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Dadich A, Samaranayake P, Hurriyet H, Elliot C. Process improvement of a paediatric feeding clinic. Heliyon 2024; 10:e23150. [PMID: 38163113 PMCID: PMC10756986 DOI: 10.1016/j.heliyon.2023.e23150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Revised: 11/20/2023] [Accepted: 11/28/2023] [Indexed: 01/03/2024] Open
Abstract
Purpose The purpose of this study is to identify opportunities to improve processes within a paediatric feeding clinic to enhance timely patient access to healthcare through effective and efficient resource use. Design/methodology/approach The study involved three interrelated methods. First, de-identified feeding clinic data, collected over seven years, were analysed to understand patient appointments. Second, clinician workshops and the swim lane method were used to map feeding clinic processes. Third, root cause analysis was conducted to identify bottlenecks and identify improvement opportunities. Findings The results revealed three, poorly connected sub-processes within the feeding clinic - namely: the patient triaging and appointment scheduling or allocation process; the clinic reporting process; and the cancellation and rescheduling process. These sub-processes were poorly connected because of inadequate resources, few standardised processes, and limited coordination between the different processes. Consequently, patient appointments were typically delayed, and patient reports were not always completed in a timely manner. Processes within the paediatric feeding clinic could therefore be improved by using digital tools, patient portals and telehealth, online interventions, an automated appointment confirmation system, and/or an automated transcription of each appointment. Originality/value This is the first published study to apply business process management to a paediatric feeding clinic. By using three methods to clarify opportunities to improve clinic processes, it highlights the potential value of health information technology in this context. This evidence will enable health service managers to ensure that children with feeding difficulties have timely access to appropriate care.
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Affiliation(s)
- Ann Dadich
- School of Business, Western Sydney University, Australia
| | | | - Hilal Hurriyet
- School of Business, Western Sydney University, Australia
| | - Chris Elliot
- Department of Paediatrics, St George Hospital, Australia
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Bonett S, Mahajan A, da Silva DT, Williams J, Brady K, Bauermeister J, Wood SM. Advancing the community plan to end the HIV Epidemic in Philadelphia: a qualitative descriptive evaluation of low-threshold PrEP services in sexual health clinics. Implement Sci Commun 2024; 5:4. [PMID: 38183133 PMCID: PMC10768374 DOI: 10.1186/s43058-023-00543-y] [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: 04/17/2023] [Accepted: 12/21/2023] [Indexed: 01/07/2024] Open
Abstract
BACKGROUND Pre-exposure prophylaxis (PrEP) is an effective HIV prevention method and a key component of Philadelphia's Community Plan to End the HIV Epidemic (EHE). However, significant barriers to accessing PrEP exist among people at risk for HIV. Low-threshold models for PrEP services that minimize barriers to entry and service engagement could help bolster access to PrEP through community-based clinics. This study aimed to describe the initial implementation of low-threshold PrEP services in three sexual health clinics funded by the Philadelphia Department of Public Health and explore strategies for delivering low-threshold PrEP services. METHODS We conducted three focus groups with staff (i.e., providers, prevention navigators, and administrative staff, N = 21) at each of three participating PDPH-funded sexual health clinics from November 2021 to January 2022. Discussion topics included details about the PrEP delivery process, clinic strengths and assets, resource gaps, and PrEP implementation goals. Follow-up interviews with staff members (N = 8) between March 2022 and May 2022 focused on identifying successful strategies for PrEP delivery and adaptations needed to optimize low-threshold PrEP service delivery. Rapid qualitative methods and the Consolidated Framework for Implementation Science were used to analyze data from focus groups and interviews. RESULTS Participants collaborated to create process maps that visualized the steps involved in delivering PrEP services within their respective settings. These maps highlighted several stages in PrEP service delivery, such as connecting individuals to services, providing prevention navigation, conducting clinical encounters, and ensuring follow-up care. Participants described effective strategies for implementing PrEP, which included integrating and co-locating services on-site, strengthening staffing resources and capacity, and addressing barriers experienced by clients. CONCLUSIONS Lessons from the implementation of low-threshold PrEP service delivery in Philadelphia can guide ongoing local adaptations and future scale-up of these models to improve access to PrEP and advance the goals of the EHE initiative.
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Affiliation(s)
- Stephen Bonett
- School of Nursing, University of Pennsylvania, Philadelphia, PA, USA.
| | | | | | | | - Kathleen Brady
- Philadelphia Department of Public Health, Philadelphia, PA, USA
| | - José Bauermeister
- School of Nursing, University of Pennsylvania, Philadelphia, PA, USA
| | - Sarah M Wood
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
- Craig Dalsimer Division of Adolescent Medicine, Children's Hospital of Philadelphia, Philadelphia, PA, USA
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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.
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Aloweni FBAB, Lim SH, Agus NLB, Ang SY, Goh MM, Yong P, Fook-Chong S, Tucker-Kellogg L, Soh CR. Evaluation of an Evidence-Based Care Bundle for Preventing Hospital-Acquired Pressure Injuries in High-Risk Surgical Patients. AORN J 2023; 118:306-320. [PMID: 37882600 DOI: 10.1002/aorn.14021] [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: 06/17/2021] [Revised: 06/07/2022] [Accepted: 11/08/2022] [Indexed: 10/27/2023]
Abstract
The aim of this study was to evaluate the effectiveness of an evidence-based care bundle to prevent perioperative pressure injuries. In a single facility, using a preintervention and postintervention quasi-experimental design, we compared the pressure injury incidence rate for two patient groups (ie, before and after care bundle implementation). The bundle included a variety of elements, such as educating patients, applying protection, controlling skin moisture, and using pressure-relieving devices according to the patient's risk. Before the intervention, patients received standard care before procedures that did not address risk for pressure injury development. The study involved a total of 944 patients, and the incidence of pressure injury was lower in the postintervention group than in the preintervention group (1.6% versus 4.8%; P < .001). However, the odds ratio was nonsignificant and therefore the clinical relevance of the bundle is unclear. Additional research with a control group and multiple sites is needed.
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Freeman S, Peach L, Ross C, Marchal K, Meyer A, Skinner K. Development and evaluation of the Rural and Northern Community Focused Model of COPD Care (RaNCoM). BMC Pulm Med 2023; 23:399. [PMID: 37864243 PMCID: PMC10589932 DOI: 10.1186/s12890-023-02683-2] [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: 01/10/2023] [Accepted: 09/27/2023] [Indexed: 10/22/2023] Open
Abstract
BACKGROUND The prevalence of COPD continues to rise. To address the challenges to provide high quality COPD care in rural and northern communities, leaders in one rural and northern community in Western Canada sought to change the culture of COPD screening and care. Recognizing effective assessment, diagnosis, and treatment for patients with COPD are crucial to improve outcomes, a program was developed between 2012 and 2021 to enhance primary care for COPD patients. METHODS A process evaluation was undertaken to assess program development, implementation, mechanisms of impact, and context of COPD program. Qualitative thematic analysis of stakeholder interviews (n = 11) and a document review (n = 60; ~ 500 pages) of key clinic documents was conducted. RESULTS We describe five phases of the COPD program's development (Survive; Reorganize and Stabilize; Assess and Respond; Build and Refine; and Sustain and Share), highlighting areas of innovation. Outreach and localizing resources improved access to the program. Acquiring secured physician compensation, capturing quality data, and improving patient and provider self-efficacy built the capacity of the system and stakeholders within it. Finally, relationships were forged through building an integrated facility, collaborative networking, and patient engagement. Key elements of program implementation included the resources (infrastructure, software, operational) required to ensure operation. CONCLUSION Team-based care and service integration enhanced care capacity and the health network. Focused use of infrastructure and resources supported the people in the care system. Upholding a shared value of relationship is critical to deliver robust and sustainable rural healthcare. Quality improvement requires investment in rural community healthcare resources.
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Affiliation(s)
- Shannon Freeman
- School of Nursing, University of Northern British Columbia, British Columbia, 3333 University Way, Prince George, V2N 4Z9, Canada.
- Centre for Technology Adoption for Aging in the North, University of Northern British Columbia, Prince George, British Columbia, Canada.
| | - Laura Peach
- School of Public Health Sciences, University of Waterloo, Waterloo, ON, Canada
| | - Christopher Ross
- Centre for Technology Adoption for Aging in the North, University of Northern British Columbia, Prince George, British Columbia, Canada
| | - Kathy Marchal
- Fort St, James Health Centre, Fort St. James, British Columbia, Canada
| | - Anthon Meyer
- Rural Coordination Centre of BC, British Columbia, Canada
| | - Kelly Skinner
- School of Public Health Sciences, University of Waterloo, Waterloo, ON, Canada
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Affiliation(s)
- Alan J Card
- From the Department of Pediatrics, University of California, San Diego, School of Medicine, La Jolla, CA
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Kruser JM, Viglianti EM, Mylvaganam R, Krolikowski KA, Khorzad R, Detsky ME, Wiegmann DA, Wunderink RG, Holl JL. Mapping the process of ICU care delivery to improve treatment decisions in acute respiratory failure. IISE TRANSACTIONS ON HEALTHCARE SYSTEMS ENGINEERING 2023; 14:32-41. [PMID: 38646086 PMCID: PMC11025699 DOI: 10.1080/24725579.2023.2188319] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/23/2024]
Abstract
Evidence suggests system-level norms and care processes influence individual patients' medical decisions, including end-of-life decisions for patients with critical illnesses like acute respiratory failure. Yet, little is known about how these processes unfold over the course of a patient's critical illness in the intensive care unit (ICU). Our objective was to map current-state ICU care delivery processes for patients with acute respiratory failure and to identify opportunities to improve the process. We conducted a process mapping study at two academic medical centers, using focus groups and semi-structured interviews. The 70 participants represented 17 distinct roles in ICU care, including interprofessional medical ICU and palliative care clinicians, surrogate decision makers, and patient survivors. Participants refined and endorsed a process map of current-state care delivery for all patients admitted to the ICU with acute respiratory failure requiring mechanical ventilation. The process contains four critical periods for active deliberation about the use of life-sustaining treatments. However, active deliberation steps are inconsistently performed and frequently disrupted, leading to prolongation of life-sustaining treatment by default, without consideration of patients' individual goals and priorities. Interventions to standardize active deliberation in the ICU may improve treatment decisions for ICU patients with acute respiratory failure.
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Affiliation(s)
- Jacqueline M Kruser
- Department of Medicine, Division of Allergy, Pulmonary, and Critical Care, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, United States of America
| | - Elizabeth M Viglianti
- Department of Internal Medicine, Division of Pulmonary and Critical Care Medicine, University of Michigan, Ann Arbor, Michigan, United States of America
| | - Ruben Mylvaganam
- Department of Medicine, Division of Pulmonary and Critical Care Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, United States of America
| | - Kristyn A Krolikowski
- Center for Health Services and Outcomes Research, Institute for Public Health and Medicine, Chicago, IL, United States
| | - Rebeca Khorzad
- Arvin LLC Healthcare Quality Improvement, Lake Forest, Illinois, United States of America
| | - Michael E Detsky
- Department of Medicine, Sinai Health System, Toronto, Canada
- Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, Canada
| | - Douglas A Wiegmann
- Department of Industrial and Systems Engineering, University of Wisconsin-Madison, Madison, Wisconsin, United States of America
| | - Richard G Wunderink
- Department of Medicine, Division of Pulmonary and Critical Care Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, United States of America
| | - Jane L Holl
- Biological Sciences Division, University of Chicago, Chicago, Illinois, United States of America
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Vanstapel FJLA, Orth M, Streichert T, Capoluongo ED, Oosterhuis WP, Çubukçu HC, Bernabeu-Andreu FA, Thelen M, Jacobs LHJ, Linko S, Bhattoa HP, Bossuyt PMM, Meško Brguljan P, Boursier G, Cobbaert CM, Neumaier M. ISO 15189 is a sufficient instrument to guarantee high-quality manufacture of laboratory developed tests for in-house-use conform requirements of the European In-Vitro-Diagnostics Regulation. Clin Chem Lab Med 2023; 61:608-626. [PMID: 36716120 DOI: 10.1515/cclm-2023-0045] [Citation(s) in RCA: 12] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2023] [Accepted: 01/15/2023] [Indexed: 01/31/2023]
Abstract
The EU In-Vitro Diagnostic Device Regulation (IVDR) aims for transparent risk-and purpose-based validation of diagnostic devices, traceability of results to uniquely identified devices, and post-market surveillance. The IVDR regulates design, manufacture and putting into use of devices, but not medical services using these devices. In the absence of suitable commercial devices, the laboratory can resort to laboratory-developed tests (LDT) for in-house use. Documentary obligations (IVDR Art 5.5), the performance and safety specifications of ANNEX I, and development and manufacture under an ISO 15189-equivalent quality system apply. LDTs serve specific clinical needs, often for low volume niche applications, or correspond to the translational phase of new tests and treatments, often extremely relevant for patient care. As some commercial tests may disappear with the IVDR roll-out, many will require urgent LDT replacement. The workload will also depend on which modifications to commercial tests turns them into an LDT, and on how national legislators and competent authorities (CA) will handle new competences and responsibilities. We discuss appropriate interpretation of ISO 15189 to cover IVDR requirements. Selected cases illustrate LDT implementation covering medical needs with commensurate management of risk emanating from intended use and/or design of devices. Unintended collateral damage of the IVDR comprises loss of non-profitable niche applications, increases of costs and wasted resources, and migration of innovative research to more cost-efficient environments. Taking into account local specifics, the legislative framework should reduce the burden on and associated opportunity costs for the health care system, by making diligent use of existing frameworks.
