1
|
Blakeney EAR, Chu F, White AA, Randy Smith G, Woodward K, Lavallee DC, Salas RME, Beaird G, Willgerodt MA, Dang D, Dent JM, Tanner E“I, Summerside N, Zierler BK, O’Brien KD, Weiner BJ. A scoping review of new implementations of interprofessional bedside rounding models to improve teamwork, care, and outcomes in hospitals. J Interprof Care 2024; 38:411-426. [PMID: 34632913 PMCID: PMC8994791 DOI: 10.1080/13561820.2021.1980379] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Revised: 08/13/2021] [Accepted: 08/29/2021] [Indexed: 01/22/2023]
Abstract
Poor communication within healthcare teams occurs commonly, contributing to inefficiency, medical errors, conflict, and other adverse outcomes. Interprofessional bedside rounds (IBR) are a promising model that brings two or more health professions together with patients and families as part of a consistent, team-based routine to share information and collaboratively arrive at a daily plan of care. The purpose of this systematic scoping review was to investigate the breadth and quality of IBR literature to identify and describe gaps and opportunities for future research. We followed an adapted Arksey and O'Malley Framework and PRISMA scoping review guidelines. PubMed, CINAHL, PsycINFO, and Embase were systematically searched for key IBR words and concepts through June 2020. Seventy-nine articles met inclusion criteria and underwent data abstraction. Study quality was assessed using the Mixed Methods Assessment Tool. Publications in this field have increased since 2014, and the majority of studies reported positive impacts of IBR implementation across an array of team, patient, and care quality/delivery outcomes. Despite the preponderance of positive findings, great heterogeneity, and a reliance on quantitative non-randomized study designs remain in the extant research. A growing number of interventions to improve safety, quality, and care experiences in hospital settings focus on redesigning daily inpatient rounds. Limited information on IBR characteristics and implementation strategies coupled with widespread variation in terminology, study quality, and design create challenges in assessing the effectiveness of models of rounds and optimal implementation strategies. This scoping review highlights the need for additional studies of rounding models, implementation strategies, and outcomes that facilitate comparative research.
Collapse
Affiliation(s)
- Erin Abu-Rish Blakeney
- Department of Biobehavioral Nursing and Health Informatics,
School of Nursing, University of Washington
| | | | - Andrew A. White
- Department of Medicine, University of Washington School of
Medicine
| | | | | | | | | | | | - Mayumi A. Willgerodt
- Department of Family and Child Nursing, School of Nursing,
University of Washington
| | | | | | | | | | - Brenda K. Zierler
- Department of Biobehavioral Nursing and Health
Informatics, School of Nursing, University of Washington
| | | | - Bryan J. Weiner
- Departments of Global Health and Health Services, School
of Public Health, University of Washington
| |
Collapse
|
2
|
Maiorella R, Fischer A, Banker SL. Shifting Perspectives: A Qualitative Study to Understand Family Expectations at the Time of Their Child's Admission. J Patient Cent Res Rev 2023; 10:13-20. [PMID: 36714001 PMCID: PMC9851390 DOI: 10.17294/2330-0698.1947] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Abstract
Purpose Patient-centered approaches to health care acknowledge the important role that families have in patients' lives. Shared expectations between families and providers have the potential to improve patient and family experience, hospital care, and outcomes. We aimed to understand families' expectations for their child's admission from the vantage point of the start of a hospital stay. Methods This qualitative research studied families of hospitalized children at a large pediatric tertiary care center. Family members were approached if their child was admitted to the general pediatrics team, was under 18 years of age, had a length of stay less than 5 days, and had an English-speaking family member present. Semi-structured interviews were conducted by study personnel during the inpatient stay and audio-recorded. Written transcripts were independently coded by multiple investigators to generate codes, which were reconciled via triangulation. Codes were translated into broad themes to provide insight into the views of the study population. An accompanying survey included demographic questions. Results We conducted 20 interviews with 23 parents of hospitalized children. Participants were 83% female, 35% White, 22% Black, 35% Hispanic, and 70% publicly insured. Participant responses led to identification of 4 themes: 1) setting the stage; 2) building trust and credibility; 3) partnering with families; and 4) maintaining frequent and transparent communication. Conclusions Findings suggest that families' priorities and expectations at the start of their inpatient stay focus on issues of trust, partnership, and communication. These concepts may help providers strengthen communication and create more meaningful partnerships with families.
