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Yang J, Triendl H, Soltan AAS, Prakash M, Clifton DA. Addressing label noise for electronic health records: insights from computer vision for tabular data. BMC Med Inform Decis Mak 2024; 24:183. [PMID: 38937744 PMCID: PMC11212446 DOI: 10.1186/s12911-024-02581-5] [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: 01/26/2024] [Accepted: 06/20/2024] [Indexed: 06/29/2024] Open
Abstract
The analysis of extensive electronic health records (EHR) datasets often calls for automated solutions, with machine learning (ML) techniques, including deep learning (DL), taking a lead role. One common task involves categorizing EHR data into predefined groups. However, the vulnerability of EHRs to noise and errors stemming from data collection processes, as well as potential human labeling errors, poses a significant risk. This risk is particularly prominent during the training of DL models, where the possibility of overfitting to noisy labels can have serious repercussions in healthcare. Despite the well-documented existence of label noise in EHR data, few studies have tackled this challenge within the EHR domain. Our work addresses this gap by adapting computer vision (CV) algorithms to mitigate the impact of label noise in DL models trained on EHR data. Notably, it remains uncertain whether CV methods, when applied to the EHR domain, will prove effective, given the substantial divergence between the two domains. We present empirical evidence demonstrating that these methods, whether used individually or in combination, can substantially enhance model performance when applied to EHR data, especially in the presence of noisy/incorrect labels. We validate our methods and underscore their practical utility in real-world EHR data, specifically in the context of COVID-19 diagnosis. Our study highlights the effectiveness of CV methods in the EHR domain, making a valuable contribution to the advancement of healthcare analytics and research.
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Affiliation(s)
- Jenny Yang
- Institute of Biomedical Engineering, Dept. Engineering Science, University of Oxford, Oxford, England.
| | | | - Andrew A S Soltan
- Institute of Biomedical Engineering, Dept. Engineering Science, University of Oxford, Oxford, England
- Oxford Cancer & Haematology Centre, Oxford University Hospitals NHS Foundation Trust, Oxford, England
- Department of Oncology, University of Oxford, Oxford, England
| | - Mangal Prakash
- Work done at Exscientia, Currently Independent Researcher, Reading, United Kingdom
| | - David A Clifton
- Institute of Biomedical Engineering, Dept. Engineering Science, University of Oxford, Oxford, England
- Oxford-Suzhou Centre for Advanced Research (OSCAR), Suzhou, China
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Kato D, Lucas J, Sittig DF. Implementation of a health information technology safety classification system in the Veterans Health Administration's Informatics Patient Safety Office. J Am Med Inform Assoc 2024; 31:1588-1595. [PMID: 38758666 PMCID: PMC11187429 DOI: 10.1093/jamia/ocae107] [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: 11/15/2023] [Revised: 04/04/2024] [Accepted: 05/01/2024] [Indexed: 05/19/2024] Open
Abstract
OBJECTIVE Implement the 5-type health information technology (HIT) patient safety concern classification system for HIT patient safety issues reported to the Veterans Health Administration's Informatics Patient Safety Office. MATERIALS AND METHODS A team of informatics safety analysts retrospectively classified 1 year of HIT patient safety issues by type of HIT patient safety concern using consensus discussions. The processes established during retrospective classification were then applied to incoming HIT safety issues moving forward. RESULTS Of 140 issues retrospectively reviewed, 124 met the classification criteria. The majority were HIT failures (eg, software defects) (33.1%) or configuration and implementation problems (29.8%). Unmet user needs and external system interactions accounted for 20.2% and 10.5%, respectively. Absence of HIT safety features accounted for 2.4% of issues, and 4% did not have enough information to classify. CONCLUSION The 5-type HIT safety concern classification framework generated actionable categories helping organizations effectively respond to HIT patient safety risks.
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Affiliation(s)
- Danielle Kato
- Pharmacy Benefits Management Clinical Informatics, Veterans Health Administration, Washington, DC 20420, United States
| | - Joe Lucas
- Certified Usability Analyst, Informatics Patient Safety, Veterans Health Administration, Washington, DC 20420, United States
| | - Dean F Sittig
- Department of Clinical and Health Informatics, University of Texas Health Science Center at Houston, Houston, TX 77030, United States
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Recsky C, Rush KL, MacPhee M, Stowe M, Blackburn L, Muniak A, Currie LM. Clinical Informatics Team Members' Perspectives on Health Information Technology Safety After Experiential Learning and Safety Process Development: Qualitative Descriptive Study. JMIR Form Res 2024; 8:e53302. [PMID: 38315544 PMCID: PMC10877498 DOI: 10.2196/53302] [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: 10/02/2023] [Revised: 01/11/2024] [Accepted: 01/11/2024] [Indexed: 02/07/2024] Open
Abstract
BACKGROUND Although intended to support improvement, the rapid adoption and evolution of technologies in health care can also bring about unintended consequences related to safety. In this project, an embedded researcher with expertise in patient safety and clinical education worked with a clinical informatics team to examine safety and harm related to health information technologies (HITs) in primary and community care settings. The clinical informatics team participated in learning activities around relevant topics (eg, human factors, high reliability organizations, and sociotechnical systems) and cocreated a process to address safety events related to technology (ie, safety huddles and sociotechnical analysis of safety events). OBJECTIVE This study aimed to explore clinical informaticians' experiences of incorporating safety practices into their work. METHODS We used a qualitative descriptive design and conducted web-based focus groups with clinical informaticians. Thematic analysis was used to analyze the data. RESULTS A total of 10 informants participated. Barriers to addressing safety and harm in their context included limited prior knowledge of HIT safety, previous assumptions and perspectives, competing priorities and organizational barriers, difficulty with the reporting system and processes, and a limited number of reports for learning. Enablers to promoting safety and mitigating harm included participating in learning sessions, gaining experience analyzing reported events, participating in safety huddles, and role modeling and leadership from the embedded researcher. Individual outcomes included increased ownership and interest in HIT safety, the development of a sociotechnical systems perspective, thinking differently about safety, and increased consideration for user perspectives. Team outcomes included enhanced communication within the team, using safety events to inform future work and strategic planning, and an overall promotion of a culture of safety. CONCLUSIONS As HITs are integrated into care delivery, it is important for clinical informaticians to recognize the risks related to safety. Experiential learning activities, including reviewing safety event reports and participating in safety huddles, were identified as particularly impactful. An HIT safety learning initiative is a feasible approach for clinical informaticians to become more knowledgeable and engaged in HIT safety issues in their work.
