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Vasudevan A, Plombon S, Piniella N, Garber A, Malik M, O'Fallon E, Goyal A, Gershanik E, Kumar V, Fiskio J, Yoon C, Lipsitz SR, Schnipper JL, Dalal AK. Effect of digital tools to promote hospital quality and safety on adverse events after discharge. J Am Med Inform Assoc 2024:ocae176. [PMID: 39013194 DOI: 10.1093/jamia/ocae176] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2024] [Revised: 06/10/2024] [Accepted: 06/26/2024] [Indexed: 07/18/2024] Open
Abstract
OBJECTIVES Post-discharge adverse events (AEs) are common and heralded by new and worsening symptoms (NWS). We evaluated the effect of electronic health record (EHR)-integrated digital tools designed to promote quality and safety in hospitalized patients on NWS and AEs after discharge. MATERIALS AND METHODS Adult general medicine patients at a community hospital were enrolled. We implemented a dashboard which clinicians used to assess safety risks during interdisciplinary rounds. Post-implementation patients were randomized to complete a discharge checklist whose responses were incorporated into the dashboard. Outcomes were assessed using EHR review and 30-day call data adjudicated by 2 clinicians and analyzed using Poisson regression. We conducted comparisons of each exposure on post-discharge outcomes and used selected variables and NWS as independent predictors to model post-discharge AEs using multivariable logistic regression. RESULTS A total of 260 patients (122 pre, 71 post [dashboard], 67 post [dashboard plus discharge checklist]) enrolled. The adjusted incidence rate ratios (aIRR) for NWS and AEs were unchanged in the post- compared to pre-implementation period. For patient-reported NWS, aIRR was non-significantly higher for dashboard plus discharge checklist compared to dashboard participants (1.23 [0.97,1.56], P = .08). For post-implementation patients with an AE, aIRR for duration of injury (>1 week) was significantly lower for dashboard plus discharge checklist compared to dashboard participants (0 [0,0.53], P < .01). In multivariable models, certain patient-reported NWS were associated with AEs (3.76 [1.89,7.82], P < .01). DISCUSSION While significant reductions in post-discharge AEs were not observed, checklist participants experiencing a post-discharge AE were more likely to report NWS and had a shorter duration of injury. CONCLUSION Interventions designed to prompt patients to report NWS may facilitate earlier detection of AEs after discharge. CLINICALTRIALS.GOV NCT05232656.
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Affiliation(s)
- Anant Vasudevan
- Division of General Internal Medicine, Department of Medicine, Brigham and Women's Hospital, Boston, MA 02115, United States
- Harvard Medical School, Boston, MA 02115, United States
| | - Savanna Plombon
- Division of General Internal Medicine, Department of Medicine, Brigham and Women's Hospital, Boston, MA 02115, United States
- Mass General Brigham, Boston, MA 02145, United States
| | - Nicholas Piniella
- Division of General Internal Medicine, Department of Medicine, Brigham and Women's Hospital, Boston, MA 02115, United States
| | - Alison Garber
- Division of General Internal Medicine, Department of Medicine, Brigham and Women's Hospital, Boston, MA 02115, United States
| | - Maria Malik
- Division of General Internal Medicine, Department of Medicine, Brigham and Women's Hospital, Boston, MA 02115, United States
| | - Erin O'Fallon
- Division of General Internal Medicine, Department of Medicine, Brigham and Women's Hospital, Boston, MA 02115, United States
- Harvard Medical School, Boston, MA 02115, United States
| | - Abhishek Goyal
- Division of General Internal Medicine, Department of Medicine, Brigham and Women's Hospital, Boston, MA 02115, United States
- Harvard Medical School, Boston, MA 02115, United States
| | - Esteban Gershanik
- Division of General Internal Medicine, Department of Medicine, Brigham and Women's Hospital, Boston, MA 02115, United States
- Harvard Medical School, Boston, MA 02115, United States
| | - Vivek Kumar
- Division of General Internal Medicine, Department of Medicine, Brigham and Women's Hospital, Boston, MA 02115, United States
- Harvard Medical School, Boston, MA 02115, United States
| | - Julie Fiskio
- Mass General Brigham, Boston, MA 02145, United States
| | - Cathy Yoon
- Division of General Internal Medicine, Department of Medicine, Brigham and Women's Hospital, Boston, MA 02115, United States
| | - Stuart R Lipsitz
- Division of General Internal Medicine, Department of Medicine, Brigham and Women's Hospital, Boston, MA 02115, United States
- Harvard Medical School, Boston, MA 02115, United States
| | - Jeffrey L Schnipper
- Division of General Internal Medicine, Department of Medicine, Brigham and Women's Hospital, Boston, MA 02115, United States
- Harvard Medical School, Boston, MA 02115, United States
| | - Anuj K Dalal
- Division of General Internal Medicine, Department of Medicine, Brigham and Women's Hospital, Boston, MA 02115, United States
- Harvard Medical School, Boston, MA 02115, United States
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Joo Y, Jang Y, Kwon OY. Contents and effectiveness of patient- and family-centred care interventions in adult intensive care units: A systematic review. Nurs Crit Care 2024. [PMID: 38899600 DOI: 10.1111/nicc.13105] [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: 10/18/2023] [Revised: 04/16/2024] [Accepted: 05/28/2024] [Indexed: 06/21/2024]
Abstract
BACKGROUND The need and values of patient- and family-centred care (PFCC) have been globally increasing in the health care landscape. However, the concept of PFCC and the components in adult intensive care units (ICUs) remain wide-ranging. AIM To elucidate the core concepts of PFCC interventions and evaluate the effects of the interventions in adult ICUs. STUDY DESIGN We searched electronic databases (PubMed, Cochrane Central, CINAHL, EMBASE, PsycINFO, RISS, KMbase and KoreaMed) from inception to 20 June 2022, for all studies on PFCC interventions. Three authors independently conducted data screening and extraction. The core concepts and the effects of PFCC interventions in adult ICUs were examined. The effects of patient- and family-centred care interventions in adult ICUs were examined. The quality of the included studies was evaluated using the Mixed Methods Appraisal Tool. RESULTS Overall, 3507 records were identified, and 14 full-text articles were assessed. Participants in the included studies were patients and/or their family members in adult ICUs. The main concepts of the studies were participation and information-sharing. Only two studies used collaboration as the main concept of intervention. PFCC interventions have shown positive outcomes for patients, including increased satisfaction, improvement of patient health status and reduced incidence of complications. They have also been beneficial for families, leading to higher satisfaction levels and decreased anxiety. Additionally, these interventions have positively impacted health care providers by enhancing satisfaction and improving rounding efficiency. Moreover, they have influenced health care utilization by decreasing hospital costs and length of stay. CONCLUSIONS This review highlights the advantages of PFCC interventions for patients, families and health care providers in adult ICUs. Future research should focus on developing strategies to incorporate collaboration more comprehensively as a core concept in the implementation of PFCC interventions. RELEVANCE TO CLINICAL PRACTICE Future research endeavours must prioritize collaborative efforts involving health care providers, patients and their families by deploying an array of strategies within the intensive care unit setting.
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Affiliation(s)
- Youngshin Joo
- College of Nursing and Brain Korea 21 FOUR Project, Yonsei University, Seoul, Republic of Korea
| | - Yeonsoo Jang
- College of Nursing and Mo-Im Kim Nursing Research Institute, Yonsei University, Seoul, Republic of Korea
| | - Oh Young Kwon
- College of Nursing and Brain Korea 21 FOUR Project, Yonsei University, Seoul, Republic of Korea
- College of Nursing and Mo-Im Kim Nursing Research Institute, Yonsei University, Seoul, Republic of Korea
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Klavansky D, Lehrer H, Levy R, Boahene-Nartey G, Riley E, Dangayach NS. Continuous Quality Improvement: Utilizing a Novel Education Platform to Enhance Care for the Caregiver in the Neurosciences Intensive Care Unit. J Intensive Care Med 2024:8850666241262284. [PMID: 38881380 DOI: 10.1177/08850666241262284] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/18/2024]
Abstract
Background: Timely patient and family communication is fundamental to the delivery of patient and family-centered care in the intensive care unit (ICU). However, repetitive, non-urgent communication with patients and designated patient contacts (DPCs) may lead to workflow disruptions, patient safety concerns and burnout. Implementing media-rich, educational content via a web-app could promote a more communication-friendly environment and reduce redundant communication. This may lower workflow disruptions and save time for more meaningful interactions with providers. The goal of this study was to deliver relevant, high-quality content via a web-app, assess time savings, and patient satisfaction with the web-app. Methods: A pre-implementation survey was distributed to Neurosciences intensive care unit (NSICU) staff to assess the burden of repetitive non-urgent communication and perceived duration of disruptions. Patients admitted to the NSICU from September 2022 to February 2023, n = 221 were included in the study. Patients were enrolled in the web-app. Patients and their DPC were granted access. Demographics including patient diagnosis, age, gender, and race were collected, along with data on weekly patient enrollment, number of DPCs granted access, total, frequency, and average view times of each piece of web-app content, and expected time saved due to review of web-app-based content by patient and/or DPCs to reduce repetitive communication by NSICU caregivers. The time saved for each piece of web-app content was calculated after getting feedback from providers (attendings, fellows, advanced practice providers, nurses) for how long it generally took them to convey each piece of information to patients and families. Results: Based on web-app content reviewed by patients and/or DPCs, the estimated average amount of NSICU caregiver time saved over the study period, based on application content views, was 82 min per week, and the cumulative total provider time saved for all content views was 26 h and 53 min. Twenty-one of 59 applications were rated by patients or their DPC and received five-star reviews (out of 5). Conclusion: The implementation of a web-app to facilitate and increase efficiency in communication leads to time savings for NSICU providers and patient/DPC satisfaction with the media-rich educational content.
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Affiliation(s)
- Dana Klavansky
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, USA
| | - Helaina Lehrer
- Department of Neurosurgery, Northwell Health, New York, USA
| | - Ruth Levy
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, USA
| | - Golda Boahene-Nartey
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, USA
| | - Elka Riley
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, USA
| | - Neha S Dangayach
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, USA
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Cai Y, Liu Y, Wang C, Liu S, Zhang M, Jiang Y. Patient and family engagement interventions for hospitalized patient safety: A scoping review. J Clin Nurs 2024; 33:2099-2111. [PMID: 38323678 DOI: 10.1111/jocn.17022] [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: 08/15/2023] [Revised: 12/02/2023] [Accepted: 01/10/2024] [Indexed: 02/08/2024]
Abstract
AIM To summarize existing studies that focused on improving hospitalized patient safety through patient and family engagement interventions to identify priorities and gaps. DESIGN A scoping review. METHODS Eight databases and citations of important reviews were searched on 30 September 2022. Two researchers independently screened the records. Then, two researchers extracted the data and cross-checked. The results were synthesized narratively, and a comparison was performed for studies from China and those from other countries. RESULTS Ninety-eight studies were included. The results indicated that patient and family engagement interventions were applied to decrease the incidence of patient safety incidents, and to improve the healthcare providers' and patients' knowledge, attitude or practice of patient safety. Most studies only engaged patients and families at the direct care level, and the engagement strategies at the organization and health system levels were insufficient. For stakeholders, many studies failed to consider patients' perspectives in intervention design and report taking staff training as a supportive strategy. Healthcare providers, especially nurses, were the main implementers of current interventions. Certain differences were observed between studies from China and those from other countries in the above aspects. CONCLUSIONS International interest in engaging patient and family for patient safety is growing. Future studies should enhance the patient and family engagement as a partner in various patient safety at the direct care level, and further explore the engagement at the organization and health system levels. RELEVANCE TO CLINICAL PRACTICE Nurses, as the main formal caregivers for patients, should promote patient and family engagement in patient safety, especially at direct care level. Nurse should also incorporate the perspectives of patients in the design and implementation of interventions. REPORTING METHOD PRISMA-ScR Checklist.
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Affiliation(s)
- Yan Cai
- Department of Neurosurgery, West China Hospital, Sichuan University/West China School of Nursing, Sichuan University, Chengdu, Sichuan, China
- Evidence-based Nursing Center, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Yuan Liu
- Department of Neurosurgery, West China Hospital, Sichuan University/West China School of Nursing, Sichuan University, Chengdu, Sichuan, China
| | - Cong Wang
- Evidence-based Nursing Center, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Shanshan Liu
- Evidence-based Nursing Center, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Mingming Zhang
- Chinese Evidence-Based Medicine Center, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Yan Jiang
- Department of Nursing, West China Hospital, Sichuan University/West China School of Nursing, Sichuan University, Chengdu, Sichuan, China
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5
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Garber A, Garabedian P, Wu L, Lam A, Malik M, Fraser H, Bersani K, Piniella N, Motta-Calderon D, Rozenblum R, Schnock K, Griffin J, Schnipper JL, Bates DW, Dalal AK. Developing, pilot testing, and refining requirements for 3 EHR-integrated interventions to improve diagnostic safety in acute care: a user-centered approach. JAMIA Open 2023; 6:ooad031. [PMID: 37181729 PMCID: PMC10172040 DOI: 10.1093/jamiaopen/ooad031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Revised: 01/04/2023] [Accepted: 04/20/2023] [Indexed: 05/16/2023] Open
Abstract
Objective To describe a user-centered approach to develop, pilot test, and refine requirements for 3 electronic health record (EHR)-integrated interventions that target key diagnostic process failures in hospitalized patients. Materials and Methods Three interventions were prioritized for development: a Diagnostic Safety Column (DSC) within an EHR-integrated dashboard to identify at-risk patients; a Diagnostic Time-Out (DTO) for clinicians to reassess the working diagnosis; and a Patient Diagnosis Questionnaire (PDQ) to gather patient concerns about the diagnostic process. Initial requirements were refined from analysis of test cases with elevated risk predicted by DSC logic compared to risk perceived by a clinician working group; DTO testing sessions with clinicians; PDQ responses from patients; and focus groups with clinicians and patient advisors using storyboarding to model the integrated interventions. Mixed methods analysis of participant responses was used to identify final requirements and potential implementation barriers. Results Final requirements from analysis of 10 test cases predicted by the DSC, 18 clinician DTO participants, and 39 PDQ responses included the following: DSC configurable parameters (variables, weights) to adjust baseline risk estimates in real-time based on new clinical data collected during hospitalization; more concise DTO wording and flexibility for clinicians to conduct the DTO with or without the patient present; and integration of PDQ responses into the DSC to ensure closed-looped communication with clinicians. Analysis of focus groups confirmed that tight integration of the interventions with the EHR would be necessary to prompt clinicians to reconsider the working diagnosis in cases with elevated diagnostic error (DE) risk or uncertainty. Potential implementation barriers included alert fatigue and distrust of the risk algorithm (DSC); time constraints, redundancies, and concerns about disclosing uncertainty to patients (DTO); and patient disagreement with the care team's diagnosis (PDQ). Discussion A user-centered approach led to evolution of requirements for 3 interventions targeting key diagnostic process failures in hospitalized patients at risk for DE. Conclusions We identify challenges and offer lessons from our user-centered design process.