Collapse
Affiliation(s)
- RosaMarie Maiorella
- Division of Hospital Medicine, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH,Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH
| | - Avital Fischer
- Division of Pediatric Palliative Care, Maine Medical Center, Barbara Bush Children’s Hospital, Portland, ME
| | - Sumeet L. Banker
- Department of Pediatrics, Columbia University Vagelos College of Physicians and Surgeons and NewYork-Presbyterian Morgan Stanley Children’s Hospital, New York, NY
| |
Collapse
|
3
|
Hettiachchi D, Hayes L, Goncalves J, Kostakos V. Team Dynamics in Hospital Workflows: An Exploratory Study of a Smartphone Task Manager. JMIR Med Inform 2021; 9:e28245. [PMID: 34398797 PMCID: PMC8406128 DOI: 10.2196/28245] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Revised: 07/01/2021] [Accepted: 07/10/2021] [Indexed: 12/01/2022] Open
Abstract
Background Although convenient and reliable modern messaging apps like WhatsApp enable efficient communication among hospital staff, hospitals are now pivoting toward purpose-built structured communication apps for various reasons, including security and privacy concerns. However, there is limited understanding of how we can examine and improve hospital workflows using the data collected through such apps as an alternative to costly and challenging research methods like ethnography and patient record analysis. Objective We seek to identify whether the structure of the collected communication data provides insights into hospitals’ workflows. Our analysis also aims to identify ways in which task management platforms can be improved and designed to better support clinical workflows. Methods We present an exploratory analysis of clinical task records collected over 22 months through a smartphone app that enables structured communication between staff to manage and execute clinical workflows. We collected over 300,000 task records between July 2018 and May 2020 completed by staff members including doctors, nurses, and pharmacists across all wards in an Australian hospital. Results We show that important insights into how teams function in a clinical setting can be readily drawn from task assignment data. Our analysis indicates that predefined labels such as urgency and task type are important and impact how tasks are accepted and completed. Our results show that both task sent-to-accepted (P<.001) and sent-to-completed (P<.001) times are significantly higher for routine tasks when compared to urgent tasks. We also show how task acceptance varies across teams and roles and that internal tasks are more efficiently managed than external tasks, possibly due to increased trust among team members. For example, task sent-to-accepted time (minutes) is significantly higher (P<.001) for external assignments (mean 22.10, SD 91.45) when compared to internal assignments (mean 19.03, SD 82.66). Conclusions Smartphone-based task assignment apps can provide unique insights into team dynamics in clinical settings. These insights can be used to further improve how well these systems support clinical work and staff.
Collapse
Affiliation(s)
- Danula Hettiachchi
- School of Computing and Information Systems, The University of Melbourne, Parkville, Australia
| | | | - Jorge Goncalves
- School of Computing and Information Systems, The University of Melbourne, Parkville, Australia
| | - Vassilis Kostakos
- School of Computing and Information Systems, The University of Melbourne, Parkville, Australia
| |
Collapse
|
4
|
Bolton KC, Lawler M, Hauptman J, Madden M, DeVoe SG, Kennedy AG, Tomkins BJ, Hodde NM. Patient Experience on a Hospital Oncology Service Before and After Implementation of a No-Visitor Policy During COVID-19. J Patient Exp 2021; 8:23743735211034620. [PMID: 34377777 PMCID: PMC8323412 DOI: 10.1177/23743735211034620] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Hospital visitor restriction policies prompted by Coronavirus Disease 2019
(COVID-19) may lead to a less comfortable or informed inpatient experience for
oncology patients admitted for non-COVID-19 conditions. We surveyed oncology
inpatients before (n = 47) and after (n = 65) implementation of a no-visitor
policy using a validated questionnaire to measure patient experience. Results
revealed no significant difference in the percentage of patients reporting “no
problems” (P < .05) in all questions. Patient experience was
not adversely impacted by visitor restrictions enacted in response to COVID-19
on an oncology service, as measured by a questionnaire capturing common concerns
among inpatients.
