences, locations, sectors, specialties and patient load. Components of patient records like clinical notes, investigation reports, previous diagnosis and treatment details were rated to be very important. 41% reported about half and 20% reported about 3/4th of their patients do not bring relevant records. Patients from rural areas, visiting state government hospitals and visiting general practitioners were less likely to bring relevant records during consultations. The fallouts of not having timely relevant patient information of the patients include more time per patient, repeat investigations, difficulty to arrive at definitive diagnosis, difficulty to take further treatment decisions and impaired overall clinical decision making which were said to be significant by respondents across the spectrum. The benefits of having timely relevant patient information were also reported consistently across the spectrum. An overwhelming proportion (83%), from across the spectrum, unequivocally expressed their willingness to use digital platforms for accessing patients’ relevant medical records. Conclusion Prevalence of informational discontinuity and its impact on clinical decision making is significant with definite benefits of having timely relevant medical history. There is strong willingness among the doctors to use digital solution(s) without any extra investment or effort on their part making customized solutions pertinent.
Collapse
Affiliation(s)
- Naveen R Gowda
- Department of Hospital Administration, All India Institute of Medical Sciences (AIIMS), New Delhi, India
| | - Atul Kumar
- Department of Hospital Administration, All India Institute of Medical Sciences (AIIMS), New Delhi, India. .,ESIC Hospital & Dental College, New Delhi, 110085, India.
| | - Sanjay K Arya
- Department of Hospital Administration, All India Institute of Medical Sciences (AIIMS), New Delhi, India
| | - Vikas H
- Department of Hospital Administration, All India Institute of Medical Sciences (AIIMS), New Delhi, India
| |
Collapse
|
15
|
Boyle DK, Baernholdt M, Adams JM, McBride S, Harper E, Poghosyan L, Manges K. Improve nurses’ well-being and joy in work: Implement true interprofessional teams and address electronic health record usability issues. Nurs Outlook 2019; 67:791-797. [DOI: 10.1016/j.outlook.2019.10.002] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
|
16
|
Zindel M, Cappelucci K, Knight HC, Busis N, Alexander C. Clinician Well-Being at Virginia Mason Kirkland Medical Center: A Case Study. NAM Perspect 2019; 2019:201908c. [PMID: 34532663 DOI: 10.31478/201908c] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
|
17
|
Challenges in the Era of Coding and Corporatization. Obstet Gynecol Clin North Am 2019; 46:553-561. [PMID: 31378295 DOI: 10.1016/j.ogc.2019.04.012] [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: 11/21/2022]
Abstract
The past 40 years have witnessed a major redesign of health care, largely driven by rampantly increasing costs and the perception of lack of better outcomes to justify those costs. Many demographic changes have also challenged the women's health care provider workforce, and evolving new payment systems are likewise a source of angst for these providers. Managed care is seeking to cut costs, and the challenge is to do so without sacrificing quality. Burnout is a new challenge in the present environment. There is now an opportunity to meet these challenges and provide the excellent care our patients deserve.