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Affiliation(s)
- Chantelle Recsky
- School of Nursing, University of British Columbia, Vancouver, BC, Canada
| | - Kathy L Rush
- School of Nursing, University of British Columbia Okanagan, Kelowna, BC, Canada
| | - Maura MacPhee
- School of Nursing, University of British Columbia, Vancouver, BC, Canada
| | - Megan Stowe
- Digital Health, Provincial Health Services Authority, Vancouver, BC, Canada
| | | | | | - Leanne M Currie
- School of Nursing, University of British Columbia, Vancouver, BC, Canada
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Lai YH, Wu MJ, Chen HH, Lin SP, Wu CY, Chin CS, Lin CH, Shiu SI, Lin YC, Chen HC, Hou SC, Chang CW. Impacts of Huddle Intervention on the Patient Safety Culture of Medical Team Members in Medical Ward: One-Group Pretest-Posttest Design. J Multidiscip Healthc 2023; 16:3599-3607. [PMID: 38024136 PMCID: PMC10680486 DOI: 10.2147/jmdh.s434185] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Accepted: 11/17/2023] [Indexed: 12/01/2023] Open
Abstract
Objective A huddle is a short, regular meetings to discuss existing or emerging patient safety issues. Hospital administrators can encourage healthcare staff to voluntarily examine the potential occurrence and severity of risks, thereby enhancing awareness of patient safety. The purpose of this study is to explore the effects of huddle intervention on patient safety culture among medical team members and related factors. Methods We used a one-group pretest-posttest research design and convenience sampled 109 members of the general internal medicine ward team members from a medical center in central Taiwan. They participated 2 times per week in 15-min huddles from 08:15 to 08:30 in the morning, which lasted for a total of 4 weeks. The process was based on submitted ideas, approved ideas, research ideas and standardization, and data on the safety attitudes questionnaire (SAQ) were collected during the huddles' intervention pretest and posttest. Results After the huddle intervention, we found significantly improved scores for safety attitude, teamwork climate (76.49±16.13 vs 83.26±13.39, p < 0.001), safety climate (75.07±16.07 vs 82.63±13.72, p < 0.001), job satisfaction (73.67±19.84 vs 83.39±17.21, p < 0.001), perceptions of management (77.87±19.99 vs 84.86±16.03, p < 0.001) and working conditions (78.96±18.16 vs 86.18±14.90, p < 0.001). Correlation analyses on the differences between pretest and posttest showed that age had a significant correlation with safety climate (r = 0.22, p = 0.022) and working conditions (r = 0.20, p = 0.035). The number of times to participate in a huddle had a significant correlation with teamwork climate (r = 0.33, p =<.001), safety climate (r = 0.30, p = 0.002), job satisfaction (r = 0.19, p = 0.043), and work conditions (r = 0.28, p = 0.003). Conclusion Huddles improve clinical team members' understanding of different dimensions and relate factors of safety attitudes. Implementation of the huddles involved standardized process will help hospital administrators understand the steps to parallel expansion to other wards.
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Affiliation(s)
- Yi-Hung Lai
- Department of Nursing, Taichung Veterans General Hospital, Taichung, Taiwan
- Department of Nursing, National Taipei University of Nursing and Health Sciences, Taipei, Taiwan
| | - Ming-Ju Wu
- Division of Nephrology, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Hsin-Hua Chen
- Division of General Medicine, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, Taiwan
- Division of Allergy, Immunology and Rheumatology, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Shih-Ping Lin
- Division of General Medicine, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, Taiwan
- Division of Infection, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Chun-Yi Wu
- Division of Nephrology, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, Taiwan
- Division of General Medicine, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Chun-Shih Chin
- Division of General Medicine, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, Taiwan
- Division of Chest Medicine, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Cheng-Hsien Lin
- Division of General Medicine, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, Taiwan
- Division of Hematology and Oncology, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Sz-Iuan Shiu
- Division of General Medicine, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, Taiwan
- Division of Gastroenterology, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Ying-Cheng Lin
- Division of General Medicine, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, Taiwan
- Division of Gastroenterology, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Hui-Chi Chen
- Department of Nursing, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Shu-Chin Hou
- Department of Nursing, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Ching-Wein Chang
- Department of Nursing, Taichung Veterans General Hospital, Taichung, Taiwan
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Recsky C, Stowe M, Rush KL, MacPhee M, Blackburn L, Muniak A, Currie LM. Characterization of Safety Events Involving Technology in Primary and Community Care. Appl Clin Inform 2023; 14:1008-1017. [PMID: 38151041 PMCID: PMC10752655 DOI: 10.1055/s-0043-1777454] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2023] [Accepted: 10/10/2023] [Indexed: 12/29/2023] Open
Abstract
BACKGROUND The adoption of technology in health care settings is often touted as an opportunity to improve patient safety. While some adverse events can be reduced by health information technologies, technology has also been implicated in or attributed to safety events. To date, most studies on this topic have focused on acute care settings. OBJECTIVES To describe voluntarily reported safety events that involved health information technology in community and primary care settings in a large Canadian health care organization. METHODS Two years of safety events involving health information technology (2016-2018) were extracted from an online voluntary safety event reporting system. Events from primary and community care settings were categorized according to clinical setting, type of event, and level of harm. The Sittig and Singh sociotechnical system model was then used to identify the most prominent sociotechnical dimensions of each event. RESULTS Of 104 reported events, most (n = 85, 82%) indicated the event resulted in no harm. Public health had the highest number of reports (n = 45, 43%), whereas home health had the fewest (n = 7, 7%). Of the 182 sociotechnical concepts identified, many events (n = 61, 59%) mapped to more than one dimension. Personnel (n = 48, 46%), Workflow and Communication (n = 37, 36%), and Content (n = 30, 29%) were the most common. Personnel and Content together was the most common combination of dimensions. CONCLUSION Most reported events featured both technical and social dimensions, suggesting that the nature of these events is multifaceted. Leveraging existing safety event reporting systems to screen for safety events involving health information technology, and applying a sociotechnical analytic framework can aid health organizations in identifying, responding to, and learning from reported events.
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Affiliation(s)
- Chantelle Recsky
- School of Nursing, University of British Columbia, Vancouver, Canada
| | - Megan Stowe
- Regional Digital Solutions, Digital Health, Provincial Health Services Authority, Vancouver, Canada
| | - Kathy L. Rush
- School of Nursing, University of British Columbia Okanagan, Kelowna, Canada
| | - Maura MacPhee
- School of Nursing, University of British Columbia, Vancouver, Canada
| | | | - Allison Muniak
- Human Factors and Administrative Burdens, Health Quality BC, Vancouver, Canada
| | - Leanne M. Currie
- School of Nursing, University of British Columbia, Vancouver, Canada
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Rabbani N, Pageler NM, Hoffman JM, Longhurst C, Sharek PJ. Association between Electronic Health Record Implementations and Hospital-Acquired Conditions in Pediatric Hospitals. Appl Clin Inform 2023; 14:521-527. [PMID: 37075806 PMCID: PMC10338103 DOI: 10.1055/a-2077-4419] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Accepted: 04/17/2023] [Indexed: 04/21/2023] Open
Abstract
BACKGROUND Implementing an electronic health record (EHR) is one of the most disruptive operational tasks a health system can undergo. Despite anecdotal reports of adverse events around the time of EHR implementations, there is limited corroborating research, particularly in pediatrics. We utilized data from Solutions for Patient Safety (SPS), a network of 145+ children's hospitals that share data and protocols to reduce harm in pediatric care delivery, to study the impact of EHR implementations on patient safety. OBJECTIVE Determine if there is an association between the time immediately surrounding an EHR implementation and hospital-acquired conditions (HACs) rates in pediatrics. METHODS A survey of information technology leaders at pediatric institutions identified EHR implementations occurring between 2012 and 2022. This list was cross-referenced with the SPS database to create an anonymized dataset of 27 sites comprising monthly HAC and care bundle compliance rates in the 7 months preceding and succeeding the transition. Six HACs were analyzed: central-line associated bloodstream infection (CLABSI), catheter-associated urinary tract infection (CAUTI), adverse drug events, surgical site infections (SSIs), pressure injuries (PIs), and falls, in addition to four associated care bundle compliance rates: CLABSI and CAUTI maintenance bundles, SSI bundle, and PI bundle. To determine if there was a statistically significant association with EHR implementation, the observation period was divided into three eras: "before" (months -7 to -3), "during" (months -2 to +2), and "after" go-live (months +3 to +7). Average monthly HAC and bundle compliance rates were calculated across eras. Paired t-tests were performed to compare rates between the eras. RESULTS No statistically significant increase in HAC rates or decrease in bundle compliance rates was observed across the EHR implementation eras. CONCLUSION This multisite study detected no significant increase in HACs and no decrease in preventive care bundle compliance in the months surrounding an EHR implementation.