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Affiliation(s)
- Alison Garber
- Division of General Internal Medicine, Brigham and Women’s Hospital, Boston, Massachusetts, USA
| | - Pamela Garabedian
- Division of General Internal Medicine, Brigham and Women’s Hospital, Boston, Massachusetts, USA
| | - Lindsey Wu
- Division of General Internal Medicine, Brigham and Women’s Hospital, Boston, Massachusetts, USA
| | - Alyssa Lam
- Division of General Internal Medicine, Brigham and Women’s Hospital, Boston, Massachusetts, USA
| | - Maria Malik
- Division of General Internal Medicine, Brigham and Women’s Hospital, Boston, Massachusetts, USA
| | - Hannah Fraser
- Division of General Internal Medicine, Brigham and Women’s Hospital, Boston, Massachusetts, USA
| | - Kerrin Bersani
- Division of General Internal Medicine, Brigham and Women’s Hospital, Boston, Massachusetts, USA
| | - Nicholas Piniella
- Division of General Internal Medicine, Brigham and Women’s Hospital, Boston, Massachusetts, USA
| | - Daniel Motta-Calderon
- Division of General Internal Medicine, Brigham and Women’s Hospital, Boston, Massachusetts, USA
| | - Ronen Rozenblum
- Division of General Internal Medicine, Brigham and Women’s Hospital, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
| | - Kumiko Schnock
- Division of General Internal Medicine, Brigham and Women’s Hospital, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
| | | | - Jeffrey L Schnipper
- Division of General Internal Medicine, Brigham and Women’s Hospital, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
| | - David W Bates
- Division of General Internal Medicine, Brigham and Women’s Hospital, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
- Department of Health Policy and Management, Harvard T. H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Anuj K Dalal
- Division of General Internal Medicine, Brigham and Women’s Hospital, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
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Newman B, Joseph K, McDonald FEJ, Harrison R, Patterson P. Using consumer engagement strategies to improve healthcare safety for young people: An exploration of the relevance and suitability of current approaches. Health Expect 2022; 25:3215-3224. [PMID: 36307993 PMCID: PMC9700142 DOI: 10.1111/hex.13629] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Revised: 09/04/2022] [Accepted: 10/02/2022] [Indexed: 11/28/2023] Open
Abstract
BACKGROUND Consumer engagement in health care is recognized as a critical strategy to minimize healthcare-associated harms, however, little research has focussed on strategies to engage young people in healthcare safety. This study explores the suitability of commonly used engagement strategies, such as brochures, interactive bedside charts or apps, for young people (14-25 years) to improve their healthcare safety, with a focus on cancer care. METHODS Four qualitative online workshops were conducted (N = 19). Two workshops included young people who had experienced cancer (n = 6) and two workshops included staff who support young people who had experienced a diagnosis of cancer (n = 12). Evidence from a systematic review was used to develop case studies of existing strategies as a topic guide for the online workshops. Data were analysed using a framework method and template analysis approach. RESULTS Thematic analysis against the analytic framework led to the development of four principles for engagement with young people: empowerment, transparency, participatory culture and flexibility. The transition from being 'looked after' to young people being responsible for their own care was an integrative theme which intersected all elements of the framework. CONCLUSION For service providers to engage with young people about safety issues in cancer services, the strategies employed need to be tailored to consider the transitional nature of being an adolescent or young adult. A systemic approach that incorporates flexible, tailored engagement strategies, education and empowerment of young people and healthcare providers is required to engage effectively with young people about safety in healthcare. These findings may have implications beyond cancer care. PATIENT OR PUBLIC CONTRIBUTION Workshop content was developed with and by the CanEngage team, including the Consumer Advisory Group, who reviewed content and inform wider project priorities.
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Affiliation(s)
- Bronwyn Newman
- Centre for Health Systems and Safety Research (CHSSR), Australian Institute of Health InnovationMacquarie UniversitySydneyNew South WalesAustralia
| | - Kathryn Joseph
- School of Nursing and Midwifery, Centre for Quality and Patient Safety Research, Institute for Health TransformationDeakin UniversityBurwoodVictoriaAustralia
| | | | - Reema Harrison
- Centre for Health Systems and Safety Research (CHSSR), Australian Institute of Health InnovationMacquarie UniversitySydneyNew South WalesAustralia
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McMahon SK, Greene EJ, Latham N, Peduzzi P, Gill TM, Bhasin S, Reuben DB. Engagement of older adults in STRIDE's multifactorial fall injury prevention intervention. J Am Geriatr Soc 2022; 70:3116-3126. [PMID: 35924574 PMCID: PMC9669158 DOI: 10.1111/jgs.17983] [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: 02/14/2022] [Revised: 05/29/2022] [Accepted: 07/04/2022] [Indexed: 01/05/2023]
Abstract
BACKGROUND Evidence-based multifactorial fall prevention interventions in clinical practice have been less effective than expected. One plausible reason is that older adults' engagement in fall prevention care is suboptimal. METHODS This was a post-hoc analysis of 2403 older adults' engagement in a multifactorial fall prevention intervention in the Strategies to Reduce Injuries and Develop Confidence in Elders (STRIDE) pragmatic trial. Based on the direct clinical care level of the Patient and Family Continuum of Engagement (CE) framework, three indicators of progressively interactive engagement were assessed: (1) Consultation (receiving information), (2) Involvement (prioritizing risks), and (3) Partnership (identifying prevention actions). Drop off at each step was determined as well as predictors of engagement. RESULTS The participants' engagement waned with increasingly interactive CE domains. Although all participants received information about their positive fall risk factors (consultation) and most (51%-96%) prioritized them (involvement), fewer participants (33%-55%) identified fall prevention actions (partnership) for most of their risk factors, except for strength gait or balance problems (95%). More participants (70%) identified home exercises than other actions. Finally, fall prevention actions were identified more commonly among participants who received two visits compared to one (OR = 2.33 [95% CI, 2.06-2.64]), were ≥80 years old (OR = 1.83 [95% CI, 1.51-2.23]), and had fewer fall risk factors (OR = 0.90 [95% CI, 0.83-0.99]). CONCLUSIONS The drop-off in participants' engagement based on the level of their interaction with clinicians suggests that future multifactorial fall prevention interventions need to be more focused on interactive patient-clinician partnerships that help older adults increase and maintain fall prevention actions. Our analyses suggest that more frequent contact with clinicians and more monitoring of the implementation and outcomes of Fall Prevention Care Plans could potentially improve engagement and help older adults maintain fall prevention actions.
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Affiliation(s)
| | - Erich J. Greene
- Department of Biostatistics, Yale Center for Analytical SciencesYale School of Public HealthNew HavenConnecticutUSA
| | - Nancy Latham
- Research Program in Men's Health: Aging and Metabolism, Brigham and Women's HospitalHarvard Medical SchoolBostonMassachusettsUSA
| | - Peter Peduzzi
- Department of Biostatistics, Yale Center for Analytical SciencesYale School of Public HealthNew HavenConnecticutUSA
| | - Thomas M. Gill
- Department of Internal MedicineYale School of MedicineNew HavenConnecticutUSA
| | - Shalender Bhasin
- Research Program in Men's Health: Aging and Metabolism, Brigham and Women's HospitalHarvard Medical SchoolBostonMassachusettsUSA
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8
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Samal L, Khasnabish S, Foskett C, Zigmont K, Faxvaag A, Chang F, Clements M, Rossetti SC, Dalal AK, Leone K, Lipsitz S, Massaro A, Rozenblum R, Schnock KO, Yoon C, Bates DW, Dykes PC. Comparison of a Voluntary Safety Reporting System to a Global Trigger Tool for Identifying Adverse Events in an Oncology Population. J Patient Saf 2022; 18:611-616. [PMID: 35858480 PMCID: PMC9391281 DOI: 10.1097/pts.0000000000001050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE There is a lack of research on adverse event (AE) detection in oncology patients, despite the propensity for iatrogenic harm. Two common methods include voluntary safety reporting (VSR) and chart review tools, such as the Institute for Healthcare Improvement's Global Trigger Tool (GTT). Our objective was to compare frequency and type of AEs detected by a modified GTT compared with VSR for identifying AEs in oncology patients in a larger clinical trial. METHODS Patients across 6 oncology units (from July 1, 2013, through May 29, 2015) were randomly selected. Retrospective chart reviews were conducted by a team of nurses and physicians to identify AEs using the GTT. The VSR system was queried by the department of quality and safety of the hospital. Adverse event frequencies, type, and harm code for both methods were compared. RESULTS The modified GTT detected 0.90 AEs per patient (79 AEs in 88 patients; 95% [0.71-1.12] AEs per patient) that were predominantly medication AEs (53/79); more than half of the AEs caused harm to the patients (41/79, 52%), but only one quarter were preventable (21/79; 27%). The VSR detected 0.24 AEs per patient (21 AEs in 88 patients; 95% [0.15-0.37] AEs per patient), a large plurality of which were medication/intravenous related (8/21); more than half did not cause harm (70%). Only 2% of the AEs (2/100) were detected by both methods. CONCLUSIONS Neither the modified GTT nor the VSR system alone is sufficient for detecting AEs in oncology patient populations. Further studies exploring methods such as automated AE detection from electronic health records and leveraging patient-reported AEs are needed.
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Affiliation(s)
- Lipika Samal
- Department of Medicine, Brigham and Women’s Hospital, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
| | - Srijesa Khasnabish
- Department of Medicine, Brigham and Women’s Hospital, Boston, Massachusetts, USA
| | - Cathy Foskett
- Department of Medicine, Brigham and Women’s Hospital, Boston, Massachusetts, USA
| | - Katherine Zigmont
- Academic Medical Center, Patient Safety Organization, Boston, Massachusetts, USA
| | - Arild Faxvaag
- Department of Neuromedicine and Movement Science & Department of Rheumatology, St. Olavs University Hospital, Trondheim, Norway
| | - Frank Chang
- Information Systems/Clinical, Partners Healthcare, Somerville, Massachusetts, USA
| | | | - Sarah Collins Rossetti
- Department of Biomedical Informatics, Columbia University Irving Medical Center, New York, New York, USA
- School of Nursing, Columbia University Irving Medical Center, New York, New York, USA
| | - Anuj K Dalal
- Department of Medicine, Brigham and Women’s Hospital, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
| | - Kathleen Leone
- Department of Nursing, Brigham and Women’s Faulkner Hospital, Boston, Massachusetts, USA
| | - Stuart Lipsitz
- Department of Medicine, Brigham and Women’s Hospital, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
| | - Anthony Massaro
- Department of Medicine, Brigham and Women’s Hospital, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
| | - Ronen Rozenblum
- Department of Medicine, Brigham and Women’s Hospital, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
| | - Kumiko O. Schnock
- Department of Medicine, Brigham and Women’s Hospital, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
| | - Catherine Yoon
- Department of Medicine, Brigham and Women’s Hospital, Boston, Massachusetts, USA
| | - David W. Bates
- Department of Medicine, Brigham and Women’s Hospital, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
| | - Patricia C. Dykes
- Department of Medicine, Brigham and Women’s Hospital, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
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9
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Allum L, Apps C, Pattison N, Connolly B, Rose L. Informing the standardising of care for prolonged stay patients in the ICU: A scoping review of quality improvement tools. Intensive Crit Care Nurs 2022; 73:103302. [PMID: 35931596 DOI: 10.1016/j.iccn.2022.103302] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2021] [Revised: 07/04/2022] [Accepted: 07/15/2022] [Indexed: 12/20/2022]
Abstract
OBJECTIVES To inform design of quality improvement (QI) tools specific to patients with prolonged intensive care unit (ICU) stay, we determined characteristics (format/content), development, implementation, and outcomes of published multi-component QI tools used in ICU irrespective of length of stay. RESEARCH METHODOLOGY Scoping review searching electronic databases, trial registries and grey literature (January 2000 to January 2022). RESULTS We screened 58,378 citations, identifying 96 studies. All tools were designed for use commencing at ICU admission except 3 tools implemented at 3, 5 or 14 days. We identified 32 studies of locally developed checklists, 28 goal setting/structured communication templates, 23 care bundles, and 9 studies of mixed format tools. Most (43 %) tools were designed for use during rounds, fewer tools were designed for use throughout the ICU day (27 %) or stay (9 %). Most studies (55 %) reported process objectives i.e., improving communication, care standardisation, or rounding efficiency. Most common clinical processes QI tools were used to standardise were sedation (62, 65 %), ventilation and weaning (55, 57 %), and analgesia management (58, 60 %). 44 studies reported the effect of the tool on patient outcomes. Of these, only two identified a negative effect - increased ICU length of stay and increased ICU days with pain and delirium. CONCLUSION Although we identified numerous QI tools for use in ICU settings, few were designed to specifically address actionable processes of care relevant to the unique needs of prolonged ICU stay patients. Tools that address these needs are urgently required. SYSTEMATIC REVIEW REGISTRATION The review protocol is registered on the Open Science Framework, https://osf.io/, DOI 10.17605/OSF.IO/Z8MRE.
