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Butler MJ, Arneil C, Whitelaw AS, Thomson K, Gordon MWG, Thorburn J, Shiels D, Lowe DJ. Implementation of major trauma app: usability and data completeness. BMC Emerg Med 2024; 24:136. [PMID: 39075337 PMCID: PMC11288075 DOI: 10.1186/s12873-024-01022-w] [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: 09/02/2023] [Accepted: 06/12/2024] [Indexed: 07/31/2024] Open
Abstract
BACKGROUND The current UK standard for major trauma patients is to record notes in a paper trauma booklet. Through an innovative collaboration between a major trauma centre and a digital transformation industry partner, a TraumaApp was developed. Electronic notes have been shown to have fewer errors, granular data collection and enable time stamped contemporaneous record keeping. Implementation of digital clinical records presents a challenge within the context of trauma multidisciplinary trauma resuscitation. Data can be easily accessible and shared for quality improvement, audit and research purposes. This study compared paper and electronic notes for completeness and for acceptability data following the implementation of the TraumaApp. METHODS Trauma team members who performed scribe function attended training for the newly launched TraumaApp. Two staff members acted as scribe, using either the paper trauma booklet or TraumaApp, and attended major trauma calls. A framework for comparison of paper and electronic notes was created and used for a retrospective review of major trauma patients' notes. Statistical analysis was performed using a two-tailed t-test. Staff using the TraumaApp completed a System Usability Score questionnaire. RESULTS There was a total of 37 data points for collection per case. The mean numbers collected were paper notes 24.1 of 37 (65.1%) and electronic notes, 25.7 of 37 (69.5%). There was no statistical significance between the completeness of paper and electronic notes. The mean System Usability Score was 68.4. DISCUSSION Recording accurate patient information during a major trauma call can be challenging and the role of the scribe to accurately record events is critical for immediate and future care. There was no statistically significant difference in completeness of paper and electronic notes, however the mean System Usability Score was 68.4, which is greater than the internationally validated standard of acceptable usability. CONCLUSION It is feasible to introduce digital data collection tools enabling accurate record keeping during trauma resuscitation and improve information sharing between clinicians.
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Affiliation(s)
- Miss Joanna Butler
- Emergency Department, Queen Elizabeth University Hospital, Glasgow, G52 4TF, UK
- Clyde Trauma and Orthopaedics, Royal Alexandra Hospital, Paisley, PA2 9PN, UK
| | - Clare Arneil
- Emergency Department, Queen Elizabeth University Hospital, Glasgow, G52 4TF, UK
| | - Alan S Whitelaw
- Emergency Department, Queen Elizabeth University Hospital, Glasgow, G52 4TF, UK
| | - Kevin Thomson
- Emergency Department, Queen Elizabeth University Hospital, Glasgow, G52 4TF, UK
| | - Malcolm W G Gordon
- Emergency Department, Queen Elizabeth University Hospital, Glasgow, G52 4TF, UK
| | - Josh Thorburn
- Emergency Department, Queen Elizabeth University Hospital, Glasgow, G52 4TF, UK
| | - Darren Shiels
- Emergency Department, Queen Elizabeth University Hospital, Glasgow, G52 4TF, UK
| | - David J Lowe
- Emergency Department, Queen Elizabeth University Hospital, Glasgow, G52 4TF, UK.
- School of Health and Wellbeing, University of Glasgow, Glasgow, G12 8RZ, UK.
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Tawfik M, Schiff E, Mosavian R, Campisi C, Shen A, Lin J, Windsor AM, Weingarten‐Arams J, Soshnick SH, Nishisaki A, Je S, Maa T, Harwayne‐Gidansky I, Fortunov RM, Yang CJ. Validation of a Novel Mobile Application for Assessing Pediatric Tracheostomy Emergency Simulations. OTO Open 2024; 8:e145. [PMID: 38974176 PMCID: PMC11222740 DOI: 10.1002/oto2.145] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2024] [Accepted: 04/27/2024] [Indexed: 07/09/2024] Open
Abstract
Objective Pediatric tracheostomy is associated with high morbidity and mortality, yet clinician knowledge and quality of tracheostomy care may vary widely. In situ simulation is effective at detecting and mitigating related latent safety threats, but evaluation via retrospective video review has disadvantages (eg, delayed analysis, and potential data loss). We evaluated whether a novel mobile application is accurate and reliable for assessment of in situ tracheostomy emergency simulations. Methods A novel mobile application was developed for assessment of tracheostomy emergency in situ simulation team performance. After 1.25 hours of training, 6 raters scored 10 tracheostomy emergency simulation videos for the occurrence and timing of 12 critical steps. To assess accuracy, rater scores were compared to a reference standard to determine agreement for occurrence or absence of critical steps and a timestamp within ±5 seconds. Interrater reliability was determined through Cohen's and Fleiss' kappa and intraclass correlation coefficient. Results Raters had 86.0% agreement with the reference standard when considering step occurrence and timing, and 92.8% agreement when considering only occurrence. The average timestamp difference from the reference standard was 1.3 ± 18.5 seconds. Overall interrater reliability was almost perfect for both step occurrence (Fleiss' kappa of 0.81) and timing of step (intraclass correlation coefficient of 0.99). Discussion Using our novel mobile application, raters with minimal training accurately and reliably assessed videos of tracheostomy emergency simulations and identified areas for future refinement. Implications for Practice With refinements, this innovative mobile application is an effective tool for real-time data capture of time-critical steps in in situ tracheostomy emergency simulations.