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Key Words
- AB, accrediting body
- BRCA1/2, breast cancer genes 1 and 2
- CA, competent authority
- CAPA, corrective and preventive actions
- CDx, companion diagnostics
- CGP, comprehensive genomic profile
- CRGA, clinically relevant genomic alterations
- EEA, European economic area
- EFLM, European Federation of Clinical Chemistry and Laboratory Medicine
- EMA, European Medicines Agency
- EU, European Union
- European Regulation 2017/746 on In-Vitro-Diagnostic Devices
- FMEA, failure-mode effects analysis
- GA, genomic alterations
- GDPR, General Data Protection Regulation
- HI, health institution
- HRD, homologous recombination deficiency
- HRR, homologous recombination repair
- ISO 15189:2012
- ISO, International Organization for Standardization
- IVDD, In-Vitro Diagnostic Device Directive
- IVDR, In-Vitro Diagnostic Device Regulation
- LDT, laboratory-developed test
- MDCG, Medical Device Coordination Group
- MSI, micro satellite instability
- MU, measurement uncertainty
- NB, notified body
- NGS, next generation sequencing
- NTRK, neurotrophic tyrosine receptor kinase
- PARPi, poly (ADP-ribose) polymerase inhibitors
- PRRC, person responsible for regulatory compliance
- PT, proficiency testing
- RUO, research use only
- RiliBÄk, Richtlinie der Bundesärztekammer zur Qualitätssicherung Laboratoriums medizinischer Untersuchungen
- SOP, standard operating procedure
- TMB, tumor mutational burden
- UDI, unique device identifier
- VAF, variant allele frequency
- iQC, internal quality control
- laboratory-developed tests for in-house use
- method validation
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Affiliation(s)
- Florent J L A Vanstapel
- Laboratory Medicine, University Hospital Leuven, Leuven, Belgium
- Department of Public Health, Biomedical Sciences Group, Catholic University Leuven, Leuven, Belgium
| | - Matthias Orth
- Institute of Laboratory Medicine, Vinzenz von Paul Kliniken gGmbH, Stuttgart, Germany
- Medical Faculty Mannheim of Heidelberg University, Mannheim, Germany
| | - Thomas Streichert
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany
| | - Ettore D Capoluongo
- Dipartimento di Medicina Molecolare e Biotecnologie Mediche, Università Federico II, Naples, Italy
| | - Wytze P Oosterhuis
- Department of Clinical Chemistry, Reinier Haga Medical Diagnostic Centre, Delft, The Netherlands
| | - Hikmet Can Çubukçu
- Ankara University Stem Cell Institute, Ankara, Türkiye
- Department of Rare Diseases, General Directorate of Health Services, Turkish Ministry of Health, Ankara, Türkiye
| | - Francisco A Bernabeu-Andreu
- Servicio Bioquímica Análisis Clínicos, Hospital Universitario Puerta de Hierro Majadahonda (Madrid), Majadahonda, Spain
| | - Marc Thelen
- Result Laboratory for Clinical Chemistry, Amphia Hospital, Breda, The Netherlands
- Department of Laboratory Medicine, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Leo H J Jacobs
- Laboratory for Clinical Chemistry and Hematology, Meander Medical Centre, Amersfoort, The Netherlands
| | | | - Harjit Pal Bhattoa
- Department of Laboratory Medicine, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - Patrick M M Bossuyt
- Department of Epidemiology and Data Science, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, The Netherlands
| | - Pika Meško Brguljan
- Department of Clinical Chemistry, University Clinic for Respiratory and Allergic Diseases Golnik, Golnik, Slovenia
| | - Guilaine Boursier
- Department of Molecular Genetics and Cytogenomics, Rare and Autoinflammatory Diseases Unit, CHU Montpellier, Univ Montpellier, Montpellier, France
| | - Christa M Cobbaert
- Department of Clinical Chemistry and Laboratory Medicine, Leiden University Medical Centre, Leiden, The Netherlands
| | - Michael Neumaier
- Institute for Clinical Chemistry, Medical Faculty Mannheim of Heidelberg University, Mannheim, Germany
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ProDeM: A Process-Oriented Delphi Method for systematic asynchronous and consensual surgical process modelling. Artif Intell Med 2023; 135:102426. [PMID: 36628778 DOI: 10.1016/j.artmed.2022.102426] [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: 05/14/2022] [Revised: 08/10/2022] [Accepted: 10/11/2022] [Indexed: 11/22/2022]
Abstract
Surgical process models support improving healthcare provision by facilitating communication and reasoning about processes in the medical domain. Modelling surgical processes is challenging as it requires integrating information that might be fragmented, scattered, and not process-oriented. These challenges can be faced by involving healthcare domain experts during process modelling. This paper presents ProDeM: a novel Process-Oriented Delphi Method for the systematic, asynchronous, and consensual modelling of surgical processes. ProDeM is an adaptable and flexible method that acknowledges that: (i) domain experts have busy calendars and might be geographically dispersed, and (ii) various elements of the process model need to be assessed to ensure model quality. The contribution of the paper is twofold as it outlines ProDeM, but also demonstrates its operationalisation in the context of a well-known surgical process. Besides showing the method's feasibility in practice, we also present an evaluation of the method by the experts involved in the demonstration.
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Lodemann T, Akçalı E, Fernandez R. Process Modeling of ABCDE Primary Survey in Trauma Resuscitations: A Crucial First Step for Agent-Based Simulation Modeling of Complex Team-Based Clinical Processes. Simul Healthc 2022; 17:425-432. [PMID: 34934025 PMCID: PMC9273801 DOI: 10.1097/sih.0000000000000622] [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: 11/26/2022]
Abstract
INTRODUCTION Trauma teams are ad hoc, multidisciplinary teams that perform complex patient care and medical decision making under dynamic conditions. The ability to measure and thus understand trauma team processes is still limited. Agent-based simulation modeling (ABSM) can be used to investigate complex relationships and performance within a trauma team. However, the foundational work to support such efforts is lacking. The goal of this work is to develop a comprehensive process model for the primary survey in trauma that can support ABSM. METHODS A process model for the primary survey of patients with blunt traumatic injuries was developed using Advanced Trauma Life Support guidelines and peer-reviewed publications. This model was then validated using video recordings of 25 trauma resuscitations in a level 1 trauma center. The assessment and treatment pathway followed in each video were mapped against the defined pathway in the process model. Deviations were noted when resuscitations performance did not follow the defined pathway. RESULTS Overall the process model contains 106 tasks and 78 decision points across all domains, with the largest number appearing in the circulation domain, followed by airway and breathing. A total of 34 deviations were observed across all 25 videos, and a maximum of 3 deviations were observed per video. CONCLUSIONS Overall, our data offered validity support for the blunt trauma primary survey process model. This process model was an important first step for the use of ABSM for the support of trauma care operations and team-based processes.
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Affiliation(s)
- Tobias Lodemann
- Department of Industrial & Systems Engineering, College of Engineering, University of Florida, Gainesville, FL
| | - Elif Akçalı
- Department of Industrial & Systems Engineering, College of Engineering, University of Florida, Gainesville, FL
| | - Rosemarie Fernandez
- Center for Experiential Learning and Simulation and Department of Emergency Medicine, University of Florida, Gainesville, FL
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Diagnosing, Managing, and Supporting Return to Work of Adults With Rotator Cuff Disorders: Clinical Practice Guideline Methods. J Orthop Sports Phys Ther 2022; 52:665-674. [PMID: 35881706 DOI: 10.2519/jospt.2022.11307] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
OBJECTIVES: To present the methods used to develop a clinical practice guideline (CPG) with recommendations endorsed by key stakeholders for assessing, managing, and supporting return to work for adults with rotator cuff disorders. DESIGN: Clinical practice guideline development. METHODS: A steering committee composed of the research team of this project led the development of this CPG in 5 phases, which followed the standards of the NICE and AGREE II collaborations. During the preparation phase (I), a multidisciplinary working committee of experts in managing rotator cuff disorders (n = 20) determined the scope and objectives of the CPG. The recommendations development phase (II) included initial knowledge synthesis, development of preliminary recommendations, systematic consultations with a multidisciplinary panel of key stakeholders (n = 51) using a modified three-round Delphi approach and drafting of the original CPG. In the external evaluation phase (III), an external committee of experts evaluated the original CPG using the AGREE II tool. In the dissemination phase (IV), the strategy for disseminating the CPG was developed and implemented. During the update phase (V), the CPG was revised based on an update of the initial knowledge synthesis. RESULTS: Seventy-three preliminary recommendations were developed from the initial knowledge synthesis. During the Delphi consultation, all of these recommendations were endorsed, and one new recommendation was proposed by panelists. The original CPG received an overall AGREE II score of 83% from the external evaluators. In 2021, an update of the initial 2017 knowledge synthesis was conducted and 13 recommendations were revised. CONCLUSION: The 5-phase consensus methods approach guided the development of a high-quality CPG on assessing, managing, and supporting return to work for adults with rotator cuff disorders. J Orthop Sports Phys Ther 2022;52(10):665-674. Epub: 27 July 2022. doi:10.2519/jospt.2022.11307.
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Variation in suspected cancer referral pathways in primary care: comparative analysis across the International Benchmarking Cancer Partnership. Br J Gen Pract 2022; 73:e88-e94. [PMID: 36127155 PMCID: PMC9512411 DOI: 10.3399/bjgp.2022.0110] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Accepted: 04/12/2022] [Indexed: 01/31/2023] Open
Abstract
BACKGROUND International variations in cancer outcomes persist and may be influenced by differences in the accessibility and organisation of cancer patient pathways. More evidence is needed to understand to what extent variations in the structure of primary care referral pathways for cancer investigation contribute to differences in the timeliness of diagnoses and cancer outcomes in different countries. AIM To explore the variation in primary care referral pathways for the management of suspected cancer across different countries. DESIGN AND SETTING Descriptive comparative analysis using mixed methods across the International Cancer Benchmarking Partnership (ICBP) countries. METHOD Schematics of primary care referral pathways were developed across 10 ICBP jurisdictions. The schematics were initially developed using the Aarhus statement (a resource providing greater insight and precision into early cancer diagnosis research) and were further supplemented with expert insights through consulting leading experts in primary care and cancer, existing ICBP data, a focused review of existing evidence on the management of suspected cancer, published primary care cancer guidelines, and evaluations of referral tools and initiatives in primary care. RESULTS Referral pathway schematics for 10 ICBP jurisdictions were presented alongside a descriptive comparison of the organisation of primary care management of suspected cancer. Several key areas of variation across countries were identified: inflexibility of referral pathways, lack of a managed route for non-specific symptoms, primary care practitioner decision-making autonomy, direct access to investigations, and use of emergency routes. CONCLUSION Analysing the differences in referral processes can prompt further research to better understand the impact of variation on the timeliness of diagnoses and cancer outcomes. Studying these schematics in local contexts may help to identify opportunities to improve care and facilitate discussions on what may constitute best referral practice.
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Hose BZ, Conn Busch J, Lane-Fall M, Bass EJ. Systematic Approach for Comparing Team-based Care Processes. PROCEEDINGS OF THE HUMAN FACTORS AND ERGONOMICS SOCIETY ... ANNUAL MEETING. HUMAN FACTORS AND ERGONOMICS SOCIETY. ANNUAL MEETING 2022; 66:580-584. [PMID: 36910699 PMCID: PMC9997683 DOI: 10.1177/1071181322661079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Team-based care process modeling techniques have focused on understanding and designing solutions for a single site. Less is known about tailoring an effective team-based care process from one site to another, which is necessary for multi-site implementation efforts. We propose an approach for analyzing and comparing a team-based care process performed at two sites to inform redesign opportunities. Our approach includes abstracting the goals and strategies of each process by identifying whether sociotechnical system element differences exist. Element differences may exist for the phase, tasks, roles, information, and technology and tools. Differences in system elements may still support process goals and strategies and, thus, be irrelevant for redesign opportunities. We demonstrate the utility of the approach using an operating room to intensive care unit handoff protocol. This approach should be useful for researchers and practitioners that are tailoring and implementing a successful team-based care process at more than one site.