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Affiliation(s)
- Naveed Rabbani
- Department of Pediatrics, Stanford University School of Medicine, Stanford, California, United States
| | - Natalie M. Pageler
- Department of Pediatrics, Stanford University School of Medicine, Stanford, California, United States
| | - James M. Hoffman
- Department of Pharmacy and Pharmaceutical Sciences, St. Jude Children's Research Hospital, Memphis, Tennessee, United States
| | - Chris Longhurst
- Department of Biomedical Informatics, University of California San Diego Health, La Jolla, California, United States
| | - Paul J. Sharek
- Center for Quality and Patient Safety, Seattle Children's, Seattle, Washington, United States
- Department of Pediatrics, University of Washington, Seattle, Washington, United States
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Khan A, Karavite DJ, Muthu N, Shelov E, Nawab U, Desai B, Luo B. Classification of Health Information Technology Safety Events in a Pediatric Tertiary Care Hospital. J Patient Saf 2023; 19:251-257. [PMID: 37094555 DOI: 10.1097/pts.0000000000001119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/26/2023]
Abstract
OBJECTIVE State agencies have developed reporting systems of safety events that include events related to health information technology (HIT). These data come from hospital reporting systems where staff submit safety reports and nurses, in the role of safety managers, review, and code events. Safety managers may have varying degrees of experience with identifying events related to HIT. Our objective was to review events potentially involving HIT and compare those with what was reported to the state. METHODS We performed a structured review of 1 year of safety events from an academic pediatric healthcare system. We reviewed the free-text description of each event and applied a classification scheme derived from the AHRQ Health IT Hazard Manager and compared the results with events reported to the state as involving HIT. RESULTS Of 33,218 safety events for a 1-year period, 1247 included key words related to HIT and/or were indicated by safety managers as involving HIT. Of the 1247 events, the structured review identified 769 as involving HIT. In comparison, safety managers only identified 194 of the 769 events (25%) as involving HIT. Most events, 353 (46%), not identified by safety managers were documentation issues. Of the 1247 events, the structured review identified 478 as not involving HIT while safety managers identified and reported 81 of these 478 events (17%) as involving HIT. CONCLUSIONS The current process of reporting safety events lacks standardization in identifying health technology contributions to safety events, which may minimize the effectiveness of safety initiatives.
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Affiliation(s)
| | - Dean J Karavite
- From the Department of Biomedical and Health Informatics, and
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Protocol for a stepped wedge cluster randomized quality improvement project to evaluate the impact of medical safety huddles on patient safety. Contemp Clin Trials Commun 2022; 30:100996. [PMID: 36134382 PMCID: PMC9483722 DOI: 10.1016/j.conctc.2022.100996] [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: 06/07/2022] [Revised: 08/19/2022] [Accepted: 09/08/2022] [Indexed: 11/22/2022] Open
Abstract
Introduction Physician engagement is crucial for furthering patient safety and quality improvement within healthcare organizations. Medical Safety Huddles, which are physician-specific huddles, is a novel way to engage physicians with patient safety and may reduce adverse events experienced by patients. We plan to conduct a multi-center quality improvement (QI) initiative to implement and evaluate Medical Safety Huddles. The primary objective is to determine the impact of the huddles on adverse events experienced by patients. Secondary objectives include assessing the impact of the huddles on patient safety culture and physician engagement, and a process evaluation to assess the fidelity of implementation. Methods This stepped wedge cluster randomized study will be conducted at four academic inpatient hospitals over 19 months. Each site will adapt Medical Safety Huddles to its own practice context to best engage physicians. We will review randomly selected patient charts for adverse events. Generalized linear mixed effects regression will be used to estimate the overall intervention effect on adverse events. Process measures such as physician attendance rates and number of safety issues raised per huddle will be tracked to monitor implementation adherence. Conclusion Medical Safety Huddles may help healthcare organizations and medical leaders to better engage physicians with patient safety. The project results will assess the fidelity of implementation and determine the impact of Medical Safety Huddles on patient safety.
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Sittig DF, Lakhani P, Singh H. Applying requisite imagination to safeguard electronic health record transitions. J Am Med Inform Assoc 2022; 29:1014-1018. [PMID: 35022741 PMCID: PMC9006683 DOI: 10.1093/jamia/ocab291] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2021] [Revised: 12/17/2021] [Accepted: 12/29/2021] [Indexed: 02/05/2023] Open
Abstract
Over the next decade, many health care organizations (HCOs) will transition from one electronic health record (EHR) to another; some forced by hospital acquisition and others by choice in search of better EHRs. Herein, we apply principles of Requisite Imagination, or the ability to imagine key aspects of the future one is planning, to offer 6 recommendations on how to proactively safeguard these transitions. First, HCOs should implement a proactive leadership structure that values communication. Second, HCOs should implement proactive risk assessment and testing processes. Third, HCOs should anticipate and reduce unwarranted variation in their EHR and clinical processes. Fourth, HCOs should establish a culture of conscious inquiry with routine system monitoring. Fifth, HCOs should foresee and reduce information access problems. Sixth, HCOs should support their workforce through difficult EHR transitions. Proactive approaches using Requisite Imagination principles outlined here can help ensure safe, effective, and economically sound EHR transitions.
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Affiliation(s)
- Dean F Sittig
- University of Texas/Memorial Hermann Center for Healthcare Quality & Safety, School of Biomedical Informatics, University of Texas Health Science Center, Houston, TX, USA
| | - Priti Lakhani
- Formerly at Office of Electronic Health Record Modernization, U.S. Department of Veterans Affairs, Washington, DC, USA
| | - Hardeep Singh
- Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey Veterans Affairs Medical Center and Baylor College of Medicine, Houston, TX, USA
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Matulis JC, Kok SN, Dankbar EC, Majka AJ. A survey of outpatient Internal Medicine clinician perceptions of diagnostic error. ACTA ACUST UNITED AC 2021; 7:107-114. [PMID: 31913847 DOI: 10.1515/dx-2019-0070] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2019] [Accepted: 12/05/2019] [Indexed: 11/15/2022]
Abstract
Background Little is known about how practicing Internal Medicine (IM) clinicians perceive diagnostic error, and whether perceptions are in agreement with the published literature. Methods A 16-question survey was administered across two IM practices: one a referral practice providing care for patients traveling for a second opinion and the other a traditional community-based primary care practice. Our aim was to identify individual- and system-level factors contributing to diagnostic error (primary outcome) and conditions at greatest risk of diagnostic error (secondary outcome). Results Sixty-five of 125 clinicians surveyed (51%) responded. The most commonly perceived individual factors contributing to diagnostic error included atypical patient presentations (83%), failure to consider other diagnoses (63%) and inadequate follow-up of test results (53%). The most commonly cited system-level factors included cognitive burden created by the volume of data in the electronic health record (EHR) (68%), lack of time to think (64%) and systems that do not support collaboration (40%). Conditions felt to be at greatest risk of diagnostic error included cancer (46%), pulmonary embolism (43%) and infection (37%). Conclusions Inadequate clinician time and sub-optimal patient and test follow-up are perceived by IM clinicians to be persistent contributors to diagnostic error. Clinician perceptions of conditions at greatest risk of diagnostic error may differ from the published literature.