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Affiliation(s)
| | | | | | | | - Amanda Shen
- Albert Einstein College of MedicineBronxNew YorkUSA
| | - Juan Lin
- Albert Einstein College of MedicineBronxNew YorkUSA
| | - Alanna M. Windsor
- Albert Einstein College of MedicineBronxNew YorkUSA
- Department of Otorhinolaryngology–Head and Neck SurgeryMontefiore Medical CenterBronxNew YorkUSA
| | - Jacqueline Weingarten‐Arams
- Albert Einstein College of MedicineBronxNew YorkUSA
- Department of Pediatrics, Division of Pediatric Critical Care MedicineChildren's Hospital at MontefioreBronxNew YorkUSA
| | - Sara H. Soshnick
- Albert Einstein College of MedicineBronxNew YorkUSA
- Department of Pediatrics, Division of Pediatric Critical Care MedicineChildren's Hospital at MontefioreBronxNew YorkUSA
| | - Akira Nishisaki
- University of Pennsylvania Perelman School of MedicinePhiladelphiaPennsylvaniaUSA
- Department of Anesthesiology and Critical Care Medicine, Division of Pediatric Critical Care MedicineChildren's Hospital of PhiladelphiaPhiladelphiaPennsylvaniaUSA
| | - Sangmo Je
- Department of Anesthesiology and Critical Care Medicine, Division of Pediatric Critical Care MedicineChildren's Hospital of PhiladelphiaPhiladelphiaPennsylvaniaUSA
| | - Tensing Maa
- Ohio State University College of MedicineColumbusOhioUSA
- Department of Pediatrics, Division of Pediatric Critical Care MedicineNationwide Children's HospitalColumbusOhioUSA
| | - Ilana Harwayne‐Gidansky
- Department of Pediatrics, Division of Pediatric Critical Care Medicine, The Bernard & Millie Duker Children's HospitalAlbany Medical CenterAlbanyNew YorkUSA
- Albany Medical CollegeAlbanyNew YorkUSA
| | - Regine M. Fortunov
- Department of Pediatrics, Division of NeonatologyBaylor College of MedicineHoustonTexasUSA
- Texas Children's HospitalHoustonTexasUSA
| | - Christina J. Yang
- Albert Einstein College of MedicineBronxNew YorkUSA
- Department of Otorhinolaryngology–Head and Neck SurgeryMontefiore Medical CenterBronxNew YorkUSA
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Cheung K, Yip CS. Documentation Completeness and Nurses' Perceptions of a Novel Electronic App for Medical Resuscitation in the Emergency Room: Mixed Methods Approach. JMIR Mhealth Uhealth 2024; 12:e46744. [PMID: 38180801 PMCID: PMC10799286 DOI: 10.2196/46744] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Revised: 09/19/2023] [Accepted: 11/29/2023] [Indexed: 01/06/2024] Open
Abstract
BACKGROUND Complete documentation of critical care events in the accident and emergency department (AED) is essential. Due to the fast-paced and complex nature of resuscitation cases, missing data is a common issue during emergency situations. OBJECTIVE This study aimed to evaluate the impact of a tablet-based resuscitation record on documentation completeness during medical resuscitations and nurses' perceptions of the use of the tablet app. METHODS A mixed methods approach was adopted. To collect quantitative data, randomized retrospective reviews of paper-based resuscitation records before implementation of the tablet (Pre-App Paper; n=176), paper-based resuscitation records after implementation of the tablet (Post-App Paper; n=176), and electronic tablet-based resuscitation records (Post-App Electronic; n=176) using a documentation completeness checklist were conducted. The checklist was validated by 4 experts in the emergency medicine field. The content validity index (CVI) was calculated using the scale CVI (S-CVI). The universal agreement S-CVI was 0.822, and the average S-CVI was 0.939. The checklist consisted of the following 5 domains: basic information, vital signs, procedures, investigations, and medications. To collect qualitative data, nurses' perceptions of the app for electronic resuscitation documentation were obtained using individual interviews. Reporting of the qualitative data was guided by Consolidated Criteria for Reporting Qualitative Studies (COREQ) to enhance rigor. RESULTS A significantly higher documentation rate in all 5 domains (ie, basic information, vital signs, procedures, investigations, and medications) was present with Post-App Electronic than with Post-App Paper, but there were no significant differences in the 5 domains between Pre-App Paper and Post-App Paper. The qualitative analysis resulted in main categories of "advantages of tablet-based documentation of resuscitation records," "challenges with tablet-based documentation of resuscitation records," and "areas for improvement of tablet-based resuscitation records." CONCLUSIONS This study demonstrated that higher documentation completion rates are achieved with electronic tablet-based resuscitation records than with traditional paper records. During the transition period, the nurse documenters faced general problems with resuscitation documentation such as multitasking and unique challenges such as software updates and a need to familiarize themselves with the app's layout. Automation should be considered during future app development to improve documentation and redistribute more time for patient care. Nurses should continue to provide feedback on the app's usability and functionality during app refinement to ensure a successful transition and future development of electronic documentation records.
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Affiliation(s)
- Kin Cheung
- School of Nursing, The Hong Kong Polytechnic University, Hong Kong, China (Hong Kong)
| | - Chak Sum Yip
- Accident and Emergency Department, Tuen Mun Hospital, Hong Kong, China (Hong Kong)
- Quality & Safety Office, The Hong Kong Children's Hospital, Hong Kong, China (Hong Kong)
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4
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Mastrianni A, Sarcevic A, Hu A, Almengor L, Tempel P, Gao S, Burd RS. Transitioning Cognitive Aids into Decision Support Platforms: Requirements and Design Guidelines. ACM TRANSACTIONS ON COMPUTER-HUMAN INTERACTION : A PUBLICATION OF THE ASSOCIATION FOR COMPUTING MACHINERY 2023; 30:41. [PMID: 37694216 PMCID: PMC10489246 DOI: 10.1145/3582431] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Accepted: 12/16/2022] [Indexed: 09/12/2023]
Abstract
Digital cognitive aids have the potential to serve as clinical decision support platforms, triggering alerts about process delays and recommending interventions. In this mixed-methods study, we examined how a digital checklist for pediatric trauma resuscitation could trigger decision support alerts and recommendations. We identified two criteria that cognitive aids must satisfy to support these alerts: (1) context information must be entered in a timely, accurate, and standardized manner, and (2) task status must be accurately documented. Using co-design sessions and near-live simulations, we created two checklist features to satisfy these criteria: a form for entering the pre-hospital information and a progress slider for documenting the progression of a multi-step task. We evaluated these two features in the wild, contributing guidelines for designing these features on cognitive aids to support alerts and recommendations in time- and safety-critical scenarios.
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Affiliation(s)
- Angela Mastrianni
- College of Computing and Informatics, Drexel University, Philadelphia, USA
| | | | - Allison Hu
- Division of Trauma and Burn Surgery, Children's National Hospital, Washington, D.C., USA
| | - Lynn Almengor
- College of Computing and Informatics, Drexel University, Philadelphia, USA
| | - Peyton Tempel
- Division of Trauma and Burn Surgery, Children's National Hospital, Washington, D.C., USA
| | - Sarah Gao
- Division of Trauma and Burn Surgery, Children's National Hospital, Washington, D.C., USA
| | - Randall S Burd
- Division of Trauma and Burn Surgery, Children's National Hospital, Washington, D.C., USA
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5
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Avila-Alvarez A, Ruiz Campillo CW, Zeballos-Sarrato G, Iriondo-Sanz M, Thio M. Time to improve documentation of neonatal resuscitation: a narrative review. Minerva Pediatr (Torino) 2022; 74:766-773. [PMID: 35511676 DOI: 10.23736/s2724-5276.22.06914-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
A complete, objective and systematic documentation of delivery room resuscitation is important for research, for quality improvement, for teaching and as a reference for postresuscitation care. However, documentation during neonatal resuscitation is usually paper-based, retrospective, inaccurate and unreliable. In this narrative review, we discuss the strengths and pitfalls of current documentation methods in neonatal resuscitation, as well as the challenges of introducing new or emerging technologies in this field. In particular, we discuss innovations in electronic and automated medical records, video recording and Smartphones and Tablet Apps. Given the lack of a consensus standard, we finally propose a list of items that should be part of any neonatal resuscitation documentation method.