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Affiliation(s)
- Bat-Zion Hose
- Department of Anesthesiology and Critical Care at the Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Julian Conn Busch
- Department of Anesthesiology and Critical Care at the Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Meghan Lane-Fall
- Department of Anesthesiology and Critical Care at the Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Ellen J Bass
- Department of Anesthesiology and Critical Care at the Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA.,Drexel University, College of Computing and Informatics, Philadelphia, PA.,Drexel University, College of Nursing and Health Professions, Philadelphia, PA
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14
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Li S, Rajapuri AS, Felix Gomez GG, Schleyer T, Mendonca EA, Thyvalikakath TP. How Do Dental Clinicians Obtain Up-To-Date Patient Medical Histories? Modeling Strengths, Drawbacks, and Proposals for Improvements. Front Digit Health 2022; 4:847080. [PMID: 35419556 PMCID: PMC8995974 DOI: 10.3389/fdgth.2022.847080] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2022] [Accepted: 03/08/2022] [Indexed: 11/13/2022] Open
Abstract
BackgroundAccess to up-to-date patient medical history is essential for dental clinicians (DCs) to avoid potential harm to patients and to improve dental treatment outcomes. The predominant approach for dental clinicians (DCs) to gather patients' medical history is through patient-reported medical histories and medical consults. However, studies reported varied concordance and reliability of patient-reported medical conditions and medication histories compared to the patient medical records and this process also places a significant burden on patients. Information technology tools/platforms such as an integrated electronic health record containing an electronic dental record module may address these issues. However, these integrated systems are expensive and technically complex and may not be easily adopted by DCs in solo and small group practice who provide the most dental care. The recent expansion of regional healthcare information exchange (HIE) provides another approach, but to date, studies on connecting DCs with HIE are very limited. Our study objectives were to model different aspects of the current approaches to identify the strengths and weaknesses, and then model the HIE approach that addresses the weaknesses and retain the strengths of current approaches. The models of current approaches identified the people, resources, organizational aspects, workflow, and areas for improvement; while models of the HIE approach identified system requirements, functions, and processes that may be shared with software developers and other stakeholders for future development.MethodsThere are three phases in this study. In Phase 1, we retrieved peer-reviewed PubMed indexed manuscripts published between January 2013 and November 2020 and extracted modeling related data from selected manuscripts. In Phase 2, we built models for the current approaches by using the Integrated DEFinition Method 0 function modeling method (IDEF0), the Unified Modeling Language (UML) Use Case Diagram, and Business Process Model and Notation (BPMN) methods. In Phase 3, we created three conceptual models for the HIE approach.ResultsFrom the 47 manuscripts identified, three themes emerged: 1) medical consult process following patient-reported medical history, 2) integrated electronic dental record-electronic health record (EDR-EHR), and 3) HIE. Three models were built for each of the three themes. The use case diagrams described the actions of the dental patients, DCs, medical providers and the use of information systems (EDR-EHR/HIE). The IDEF0 models presented the major functions involved. The BPMN models depicted the detailed steps of the process and showed how the patient's medical history information flowed through different steps. The strengths and weaknesses revealed by the models of the three approaches were also compared.ConclusionsWe successfully modeled the DCs' current approaches of accessing patient medical history and designed an HIE approach that addressed the current approaches' weaknesses as well as leveraged their strengths. Organizational management and end-users can use this information to decide the optimum approach to integrate dental and medical care. The illustrated models are comprehensive and can also be adopted by EHR and EDR vendors to develop a connection between dental systems and HIEs.
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Affiliation(s)
- Shuning Li
- Dental Informatics, Indiana University School of Dentistry, Indianapolis, IN, United States
- *Correspondence: Shuning Li
| | - Anushri Singh Rajapuri
- Dental Informatics, Indiana University School of Dentistry, Indianapolis, IN, United States
- Center for Biomedical Informatics, Regenstrief Institute, Inc., Indianapolis, IN, United States
| | - Grace Gomez Felix Gomez
- Dental Informatics, Indiana University School of Dentistry, Indianapolis, IN, United States
- Center for Biomedical Informatics, Regenstrief Institute, Inc., Indianapolis, IN, United States
| | - Titus Schleyer
- Center for Biomedical Informatics, Regenstrief Institute, Inc., Indianapolis, IN, United States
- Indiana University School of Medicine, Indianapolis, IN, United States
| | - Eneida A. Mendonca
- Center for Biomedical Informatics, Regenstrief Institute, Inc., Indianapolis, IN, United States
- Indiana University School of Medicine, Indianapolis, IN, United States
| | - Thankam P. Thyvalikakath
- Dental Informatics, Indiana University School of Dentistry, Indianapolis, IN, United States
- Center for Biomedical Informatics, Regenstrief Institute, Inc., Indianapolis, IN, United States
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15
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Stubbs DJ, Davies BM, Menon DK. Chronic subdural haematoma: the role of peri‐operative medicine in a common form of reversible brain injury. Anaesthesia 2022; 77 Suppl 1:21-33. [DOI: 10.1111/anae.15583] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/02/2021] [Indexed: 01/08/2023]
Affiliation(s)
- D. J. Stubbs
- University Division of Anaesthesia Department of Medicine Addenbrooke’s Hospital Cambridge UK
| | - B. M. Davies
- Department of Academic Neurosurgery Addenbrooke’s Hospital Cambridge UK
| | - D. K. Menon
- University Division of Anaesthesia Department of Medicine Addenbrooke’s Hospital Cambridge UK
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16
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Wooldridge AR, Carayon P, Hoonakker P, Hose BZ, Schroeer K, Brazelton T, Eithun B, Rusy D, Ross J, Kohler J, Kelly MM, Dean S, Springman S, Rahal R, Gurses AP. Care transition of trauma patients: Processes with articulation work before and after handoff. APPLIED ERGONOMICS 2022; 98:103606. [PMID: 34638036 PMCID: PMC10373374 DOI: 10.1016/j.apergo.2021.103606] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/25/2021] [Revised: 09/23/2021] [Accepted: 10/05/2021] [Indexed: 06/13/2023]
Abstract
While care transitions influence quality of care, less work studies transitions between hospital units. We studied care transitions from the operating room (OR) to pediatric and adult intensive critical care units (ICU) using Systems Engineering Initiative for Patient Safety (SEIPS)-based process modeling. We interviewed twenty-nine physicians (surgery, anesthesia, pediatric critical care) and nurses (OR, ICU) and administered the AHRQ Hospital Survey on Patient Safety Culture items about handoffs, care transitions and teamwork. Care transitions are complex, spatio-temporal processes and involve work during the transition (i.e., handoff and transport) and preparation and follow up activities (i.e., articulation work). Physicians defined the transition as starting earlier and ending later than nurses. Clinicians in the OR to adult ICU transition without a team handoff reported significantly less information loss and better cooperation, despite positive interview data. A team handoff and supporting articulation work should increase awareness, improving quality and safety of care transitions.
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Affiliation(s)
- Abigail R Wooldridge
- Department of Industrial and Enterprise Systems Engineering, University of Illinois at Urbana-Champaign, Urbana, IL, USA.
| | - Pascale Carayon
- Wisconsin Institute for Healthcare Systems Engineering, University of Wisconsin, Madison, USA; Department of Industrial and Systems Engineering, University of Wisconsin, Madison, USA
| | - Peter Hoonakker
- Wisconsin Institute for Healthcare Systems Engineering, University of Wisconsin, Madison, USA
| | - Bat-Zion Hose
- Department of Anesthesiology and Critical Care at the Perelman School of Medicine, University of Pennsylvania, USA
| | - Katherine Schroeer
- Wisconsin Institute for Healthcare Systems Engineering, University of Wisconsin, Madison, USA; Department of Industrial and Systems Engineering, University of Wisconsin, Madison, USA
| | - Tom Brazelton
- University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Ben Eithun
- University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Deborah Rusy
- University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Joshua Ross
- University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | | | - Michelle M Kelly
- University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Shannon Dean
- University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Scott Springman
- University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Rima Rahal
- Vituity, Mercy General Hospital and Sutter Medical Center, Sacramento, CA, USA
| | - 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, USA
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17
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Process Mining for Healthcare: Characteristics and Challenges. J Biomed Inform 2022; 127:103994. [DOI: 10.1016/j.jbi.2022.103994] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Revised: 11/16/2021] [Accepted: 01/10/2022] [Indexed: 12/23/2022]
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18
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Crumley ET, Kelly S, Young J, Phinney N, McCarthy J, Gubitz G. How is the medical assistance in dying (MAID) process carried out in Nova Scotia, Canada? A qualitative process model flowchart study. BMJ Open 2021; 11:e048698. [PMID: 34312206 PMCID: PMC8314721 DOI: 10.1136/bmjopen-2021-048698] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVES The aims of this study are: (1) to create a flowchart process model of how medical assistance in dying (MAID) occurs in Nova Scotia (NS), Canada and (2) to detail how NS healthcare professionals are involved in each stage of MAID. The research questions are: how is the MAID process carried out and which professionals are involved at which points? and which roles and activities do professionals carry out during MAID? DESIGN Qualitative process model flowchart study with semistructured interviews. SETTING Primary and secondary care in NS, Canada. PARTICIPANTS Thirty-two interviewees self-selected to participate (12 physicians, 3 nurse practitioners (NP), 6 nurses, 6 pharmacists and 5 healthcare administrators and advocates). Participants were included if they conduct assessments, provide MAID, fill prescriptions, insert the intravenous lines, organise care and so on. RESULTS The flowchart process model details five stages of how MAID occurs in NS: (1) starting the MAID process, (2) MAID assessments, (3) MAID preparation (hospital in-patient, hospital outpatient, non-hospital), (4) day of MAID and (5) post-MAID (hospital in-patient and outpatient, non-hospital, after leaving setting). Nineteen points where the process could stop or be delayed were identified. MAID differs slightly by location and multiple professionals from different organisations are involved at different points. Some physicians and NP provide MAID for free as they cannot be reimbursed or find it too difficult to be reimbursed. CONCLUSIONS Our study adds knowledge about the MAID activities and roles of NS professionals, which are not documented in the international literature. Clinicians and pharmacists spend significant additional time to participate, raising questions about MAID's sustainability and uncompensated costs. The process model flowchart identifies where MAID can stop or be delayed, signalling where resources, training and relationship-building may need to occur. Knowing where potential delays can occur can help clinicians, administrators and policymakers in other jurisdictions improve MAID.
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Affiliation(s)
- Ellen T Crumley
- Health, Saint Francis Xavier University, Antigonish, Nova Scotia, Canada
| | - Scarlett Kelly
- Treasury Board of Canada Secretariat, Ottawa, Ontario, Canada
| | - Joel Young
- Dalhousie Medical School, Halifax, Nova Scotia, Canada
| | - Nicole Phinney
- Medical Assistance in Dying Program, Nova Scotia Health Authority, Halifax, Nova Scotia, Canada
| | - John McCarthy
- Medical Assistance in Dying Program, Nova Scotia Health Authority, Halifax, Nova Scotia, Canada
| | - Gordon Gubitz
- Neurology, Faculty of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
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Lane-Fall MB, Christakos A, Russell GC, Hose BZ, Dauer ED, Greilich PE, Hong Mershon B, Potestio CP, Pukenas EW, Kimberly JR, Stephens-Shields AJ, Trotta RL, Beidas RS, Bass EJ. Handoffs and transitions in critical care-understanding scalability: study protocol for a multicenter stepped wedge type 2 hybrid effectiveness-implementation trial. Implement Sci 2021; 16:63. [PMID: 34130725 PMCID: PMC8204062 DOI: 10.1186/s13012-021-01131-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Accepted: 05/26/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The implementation of evidence-based practices in critical care faces specific challenges, including intense time pressure and patient acuity. These challenges result in evidence-to-practice gaps that diminish the impact of proven-effective interventions for patients requiring intensive care unit support. Research is needed to understand and address implementation determinants in critical care settings. METHODS The Handoffs and Transitions in Critical Care-Understanding Scalability (HATRICC-US) study is a Type 2 hybrid effectiveness-implementation trial of standardized operating room (OR) to intensive care unit (ICU) handoffs. This mixed methods study will use a stepped wedge design with randomized roll out to test the effectiveness of a customized protocol for structuring communication between clinicians in the OR and the ICU. The study will be conducted in twelve ICUs (10 adult, 2 pediatric) based in five United States academic health systems. Contextual inquiry incorporating implementation science, systems engineering, and human factors engineering approaches will guide both protocol customization and identification of protocol implementation determinants. Implementation mapping will be used to select appropriate implementation strategies for each setting. Human-centered design will be used to create a digital toolkit for dissemination of study findings. The primary implementation outcome will be fidelity to the customized handoff protocol (unit of analysis: handoff). The primary effectiveness outcome will be a composite measure of new-onset organ failure cases (unit of analysis: ICU). DISCUSSION The HATRICC-US study will customize, implement, and evaluate standardized procedures for OR to ICU handoffs in a heterogenous group of United States academic medical center intensive care units. Findings from this study have the potential to improve postsurgical communication, decrease adverse clinical outcomes, and inform the implementation of other evidence-based practices in critical care settings. TRIAL REGISTRATION ClinicalTrials.gov identifier: NCT04571749 . Date of registration: October 1, 2020.