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Affiliation(s)
- Laura Allum
- Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, King's College London, James Clerk Maxwell Building, 57 Waterloo Road, SE1 8WA London, UK; Lane Fox Clinical Respiratory Physiology Research Centre, St Thomas' Hospital, Guy's and St. Thomas' NHS Foundation Trust, Westminster Bridge Road, SE1 7EH London, UK.
| | - Chloe Apps
- Critical Care Research Group and Physiotherapy Department, St. Thomas' Hospital, Guy's and St. Thomas' NHS Foundation Trust, Westminster Bridge Rd, London SE1 7EH, UK.
| | - Natalie Pattison
- University of Hertfordshire, College Lane, Hatfield AL109AB, UK; East & North Herts NHS Trust, Coreys Mill Lane, Stevenage SG14AB, UK.
| | - Bronwen Connolly
- Lane Fox Clinical Respiratory Physiology Research Centre, St Thomas' Hospital, Guy's and St. Thomas' NHS Foundation Trust, Westminster Bridge Road, SE1 7EH London, UK; Wellcome-Wolfson Institute for Experimental Medicine, Queen's University Belfast, Belfast, UK; Centre for Human and Applied Physiological Sciences, King's College London, UK; Department of Physiotherapy, The University of Melbourne, Melbourne, Australia.
| | - Louise Rose
- Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, King's College London, James Clerk Maxwell Building, 57 Waterloo Road, SE1 8WA London, UK; Lane Fox Clinical Respiratory Physiology Research Centre, St Thomas' Hospital, Guy's and St. Thomas' NHS Foundation Trust, Westminster Bridge Road, SE1 7EH London, UK.
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10
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Buja A, Damiani G, Manfredi M, Zampieri C, Dentuti E, Grotto G, Sabatelli G. Governance for Patient Safety: A Framework of Strategy Domains for Risk Management. J Patient Saf 2022; 18:e769-e800. [PMID: 35067624 DOI: 10.1097/pts.0000000000000947] [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: 11/26/2022]
Abstract
BACKGROUND Adverse events in healthcare are primarily due to system failures rather than individuals. Risk reduction strategies should therefore focus on strengthening systems, bringing about improvements in governance, and targeting individual practices or products. The purpose of this study was to conduct a scoping review to develop a global framework of management strategies for sustaining a safety-oriented culture in healthcare organizations, focusing on patient safety and the adoption of good safety-related practices. METHODS We conducted a search on safety-related strategies in 2 steps. The first involved a search in the PubMed database to identify effective, broadly framed, cross-sector domains relevant to clinical risk management strategies in healthcare systems. In the second step, we then examined the strategies adopted by running a scoping review for each domain. RESULTS Our search identified 8 strategy domains relevant to patient safety: transformational leadership, patient engagement, human resources management quality, innovation technology, skills certification, education in patient safety, teamwork, and effective communication. CONCLUSIONS This scoping review explores management strategies key to healthcare systems' efforts to create safety-oriented organizations. Improvement efforts should focus particularly on the domains identified: combined together, they would nurture an overall safety-oriented culture and have an impact on preventable adverse events.
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Affiliation(s)
- Alessandra Buja
- From the Department of Cardiological, Thoracic, Vascular Sciences and Public Health, Padova
| | | | - Mariagiovanna Manfredi
- From the Department of Cardiological, Thoracic, Vascular Sciences and Public Health, Padova
| | - Chiara Zampieri
- From the Department of Cardiological, Thoracic, Vascular Sciences and Public Health, Padova
| | - Elena Dentuti
- University of Padua School of Nursing Sciences, Padova
| | - Giulia Grotto
- From the Department of Cardiological, Thoracic, Vascular Sciences and Public Health, Padova
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11
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Humphrey KE, Sundberg M, Milliren CE, Graham DA, Landrigan CP. Frequency and Nature of Communication and Handoff Failures in Medical Malpractice Claims. J Patient Saf 2022; 18:130-137. [PMID: 35188927 DOI: 10.1097/pts.0000000000000937] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND The Joint Commission has identified miscommunication as a leading cause of sentinel events, the most serious adverse events, but it is unclear what role miscommunications play in malpractice claims. We sought to determine the proportion of medical malpractice claims involving communication failure and describe their nature, including providers involved, locations, miscommunications types, costs, and the potential for handoff tools to avert risk and associated costs. METHODS We retrospectively reviewed a random sample of malpractice claims from 2001 to 2011, collected in CRICO Strategies' Comparative Benchmarking System, a national claims database. Two researchers reviewed cases to determine if a claim involved communication failure, its type, and potential preventability using a communication tool. Interrater reliability was assessed by dual review of 50 cases (81% agreement, κ = 0.62 for evidence of miscommunication). Claimant demographics, case characteristics, and financial data were analyzed. RESULTS Communication failures were identified in 49% of claims. Claims with communication failures were significantly less likely to be dropped, denied, or dismissed than claims without (54% versus 67%, P = 0.015). Fifty-three percent of claims with communication failures involved provider-patient miscommunication, and 47% involved provider-provider miscommunication. The information types most frequently miscommunicated were contingency plans, diagnosis, and illness severity. Forty percent of communication failures involved a failed handoff; the majority could potentially have been averted by using a handoff tool (77%). Mean total costs for cases involving communication failures were higher ($237,600 versus $154,100, P = 0.005). CONCLUSIONS Communication failures are a significant contributing cause of malpractice claims and impose a substantial financial burden on the healthcare system. Interventions to improve transmission of critical patient information have the potential to substantially reduce malpractice expenditures.
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12
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Wallander Karlsen MM, Finset A, Heggdal K, Günterberg Heyn L. Caught between ideals and reality: Phenomenological-hermeneutic study of healthcare providers' experiences while interacting with mechanically ventilated patients. J Interprof Care 2022; 36:492-499. [PMID: 35129397 DOI: 10.1080/13561820.2021.1967303] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
This study aimed to explore healthcare providers' experiences of their communication and interaction with conscious patients on mechanical ventilation in intensive care. Nurses, physicians, and physiotherapists were interviewed after they had been video recorded in naturally occurring interactions with patients. The interviews were analyzed using a phenomenological-hermeneutical approach. Three themes were identified: The willingness to engage and understand the mechanically ventilated patient, the potential risk of neglecting the patient in the encounters, and provider interdependence as the core of intensive care. The themes elicited how providers handled the dissonance between their own personal ideals of care and their real-world encounters with patients and other professionals. The healthcare providers were aware of how easily patients could be neglected while being non-vocal, and therefore invested time and effort communicating with the patients. Based on their personal ideals of patient participation and autonomy, it was difficult to perform procedures, such as weaning off the ventilator or mobilization, to which the patient was opposed. Interprofessional collaboration was valued by the providers in such situations. The study revealed that providers need to consider the communication barriers that exist on the individual and team levels when interacting with patients on mechanical ventilation.
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Affiliation(s)
| | - Arnstein Finset
- Institute of Basic Medical Sciences, Faculty of Medicine, University of Oslo, Oslo, Norway
| | | | - Lena Günterberg Heyn
- Lovisenberg Diaconal University College, Oslo, Norway.,University of South-Eastern Norway, Oslo, Norway
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13
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Dworsky ZD, Rhee KE, Patel AR, McMahon MK, Pierce HC, Stucky Fisher E. Assessing Parental Discharge Readiness by Using the Ticket to Home Survey Tool. Hosp Pediatr 2022; 12:85-93. [PMID: 34889352 DOI: 10.1542/hpeds.2021-005832] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
OBJECTIVES Ticket to Home (TTH), a survey tool designed to assess parental comprehension of their child's hospitalization and postdischarge care needs, allows providers to address knowledge gaps before discharge. Our goal was to evaluate the impact of TTH on parents' retention of discharge teaching. METHODS In this pilot study, we enrolled a convenience sample of families admitted to pediatric hospital medicine and randomly assigned families on the basis of team assignment. The intervention group received TTH before discharge. The control group received usual care (without TTH survey tool). Both groups were sent a survey 24 to 72 hours postdischarge to assess parental understanding of discharge teaching. A senior-level provider also completed a survey; responses were compared with evaluate parent level of understanding. Descriptive statistics and logistic regression were used for analysis. RESULTS Although 495 parents consented to participate, only 100 completed the necessary surveys (41 intervention and 59 control). Both groups showed high parent-provider concordance regarding reason for admission (92.7% intervention versus 86.4% control; P = .33). The intervention group had significantly higher concordance for return precautions (90.2% vs 58.2%; P < .001), which remained significant when controlling for covariates (odds ratio 6.24, 95% confidence interval 1.78-21.93). Most parents in the intervention group felt sharing TTH responses with their medical team was beneficial (95.0%). CONCLUSIONS Parents who received TTH before discharge were more likely to accurately recall return precautions and valued sharing TTH results with the team. Given that response bias may have affected pilot results, additional studies in which researchers use larger samples with more diverse patient populations is required.
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Affiliation(s)
- Zephyr D Dworsky
- Rady Children's Hospital San Diego and Division of Pediatric Hospital Medicine, Department of Pediatrics, University of California San Diego, San Diego, California
| | - Kyung E Rhee
- Rady Children's Hospital San Diego and Division of Pediatric Hospital Medicine, Department of Pediatrics, University of California San Diego, San Diego, California
| | - Aarti R Patel
- Rady Children's Hospital San Diego and Division of Pediatric Hospital Medicine, Department of Pediatrics, University of California San Diego, San Diego, California
| | - Molly K McMahon
- Rady Children's Hospital San Diego and Division of Pediatric Hospital Medicine, Department of Pediatrics, University of California San Diego, San Diego, California.,College of Osteopathic Medicine of the Pacific, Western University of Health Sciences, Pomona, California
| | - Heather C Pierce
- Rady Children's Hospital San Diego and Division of Pediatric Hospital Medicine, Department of Pediatrics, University of California San Diego, San Diego, California
| | - Erin Stucky Fisher
- Rady Children's Hospital San Diego and Division of Pediatric Hospital Medicine, Department of Pediatrics, University of California San Diego, San Diego, California
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14
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Newman B, Joseph K, Chauhan A, Seale H, Li J, Manias E, Walton M, Mears S, Jones B, Harrison R. Do patient engagement interventions work for all patients? A systematic review and realist synthesis of interventions to enhance patient safety. Health Expect 2021; 24:1905-1923. [PMID: 34432339 PMCID: PMC8628590 DOI: 10.1111/hex.13343] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Revised: 07/14/2021] [Accepted: 08/04/2021] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND Patients are increasingly being asked for feedback about their healthcare and treatment, including safety, despite little evidence to support this trend. This review identifies the strategies used to engage patients in safety during direct care, explores who is engaged and determines the mechanisms that impact effectiveness. METHODS A systematic review was performed of seven databases (CINAHL, Cochrane, Cochrane-Central, Embase, ISI Web of Science, Medline, PsycINFO) that included research published between 2010 and 2020 focused on patient engagement interventions to increase safety during direct care and reported using PRISMA. All research designs were eligible; two reviewers applied criteria independently to determine eligibility and quality. A narrative review and realist synthesis were conducted. RESULTS Twenty-six papers reporting on twenty-seven patient engagement strategies were included and classified as consultation (9), involvement (7) and partnership (11). The definitions of 'patient engagement' varied, and we found limited details about participant characteristics or interactions between people utilizing strategies. Collaborative strategy development, a user-friendly design, proactive messaging and agency sponsorship were identified as mechanisms to improve engagement about safety at the point of direct care. CONCLUSIONS Agency sponsorship of collaboration between staff and patients is essential in the development and implementation of strategies to keep patients safe during direct care. Insufficient details about participant characteristics and patient-provider interactions limit recommendations for practice change. More needs to be learned about how patients are engaged in discussions about safety, particularly minority groups unable to engage with standard information. PATIENT OR PUBLIC CONTRIBUTION Review progress was reported to the CanEngage team, including the consumer steering group, to inform project priorities (PROSPERO CRD42020196453).
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Affiliation(s)
- Bronwyn Newman
- Centre for Health Systems and Safety Research (CHSSR), Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
| | - Kathryn Joseph
- School of Nursing and Midwifery, Centre for Quality and Patient Safety Research, Institute for Health Transformation, Deakin University, Geelong, Australia
| | - Ashfaq Chauhan
- Centre for Health Systems and Safety Research (CHSSR), Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
| | - Holly Seale
- Faculty of Medicine and Health, School of Population Health, University of New South Wales, Sydney, New South Wales, Australia
| | - Jiadai Li
- Centre for Health Systems and Safety Research (CHSSR), Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
| | - Elizabeth Manias
- School of Nursing and Midwifery, Centre for Quality and Patient Safety Research, Institute for Health Transformation, Deakin University, Geelong, Australia
| | - Merrilyn Walton
- School of Public Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Stephen Mears
- Hunter New England Health Libraries, John Hunter Hospital, HRMC, Newcastle, New South Wales, Australia
| | - Benjamin Jones
- Faculty of Medicine and Health, School of Population Health, University of New South Wales, Sydney, New South Wales, Australia
| | - Reema Harrison
- Centre for Health Systems and Safety Research (CHSSR), Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
- Faculty of Medicine and Health, School of Population Health, University of New South Wales, Sydney, New South Wales, Australia
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15
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Wu AW. Having a patient in the room changes the discussion. JOURNAL OF PATIENT SAFETY AND RISK MANAGEMENT 2021. [DOI: 10.1177/25160435211050802] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Albert W. Wu
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
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16
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Mangal S, Pho A, Arcia A, Carter E. Patient and Family Engagement in Catheter-Associated Urinary Tract Infection (CAUTI) Prevention: A Systematic Review. Jt Comm J Qual Patient Saf 2021; 47:591-603. [PMID: 34215555 PMCID: PMC8506981 DOI: 10.1016/j.jcjq.2021.05.009] [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: 01/12/2021] [Revised: 05/26/2021] [Accepted: 05/27/2021] [Indexed: 11/18/2022]
Abstract
BACKGROUND Catheter-associated urinary tract infections (CAUTIs) are detrimental to health and are largely preventable with adherence to CAUTI prevention guidelines. Patient and family engagement in CAUTI prevention is often encouraged in these guidelines; however, little is known about how this engagement is operationalized in practice. A systematic review was conducted to synthesize the content, format, and outcomes of interventions that engage patients and/or families in CAUTI prevention. METHODS Two reviewers independently screened records from four databases up to March 2021 and searched reference lists of final articles. Included articles were primary research, tested an intervention, involved indwelling urinary catheters, and described at least one patient and/or family engagement method. Articles were appraised for quality using the Downs and Black checklist. RESULTS After 720 records were screened, 12 were included. Study quality ranged from good to poor, scoring lowest in internal validity. The most common formats of patient/family engagement were flyers/handouts (83.3%) and verbal education (58.3%). Common content areas were urinary catheter care and maintenance strategies. Most study outcomes (83.3%) measured CAUTI rates, and half measured patient/family-related outcomes. Improvements were seen in at least one outcome across all studies, but less than half (41.7%) showed statistically significant results. CONCLUSION The researchers found that most interventions lacked sufficient detail on the content, delivery, and/or outcome measurement of patient/family engagement, which limits transferability. More high-quality, generalizable trials are warranted in this area. Future research should focus on integrating publicly available resources into practice that can be tested for comprehension and revised based on feedback from target audiences.