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Affiliation(s)
- Alejandro Avila-Alvarez
- Neonatal Unit, Department of Pediatrics, A Coruña University Hospital, A Coruña Biomedical Research Institute (INIBIC), A Coruña, Spain - .,Spanish Neonatal Resuscitation Group, Sociedad Española de Neonatología (SENeo), Madrid, Spain -
| | - Cesar W Ruiz Campillo
- Spanish Neonatal Resuscitation Group, Sociedad Española de Neonatología (SENeo), Madrid, Spain.,Division of Neonatology, Vall d'Hebron University Hospital, Barcelona, Spain
| | - Gonzalo Zeballos-Sarrato
- Spanish Neonatal Resuscitation Group, Sociedad Española de Neonatología (SENeo), Madrid, Spain.,Division of Neonatology, Gregorio Marañón University Hospital, Madrid, Spain
| | - Martin Iriondo-Sanz
- Spanish Neonatal Resuscitation Group, Sociedad Española de Neonatología (SENeo), Madrid, Spain.,Division of Neonatology, Sant Joan de Déu Hospital, Barcelona, Spain
| | - Marta Thio
- Spanish Neonatal Resuscitation Group, Sociedad Española de Neonatología (SENeo), Madrid, Spain.,Newborn Research Centre and Neonatal Services, Royal Women's Hospital, Melbourne, Australia.,The Murdoch Children's Research Institute, Parkville, Victoria, Australia.,Department of Obstetrics and Gynaecology, The University of Melbourne, Parkville, Victoria, Australia
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6
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Goodwin AJ, Eytan D, Dixon W, Goodfellow SD, Doherty Z, Greer RW, McEwan A, Tracy M, Laussen PC, Assadi A, Mazwi M. Timing errors and temporal uncertainty in clinical databases-A narrative review. Front Digit Health 2022; 4:932599. [PMID: 36060541 PMCID: PMC9433547 DOI: 10.3389/fdgth.2022.932599] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2022] [Accepted: 07/11/2022] [Indexed: 11/28/2022] Open
Abstract
A firm concept of time is essential for establishing causality in a clinical setting. Review of critical incidents and generation of study hypotheses require a robust understanding of the sequence of events but conducting such work can be problematic when timestamps are recorded by independent and unsynchronized clocks. Most clinical models implicitly assume that timestamps have been measured accurately and precisely, but this custom will need to be re-evaluated if our algorithms and models are to make meaningful use of higher frequency physiological data sources. In this narrative review we explore factors that can result in timestamps being erroneously recorded in a clinical setting, with particular focus on systems that may be present in a critical care unit. We discuss how clocks, medical devices, data storage systems, algorithmic effects, human factors, and other external systems may affect the accuracy and precision of recorded timestamps. The concept of temporal uncertainty is introduced, and a holistic approach to timing accuracy, precision, and uncertainty is proposed. This quantitative approach to modeling temporal uncertainty provides a basis to achieve enhanced model generalizability and improved analytical outcomes.
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Affiliation(s)
- Andrew J. Goodwin
- Department of Critical Care Medicine, The Hospital for Sick Children, Toronto, ON, Canada
- School of Biomedical Engineering, University of Sydney, Sydney, NSW, Australia
| | - Danny Eytan
- Department of Critical Care Medicine, The Hospital for Sick Children, Toronto, ON, Canada
- Department of Medicine, Technion - Israel Institute of Technology, Haifa, Israel
| | - William Dixon
- Department of Critical Care Medicine, The Hospital for Sick Children, Toronto, ON, Canada
| | - Sebastian D. Goodfellow
- Department of Critical Care Medicine, The Hospital for Sick Children, Toronto, ON, Canada
- Department of Civil and Mineral Engineering, University of Toronto, Toronto, ON, Canada
| | - Zakary Doherty
- Research Fellow, School of Rural Health, Monash University, Melbourne, VIC, Australia
| | - Robert W. Greer
- Department of Critical Care Medicine, The Hospital for Sick Children, Toronto, ON, Canada
| | - Alistair McEwan
- School of Biomedical Engineering, University of Sydney, Sydney, NSW, Australia
| | - Mark Tracy
- Neonatal Intensive Care Unit, Westmead Hospital, Sydney, NSW, Australia
- Department of Paediatrics and Child Health, The University of Sydney, Sydney, NSW, Australia
| | - Peter C. Laussen
- Department of Anesthesia, Boston Children's Hospital, Boston, MA, United States
| | - Azadeh Assadi
- Department of Critical Care Medicine, The Hospital for Sick Children, Toronto, ON, Canada
- Department of Engineering and Applied Sciences, Institute of Biomedical Engineering, University of Toronto, Toronto, ON, Canada
| | - Mjaye Mazwi
- Department of Critical Care Medicine, The Hospital for Sick Children, Toronto, ON, Canada
- Department of Paediatrics, University of Toronto, Toronto, ON, Canada
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7
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Barriers and facilitators for successful AED usage during in-situ simulated in-hospital cardiac arrest. Resusc Plus 2022; 10:100257. [PMID: 35677834 PMCID: PMC9168694 DOI: 10.1016/j.resplu.2022.100257] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Revised: 05/18/2022] [Accepted: 05/22/2022] [Indexed: 11/21/2022] Open
Abstract
Introduction Methods Results Conclusion
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8
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Stærk M, Lauridsen KG, Krogh K, Løfgren B. Distribution and use of automated external defibrillators and their effect on return of spontaneous circulation in Danish hospitals. Resusc Plus 2022; 9:100211. [PMID: 35199074 PMCID: PMC8842076 DOI: 10.1016/j.resplu.2022.100211] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2021] [Revised: 01/19/2022] [Accepted: 01/19/2022] [Indexed: 11/18/2022] Open
Abstract
Introduction Automated external defibrillators (AEDs) increase survival after out-of-hospital cardiac arrest. However, the effect of AEDs for in-hospital cardiac arrest (IHCA) remains uncertain. This study aims to describe the distribution and use of AEDs in Danish hospitals and investigate whether early rhythm analysis is associated with return of spontaneous circulation (ROSC). Methods All Danish public hospitals with a cardiac arrest team were included and sent a questionnaire on the in-hospital distribution of AEDs and manual defibrillators. Further, we collected data on IHCAs including rhythm analysis, device type, cardiac arrest team arrival, and ROSC from the national database on IHCA (DANARREST). Results Of 46 hospitals, 93% had AEDs and 93% had manual defibrillators. AEDs were often placed in wards or non-clinical areas, whereas manual defibrillators were often placed in areas with high-risk patients. We identified 3,204 IHCAs. AEDs were used in 13% of IHCAs. After adjustment for confounders, chance of ROSC was higher if the first rhythm analysis was performed before the arrival of the cardiac arrest team (RR: 1.28 (95% CI: 1.12–1.46)). The relative risk of ROSC was 1.09 (0.84–1.41) when analyzing with an AED before cardiac arrest team arrival and 1.19 (1.00–1.41) when using a manual defibrillator. However, there was no significant effect modification for AED vs manual defibrillator (p = 0.26). Conclusion AEDs are widely distributed in Danish hospitals but less commonly used for IHCAs compared to manual defibrillators. Rhythm analysis before arrival of the cardiac arrest team was associated with ROSC without significant effect modification of device type.
