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Arbaje AI, Hsu YJ, Greyson S, Gurses AP, Marsteller J, Bowles KH, McDonald MV, Vergez S, Harbison K, Hohl D, Carl K, Leff B. Hospital-to-Home-Health Transition Quality (H3TQ) Index: Further Evidence on its Validity and Recommendations for Implementation. Med Care 2024; 62:503-510. [PMID: 38967994 DOI: 10.1097/mlr.0000000000002015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/07/2024]
Abstract
BACKGROUND We developed the Hospital-to-Home-Health Transition Quality (H3TQ) Index for skilled home healthcare (HH) agencies to identify threats to safe, high-quality care transitions in real time. OBJECTIVE Assess the validity of H3TQ in a large sample across diverse communities. RESEARCH DESIGN A survey of recently hospitalized older adults referred for skilled HH services and their HH provider at two large HH agencies in Baltimore, MD, and New York, NY. SUBJECTS There were five hundred eighty-seven participants (309 older adults, 141 informal caregivers, and 137 HH providers). Older adults, caregivers, and HH providers rated 747 unique transitions. Of these, 403 were rated by both the older adult/caregiver and their HH provider, whereas the remaining transitions were rated by either party. MEASURES Construct, concurrent, and predictive validity were assessed via the overall H3TQ rating, correlation with the care transition measure (CTM), and the Medicare Outcome and Assessment Information Set (OASIS). RESULTS Proportion of transitions with quality issues as identified by HH providers and older adults/caregivers, respectively; Baltimore 55%, 35%; NYC 43%, 32%. Older adults/caregivers across sites rated their transitions as higher quality than did providers (P<0.05). H3TQ summed scores showed construct validity with the CTM-3 and concurrent validity with OASIS measures. Summed H3TQ scores were not significantly correlated with 30-day ED visits or rehospitalization. CONCLUSIONS The H3TQ identifies care transition quality issues in real-time and demonstrated construct and concurrent validity, but not predictive validity. Findings demonstrate value in collecting multiple perspectives to evaluate care transition quality. Implementing the H3TQ could help identify transition-quality intervention opportunities for HH patients.
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Affiliation(s)
- Alicia I Arbaje
- Department of Medicine, Division of Geriatric Medicine and Gerontology, Center for Transformative Geriatric Research, Johns Hopkins University School of Medicine, Baltimore, MD
- Department of Health Policy and Management, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD
- Armstrong Institute Center for Health Care Human Factors, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Yea-Jen Hsu
- Department of Health Policy and Management, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD
| | - Sylvan Greyson
- Department of Medicine, Division of Geriatric Medicine and Gerontology, Center for Transformative Geriatric Research, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Ayse P Gurses
- Department of Health Policy and Management, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD
- Armstrong Institute Center for Health Care Human Factors, Johns Hopkins University School of Medicine, Baltimore, MD
- Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Jill Marsteller
- Department of Health Policy and Management, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD
| | - Kathryn H Bowles
- Department of Biobehavioral Health Sciences, New Courtland Center for Transitions and Health, School of Nursing, University of Pennsylvania, Philadelphia, PA
- Center for Home Care Policy and Research, VNS Health, New York City, NY
| | | | - Sasha Vergez
- Center for Home Care Policy and Research, VNS Health, New York City, NY
| | - Katie Harbison
- Department of Medicine, Division of Geriatric Medicine and Gerontology, Center for Transformative Geriatric Research, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Dawn Hohl
- Johns Hopkins Home Care Group, Baltimore, MD
| | | | - Bruce Leff
- Department of Medicine, Division of Geriatric Medicine and Gerontology, Center for Transformative Geriatric Research, Johns Hopkins University School of Medicine, Baltimore, MD
- Department of Health Policy and Management, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD
- Department of Community and Public Health, Johns Hopkins School of Nursing, Baltimore, MD
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2
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Ferguson J, Stringer G, Walshe K, Allen T, Grigoroglou C, Ashcroft DM, Kontopantelis E. Locum doctor working and quality and safety: a qualitative study in English primary and secondary care. BMJ Qual Saf 2024; 33:354-362. [PMID: 38627099 PMCID: PMC11103325 DOI: 10.1136/bmjqs-2023-016699] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2023] [Accepted: 12/12/2023] [Indexed: 05/19/2024]
