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Coleman JJ, Atia J, Evison F, Wilson L, Gallier S, Sames R, Capewell A, Copley R, Gyves H, Ball S, Pankhurst T. Adoption by clinicians of electronic order communications in NHS secondary care: a descriptive account. BMJ Health Care Inform 2024; 31:e100850. [PMID: 38729772 PMCID: PMC11097811 DOI: 10.1136/bmjhci-2023-100850] [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: 07/07/2023] [Accepted: 02/24/2024] [Indexed: 05/12/2024] Open
Abstract
BACKGROUND Due to the rapid advancement in information technology, changes to communication modalities are increasingly implemented in healthcare. One such modality is Computerised Provider Order Entry (CPOE) systems which replace paper, verbal or telephone orders with electronic booking of requests. We aimed to understand the uptake, and user acceptability, of CPOE in a large National Health Service hospital system. METHODS This retrospective single-centre study investigates the longitudinal uptake of communications through the Prescribing, Information and Communication System (PICS). The development and configuration of PICS are led by the doctors, nurses and allied health professionals that use it and requests for CPOE driven by clinical need have been described.Records of every request (imaging, specialty review, procedure, laboratory) made through PICS were collected between October 2008 and July 2019 and resulting counts were presented. An estimate of the proportion of completed requests made through the system has been provided for three example requests. User surveys were completed. RESULTS In the first 6 months of implementation, a total of 832 new request types (imaging types and specialty referrals) were added to the system. Subsequently, an average of 6.6 new request types were added monthly. In total, 8 035 132 orders were requested through PICS. In three example request types (imaging, endoscopy and full blood count), increases in the proportion of requests being made via PICS were seen. User feedback at 6 months reported improved communications using the electronic system. CONCLUSION CPOE was popular, rapidly adopted and diversified across specialties encompassing wide-ranging requests.
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Affiliation(s)
- Jamie J Coleman
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
- University of Birmingham, Birmingham, UK
| | - Jolene Atia
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Felicity Evison
- Data Science Team, Research Development and Innovation, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | | | - Suzy Gallier
- PIONEER Health Data Research Hub, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Richard Sames
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Andrew Capewell
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Richard Copley
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Helen Gyves
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Simon Ball
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Tanya Pankhurst
- Digital Healthcare and Department of Renal Medicine, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
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Shah HA, O'Donnell DB, Galvez R, Reed ME, Ghosh D, Katz RR, Bedi AD, D'Amico RS. Digital health technology utilization is associated with enhanced patient perspectives of care. Clin Neurol Neurosurg 2024; 239:108218. [PMID: 38447481 DOI: 10.1016/j.clineuro.2024.108218] [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: 02/21/2024] [Accepted: 02/28/2024] [Indexed: 03/08/2024]
Abstract
BACKGROUND Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) scores measure patient experience and perspectives on care. Novel health information technologies facilitate communication between patients and healthcare teams. Playback Health is a health information technology that incorporates multimedia for providers to communicate health information to patients, their support network, and their healthcare teams. We hypothesized implementing Playback Health may enhance patient perspectives on care. METHODS HCAHPS scores were obtained retrospectively from a neurosurgical practice located in a metropolitan area between 2020 and 2022 for seven providers. Of these, four providers utilized Playback Health, and three did not. Individual providers' scores were compared between domains using two tailed t-tests at a significance level of p < 0.05. RESULTS Playback Health use was associated with higher HCAHPS scores across varying domains from 2020 through 2022 as well as overall scores. In 2020, the mean overall score of HCAHPS users was higher than non-users (89.65 vs. 87.28, p = 0.0095). In 2021, again higher mean overall scores were observed in users as compared to non-users (89.11 vs. 87.79, p 0.0266). In 2022, Playback Health users maintained higher scores across communication domains and overall scores (p < 0.00001). Comparisons within domains between Playback Health users and non-users revealed no domains in which non-users had a significantly higher score than users. CONCLUSION The addition of Playback Health multimedia health information technology was associated with improved patient satisfaction scores. When used as an adjunct to existing patient care, multimedia health information technologies may improve patient perceived care.