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Affiliation(s)
- Mathilde Stærk
- Department of Medicine, Randers Regional Hospital, Denmark
- Education and Research, Randers Regional Hospital, Denmark
| | - Kasper G. Lauridsen
- Research Center for Emergency Medicine, Aarhus University Hospital, Denmark
- Emergency Department, Randers Regional Hospital, Denmark
- Department of Anesthesiology and Critical Care Medicine, Children’s Hospital of Philadelphia, USA
| | - Kristian Krogh
- Research Center for Emergency Medicine, Aarhus University Hospital, Denmark
- Department of Anaesthesiology and Intensive Care, Aarhus University Hospital, Denmark
| | - Bo Løfgren
- Department of Medicine, Randers Regional Hospital, Denmark
- Research Center for Emergency Medicine, Aarhus University Hospital, Denmark
- Department of Clinical Medicine, Aarhus University, Denmark
- Corresponding author at: Department of Medicine, Randers Regional Hospital, Skovlyvej 15, 8930 Randers NE, Denmark.
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9
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Chang HY, Lai PF, Jiang JL. Nurses' Acceptance of and Satisfaction With the Advanced Cardiac Life Support Electronic Information System in Emergency Departments and Critical Care Units. Comput Inform Nurs 2022; 41:00024665-900000000-99186. [PMID: 35234707 DOI: 10.1097/cin.0000000000000888] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Emergency and critical care nurses perform an important role in documenting the resuscitation process. However, paper-based recording is labor intensive and complex and may result in incorrect recording of important parameters, which suggests the need for an appropriate electronic information system for emergency care. This cross-sectional descriptive study explores emergency and critical care nurses' acceptance of, and satisfaction with, the newly developed advanced cardiac life support electronic information system and examines whether paper-based recording and electronic recording approaches differ in the completeness of resuscitation records. Data were collected through a self-designed structured questionnaire and a retrospective review of medical records. Data were analyzed by descriptive statistics, independent sample t test, and one-way analysis of variance. The results indicated that novice nurses were more satisfied with the electronic information system than others. Emergency care nurses were significantly more satisfied than medical and surgical ICU nurses. The electronic information system improved the completeness of resuscitation recording by 23.5%, compared with the paper-based recording approach. Emergency and critical care nurses have a moderate to high degree of acceptance of, and satisfaction with, electronic information systems.
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Affiliation(s)
- Hui-Ying Chang
- Author Affiliations: Department of Emergency, Buddhist Tzu Chi General Hospital (Chang and Dr Lai); and School of Medicine (Dr Lai) and Department of Nursing (Dr Jiang), Tzu Chi University, Hualien, Taiwan
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10
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Lucas B, Mathieu SC, Pliske G, Schirrmeister W, Kulla M, Walcher F. The impact of a qualified medical documentation assistant on trauma room management. Eur J Trauma Emerg Surg 2022; 48:689-696. [PMID: 33025169 PMCID: PMC8825361 DOI: 10.1007/s00068-020-01513-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2020] [Accepted: 09/25/2020] [Indexed: 11/26/2022]
Abstract
PURPOSE To improve quality of trauma room management, intra- and inter-hospital benchmarking are important tools. However, primary data quality is crucial for benchmarking reliability. In this study, we analyzed the effect of a medical documentation assistant on documentation completeness in trauma room management in comparison to documentation by physicians involved in direct patient treatment. METHODS We included all patients treated in the trauma room from 2016/01/01 to 2016/12/31 that were documented with the trauma module of the German Emergency Department Medical Record V2015.1. We divided the data into documentation by medical documentation assistant (DA, 07:00 to 17:00), physician in daytime (PD, 07:00 to 17:00), and physician at night (PN, 17:00 to 07:00). Data were analyzed for completeness (primary outcome parameter) as well as diagnostic intervals. RESULTS There was a significant increase in complete recorded data for DA (74.5%; IQR 14.5%) compared to PD (26.9%; IQR 18.7%; p < 0.001) and PN (30.8%; IQR 18.9; p < 0.001). The time to whole-body computed tomography (WBCT) significantly decreased for DA (19 min; IQR 8.3) compared to PD (24 min; IQR 12.8; p = 0.007) or PN (24.5 min; IQR 10.0; p = 0.001). CONCLUSION In presence of a qualified medical documentation assistant, data completeness and time to WBCT improved significantly. Therefore, utilizing a professional DA in the trauma room appears beneficial for data quality and time management.
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Affiliation(s)
- Benjamin Lucas
- Department of Trauma Surgery, Otto-Von-Guericke University Magdeburg, Leipziger Str. 44, 39120 Magdeburg, Germany
| | - Sophie-Cecil Mathieu
- Department of Trauma Surgery, Otto-Von-Guericke University Magdeburg, Leipziger Str. 44, 39120 Magdeburg, Germany
- Department of Orthopaedic Surgery, Otto-Von-Guericke University Magdeburg, 39120 Magdeburg, Germany
| | - Gerald Pliske
- Department of Trauma Surgery, Otto-Von-Guericke University Magdeburg, Leipziger Str. 44, 39120 Magdeburg, Germany
| | - Wiebke Schirrmeister
- Department of Trauma Surgery, Otto-Von-Guericke University Magdeburg, Leipziger Str. 44, 39120 Magdeburg, Germany
| | - Martin Kulla
- Department of Anaesthesiology, Intensive Care Medicine, Emergency Medicine and Pain Therapy, Bundeswehrhospital Ulm, Oberer Eselsberg 40, 89081 Ulm, Germany
| | - Felix Walcher
- Department of Trauma Surgery, Otto-Von-Guericke University Magdeburg, Leipziger Str. 44, 39120 Magdeburg, Germany
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11
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Vestergaard LD, Lauridsen KG, Krarup NHV, Kristensen JU, Andersen LK, Løfgren B. Quality of Cardiopulmonary Resuscitation and 5-Year Survival Following in-Hospital Cardiac Arrest. Open Access Emerg Med 2021; 13:553-560. [PMID: 34938129 PMCID: PMC8687881 DOI: 10.2147/oaem.s341479] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Accepted: 12/03/2021] [Indexed: 12/26/2022] Open
Abstract
PURPOSE To improve cardiac arrest survival, international resuscitation guidelines emphasize measuring the quality of cardiopulmonary resuscitation (CPR). We aimed to investigate CPR quality during in-hospital cardiac arrest (IHCA) and study long-term survival outcomes. PATIENTS AND METHODS This was a cohort study of IHCA from December 2011 until November 2014. Data were collected from the hospital switch board, patient records, and from defibrillators. Impedance data from defibrillators were analyzed manually at the level of single compressions. Long-term survival at 1-, 3-, and 5 years is reported. RESULTS The study included 189 IHCAs; median (interquartile range (IQR)) time to first rhythm analysis was 116 (70-201) seconds and median (IQR) time to first defibrillation was 133 (82-264) seconds. Median (IQR) chest compression rate was 126 (119-131) per minute and chest compression fraction (CCF) was 78% (69-86). Thirty-day survival was 25%, while 1-year-, 3-year-, and 5-year survival were 21%, 14%, and 13%, respectively. There was no significant association between any survival outcomes and CCF, whereas chest compression rate was associated with survival to 30 days and 3 years. Overall, 5-year survival was associated with younger age (median 68 vs 74 years, p=0.003), less comorbidity (Charlson comorbidity index median 3 vs 5, p<0.001), and witnessed cardiac arrest (96% vs 77%, p=0.03). CONCLUSION We established a systematic collection of IHCA CPR quality data to measure and improve CPR quality and long-term survival outcomes. Median time to first rhythm check/defibrillation was <3 minutes, but median chest compression rate was too fast and median CCF slightly below 80%. More than half of 30-day survivors were still alive at 5 years.