Abstract
BACKGROUND The use of temporary doctors, known as locums, has been common practice for managing staffing shortages and maintaining service delivery internationally. However, there has been little empirical research on the implications of locum working for quality and safety. This study aimed to investigate the implications of locum working for quality and safety. METHODS Qualitative semi-structured interviews and focus groups were conducted with 130 participants, including locums, patients, permanently employed doctors, nurses and other healthcare professionals with governance and recruitment responsibilities for locums across primary and secondary healthcare organisations in the English NHS. Data were collected between March 2021 and April 2022. Data were analysed using reflexive thematic analysis and abductive analysis. RESULTS Participants described the implications of locum working for quality and safety across five themes: (1) 'familiarity' with an organisation and its patients and staff was essential to delivering safe care; (2) 'balance and stability' of services reliant on locums were seen as at risk of destabilisation and lacking leadership for quality improvement; (3) 'discrimination and exclusion' experienced by locums had negative implications for morale, retention and patient outcomes; (4) 'defensive practice' by locums as a result of perceptions of increased vulnerability and decreased support; (5) clinical governance arrangements, which often did not adequately cover locum doctors. CONCLUSION Locum working and how locums were integrated into organisations posed some significant challenges and opportunities for patient safety and quality of care. Organisations should take stock of how they work with the locum workforce to improve not only quality and safety but also locum experience and retention.
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Affiliation(s)
- Jane Ferguson
- Health Services Management Centre, School of Social Policy, University of Birmingham, Birmingham, UK
| | - Gemma Stringer
- Alliance Manchester Business School, University of Manchester, Manchester, UK
| | - Kieran Walshe
- Alliance Manchester Business School, University of Manchester, Manchester, UK
| | - Thomas Allen
- Manchester Centre for Health Economics, Division of Population Health, Health Services Research and Primary Care, University of Manchester, Manchester, UK
- Danish Centre for Health Economics, University of Southern Denmark, Odense, Denmark
| | - Christos Grigoroglou
- Manchester Centre for Health Economics, Division of Population Health, Health Services Research and Primary Care, University of Manchester, Manchester, UK
| | - Darren M Ashcroft
- NIHR Greater Manchester Patient Safety Research Collaboration (PSRC), Division of Pharmacy and Optometry, Faculty of Biology Medicine and Health, University of Manchester, Manchester, UK
| | - Evangelos Kontopantelis
- Division of Informatics, Imaging and Data Sciences, University of Manchester, Manchester, UK
- NIHR School for Primary Care Research, Centre for Primary Care, Division of Population Health, Health Services Research and Primary Care, University of Manchester, Manchester, UK
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Weller JM, Mahajan R, Fahey-Williams K, Webster CS. Teamwork matters: team situation awareness to build high-performing healthcare teams, a narrative review. Br J Anaesth 2024; 132:771-778. [PMID: 38310070 DOI: 10.1016/j.bja.2023.12.035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Revised: 12/12/2023] [Accepted: 12/18/2023] [Indexed: 02/05/2024] Open
Abstract
Healthcare today is the prerogative of teams rather than of individuals. In acute care domains such as anaesthesia, intensive care, and emergency medicine, the work is complex and fast-paced, and the team members are diverse and interdependent. Three decades of research into the behaviours of high-performing teams provides us with clear guidance on team training, demonstrating positive effects on patient safety and staff wellbeing. Here we consider team performance through the lens of situation awareness. Maintaining situation awareness is an absolute requirement for safe and effective patient management. Situation awareness is a dynamic process of perceiving cues in the environment, understanding what they mean, and predicting how the situation may evolve. In the context of acute clinical care, situation awareness can be improved if the whole team actively contributes to monitoring the environment, processing information, and planning next steps. In this narrative review, we explore the concept of situation awareness at the level of the team, the conditions required to maintain team situation awareness, and the relationship between team situation awareness, shared mental models, and team performance. Our ultimate goal is to help clinicians create the conditions required for high-functioning teams, and ultimately improve the safety of clinical care.