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Affiliation(s)
| | - Athena Christakos
- 3400 Spruce Street 6th Floor Dulles Building, Philadelphia, PA 19104 USA
| | - Gina C. Russell
- 3400 Civic Center Boulevard, Building 421, Philadelphia, PA 19104 USA
| | - Bat-Zion Hose
- 423 Guardian Drive, 333 Blockley Hall, Philadelphia, PA 19104 USA
| | | | | | | | | | | | - John R. Kimberly
- 3620 Locust Walk, 2109 Steinberg-Dietrich Hall, Philadelphia, PA 19104 USA
| | | | | | | | - Ellen J. Bass
- Drexel University, 3675 Market Street, Suite 1000, Philadelphia, PA 19104 USA
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20
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Holden RJ, Carayon P. SEIPS 101 and seven simple SEIPS tools. BMJ Qual Saf 2021; 30:901-910. [PMID: 34039748 PMCID: PMC8543199 DOI: 10.1136/bmjqs-2020-012538] [Citation(s) in RCA: 55] [Impact Index Per Article: 18.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2020] [Accepted: 05/11/2021] [Indexed: 11/04/2022]
Affiliation(s)
| | - Pascale Carayon
- Industrial and Systems Engineering, University of Wisconsin-Madison, Madison, Wisconsin, USA
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21
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Antonacci G, Lennox L, Barlow J, Evans L, Reed J. Process mapping in healthcare: a systematic review. BMC Health Serv Res 2021; 21:342. [PMID: 33853610 PMCID: PMC8048073 DOI: 10.1186/s12913-021-06254-1] [Citation(s) in RCA: 40] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2020] [Accepted: 03/08/2021] [Indexed: 01/01/2023] Open
Abstract
INTRODUCTION Process mapping (PM) supports better understanding of complex systems and adaptation of improvement interventions to their local context. However, there is little research on its use in healthcare. This study (i) proposes a conceptual framework outlining quality criteria to guide the effective implementation, evaluation and reporting of PM in healthcare; (ii) reviews published PM cases to identify context and quality of PM application, and the reported benefits of using PM in healthcare. METHODS We developed the conceptual framework by reviewing methodological guidance on PM and empirical literature on its use in healthcare improvement interventions. We conducted a systematic review of empirical literature using PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) methodology. Inclusion criteria were: full text empirical study; describing the process through which PM has been applied in a healthcare setting; published in English. Databases searched are: Medline, Embase, HMIC-Health Management Information Consortium, CINAHL-Cumulative Index to Nursing and Allied Health Literature, Scopus. Two independent reviewers extracted and analysed data. Each manuscript underwent line by line coding. The conceptual framework was used to evaluate adherence of empirical studies to the identified PM quality criteria. Context in which PM is used and benefits of using PM were coded using an inductive thematic analysis approach. RESULTS The framework outlines quality criteria for each PM phase: (i) preparation, planning and process identification, (ii) data and information gathering, (iii) process map generation, (iv) analysis, (v) taking it forward. PM is used in a variety of settings and approaches to improvement. None of the reviewed studies (N = 105) met all ten quality criteria; 7% were compliant with 8/10 or 9/10 criteria. 45% of studies reported that PM was generated through multi-professional meetings and 15% reported patient involvement. Studies highlighted the value of PM in navigating the complexity characterising healthcare improvement interventions. CONCLUSION The full potential of PM is inhibited by variance in reporting and poor adherence to underpinning principles. Greater rigour in the application of the method is required. We encourage the use and further development of the proposed framework to support training, application and reporting of PM. TRIAL REGISTRATION Prospero ID: CRD42017082140.
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Affiliation(s)
- Grazia Antonacci
- Department of Primary Care and Public Health, Imperial College London, National Institute of Health Research (NIHR) Applied Research Collaboration (ARC) Northwest London, London, UK
- Business School, Centre for Health Economics and Policy Innovation (CHEPI), Imperial College London, London, UK
| | - Laura Lennox
- Department of Primary Care and Public Health, Imperial College London, National Institute of Health Research (NIHR) Applied Research Collaboration (ARC) Northwest London, London, UK
| | - James Barlow
- Business School, Centre for Health Economics and Policy Innovation (CHEPI), Imperial College London, London, UK
| | - Liz Evans
- Department of Primary Care and Public Health, Imperial College London, National Institute of Health Research (NIHR) Collaboration for Leadership in Applied Health Research and Care (CLAHRC) Northwest London, London, UK
| | - Julie Reed
- Department of Primary Care and Public Health, Imperial College London, National Institute of Health Research (NIHR) Collaboration for Leadership in Applied Health Research and Care (CLAHRC) Northwest London, London, UK
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22
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Wai B, Vasarhelyi K, Rutherford AR, Buchner C, Gustafson R, Compton M, Hull M, Williams J, Barrios R. A qualitative model of the HIV care continuum in Vancouver, Canada. Health Syst (Basingstoke) 2021; 11:84-97. [DOI: 10.1080/20476965.2021.1906762] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
Affiliation(s)
- Benny Wai
- Department of Mathematics, Simon Fraser University, Burnaby, Canada
| | - Krisztina Vasarhelyi
- Faculty of Health Sciences, Simon Fraser University, Burnaby, Canada
- Vancouver Coastal Health Research Institute, Vancouver Coastal Health, Vancouver, Canada
| | | | - Chris Buchner
- Population and Public Health, Fraser Health, Surrey, Canada
| | - Reka Gustafson
- Vancouver Coastal Health Research Institute, Vancouver Coastal Health, Vancouver, Canada
| | - Miranda Compton
- Vancouver Coastal Health Research Institute, Vancouver Coastal Health, Vancouver, Canada
| | - Mark Hull
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, Canada
| | - Jf Williams
- Department of Mathematics, Simon Fraser University, Burnaby, Canada
| | - Rolando Barrios
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, Canada
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23
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Iflaifel MH, Lim R, Crowley C, Ryan K, Greco F. Detailed analysis of 'work as imagined' in the use of intravenous insulin infusions in a hospital: a hierarchical task analysis. BMJ Open 2021; 11:e041848. [PMID: 33757944 PMCID: PMC7993247 DOI: 10.1136/bmjopen-2020-041848] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
OBJECTIVE Variable rate intravenous insulin infusions (VRIII) is a high-risk medication that has a potential to cause significant patient harm if used in error. Complex preparation of VRIII in clinical areas and the need for frequent monitoring and adjustment increase the complexity of using VRIII. An emerging approach, called Resilient Healthcare, proposes understanding complexity of work by exploring how work is assumed to be done and compare it with everyday work. This study aimed to explore how VRIII is perceived to be used by healthcare practitioners, focusing on one aspect of Resilient Healthcare: understanding how work is assumed to be done, using a method called hierarchical task analysis (HTA). DESIGN A qualitative study using document analysis and focus groups. SETTING A vascular surgery unit in an acute National Health Service teaching hospital in the UK. PARTICIPANTS Stakeholders/users in different professional roles involved in the process of using VRIII. RESULTS The HTA showed the complexity of using VRIII and highlighted more than 115 steps required to treat elevated blood glucose. The process of producing hospital-specific guidelines was iterative. Careful consideration was taken to coordinate the development and implementation of guidelines. Documents provided detailed clinical instructions related to the use of VRIII but practitioners selectively used them, often in deference to senior colleagues. Intentional adaptations, for example, proactively asking for a VRIII prescription occurred and were acknowledged as part of providing individualised patient care. CONCLUSION Using VRIII to treat elevated blood glucose is a complex but necessary process mediated by a range of factors such as organisational influences. Adaptive strategies to mitigate errors were common and future research can build on insights from this study to develop a broader understanding of how VRIII is used and to understand how adaptations are made in relation to the use of VRIII.
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Affiliation(s)
- Mais Hasan Iflaifel
- Reading School of Pharmacy, University of Reading School of Chemistry Food and Pharmacy, Reading, UK
| | - Rosemary Lim
- Reading School of Pharmacy, University of Reading School of Chemistry Food and Pharmacy, Reading, UK
| | - Clare Crowley
- Pharmacy, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Kath Ryan
- Reading School of Pharmacy, University of Reading School of Chemistry Food and Pharmacy, Reading, UK
| | - Francesca Greco
- Reading School of Pharmacy, University of Reading School of Chemistry Food and Pharmacy, Reading, UK
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24
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Orenstein EW, Yun K, Warden C, Westerhaus MJ, Mirth MG, Karavite D, Mamo B, Sundar K, Michel JJ. Development and dissemination of clinical decision support across institutions: standardization and sharing of refugee health screening modules. J Am Med Inform Assoc 2021; 26:1515-1524. [PMID: 31373356 DOI: 10.1093/jamia/ocz124] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2019] [Revised: 06/17/2019] [Accepted: 06/25/2019] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES We developed and piloted a process for sharing guideline-based clinical decision support (CDS) across institutions, using health screening of newly arrived refugees as a case example. MATERIALS AND METHODS We developed CDS to support care of newly arrived refugees through a systematic process including a needs assessment, a 2-phase cognitive task analysis, structured preimplementation testing, local implementation, and staged dissemination. We sought consensus from prospective users on CDS scope, applicable content, basic supported workflows, and final structure. We documented processes and developed sharable artifacts from each phase of development. We publically shared CDS artifacts through online dissemination platforms. We collected feedback and implementation data from implementation sites. RESULTS Responses from 19 organizations demonstrated a need for improved CDS for newly arrived refugee patients. A guided multicenter workflow analysis identified 2 main workflows used by organizations that would need to be supported by shared CDS. We developed CDS through an iterative design process, which was successfully disseminated to other sites using online dissemination repositories. Implementation sites had a small-to-modest analyst time commitment but reported a good match between CDS and workflow. CONCLUSION Sharing of CDS requires overcoming technical and workflow barriers. We used a guided multicenter workflow analysis and online dissemination repositories to create flexible CDS that has been adapted at 3 sites. Organizations looking to develop sharable CDS should consider evaluating the workflows of multiple institutions and collecting feedback on scope, design, and content in order to make a more generalizable product.
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Affiliation(s)
- Evan W Orenstein
- Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia, USA.,Division of Hospital Medicine, Children's Healthcare of Atlanta, Atlanta, Georgia, USA
| | - Katherine Yun
- PolicyLab, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA.,Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Clara Warden
- PolicyLab, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Michael J Westerhaus
- Department of Medicine, HealthPartners Center for International Health, Minneapolis, Minnesota, USA
| | - Morgan G Mirth
- PolicyLab, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA.,Division of Emergency Medicine, Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Dean Karavite
- Department of Biomedical and Health Informatics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Blain Mamo
- Minnesota Department of Public Health, Minneapolis, Minnesota, USA
| | - Kavya Sundar
- PolicyLab, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Jeremy J Michel
- Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA.,Department of Biomedical and Health Informatics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
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25
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Winter M, Pryss R, Probst T, Reichert M. Applying Eye Movement Modeling Examples to Guide Novices' Attention in the Comprehension of Process Models. Brain Sci 2021; 11:brainsci11010072. [PMID: 33430418 PMCID: PMC7827780 DOI: 10.3390/brainsci11010072] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2020] [Revised: 12/23/2020] [Accepted: 01/01/2021] [Indexed: 11/20/2022] Open
Abstract
Process models are crucial artifacts in many domains, and hence, their proper comprehension is of importance. Process models mediate a plethora of aspects that are needed to be comprehended correctly. Novices especially face difficulties in the comprehension of process models, since the correct comprehension of such models requires process modeling expertise and visual observation capabilities to interpret these models correctly. Research from other domains demonstrated that the visual observation capabilities of experts can be conveyed to novices. In order to evaluate the latter in the context of process model comprehension, this paper presents the results from ongoing research, in which gaze data from experts are used as Eye Movement Modeling Examples (EMMEs) to convey visual observation capabilities to novices. Compared to prior results, the application of EMMEs improves process model comprehension significantly for novices. Novices achieved in some cases similar performances in process model comprehension to experts. The study’s insights highlight the positive effect of EMMEs on fostering the comprehension of process models.