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Affiliation(s)
- Sabrina Mangal
- Columbia University School of Nursing, New York, NY, USA
- Weill Cornell Medical College, New York, NY, USA (Present affiliation)
| | - Anthony Pho
- Columbia University School of Nursing, New York, NY, USA
- Stanford University School of Medicine, Stanford, CA, USA (Present affiliation)
| | - Adriana Arcia
- Columbia University School of Nursing, New York, NY, USA
| | - Eileen Carter
- Columbia University School of Nursing, New York, NY, USA
- University of Connecticut School of Nursing, Storrs, CT, USA (Present affiliation)
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Xyrichis A, Fletcher S, Philippou J, Brearley S, Terblanche M, Rafferty AM. Interventions to promote family member involvement in adult critical care settings: a systematic review. BMJ Open 2021; 11:e042556. [PMID: 33827833 PMCID: PMC8031009 DOI: 10.1136/bmjopen-2020-042556] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE To identify, appraise and synthesise evidence of interventions designed to promote family member involvement in adult critical care units; and to develop a working typology of interventions for use by health professionals and family members. DESIGN Mixed-method systematic review. DATA SOURCES Bibliographic databases were searched without date restriction up to June 2019: MEDLINE, EMBASE and CINAHL; the Cochrane Central Register of Controlled Trials, Joanna Briggs and Cochrane Libraries. Back issues of leading critical care and patient experience journals were manually searched, as were the reference lists of included studies. All evaluation studies of relevant intervention activities were included; all research designs and outcome measures were eligible. Due to heterogeneity in interventions, designs and outcome measures, the synthesis followed a narrative approach. Service users met with the research team termly. RESULTS Out of 4962 possible citations, a total of 20 studies were included. The overall evidence base was assessed as moderate to weak. Six categories of interventions were identified: environmental unit changes (n=2), web-based support (n=4), discussion-based support (n=6), multicomponent support (n=4), participation in rounds (n=3) and participation in physical care (n=1). Clinical and methodological heterogeneity across studies hindered meta-analysis, hence a narrative synthesis was pursued. Six main outcomes were identified, grouped under two categories: (i) involvement outcomes: communication (mean difference ranged from 6.39 to 8.83), decision-making (mean difference ranged from -0.8 to 5.85), satisfaction (mean difference ranged from 0.15 to 2.48); and (ii) health outcomes: family trauma (mean difference ranged from -7.12 to 0.9), family well-being (mean difference ranged from -0.7 to -4), patient outcomes (relative risk ranged from 1.27 to 4.91). The findings from the qualitative studies were thematically analysed to identify features of the interventions that participants perceived to influence effectiveness. Synthesised into five overarching categories (practicality, development, interaction, reflexivity and bridging), these can serve as principles to inform the future design and development of more refined family member involvement interventions. CONCLUSIONS Future interventions should be developed with much closer family member input and designed by considering the key features we identified. We call for future interventions to be multilayered and allow for a greater or lesser level, and different kinds, of involvement for family members. Choice of intervention should be informed by a baseline diagnostic of family members' needs, readiness and preparedness for involvement. PROSPERO REGISTRATION CRD42018086325.
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Affiliation(s)
- Andreas Xyrichis
- Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, King's College London, London, England, UK
| | - Simon Fletcher
- Health, Social Care and Education, Kingston and St Georges University London, London, England, UK
| | - Julia Philippou
- Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, King's College London, London, England, UK
| | - Sally Brearley
- Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, King's College London, London, England, UK
| | - Marius Terblanche
- Critical Care, Guy's and St Thomas' NHS Foundation Trust, London, England, UK
| | - Anne Marie Rafferty
- Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, King's College London, London, England, UK
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18
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Affiliation(s)
- Liana Puscas
- Liana Puscas, MD, MHS, MA, is Associate Professor, Department of Head and Neck Surgery & Communication Sciences, Duke University School of Medicine
| | - Jennifer R. Kogan
- Jennifer R. Kogan, MD, is Professor of Medicine, Department of Medicine, University of Pennsylvania Perelman School of Medicine
| | - Eric S. Holmboe
- Eric S. Holmboe, MD, MACP, FRCP, is Chief Research, Milestone Development, and Evaluation Officer, Accreditation Council for Graduate Medical Education
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Dalal AK, Piniella N, Fuller TE, Pong D, Pardo M, Bessa N, Yoon C, Lipsitz S, Schnipper JL. Evaluation of electronic health record-integrated digital health tools to engage hospitalized patients in discharge preparation. J Am Med Inform Assoc 2021; 28:704-712. [PMID: 33463681 PMCID: PMC7973476 DOI: 10.1093/jamia/ocaa321] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2020] [Accepted: 12/01/2020] [Indexed: 01/26/2023] Open
Abstract
OBJECTIVE To evaluate the effect of electronic health record (EHR)-integrated digital health tools comprised of a checklist and video on transitions-of-care outcomes for patients preparing for discharge. MATERIALS AND METHODS English-speaking, general medicine patients (>18 years) hospitalized at least 24 hours at an academic medical center in Boston, MA were enrolled before and after implementation. A structured checklist and video were administered on a mobile device via a patient portal or web-based survey at least 24 hours prior to anticipated discharge. Checklist responses were available for clinicians to review in real time via an EHR-integrated safety dashboard. The primary outcome was patient activation at discharge assessed by patient activation (PAM)-13. Secondary outcomes included postdischarge patient activation, hospital operational metrics, healthcare resource utilization assessed by 30-day follow-up calls and administrative data and change in patient activation from discharge to 30 days postdischarge. RESULTS Of 673 patients approached, 484 (71.9%) enrolled. The proportion of activated patients (PAM level 3 or 4) at discharge was nonsignificantly higher for the 234 postimplementation compared with the 245 preimplementation participants (59.8% vs 56.7%, adjusted OR 1.23 [0.38, 3.96], P = .73). Postimplementation participants reported 3.75 (3.02) concerns via the checklist. Mean length of stay was significantly higher for postimplementation compared with preimplementation participants (10.13 vs 6.21, P < .01). While there was no effect on postdischarge outcomes, there was a nonsignificant decrease in change in patient activation within participants from pre- to postimplementation (adjusted difference-in-difference of -16.1% (9.6), P = .09). CONCLUSIONS EHR-integrated digital health tools to prepare patients for discharge did not significantly increase patient activation and was associated with a longer length of stay. While issues uncovered by the checklist may have encouraged patients to inquire about their discharge preparedness, other factors associated with patient activation and length of stay may explain our observations. We offer insights for using PAM-13 in context of real-world health-IT implementations. TRIAL REGISTRATION NIH US National Library of Medicine, NCT03116074, clinicaltrials.gov.
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Affiliation(s)
- Anuj K Dalal
- Brigham and Women’s Hospital, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
| | | | | | - Denise Pong
- Brigham and Women’s Hospital, Boston, Massachusetts, USA
| | - Michael Pardo
- Brigham and Women’s Hospital, Boston, Massachusetts, USA
| | | | - Catherine Yoon
- Brigham and Women’s Hospital, Boston, Massachusetts, USA
| | - Stuart Lipsitz
- Brigham and Women’s Hospital, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
| | - Jeffrey L Schnipper
- Brigham and Women’s Hospital, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
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20
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Home Healthcare Clinical Notes Predict Patient Hospitalization and Emergency Department Visits. Nurs Res 2021; 69:448-454. [PMID: 32852359 DOI: 10.1097/nnr.0000000000000470] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
BACKGROUND About 30% of home healthcare patients are hospitalized or visit an emergency department (ED) during a home healthcare (HHC) episode. Novel data science methods are increasingly used to improve identification of patients at risk for negative outcomes. OBJECTIVES The aim of the study was to identify patients at heightened risk hospitalization or ED visits using HHC narrative data (clinical notes). METHODS This study used a large database of HHC visit notes (n = 727,676) documented for 112,237 HHC episodes (89,459 unique patients) by clinicians of the largest nonprofit HHC agency in the United States. Text mining and machine learning algorithms (Naïve Bayes, decision tree, random forest) were implemented to predict patient hospitalization or ED visits using the content of clinical notes. Risk factors associated with hospitalization or ED visits were identified using a feature selection technique (gain ratio attribute evaluation). RESULTS Best performing text mining method (random forest) achieved good predictive performance. Seven risk factors categories were identified, with clinical factors, coordination/communication, and service use being the most frequent categories. DISCUSSION This study was the first to explore the potential contribution of HHC clinical notes to identifying patients at risk for hospitalization or an ED visit. Our results suggest that HHC visit notes are highly informative and can contribute significantly to identification of patients at risk. Further studies are needed to explore ways to improve risk prediction by adding more data elements from additional data sources.
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21
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Bruce C, Harrison P, Giammattei C, Desai SN, Sol JR, Jones S, Schwartz R. Evaluating Patient-Centered Mobile Health Technologies: Definitions, Methodologies, and Outcomes. JMIR Mhealth Uhealth 2020; 8:e17577. [PMID: 33174846 PMCID: PMC7688390 DOI: 10.2196/17577] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2019] [Revised: 04/11/2020] [Accepted: 10/23/2020] [Indexed: 01/20/2023] Open
Abstract
Several recently published studies and consensus statements have demonstrated that there is only modest (and in many cases, low-quality) evidence that mobile health (mHealth) can improve patient clinical outcomes such as the length of stay or reduction of readmissions. There is also uncertainty as to whether mHealth can improve patient-centered outcomes such as patient engagement or patient satisfaction. One principal challenge behind the “effectiveness” research in this field is a lack of common understanding about what it means to be effective in the digital space (ie, what should constitute a relevant outcome and how best to measure it). In this viewpoint, we call for interdisciplinary, conceptual clarity on the definitions, methodologies, and patient-centered outcomes frequently used in mHealth research. To formulate our recommendations, we used a snowballing approach to identify relevant definitions, outcomes, and methodologies related to mHealth. To begin, we drew heavily upon previously published detailed frameworks that enumerate definitions and measurements of engagement. We built upon these frameworks by extracting other relevant measures of patient-centered care, such as patient satisfaction, patient experience, and patient activation. We describe several definitional inconsistencies for key constructs in the mHealth literature. In an effort to achieve clarity, we tease apart several patient-centered care outcomes, and outline methodologies appropriate to measure each of these patient-care outcomes. By creating a common pathway linking definitions with outcomes and methodologies, we provide a possible interdisciplinary approach to evaluating mHealth technologies. With the broader goal of creating an interdisciplinary approach, we also provide several recommendations that we believe can advance mHealth research and implementation.
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Affiliation(s)
- Courtenay Bruce
- System Quality & Patient Safety, Houston Methodist System, Houston, TX, United States
| | - Patricia Harrison
- System Quality & Patient Safety, Houston Methodist System, Houston, TX, United States
| | | | - Shetal-Nicholas Desai
- Center for Innovation, Houston Methodist Hospital, Houston, TX, United States.,Information Technology Division, Houston Methodist Hospital, Houston, TX, United States
| | - Joshua R Sol
- Center for Innovation, Houston Methodist Hospital, Houston, TX, United States.,Information Technology Division, Houston Methodist Hospital, Houston, TX, United States
| | - Stephen Jones
- Center for Outcomes Research, Houston Methodist Research Institute, Houston, TX, United States.,Department of Surgery, Houston Methodist Hospital, Houston, TX, United States
| | - Roberta Schwartz
- Center for Innovation, Houston Methodist Hospital, Houston, TX, United States
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22
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Lyles CR, Nelson EC, Frampton S, Dykes PC, Cemballi AG, Sarkar U. Using Electronic Health Record Portals to Improve Patient Engagement: Research Priorities and Best Practices. Ann Intern Med 2020; 172:S123-S129. [PMID: 32479176 PMCID: PMC7800164 DOI: 10.7326/m19-0876] [Citation(s) in RCA: 74] [Impact Index Per Article: 18.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
Ninety percent of health care systems now offer patient portals to access electronic health records (EHRs) in the United States, but only 15% to 30% of patients use these platforms. Using PubMed, the authors identified 53 studies published from September 2013 to June 2019 that informed best practices and priorities for future research on patient engagement with EHR data through patient portals, These studies mostly involved outpatient settings and fell into 3 major categories: interventions to increase use of patient portals, usability testing of portal interfaces, and documentation of patient and clinician barriers to portal use. Interventions that used one-on-one patient training were associated with the highest portal use. Patients with limited health or digital literacy faced challenges to portal use. Clinicians reported a lack of workflows to support patient use of portals in routine practice. These studies suggest that achieving higher rates of patient engagement through EHR portals will require paying more attention to the needs of diverse patients and systematically measuring usability as well as scope of content. Future work should incorporate implementation science approaches and directly address the key role of clinicians and staff in promoting portal use.
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Affiliation(s)
- Courtney R Lyles
- UCSF Department of Medicine, Center for Vulnerable Populations at Zuckerberg San Francisco General Hospital, San Francisco, California (C.R.L., A.G.C., U.S.)
| | - Eugene C Nelson
- Geisel School of Medicine, Dartmouth College, Lebanon, New Hampshire (E.C.N.)
| | | | - Patricia C Dykes
- Center for Patient Safety, Research, and Practice, Brigham and Women's Hospital, Boston, Massachusetts (P.C.D.)
| | - Anupama G Cemballi
- UCSF Department of Medicine, Center for Vulnerable Populations at Zuckerberg San Francisco General Hospital, San Francisco, California (C.R.L., A.G.C., U.S.)
| | - Urmimala Sarkar
- UCSF Department of Medicine, Center for Vulnerable Populations at Zuckerberg San Francisco General Hospital, San Francisco, California (C.R.L., A.G.C., U.S.)