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Affiliation(s)
- John C Matulis
- Division of Community Internal Medicine, Mayo Clinic, Rochester, USA
| | - Susan N Kok
- Division of General Internal Medicine, Mayo Clinic, Rochester, MN, USA
| | - Eugene C Dankbar
- The Division of Management, Engineering and Internal Consulting, Mayo Clinic, Rochester, MN, USA
| | - Andrew J Majka
- Division of General Internal Medicine, Mayo Clinic, Rochester, MN, USA
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Huddles and their effectiveness at the frontlines of clinical care: a scoping review. J Gen Intern Med 2021; 36:2772-2783. [PMID: 33559062 PMCID: PMC8390736 DOI: 10.1007/s11606-021-06632-9] [Citation(s) in RCA: 38] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2020] [Accepted: 01/17/2021] [Indexed: 12/11/2022]
Abstract
BACKGROUND Brief, stand-up meetings known as huddles may improve clinical care, but knowledge about huddle implementation and effectiveness at the frontlines is fragmented and setting specific. This work provides a comprehensive overview of huddles used in diverse health care settings, examines the empirical support for huddle effectiveness, and identifies knowledge gaps and opportunities for future research. METHODS A scoping review was completed by searching the databases PubMed, EBSCOhost, ProQuest, and OvidSP for studies published in English from inception to May 31, 2019. Eligible studies described huddles that (1) took place in a clinical or medical setting providing health care patient services, (2) included frontline staff members, (3) were used to improve care quality, and (4) were studied empirically. Two reviewers independently screened abstracts and full texts; seven reviewers independently abstracted data from full texts. RESULTS Of 2,185 identified studies, 158 met inclusion criteria. The majority (67.7%) of studies described huddles used to improve team communication, collaboration, and/or coordination. Huddles positively impacted team process outcomes in 67.7% of studies, including improvements in efficiency, process-based functioning, and communication across clinical roles (64.4%); situational awareness and staff perceptions of safety and safety climate (44.6%); and staff satisfaction and engagement (29.7%). Almost half of studies (44.3%) reported huddles positively impacting clinical care outcomes such as patients receiving timely and/or evidence-based assessments and care (31.4%); decreased medical errors and adverse drug events (24.3%); and decreased rates of other negative outcomes (20.0%). DISCUSSION Huddles involving frontline staff are an increasingly prevalent practice across diverse health care settings. Huddles are generally interdisciplinary and aimed at improving team communication, collaboration, and/or coordination. Data from the scoping review point to the effectiveness of huddles at improving work and team process outcomes and indicate the positive impact of huddles can extend beyond processes to include improvements in clinical outcomes. STUDY REGISTRATION This scoping review was registered with the Open Science Framework on 18 January 2019 ( https://osf.io/bdj2x/ ).
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Ndabu T, Mulgund P, Sharman R, Singh R. Perceptual Gaps Between Clinicians and Technologists on Health Information Technology-Related Errors in Hospitals: Observational Study. JMIR Hum Factors 2021; 8:e21884. [PMID: 33544089 PMCID: PMC7971770 DOI: 10.2196/21884] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Revised: 11/06/2020] [Accepted: 12/17/2020] [Indexed: 01/23/2023] Open
Abstract
BACKGROUND Health information technology (HIT) has been widely adopted in hospital settings, contributing to improved patient safety. However, many types of medical errors attributable to information technology (IT) have negatively impacted patient safety. The continued occurrence of many errors is a reminder that HIT software testing and validation is not adequate in ensuring errorless software functioning within the health care organization. OBJECTIVE This pilot study aims to classify technology-related medical errors in a hospital setting using an expanded version of the sociotechnical framework to understand the significant differences in the perceptions of clinical and technology stakeholders regarding the potential causes of these errors. The paper also provides some recommendations to prevent future errors. METHODS Medical errors were collected from previous studies identified in leading health databases. From the main list, we selected errors that occurred in hospital settings. Semistructured interviews with 5 medical and 6 IT professionals were conducted to map the events on different dimensions of the expanded sociotechnical framework. RESULTS Of the 2319 identified publications, 36 were included in the review. Of the 67 errors collected, 12 occurred in hospital settings. The classification showed the "gulf" that exists between IT and medical professionals in their perspectives on the underlying causes of medical errors. IT experts consider technology as the source of most errors and suggest solutions that are mostly technical. However, clinicians assigned the source of errors within the people, process, and contextual dimensions. For example, for the error "Copied and pasted charting in the wrong window: Before, you could not easily get into someone else's chart accidentally...because you would have to pull the chart and open it," medical experts highlighted contextual issues, including the number of patients a health care provider sees in a short time frame, unfamiliarity with a new electronic medical record system, nurse transitions around the time of error, and confusion due to patients having the same name. They emphasized process controls, including failure modes, as a potential fix. Technology experts, in contrast, discussed the lack of notification, poor user interface, and lack of end-user training as critical factors for this error. CONCLUSIONS Knowledge of the dimensions of the sociotechnical framework and their interplay with other dimensions can guide the choice of ways to address medical errors. These findings lead us to conclude that designers need not only a high degree of HIT know-how but also a strong understanding of the medical processes and contextual factors. Although software development teams have historically included clinicians as business analysts or subject matter experts to bridge the gap, development teams will be better served by more immersive exposure to clinical environments, leading to better software design and implementation, and ultimately to enhanced patient safety.
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Affiliation(s)
- Theophile Ndabu
- Department of Management Science and Systems, School of Management, State University of New York at Buffalo, Buffalo, NY, United States
| | - Pavankumar Mulgund
- Department of Management Science and Systems, School of Management, State University of New York at Buffalo, Buffalo, NY, United States
| | - Raj Sharman
- Department of Management Science and Systems, School of Management, State University of New York at Buffalo, Buffalo, NY, United States
| | - Ranjit Singh
- School of Medicine and Biomedical Sciences, State University of New York at Buffalo, Buffalo, NY, United States
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Development of a Taxonomy for Medication-Related Patient Safety Events Related to Health Information Technology in Pediatrics. Appl Clin Inform 2020; 11:714-724. [PMID: 33113568 DOI: 10.1055/s-0040-1717084] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Although electronic health records (EHRs) are designed to improve patient safety, they have been associated with serious patient harm. An agreed-upon and standard taxonomy for classifying health information technology (HIT) related patient safety events does not exist. OBJECTIVES We aimed to develop and evaluate a taxonomy for medication-related patient safety events associated with HIT and validate it using a set of events involving pediatric patients. METHODS We performed a literature search to identify existing classifications for HIT-related safety events, which were assessed using real-world pediatric medication-related patient safety events extracted from two sources: patient safety event reporting system (ERS) reports and information technology help desk (HD) tickets. A team of clinical and patient safety experts used iterative tests of change and consensus building to converge on a single taxonomy. The final devised taxonomy was applied to pediatric medication-related events assess its characteristics, including interrater reliability and agreement. RESULTS Literature review identified four existing classifications for HIT-related patient safety events, and one was iteratively adapted to converge on a singular taxonomy. Safety events relating to usability accounted for a greater proportion of ERS reports, compared with HD tickets (37 vs. 20%, p = 0.022). Conversely, events pertaining to incorrect configuration accounted for a greater proportion of HD tickets, compared with ERS reports (63 vs. 8%, p < 0.01). Interrater agreement (%) and reliability (kappa) were 87.8% and 0.688 for ERS reports and 73.6% and 0.556 for HD tickets, respectively. DISCUSSION A standardized taxonomy for medication-related patient safety events related to HIT is presented. The taxonomy was validated using pediatric events. Further evaluation can assess whether the taxonomy is suitable for nonmedication-related events and those occurring in other patient populations. CONCLUSION Wider application of standardized taxonomies will allow for peer benchmarking and facilitate collaborative interinstitutional patient safety improvement efforts.
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Mena Lora AJ, Ali M, Krill C, Spencer S, Takhsh E, Bleasdale SC. Impact of a hospital-wide huddle on device utilisation and infection rates: a community hospital's journey to zero. J Infect Prev 2020; 21:228-233. [PMID: 33408760 DOI: 10.1177/1757177420939239] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2020] [Accepted: 05/31/2020] [Indexed: 11/16/2022] Open
Abstract
Background Device utilisation ratios (DUR) correlate with device-associated complications and rates of infection. We implemented a hospital-wide Daily Interdisciplinary Safety Huddle (DISH) with infection control and device components. The aim of this study was to evaluate the impact of DISH on DURs and rates of infection for indwelling urinary catheters (IUC) and central venous catheters (CVC). Methods A quasi-experimental study assessing DURs and rates of infection before and after implementation of DISH. At DISH, usage of IUC and CVC is reported by managers and the infection preventionist reviews indications and plans for removal. Data before and after implementation were compared. Paired T-test was used to assess for differences between both groups. Results DISH was successfully implemented at a community hospital. The average DUR for IUC in intensive care unit (ICU) and non-ICU settings was reduced from 0.56 to 0.35 and 0.27 to 0.12, respectively. CVC DUR decreased from 0.29 to 0.26 in the ICU and 0.14 to 0.12 in non-ICU settings. Catheter-associated urinary tract infections (CAUTIs) decreased by 87% and central line-associated bloodstream infections (CLABSIs) by 96%. Conclusion DISH was associated with hospital-wide reductions in DUR and device-associated healthcare-associated infections. Reduction of CLABSIs and CAUTIs had estimated cost savings of $688,050. The impact was more profound in non-ICU settings. To our knowledge, an infection prevention hospital-wide safety huddle has not been reported in the literature. DISH increased device removal, accountability and promoted a culture of safety.