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Affiliation(s)
- Jennifer M Weller
- Centre for Medical and Health Sciences Education, School of Medicine, University of Auckland, Auckland, New Zealand; Department of Anaesthesia, Auckland City Hospital, Auckland, New Zealand.
| | - Ravi Mahajan
- Centre of Excellence in Critical Care, Apollo Hospitals Group, Chennai, India; Department of Anaesthesia and Intensive Care, University of Nottingham, Nottingham, UK
| | - Kathryn Fahey-Williams
- Centre for Medical and Health Sciences Education, School of Medicine, University of Auckland, Auckland, New Zealand
| | - Craig S Webster
- Centre for Medical and Health Sciences Education, School of Medicine, University of Auckland, Auckland, New Zealand; Department of Anaesthesiology, School of Medicine, University of Auckland, Auckland, New Zealand
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Cammer NC, Mascarenhas KM, Delgado-Landino MC, Horn DB, Araya RJ, Epstein RH, Corvington JR, Marudo CP, Stein AL, Maga JM. Evaluation of a Course to Teach Medical Students Latent Hazard Identification in the Operating Room. Cureus 2024; 16:e56367. [PMID: 38501026 PMCID: PMC10948080 DOI: 10.7759/cureus.56367] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/18/2024] [Indexed: 03/20/2024] Open
Abstract
INTRODUCTION To improve situational awareness in the operating room (OR), a virtual online operating room of hazards (ROH) with deliberately placed risks was created. We hypothesized that subjects first participating in the virtual online ROH would identify more hazards during an in-person ROH exercise in a physical OR than those in the control group who only received didactic training. METHODS We conducted a randomized controlled trial at a major academic medical center, enrolling 48 pre-clinical medical students with no previous OR exposure during their classes. Control and experimental group subjects participated in a brief, online didactic orientation session conducted live over Zoom (Zoom Video Communications, Inc., San Jose, CA) to learn about latent hazards in the OR. Experimental group subjects further interacted with a virtual online operating ROH in which latent hazards were present. The fraction of deliberately created latent hazards placed in a physical, in-person OR identified by subjects was calculated. RESULTS Experimental group subjects identified a significantly larger fraction of the created hazards (41.3%) than the control group (difference = 16.4%, 95% CI: 11.3% to 21.4%, P < 0.0001). There was no difference in the number of non-hazards misidentified as hazards between the groups. CONCLUSIONS Participation in the virtual online environment resulted in greater recognition of latent operating room hazards during a simulation conducted in a physical, in-person OR than in a didactic experience alone. Because creating an in-room experience to teach the identification of latent hazards in an OR is resource-intensive and requires removing the OR from clinical use, we recommend the virtual online approach described for training purposes. Adding items most misidentified as hazards is suggested for future implementation.