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23
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Fuller TE, Pong DD, Piniella N, Pardo M, Bessa N, Yoon C, Boxer RB, Schnipper JL, Dalal AK. Interactive Digital Health Tools to Engage Patients and Caregivers in Discharge Preparation: Implementation Study. J Med Internet Res 2020; 22:e15573. [PMID: 32343248 PMCID: PMC7218608 DOI: 10.2196/15573] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2019] [Revised: 12/16/2019] [Accepted: 02/04/2020] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND Poor discharge preparation during hospitalization may lead to adverse events after discharge. Checklists and videos that systematically engage patients in preparing for discharge have the potential to improve safety, especially when integrated into clinician workflow via the electronic health record (EHR). OBJECTIVE This study aims to evaluate the implementation of a suite of digital health tools integrated with the EHR to engage hospitalized patients, caregivers, and their care team in preparing for discharge. METHODS We used the Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) framework to identify pertinent research questions related to implementation. We iteratively refined patient and clinician-facing intervention components using a participatory process involving end users and institutional stakeholders. The intervention was implemented at a large academic medical center from December 2017 to July 2018. Patients who agreed to participate were coached to watch a discharge video, complete a checklist assessing discharge readiness, and request postdischarge text messaging with a physician 24 to 48 hours before their expected discharge date, which was displayed via a patient portal and bedside display. Clinicians could view concerns reported by patients based on their checklist responses in real time via a safety dashboard integrated with the EHR and choose to open a secure messaging thread with the patient for up to 7 days after discharge. We used mixed methods to evaluate our implementation experience. RESULTS Of 752 patient admissions, 510 (67.8%) patients or caregivers participated: 416 (55.3%) watched the video and completed the checklist, and 94 (12.5%) completed the checklist alone. On average, 4.24 concerns were reported per each of the 510 checklist submissions, most commonly about medications (664/2164, 30.7%) and follow-up (656/2164, 30.3%). Of the 510 completed checklists, a member of the care team accessed the safety dashboard to view 210 (41.2%) patient-reported concerns. For 422 patient admissions where postdischarge messaging was available, 141 (33.4%) patients requested this service; of these, a physician initiated secure messaging for 3 (2.1%) discharges. Most patient survey participants perceived that the intervention promoted self-management and communication with their care team. Patient interview participants endorsed gaps in communication with their care team and thought that the video and checklist would be useful closer toward discharge. Clinicians participating in focus groups perceived the value for patients but suggested that low awareness and variable workflow regarding the intervention, lack of technical optimization, and inconsistent clinician leadership limited the use of clinician-facing components. CONCLUSIONS A suite of EHR-integrated digital health tools to engage patients, caregivers, and clinicians in discharge preparation during hospitalization was feasible, acceptable, and valuable; however, important challenges were identified during implementation. We offer strategies to address implementation barriers and promote adoption of these tools. TRIAL REGISTRATION ClinicalTrials.gov NCT03116074; https://clinicaltrials.gov/ct2/show/NCT03116074.
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Affiliation(s)
| | - Denise D Pong
- Brigham and Women's Hospital, Boston, MA, United States
| | | | - Michael Pardo
- Brigham and Women's Hospital, Boston, MA, United States
| | - Nathaniel Bessa
- Brigham and Women's Hospital, Boston, MA, United States
- Harvard Medical School, Boston, MA, United States
| | | | - Robert B Boxer
- Brigham and Women's Hospital, Boston, MA, United States
- Harvard Medical School, Boston, MA, United States
| | - Jeffrey Lawrence Schnipper
- Brigham and Women's Hospital, Boston, MA, United States
- Harvard Medical School, Boston, MA, United States
| | - Anuj K Dalal
- Brigham and Women's Hospital, Boston, MA, United States
- Harvard Medical School, Boston, MA, United States
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24
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Kelly MM, Thurber AS, Coller RJ, Khan A, Dean SM, Smith W, Hoonakker PLT. Parent Perceptions of Real-time Access to Their Hospitalized Child's Medical Records Using an Inpatient Portal: A Qualitative Study. Hosp Pediatr 2020; 9:273-280. [PMID: 30894398 DOI: 10.1542/hpeds.2018-0166] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
BACKGROUND AND OBJECTIVES Engaging with parents in care improves pediatric care quality and patient safety; however, parents of hospitalized children often lack the information necessary to effectively participate. To enhance engagement, some hospitals now provide parents with real-time online access to information from their child's inpatient medical record during hospitalization. Whether these "inpatient portals" provide benefits for parents of hospitalized children is unknown. Our objectives were to identify why parents used an inpatient portal application on a tablet computer during their child's hospitalization and identify their perspectives of ways to optimize the technology. METHODS Semistructured in-person interviews were conducted with 14 parents who were given a tablet computer with a commercially available inpatient portal application for use throughout their child's hospitalization. The portal included vital signs, diagnoses, medications, laboratory test results, patients' schedule, messaging, education, and provider pictures and/or roles. Interviews were audio recorded and transcribed and continued until reaching thematic saturation. Three researchers used an inductive approach to identify emergent themes regarding why parents used the portal. RESULTS Five themes emerged regarding parent motivations for accessing information within the portal: (1) monitoring progress, (2) feeling empowered and/or relying less on staff, (3) facilitating rounding communication and/or decision-making, (4) ensuring information accuracy and/or providing reassurance, and (5) aiding memory. Parents recommended that the hospital continue to offer the portal and expand it to allow parents to answer admission questions, provide feedback, and access doctors' daily notes. CONCLUSIONS Providing parents with real-time clinical information during their child's hospitalization using an inpatient portal may enhance their ability to engage in caregiving tasks critical to ensuring inpatient care quality and safety.
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Affiliation(s)
- Michelle M Kelly
- Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin; .,Center for Quality and Productivity Improvement, University of Wisconsin-Madison, Madison, Wisconsin
| | - Anne S Thurber
- Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - Ryan J Coller
- Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - Alisa Khan
- Division of General Pediatrics, Boston Children's Hospital, Boston, Massachusetts.,Department of Pediatrics, Harvard Medical School, Boston, Massachusetts; and
| | - Shannon M Dean
- Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin.,University of Wisconsin Health, Madison, Wisconsin
| | - Windy Smith
- University of Wisconsin Health, Madison, Wisconsin
| | - Peter L T Hoonakker
- Center for Quality and Productivity Improvement, University of Wisconsin-Madison, Madison, Wisconsin
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25
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Abid MH, Abid MM, Surani S, Ratnani I. Patient Engagement and Patient Safety: Are We Missing the Patient in the Center? Cureus 2020; 12:e7048. [PMID: 32219044 PMCID: PMC7086117 DOI: 10.7759/cureus.7048] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Abstract
The global healthcare delivery paradigm shift calls for enhanced strategies to engage patients in delivering safer and high-quality healthcare. There still exists a gap area in a globally accepted measure for the person-centered care. Recent tri-institutional global quality reports from National Academies of Sciences, Engineering, and Medicine (NAESM), World Bank Group, and Lancet Global Health Commission attempted to report the patient engagement measures used globally. We aim to understand the variation in these globally reported patient-centered care measures and highlight the recent proactive strategies to enhance patient engagement to improve patient safety. I.
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Affiliation(s)
| | | | - Salim Surani
- Internal Medicine, Texas A&M Health Science Center, Bryan, USA.,Internal Medicine, Corpus Christi Medical Center, Corpus Christi, USA.,Internal Medicine, University of North Texas, Dallas, USA
| | - Iqbal Ratnani
- Internal Medicine, Weil Cornell College of Medicine, Houston, USA
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27
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Lippke S, Wienert J, Keller FM, Derksen C, Welp A, Kötting L, Hofreuter-Gätgens K, Müller H, Louwen F, Weigand M, Ernst K, Kraft K, Reister F, Polasik A, Huener nee Seemann B, Jennewein L, Scholz C, Hannawa A. Communication and patient safety in gynecology and obstetrics - study protocol of an intervention study. BMC Health Serv Res 2019; 19:908. [PMID: 31779620 PMCID: PMC6883614 DOI: 10.1186/s12913-019-4579-y] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2019] [Accepted: 10/09/2019] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Patient safety is a key target in public health, health services and medicine. Communication between all parties involved in gynecology and obstetrics (clinical staff/professionals, expectant mothers/patients and their partners, close relatives or friends providing social support) should be improved to ensure patient safety, including the avoidance of preventable adverse events (pAEs). Therefore, interventions including an app will be developed in this project through a participatory approach integrating two theoretical models. The interventions will be designed to support participants in their communication with each other and to overcome difficulties in everyday hospital life. The aim is to foster effective communication in order to reduce the frequency of pAEs. If communication is improved, clinical staff should show an increase in work satisfaction and patients should show an increase in patient satisfaction. METHODS The study will take place in two maternity clinics in Germany. In line with previous studies of complex interventions, it is divided into three interdependent phases. Each phase provides its own methods and data. Phase 1: Needs assessment and a training for staff (n = 140) tested in a pre-experimental study with a pre/post-design. Phase 2: Assessment of communication training for patients and their social support providers (n = 423) in a randomized controlled study. Phase 3: Assessment of an app supporting the communication between staff, patients, and their social support providers (n = 423) in a case-control study. The primary outcome is improvement of communication competencies. A range of other implementation outcomes will also be assessed (i.e. pAEs, patient/treatment satisfaction, work satisfaction, safety culture, training-related outcomes). DISCUSSION This is the first large intervention study on communication and patient safety in gynecology and obstetrics integrating two theoretical models that have not been applied to this setting. It is expected that the interventions, including the app, will improve communication practice which is linked to a lower probability of pAEs. The app will offer an effective and inexpensive way to promote effective communication independent of users' motivation. Insights gained from this study can inform other patient safety interventions and health policy developments. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT03855735; date of registration: February 27, 2019.
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Affiliation(s)
- Sonia Lippke
- Jacobs University Bremen gGmbH, Germany Campus Ring 1, 28759 Bremen, Germany
| | - Julian Wienert
- Jacobs University Bremen gGmbH, Germany Campus Ring 1, 28759 Bremen, Germany
| | | | - Christina Derksen
- Jacobs University Bremen gGmbH, Germany Campus Ring 1, 28759 Bremen, Germany
| | - Annalena Welp
- Jacobs University Bremen gGmbH, Germany Campus Ring 1, 28759 Bremen, Germany
| | - Lukas Kötting
- Jacobs University Bremen gGmbH, Germany Campus Ring 1, 28759 Bremen, Germany
| | - Kerstin Hofreuter-Gätgens
- Die Techniker; Unternehmenszentrale, Fachbereich Versorgungsmanagement, Bramfelder Str. 140, 22305 Hamburg, Germany
| | - Hardy Müller
- Die Techniker; Unternehmenszentrale, Fachbereich Versorgungsmanagement, Bramfelder Str. 140, 22305 Hamburg, Germany
- Aktionsbündnis Patientensicherheit, Am Zirkus 2, 10117 Berlin, Germany
| | - Frank Louwen
- Klinik für Frauenheilkunde und Geburtshilfe, Universitätsklinikum Frankfurt Goethe-Universität, Theodor-Stern-Kai 7, 60596 Frankfurt am Main, Germany
| | - Marcel Weigand
- Aktionsbündnis Patientensicherheit, Am Zirkus 2, 10117 Berlin, Germany
| | - Kristina Ernst
- Universitätsklinikum Ulm, Prittwitzstr. 43, 89075 Ulm, Germany
| | - Katrina Kraft
- Universitätsklinikum Ulm, Prittwitzstr. 43, 89075 Ulm, Germany
| | - Frank Reister
- Universitätsklinikum Ulm, Albert-Einstein-Allee 23, 89070 Ulm, Germany
| | - Arkadius Polasik
- Universitätsklinikum Ulm, Albert-Einstein-Allee 23, 89070 Ulm, Germany
| | | | - Lukas Jennewein
- Klinik für Frauenheilkunde und Geburtshilfe, Universitätsklinikum Frankfurt Goethe-Universität, Theodor-Stern-Kai 7, 60596 Frankfurt am Main, Germany
| | - Christoph Scholz
- Universitätsklinikum Ulm, Albert-Einstein-Allee 23, 89070 Ulm, Germany
| | - Annegret Hannawa
- Center for the Advancement of Healthcare Quality and Patient Safety (CAHQS), Faculty of CommunicationSciences, Università della Svizzera Italiana, Lugano, Switzerland
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Patient and family engagement in communicating with electronic medical records in hospitals: A systematic review. Int J Med Inform 2019; 134:104036. [PMID: 31835159 DOI: 10.1016/j.ijmedinf.2019.104036] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2019] [Revised: 11/14/2019] [Accepted: 11/25/2019] [Indexed: 12/19/2022]
Abstract
BACKGROUND Use of electronic medical records (EMRs) in hospitals affects how individuals communicate with each other. OBJECTIVE To examine how EMRs mediate communication between inpatients, their families, and health professionals to support patient and family engagement in care. METHODS The following electronic bibliographic databases were searched for relevant studies: Association for Computing Machinery Digital Library, CINAHL, Medline, the Cochrane Central Register of Controlled Trials, PsycInfo, and EMBASE. RESULTS The search identified 850 papers, and of these, 32 met the inclusion criteria. Interactions with the EMR tended to be unidirectional in nature, where health professionals consulted with patients and families to update patient information. Engagement rarely extended to facilitating patient and family participation beyond consultation. There were few examples of patient and family partnership and shared leadership, mainly with secure messaging and use of the patient portal. Strategies that worked in facilitating active engagement involved patients and families employing creative means of gathering information and directing this information to health professionals. Use of such strategies were rare and involved the attributes of particular individuals, rather than considering the inherent culture of clinical settings. CONCLUSION Further research is urgently needed to examine possibilities of patient and family involvement in treatment modalities, and partnership and shared governance in using the EMR.