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Affiliation(s)
- Michael Winter
- Institute of Databases and Information Systems, Ulm University, 89081 Ulm, Germany;
- Correspondence:
| | - Rüdiger Pryss
- Institute of Clinical Epidemiology and Biometry, University of Würzburg, 97070 Würzburg, Germany;
| | - Thomas Probst
- Department for Psychotherapy and Biopsychological Health, Danube University Krems, 3500 Krems, Austria;
| | - Manfred Reichert
- Institute of Databases and Information Systems, Ulm University, 89081 Ulm, Germany;
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26
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Alkaabi M, Simsekler MCE, Jayaraman R, Al Kaf A, Ghalib H, Quraini D, Ellahham S, Tuzcu EM, Demirli K. Evaluation of System Modelling Techniques for Waste Identification in Lean Healthcare Applications. Risk Manag Healthc Policy 2021; 13:3235-3243. [PMID: 33447104 PMCID: PMC7802016 DOI: 10.2147/rmhp.s283189] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2020] [Accepted: 10/30/2020] [Indexed: 11/23/2022] Open
Abstract
Purpose Waste identification plays a vital role in lean healthcare applications. While the value stream map (VSM) is among the most commonly used tools for waste identification, it may be limited to visualize the behaviour of dynamic and complex healthcare systems. To address this limitation, system modelling techniques (SMTs) can be used to provide a comprehensive picture of various system-wide wastes. However, there is a lack of evidence in the current literature about the potential contribution of SMTs for waste identification in healthcare processes. Methods This study evaluates the usability and utility of six types of SMTs along with the VSM. For the evaluation, interview-based questionnaires were conducted with twelve stakeholders from the outpatient clinic at the Heart and Vascular Institute at Cleveland Clinic Abu Dhabi. Results VSM was found to be the most useful diagram in waste identification in general. However, some SMTs that represent the system behaviour outperformed the VSM in identifying particular waste types, e.g., communication diagram in identifying over-processing waste and flow diagram in identifying transportation waste. Conclusion As behavioural SMTs and VSM have unique strengths in identifying particular waste types, the use of multiple diagrams is recommended for a comprehensive waste identification in lean. However, limited resources and time, as well as limited experience of stakeholders with SMTs, may still present obstacles for their potential contribution in lean healthcare applications.
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Affiliation(s)
- Maitha Alkaabi
- Department of Industrial and Systems Engineering, Khalifa University of Science and Technology, Abu Dhabi, United Arab Emirates
| | - Mecit Can Emre Simsekler
- Department of Industrial and Systems Engineering, Khalifa University of Science and Technology, Abu Dhabi, United Arab Emirates
| | - Raja Jayaraman
- Department of Industrial and Systems Engineering, Khalifa University of Science and Technology, Abu Dhabi, United Arab Emirates
| | - Abdulqader Al Kaf
- Department of Industrial and Systems Engineering, Khalifa University of Science and Technology, Abu Dhabi, United Arab Emirates
| | - Hussam Ghalib
- Heart and Vascular Institute, Cleveland Clinic Abu Dhabi, Abu Dhabi, United Arab Emirates
| | - Dima Quraini
- Heart and Vascular Institute, Cleveland Clinic Abu Dhabi, Abu Dhabi, United Arab Emirates
| | - Samer Ellahham
- Heart and Vascular Institute, Cleveland Clinic Abu Dhabi, Abu Dhabi, United Arab Emirates
| | - E Murat Tuzcu
- Heart and Vascular Institute, Cleveland Clinic Abu Dhabi, Abu Dhabi, United Arab Emirates
| | - Kudret Demirli
- Department of Mechanical, Industrial and Aerospace Engineering, Concordia University, Montreal, Canada
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Austin JD, Rodriguez SA, Savas LS, Megdal T, Ramondetta L, Fernandez ME. Using Intervention Mapping to Develop a Provider Intervention to Increase HPV Vaccination in a Federally Qualified Health Center. Front Public Health 2020; 8:530596. [PMID: 33392125 PMCID: PMC7775559 DOI: 10.3389/fpubh.2020.530596] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2020] [Accepted: 11/18/2020] [Indexed: 11/13/2022] Open
Abstract
Introduction: A healthcare provider's ability to give a strong recommendation for the HPV vaccine is of utmost importance in increasing HPV vaccination. To reduce the burden of HPV-related cancers, there is a critical need to develop and implement theory-based interventions aimed at strengthening healthcare providers' communication about the HPV vaccine. Methods: We used Intervention Mapping (IM) steps 1-5 to develop and implement a provider-level intervention that aligns with the priorities and needs of a large, urban Federally Qualified Health Center (FQHC). Results: In step 1, a diverse planning group identified barriers to HPV vaccination in clinical settings and generated process maps and a logic model of the problem. Step 2 outlined outcomes and provider performance objectives of the intervention and identified knowledge, skills, self-efficacy, outcome expectations, and normative beliefs as modifiable targets that need to change for providers to deliver strong recommendations for the HPV vaccine to parents and patients. In step 3, the planning group mapped the methods of persuasive communication, information, and modeling and skills training to behavioral targets and outlined the program practical applications (strategies) components, scope, and sequence. In steps 4 and 5, the planning group produced the intervention and planned for program implementation. The iterative and participatory process of IM resulted in modifications to the initial intervention that aligned with the needs of the FQHC. Discussion: IM provided a systematic, participatory, and iterative approach for developing a theory-based provider-level intervention aimed at strengthening healthcare providers' ability to provide a strong recommendation for the HPV vaccine to eligible patients and parents served by a large FQHC. IM assisted with the identification of behavioral targets and methods that move beyond HPV knowledge and reminders to create behavior change. IM can help researchers and planners describe the processes and rational behind developing interventions and may help to facilitate implementation in real-world clinical settings by tailoring intervention components to the needs of the population.
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Affiliation(s)
- Jessica D. Austin
- The University of Texas Health Science Center School of Public Health, Dallas Regional Campus, Dallas, TX, United States
| | - Serena A. Rodriguez
- Department of Population and Data Sciences, University of Texas Southwestern Medical Center, Dallas, TX, United States
| | - Lara S. Savas
- Center for Health Promotion and Prevention Research, The University of Texas Health Science Center at Houston School of Public Health, Houston, TX, United States
| | - Tina Megdal
- Legacy Community Health, Houston, TX, United States
| | - Lois Ramondetta
- Department of Gynecologic Oncology and Reproductive Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Maria E. Fernandez
- Center for Health Promotion and Prevention Research, The University of Texas Health Science Center at Houston School of Public Health, Houston, TX, United States
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A process modelling approach to assess the impact of teledermatology deployment onto the skin tumor care pathway. Int J Med Inform 2020; 146:104361. [PMID: 33348274 DOI: 10.1016/j.ijmedinf.2020.104361] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2020] [Revised: 11/30/2020] [Accepted: 12/01/2020] [Indexed: 12/25/2022]
Abstract
BACKGROUND Teledermatology was raised as a potential answer to increase access and decrease delay for skin cancer management. However, its influence on non-melanoma skin cancer (NMSC) care pathway has never been studied. OBJECTIVES To compare conventional care pathway to teledermatology (TD) in NMSC care pathways using a process modelling approach. PATIENTS AND METHODS A period study including three groups was conducted in a department of dermatology. During the first period from January till February 2013 a NMSC care pathway was mapped for a group a prior TD integration. During the second period from September 2016 till October 2018, the NMSC care pathway was determined for patients managed by a conventional care process and after TD diagnosis. Patients characteristics, type of tumors and processes were compared using time as a key performance indicator. Mean were reported with their ± SD. Linear regression was performed using time between multidisciplinary consultation and surgery as outcome adjusted on sex, age and cancer type. RESULTS During the first period (prior to TD) 89 NMSC patients were managed (mean age = 76 yr old ± 13) during the second period, 36 patients NMSC were managed after TD, mean age of 89 years old ± 6 and 954 patients in a conventional process, mean age of 78 years old ±12. In comparison between the two periods patient's age, sex and cancer distribution significantly differed while the rate of surgery was not significantly different (p = 0.967). Linear multivariate regression using time between multidisciplinary consultation and surgery as outcome adjusted on sex age and cancer type displayed that during the second period patients in the TD group spent 17.6 days more [0.98,34.25] while patient in the conventional care process group had 9.8 days [1.85,17.74] more than patient in the study period 1, (p = 0.04, p = 0.02) without significant difference for age and sex (p = 0.29, p = 0.51). Patients with a SCC had a decreased time between multidisciplinary consultation and surgery of -12.97 days [-17.43, -8.5], p < 10-3. CONCLUSION Interestingly, patients managed by TD were significantly older than those managed using a conventional care pathway. Unexpectedly their total time spent in the process was not shorter. The results of this analysis illustrated the interest of using process modelling approach to assess the impact of a healthcare innovation integration and to further rethink coordination and care pathways for NSMC post TD.
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Gravitt PE, Rositch AF, Jurczuk M, Meza G, Carillo L, Jeronimo J, Adsul P, Nervi L, Kosek M, Tracy JK, Paz-Soldan VA. Integrative Systems Praxis for Implementation Research (INSPIRE): An Implementation Methodology to Facilitate the Global Elimination of Cervical Cancer. Cancer Epidemiol Biomarkers Prev 2020; 29:1710-1719. [PMID: 32561563 DOI: 10.1158/1055-9965.epi-20-0501] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Revised: 06/09/2020] [Accepted: 06/11/2020] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND The World Health Organization (WHO) has called for a systems thinking approach to health systems strengthening to increase adoption of evidence-based interventions (EBI). The Integrative Systems Praxis for Implementation Research (INSPIRE) methodology operationalizes the WHO systems thinking framework to meet cervical cancer elimination-early detection and treatment (CC-EDT) goals. METHODS Using a systems thinking approach and grounded in the consolidated framework for implementation research, INSPIRE integrates multiple research methodologies and evaluation frameworks into a multilevel implementation strategy. RESULTS In phase I (creating a shared understanding), soft systems methodology and pathway analysis are used to create a shared visual understanding of the CC-EDT system, incorporating diverse stakeholder perspectives of the "what, how, and why" of system behavior. Phase II (finding leverage) facilitates active stakeholder engagement in knowledge transfer and decision-making using deliberative dialogues and multiple scenario analyses. Phase III (acting strategically) represents stakeholder-engaged implementation planning, using well-defined implementation strategies of education, training, and infrastructure development. In phase IV (learning and adapting), evaluation of key performance indicators via a reach, effectiveness, adoption, implementation, and maintenance framework is reviewed by stakeholder teams, who continuously adapt implementation plans to improve system effectiveness. CONCLUSIONS The INSPIRE methodology is a generalizable approach to context-adapted implementation of EBIs. IMPACT Replacing static dissemination of implementation "roadmaps" with learning health systems through the integration of systems thinking and participatory action research, INSPIRE facilitates the development of scalable and sustainable implementation strategies adapted to local contexts.
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Affiliation(s)
- Patti E Gravitt
- Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, Maryland.
| | - Anne F Rositch
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Magdalena Jurczuk
- Department of Global Community Health and Behavioral Sciences, Tulane University School of Public Health and Tropical Medicine, New Orleans, Louisiana
| | - Graciela Meza
- Facultad de Medicina Humana, Universidad Nacional de la Amazonia Peruana, Iquitos, Peru
| | | | - Jose Jeronimo
- Global Coalition Against Cervical Cancer, Arlington, Virginia
| | - Prajakta Adsul
- Department of Internal Medicine, University of New Mexico, Albuquerque, New Mexico
| | - Laura Nervi
- College of Population Health, University of New Mexico, Albuquerque, New Mexico
| | - Margaret Kosek
- Department of Medicine, University of Virginia, Charlottesville, Virginia
| | - J Kathleen Tracy
- Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, Maryland
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Odberg KR, Hansen BS, Aase K, Wangensteen S. A work system analysis of the medication administration process in a Norwegian nursing home ward. APPLIED ERGONOMICS 2020; 86:103100. [PMID: 32342890 DOI: 10.1016/j.apergo.2020.103100] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/29/2019] [Revised: 02/20/2020] [Accepted: 03/19/2020] [Indexed: 06/11/2023]
Abstract
Nursing home patients often have multiple diagnoses and a high prevalence of polypharmacy and are at risk of experiencing adverse drug events. The study aims to explore the dynamic interactions of stakeholders and work system elements in the medication administration process in a nursing home ward. Data were collected using observations and interviews. A deductive content analysis led to a SEIPS-based process map and an accompanying work system analysis. The study increases knowledge of the complexity of the medication administration process by portraying the dynamic interactions between the major stakeholders in the work system, and the temporal flow of the activities involved. Secondly, it identifies facilitators and barriers in the work system linked to the medication administration process. Most barriers and facilitators are associated with the work system elements - tools & technology, organisation and tasks - and occur early in the medication administration process.
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Affiliation(s)
- Kristian Ringsby Odberg
- Norwegian University of Science and Technology (NTNU), Department of Health Sciences in Gjøvik, Norway.
| | | | - Karina Aase
- University of Stavanger, Department of Health Studies, Centre Director, SHARE - Centre for Resilience in Healthcare, Norway
| | - Sigrid Wangensteen
- Norwegian University of Science and Technology (NTNU), Department of Health Sciences in Gjøvik, Norway.