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Affiliation(s)
- Natasha C Cammer
- Anesthesiology, Perioperative Medicine, and Pain Management, University of Miami Miller School of Medicine, Miami, USA
| | - Kristen M Mascarenhas
- Anesthesiology, Perioperative Medicine, and Pain Management, University of Miami Miller School of Medicine, Miami, USA
| | | | - Danielle B Horn
- Anesthesiology, Perioperative Medicine, and Pain Management, University of Miami Miller School of Medicine, Miami, USA
| | - Roxanna J Araya
- Center for Patient Safety, University of Miami/Jackson Memorial Hospital, Jackson Health System, Miami, USA
| | - Richard H Epstein
- Anesthesiology, Perioperative Medicine, and Pain Management, University of Miami Miller School of Medicine, Miami, USA
| | - Jean R Corvington
- Anesthesiology, Perioperative Medicine, and Pain Management, University of Miami Miller School of Medicine, Miami, USA
| | - Catherine P Marudo
- Anesthesiology, Perioperative Medicine, and Pain Management, University of Miami Miller School of Medicine, Miami, USA
| | - Alecia L Stein
- Anesthesiology, Perioperative Medicine, and Pain Management, University of Miami Miller School of Medicine, Miami, USA
| | - Joni M Maga
- Anesthesiology, Perioperative Medicine, and Pain Management, University of Miami Miller School of Medicine, Miami, USA
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Abraham J, Kandasamy M, Huggins A. Articulation of postsurgical patient discharges: coordinating care transitions from hospital to home. J Am Med Inform Assoc 2022; 29:1546-1558. [PMID: 35713640 DOI: 10.1093/jamia/ocac099] [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: 03/29/2022] [Revised: 05/25/2022] [Accepted: 06/06/2022] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Cardiac surgery patients are at high risk for readmissions after hospital discharge- few of these readmissions are preventable by mitigating barriers underlying discharge care transitions. An in-depth evaluation of the nuances underpinning the discharge process and the use of tools to support the process, along with insights on patient and clinician experiences, can inform the design of evidence-based strategies to reduce preventable readmissions. OBJECTIVE The study objectives are 3-fold: elucidate perceived factors affecting the postsurgical discharge care transitions of cardiac surgery patients going home; highlight differences among clinician and patient perceptions of the postsurgical discharge experiences, and ascertain the impact of these transitions on patient recovery at home. METHODS We conducted a prospective multi-stakeholder study using mixed methods, including general observations, patient shadowing, chart reviews, clinician interviews, and follow-up telephone patient and caregiver surveys/interviews. We followed thematic and content analyses. FINDINGS Participants included 49 patients, 6 caregivers, and 27 clinicians. We identified interdependencies between the predischarge preparation, discharge education, and postdischarge follow-up care phases that must be coordinated for effective discharge care transitions. We identified several factors that could lead to fragmented discharges, including limited preoperative preparation, ill-defined discharge education, and postoperative plans. To address these, clinicians often performed behind-the-scenes work, including offering informal preoperative preparation, tailoring discharge education, and personalizing postdischarge follow-up plans. As a result, majority of patients reported high satisfaction with care transitions and their positive impact on their home recovery. DISCUSSION AND CONCLUSIONS Articulation work by clinicians (ie, behind the scenes work) is critical for ensuring safety, care continuity, and overall patient experience during care transitions. We discuss key evidence-based considerations for re-engineering postsurgical discharge workflows and re-designing discharge interventions.
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Affiliation(s)
- Joanna Abraham
- Department of Anesthesiology, Washington University School of Medicine, St. Louis, Missouri, USA
- Institute for Informatics, Washington University School of Medicine, St. Louis, Missouri, USA
- Division of Biology and Biomedical Sciences, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Madhumitha Kandasamy
- Department of Anesthesiology, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Ashley Huggins
- Department of Anesthesiology, Washington University School of Medicine, St. Louis, Missouri, USA
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Lewis K, O V, Garber AM, Sweet M, Novoa-Takara K, McConville J, Readlynn JK, Alweis R. AAIM Recommendations to Improve Learner Transitions. Am J Med 2022; 135:536-542. [PMID: 35038408 DOI: 10.1016/j.amjmed.2022.01.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Accepted: 01/03/2022] [Indexed: 12/23/2022]
Affiliation(s)
- Kristen Lewis
- The Ohio State University College of Medicine, Columbus, Ohio
| | - Valerie O
- Alliance for Academic Internal Medicine, Alexandria, Virginia
| | - Adam M Garber
- Virginia Commonwealth University School of Medicine, Richmond, Virginia
| | - Michelle Sweet
- Rush Medical College of Rush University, Chicago, Illinois
| | | | | | - Jennifer K Readlynn
- University of Rochester School of Medicine and Dentistry,Rochester, New York
| | - Richard Alweis
- Rochester Regional Health, Lake Eric College of Osteopathic Medicine, Rochester, New York.
