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Rogers KJ, Krasowski MD. A dataset examining the impact of direct electronic medical record interfacing on the accuracy of point-of-care urinalysis results. Data Brief 2023; 47:109012. [PMID: 36936643 PMCID: PMC10014286 DOI: 10.1016/j.dib.2023.109012] [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: 12/29/2022] [Revised: 02/13/2023] [Accepted: 02/21/2023] [Indexed: 03/05/2023] Open
Abstract
Point-of-care testing is widely used in a variety of clinical settings. While this testing provides immediate and actionable clinical information, it is prone to error in both the interpretation and reporting of results. Point-of-care urinalysis presents unique opportunities for errors, ranging from variation in visual interpretation to input of results. The data included here represent the results from 63,279 urinalyses from 36,780 unique patients performed over a span of three years at an academic medical center and its associated clinics. The data include the patient age/legal sex, methodology (instrument and test strip used), and the available test results (color, clarity, glucose, bilirubin, ketones, specific gravity, blood, pH, protein, urobilinogen, nitrite, and leukocyte esterase). Additionally, we include the method of interface between the testing instrumentation and our electronic medical record (EMR). These fell into one of three broad categories: "Interfaced" (results directly transmitted from the urinalysis instrument to the EMR via specialized data interface), "Manual" (results input by selecting from a drop-down menu in the laboratory information system), and "Enter/Edit" (results typed freely into a text field in the EMR). Analysis of this data was primarily a direct comparison of detectable errors (typos, uninterpretable results, and results outside the reportable range) as a function of the method of entry into the EMR. Secondary analysis comparing the impact of restricting drop-down menu options for urine color and clarity was also performed. These data are of use to others as they are diverse in terms of the test performed and the method of interface. Others may wish to analyze these data when making decisions as to how to perform and report these tests and when estimating risks of error with various methods of data entry.
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Affiliation(s)
- Kai J. Rogers
- Department of Pathology, University of Iowa Hospitals and Clinics, Iowa City, IA 52242, USA
| | - Matthew D. Krasowski
- Department of Pathology, University of Iowa Hospitals and Clinics, Iowa City, IA 52242, USA
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2
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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: 3] [Impact Index Per Article: 1.5] [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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Fleishhacker ZJ, Rastogi P, Davis SR, Aman DR, Morris CS, Dyson RL, Krasowski MD. Impact of Interfacing Near Point of Care Clinical Chemistry and Hematology Analyzers at Urgent Care Clinics at an Academic Health System. J Pathol Inform 2022; 13:100006. [PMID: 35242445 PMCID: PMC8886311 DOI: 10.1016/j.jpi.2022.100006] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2021] [Accepted: 12/07/2021] [Indexed: 11/25/2022] Open
Abstract
Background Point-of-care (POC) testing equipment is commonly utilized in outpatient clinics. Our institution recently interfaced POC chemistry and hematology devices at two outpatient clinics via middleware software to the central electronic health record (EHR), facilitating a comparison of manual transcription versus automatic reporting via interface. This allowed for estimation of serious/obvious error rates and manual time savings. Additional goals were to develop autoverification rules and analyze broad trends of results in response to common clinician complaints on the POC testing. Material and Methods Data were obtained from two satellite clinic sites providing both primary and urgent care within an academic health system. Interface of devices was accomplished via Instrument Manager middleware software and occurred approximately halfway through the 38 month retrospective timeframe. Laboratory results for three testing POC chemistry and hematology panels were extracted with EHR tools. Results Nearly 100,000 lab values were analyzed and revealed that the rate of laboratory values outside reference range was essentially unchanged before and after interface of POC testing devices (2.0–2.1%). Serious/obvious errors, while rare overall, declined significantly, with none recorded after the interface with autoverified results and only three related to manual edits of results that failed autoverification. Fewer duplicated test results were identified after the interface, most notably with the hematology testing. Anion gap values of less than zero were observed more frequently in POC device tests when compared to central laboratory tests and are attributed to a higher proportion of Cl values greater than 110 mEq/L and CO2 values greater than 30 mEq/L with POC results. Time savings of eliminating manual data entry were calculated to be 21.6 employee hours per month. Conclusions In a switch from manual entry to automatic interface for POC chemistry and hematology, the most notable changes were reduction of serious/obvious errors and duplicate results. Significant time employee time savings highlight an additional benefit of instrument interfacing. Lastly, a difference between POC and central laboratory instruments is a higher rate of high Cl and CO2 values relative to the central laboratory.