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Woodward M, De Pennington N, Grandidge C, McCulloch P, Morgan L. Development and evaluation of an electronic hospital referral system: a human factors approach. ERGONOMICS 2020; 63:710-723. [PMID: 32220218 DOI: 10.1080/00140139.2020.1748232] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/09/2019] [Accepted: 03/09/2020] [Indexed: 06/10/2023]
Abstract
Coordinating care across hospitals has been identified as a patient safety risk as referrals are often paper-based and poorly documented. Electronic referral systems have the potential to improve the situation but can fail to gain uptake. We applied a human factors/ergonomics (HFE) approach to place analysis of local workflow and user engagement central to the development of a new regional electronic referral system. The intervention was evaluated with a before-and-after study. Referral quality improved, referrals containing sufficient clinical information for continuation of care increased from 36.9% to 83.5% and completeness of referral information significantly improved. There was a 35.7% reduction in the number of calls to the on-call specialist, and the mean period between admission and surgery for expedited transfers was reduced. Applying HFE informed design with use-based evidence; the system maintains sustained uptake three years after implementation. Reliable recording of information translates to better patient safety during inter-hospital transitions. Practitioners summary: This study developed, implemented and evaluated a clinical referral system using a human factors approach. Process analysis and usability studies were used to inform the application requirements and design. Region-wide implementation in hospitals resulted in the improved quality and completeness of clinical referral information and efficiencies in the referral process.
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Affiliation(s)
- Matthew Woodward
- Nuffield Department of Surgical Sciences, University of Oxford, Oxford, UK
| | | | - Carly Grandidge
- Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Peter McCulloch
- Nuffield Department of Surgical Sciences, University of Oxford, Oxford, UK
| | - Lauren Morgan
- Nuffield Department of Surgical Sciences, University of Oxford, Oxford, UK
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Wooldridge AR, Carayon P, Hoonakker P, Hose BZ, Eithun B, Brazelton T, Ross J, Kohler JE, Kelly MM, Dean SM, Rusy D, Gurses AP. Work system barriers and facilitators in inpatient care transitions of pediatric trauma patients. APPLIED ERGONOMICS 2020; 85:103059. [PMID: 32174347 PMCID: PMC7309517 DOI: 10.1016/j.apergo.2020.103059] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/18/2019] [Revised: 11/13/2019] [Accepted: 01/13/2020] [Indexed: 06/02/2023]
Abstract
Hospital-based care of pediatric trauma patients includes transitions between units that are critical for quality of care and patient safety. Using a macroergonomics approach, we identify work system barriers and facilitators in care transitions. We interviewed eighteen healthcare professionals involved in transitions from emergency department (ED) to operating room (OR), OR to pediatric intensive care unit (PICU) and ED to PICU. We applied the Systems Engineering Initiative for Patient Safety (SEIPS) process modeling method and identified nine dimensions of barriers and facilitators - anticipation, ED decision making, interacting with family, physical environment, role ambiguity, staffing/resources, team cognition, technology and characteristic of trauma care. For example, handoffs involving all healthcare professionals in the OR to PICU transition created a shared understanding of the patient, but sometimes included distractions. Understanding barriers and facilitators can guide future improvements, e.g., designing a team display to support team cognition of healthcare professionals in the care transitions.
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Affiliation(s)
- Abigail R Wooldridge
- Department of Industrial and Enterprise Systems Engineering, University of Illinois at Urbana-Champaign, Urbana, IL, USA.
| | - Pascale Carayon
- Department of Industrial and Systems Engineering, University of Wisconsin-Madison, Madison, WI, USA; Wisconsin Institute for Healthcare Systems Engineering, University of Wisconsin-Madison, Madison, WI, USA
| | - Peter Hoonakker
- Wisconsin Institute for Healthcare Systems Engineering, University of Wisconsin-Madison, Madison, WI, USA
| | - Bat-Zion Hose
- Department of Industrial and Systems Engineering, University of Wisconsin-Madison, Madison, WI, USA; Wisconsin Institute for Healthcare Systems Engineering, University of Wisconsin-Madison, Madison, WI, USA
| | - Benjamin Eithun
- American Family Children's Hospital, University of Wisconsin School of Medicine and Public Health, School of Nursing, University of Wisconsin-Madison, Madison, WI, USA
| | - Thomas Brazelton
- Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Joshua Ross
- Department of Emergency Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Jonathan E Kohler
- Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Michelle M Kelly
- Wisconsin Institute for Healthcare Systems Engineering, University of Wisconsin-Madison, Madison, WI, USA; Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Shannon M Dean
- Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Deborah Rusy
- Department of Anesthesiology, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Ayse P Gurses
- Center for Health Care Human Factors, Armstrong Institute for Patient Safety and Quality, Johns Hopkins University, Baltimore, MD, USA; Division of Health Sciences Informatics, School of Medicine, Johns Hopkins University, Baltimore, MD, USA; Bloomberg School of Public Health and Whiting School of Engineering, Johns Hopkins University, Baltimore, MD, USA
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McLachlan S, Kyrimi E, Dube K, Hitman G, Simmonds J, Fenton N. Towards standardisation of evidence-based clinical care process specifications. Health Informatics J 2020; 26:2512-2537. [DOI: 10.1177/1460458220906069] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
There is a strong push towards standardisation of treatment approaches, care processes and documentation of clinical practice. However, confusion persists regarding terminology and description of many clinical care process specifications which this research seeks to resolve by developing a taxonomic characterisation of clinical care process specifications. Literature on clinical care process specifications was analysed, creating the starting point for identifying common characteristics and how each is constructed and used in the clinical setting. A taxonomy for clinical care process specifications is presented. The De Bleser approach to limited clinical care process specifications characterisation was extended and each clinical care process specification is successfully characterised in terms of purpose, core elements and relationship to the other clinical care process specification types. A case study on the diagnosis and treatment of Type 2 Diabetes in the United Kingdom was used to evaluate the taxonomy and demonstrate how the characterisation framework applies. Standardising clinical care process specifications ensures that the format and content are consistent with expectations, can be read more quickly and high-quality information can be recorded about the patient. Standardisation also enables computer interpretability, which is important in integrating Learning Health Systems into the modern clinical environment. The approach presented allows terminologies for clinical care process specifications that were widely used interchangeably to be easily distinguished, thus, eliminating the existing confusion.
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Affiliation(s)
- Scott McLachlan
- Health informatics and Knowledge Engineering Research Group (HiKER), New Zealand; Queen Mary University of London, UK
| | | | - Kudakwashe Dube
- Health informatics and Knowledge Engineering Research Group (HiKER), New Zealand; Massey University, New Zealand
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Dean J. Update from RCP Quality Improvement: Improving improvement through practice, learning and research. Future Healthc J 2020; 7:6-7. [PMID: 32104757 DOI: 10.7861/fhj.qi-7-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Rosati S, Valeri F, Borchiellini A, Gianfreda CM, Balestra G. Characterization of Physicians Workload in a Reference Center for the Treatment of Thrombotic and Bleeding Disorders .. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2020; 2019:1359-1362. [PMID: 31946145 DOI: 10.1109/embc.2019.8856820] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Heavy workloads in healthcare have been often associated to adverse clinical outcomes. To reduce workloads, an optimal scheduling of clinical staff resources is not enough, but particular attention must be payed to work organization and task characteristics. Moreover, interruptions during the clinical practice contribute to increase perceived workloads. In this study we analyzed and characterized the physicians' workload in an Italian center for the treatment of thrombotic and bleeding disorders. First, all clinical and administrative processes performed in the center were analyzed by means of two process modelling tools. Then, the quantification of the physicians' workload and the characterization of interruptions during practice were conducted. From our results it emerged that the task that mainly impacts on the workload is ambulatory care (42% of total workload) while interruptions produce a delay of almost 15 minutes per day and mainly occur during visits. Including all activities, the total daily workload per physician was 8 hours on average. In this time breaks were not taken into account. Concluding, from our analysis it is evident that the physicians' workload in the analyzed center is heavy and interruptions represent a source of delay in the workflow, that impact the physicians' workload.
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Thomas J, Dahm MR, Li J, Westbrook JI, Georgiou A. A comparative study of the utilisation of an electronic test-result management system in emergency and intensive care settings. Health Informatics J 2019; 26:3072-3087. [PMID: 31793817 DOI: 10.1177/1460458219889223] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
The purpose of this qualitative study was to identify differences in the utilisation of an electronic medical record test-result management system between two acute care departments. Field observations (130 min) and semi-structured interviews (n = 24) were conducted in the Intensive Care Unit and Emergency Department of an Australian hospital. Work processes identified from audio transcripts were modelled using business process modelling. Comparison of the Emergency Department and Intensive Care Unit identified the following: (1) test ordering variations according to clinical roles, (2) differences in the use of electronic medical record functionality according to specific demands of the clinical environment and (3) the non-linear components of the test-result management process. Variations were identified in the number of process decisions, external collaborations and temporal process workflows. Modelling the business processes, collaboration and communication needs of individual clinical environments can aid in enhancing the quality and appositeness of health information technology interventions and thus contribute to improving patient safety. Future health information technology interventions/evaluations aimed at improving the safety of test-result management processes need to address both the nuances of the clinical environment and accommodate the individual work practices of clinicians within that environment.
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Kriznik NM, Lamé G, Dixon-Woods M. Challenges in making standardisation work in healthcare: lessons from a qualitative interview study of a line-labelling policy in a UK region. BMJ Open 2019; 9:e031771. [PMID: 31780591 PMCID: PMC6887013 DOI: 10.1136/bmjopen-2019-031771] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE To identify and learn from efforts to design and implement a standardised policy for labelling of invasive tubing and lines across a regional health system. DESIGN Single case study involving qualitative interviews and documentary analysis. SETTING A devolved health system in the UK National Health Service (NHS). PARTICIPANTS NHS staff (n=10) and policy-makers (n=8) who were involved in the design and/or implementation of the standardised policy. RESULTS Though standardising labelling of invasive tubing and lines was initially seen as a common-sense technical change, challenges during the process of developing and implementing the policy were multiple and sociotechnical in nature. Major challenges related to defining the problem and the solution, limited sustained engagement with stakeholders and users, prototyping/piloting of the solution, and planning for implementation. Some frontline staff remained unconvinced of the need for or value of the policy, since they either did not believe that there was a problem or did not agree that standardised labelling was the right solution. Mundane practical issues such authorisation and resourcing, supply chains for labels, the need to restructure work practices to accommodate the new standard, and the physical features of the labels in specific clinical settings all had important impacts. CONCLUSIONS Newly standardised tools and practices have to fit within a system of pre-existing norms, practices and procedures. We identified a number of practical, social and cultural challenges when designing and implementing a standardised policy in a regional healthcare system. Taking account of both sociocultural and technical aspects of standardisation, combined with systems thinking, could lead to more effective implementation and increase acceptability and usability of new standards.
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Affiliation(s)
- Natasha Marie Kriznik
- THIS Institute (The Healthcare Improvement Studies Institute), Department of Public Health and Primary Care, University of Cambridge, Cambridge, Cambridgeshire, UK
| | - Guillaume Lamé
- THIS Institute (The Healthcare Improvement Studies Institute), Department of Public Health and Primary Care, University of Cambridge, Cambridge, Cambridgeshire, UK
| | - Mary Dixon-Woods
- THIS Institute (The Healthcare Improvement Studies Institute), Department of Public Health and Primary Care, University of Cambridge, Cambridge, Cambridgeshire, UK
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Alfred M, Catchpole K, Huffer E, Fredendall L, Taaffe KM. Work systems analysis of sterile processing: decontamination. BMJ Qual Saf 2019; 29:320-328. [PMID: 31723018 DOI: 10.1136/bmjqs-2019-009422] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2019] [Revised: 10/24/2019] [Accepted: 11/04/2019] [Indexed: 12/23/2022]
Abstract
BACKGROUND Few studies have explored the work of sterile processing departments (SPD) from a systems perspective. Effective decontamination is critical for removing organic matter and reducing microbial levels from used surgical instruments prior to disinfection or sterilisation and is delivered through a combination of human work and supporting technologies and processes. OBJECTIVE In this paper we report the results of a work systems analysis that sought to identify the complex multilevel interdependencies that create performance variation in decontamination and identify potential improvement interventions. METHODS The research was conducted at a 700-bed academic hospital with two reprocessing facilities decontaminating approximately 23 000 units each month. Mixed methods, including 56 hours of observations of work as done, formal and informal interviews with relevant stakeholders and analysis of data collected about the system, were used to iteratively develop a process map, task analysis, abstraction hierarchy and a variance matrix. RESULTS We identified 21 different performance shaping factors, 30 potential failures, 16 types of process variance, and 10 outcome variances in decontamination. Approximately 2% of trays were returned to decontamination from assembly, while decontamination problems were found in about 1% of surgical cases. Staff knowledge, production pressures, instrument design, tray composition and workstation design contributed to outcomes such as reduced throughput, tray defects, staff injuries, increased inventory and equipment costs, and patient injuries. CONCLUSIONS Ensuring patients and technicians' safety and efficient SPD operation requires improved design of instruments and the decontamination area, skilled staff, proper equipment maintenance and effective coordination of reprocessing tasks.