Collapse
Affiliation(s)
- Kenyon C Bolton
- The University of Vermont Medical Center, Burlington, VT, USA
| | - Michael Lawler
- The Robert Larner, MD College of Medicine, The University of Vermont, Burlington, VT, USA
| | | | - Marissa Madden
- The University of Vermont Medical Center, Burlington, VT, USA
| | - Stephen G DeVoe
- Department of Medicine Quality Program, The Robert Larner, MD College of Medicine, The University of Vermont, Burlington, VT, USA
| | - Amanda G Kennedy
- Department of Medicine Quality Program, The Robert Larner, MD College of Medicine, The University of Vermont, Burlington, VT, USA
| | - Bradley J Tomkins
- Department of Medicine Quality Program, The Robert Larner, MD College of Medicine, The University of Vermont, Burlington, VT, USA
| | - Naomi M Hodde
- The University of Vermont Medical Center, Burlington, VT, USA.,The Robert Larner, MD College of Medicine, The University of Vermont, Burlington, VT, USA
| |
Collapse
|
5
|
Ouellet JA, Prsic EH, Spear RA, Blatt L, Kukulka S, Cronin-Ozyck R, Kapo JM, Lai JM. An observational case series of targeted virtual geriatric medicine and palliative care consults for hospitalized older adults with COVID-19. Ann Palliat Med 2021; 10:6297-6306. [PMID: 34154358 DOI: 10.21037/apm-21-117] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/15/2021] [Accepted: 05/13/2021] [Indexed: 11/06/2022]
Abstract
BACKGROUND COVID-19 presents unique challenges to the care of hospitalized older adults, including fractured lines of communication and uncertainty surrounding long term trajectories in cognition and function. Geriatric medicine and palliative care clinicians bring specialized training in facilitating communication in the face of uncertainty. Insurance expansion of virtual visits enabled inpatient virtual consultation, which can preserve personal protective equipment and minimize exposure to clinicians. We examined changes in goals of care and code status following an inpatient virtual consultation with geriatric medicine and palliative care clinicians. METHODS This was an observational case series study performed at a large tertiary Academic Hospital. The study population included 78 patients aged 65 years and older, hospitalized with COVID-19 who had an inpatient consultation completed by geriatric medicine or palliative care clinicians between April 9, 2020 through May 9, 2020. The intervention was targeted, virtual geriatric medicine or palliative care consultation. All patients admitted to a medical floor with COVID-19 were screened four days a week and if a patient was over the age of 65, the medical team was offered a consultation by geriatric medicine (ages 80 and above) or palliative care (ages 65-79). Consultation included medical record review, telephone conversations with clinicians and nurses, telephone or video conversations with patients and/or surrogate decision-makers and collaborative case review on daily virtual huddles with an interprofessional team of geriatric medicine and palliative care clinicians. Descriptive statistics were applied to categorize outcomes after chart abstraction. RESULTS Following consultation, 24 patients (31%) patients changed their code status to less invasive interventions. Of patients who were FULL CODE at the time of consultation (n=42), 2 (4.8%) transitioned to DNR only and 16 (38.1%) transitioned to DNR/DNI after consultation. While 8 patients (10.3%) utilized intensive care unit (ICU) level of care prior to consultation, 6 (7.6%) patients utilized ICU after consultation. After consultation, 11 (14.1%) patients were referred to hospice. CONCLUSIONS Given uncertain trajectories in older adults hospitalized with COVID-19 and variability in patient preferences, virtual goals of care geriatric medicine and palliative care consultations should be considered as a key component of COVID-19 hospital protocols.