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Affiliation(s)
| | - Kasper Glerup Lauridsen
- Department of Internal Medicine, Randers Regional Hospital, Randers, Denmark
- Research Center for Emergency Medicine, Aarhus University Hospital, Aarhus, Denmark
| | | | | | | | - Bo Løfgren
- Department of Internal Medicine, Randers Regional Hospital, Randers, Denmark
- Research Center for Emergency Medicine, Aarhus University Hospital, Aarhus, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
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12
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Grundgeiger T, Hahn F, Wurmb T, Meybohm P, Happel O. The use of a cognitive aid app supports guideline-conforming cardiopulmonary resuscitations: A randomized study in a high-fidelity simulation. Resusc Plus 2021; 7:100152. [PMID: 34458879 PMCID: PMC8379507 DOI: 10.1016/j.resplu.2021.100152] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Revised: 06/24/2021] [Accepted: 07/06/2021] [Indexed: 12/04/2022] Open
Abstract
Aim Cardiac arrests require fast, well-timed, and well-coordinated interventions delivered by several staff members. We evaluated a cognitive aid that works as an attentional aid to support specifically the timing and coordination of these interventions. We report the results of an experimental, simulation-based evaluation of the tablet-based cognitive aid in performing guideline-conforming cardiopulmonary resuscitation. Methods In a parallel group design, emergency teams (one qualified emergency physician as team leader and one qualified nurse) were randomly assigned to the cognitive aid application (CA App) group or the no application (No App) group and then participated in a simulated scenario of a cardiac arrest. The primary outcome was a cardiopulmonary resuscitation performance score ranging from zero to two for each team based on the videotaped scenarios in relation to twelve performance variables derived from the European Resuscitation Guidelines. As a secondary outcome, we measured the participants’ subjective workload. Results A total of 67 teams participated. The CA App group (n = 32 teams) showed significantly better cardiopulmonary resuscitation performance than the No App group (n = 31 teams; mean difference = 0.23, 95 %CI = 0.08 to 0.38, p = 0.002, d = 0.83). The CA App group team leaders indicated significantly less mental and physical demand and less effort to achieve their performance compared to the No App group team leaders. Conclusions Among well-trained in-hospital emergency teams, the cognitive aid could improve cardiopulmonary resuscitation coordination performance and decrease mental workload.
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Affiliation(s)
- T Grundgeiger
- Institute Human-Computer-Media, Julius-Maximilians-Universität Würzburg, Oswald-Külpe-Weg 82, 97074 Würzburg, Germany
| | - F Hahn
- Department of Anaesthesiology, Intensive Care, Emergency and Pain Medicine, University Hospital of Würzburg, Oberdürrbacher Straße 6, 97080 Würzburg, Germany
| | - T Wurmb
- Department of Anaesthesiology, Intensive Care, Emergency and Pain Medicine, University Hospital of Würzburg, Oberdürrbacher Straße 6, 97080 Würzburg, Germany
| | - P Meybohm
- Department of Anaesthesiology, Intensive Care, Emergency and Pain Medicine, University Hospital of Würzburg, Oberdürrbacher Straße 6, 97080 Würzburg, Germany
| | - O Happel
- Department of Anaesthesiology, Intensive Care, Emergency and Pain Medicine, University Hospital of Würzburg, Oberdürrbacher Straße 6, 97080 Würzburg, Germany
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13
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Avila-Alvarez A, Davis PG, Kamlin COF, Thio M. Documentation during neonatal resuscitation: a systematic review. Arch Dis Child Fetal Neonatal Ed 2021; 106:376-380. [PMID: 33243927 DOI: 10.1136/archdischild-2020-319948] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2020] [Revised: 09/26/2020] [Accepted: 11/09/2020] [Indexed: 11/04/2022]
Abstract
OBJECTIVE Accurate documentation in healthcare is necessary for ethical, legal, research and quality improvement purposes. In this review, we aimed to evaluate the accuracy of methods of documentation of delivery room resuscitations. METHODS A systematic literature search in MEDLINE was conducted to identify original studies that reported the quality of documentation records during newborn resuscitation in the delivery room. Data extracted from the studies included population characteristics, methodology, documentation protocols, use of gold standard and main results (initial assessment of heart rate and peripheral oxygen saturation, respiratory support and supplementary oxygen). RESULTS In total, 197 records were screened after initial database search, of which seven studies met the inclusion criteria and were finally included in this review. Four studies were chart reviews and three studies compared conventional documentation methods with video recording. Only one study tested an intervention to improve documentation. Documentation was often inaccurate and important resuscitation events and interventions were poorly recorded. Lack of uniformity among studies preclude pooled analysis, but it seems that complex or advanced procedures were more accurately reported than basic interventions. CONCLUSIONS There is little literature regarding accuracy of documentation during neonatal resuscitation, but current quality of documentation seems to be unsatisfactory. There is a need for consensus guidelines and innovative solutions in newborn resuscitation documentation.
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Affiliation(s)
| | - Peter Graham Davis
- Newborn Research Centre and Neonatal Services, The Royal Women's Hospital, Melbourne, Victoria, Australia.,Department of Obstetrics and Gynecology, The University of Melbourne, Melbourne, Victoria, Australia
| | - Camille Omar Farouk Kamlin
- Newborn Research Centre and Neonatal Services, The Royal Women's Hospital, Melbourne, Victoria, Australia.,Department of Obstetrics and Gynecology, The University of Melbourne, Melbourne, Victoria, Australia
| | - Marta Thio
- Newborn Research Centre and Neonatal Services, The Royal Women's Hospital, Melbourne, Victoria, Australia.,Department of Obstetrics and Gynecology, The University of Melbourne, Melbourne, Victoria, Australia.,Pediatric Infant Perinatal Emergency Retrieval - Neonatal Retrieval Services, The Royal Children's Hospital, Melbourne, Victoria, Australia.,Murdoch Children's Research Institute, Melbourne, Victoria, Australia
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14
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Whalen K, Grella P, Snydeman C, Dwyer AM, Yager P. Nursing Attitudes and Practices in Code Documentation Employing a New Electronic Health Record. Appl Clin Inform 2021; 12:589-596. [PMID: 34161987 DOI: 10.1055/s-0041-1731340] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
Abstract
OBJECTIVE Based on feedback from nurses regarding the challenges of code documentation following the implementation of a new electronic health record (EHR), we sought to better understand inpatient nurse attitudes and practices in code documentation and to identify opportunities for improvement. METHODS An anonymous electronic survey was distributed to all inpatient nurses working at a single, 999-bed, university-based, and quaternary care hospital. Participation in the study was voluntary and consent was implied by survey completion. RESULTS Overall, 432 (14%) of 3,121 inpatient nurses completed the survey. While nearly 80% of respondents indicated feeling very comfortable using computers for personal use, only 5% felt very comfortable navigating the EHR to document codes in real time. While 53% had documented codes in the new EHR, most admitted to documenting on paper with retroactive entry into the EHR. About 25% reported having participated in a code that was not accurately documented in the new EHR. All respondents provided specific suggestions for improving the EHR interface, and over 90% expressed interest in having opportunities to practice code documentation using simulated code events. CONCLUSION Despite completion of training modules in code documentation in a new EHR, many inpatient nurses in a single institution feel uncomfortable documenting codes directly into the EHR, and some question the accuracy of this documentation. Improving EHR functionality based on specific recommendations from end-users coupled with more practice documenting simulated codes may ease EHR navigation, leading to nurses' acceptance of the EHR tool, more accurate and efficient documentation, greater nurse satisfaction and more appropriate quality improvement measures.