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Affiliation(s)
- Myrtede Alfred
- Department of Anesthesia and Perioperative Medicine, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Ken Catchpole
- Department of Anesthesia and Perioperative Medicine, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Emily Huffer
- Department of Industrial Engineering, Clemson University, Clemson, South Carolina, USA
| | - Larry Fredendall
- Department of Management, Clemson University, Clemson, South Carolina, USA
| | - Kevin M Taaffe
- Department of Industrial Engineering, Clemson University, Clemson, South Carolina, USA
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Simsekler MCE, Kaya GK, Ward JR, Clarkson PJ. Evaluating inputs of failure modes and effects analysis in identifying patient safety risks. Int J Health Care Qual Assur 2019; 32:191-207. [PMID: 30859865 DOI: 10.1108/ijhcqa-12-2017-0233] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
PURPOSE There is a growing awareness on the use of systems approaches to improve patient safety and quality. While earlier studies evaluated the validity of such approaches to identify and mitigate patient safety risks, so far only little attention has been given to their inputs, such as structured brainstorming and use of system mapping approaches (SMAs), to understand their impact in the risk identification process. To address this gap, the purpose of this paper is to evaluate the inputs of a well-known systems approach, failure modes and effects analysis (FMEA), in identifying patient safety risks in a real healthcare setting. DESIGN/METHODOLOGY/APPROACH This study was conducted in a newly established adult attention deficit hyperactivity disorder service at Cambridge and Peterborough Foundation Trust in the UK. Three stakeholders of the chosen service together with the facilitators conducted an FMEA exercise along with a particular system diagram that was initially found as the most useful SMA by eight stakeholders of the service. FINDINGS In this study, it was found that the formal structure of FMEA adds value to the risk identification process through comprehensive system coverage with the help of the system diagram. However, results also indicates that the structured brainstorming refrains FMEA participants from identifying and imagining new risks since they follow the process predefined in the given system diagram. ORIGINALITY/VALUE While this study shows the potential contribution of FMEA inputs, it also suggests that healthcare organisations should not depend solely on FMEA results when identifying patient safety risks; and therefore prioritising their safety concerns.
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Affiliation(s)
- Mecit Can Emre Simsekler
- Department of Industrial and Systems Engineering, Khalifa University of Science Technology , Abu Dhabi, United Arab Emirates.,School of Management, University College London , London, UK
| | | | - James R Ward
- Department of Engineering, University of Cambridge , Cambridge, UK
| | - P John Clarkson
- Department of Engineering, University of Cambridge , Cambridge, UK
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Vesterinen HM, Dutcher TV, Errecaborde KM, Mahero MW, Macy KW, Prasarnphanich OO, Kassenborg H, Yulizar E, Fauzi RP, Budayanti NS, Suwandono A, Artama WT, Valeri L, Pelican KM. Strengthening multi-sectoral collaboration on critical health issues: One Health Systems Mapping and Analysis Resource Toolkit (OH-SMART) for operationalizing One Health. PLoS One 2019; 14:e0219197. [PMID: 31276535 PMCID: PMC6611682 DOI: 10.1371/journal.pone.0219197] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2019] [Accepted: 06/18/2019] [Indexed: 11/18/2022] Open
Abstract
Addressing critical global health issues, such as antimicrobial resistance, infectious disease outbreaks, and natural disasters, requires strong coordination and management across sectors. The One Health approach is the integrative effort of multiple sectors working to attain optimal health for people, animals, and the environment, and is increasingly recognized by experts as a means to address complex challenges. However, practical application of the One Health approach has been challenging. The One Health Systems Mapping and Analysis Resource Toolkit (OH-SMART) introduced in this paper was designed using a multistage prototyping process to support systematic improvement in multi-sectoral coordination and collaboration to better address complex health concerns through an operational, stepwise, and practical One Health approach. To date, OH-SMART has been used to strengthen One Health systems in 17 countries and has been deployed to revise emergency response frameworks, improve antimicrobial resistance national action plans and create multi agency infectious disease collaboration protocols. OH-SMART has proven to be user friendly, robust, and capable of fostering multi-sectoral collaboration and complex system-wide problem solving.
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Affiliation(s)
- Heidi M. Vesterinen
- Center for Animal Health and Food Safety, Veterinary Population Medicine Department, College of Veterinary Medicine, University of Minnesota, St. Paul, Minnesota, United States of America
- * E-mail:
| | - Tracey V. Dutcher
- Veterinary Services, Animal and Plant Health Inspection Service, United States Department of Agriculture, St. Paul, Minnesota, United States of America
| | - Kaylee M. Errecaborde
- One Health Division, Veterinary Population Medicine Department, College of Veterinary Medicine, University of Minnesota, St. Paul, Minnesota, United States of America
| | - Michael W. Mahero
- One Health Division, Veterinary Population Medicine Department, College of Veterinary Medicine, University of Minnesota, St. Paul, Minnesota, United States of America
| | - Katelyn W. Macy
- One Health Division, Veterinary Population Medicine Department, College of Veterinary Medicine, University of Minnesota, St. Paul, Minnesota, United States of America
| | - Ong-Orn Prasarnphanich
- Center for Animal Health and Food Safety, Veterinary Population Medicine Department, College of Veterinary Medicine, University of Minnesota, St. Paul, Minnesota, United States of America
| | - Heidi Kassenborg
- Minnesota Department of Agriculture, St. Paul, Minnesota, United States of America
| | - Erinaldi Yulizar
- Veterinary Services of West Sumatra, Padang, West Sumatra, Indonesia
| | - Rama P. Fauzi
- Coordinating Ministry for People’s Welfare, Jakarta, Indonesia
| | | | - Agus Suwandono
- College of Public Health, University of Diponegoro, Semarang, Central Java, Indonesia
| | | | - Linda Valeri
- One Health Division, Veterinary Population Medicine Department, College of Veterinary Medicine, University of Minnesota, St. Paul, Minnesota, United States of America
| | - Katharine M. Pelican
- One Health Division, Veterinary Population Medicine Department, College of Veterinary Medicine, University of Minnesota, St. Paul, Minnesota, United States of America
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Lamé G, Liberati E, Burt J, Draycott T, Winter C, Ward J, Dixon-Woods M. IMproving the practice of intrapartum electronic fetal heart rate MOnitoring with cardiotocography for safer childbirth (the IMMO programme): protocol for a qualitative study. BMJ Open 2019; 9:e030271. [PMID: 31256041 PMCID: PMC6609047 DOI: 10.1136/bmjopen-2019-030271] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2019] [Revised: 05/22/2019] [Accepted: 06/10/2019] [Indexed: 11/30/2022] Open
Abstract
INTRODUCTION Suboptimal electronic fetal heart rate monitoring (EFM) in labour using cardiotocography (CTG) has been identified as one of the most common causes of avoidable harm in maternity care. Training staff is a frequently proposed solution to reduce harm. However, current approaches to training are heterogeneous in content and format, making it difficult to assess effectiveness. Technological solutions, such as digital decision support, have not yet demonstrated improved outcomes. Effective improvement strategies require in-depth understanding of the technical and social mechanisms underpinning the EFM process. The aim of this study is to advance current knowledge of the types of errors, hazards and failure modes in the process of classifying, interpreting and responding to CTG traces. This study is part of a broader research programme aimed at developing and testing an intervention to improve intrapartum EFM. METHODS AND ANALYSIS The study is organised into two workstreams. First, we will conduct observations and interviews in three UK maternity units to gain an in-depth understanding of how intrapartum EFM is performed in routine clinical practice. Data analysis will combine the insights of an ethnographic approach (focused on the social norms and interactions, values and meanings that appear to be linked with the process of EFM) with a systems thinking approach (focused on modelling processes, actors and their interactions). Second, we will use risk analysis techniques to develop a framework of the errors, hazards and failure modes that affect intrapartum EFM. ETHICS AND DISSEMINATION This study has been approved by the West Midlands-South Birmingham Research Ethics Committee, reference number: 18/WM/0292. Dissemination will take the form of academic articles in peer-reviewed journals and conferences, along with tailored communication with various stakeholders in maternity care.
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Affiliation(s)
- Guillaume Lamé
- The Healthcare Improvement Studies Institute (THIS Institute), University of Cambridge, Cambridge, UK
| | - Elisa Liberati
- The Healthcare Improvement Studies Institute (THIS Institute), University of Cambridge, Cambridge, UK
| | - Jenni Burt
- The Healthcare Improvement Studies Institute (THIS Institute), University of Cambridge, Cambridge, UK
| | - Tim Draycott
- School of Social and Community Medicine, University of Bristol, Bristol, UK
- Women and Children's Health, North Bristol NHS Trust, Westbury on Trym, UK
| | - Cathy Winter
- School of Social and Community Medicine, University of Bristol, Bristol, UK
- Women and Children's Health, North Bristol NHS Trust, Westbury on Trym, UK
| | - James Ward
- Engineering Design Centre, University of Cambridge, Cambridge, UK
| | - Mary Dixon-Woods
- The Healthcare Improvement Studies Institute (THIS Institute), University of Cambridge, Cambridge, UK
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Simsekler MCE, Ward JR, Clarkson PJ. Evaluation of system mapping approaches in identifying patient safety risks. Int J Qual Health Care 2018; 30:227-233. [PMID: 29346654 DOI: 10.1093/intqhc/mzx176] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2016] [Accepted: 12/06/2017] [Indexed: 11/13/2022] Open
Abstract
Objective While many system mapping approaches (SMAs) have been broadly used in safety-critical industries, few have so far been employed in the healthcare field to assist in the identification of patient safety risks. In this study, we evaluated a set of system modelling approaches to assess their potential contribution to the identification of risks affecting patient safety. The aim was to gain a greater understanding of the practical application of system modelling approaches with the help of the risk categorization framework developed in this study. Setting We conducted this study in a newly established Adult Attention Deficit Hyperactivity Disorder (ADHD) service at Cambridge and Peterborough Foundation Trust. Study participants Eight key stakeholders of the chosen service, including clinicians, managers and administrative staff, were individually asked to evaluate a set of pre-defined six SMAs according to their usefulness in identifying patient safety risks through interview-based questionnaires. Results It was found that each SMA could be useful in the chosen healthcare service in different ways. Further, specific types of diagrams were selected by stakeholders as more useful than others in identifying different sources of risks within the given system. Conclusions The results of the evaluation showed that the system diagram is the most useful SMA in risk identification within the given system, while limited time, resources and experience of stakeholders with SMAs may present possible obstacles for their potential use in the healthcare field in future.
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Affiliation(s)
- Mecit Can Emre Simsekler
- Department of Industrial and Systems Engineering, Khalifa University of Science and Technology, Abu Dhabi Campus, Abu Dhabi 127788, United Arab Emirates.,School of Management, University College London, 1 Canada Square, London E14 5AA, UK
| | - James R Ward
- Engineering Department, Engineering Design Centre, University of Cambridge, Trumpington Street, Cambridge CB2 1PZ, UK
| | - P John Clarkson
- Engineering Department, Engineering Design Centre, University of Cambridge, Trumpington Street, Cambridge CB2 1PZ, UK
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Mincarone P, Leo CG, Trujillo-Martín MDM, Manson J, Guarino R, Ponzini G, Sabina S. Standardized languages and notations for graphical modelling of patient care processes: a systematic review. Int J Qual Health Care 2018; 30:169-177. [PMID: 29346638 DOI: 10.1093/intqhc/mzx197] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2017] [Accepted: 12/22/2017] [Indexed: 11/12/2022] Open
Abstract
Purpose The importance of working toward quality improvement in healthcare implies an increasing interest in analysing, understanding and optimizing process logic and sequences of activities embedded in healthcare processes. Their graphical representation promotes faster learning, higher retention and better compliance. The study identifies standardized graphical languages and notations applied to patient care processes and investigates their usefulness in the healthcare setting. Data sources Peer-reviewed literature up to 19 May 2016. Information complemented by a questionnaire sent to the authors of selected studies. Study selection Systematic review conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement. Data extraction Five authors extracted results of selected studies. Results of data synthesis Ten articles met the inclusion criteria. One notation and language for healthcare process modelling were identified with an application to patient care processes: Business Process Model and Notation and Unified Modeling Language™. One of the authors of every selected study completed the questionnaire. Users' comprehensibility and facilitation of inter-professional analysis of processes have been recognized, in the filled in questionnaires, as major strengths for process modelling in healthcare. Conclusion Both the notation and the language could increase the clarity of presentation thanks to their visual properties, the capacity of easily managing macro and micro scenarios, the possibility of clearly and precisely representing the process logic. Both could increase guidelines/pathways applicability by representing complex scenarios through charts and algorithms hence contributing to reduce unjustified practice variations which negatively impact on quality of care and patient safety.