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Affiliation(s)
- Alfredo J Mena Lora
- Division of Infectious Diseases, Department of Medicine, University of Illinois at Chicago, Chicago, IL, USA.,Quality Resources Department, Saint Anthony Hospital, Chicago, IL, USA
| | - Mirza Ali
- Quality Resources Department, Saint Anthony Hospital, Chicago, IL, USA
| | - Candice Krill
- Quality Resources Department, Saint Anthony Hospital, Chicago, IL, USA
| | - Sherrie Spencer
- Quality Resources Department, Saint Anthony Hospital, Chicago, IL, USA
| | - Eden Takhsh
- Quality Resources Department, Saint Anthony Hospital, Chicago, IL, USA
| | - Susan C Bleasdale
- Division of Infectious Diseases, Department of Medicine, University of Illinois at Chicago, Chicago, IL, USA
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Singh H, Sittig DF. A Sociotechnical Framework for Safety-Related Electronic Health Record Research Reporting: The SAFER Reporting Framework. Ann Intern Med 2020; 172:S92-S100. [PMID: 32479184 DOI: 10.7326/m19-0879] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
Electronic health record (EHR)-based interventions to improve patient safety are complex and sensitive to who, what, where, why, when, and how they are delivered. Success or failure depends not only on the characteristics and behaviors of individuals who are targeted by an intervention, but also on the technical characteristics of the intervention and the culture and environment of the health system that implements it. Current reporting guidelines do not capture the complexity of sociotechnical factors (technical and nontechnical factors, such as workflow and organizational issues) that confound or influence these interventions. This article proposes a methodological reporting framework for EHR interventions targeting patient safety and builds on an 8-dimension sociotechnical model previously developed by the authors for design, development, implementation, use, and evaluation of health information technology. The Safety-related EHR Research (SAFER) Reporting Framework enables reporting of patient safety-focused EHR-based interventions while accounting for the multifaceted, dynamic sociotechnical context affecting intervention implementation, effectiveness, and generalizability. As an example, an EHR-based intervention to improve communication and timely follow-up of subcritical abnormal test results to operationalize the framework is presented. For each dimension, reporting should include what sociotechnical changes were made to implement an EHR-related intervention to improve patient safety, why the intervention did or did not lead to safety improvements, and how this intervention can be applied or exported to other health care organizations. A foundational list of research and reporting recommendations to address implementation, effectiveness, and generalizability of EHR-based interventions needed to effectively reduce preventable patient harm is provided. The SAFER Reporting Framework is not meant to replace previous research reporting guidelines, but rather provides a sociotechnical adjunct that complements their use.
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Affiliation(s)
- Hardeep Singh
- Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey Veterans Affairs Medical Center and Baylor College of Medicine, Houston, Texas (H.S.)
| | - Dean F Sittig
- University of Texas Memorial Hermann Center for Healthcare Quality & Safety, School of Biomedical Informatics, University of Texas Health Science Center at Houston, Texas (D.F.S.)
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16
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Powell L, Sittig DF, Chrouser K, Singh H. Assessment of Health Information Technology-Related Outpatient Diagnostic Delays in the US Veterans Affairs Health Care System: A Qualitative Study of Aggregated Root Cause Analysis Data. JAMA Netw Open 2020; 3:e206752. [PMID: 32584406 PMCID: PMC7317596 DOI: 10.1001/jamanetworkopen.2020.6752] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
IMPORTANCE Diagnostic delay in the outpatient setting is an emerging safety priority that health information technology (HIT) should help address. However, diagnostic delays have persisted, and new safety concerns associated with the use of HIT have emerged. OBJECTIVE To analyze HIT-related outpatient diagnostic delays within a large, integrated health care system. DESIGN, SETTING, AND PARTICIPANTS This cohort study involved qualitative content analysis of safety concerns identified in aggregated root cause analysis (RCA) data related to HIT and outpatient diagnostic delays. The setting was the US Department of Veterans Affairs using all RCAs submitted to the Veterans Affairs (VA) National Center for Patient Safety from January 1, 2013, to July 31, 2018. MAIN OUTCOMES AND MEASURES Common themes associated with the role of HIT-related safety concerns were identified and categorized according to the Health IT Safety framework for measuring, monitoring, and improving HIT safety. This framework includes 3 related domains (ie, safe HIT, safe use of HIT, and using HIT to improve safety) situated within an 8-dimensional sociotechnical model accounting for interacting technical and nontechnical variables associated with safety. Hence, themes identified enhanced understanding of the sociotechnical context and domain of HIT safety involved. RESULTS Of 214 RCAs categorized by the terms delay and outpatient submitted during the study period, 88 were identified as involving diagnostic delays and HIT, from which 172 unique HIT-related safety concerns were extracted (mean [SD], 1.97 [1.53] per RCA). Most safety concerns (82.6% [142 of 172]) involved problems with safe use of HIT, predominantly sociotechnical factors associated with people, workflow and communication, and a poorly designed human-computer interface. Fewer safety concerns involved problems with safe HIT (14.5% [25 of 172]) or using HIT to improve safety (0.3% [5 of 172]). The following 5 key high-risk areas for diagnostic delays emerged: managing electronic health record inbox notifications and communication, clinicians gathering key diagnostic information, technical problems, data entry problems, and failure of a system to track test results. CONCLUSIONS AND RELEVANCE This qualitative study of a national RCA data set suggests that interventions to reduce outpatient diagnostic delays could aim to improve test result management, interoperability, data visualization, and order entry, as well as to decrease information overload.
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Affiliation(s)
- Lauren Powell
- Veterans Affairs (VA) National Center for Patient Safety, Ann Arbor, Michigan
| | - Dean F Sittig
- School of Biomedical Informatics, The University of Texas Health Science Center at Houston
| | | | - Hardeep Singh
- Center for Innovations in Quality, Effectiveness, and Safety (IQuESt) at the Michael E. DeBakey VA Medical Center and Baylor College of Medicine, Houston, Texas
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Franklin BJ, Gandhi TK, Bates DW, Huancahuari N, Morris CA, Pearson M, Bass MB, Goralnick E. Impact of multidisciplinary team huddles on patient safety: a systematic review and proposed taxonomy. BMJ Qual Saf 2020; 29:1-2. [PMID: 32265256 DOI: 10.1136/bmjqs-2019-009911] [Citation(s) in RCA: 49] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2019] [Revised: 02/16/2020] [Accepted: 03/04/2020] [Indexed: 12/21/2022]
Abstract
BACKGROUND Despite significant advances, patient safety remains a critical public health concern. Daily huddles-discussions to identify and respond to safety risks-have been credited with enhancing safety culture in operationally complex industries including aviation and nuclear power. More recently, huddles have been endorsed as a mechanism to improve patient safety in healthcare. This review synthesises the literature related to the impact of hospital-based safety huddles. METHODS We conducted a systematic review of peer-reviewed literature related to scheduled, multidisciplinary, hospital-based safety huddles through December 2019. We screened for studies (1) in which huddles were the primary intervention being assessed and (2) that measured the huddle programme's apparent impact using at least one quantitative metric. RESULTS We identified 1034 articles; 24 met our criteria for review, of which 19 reflected unit-based huddles and 5 reflected hospital-wide or multiunit huddles. Of the 24 included articles, uncontrolled pre-post comparison was the prevailing study design; we identified only two controlled studies. Among the 12 unit-based studies that provided complete measures of statistical significance for reported outcomes, 11 reported statistically significant improvement among some or all outcomes. The objectives of huddle programmes and the language used to describe them varied widely across the studies we reviewed. CONCLUSION While anecdotal accounts of successful huddle programmes abound and the evidence we reviewed appears favourable overall, high-quality peer-reviewed evidence regarding the effectiveness of hospital-based safety huddles, particularly at the hospital-wide level, is in its earliest stages. Additional rigorous research-especially focused on huddle programme design and implementation fidelity-would enhance the collective understanding of how huddles impact patient safety and other targeted outcomes. We propose a taxonomy and standardised reporting measures for future huddle-related studies to enhance comparability and evidence quality.