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Moheet AM, Livesay SL, Abdelhak T, Bleck TP, Human T, Karanjia N, Lamer-Rosen A, Medow J, Nyquist PA, Rosengart A, Smith W, Torbey MT, Chang CWJ. Standards for Neurologic Critical Care Units: A Statement for Healthcare Professionals from The Neurocritical Care Society. Neurocrit Care 2019; 29:145-160. [PMID: 30251072 DOI: 10.1007/s12028-018-0601-1] [Citation(s) in RCA: 49] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
Neurocritical care is a distinct subspecialty focusing on the optimal management of acutely ill patients with life-threatening neurologic and neurosurgical disease or with life-threatening neurologic manifestations of systemic disease. Care by expert healthcare providers to optimize neurologic recovery is necessary. Given the lack of an organizational framework and criteria for the development and maintenance of neurological critical care units (NCCUs), this document is put forth by the Neurocritical Care Society (NCS). Recommended organizational structure, personnel and processes necessary to develop a successful neurocritical care program are outlined. Methods: Under the direction of NCS Executive Leadership, a multidisciplinary writing group of NCS members was formed. After an iterative process, a framework was proposed and approved by members of the writing group. A draft was then written, which was reviewed by the NCS Quality Committee and NCS Guidelines Committee, members at large, and posted for public comment. Feedback was formally collated, reviewed and incorporated into the final document which was subsequently approved by the NCS Board of Directors.
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Affiliation(s)
| | | | | | | | | | | | | | - Joshua Medow
- School of Medicine and Public Health, University of Wisconsin, Madison, WI, USA
| | | | | | - Wade Smith
- University of California, San Francisco, San Francisco, CA, USA
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30
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Burns KEA, Misak C, Herridge M, Meade MO, Oczkowski S. Patient and Family Engagement in the ICU. Untapped Opportunities and Underrecognized Challenges. Am J Respir Crit Care Med 2019; 198:310-319. [PMID: 29624408 DOI: 10.1164/rccm.201710-2032ci] [Citation(s) in RCA: 61] [Impact Index Per Article: 12.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
The call for meaningful patient and family engagement in health care and research is gaining impetus. Healthcare institutions and research funding agencies increasingly encourage clinicians and researchers to work actively with patients and their families to advance clinical care and research. Engagement is increasingly mandated by healthcare organizations and is becoming a prerequisite for research funding. In this article, we review the rationale and the current state of patient and family engagement in patient care and research in the ICU. We identify opportunities to strengthen engagement in patient care by promoting greater patient and family involvement in care delivery and supporting their participation in shared decision-making. We also identify challenges related to patient willingness to engage, barriers to participation, participant risks, and participant expectations. To advance engagement, clinicians and researchers can develop the science behind engagement in the ICU context and demonstrate its impact on patient- and process-related outcomes. In addition, we provide practical guidance on how to engage, highlight features of successful engagement strategies, and identify areas for future research. At present, enormous opportunities remain to enhance engagement across the continuum of ICU care and research.
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Affiliation(s)
- Karen E A Burns
- 1 Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario, Canada.,2 Interdepartmental Division of Critical Care and.,3 Department of Clinical Epidemiology and Biostatistics and
| | - Cheryl Misak
- 4 Department of Philosophy, University of Toronto, Toronto, Ontario, Canada; and
| | - Margaret Herridge
- 1 Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario, Canada.,2 Interdepartmental Division of Critical Care and
| | - Maureen O Meade
- 3 Department of Clinical Epidemiology and Biostatistics and.,5 Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Simon Oczkowski
- 3 Department of Clinical Epidemiology and Biostatistics and.,5 Department of Medicine, McMaster University, Hamilton, Ontario, Canada
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Murray NM, Joshi AN, Kronfeld K, Hobbs K, Bernier E, Hirsch KG, Gold CA. A Standardized Checklist Improves the Transfer of Stroke Patients from the Neurocritical Care Unit to Hospital Ward. Neurohospitalist 2019; 10:100-108. [PMID: 32373272 DOI: 10.1177/1941874419873810] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Background and Purpose The transfer of patients with ischemic stroke from the intensive care unit (ICU) to noncritical care inpatient wards involves detailed information sharing between care teams. Our local transfer process was not standardized, leading to potential patient risk. We developed and evaluated an "ICU Transfer Checklist" to standardize communication between the neurocritical care team and the stroke ward team. Methods Retrospective review of consecutive patients with ischemic stroke admitted to the neurocritical care unit who were transferred to the stroke ward was used to characterize transfer documentation. A multidisciplinary team developed and implemented an ICU Transfer Checklist that contained a synthesis of the patient's clinical course, immediate "to-do" action items, and a system-based review of active medical problems. Postintervention checklist utilization was recorded for 8 months, and quality metrics for the postintervention cohort were compared to the preintervention cohort. Providers were surveyed pre- and postintervention to characterize perceived workflow and quality of care. Results Patients before (n = 52) and after (n = 81) ICU Transfer Checklist implementation had similar demographic and clinical characteristics. In the postchecklist implementation period, the ICU Transfer Checklist was used in over 85% of patients and median hospital length of stay (LOS) decreased (8.6 days vs 5.4 days, P = .003), while ICU readmission rate remained low. The checklist was associated with improved perceptions of safety and decreased time needed to transfer patients. Conclusions Use of the standardized ICU Transfer Checklist was associated with decreased hospital LOS and with improvements in providers' perceptions of patient safety.
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Affiliation(s)
- Nick M Murray
- Department of Neurology & Neurological Sciences, Stanford University, CA, USA
| | - Aditya N Joshi
- Department of Neurology & Neurological Sciences, Stanford University, CA, USA
| | - Kassi Kronfeld
- Department of Neurology & Neurological Sciences, Stanford University, CA, USA
| | - Kyle Hobbs
- Department of Neurology, Wake Forest University, Medical Center Boulevard, Winston-Salem, NC, USA
| | - Eric Bernier
- Department of Neurology & Neurological Sciences, Stanford University, CA, USA
| | - Karen G Hirsch
- Department of Neurology & Neurological Sciences, Stanford University, CA, USA
| | - Carl A Gold
- Department of Neurology & Neurological Sciences, Stanford University, CA, USA
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Abstract
Communication errors during transitions of care are a leading source of adverse events for hospitalized patients. This article provides an overview of the role of communication errors in adverse events, describes the complexities of communication for hospitalized patients, and provides evidence regarding the positive effects of applying high-reliability principles to transitions of care and culture of safety. Elements of effective handoffs and a detailed approach for successful implementation of a handoff program are provided. The role of handoff communication in medical education at all levels, as well as for the interprofessional team, is discussed.
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Affiliation(s)
- Shilpa J Patel
- John A. Burns School of Medicine, Kapi`olani Medical Center for Women & Children, Hawaii Pacific Health, 1319 Punahou Street, 7th Floor, Honolulu, HI 96826, USA.
| | - Christopher P Landrigan
- Boston Children's Hospital, Brigham & Women's Hospital, Harvard Medical School, 300 Longwood Avenue, Enders 1, Boston, MA 02115, USA
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Schnock KO, Snyder JE, Fuller TE, Duckworth M, Grant M, Yoon C, Lipsitz S, Dalal AK, Bates DW, Dykes PC. Acute Care Patient Portal Intervention: Portal Use and Patient Activation. J Med Internet Res 2019; 21:e13336. [PMID: 31322123 PMCID: PMC6670280 DOI: 10.2196/13336] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2019] [Revised: 05/08/2019] [Accepted: 05/10/2019] [Indexed: 01/21/2023] Open
Abstract
Background Patient-facing health information technology (HIT) tools, such as patient portals, are recognized as a potential mechanism to facilitate patient engagement and patient-centered care, yet the use of these tools remains limited in the hospital setting. Although research in this area is growing, it is unclear how the use of acute care patient portals might affect outcomes, such as patient activation. Objective The aim of this study was to describe the use of an acute care patient portal and investigate its association with patient and care partner activation in the hospital setting. Methods We implemented an acute care patient portal on 6 acute care units over an 18-month period. We investigated the characteristics of the users (patients and their care partners) of the patient portal, as well as their use of the portal. This included the number of visits to each page, the number of days used, the length of the user’s access period, and the average percent of days used during the access period. Patient and care partner activation was assessed using the short form of the patient activation measure (PAM-13) and the caregiver patient activation measure (CG-PAM). Comparisons of the activation scores were performed using propensity weighting and robust weighted linear regression. Results Of the 2974 randomly sampled patients, 59.01% (1755/2974) agreed to use the acute care patient portal. Acute care patient portal enrollees were younger, less sick, less likely to have Medicare as their insurer, and more likely to use the Partners Healthcare enterprise ambulatory patient portal (Patient Gateway). The most used features of the acute care patient portal were the laboratory test results, care team information, and medication list. Most users accessed the portal between 1 to 4 days during their hospitalization, and the average number of days used (logged in at least once per day) was 1.8 days. On average, users accessed the portal 42.69% of the hospital days during which it was available. There was significant association with patient activation on the neurology service (P<.001) and medicine service (P=.01), after the introduction of HIT tools and the acute care patient portal, but not on the oncology service. Conclusions Portal users most often accessed the portal to view their clinical information, though portal usage was limited to only the first few days of enrollment. We found an association between the use of the portal and HIT tools with improved levels of patient activation. These tools may help facilitate patient engagement and improve outcomes when fully utilized by patients and care partners. Future study should leverage usage metrics to describe portal use and assess the impact of HIT tools on specific outcome measures in the hospital setting.
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Affiliation(s)
- Kumiko O Schnock
- Division of General Internal Medicine and Primary Care, Brigham and Women's Hospital, Boston, MA, United States.,Harvard Medical School, Boston, MA, United States
| | - Julia E Snyder
- Division of General Internal Medicine and Primary Care, Brigham and Women's Hospital, Boston, MA, United States
| | - Theresa E Fuller
- Division of General Internal Medicine and Primary Care, Brigham and Women's Hospital, Boston, MA, United States
| | - Megan Duckworth
- Division of General Internal Medicine and Primary Care, Brigham and Women's Hospital, Boston, MA, United States
| | - Maxwell Grant
- Division of General Internal Medicine and Primary Care, Brigham and Women's Hospital, Boston, MA, United States
| | - Catherine Yoon
- Division of General Internal Medicine and Primary Care, Brigham and Women's Hospital, Boston, MA, United States
| | - Stuart Lipsitz
- Division of General Internal Medicine and Primary Care, Brigham and Women's Hospital, Boston, MA, United States.,Harvard Medical School, Boston, MA, United States
| | - Anuj K Dalal
- Division of General Internal Medicine and Primary Care, Brigham and Women's Hospital, Boston, MA, United States.,Harvard Medical School, Boston, MA, United States
| | - David W Bates
- Division of General Internal Medicine and Primary Care, Brigham and Women's Hospital, Boston, MA, United States.,Harvard Medical School, Boston, MA, United States
| | - Patricia C Dykes
- Division of General Internal Medicine and Primary Care, Brigham and Women's Hospital, Boston, MA, United States.,Harvard Medical School, Boston, MA, United States
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Goodridge D, McDonald M, New L, Scharf M, Harrison E, Rotter T, Watson E, Henry C, Penz ED. Building patient capacity to participate in care during hospitalisation: a scoping review. BMJ Open 2019; 9:e026551. [PMID: 31272973 PMCID: PMC6615828 DOI: 10.1136/bmjopen-2018-026551] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2018] [Revised: 06/07/2019] [Accepted: 06/13/2019] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVES To map the existing literature and describe interventions aimed at building the capacity of patients to participate in care during hospitalisation by: (1) describing and categorising the aspects of care targeted by these interventions and (2) identifying the behaviour change techniques (BCTs) used in these interventions. A patient representative participated in all aspects of this project. DESIGN Scoping review. DATA SOURCES MEDLINE, Embase and CINAHL (Inception -2017). STUDY SELECTION Studies reporting primary research studies on building the capacity of hospitalised adult patients to participate in care which described or included one or more structured or systematic interventions and described the outcomes for at least the key stakeholder group were included. DATA EXTRACTION Title and abstract screening and full text screening were conducted by pairs of trained reviewers. One reviewer extracted data, which were verified by a second reviewer. Interventions were classified according to seven aspects of care relevant to hospital settings. BCTs identified in the articles were assigned through consensus of three reviewers. RESULTS Database searches yielded a total 9899 articles, resulting in 87 articles that met the inclusion criteria. Interventions directed at building patient capacity to participate in care while hospitalised were categorised as those related to improving: patient safety (20.9%); care coordination (5.7%); effective treatment (5.7%) and/or patient-centred care using: bedside nursing handovers (5.7%); communication (29.1%); care planning (14%) or the care environment (19.8%). The majority of studies reported one or more positive outcomes from the defined intervention. Adding new elements (objects) to the environment and restructuring the social and/or physical environment were the most frequently identified BCTs. CONCLUSIONS The majority of studies to build capacity for participation in care report one or more positive outcomes, although a more comprehensive analysis is warranted.
