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Sangal RB, Liu RB, Cole KO, Rothenberg C, Ulrich A, Rhodes D, Venkatesh AK. Implementation of an Electronic Health Record Integrated Clinical Pathway Improves Adherence to COVID-19 Hospital Care Guidelines. Am J Med Qual 2022; 37:335-341. [PMID: 35026785 PMCID: PMC9241559 DOI: 10.1097/jmq.0000000000000036] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND During the COVID-19 pandemic, frequently changing guidelines presented challenges to emergency department (ED) clinicians. The authors implemented an electronic health record (EHR)-integrated clinical pathway that could be accessed by clinicians within existing workflows when caring for patients under investigation (PUI) for COVID-19. The objective was to examine the association between clinical pathway utilization and adherence to institutional best practice treatment recommendations for COVID-19. METHODS The authors conducted an observational analysis of all ED patients seen in a health system inclusive of seven EDs between March 18, 2020, and April 20, 2021. They implemented the pathway as an interactive flow chart that allowed clinicians to place orders while viewing the most up-to-date institutional guidance. Primary outcomes were proportion of admitted PUIs receiving dexamethasone and aspirin in the ED, and secondary outcome was time to delivering treatment. RESULTS A total of 13 269 patients were admitted PUIs. The pathway was used by 40.6% of ED clinicians. When clinicians used the pathway, patients were more likely to be prescribed aspirin (OR, 7.15; 95% CI, 6.2-8.26) and dexamethasone (10.4; 8.85-12.2). For secondary outcomes, clinicians using the pathway had statistically significant ( P < 0.0001) improvement in timeliness of ordering medications and admission to the hospital. Aspirin, dexamethasone, and admission order time were improved by 103.89, 94.34, and 121.94 minutes, respectively. CONCLUSIONS The use of an EHR-integrated clinical pathway improved clinician adherence to changing COVID-19 treatment guidelines and timeliness to associated medication administration. As pathways continue to be implemented, their effects on improving patient outcomes and decreasing disparities in patient care should be further examined.
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Affiliation(s)
- Rohit B. Sangal
- Department of Emergency Medicine, Yale University School of Medicine, New Haven, CT
| | - Rachel B. Liu
- Department of Emergency Medicine, Yale University School of Medicine, New Haven, CT
| | | | - Craig Rothenberg
- Department of Emergency Medicine, Yale University School of Medicine, New Haven, CT
| | - Andrew Ulrich
- Department of Emergency Medicine, Yale University School of Medicine, New Haven, CT
| | | | - Arjun K. Venkatesh
- Department of Emergency Medicine, Yale University School of Medicine, New Haven, CT
- Center for Outcomes Research, Yale University School of Medicine, New Haven, CT
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2
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Lavoie B, Bourque CJ, Côté AJ, Rajagopal M, Clerc P, Bourdeau V, Ali S, Doyon-Trottier E, Castonguay V, Fontaine-Pagé É, Burstein B, Desaulniers P, Goldman RD, Thompson G, Berthelot S, Lagacé M, Gaucher N. The responsibility to care: lessons learned from emergency department workers' perspectives during the first wave of the COVID-19 pandemic in Canada. CAN J EMERG MED 2022; 24:482-492. [PMID: 35543924 PMCID: PMC9091548 DOI: 10.1007/s43678-022-00306-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2021] [Accepted: 03/24/2022] [Indexed: 11/24/2022]
Abstract
Background This study’s objective was to examine emergency department (ED) workers’ perspectives during the Canadian COVID-19 first wave. Methods This qualitative study included workers from nine Canadian EDs who participated in 3 monthly video focus groups between April and July 2020 to explore (1) personal/professional experiences, (2) patient care and ED work, (3) relationships with teams, institutions and governing bodies. Framework analysis informed data collection and analysis. Results Thirty-six focus groups and 15 interviews were conducted with 53 participants (including 24 physicians, 16 nurses). Median age was 37.5 years, 51% were female, 79% had more than 5 years’ experience. Three main themes emerged. (1) Early in this pandemic, participants felt a responsibility to provide care to patients and solidarity toward their ED colleagues and team, while balancing many risks with their personal protection. (2) ED teams wanted to be engaged in decision-making, based on the best available scientific knowledge. Institutional decisions and clinical guidelines needed to be adapted to the specificity of each ED environment. (3) Working during the pandemic created new sources of moral distress and fatigue, including difficult clinical practices, distance with patients and families, frequent changes in information and added sources of fatigue. Although participants quickly adapted to a “new normal”, they were concerned about long-term burnout. Participants who experienced high numbers of patient deaths felt especially unprepared. Interpretation ED workers believe they have a responsibility to provide care through a pandemic. Trust in leadership is supported by managers who are present and responsive, transparent in their communication, and involve ED staff in the development and practice of policies and procedures. Such practices will help protect from burnout and ensure the workforce’s long-term sustainability. Supplementary Information The online version contains supplementary material available at 10.1007/s43678-022-00306-z.