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Affiliation(s)
| | - Prerna Rastogi
- Department of Pathology, University of Iowa Hospitals and Clinics, Iowa City, IA, USA
| | - Scott R Davis
- Department of Pathology, University of Iowa Hospitals and Clinics, Iowa City, IA, USA
| | - Dean R Aman
- Health Care Information Systems, University of Iowa Hospitals and Clinics, Iowa City, IA, USA
| | - Cory S Morris
- Health Care Information Systems, University of Iowa Hospitals and Clinics, Iowa City, IA, USA
| | - Richard L Dyson
- Health Care Information Systems, University of Iowa Hospitals and Clinics, Iowa City, IA, USA
| | - Matthew D Krasowski
- Department of Pathology, University of Iowa Hospitals and Clinics, Iowa City, IA, USA
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Ehrler F, Wu DTY, Ducloux P, Blondon K. A mobile application to support bedside nurse documentation and care: a time and motion study. JAMIA Open 2021; 4:ooab046. [PMID: 34345804 PMCID: PMC8324781 DOI: 10.1093/jamiaopen/ooab046] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2020] [Revised: 01/22/2021] [Accepted: 05/28/2021] [Indexed: 12/19/2022] Open
Abstract
Documentation at the bedside is still often initiated on paper before being entered in electronic charts, even after implementing electronic health records (EHRs). This 2-step process is time-consuming, a potential source of error, and hinders the use of real-time information. We developed the “Bedside mobility” smartphone application to facilitate bedside documentation in the EHR. Objective This study aims to evaluate the impact of our app in 2 wards of a teaching hospital with a pre-post design. Materials and methods The duration and location of all documentation activities were recorded using a time motion study. Results Using the app significantly decreased the duration of EHR documentation per hour of observation by 4.10 min (P = 0.003), while the time spent interacting with patient increased by 1.45 min although not significantly. Also, in the intervention period, the average duration of uninterrupted documentation episodes increased by 0.27 min (P = 0.16) and the uninterrupted interaction with patient increased by 8.50 min (P = 0.027). Discussion By reducing the fragmentation of documentation workflow, decreasing the overall EHR documentation time and allowing nurses to spend more time with their patients, app use led to potential higher quality of care and higher patient satisfaction and may help maintain a smoother workflow. Conclusion Our mobile app has the potential to positively impact bedside nurses’ clinical workflow and documentation, as well as patient–provider communication and relationship.
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Affiliation(s)
- Frederic Ehrler
- Division of Medical Information Sciences, University Hospitals of Geneva, Geneva, Switzerland
| | - Danny T Y Wu
- Department of Biomedical Informatics and Pediatrics, University of Cincinnati, Cincinnati, Ohio, USA
| | - Pascal Ducloux
- Nursing Directorate, University Hospitals of Geneva, Geneva, Switzerland
| | - Katherine Blondon
- Medical Directorate, University Hospitals of Geneva, Geneva, Switzerland
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Rosen MA, Romig M, Demko Z, Barasch N, Dwyer C, Pronovost PJ, Sapirstein A. Smart agent system for insulin infusion protocol management: a simulation-based human factors evaluation study. BMJ Qual Saf 2021; 30:893-900. [PMID: 33692190 PMCID: PMC8543218 DOI: 10.1136/bmjqs-2020-011420] [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: 04/27/2020] [Revised: 02/09/2021] [Accepted: 02/18/2021] [Indexed: 12/25/2022]
Abstract
OBJECTIVE To compare the insulin infusion management of critically ill patients by nurses using either a common standard (ie, human completion of insulin infusion protocol steps) or smart agent (SA) system that integrates the electronic health record and infusion pump and automates insulin dose selection. DESIGN A within subjects design where participants completed 12 simulation scenarios, in 4 blocks of 3 scenarios each. Each block was performed with either the manual standard or the SA system. The initial starting condition was randomised to manual standard or SA and alternated thereafter. SETTING A simulation-based human factors evaluation conducted at a large academic medical centre. SUBJECTS Twenty critical care nurses. INTERVENTIONS A systems engineering intervention, the SA, for insulin infusion management. MEASUREMENTS The primary study outcomes were error rates and task completion times. Secondary study outcomes were perceived workload, trust in automation and system usability, all measured with previously validated scales. MAIN RESULTS The SA system produced significantly fewer dose errors compared with manual calculation (17% (n=20) vs 0, p<0.001). Participants were significantly faster, completing the protocol using the SA system (p<0.001). Overall ratings of workload for the SA system were significantly lower than with the manual system (p<0.001). For trust ratings, there was a significant interaction between time (first or second exposure) and the system used, such that after their second exposure to the two systems, participants had significantly more trust in the SA system. Participants rated the usability of the SA system significantly higher than the manual system (p<0.001). CONCLUSIONS A systems engineering approach jointly optimised safety, efficiency and workload considerations.