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Affiliation(s)
- Kimberly Whalen
- Division of Pediatric Critical Care Medicine, Massachusetts General Hospital, Boston, Massachusetts, United States
| | - Pat Grella
- Patient Care Services Informatics, Massachusetts General Hospital, Boston, Massachusetts, United States
| | - Colleen Snydeman
- Patient Care Services Quality and Safety, Massachusetts General Hospital, Boston, Massachusetts, United States
| | - Ann-Marie Dwyer
- Patient Care Services Informatics, Massachusetts General Hospital, Boston, Massachusetts, United States
| | - Phoebe Yager
- Division of Pediatric Critical Care Medicine, Massachusetts General Hospital, Boston, Massachusetts, United States
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15
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Dittmar MS, Zimmermann S, Creutzenberg M, Bele S, Bitzinger D, Lunz D, Graf BM, Kieninger M. Evaluation of comprehensiveness and reliability of electronic health records concerning resuscitation efforts within academic intensive care units: a retrospective chart analysis. BMC Emerg Med 2021; 21:69. [PMID: 34112106 PMCID: PMC8194046 DOI: 10.1186/s12873-021-00462-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2021] [Accepted: 05/19/2021] [Indexed: 11/25/2022] Open
Abstract
Background According to the literature, the validity and reliability of medical documentation concerning episodes of cardiopulmonary resuscitation (CPR) is suboptimal. However, little is known about documentation quality of CPR efforts during intensive care unit (ICU) stays in electronic patient data management systems (PDMS). This study analyses the reliability of CPR-related medical documentation within the ICU PDMS. Methods In a retrospective chart analysis, PDMS records of three ICUs of a single university hospital were searched over 5 y for CPR check marks. Respective datasets were analyzed concerning data completeness and data consistency by comparing the content of three documentation forms (physicians’ log, nurses’ log, and CPR incident form), as well as physiological and therapeutic information of individual cases, for missing data and plausibility of CPR starting time and duration. To compare data reliability and completeness, a quantitative measure, the Consentaneity Index (CI), is proposed. Results One hundred sixty-five datasets were included into the study. In 9% (n = 15) of cases, there was neither information on the time points of CPR initiation nor on CPR duration available in any data source. Data on CPR starting time and duration were available from at least two data sources in individual cases in 54% (n = 90) and 45% (n = 74), respectively. In these cases, the specifications of CPR starting time did differ by a median ± interquartile range of 10.0 ± 18.5 min, CPR duration by 5.0 ± 17.3 min. The CI as a marker of data reliability revealed a low consistency of CPR documentation in most cases, with more favorable results, if the time interval between the CPR episode and the time of documentation was short. Conclusions This study reveals relevant proportions of missing and inconsistent data in electronic CPR documentation in the ICU setting. The CI is suggested as a tool for documentation quality analysis and monitoring of improvements.
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Affiliation(s)
- Michael S Dittmar
- Department of Anesthesiology, Regensburg University Medical Center, Franz-Josef-Strauss-Allee 11, 93053, Regensburg, Germany.
| | - Sabrina Zimmermann
- Department of Anesthesiology, Regensburg University Medical Center, Franz-Josef-Strauss-Allee 11, 93053, Regensburg, Germany.,Department of Forensic Psychiatry, Bezirksklinikum Regensburg, Universitätsstraße 84, 93053, Regensburg, Germany
| | - Marcus Creutzenberg
- Department of Anesthesiology, Regensburg University Medical Center, Franz-Josef-Strauss-Allee 11, 93053, Regensburg, Germany
| | - Sylvia Bele
- Department of Neurosurgery, Regensburg University Medical Center, Franz-Josef-Strauss-Allee 11, 93053, Regensburg, Germany
| | - Diane Bitzinger
- Department of Anesthesiology, Regensburg University Medical Center, Franz-Josef-Strauss-Allee 11, 93053, Regensburg, Germany
| | - Dirk Lunz
- Department of Anesthesiology, Regensburg University Medical Center, Franz-Josef-Strauss-Allee 11, 93053, Regensburg, Germany
| | - Bernhard M Graf
- Department of Anesthesiology, Regensburg University Medical Center, Franz-Josef-Strauss-Allee 11, 93053, Regensburg, Germany
| | - Martin Kieninger
- Department of Anesthesiology, Regensburg University Medical Center, Franz-Josef-Strauss-Allee 11, 93053, Regensburg, Germany
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Mastrianni A, Sarcevic A, Chung LS, Zakeri I, Alberto EC, Milestone ZP, Burd RS, Marsic I. Designing Interactive Alerts to Improve Recognition of Critical Events in Medical Emergencies. DIS. DESIGNING INTERACTIVE SYSTEMS (CONFERENCE) 2021; 2021:864-878. [PMID: 35330919 PMCID: PMC8941664 DOI: 10.1145/3461778.3462051] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Vital sign values during medical emergencies can help clinicians recognize and treat patients with life-threatening injuries. Identifying abnormal vital signs, however, is frequently delayed and the values may not be documented at all. In this mixed-methods study, we designed and evaluated a two-phased visual alert approach for a digital checklist in trauma resuscitation that informs users about undocumented vital signs. Using an interrupted time series analysis, we compared documentation in the periods before (two years) and after (four months) the introduction of the alerts. We found that introducing alerts led to an increase in documentation throughout the post-intervention period, with clinicians documenting vital signs earlier. Interviews with users and video review of cases showed that alerts were ineffective when clinicians engaged less with the checklist or set the checklist down to perform another activity. From these findings, we discuss approaches to designing alerts for dynamic team-based settings.