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Affiliation(s)
- Bertrand Lavoie
- Faculty of Law, Université Sherbrooke, CHU Sainte-Justine Research Centre, Montreal, QC, Canada
| | - Claude Julie Bourque
- CHU Sainte-Justine Research Centre and Pediatric Emergency Medicine, Department of Pediatrics, CHU Sainte-Justine, Université de Montréal, Montreal, QC, Canada
| | - Anne-Josée Côté
- Department of Pediatric Emergency Medicine, University of Calgary, Calgary, AB, Canada
| | - Manasi Rajagopal
- Department of Pediatrics, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada
| | - Paul Clerc
- Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Valérie Bourdeau
- Centre d'excellence en Éthique Et Partenariat, CHU Sainte-Justine, Montreal, QC, Canada
| | - Samina Ali
- Departments of Pediatrics and Emergency Medicine, Faculty of Medicine and Dentistry, Women and Children's Health Research Institute, University of Alberta, Edmonton, AB, Canada
| | - Evelyne Doyon-Trottier
- Pediatric Emergency Medicine, Department of Pediatrics, CHU Sainte-Justine, Université de Montréal, Montreal, QC, Canada
| | - Véronique Castonguay
- Department of Family and Emergency Medicine, Sacré Coeur Hospital, Université de Montréal, Montreal, QC, Canada
| | - Érika Fontaine-Pagé
- Verdun Hospital, CIUSSS Centre-Sud-de-L'Île-de-Montréal, Montreal, QC, Canada
| | - Brett Burstein
- Division of Pediatric Emergency Medicine, Department of Pediatrics, Montreal Children's Hospital, McGill University Health Centre, Montreal, QC, Canada.,Department of Epidemiology, Biostatics and Occupational Health, McGill University, Montreal, QC, Canada
| | - Pierre Desaulniers
- Department of Family and Emergency Medicine, Centre Hospitalier de L'Université de Montréal, Université de Montréal, Montreal, QC, Canada
| | - Ran D Goldman
- The Pediatric Research in Emergency Therapeutics Program, Division of Emergency Medicine, Department of Pediatrics, University of British Columbia, Vancouver, BC, Canada.,BC Children's Hospital Research Institute, Vancouver, BC, Canada
| | - Graham Thompson
- Departments of Pediatrics and Emergency Medicine, Alberta Children's Hospital Research Institute, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Simon Berthelot
- CHU de Québec-Université Laval, Département de Médecine Familiale Et de Médecine d'urgence, Université Laval, Quebec City, QC, Canada
| | - Maryse Lagacé
- CHU Sainte-Justine Research Centre, Montreal, QC, Canada
| | - Nathalie Gaucher
- CHU Sainte-Justine Research Centre and Pediatric Emergency Medicine, Department of Pediatrics, CHU Sainte-Justine, Université de Montréal, Montreal, QC, Canada.