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Affiliation(s)
- Brian J Franklin
- University of Michigan Medical School, Ann Arbor, Michigan, USA .,Harvard Business School, Boston, Massachusetts, USA
| | | | - David W Bates
- Division of General Internal Medicine and Primary Care, Brigham and Women's Hospital, Boston, Massachusetts, USA.,Harvard Medical School, Boston, Massachusetts, USA
| | - Nadia Huancahuari
- Harvard Medical School, Boston, Massachusetts, USA.,Department of Emergency Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Charles A Morris
- Division of General Internal Medicine and Primary Care, Brigham and Women's Hospital, Boston, Massachusetts, USA.,Harvard Medical School, Boston, Massachusetts, USA
| | | | - Michelle Beth Bass
- Countway Library of Medicine, Harvard Medical School, Boston, Massachusetts, USA
| | - Eric Goralnick
- Department of Emergency Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA.,Center for Surgery and Public Health, Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
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18
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Montague J, Crosswaite K, Lamming L, Cracknell A, Lovatt A, Mohammed MA. Sustaining the commitment to patient safety huddles: insights from eight acute hospital ward teams. ACTA ACUST UNITED AC 2020; 28:1316-1324. [PMID: 31714819 DOI: 10.12968/bjon.2019.28.20.1316] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND A recent initiative in hospital settings is the patient safety huddle (PSH): a brief multidisciplinary meeting held to highlight patient safety issues and actions to mitigate identified risks. AIM The authors studied eight ward teams that had sustained PSHs for over 2 years in order to identify key contributory factors. METHODS Unannounced observations of the PSH on eight acute wards in one UK hospital were undertaken. Interviews and focus groups were also conducted. These were recorded and transcribed for framework analysis. FINDINGS A range of factors contributes to the sustainability of the PSH including a high degree of belief and consensus in purpose, adaptability, determination, multidisciplinary team involvement, a non-judgemental space, committed leadership and consistent reward and celebration. CONCLUSION The huddles studied have developed and been shaped over time through a process of trial and error, and persistence. Overall this study offers insights into the factors that contribute to this sustainability.
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Affiliation(s)
- Jane Montague
- Lecturer, Faculty of Health Studies, University of Bradford
| | - Kate Crosswaite
- Research Fellow, Faculty of Health Studies, University of Bradford
| | - Laura Lamming
- Research Fellow, Faculty of Health Studies, University of Bradford
| | - Alison Cracknell
- Consultant Physician, St James's University Hospital, Leeds Teaching Hospitals Trust
| | - Alison Lovatt
- Director, The Improvement Academy, Bradford Institute for Health Research
| | - Mohammed A Mohammed
- Professor of Healthcare Quality and Effectiveness, Faculty of Health Studies, University of Bradford
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19
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Chapman LR, Molloy L, Wright F, Oswald C, Adnum K, O'Brien TA, Mitchell R. Implementation of Situational Awareness in the Pediatric Oncology Setting. Does a 'huddle' Work and Is it Sustainable? J Pediatr Nurs 2020; 50:75-80. [PMID: 31770680 DOI: 10.1016/j.pedn.2019.10.016] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2019] [Revised: 10/30/2019] [Accepted: 10/30/2019] [Indexed: 10/25/2022]
Abstract
BACKGROUND Huddles are short, regular debriefings that are designed to engage clinical staff in discussions about existing or emerging safety issues. They allow a brief conversation to take place creating a 'situational awareness' about the complexities of the healthcare environment for that day. METHODS The huddle was implemented in a pediatric oncology service as an intervention aimed at improving patient safety and staff communication to enhance situational awareness. To ensure an efficient format for each huddle a huddle observational tool (HOT) was developed. An initial electronic anonymous survey focusing on safety and situational awareness was distributed to all of the multi-disciplinary (MDT) team. A second survey was disseminated 18 months post huddle introduction to scrutinize its effectiveness. Sustainability was assessed using staff attendance and huddle numbers. RESULTS Four key areas demonstrated high situational awareness; safety awareness, incident management, communication and teamwork. Positive/negative pooled responses from both survey time points demonstrated a high percentage of positive responses, particularly relating to teamwork enhancement. The overwhelming finding was sustainability of the intervention of the huddle. The pediatric oncology services have now conducted over 700 huddles events over a three-year period. CONCLUSION The initiation of the huddle has led to increased situational awareness and promotion of safety. It has been shown to be sustainable in the pediatric oncology setting, with durability and attendance of the huddle being the most significant outcome.
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Affiliation(s)
- Laura Rm Chapman
- Kids Cancer Center, Sydney Children's Hospital, Randwick, NSW, Australia.
| | - Luke Molloy
- The University of Wollongong, Wollongong, NSW, Australia.
| | - Felicity Wright
- Kids Cancer Center, Sydney Children's Hospital, Randwick, NSW, Australia; Graduate School of Health, University of Technology Sydney, Australia.
| | - Cecilia Oswald
- Kids Cancer Center, Sydney Children's Hospital, Randwick, NSW, Australia.
| | - Kirsten Adnum
- Kids Cancer Center, Sydney Children's Hospital, Randwick, NSW, Australia.
| | - Tracey A O'Brien
- Kids Cancer Center, Sydney Children's Hospital, Randwick, NSW, Australia; School of Women's & Children's Health, University of New South Wales, Sydney, NSW, Australia.
| | - Richard Mitchell
- Kids Cancer Center, Sydney Children's Hospital, Randwick, NSW, Australia; School of Women's & Children's Health, University of New South Wales, Sydney, NSW, Australia.
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20
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The Role of Nurse Managers in the Adoption of Health Information Technology: Findings From a Qualitative Study. J Nurs Adm 2019; 49:549-555. [PMID: 31651615 DOI: 10.1097/nna.0000000000000810] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE This study aims to investigate the role of nurse managers in supporting point-of-care nurses' health information technology (IT) use and identify strategies employed by nurse managers to improve adoption, while also gathering point-of-care nurses' perceptions of these strategies. BACKGROUND Nurse managers are essential in facilitating point-of-care nurses' use of health IT; however, the underlying phenomenon for this facilitation remains unreported. METHODS A qualitative descriptive study was conducted with 10 nurse managers and 14 point-of-care nurses recruited from a mental health hospital environment in Ontario, Canada. Inductive and deductive content analyses were used to analyze the semistructured interviews. RESULTS Nurse managers adopt the role of advocate, educator, and connector, using the following strategies: communicating system updates, demonstrating use of health IT, linking staff to resources, facilitating education, and providing IT oversight. CONCLUSIONS Nurse managers use a variety of strategies to support nurses' use of health IT. Future research should focus on the effectiveness of these strategies.