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17
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Jensen FB, Ladefoged KT, Lindskou TA, Søvsø MB, Christensen EF, Teli M. Understanding the Effect of Electronic Prehospital Medical Records in Ambulances: A Qualitative Observational Study in a Prehospital Setting. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18052330. [PMID: 33673420 PMCID: PMC7967689 DOI: 10.3390/ijerph18052330] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Revised: 02/12/2021] [Accepted: 02/22/2021] [Indexed: 11/21/2022]
Abstract
Little is known of ambulance professionals’ work practices regarding the use of medical records, their communication with patients, before and during hand over to Emergency Departments (ED). An electronic Prehospital Medical Record (ePMR) has been implemented in all Danish ambulances since 2015. Our aim was to investigate the use of ePMR and whether it affected the ambulance professionals’ clinical practice. We performed a qualitative study with observations of ePMR use in ambulance runs in the North Denmark Region. Furthermore, informal interviews with ambulance professionals was performed. Analysis was accomplished with inspiration from grounded theory. Our main findings were: (1) the ePMR is an essential work tool which aided ambulance professionals with overview of data collection and facilitated a checklist for ED hand overs, (2) mobility and flexibility of the ePMR facilitated conversations and relations with the patients, and (3) in acute severe situations, the ePMR could not stand alone in hand over or communication with the ED. The ePMR affected the ambulance professionals’ work practice in various ways and utilization of ePMR while simultaneously treating patients in ambulances does not obstruct the relation with the patient. To this end, the ePMR appears feasible in collaboration across the prehospital setting.
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Affiliation(s)
- Frederikke Bøgh Jensen
- Techno-Anthropology, Technical Faculty of IT and Design, Aalborg University, 9000 Aalborg, Denmark;
- Correspondence:
| | | | - Tim Alex Lindskou
- Centre for Prehospital and Emergency Research, Department of Clinical Medicine, Aalborg University, 9000 Aalborg, Denmark; (T.A.L.); (M.B.S.); (E.F.C.)
| | - Morten Breinholt Søvsø
- Centre for Prehospital and Emergency Research, Department of Clinical Medicine, Aalborg University, 9000 Aalborg, Denmark; (T.A.L.); (M.B.S.); (E.F.C.)
| | - Erika Frischknecht Christensen
- Centre for Prehospital and Emergency Research, Department of Clinical Medicine, Aalborg University, 9000 Aalborg, Denmark; (T.A.L.); (M.B.S.); (E.F.C.)
| | - Maurizio Teli
- Department of Planning, Aalborg University, 9000 Aalborg, Denmark;
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18
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Kulp L, Sarcevic A, Zheng Y, Cheng M, Alberto E, Burd R. Checklist Design Reconsidered: Understanding Checklist Compliance and Timing of Interactions. PROCEEDINGS OF THE SIGCHI CONFERENCE ON HUMAN FACTORS IN COMPUTING SYSTEMS. CHI CONFERENCE 2020; 2020. [PMID: 32685940 DOI: 10.1145/3313831.3376853] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
We examine the association between user interactions with a checklist and task performance in a time-critical medical setting. By comparing 98 logs from a digital checklist for trauma resuscitation with activity logs generated by video review, we identified three non-compliant checklist use behaviors: failure to check items for completed tasks, falsely checking items when tasks were not performed, and inaccurately checking items for incomplete tasks. Using video review, we found that user perceptions of task completion were often misaligned with clinical practices that guided activity coding, thereby contributing to non-compliant check-offs. Our analysis of associations between different contexts and the timing of check-offs showed longer delays when (1) checklist users were absent during patient arrival, (2) patients had penetrating injuries, and (3) resuscitations were assigned to the highest acuity. We discuss opportunities for reconsidering checklist designs to reduce non-compliant checklist use.
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Affiliation(s)
- Leah Kulp
- Drexel University, Philadelphia, PA, USA
| | | | - Yinan Zheng
- Children's National Medical Center, Washington DC, USA
| | - Megan Cheng
- Children's National Medical Center, Washington DC, USA
| | - Emily Alberto
- Children's National Medical Center, Washington DC, USA
| | - Randall Burd
- Children's National Medical Center, Washington DC, USA
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19
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Freytag J, Stroben F, Hautz WE, Schauber SK, Kämmer JE. Rating the quality of teamwork-a comparison of novice and expert ratings using the Team Emergency Assessment Measure (TEAM) in simulated emergencies. Scand J Trauma Resusc Emerg Med 2019; 27:12. [PMID: 30736821 PMCID: PMC6368771 DOI: 10.1186/s13049-019-0591-9] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2018] [Accepted: 11/14/2018] [Indexed: 01/01/2023] Open
Abstract
Background Training in teamwork behaviour improves technical resuscitation performance. However, its effect on patient outcome is less clear, partly because teamwork behaviour is difficult to measure. Furthermore, it is unknown who should evaluate it. In clinical practice, experts are obliged to participate in resuscitation efforts and are thus unavailable to assess teamwork quality. Consequently, we sought to determine if raters with little clinical experience and experts provide comparable evaluations of teamwork behaviour. Methods Novice and expert raters judged teamwork behaviour during 6 emergency medicine simulations using the Teamwork Emergency Assessment Measure (TEAM). Ratings of both groups were analysed descriptively and compared with U and t tests. We used a mixed effects model to identify the proportion of variance in TEAM scores attributable to rater status and other sources. Results Twelve raters evaluated 7 teams rotating through 6 cases, for a total of 84 observations. We found no significant difference between expert and novice ratings for 7 of the 11 items of the TEAM or in the sums of all item scores. Novices rated teamwork behaviour higher on 4 items and overall. Rater status accounted for 11.1% of the total variance in scores. Conclusions Experts’ and novices’ ratings were similarly distributed, implying that raters with limited experience can provide reliable data on teamwork behaviour. Novices show a consistent, but slightly more lenient rating behaviour. Clinical studies and real-life teams may thus employ novices using a structured observational tool such as TEAM to inform their performance review and improvement. Electronic supplementary material The online version of this article (10.1186/s13049-019-0591-9) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Julia Freytag
- Simulated Patients Program, Office of the Vice Dean for Teaching and Learning, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Charitéplatz 1, 10117, Berlin, Germany
| | - Fabian Stroben
- Lernzentrum, Office of the Vice Dean for Teaching and Learning, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Charitéplatz 1, 10117, Berlin, Germany.,AG Progress Test Medizin, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Charitéplatz 1, 10117, Berlin, Germany
| | - Wolf E Hautz
- Department of Emergency Medicine, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse 4, 3010, Bern, Switzerland.,Centre for Health Sciences Education, University of Oslo, Gaustadalléen 30, 0373, Oslo, Norway
| | - Stefan K Schauber
- Centre for Health Sciences Education, University of Oslo, Gaustadalléen 30, 0373, Oslo, Norway
| | - Juliane E Kämmer
- AG Progress Test Medizin, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Charitéplatz 1, 10117, Berlin, Germany. .,Center for Adaptive Rationality, Max Planck Institute for Human Development, Lentzeallee 94, 14195, Berlin, Germany.