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Affiliation(s)
- Michael A Rosen
- Armstrong Institute for Patient Safety and Quality, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA .,Department of Health Policy and Management, Bloomberg School of Public Health, School of Nursing; Institute for Clinical and Translational Research, Baltimore, Maryland, USA
| | - Mark Romig
- Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Zoe Demko
- Armstrong Institute for Patient Safety and Quality, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Noah Barasch
- Armstrong Institute for Patient Safety and Quality, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Cynthia Dwyer
- Armstrong Institute for Patient Safety and Quality, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Peter J Pronovost
- University Hospitals of Cleveland, Shaker Heights, Ohio, USA.,Anesthesiology and Critical Care Medicine, Case Western Reserve University School of Medicine, Cleveland, Ohio, USA
| | - Adam Sapirstein
- Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
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Barasch N, Romig MC, Demko ZO, Dwyer C, Dietz A, Rosen M, Griffiths SM, Ravitz AD, Pronovost PJ, Sapirstein A. Automation and interoperability of a nurse-managed insulin infusion protocol as a model to improve safety and efficiency in the delivery of high-alert medications. JOURNAL OF PATIENT SAFETY AND RISK MANAGEMENT 2019. [DOI: 10.1177/2516043519893228] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Affiliation(s)
- Noah Barasch
- The Johns Hopkins Medicine Armstrong Institute for Patient Safety and Quality, Baltimore, MD, USA
| | - Mark C Romig
- The Johns Hopkins Medicine Armstrong Institute for Patient Safety and Quality, Baltimore, MD, USA
- Department of Anesthesiology and Critical Care Medicine, The Johns Hopkins University, Baltimore, MD, USA
| | - Zoe O Demko
- The Johns Hopkins Medicine Armstrong Institute for Patient Safety and Quality, Baltimore, MD, USA
| | - Cindy Dwyer
- The Johns Hopkins Medicine Armstrong Institute for Patient Safety and Quality, Baltimore, MD, USA
| | - Aaron Dietz
- The Johns Hopkins Medicine Armstrong Institute for Patient Safety and Quality, Baltimore, MD, USA
| | - Michael Rosen
- The Johns Hopkins Medicine Armstrong Institute for Patient Safety and Quality, Baltimore, MD, USA
| | - Steven M Griffiths
- Applied Physics Laboratory, The Johns Hopkins University, Baltimore, MD, USA
| | - Alan D Ravitz
- Applied Physics Laboratory, The Johns Hopkins University, Baltimore, MD, USA
| | - Peter J Pronovost
- The Johns Hopkins Medicine Armstrong Institute for Patient Safety and Quality, Baltimore, MD, USA
- Department of Anesthesiology and Critical Care Medicine, The Johns Hopkins University, Baltimore, MD, USA
| | - Adam Sapirstein
- The Johns Hopkins Medicine Armstrong Institute for Patient Safety and Quality, Baltimore, MD, USA
- Department of Anesthesiology and Critical Care Medicine, The Johns Hopkins University, Baltimore, MD, USA
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7
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Menon A, Fatehi F, Ding H, Bird D, Karunanithi M, Gray L, Russell A. Outcomes of a feasibility trial using an innovative mobile health programme to assist in insulin dose adjustment. BMJ Health Care Inform 2019; 26:bmjhci-2019-100068. [PMID: 31676495 PMCID: PMC7062342 DOI: 10.1136/bmjhci-2019-100068] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2019] [Revised: 10/08/2019] [Accepted: 10/12/2019] [Indexed: 12/21/2022] Open
Abstract
Objective Intensification of diabetes therapy with insulin is often delayed for people with suboptimal glycaemic control. This paper reports on the feasibility of using an innovative mobile health (mHealth) programme to assist a diabetes insulin dose adjustment (IDA) service. Methods Twenty adults with diabetes referred to a tertiary hospital IDA service were recruited. They were provided with a cloud-based mobile remote monitoring system—the mobile diabetes management system (MDMS). The credentialled diabetes educator (CDE) recorded the time taken to perform IDA utilising the MDMS versus the conventional method—which is a weekly adjustment of insulin doses by a CDE through telephone contact based on three or more daily blood glucose readings. Participants and staff completed a feedback questionnaire. Results The CDE spent 55% less time performing IDA using MDMS than using the conventional method. The participants were satisfied with MDMS use and the CDEs reported improved efficiency. Conclusion Incorporating a mHealth programme for an IDA service has the potential to improve service delivery efficiencies while simultaneously improving the patient experience.
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Affiliation(s)
- Anish Menon
- Centre for Health Services Research, University of Queensland, Brisbane, Queensland, Australia .,Department of Diabetes and Endocrinology, Princess Alexandra Hospital, Brisbane, Queensland, Australia
| | - Farhad Fatehi
- Centre for Health Services Research, University of Queensland, Brisbane, Queensland, Australia.,School of Advanced Technologies in Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Hang Ding
- The Australian EHealth Research Centre, The Commonwealth Scientific and Industrial Research Organisation, Brisbane, Queensland, Australia
| | - Dominique Bird
- Centre for Health Services Research, University of Queensland, Brisbane, Queensland, Australia
| | - Mohan Karunanithi
- The Australian EHealth Research Centre, The Commonwealth Scientific and Industrial Research Organisation, Brisbane, Queensland, Australia
| | - Leonard Gray
- Centre for Health Services Research, University of Queensland, Brisbane, Queensland, Australia
| | - Anthony Russell
- Centre for Health Services Research, University of Queensland, Brisbane, Queensland, Australia.,Department of Diabetes and Endocrinology, Princess Alexandra Hospital, Brisbane, Queensland, Australia
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