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21
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Angelopoulou P, Panagopoulou E. Non-clinical rounds in hospital settings: a scoping review. J Health Organ Manag 2019; 33:605-616. [PMID: 31483207 DOI: 10.1108/jhom-09-2018-0244] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE The purpose of this paper is to systematically describe the types of non-clinical rounds implemented in hospital settings. DESIGN/METHODOLOGY/APPROACH This scoping review was conducted and reported in accordance with the PRISMA. The review followed the four stages of conducting scoping review as defined by Arskey and O'Malley (2005). FINDINGS Initially, 978 articles were identified through database search from which only 24 studies were considered relevant and included in the final review. Overall, eight types of non-clinical rounds were identified (death rounds, grand rounds, morbidity and mortality conferences, multidisciplinary rounds, patient safety rounds, patient safety huddles, walkarounds and Schwartz rounds) that independently of their format, goal, participants and type of outcomes aimed to enhance patient safety and improve quality of healthcare delivery in hospital settings, either by focusing on physician, patient or organizational system. ORIGINALITY/VALUE To the authors' knowledge this is the first review that aims to provide a comprehensive summary to the types of non-clinical rounds that has been applied in clinical settings.
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Affiliation(s)
| | - Efharis Panagopoulou
- Department of Medicine, Aristotle University of Thessaloniki , Thessaloniki, Greece
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22
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Ratwani RM, Savage E, Will A, Fong A, Karavite D, Muthu N, Rivera AJ, Gibson C, Asmonga D, Moscovitch B, Grundmeier R, Rising J. Identifying Electronic Health Record Usability And Safety Challenges In Pediatric Settings. Health Aff (Millwood) 2019; 37:1752-1759. [PMID: 30395517 DOI: 10.1377/hlthaff.2018.0699] [Citation(s) in RCA: 84] [Impact Index Per Article: 16.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Pediatric populations are uniquely vulnerable to the usability and safety challenges of electronic health records (EHRs), particularly those related to medication, yet little is known about the specific issues contributing to hazards. To understand specific usability issues and medication errors in the care of children, we analyzed 9,000 patient safety reports, made in the period 2012-17, from three different health care institutions that were likely related to EHR use. Of the 9,000 reports, 3,243 (36 percent) had a usability issue that contributed to the medication event, and 609 (18.8 percent) of the 3,243 might have resulted in patient harm. The general pattern of usability challenges and medication errors were the same across the three sites. The most common usability challenges were associated with system feedback and the visual display. The most common medication error was improper dosing.
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Affiliation(s)
- Raj M Ratwani
- Raj M. Ratwani ( ) is director of the National Center for Human Factors in Healthcare, MedStar Health, and an assistant professor of emergency medicine, Department of Emergency Medicine, Georgetown University School of Medicine, both in Washington, D.C
| | - Erica Savage
- Erica Savage is a manager in Ambulatory Quality and Safety, MedStar Health
| | - Amy Will
- Amy Will is a research program manager at the National Center for Human Factors in Healthcare, MedStar Health
| | - Allan Fong
- Allan Fong is a research scientist at the National Center for Human Factors in Healthcare, MedStar Health
| | - Dean Karavite
- Dean Karavite is principal human computer interaction specialist, Department of Biomedical and Health Informatics, Children's Hospital of Philadelphia, in Pennsylvania
| | - Naveen Muthu
- Naveen Muthu is director of the Cognitive Informatics Group, Department of Biomedical and Health Informatics, Children's Hospital of Philadelphia, and an instructor of pediatrics, University of Pennsylvania Perelman School of Medicine
| | - A Joy Rivera
- A. Joy Rivera is a senior human factors system engineer at the Children's Hospital of Wisconsin, in Milwaukee
| | - Cori Gibson
- Cori Gibson is a safety specialist at the Children's Hospital of Wisconsin
| | - Don Asmonga
- Don Asmonga is an officer in the Health Information Technology Initiative, Pew Charitable Trusts, in Washington, D.C
| | - Ben Moscovitch
- Ben Moscovitch is the project director of the Health Information Technology Initiative, Pew Charitable Trusts
| | - Robert Grundmeier
- Robert Grundmeier is director of clinical informatics, Department of Biomedical and Health Informatics, Children's Hospital of Philadelphia, and an assistant professor of pediatrics, University of Pennsylvania Perelman School of Medicine
| | - Josh Rising
- Josh Rising is director of Healthcare Programs, Pew Health Group, Pew Charitable Trusts
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23
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Dugstad J, Eide T, Nilsen ER, Eide H. Towards successful digital transformation through co-creation: a longitudinal study of a four-year implementation of digital monitoring technology in residential care for persons with dementia. BMC Health Serv Res 2019; 19:366. [PMID: 31182093 PMCID: PMC6558683 DOI: 10.1186/s12913-019-4191-1] [Citation(s) in RCA: 44] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2018] [Accepted: 05/28/2019] [Indexed: 02/01/2023] Open
Abstract
Background Implementation of digital monitoring technology systems is considered beneficial for increasing the safety and quality of care for residents in nursing homes and simultaneously improving care providers’ workflow. Co-creation is a suitable approach for developing and implementing digital technologies and transforming the service accordingly. This study aimed to identify the facilitators and barriers for implementation of digital monitoring technology in residential care for persons with dementia and wandering behaviour, and explore co-creation as an implementation strategy and practice. Methods In this longitudinal case study, we observed and elicited the experiences of care providers and healthcare managers in eight nursing homes, in addition to those of the information technology (IT) support services and technology vendors, during a four-year implementation process. We were guided by theories on innovation, implementation and learning, as well as co-creation and design. The data were analysed deductively using a determinants of innovation framework, followed by an inductive content analysis of interview and observation data. Results The implementation represented radical innovation and required far more resources than the incremental changes anticipated by the participants. Five categories of facilitators and barriers were identified, including several subcategories for each category: 1) Pre-implementation preparations; 2) Implementation strategy; 3) Technology stability and usability; 4) Building competence and organisational learning; and 5) Service transformation and quality management. The combination of IT infrastructure instability and the reluctance of the IT support service to contribute in co-creating value with the healthcare services was the most persistent barrier. Overall, the co-creation methodology was the most prominent facilitator, resulting in a safer night monitoring service. Conclusion Successful implementation of novel digital monitoring technologies in the care service is a complex and time-consuming process and even more so when the technology allows care providers to radically transform clinical practices at the point of care, which offers new affordances in the co-creation of value with their residents. From a long-term perspective, the digital transformation of municipal healthcare services requires more advanced IT competence to be integrated directly into the management and provision of healthcare and value co-creation with service users and their relatives.
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Affiliation(s)
- Janne Dugstad
- The Science Centre Health and Technology, Faculty of Health and Social Sciences, University of South-Eastern Norway, Drammen, Norway.
| | - Tom Eide
- The Science Centre Health and Technology, Faculty of Health and Social Sciences, University of South-Eastern Norway, Drammen, Norway
| | - Etty R Nilsen
- The Science Centre Health and Technology, School of Business, University of South-Eastern Norway, Drammen, Norway
| | - Hilde Eide
- The Science Centre Health and Technology, Faculty of Health and Social Sciences, University of South-Eastern Norway, Drammen, Norway
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Ryan S, Ward M, Vaughan D, Murray B, Zena M, O'Connor T, Nugent L, Patton D. Do safety briefings improve patient safety in the acute hospital setting? A systematic review. J Adv Nurs 2019; 75:2085-2098. [PMID: 30816565 DOI: 10.1111/jan.13984] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2017] [Revised: 12/06/2018] [Accepted: 12/14/2018] [Indexed: 12/01/2022]
Abstract
AIMS To synthesize current knowledge about the impact of safety briefings as an intervention to improve patient safety. BACKGROUND Improving safety in health care remains an ongoing challenge. There is a lack of evidence underpinning safety enhancing interventions. DESIGN Mixed method multi-level synthesis. DATA SOURCES Four health literature databases were searched (Cinahl, Medline, Scopus and Health Business Elite) from January 2002 - March 2017. REVIEW METHODS Thomas and Harden approach to mixed method synthesis. RESULTS Following quality appraisal, 12 studies were included. There was significant heterogeneity in study aims, measures, and outcomes. Findings showed that safety briefings achieved beneficial outcomes and can improve safety culture. Outcomes included improved risk identification, reduced falls, enhanced relationships, increased incident reporting, ability to voice concerns, and reduced length of stay. CONCLUSION Healthcare leaders should embrace the potential of safety briefings by promoting their effective use whilst allowing for local adaptation.