Collapse
Affiliation(s)
- Jennifer A Ouellet
- Yale School of Medicine, Section of Geriatrics, Department of Internal Medicine, New Haven, CT, USA
| | - Elizabeth H Prsic
- Yale School of Medicine, Palliative Care Program, Department of Internal Medicine, New Haven, CT, USA
| | - Rebecca A Spear
- Yale School of Medicine, Section of Geriatrics, Department of Internal Medicine, New Haven, CT, USA; Yale School of Medicine, Palliative Care Program, Department of Internal Medicine, New Haven, CT, USA; Maine Dartmouth Family Medicine Residency, Augusta, ME, USA
| | - Leslie Blatt
- Yale School of Medicine, Palliative Care Program, Department of Internal Medicine, New Haven, CT, USA
| | - Shannon Kukulka
- Yale School of Medicine, Section of Geriatrics, Department of Internal Medicine, New Haven, CT, USA
| | - Rosemary Cronin-Ozyck
- Yale School of Medicine, Palliative Care Program, Department of Internal Medicine, New Haven, CT, USA
| | - Jennifer M Kapo
- Yale School of Medicine, Palliative Care Program, Department of Internal Medicine, New Haven, CT, USA
| | - James M Lai
- Yale School of Medicine, Section of Geriatrics, Department of Internal Medicine, New Haven, CT, USA
| |
Collapse
|
6
|
Howard-Anderson J, Schwab KE, Chang S, Wilhalme H, Graber CJ, Quinn R. Internal medicine residents' evaluation of fevers overnight. Diagnosis (Berl) 2019; 6:157-163. [PMID: 30875319 PMCID: PMC6541517 DOI: 10.1515/dx-2018-0066] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2018] [Accepted: 02/12/2019] [Indexed: 01/01/2023]
Abstract
Background Scant data exists to guide the work-up for fever in hospitalized patients, and little is known about what diagnostic tests medicine residents order for such patients. We sought to analyze how cross-covering medicine residents address fever and how sign-out systems affect their response. Methods We conducted a prospective cohort study to evaluate febrile episodes that residents responded to overnight. Primary outcomes included diagnostic tests ordered, if an in-person evaluation occurred, and the effect of sign-out instructions that advised a "full fever work-up" (FFWU). Results Investigators reviewed 253 fevers in 155 patients; sign-out instructions were available for 204 fevers. Residents evaluated the patient in person in 29 (11%) episodes. The most common tests ordered were: blood cultures (48%), urinalysis (UA) with reflex culture (34%), and chest X-ray (30%). If the sign-out advised an FFWU, residents were more likely to order blood cultures [odds ratio (OR) 14.75, 95% confidence interval (CI) 7.52-28.90], UA with reflex culture (OR 12.07, 95% CI 5.56-23.23), chest X-ray (OR 16.55, 95% CI 7.03-39.94), lactate (OR 3.33, 95% CI 1.47-7.55), and complete blood count (CBC) (OR 3.16, 95% CI 1.17-8.51). In a multivariable regression, predictors of the number of tests ordered included hospital location, resident training level, timing of previous blood culture, in-person evaluation, escalation to a higher level of care, and sign-out instructions. Conclusions Sign-out instructions and a few patient factors significantly impacted cross-cover resident diagnostic test ordering for overnight fevers. This practice can be targeted in resident education to improve diagnostic reasoning and stewardship.
Collapse
Affiliation(s)
- Jessica Howard-Anderson
- Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, 49 Jesse Hill Jr. Drive, Atlanta, GA 30303, USA
| | - Kristin E. Schwab
- Department of Medicine, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA
| | - Sandy Chang
- Department of Medicine, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA
| | - Holly Wilhalme
- Department of Medicine Statistics Core, University of California Los Angeles, Los Angeles, CA, USA
| | - Christopher J. Graber
- Department of Medicine, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA; and Infectious Diseases Section, VA Greater Los Angeles Healthcare System, Los Angeles, CA, USA
| | - Roswell Quinn
- Department of Medicine, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA; and Hospitalist Division of the Department of Medicine, VA Greater Los Angeles Healthcare System, Los Angeles, CA, USA
| |
Collapse
|