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Affiliation(s)
- Donna Goodridge
- Department of Medicine, College of Medicine, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Meghan McDonald
- School of Nursing, Saskatchewan Polytechnic, Saskatoon, Saskatchewan, Canada
| | - Lucia New
- School of Nursing, Saskatchewan Polytechnic, Saskatoon, Saskatchewan, Canada
| | - Murray Scharf
- College of Education, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Elizabeth Harrison
- School of Rehabilitation Science, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Thomas Rotter
- Healthcare Quality Programs, Queen’s University, Kingston, Ontario, Canada
| | - Erin Watson
- Leslie and Irene Dube Health Sciences Library, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Chrysanthus Henry
- Department of Community Health and Epidemiology, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Erika D Penz
- Medicine, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
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Álvarez-Maldonado P, Reding-Bernal A, Hernández-Solís A, Cicero-Sabido R. Impact of strategic planning, organizational culture imprint and care bundles to reduce adverse events in the ICU. Int J Qual Health Care 2019; 31:480-484. [PMID: 30256944 DOI: 10.1093/intqhc/mzy198] [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: 03/19/2018] [Revised: 06/26/2018] [Accepted: 09/04/2018] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE To evaluate the occurrence of adverse events during a multifaceted program implementation. DESIGN Cross-sectional secondary analysis. SETTING The respiratory-ICU of a large tertiary care center. PARTICIPANTS Retrospectively collected data of patients admitted from 1 March 2010 to 28 February 2014 (usual care period) and from 1 March 2014 to 1 March 2017 (multifaceted program period) were used. INTERVENTIONS The program integrated three components: (1) strategic planning and organizational culture imprint; (2) training and practice and (3) implementation of care bundles. Strategic planning redefined the respiratory-ICU Mission and Vision, its SWOT matrix (strengths, weaknesses, opportunities, threats) as well as its medium to long-term aims and planned actions. A 'Wear the Institution's T-shirt' monthly conference was given in order to foster organizational culture in healthcare personnel. Training was conducted on hand hygiene and projects 'Pneumonia Zero' and 'Bacteremia Zero'. Finally, actions of both projects were implemented. MAIN OUTCOME MEASURES Rates of adverse events (episodes per 1000 patient/days). RESULTS Out of 1662 patients (usual care, n = 981; multifaceted program, n = 681) there was a statistically significant reduction during the multifaceted program in episodes of accidental extubation ([Rate ratio, 95% CI] 0.31, 0.17-0.55), pneumothorax (0.48, 0.26-0.87), change of endotracheal tube (0.17, 0.07-0.44), atelectasis (0.37, 0.20-0.68) and death in the ICU (0.82, 0.69-0.97). CONCLUSIONS A multifaceted program including strategic planning, organizational culture imprint and care protocols was associated with a significant reduction of adverse events in the respiratory-ICU.
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Affiliation(s)
- Pablo Álvarez-Maldonado
- Division of Pulmonology and Thoracic Surgery, General Hospital of Mexico, c/Dr. Balmis 148, Colonia Doctores, Delegación Cuauhtémoc, CP, Mexico City, Mexico
| | - Arturo Reding-Bernal
- Research Division, General Hospital of Mexico, c/Dr. Balmis 148, Colonia Doctores, Delegación Cuauhtémoc, CP, Mexico City, Mexico
| | - Alejandro Hernández-Solís
- Division of Pulmonology and Thoracic Surgery, General Hospital of Mexico, c/Dr. Balmis 148, Colonia Doctores, Delegación Cuauhtémoc, CP, Mexico City, Mexico
| | - Raúl Cicero-Sabido
- Division of Pulmonology and Thoracic Surgery, General Hospital of Mexico, c/Dr. Balmis 148, Colonia Doctores, Delegación Cuauhtémoc, CP, Mexico City, Mexico.,Faculty of Medicine, National Autonomous University of Mexico, Av. Universidad 3000, Copilco, Cd. Universitaria, CP 04510 Coyoacán, Mexico City, Mexico
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Inpatients Sign On: An Opportunity to Engage Hospitalized Patients and Caregivers Using Inpatient Portals. Med Care 2019; 57:98-100. [PMID: 30520834 DOI: 10.1097/mlr.0000000000001043] [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
BACKGROUND Inpatient portals are online patient portals linked to electronic health records that provide hospitalized patients and caregivers secure access to real-time clinical information and tools to enhance their communication with providers and hospital experience. OBJECTIVE The main objective of this commentary was to provide a perspective that inpatient portals are innovative tools poised to engage patients and caregivers during hospitalization and, thus, enhance patient-centered care. RESULTS Inpatient portals are desired by patients and caregivers and may contribute to improved recognition of their inpatient care team, knowledge of their treatment plan and overall inpatient experience. A sociotechnical systems approach is recommended to mitigate potential unintended consequences of inpatient portal use and support effective portal design, implementation and evaluation. CONCLUSIONS This article highlights the potential of using inpatient portals to engage hospitalized patients and caregivers and proposes next steps to evaluate this emerging technology.
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Improving Medical ICU Outcomes: Promoting Respect and Ongoing Safety Through Patient Engagement Communication and Technology Study. Crit Care Med 2019; 45:1424-1425. [PMID: 28708689 DOI: 10.1097/ccm.0000000000002486] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Bergman L, Pettersson M, Chaboyer W, Carlström E, Ringdal M. Improving quality and safety during intrahospital transport of critically ill patients: A critical incident study. Aust Crit Care 2019; 33:12-19. [PMID: 30674422 DOI: 10.1016/j.aucc.2018.12.003] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2018] [Revised: 11/29/2018] [Accepted: 12/11/2018] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Intrahospital transport is a high-risk procedure for critically ill patients, yet there is little known about how the transport team manages critical incidents that occur. OBJECTIVES The aim of this study was to explore critical care nurses' and physicians' experiences and practices associated with critical incidents during the transfer process in critically ill patients. METHODS As a part of an ethnographic study, semistructured interviews were performed using the critical incident technique. Data were collected in two intensive care units at one university hospital in a Swedish metropolitan city. Critical care nurses (n = 15) and physicians (n = 5) were interviewed, together describing a total of 46 critical incidents. Data were analysed using qualitative content and thematic analysis approaches. RESULTS Content analysis of nurses' and physicians' practices resulted in a description of requirements for safe transports, including organisational prerequisites, professional skills and attributes, as well as actions and behaviours of safely performing transfers. Exploring the experiences of nurses and physicians in transporting critically ill patients yielded three main themes. The first theme, a hazardous process, revealed how caring for critically ill patients during intrahospital transfers was perceived as an unsafe, demanding task that presents several threats to the patient's safety. However, despite worries and concerns, participants trusted their own abilities to handle unexpected events, resulting in the second theme, performing when it matters. The third theme, towards safe practice, captured suggestions for improvement and attitudes towards existing safety hazards. CONCLUSIONS To prevent and manage critical incidents during intrahospital transport, findings of this study suggest that nontechnical skills such as situational awareness and teamwork are essential. In addition, the team must possess the requisite technical skills and knowledge to undertake transports. Finally, organisations are required to provide a supportive and sustainable transport environment that includes fewer transport-related hazards.
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Affiliation(s)
- Lina Bergman
- Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, PO Box 457, SE-405 30, Gothenburg, Sweden.
| | - Monica Pettersson
- Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, PO Box 457, SE-405 30, Gothenburg, Sweden; Vascular Department, Sahlgrenska University Hospital, SE-413 45, Gothenburg, Sweden.
| | - Wendy Chaboyer
- Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, PO Box 457, SE-405 30, Gothenburg, Sweden; Menzies Health Institute Queensland, G40 Griffith Health Centre, Level 8.86, Gold Coast Campus, Griffith University, QLD 4222, Australia.
| | - Eric Carlström
- Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, PO Box 457, SE-405 30, Gothenburg, Sweden; University of Southeast Norway, Vestfold, Postbox 235, 3603 Kongsberg, Norway.
| | - Mona Ringdal
- Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, PO Box 457, SE-405 30, Gothenburg, Sweden; Department of Anaesthesiology and Intensive Care, Kungälvs Hospital, SE-442 83, Kungälv, Sweden.
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Khan A, Spector ND, Baird JD, Ashland M, Starmer AJ, Rosenbluth G, Garcia BM, Litterer KP, Rogers JE, Dalal AK, Lipsitz S, Yoon CS, Zigmont KR, Guiot A, O'Toole JK, Patel A, Bismilla Z, Coffey M, Langrish K, Blankenburg RL, Destino LA, Everhart JL, Good BP, Kocolas I, Srivastava R, Calaman S, Cray S, Kuzma N, Lewis K, Thompson ED, Hepps JH, Lopreiato JO, Yu CE, Haskell H, Kruvand E, Micalizzi DA, Alvarado-Little W, Dreyer BP, Yin HS, Subramony A, Patel SJ, Sectish TC, West DC, Landrigan CP. Patient safety after implementation of a coproduced family centered communication programme: multicenter before and after intervention study. BMJ 2018; 363:k4764. [PMID: 30518517 PMCID: PMC6278585 DOI: 10.1136/bmj.k4764] [Citation(s) in RCA: 116] [Impact Index Per Article: 19.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To determine whether medical errors, family experience, and communication processes improved after implementation of an intervention to standardize the structure of healthcare provider-family communication on family centered rounds. DESIGN Prospective, multicenter before and after intervention study. SETTING Pediatric inpatient units in seven North American hospitals, 17 December 2014 to 3 January 2017. PARTICIPANTS All patients admitted to study units (3106 admissions, 13171 patient days); 2148 parents or caregivers, 435 nurses, 203 medical students, and 586 residents. INTERVENTION Families, nurses, and physicians coproduced an intervention to standardize healthcare provider-family communication on ward rounds ("family centered rounds"), which included structured, high reliability communication on bedside rounds emphasizing health literacy, family engagement, and bidirectional communication; structured, written real-time summaries of rounds; a formal training programme for healthcare providers; and strategies to support teamwork, implementation, and process improvement. MAIN OUTCOME MEASURES Medical errors (primary outcome), including harmful errors (preventable adverse events) and non-harmful errors, modeled using Poisson regression and generalized estimating equations clustered by site; family experience; and communication processes (eg, family engagement on rounds). Errors were measured via an established systematic surveillance methodology including family safety reporting. RESULTS The overall rate of medical errors (per 1000 patient days) was unchanged (41.2 (95% confidence interval 31.2 to 54.5) pre-intervention v 35.8 (26.9 to 47.7) post-intervention, P=0.21), but harmful errors (preventable adverse events) decreased by 37.9% (20.7 (15.3 to 28.1) v 12.9 (8.9 to 18.6), P=0.01) post-intervention. Non-preventable adverse events also decreased (12.6 (8.9 to 17.9) v 5.2 (3.1 to 8.8), P=0.003). Top box (eg, "excellent") ratings for six of 25 components of family reported experience improved; none worsened. Family centered rounds occurred more frequently (72.2% (53.5% to 85.4%) v 82.8% (64.9% to 92.6%), P=0.02). Family engagement 55.6% (32.9% to 76.2%) v 66.7% (43.0% to 84.1%), P=0.04) and nurse engagement (20.4% (7.0% to 46.6%) v 35.5% (17.0% to 59.6%), P=0.03) on rounds improved. Families expressing concerns at the start of rounds (18.2% (5.6% to 45.3%) v 37.7% (17.6% to 63.3%), P=0.03) and reading back plans (4.7% (0.7% to 25.2%) v 26.5% (12.7% to 7.3%), P=0.02) increased. Trainee teaching and the duration of rounds did not change significantly. CONCLUSIONS Although overall errors were unchanged, harmful medical errors decreased and family experience and communication processes improved after implementation of a structured communication intervention for family centered rounds coproduced by families, nurses, and physicians. Family centered care processes may improve safety and quality of care without negatively impacting teaching or duration of rounds. TRIAL REGISTRATION ClinicalTrials.gov NCT02320175.