Collapse
|
18
|
|
19
|
Sensmeier J. Clinical decision support: Are we realizing the promise? Nurs Manag (Harrow) 2018; 49:8-11. [PMID: 30376469 DOI: 10.1097/01.numa.0000547253.84591.e2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Affiliation(s)
- Joyce Sensmeier
- Joyce Sensmeier is the vice president of informatics for the Healthcare Information and Management Systems Society and a Nursing Management editorial board member
| |
Collapse
|
20
|
Barr PJ, Bonasia K, Verma K, Dannenberg MD, Yi C, Andrews E, Palm M, Cavanaugh KL, Masel M, Durand MA. Audio-/Videorecording Clinic Visits for Patient's Personal Use in the United States: Cross-Sectional Survey. J Med Internet Res 2018; 20:e11308. [PMID: 30209029 PMCID: PMC6231772 DOI: 10.2196/11308] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2018] [Revised: 07/19/2018] [Accepted: 07/19/2018] [Indexed: 11/19/2022] Open
Abstract
Background Few clinics in the United States routinely offer patients audio or video recordings of their clinic visits. While interest in this practice has increased, to date, there are no data on the prevalence of recording clinic visits in the United States. Objective Our objectives were to (1) determine the prevalence of audiorecording clinic visits for patients’ personal use in the United States, (2) assess the attitudes of clinicians and public toward recording, and (3) identify whether policies exist to guide recording practices in 49 of the largest health systems in the United States. Methods We administered 2 parallel cross-sectional surveys in July 2017 to the internet panels of US-based clinicians (SERMO Panel) and the US public (Qualtrics Panel). To ensure a diverse range of perspectives, we set quotas to capture clinicians from 8 specialties. Quotas were also applied to the public survey based on US census data (gender, race, ethnicity, and language other than English spoken at home) to approximate the US adult population. We contacted 49 of the largest health systems (by clinician number) in the United States by email and telephone to determine the existence, or absence, of policies to guide audiorecordings of clinic visits for patients’ personal use. Multiple logistic regression models were used to determine factors associated with recording. Results In total, 456 clinicians and 524 public respondents completed the surveys. More than one-quarter of clinicians (129/456, 28.3%) reported that they had recorded a clinic visit for patients’ personal use, while 18.7% (98/524) of the public reported doing so, including 2.7% (14/524) who recorded visits without the clinician’s permission. Amongst clinicians who had not recorded a clinic visit, 49.5% (162/327) would be willing to do so in the future, while 66.0% (346/524) of the public would be willing to record in the future. Clinician specialty was associated with prior recording: specifically oncology (odds ratio [OR] 5.1, 95% CI 1.9-14.9; P=.002) and physical rehabilitation (OR 3.9, 95% CI 1.4-11.6; P=.01). Public respondents who were male (OR 2.11, 95% CI 1.26-3.61; P=.005), younger (OR 0.73 for a 10-year increase in age, 95% CI 0.60-0.89; P=.002), or spoke a language other than English at home (OR 1.99; 95% CI 1.09-3.59; P=.02) were more likely to have recorded a clinic visit. None of the large health systems we contacted reported a dedicated policy; however, 2 of the 49 health systems did report an existing policy that would cover the recording of clinic visits for patient use. The perceived benefits of recording included improved patient understanding and recall. Privacy and medicolegal concerns were raised. Conclusions Policy guidance from health systems and further examination of the impact of recordings—positive or negative—on care delivery, clinician-related outcomes, and patients’ behavioral and health-related outcomes is urgently required.
Collapse
Affiliation(s)
- Paul J Barr
- The Dartmouth Institute for Health Policy & Clinical Practice, Geisel School of Medicine at Dartmouth, Dartmouth College, Lebanon, NH, United States
| | - Kyra Bonasia
- Geisel School of Medicine at Dartmouth, Dartmouth College, Hanover, NH, United States
| | - Kanak Verma
- Geisel School of Medicine at Dartmouth, Dartmouth College, Hanover, NH, United States
| | - Michelle D Dannenberg
- The Dartmouth Institute for Health Policy & Clinical Practice, Geisel School of Medicine at Dartmouth, Dartmouth College, Lebanon, NH, United States
| | - Cameron Yi
- Geisel School of Medicine at Dartmouth, Dartmouth College, Hanover, NH, United States
| | | | - Marisha Palm
- The Dartmouth Institute for Health Policy & Clinical Practice, Geisel School of Medicine at Dartmouth, Dartmouth College, Lebanon, NH, United States
| | - Kerri L Cavanaugh
- Vanderbilt Center for Effective Health Communication, Vanderbilt University Medical Center, Nashville, TN, United States.,Division of Nephrology and Hypertension, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, United States
| | - Meredith Masel
- Oliver Center for Patient Safety & Quality Healthcare, University of Texas Medical Branch, Galveston, TX, United States
| | - Marie-Anne Durand
- The Dartmouth Institute for Health Policy & Clinical Practice, Geisel School of Medicine at Dartmouth, Dartmouth College, Lebanon, NH, United States
| |
Collapse
|