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20
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Montagna S, Croatti A, Ricci A, Agnoletti V, Albarello V, Gamberini E. Real-time tracking and documentation in trauma management. Health Informatics J 2019; 26:328-341. [PMID: 30726161 DOI: 10.1177/1460458219825507] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
In trauma resuscitation, an accurate documentation is crucial to improve the quality of trauma care. Hospital emergency departments typically adopt handwritten paper records and flow sheets for acquiring data, which are often inaccurate. In this article, we describe TraumaTracker, a computer-based system for trauma tracking and documentation. Results demonstrate that completeness and accuracy of trauma documentation significantly improved using TraumaTracker, since it enables to add data and information that were not recorded in paper documentation - especially precise times and locations of events.
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21
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Fishman CE, Weinberg DD, Murray A, Foglia EE. Accuracy of real-time delivery room resuscitation documentation. Arch Dis Child Fetal Neonatal Ed 2018; 105:222-224. [PMID: 30472661 PMCID: PMC6534487 DOI: 10.1136/archdischild-2018-315723] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2018] [Revised: 10/31/2018] [Accepted: 11/10/2018] [Indexed: 11/03/2022]
Abstract
OBJECTIVE To assess the accuracy of real-time delivery room resuscitation documentation. DESIGN Retrospective observational study. SETTING Level 3 academic neonatal intensive care unit. PARTICIPANTS Fifty infants with video recording of neonatal resuscitation. MAIN OUTCOME MEASURES Vital sign assessments and interventions performed during resuscitation. The accuracy of written documentation was compared with video gold standard. RESULTS Timing of initial heart rate assessment agreed with video in 44/50 (88%) records; the documented heart rate was correct in 34/44 (77%) of these. Heart rate and oxygen saturation were documented at 5 min of life in 90% of resuscitations. Of these, 100% of heart rate and 93% of oxygen saturation values were correctly recorded. Written records accurately reflected the mode(s) of respiratory support for 89%-100%, procedures for 91%-100% and medications for 100% of events. CONCLUSION Real-time documentation correctly reflects interventions performed during delivery room resuscitation but is less accurate for early vital sign assessments.
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Affiliation(s)
- Claire E. Fishman
- Department of Pediatrics, University of Pennsylvania School of Medicine, Philadelphia, PA USA
| | - Danielle D. Weinberg
- Division of Neonatology, The Children’s Hospital of Philadelphia, Philadelphia, PA USA
| | - Ashley Murray
- Department of Nursing, Hospital of the University of Pennsylvania, Philadelphia, PA USA
| | - Elizabeth E. Foglia
- Department of Pediatrics, University of Pennsylvania School of Medicine, Philadelphia, PA USA,Division of Neonatology, The Children’s Hospital of Philadelphia, Philadelphia, PA USA
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Sondheim SE, Devlin J, Seward WH, Bernard AW, Feinn RS, Cone DC. Recording Out-of-Hospital Cardiac Arrest Treatment via a Mobile Smartphone Application: A Feasibility Simulation Study. PREHOSP EMERG CARE 2018; 23:284-289. [DOI: 10.1080/10903127.2018.1490838] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Lucyk K, Tang K, Quan H. Barriers to data quality resulting from the process of coding health information to administrative data: a qualitative study. BMC Health Serv Res 2017; 17:766. [PMID: 29166905 PMCID: PMC5700659 DOI: 10.1186/s12913-017-2697-y] [Citation(s) in RCA: 59] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2016] [Accepted: 11/07/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Administrative health data are increasingly used for research and surveillance to inform decision-making because of its large sample sizes, geographic coverage, comprehensivity, and possibility for longitudinal follow-up. Within Canadian provinces, individuals are assigned unique personal health numbers that allow for linkage of administrative health records in that jurisdiction. It is therefore necessary to ensure that these data are of high quality, and that chart information is accurately coded to meet this end. Our objective is to explore the potential barriers that exist for high quality data coding through qualitative inquiry into the roles and responsibilities of medical chart coders. METHODS We conducted semi-structured interviews with 28 medical chart coders from Alberta, Canada. We used thematic analysis and open-coded each transcript to understand the process of administrative health data generation and identify barriers to its quality. RESULTS The process of generating administrative health data is highly complex and involves a diverse workforce. As such, there are multiple points in this process that introduce challenges for high quality data. For coders, the main barriers to data quality occurred around chart documentation, variability in the interpretation of chart information, and high quota expectations. CONCLUSIONS This study illustrates the complex nature of barriers to high quality coding, in the context of administrative data generation. The findings from this study may be of use to data users, researchers, and decision-makers who wish to better understand the limitations of their data or pursue interventions to improve data quality.
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Affiliation(s)
- Kelsey Lucyk
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, 3rd Floor TRW, 3280 Hospital Drive NW, Calgary, Alberta, T2N 4Z6, Canada.
| | - Karen Tang
- Department of Medicine, Cumming School of Medicine, University of Calgary, Health Sciences Centre, Foothills Campus, 3330 Hospital Drive NW, Calgary, Alberta, T2N 4N1, Canada
| | - Hude Quan
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, 3rd Floor TRW, 3280 Hospital Drive NW, Calgary, Alberta, T2N 4Z6, Canada
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Silva RMFLD, Silva BAGDLE, Silva FJME, Amaral CFS. Cardiopulmonary resuscitation of adults with in-hospital cardiac arrest using the Utstein style. Rev Bras Ter Intensiva 2017; 28:427-435. [PMID: 28099640 PMCID: PMC5225918 DOI: 10.5935/0103-507x.20160076] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2016] [Accepted: 10/17/2016] [Indexed: 12/02/2022] Open
Abstract
Objective The objective of this study was to analyze the clinical profile of patients
with in-hospital cardiac arrest using the Utstein style. Methods This study is an observational, prospective, longitudinal study of patients
with cardiac arrest treated in intensive care units over a period of 1
year. Results The study included 89 patients who underwent cardiopulmonary resuscitation
maneuvers. The cohort was 51.6% male with a mean age 59.0 years. The
episodes occurred during the daytime in 64.6% of cases.
Asystole/bradyarrhythmia was the most frequent initial rhythm (42.7%). Most
patients who exhibited a spontaneous return of circulation experienced
recurrent cardiac arrest, especially within the first 24 hours (61.4%). The
mean time elapsed between hospital admission and the occurrence of cardiac
arrest was 10.3 days, the mean time between cardiac arrest and
cardiopulmonary resuscitation was 0.68 min, the mean time between cardiac
arrest and defibrillation was 7.1 min, and the mean duration of
cardiopulmonary resuscitation was 16.3 min. Associations between gender and
the duration of cardiopulmonary resuscitation (19.2 min in women versus 13.5
min in men, p = 0.02), the duration of cardiopulmonary resuscitation and the
return of spontaneous circulation (10.8 min versus 30.7 min, p < 0.001)
and heart disease and age (60.6 years versus 53.6, p < 0.001) were
identified. The immediate survival rates after cardiac arrest, until
hospital discharge and 6 months after discharge were 71%, 9% and 6%,
respectively. Conclusions The main initial rhythm detected was asystole/bradyarrhythmia; the interval
between cardiac arrest and cardiopulmonary resuscitation was short, but
defibrillation was delayed. Women received cardiopulmonary resuscitation for
longer periods than men. The in-hospital survival rate was low.
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