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De Angulo NR, Penwill N, Pathak PR, Ja C, Elster MJ, Hochreiter D, Newton JM, Wilson KM, Kaiser SV. Quality and Safety in Hospital Pediatrics During COVID-19: A National Qualitative Study. Hosp Pediatr 2021:e2021006115. [PMID: 34939112 DOI: 10.1542/hpeds.2021-006115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
OBJECTIVE To describe challenges in inpatient pediatric quality and safety during the coronavirus disease 2019 (COVID-19) pandemic. METHODS In a previous qualitative study, our team sought to broadly describe changes in pediatric inpatient care during the pandemic. For both that study and this ancillary analysis, we purposefully sampled participants from community and children's hospitals in the 6 US states with the highest COVID-19 hospitalization rates from March to May 2020. We recruited 2 to 3 participants from each hospital (administrators, front-line physicians, nurses, caregivers) for semistructured interviews. We used constant comparative methods to identify themes regarding quality and safety challenges during the pandemic. RESULTS We interviewed 30 participants from 12 hospitals. Participants described several impacts to clinical workflows, including decreased direct clinician-patient interactions and challenges to communication, partly addressed through innovative use of telehealth technology. Participants reported changes in the discharge and transfer process (eg, discharges, difficulties accessing specialized facilities). Participants also described impacts to hospital operations, including changes in quality monitoring and operations (eg, decreased staff, data collection), increased health risks for clinicians and staff (eg, COVID-19 exposure, testing delays), and staff and supply shortages. Participants voiced concerns that negative quality and safety impacts could include increased risk of preventable safety events and hospital readmissions, and decreased patient engagement, education, and satisfaction. CONCLUSIONS We identified several impacts to clinical workflows and hospital operations during the pandemic that may have affected inpatient pediatric care quality and safety. Our findings highlight potentially important areas of focus for planning pandemic recovery, preparing for future pandemics, and conducting future research on inpatient pediatric quality and safety.
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Affiliation(s)
| | | | | | | | | | | | | | - Karen M Wilson
- The Kravis Children's Hospital at the Icahn School of Medicine at Mount Sinai, New York City, New York
| | - Sunitha V Kaiser
- University of California, San Francisco, California
- Philip R. Lee Institute for Health Policy Studies, San Francisco, California
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Jain PN, Cotter JM, Tchou MJ. Practicing High-Value Pediatric Care During a Pandemic: The Challenges and Opportunities. J Hosp Med 2021; 16:631-633. [PMID: 34613900 DOI: 10.12788/jhm.3688] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Accepted: 07/16/2021] [Indexed: 11/20/2022]
Affiliation(s)
- Priya N Jain
- Department of Pediatrics, East Tennessee State University, Johnson City, TN
| | - Jillian M Cotter
- Department of Pediatrics, University of Colorado School of Medicine and Children's Hospital Colorado, Aurora, Colorado
| | - Michael J Tchou
- Department of Pediatrics, University of Colorado School of Medicine and Children's Hospital Colorado, Aurora, Colorado
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Lyman B, Horton MK, Oman A. Organizational learning during COVID-19: A qualitative study of nurses' experiences. J Nurs Manag 2021; 30:4-14. [PMID: 34414626 PMCID: PMC8420306 DOI: 10.1111/jonm.13452] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Revised: 08/08/2021] [Accepted: 08/15/2021] [Indexed: 02/06/2023]
Abstract
Aim The aim of this study is to test the validity of the Organizational Learning in Hospitals model in the context of the COVID‐19 pandemic. Background Organizational learning is especially crucial in circumstances of intense, complex, enduring change, as with the COVID‐19 pandemic. Nurse managers need additional guidance for fostering organizational learning under such circumstances. The Organizational Learning in Hospitals model may be a helpful resource but requires additional validation. Methods Semi‐structured interviews were conducted to gather 19 nurses' first‐hand experiences of organizational learning during the COVID‐19 pandemic. Data were analysed using deductive thematic analysis. Results Nurses' experiences of organizational learning generally aligned with the tenets of the model. Specifically, effective organizational learning occurred when the contextual factors and mechanisms portrayed in the model converged. Model and contrary cases illustrate this phenomenon. Conclusions This study validates and adds context to the model. It offers practical examples of the contextual factors and mechanisms of organizational learning. Leaders can use the model to guide their efforts to foster organizational learning. Implications for Nursing Management This study reaffirms the importance of nurse leaders' central role in organizational learning. Nurse leaders can use the Organizational Learning in Hospitals model, and the practical examples provided, to foster organizational learning during challenging times.
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Affiliation(s)
- Bret Lyman
- College of Nursing, Brigham Young University, Provo, Utah, USA
| | - Morgan K Horton
- College of Nursing, Brigham Young University, Provo, Utah, USA
| | - Alyssa Oman
- College of Nursing, Brigham Young University, Provo, Utah, USA
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