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Affiliation(s)
- Pierpaolo Mincarone
- National Research Council of Italy, Institute for Research on Population and Social Policies, URT Brindisi, c/o ex Osp. Di Summa, Piazza Di Summa, 72100 Brindisi, Italy
| | - Carlo Giacomo Leo
- National Research Council of Italy, Institute of Clinical Physiology, Unit of Lecce, c/o Ecotekne via Monteroni, 73100 Lecce, Italy.,Tufts Medical Center, Department of Medicine, 800 Washington Street, Boston, MA 02111, USA
| | - Maria Del Mar Trujillo-Martín
- Canary Foundation of Health Research, Camino Candelaria, 44 C.S. San Isidro-El Chorrillo, 38109 El Rosario, Canary Islands, Spain
| | - Jan Manson
- Scottish Medicines Consortium, Delta House, 50 West Nile Street, Glasgow G1 2NP, UK
| | - Roberto Guarino
- National Research Council of Italy, Institute of Clinical Physiology, Unit of Lecce, c/o Ecotekne via Monteroni, 73100 Lecce, Italy
| | - Giuseppe Ponzini
- National Research Council of Italy, Institute for Research on Population and Social Policies, URT Brindisi, c/o ex Osp. Di Summa, Piazza Di Summa, 72100 Brindisi, Italy
| | - Saverio Sabina
- National Research Council of Italy, Institute of Clinical Physiology, Unit of Lecce, c/o Ecotekne via Monteroni, 73100 Lecce, Italy
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Hitzert M, Boesveld IC, Hermus MAA, de Graaf JP, Wiegers TA, Steegers EAP, Meijboom BR, Akkermans HA. Quality improvement opportunities for handover practices in birth centres: A case study from a process perspective. J Eval Clin Pract 2018; 24:590-597. [PMID: 29878610 DOI: 10.1111/jep.12939] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2017] [Revised: 03/30/2018] [Accepted: 04/02/2018] [Indexed: 11/27/2022]
Abstract
RATIONALE, AIMS AND OBJECTIVES Handovers within and between health care settings are known to affect quality of care. Health care organizations, struggle how to guarantee best care during handovers. The aim of this paper is to evaluate handover practices in Dutch birth centres from a process perspective, to identify obstacles and opportunities for quality improvements. METHODS This case study in 7 Dutch birth centres was undertaken from a process perspective by conducting observations and using process mapping. This study is part of the Dutch Birth Centre Study. RESULTS Solutions to obstacles during handovers from a birth centre to a hospital were identified in at least 1 of the 7 birth centres. Four of the centres had agreements with a hospital for client support when a caregiver in a birth centre was absent. Face-to-face communication during handover was observed in 6 of the 7 centres. An electronic health record was noted in 1 centre; joint training of acute situations was available in 2 centres with 3 centres indicating that this was not compulsory. Continuity of caregiver was present in 4 birth centres with postpartum care available in 3 centres. CONCLUSIONS Ensuring quality during handovers requires a case-specific process approach. This study reveals distinctive aspects during handovers, concrete obstacles, and potential solutions for quality improvements in inter-organizational networks, transferrable to birth centres in other countries as well.
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Affiliation(s)
- Marit Hitzert
- Department of Obstetrics and Gynaecology, Erasmus University Medical Centre, Rotterdam, The Netherlands
| | | | | | - Johanna P de Graaf
- Department of Obstetrics and Gynaecology, Erasmus University Medical Centre, Rotterdam, The Netherlands
| | | | - Eric A P Steegers
- Department of Obstetrics and Gynaecology, Erasmus University Medical Centre, Rotterdam, The Netherlands
| | | | - Henk A Akkermans
- Tilburg School of Economics and Management, Tilburg, The Netherlands
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Antonacci G, Reed JE, Lennox L, Barlow J. The use of process mapping in healthcare quality improvement projects. Health Serv Manage Res 2018; 31:74-84. [PMID: 29707978 DOI: 10.1177/0951484818770411] [Citation(s) in RCA: 65] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Introduction Process mapping provides insight into systems and processes in which improvement interventions are introduced and is seen as useful in healthcare quality improvement projects. There is little empirical evidence on the use of process mapping in healthcare practice. This study advances understanding of the benefits and success factors of process mapping within quality improvement projects. Methods Eight quality improvement projects were purposively selected from different healthcare settings within the UK's National Health Service. Data were gathered from multiple data-sources, including interviews exploring participants' experience of using process mapping in their projects and perceptions of benefits and challenges related to its use. These were analysed using inductive analysis. Results Eight key benefits related to process mapping use were reported by participants (gathering a shared understanding of the reality; identifying improvement opportunities; engaging stakeholders in the project; defining project's objectives; monitoring project progress; learning; increased empathy; simplicity of the method) and five factors related to successful process mapping exercises (simple and appropriate visual representation, information gathered from multiple stakeholders, facilitator's experience and soft skills, basic training, iterative use of process mapping throughout the project). Conclusions Findings highlight benefits and versatility of process mapping and provide practical suggestions to improve its use in practice.
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Affiliation(s)
- Grazia Antonacci
- 1 Department of Public Health and Primary Care, 4615 Imperial College London , London, UK.,2 NIHR CLAHRC for Northwest London, London, UK.,3 Department of Management and Centre for Health Economics and Policy Innovation, Imperial College Business School, Imperial College London, London, UK
| | - Julie E Reed
- 1 Department of Public Health and Primary Care, 4615 Imperial College London , London, UK.,2 NIHR CLAHRC for Northwest London, London, UK
| | - Laura Lennox
- 1 Department of Public Health and Primary Care, 4615 Imperial College London , London, UK.,2 NIHR CLAHRC for Northwest London, London, UK
| | - James Barlow
- 3 Department of Management and Centre for Health Economics and Policy Innovation, Imperial College Business School, Imperial College London, London, UK
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Bashford T, Clarkson PJ, Menon DK, Hutchinson PJA. Unpicking the Gordian knot: a systems approach to traumatic brain injury care in low-income and middle-income countries. BMJ Glob Health 2018; 3:e000768. [PMID: 29607105 PMCID: PMC5873538 DOI: 10.1136/bmjgh-2018-000768] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2018] [Revised: 03/06/2018] [Accepted: 03/11/2018] [Indexed: 11/25/2022] Open
Affiliation(s)
- Tom Bashford
- NIHR Global Health Research Group for Neurotrauma, University of Cambridge, Cambridge, UK.,Engineering Design Centre, Department of Engineering, University of Cambridge, Cambridge, UK.,Division of Anaesthesia, Department of Medicine, University of Cambridge, Cambridge, UK
| | - P John Clarkson
- NIHR Global Health Research Group for Neurotrauma, University of Cambridge, Cambridge, UK.,Engineering Design Centre, Department of Engineering, University of Cambridge, Cambridge, UK
| | - David K Menon
- NIHR Global Health Research Group for Neurotrauma, University of Cambridge, Cambridge, UK.,Division of Anaesthesia, Department of Medicine, University of Cambridge, Cambridge, UK
| | - Peter J A Hutchinson
- NIHR Global Health Research Group for Neurotrauma, University of Cambridge, Cambridge, UK.,Division of Neurosurgery, Department of Clinical Neurosciences, University of Cambridge, Cambridge, UK
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Araújo J, Pestana G. A framework for social well-being and skills management at the workplace. INTERNATIONAL JOURNAL OF INFORMATION MANAGEMENT 2017. [DOI: 10.1016/j.ijinfomgt.2017.07.009] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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The development and practical application of a simulation model to inform musculoskeletal service delivery in an Australian public health service. ACTA ACUST UNITED AC 2017. [DOI: 10.1016/j.orhc.2017.07.002] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Rosati S, Zema M, Castagneri C, Marchetti F, Balestra G. Modelling and analysis of four telemedicine Italian experiences. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2017; 2017:2634-2637. [PMID: 29060440 DOI: 10.1109/embc.2017.8037398] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
In the last 10 years the European population aged 65 years and over grew of 2.3%, with Italy having the highest share of elderly persons in the total population. OPLON (OPportunities for active and healthy LONgevity) is a project supported by the Italian Ministry of Education, Universities, and Research aiming to identify and prevent frailty and to improve the life quality of elderly subjects. The main goal of OPLON is to develop a "Care&Cure" model for the management of subjects with different morbidities and co-morbidities, adaptable to the subject's risk level and to the regional contexts. In this study we analyzed four Italian telemedicine experiences addressed to chronic, geriatric or partially self-sufficient subjects. Each of them was exhaustively described by means of three process modelling tools (synopsis, workflow and swimlane activity diagrams). Starting from this analysis, we defined a general model of tele-monitoring and tele-assistance of frail and pre-frail people with different needs and pathologies. The proposed model was characterized by three macro processes (enrollment, assessment and assistance) and four groups of actors (patient, general practitioner/specialist physician, multidisciplinary team, and healthcare professionals). Combining this model with a detailed analysis of regulations and legislations in force both at local and national level, it will be possible to design the complete and efficient "Care&Cure" model.
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Mohiuddin S, Busby J, Savović J, Richards A, Northstone K, Hollingworth W, Donovan JL, Vasilakis C. Patient flow within UK emergency departments: a systematic review of the use of computer simulation modelling methods. BMJ Open 2017; 7:e015007. [PMID: 28487459 PMCID: PMC5566625 DOI: 10.1136/bmjopen-2016-015007] [Citation(s) in RCA: 56] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
OBJECTIVES Overcrowding in the emergency department (ED) is common in the UK as in other countries worldwide. Computer simulation is one approach used for understanding the causes of ED overcrowding and assessing the likely impact of changes to the delivery of emergency care. However, little is known about the usefulness of computer simulation for analysis of ED patient flow. We undertook a systematic review to investigate the different computer simulation methods and their contribution for analysis of patient flow within EDs in the UK. METHODS We searched eight bibliographic databases (MEDLINE, EMBASE, COCHRANE, WEB OF SCIENCE, CINAHL, INSPEC, MATHSCINET and ACM DIGITAL LIBRARY) from date of inception until 31 March 2016. Studies were included if they used a computer simulation method to capture patient progression within the ED of an established UK National Health Service hospital. Studies were summarised in terms of simulation method, key assumptions, input and output data, conclusions drawn and implementation of results. RESULTS Twenty-one studies met the inclusion criteria. Of these, 19 used discrete event simulation and 2 used system dynamics models. The purpose of many of these studies (n=16; 76%) centred on service redesign. Seven studies (33%) provided no details about the ED being investigated. Most studies (n=18; 86%) used specific hospital models of ED patient flow. Overall, the reporting of underlying modelling assumptions was poor. Nineteen studies (90%) considered patient waiting or throughput times as the key outcome measure. Twelve studies (57%) reported some involvement of stakeholders in the simulation study. However, only three studies (14%) reported on the implementation of changes supported by the simulation. CONCLUSIONS We found that computer simulation can provide a means to pretest changes to ED care delivery before implementation in a safe and efficient manner. However, the evidence base is small and poorly developed. There are some methodological, data, stakeholder, implementation and reporting issues, which must be addressed by future studies.
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Affiliation(s)
- Syed Mohiuddin
- NIHR CLAHRC West, University Hospitals Bristol NHS Foundation Trust, Bristol, UK
- School of Social and Community Medicine, University of Bristol, Bristol, UK
| | - John Busby
- School of Medicine, Queen’s University Belfast, Belfast, UK
| | - Jelena Savović
- NIHR CLAHRC West, University Hospitals Bristol NHS Foundation Trust, Bristol, UK
- School of Social and Community Medicine, University of Bristol, Bristol, UK
| | - Alison Richards
- NIHR CLAHRC West, University Hospitals Bristol NHS Foundation Trust, Bristol, UK
- School of Social and Community Medicine, University of Bristol, Bristol, UK
| | - Kate Northstone
- NIHR CLAHRC West, University Hospitals Bristol NHS Foundation Trust, Bristol, UK
- School of Social and Community Medicine, University of Bristol, Bristol, UK
| | - William Hollingworth
- NIHR CLAHRC West, University Hospitals Bristol NHS Foundation Trust, Bristol, UK
- School of Social and Community Medicine, University of Bristol, Bristol, UK
| | - Jenny L Donovan
- NIHR CLAHRC West, University Hospitals Bristol NHS Foundation Trust, Bristol, UK
- School of Social and Community Medicine, University of Bristol, Bristol, UK
| | - Christos Vasilakis
- Centre for Healthcare Innovation & Improvement (CHI2), School of Management, University of Bath, Bath, UK
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