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7
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Willis MA, Hein LB, Hu Z, Saran R, Argentina M, Bragg-Gresham J, Krein SL, Gillespie B, Zheng K, Veinot TC. Feeling better on hemodialysis: user-centered design requirements for promoting patient involvement in the prevention of treatment complications. J Am Med Inform Assoc 2021; 28:1612-1631. [PMID: 34117493 PMCID: PMC8324235 DOI: 10.1093/jamia/ocab033] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2020] [Revised: 02/02/2021] [Accepted: 02/09/2021] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVE Hemodialysis patients frequently experience dialysis therapy sessions complicated by intradialytic hypotension (IDH), a major patient safety concern. We investigate user-centered design requirements for a theory-informed, peer mentoring-based, informatics intervention to activate patients toward IDH prevention. METHODS We conducted observations (156 hours) and interviews (n = 28) with patients in 3 hemodialysis clinics, followed by 9 focus groups (including participatory design activities) with patients (n = 17). Inductive and deductive analyses resulted in themes and design principles linked to constructs from social, cognitive, and self-determination theories. RESULTS Hemodialysis patients want an informatics intervention for IDH prevention that collapses distance between patients, peers, and family; harnesses patients' strength of character and resolve in all parts of their life; respects and supports patients' individual needs, preferences, and choices; and links "feeling better on dialysis" to becoming more involved in IDH prevention. Related design principles included designing for: depth of interpersonal connections; positivity; individual choice and initiative; and comprehension of connections and possible actions. DISCUSSION Findings advance the design of informatics interventions by presenting design requirements for outpatient safety and addressing key design opportunities for informatics to support patient involvement; these include incorporation of behavior change theories. Results also demonstrate the meaning of design choices for hemodialysis patients in the context of their experiences; this may have applicability to other populations with serious illnesses. CONCLUSION The resulting patient-facing informatics intervention will be evaluated in a pragmatic cluster-randomized controlled trial in 28 hemodialysis facilities in 4 US regions.
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Affiliation(s)
- Matthew A Willis
- School of Information, University of Michigan, Ann Arbor,
Michigan, USA
| | - Leah Brand Hein
- School of Information, University of Michigan, Ann Arbor,
Michigan, USA
| | - Zhaoxian Hu
- School of Information and Computer Sciences, University of
California, Irvine, California, USA
| | - Rajiv Saran
- Division of Nephrology, Department of Medicine, University of
Michigan, Ann Arbor, Michigan, USA
- Kidney Epidemiology and Cost Center, University of Michigan, Ann
Arbor, Michigan, USA
| | | | - Jennifer Bragg-Gresham
- Division of Nephrology, Department of Medicine, University of
Michigan, Ann Arbor, Michigan, USA
- Kidney Epidemiology and Cost Center, University of Michigan, Ann
Arbor, Michigan, USA
| | - Sarah L Krein
- Department of Internal Medicine, University of Michigan Medical
School, Ann Arbor, Michigan, USA
- Veterans Affairs Ann Arbor Center for Clinical Management
Research, Ann Arbor, Michigan, USA
| | - Brenda Gillespie
- Department of Biostatistics, Consulting for Statistics, Computing and Analytics
Research, University of Michigan, Ann Arbor, Michigan, USA
| | - Kai Zheng
- School of Information and Computer Sciences, University of
California, Irvine, California, USA
| | - Tiffany C Veinot
- School of Information, University of Michigan, Ann Arbor,
Michigan, USA
- School of Public Health, University of Michigan, Ann Arbor,
Michigan, USA
- Corresponding Author: Tiffany C. Veinot, MLS, PhD, School of
Information, University of Michigan, 4314 North Quad, 105 S State St, Ann Arbor, MI 48109,
USA;
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Unertl KM, Abraham J, Bakken S. Building on Diana Forsythe's legacy: the value of human experience and context in biomedical and health informatics. J Am Med Inform Assoc 2021; 28:197-208. [PMID: 33587750 PMCID: PMC7883988 DOI: 10.1093/jamia/ocaa337] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Accepted: 12/16/2020] [Indexed: 11/13/2022] Open
Affiliation(s)
- Kim M Unertl
- Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Joanna Abraham
- Department of Anesthesiology and Institute for Informatics, School of Medicine, Washington University in St. Louis, St. Louis, Missouri, USA
| | - Suzanne Bakken
- School of Nursing, Department of Biomedical Informatics, and Data Science Institute, Columbia University, New York, New York, USA
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