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Affiliation(s)
- Alisa Khan
- Harvard Medical School, Boston, MA, USA
- Department of Medicine and Division of General Pediatrics, Boston Children's Hospital, Boston, MA, USA
| | - Nancy D Spector
- Drexel University College of Medicine, Philadelphia, PA, USA
- Department of Pediatrics, St Christopher's Hospital for Children, Philadelphia, PA, USA
| | - Jennifer D Baird
- Institute for Nursing and Interprofessional Research, Children's Hospital Los Angeles, Los Angeles, CA, USA
| | - Michele Ashland
- Family-Centered Care Department, Lucile Packard Children's Hospital Stanford, Palo Alto, CA, USA
| | - Amy J Starmer
- Harvard Medical School, Boston, MA, USA
- Department of Medicine and Division of General Pediatrics, Boston Children's Hospital, Boston, MA, USA
| | - Glenn Rosenbluth
- University of California San Francisco School of Medicine, San Francisco, CA, USA
- Department of Pediatrics, Benioff Children's Hospital, San Francisco, CA, USA
| | - Briana M Garcia
- University of California San Francisco School of Medicine, San Francisco, CA, USA
- Department of Medicine and Division of General Pediatrics, Boston Children's Hospital, Boston, MA, USA
| | | | - Jayne E Rogers
- Inpatient Medicine, Boston Children's Hospital, Boston, MA, USA
| | - Anuj K Dalal
- Harvard Medical School, Boston, MA, USA
- Center for Patient Safety Research, Division of General Medicine, Department of Medicine at Brigham and Women's Hospital, Boston, MA, USA
| | - Stuart Lipsitz
- Harvard Medical School, Boston, MA, USA
- Center for Patient Safety Research, Division of General Medicine, Department of Medicine at Brigham and Women's Hospital, Boston, MA, USA
| | - Catherine S Yoon
- Center for Patient Safety Research, Division of General Medicine, Department of Medicine at Brigham and Women's Hospital, Boston, MA, USA
| | - Katherine R Zigmont
- Center for Patient Safety Research, Division of General Medicine, Department of Medicine at Brigham and Women's Hospital, Boston, MA, USA
| | - Amy Guiot
- University of Cincinnati College of Medicine, Cincinnati, OH, USA
- Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Jennifer K O'Toole
- University of Cincinnati College of Medicine, Cincinnati, OH, USA
- Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Aarti Patel
- University of California San Diego School of Medicine, San Diego, CA, USA
- Division of Pediatric Hospital Medicine, Rady Children's Hospital San Diego, San Diego, CA, USA
| | - Zia Bismilla
- Pediatrics, University of Toronto, Toronto, ON, Canada
- Department of Pediatrics, Hospital for Sick Children, Toronto, ON, Canada
| | - Maitreya Coffey
- Pediatrics, University of Toronto, Toronto, ON, Canada
- Department of Pediatrics, Hospital for Sick Children, Toronto, ON, Canada
| | - Kate Langrish
- Faculty of Nursing, University of Toronto, Toronto, ON, Canada
- Division of Pediatric Hospital Medicine, Hospital for Sick Children, Toronto, ON, Canada
| | - Rebecca L Blankenburg
- Stanford School of Medicine, Palo Alto, CA, USA
- Lucile Packard Children's Hospital Stanford, Palo Alto, CA, USA
| | - Lauren A Destino
- Stanford School of Medicine, Palo Alto, CA, USA
- Lucile Packard Children's Hospital Stanford, Palo Alto, CA, USA
| | - Jennifer L Everhart
- Stanford School of Medicine, Palo Alto, CA, USA
- Lucile Packard Children's Hospital Stanford, Palo Alto, CA, USA
| | - Brian P Good
- University of Utah School of Medicine, Salt Lake City, UT, USA
- Department of Pediatrics, Primary Children's Hospital, Salt Lake City, UT, USA
| | - Irene Kocolas
- University of Utah School of Medicine, Salt Lake City, UT, USA
- Department of Pediatrics, Primary Children's Hospital, Salt Lake City, UT, USA
| | - Rajendu Srivastava
- University of Utah School of Medicine, Salt Lake City, UT, USA
- Department of Pediatrics, Primary Children's Hospital, Salt Lake City, UT, USA
| | - Sharon Calaman
- Drexel University College of Medicine, Philadelphia, PA, USA
- Department of Pediatrics, St Christopher's Hospital for Children, Philadelphia, PA, USA
| | - Sharon Cray
- Family Advisory Council, St Christopher's Hospital for Children, Philadelphia, PA, USA
| | - Nicholas Kuzma
- Drexel University College of Medicine, Philadelphia, PA, USA
- Department of Pediatrics, St Christopher's Hospital for Children, Philadelphia, PA, USA
| | - Kheyandra Lewis
- Drexel University College of Medicine, Philadelphia, PA, USA
- Department of Pediatrics, St Christopher's Hospital for Children, Philadelphia, PA, USA
| | - E Douglas Thompson
- Drexel University College of Medicine, Philadelphia, PA, USA
- Department of Pediatrics, St Christopher's Hospital for Children, Philadelphia, PA, USA
| | - Jennifer H Hepps
- Uniformed Services University of the Health Sciences, Walter Reed National Military Medical Center, Bethesda, MD, USA
- Walter Reed National Military Medical Center, Bethesda, MD, USA
| | - Joseph O Lopreiato
- Uniformed Services University of the Health Sciences, Walter Reed National Military Medical Center, Bethesda, MD, USA
| | - Clifton E Yu
- Uniformed Services University of the Health Sciences, Walter Reed National Military Medical Center, Bethesda, MD, USA
- Walter Reed National Military Medical Center, Bethesda, MD, USA
| | | | - Elizabeth Kruvand
- Family Partner Program, St Louis Children's Hospital, St Louis, MO, USA
- St Louis Children's Hospital, St Louis, MO, USA
| | - Dale A Micalizzi
- The Justin's HOPE Project, Task Force for Global Health, Decatur, GA, USA
| | - Wilma Alvarado-Little
- New York State Department of Health, New York, NY, USA
- New York State Department of Health, New York, NY, USA
| | - Benard P Dreyer
- New York University School of Medicine, New York, NY, USA
- Division of Developmental-Behavioral Pediatrics, New York University Langone Medical Center, New York, NY, USA
| | - H Shonna Yin
- New York University School of Medicine, New York, NY, USA
- Departments of Pediatrics and Population Health at New York University Langone Medical Center, New York, NY, USA
| | - Anupama Subramony
- Cohen Children's Medical Center, New York, NY, USA
- Hofstra Northwell School of Medicine, Queens, NY, USA
| | - Shilpa J Patel
- University of Hawaii John A Burns School of Medicine, Honolulu, HI, USA
- Hawai'i Pacific Health, Honolulu, HI, USA
| | - Theodore C Sectish
- Harvard Medical School, Boston, MA, USA
- Department of Medicine and Division of General Pediatrics, Boston Children's Hospital, Boston, MA, USA
| | - Daniel C West
- University of California San Francisco School of Medicine, San Francisco, CA, USA
- Department of Pediatrics, Benioff Children's Hospital, San Francisco, CA, USA
| | - Christopher P Landrigan
- Harvard Medical School, Boston, MA, USA
- Department of Medicine and Division of General Pediatrics, Boston Children's Hospital, Boston, MA, USA
- Brigham and Women's Hospital, Boston, MA, USA
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Mishra SR, Haldar S, Khelifi M, Pollack AH, Wanda P. Must We Bust the Trust?: Understanding How the Clinician-Patient Relationship Influences Patient Engagement in Safety. AMIA ... ANNUAL SYMPOSIUM PROCEEDINGS. AMIA SYMPOSIUM 2018; 2018:1425-1434. [PMID: 30815187 PMCID: PMC6371248] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Although patients desire safe care, they are reluctant to perform safety-related behaviors when they worry it could harm the relationships they have with clinicians. This influence of the clinician-patient relationship on patient engagement in safety is poorly understood, and most patient-facing safety interventions ignore its influence, focusing instead on helping patients access information about their care and report errors. We conducted semi-structured interviews with hospitalized patients to uncover their needs for patient-facing information systems that could help them prevent medical errors. We found that the clinician-patient relationship could either encourage or discourage patients and caregivers from engaging in patient safety actions. We describe our findings and discuss the implications for the design of patient-facing interventions to promote patient engagement in safety. Our findings shed light on how patient-facing safety interventions can be designed to effectively engage patients and caregivers.
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Affiliation(s)
| | | | | | - Ari H Pollack
- University of Washington, Seattle, WA
- Seattle Children's Hospital, Seattle, WA
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Grossman LV, Masterson Creber RM, Ryan B, Restaino S, Alarcon I, Polubriaginof F, Bakken S, Vawdrey DK. Providers' Perspectives on Sharing Health Information through Acute Care Patient Portals. AMIA ... ANNUAL SYMPOSIUM PROCEEDINGS. AMIA SYMPOSIUM 2018; 2018:1273-1281. [PMID: 30815169 PMCID: PMC6371328] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Engaging healthcare providers in acute care patient portal implementation is critical to ensure productive use. However, few studies have assessed provider's perceptions of an acute care portal after implementation. In this study, we surveyed 63 nurses, physicians, and physician assistants following a 3-year randomized trial of an acute care portal. The survey assessed providers' perceptions of the portal and its impact on care delivery. Respondents reported that the portal positively impacted care, and they perceived that their patients found it usable and trustworthy. Respondents reported that all the portal's features were useful, especially the display of laboratory test results. Compared with the results of a patient survey, providers underestimated the portal's usefulness to patients, and ranked features as very useful significantly less often than patients (57% vs. 74%; p<0.001). Our study found that providers supported their patients' use of the portal, but may have underappreciated the portal's value to patients.
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Affiliation(s)
- Lisa V Grossman
- Department of Biomedical Informatics, Columbia University, New York, NY
- College of Physicians and Surgeons, Columbia University, New York, NY
| | | | - Beatriz Ryan
- Value Institute, NewYork-Presbyterian Hospital, New York, NY
| | - Susan Restaino
- Department of Medicine, Columbia University, New York, NY
| | - Irma Alarcon
- Department of Medicine, Columbia University, New York, NY
| | | | - Suzanne Bakken
- Department of Biomedical Informatics, Columbia University, New York, NY
- School of Nursing, Columbia University, New York, NY
| | - David K Vawdrey
- Department of Biomedical Informatics, Columbia University, New York, NY
- Value Institute, NewYork-Presbyterian Hospital, New York, NY
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Manias E. A patient-centred care and engagement program in intensive care reduces adverse events and improves patient and care partner satisfaction. Aust Crit Care 2018; 32:179-181. [PMID: 30471940 DOI: 10.1016/j.aucc.2018.10.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2018] [Accepted: 10/02/2018] [Indexed: 11/26/2022] Open
Affiliation(s)
- Elizabeth Manias
- Deakin University, School of Nursing and Midwifery, Centre for Quality and Patient Safety Research, 221 Burwood Highway, Burwood, 3125, Victoria, Australia.
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Son YJ, Lee SK, Nam S, Shim JL. Exploring Research Topics and Trends in Nursing-related Communication in Intensive Care Units Using Social Network Analysis. Comput Inform Nurs 2018; 36:383-392. [PMID: 29742551 DOI: 10.1097/cin.0000000000000444] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
This study used social network analysis to identify the main research topics and trends in nursing-related communication in intensive care units. Keywords from January 1967 to June 2016 were extracted from PubMed using Medical Subject Headings terms. Social network analysis was performed using Gephi software. Research publications and newly emerging topics in nursing-related communication in intensive care units were classified into five chronological phases. After the weighting was adjusted, the top five keyword searches were "conflict," "length of stay," "nursing continuing education," "family," and "nurses." During the most recent phase, research topics included "critical care nursing," "patient handoff," and "quality improvement." The keywords of the top three groups among the 10 groups identified were related to "neonatal nursing and practice guideline," "infant or pediatric and terminal care," and "family, aged, and nurse-patient relations," respectively. This study can promote a systematic understanding of communication in intensive care units by identifying topic networks. Future studies are needed to conduct large prospective cohort studies and randomized controlled trials to verify the effects of patient-centered communication in intensive care units on patient outcomes, such as length of hospital stay and mortality.
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Affiliation(s)
- Youn-Jung Son
- Author Affiliations: Red Cross College of Nursing, Chung-Ang University (Dr Son), Seoul; College of Nursing, Keimyung University (Dr Lee), Daegu; National Center of Excellence in Software, Chungnam National University (Dr Nam), Daejeon; and Department of Nursing, College of Medicine, Dongguk University (Dr Shim), Gyeongju-si, Gyeongsangbuk-do, Republic of Korea
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Mishra SR, Miller AD, Haldar S, Khelifi M, Eschler J, Elera RG, Pollack AH, Pratt W. Supporting Collaborative Health Tracking in the Hospital: Patients' Perspectives. PROCEEDINGS OF THE SIGCHI CONFERENCE ON HUMAN FACTORS IN COMPUTING SYSTEMS. CHI CONFERENCE 2018; 2018:650. [PMID: 29721554 PMCID: PMC5927606 DOI: 10.1145/3173574.3174224] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
The hospital setting creates a high-stakes environment where patients' lives depend on accurate tracking of health data. Despite recent work emphasizing the importance of patients' engagement in their own health care, less is known about how patients track their health and care in the hospital. Through interviews and design probes, we investigated hospitalized patients' tracking activity and analyzed our results using the stage-based personal informatics model. We used this model to understand how to support the tracking needs of hospitalized patients at each stage. In this paper, we discuss hospitalized patients' needs for collaboratively tracking their health with their care team. We suggest future extensions of the stage-based model to accommodate collaborative tracking situations, such as hospitals, where data is collected, analyzed, and acted on by multiple people. Our findings uncover new directions for HCI research and highlight ways to support patients in tracking their care and improving patient safety.
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Affiliation(s)
- Sonali R Mishra
- The Information School, University of Washington, Seattle, WA, USA
| | - Andrew D Miller
- Human Centered Computing Indiana University, IUPUI Indianapolis, IN, USA
| | - Shefali Haldar
- Biomedical & Health Informatics, University of Washington, Seattle, WA, USA
| | - Maher Khelifi
- Biomedical & Health Informatics, University of Washington, Seattle, WA, USA
| | - Jordan Eschler
- The Information School, University of Washington, Seattle, WA, USA
| | - Rashmi G Elera
- The Information School, University of Washington, Seattle, WA, USA
| | - Ari H Pollack
- Biomedical & Health Informatics, University of Washington, Seattle, WA, USA
- Department of Pediatrics, University of Washington, Seattle, WA, USA
- Division of Nephrology, Seattle Children's Hospital, Seattle, WA, USA
| | - Wanda Pratt
- The Information School, University of Washington, Seattle, WA, USA
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Visscher CM, Baad-Hansen L, Durham J, Goulet JP, Michelotti A, Roldán Barraza C, Häggman-Henrikson B, Ekberg E, Raphael KG. Benefits of implementing pain-related disability and psychological assessment in dental practice for patients with temporomandibular pain and other oral health conditions. J Am Dent Assoc 2018; 149:422-431. [PMID: 29653670 DOI: 10.1016/j.adaj.2017.12.031] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2017] [Revised: 12/15/2017] [Accepted: 12/20/2017] [Indexed: 10/17/2022]
Abstract
BACKGROUND Evidence in the field of dentistry has demonstrated the importance of pain-related disability and psychological assessment in the development of chronic symptoms. The Diagnostic Criteria for Temporomandibular Disorders offer a brief assessment for the diagnostic process in patients with orofacial pain (Axis II). The authors describe relevant outcomes that may guide general oral health care practitioners toward tailored treatment decisions and improved treatment outcomes and provide recommendations for the primary care setting. METHODS The authors conducted a review of the literature to provide an overview of knowledge about Axis II assessment relevant for the general oral health care practitioner. RESULTS The authors propose 3 domains of the Axis II assessment to be used in general oral health care: pain location (pain drawing), pain intensity and related disability (Graded Chronic Pain Scale [GCPS]), and psychological distress (Patient Health Questionnaire-4 [PHQ-4]). In the case of localized pain, low GCPS scores (0-II), and low PHQ-4 scores (0-5), patients preferably receive treatment in primary care. In the case of widespread pain, high GCPS scores (III-IV), and high PHQ-4 scores (6-12), the authors recommend referral to a multidisciplinary team, especially for patients with temporomandibular disorder (TMD) pain. CONCLUSIONS The authors recommend psychological assessment at first intake of a new adult patient or for patients with persistent TMD pain. The authors recommend the pain-related disability screening tools for all TMD pain symptoms and for dental pain symptoms that persist beyond the normal healing period. PRACTICAL IMPLICATIONS A brief psychological and pain-related disability assessment for patients in primary care may help the general oral health care practitioner make tailored treatment decisions.
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User-Centered Collaborative Design and Development of an Inpatient Safety Dashboard. Jt Comm J Qual Patient Saf 2017; 43:676-685. [PMID: 29173289 DOI: 10.1016/j.jcjq.2017.05.010] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2017] [Revised: 05/24/2017] [Accepted: 05/31/2017] [Indexed: 11/22/2022]
Abstract
Patient safety remains a key concern in hospital care. This article summarizes the iterative participatory development, features, functions, and preliminary evaluation of a patient safety dashboard for interdisciplinary rounding teams on inpatient medical services. This electronic health record (EHR)-embedded dashboard collects real-time data covering 13 safety domains through web services and applies logic to generate stratified alerts with an interactive check-box function. The technological infrastructure is adaptable to other EHR environments. Surveyed users perceived the tool as highly usable and useful. Integration of the dashboard into clinical care is intended to promote communication about patient safety and facilitate identification and management of safety concerns.
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