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Affiliation(s)
- Sharon Ryan
- Children's University Hospital, Dublin, Ireland
| | - Marie Ward
- Children's University Hospital, Dublin, Ireland
| | | | - Bridget Murray
- School of Nursing and Midwifery, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Moore Zena
- School of Nursing and Midwifery, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Tom O'Connor
- School of Nursing and Midwifery, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Linda Nugent
- School of Nursing and Midwifery, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Declan Patton
- School of Nursing and Midwifery, Royal College of Surgeons in Ireland, Dublin, Ireland
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Coiera E, Magrabi F, Talmon J. Engineering technology resilience through informatics safety science. J Am Med Inform Assoc 2019; 24:244-245. [PMID: 28040683 DOI: 10.1093/jamia/ocw162] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Affiliation(s)
- Enrico Coiera
- Centre for Health Informatics, Australian Institute of Health Innovation, Faculty of Medicine and Health Science, Macquarie University, Sydney, Australia
| | - Farah Magrabi
- Centre for Health Informatics, Australian Institute of Health Innovation, Macquarie University, Sydney, 2109, NSW, Australia
| | - Jan Talmon
- Centre for Health Informatics, Australian Institute of Health Innovation, Macquarie University, Sydney, 2109, NSW, Australia
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Fencl JL, Willoughby C. Daily Organizational Safety Huddles: An Important Pause for Situational Awareness. AORN J 2018; 109:111-118. [DOI: 10.1002/aorn.12571] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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Guo M, Tardif G, Bayley M. Medical Safety Huddles in Rehabilitation: A Novel Patient Safety Strategy. Arch Phys Med Rehabil 2017; 99:1217-1219. [PMID: 29030096 DOI: 10.1016/j.apmr.2017.09.113] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2017] [Revised: 09/06/2017] [Accepted: 09/08/2017] [Indexed: 10/18/2022]
Abstract
OBJECTIVE To describe the implementation process, outcomes, and lessons learned in the implementation of medical safety huddles, a novel patient safety monitoring strategy that promotes physician engagement with patient safety. DESIGN Single-center observational study. SETTING Brain and spinal cord injury rehabilitation program at an urban, academic adult rehabilitation hospital. PARTICIPANTS Physicians associated with the program (N=18). INTERVENTIONS Weekly physicians' safety huddles were implemented to review, anticipate, and address patient safety issues. MAIN OUTCOME MEASURES Main outcome measures were the number and nature of identified and anticipated patient safety incidents, actions taken, and physician attendance during huddles. The number of adverse events in the program before and after huddle implementation were secondary measures. RESULTS Over a 7-month period, average physician attendance at medical huddles was 76.0%. There were 1.0±0.8 patient safety incidents and 3.2±2.1 anticipated patient safety issues identified in each weekly huddle. Most patient safety incidents identified were clinical administrative and clinical process related, which differed from information gathered from the organization's preexisting patient safety monitoring strategies. A total of 79 actions, or 3.3±1.8 actions per huddle, were taken in response to improve patient safety for the program. Adverse events decreased from 31.2 (95% confidence interval [CI], 27.0-35.3) to 22.9 per month (95% CI, 19.3-26.5) after implementation. CONCLUSIONS Medical safety huddles are a novel strategy to engage physicians in patient safety and organizational quality improvement. They have the potential to enhance organizational anticipation of safety risks by supplementing existing methods. Other rehabilitation settings may wish to consider implementing and evaluating similar huddles into their existing patient safety and quality improvement frameworks.
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Affiliation(s)
- Meiqi Guo
- Division of Physical Medicine and Rehabilitation, Department of Medicine, University of Toronto, Toronto, ON; and the Toronto Rehabilitation Institute, University Health Network, Toronto, ON, Canada.
| | - Gaetan Tardif
- Division of Physical Medicine and Rehabilitation, Department of Medicine, University of Toronto, Toronto, ON; and the Toronto Rehabilitation Institute, University Health Network, Toronto, ON, Canada
| | - Mark Bayley
- Division of Physical Medicine and Rehabilitation, Department of Medicine, University of Toronto, Toronto, ON; and the Toronto Rehabilitation Institute, University Health Network, Toronto, ON, Canada
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28
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Toward More Proactive Approaches to Safety in the Electronic Health Record Era. Jt Comm J Qual Patient Saf 2017; 43:540-547. [PMID: 28942779 DOI: 10.1016/j.jcjq.2017.06.005] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2017] [Revised: 06/01/2017] [Accepted: 06/05/2017] [Indexed: 02/08/2023]
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Labkoff SE, Sittig DF. Who Watches the Watchers. Working Towards Safety for EHR Knowledge Resources. Appl Clin Inform 2017; 8:680-685. [PMID: 28657638 PMCID: PMC6241753 DOI: 10.4338/aci-2017-02-ie-0032] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2017] [Accepted: 04/20/2017] [Indexed: 02/05/2023] Open
Abstract
The rise in the use of electronic health records (EHRs) and associated resources over the last decade is leading to the end of the paper medical record and all the risks associated with the use of a paper chart. However, there has not been a concomitant creation of a systematic oversight body that is specifically charged with ensuring the public's safety through the use of EHR knowledge resource tools or EHRs themselves. We recommend the formation a Health Information Technology Safety Center. Such a center could collect error reports, review EHRs and the knowledge resources incorporated within them, and investigate particularly challenging EHR-related safety issues at participating health care delivery organizations. Safety issues could be identified, corrected, and the solutions widely disseminated.
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Affiliation(s)
- Steven E Labkoff
- Steven E. Labkoff, MD, FACP, FACMI, Purdue Pharma L.P., Stamford, CT.,
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Patterson ES, Anders S, Moffatt-Bruce S. CLUSTERING AND PRIORITIZING PATIENT SAFETY ISSUES DURING EHR IMPLEMENTATION AND UPGRADES IN HOSPITAL SETTINGS. ACTA ACUST UNITED AC 2017; 6:125-131. [PMID: 30035145 DOI: 10.1177/2327857917061028] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Our aim was to elicit, label, and prioritize clusters of de-identified patient safety issues experienced during the implementation and upgrade installations of Electronic Health Records (EHRs) in hospitals. Conference participants included clinical personnel (physicians, nurses, pharmacists), human factors experts, patient safety experts, information technology experts from vendors and hospitals, academic experts, graduate students, and other attendees. De-identified reports of patient safety issues were shared via share4safety@gmail.com by conference and non-conference attendees before and during a 90-minute session featured at the Human Factors in Healthcare International Symposium on March 8, 2017. One submitted example of a reported patient safety issue was provided to the group. During the session, each attendee shared with a partner five concerns and identified their top concern. Subsequently, each two-person group shared with the larger group these issues, which were written by a facilitator onto sticky paper and placed on the walls. The issues were grouped using pre-defined categories and new categories were identified. Next, each participant voted for the highest priority cluster and/or individual patient safety issue using stickers. This paper reports the results of the interactive session, including the labeled and prioritized clusters and illustrative examples for each cluster. These clusters may inform reporting systems and quality improvement initiatives with health information technology where choices made during implementation and upgrades as well as design flaws with EHR technology both contribute and interact to produce potential patient safety issues.
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Affiliation(s)
- Emily S Patterson
- Division of Health Information Management and Systems, School of Health and Rehabilitation Sciences, The Ohio State University, Columbus, Ohio, USA
| | - Shilo Anders
- Center for Research and Innovation in Systems Safety, Department of Anesthesiology, Vanderbilt University Medical Center, Nashville, Tennessee, USA
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