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Affiliation(s)
- Harshal A Shah
- Department of Neurosurgery, Lenox Hill Hospital/Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, New York, NY, USA.
| | - Devon B O'Donnell
- Department of Neurosurgery, Lenox Hill Hospital/Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, New York, NY, USA
| | - Rosivel Galvez
- Department of Neurosurgery, Lenox Hill Hospital/Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, New York, NY, USA
| | - Max E Reed
- Weill Cornell Medical College, New York, NY, USA
| | | | - Rebecca R Katz
- Department of Neurosurgery, Lenox Hill Hospital/Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, New York, NY, USA
| | - Anupama D Bedi
- Department of Neurosurgery, Lenox Hill Hospital/Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, New York, NY, USA
| | - Randy S D'Amico
- Department of Neurosurgery, Lenox Hill Hospital/Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, New York, NY, USA
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Wang W, Li H, Huang M. A literature review on the impact of disasters on healthcare systems, the role of nursing in disaster management, and strategies for cancer care delivery in disaster-affected populations. Front Oncol 2023; 13:1178092. [PMID: 37519811 PMCID: PMC10382130 DOI: 10.3389/fonc.2023.1178092] [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: 03/02/2023] [Accepted: 05/15/2023] [Indexed: 08/01/2023] Open
Abstract
This review article highlights the critical role of nurses in disaster management, with a specific focus on addressing blood tumors in disaster-affected populations. Disasters have a significant impact on healthcare systems and populations, and nurses play a crucial role in disaster preparedness, response, and recovery. The article provides case studies and successful examples of nursing interventions in disaster settings and tumor management, emphasizing the challenges and opportunities in providing cancer care in disaster settings. Recommendations for future research and practice in disaster nursing and blood tumor care are also presented. This information is essential for healthcare professionals and policymakers involved in disaster management, as well as researchers and clinicians working in the field of cancer care.
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McInerney C, McCrorie C, Benn J, Habli I, Lawton T, Mebrahtu TF, Randell R, Sheikh N, Johnson O. Evaluating the safety and patient impacts of an artificial intelligence command centre in acute hospital care: a mixed-methods protocol. BMJ Open 2022; 12:e054090. [PMID: 35232784 PMCID: PMC8889317 DOI: 10.1136/bmjopen-2021-054090] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [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
INTRODUCTION This paper presents a mixed-methods study protocol that will be used to evaluate a recent implementation of a real-time, centralised hospital command centre in the UK. The command centre represents a complex intervention within a complex adaptive system. It could support better operational decision-making and facilitate identification and mitigation of threats to patient safety. There is, however, limited research on the impact of such complex health information technology on patient safety, reliability and operational efficiency of healthcare delivery and this study aims to help address that gap. METHODS AND ANALYSIS We will conduct a longitudinal mixed-method evaluation that will be informed by public-and-patient involvement and engagement. Interviews and ethnographic observations will inform iterations with quantitative analysis that will sensitise further qualitative work. Quantitative work will take an iterative approach to identify relevant outcome measures from both the literature and pragmatically from datasets of routinely collected electronic health records. ETHICS AND DISSEMINATION This protocol has been approved by the University of Leeds Engineering and Physical Sciences Research Ethics Committee (#MEEC 20-016) and the National Health Service Health Research Authority (IRAS No.: 285933). Our results will be communicated through peer-reviewed publications in international journals and conferences. We will provide ongoing feedback as part of our engagement work with local trust stakeholders.
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Affiliation(s)
- Ciarán McInerney
- School of Computing, University of Leeds Faculty of Engineering and Physical Sciences, Leeds, UK
- Bradford Royal Infirmary, Wolfson Centre for Applied Health Research, Bradford, UK
| | - Carolyn McCrorie
- Bradford Royal Infirmary, Wolfson Centre for Applied Health Research, Bradford, UK
- School of Psychology, University of Leeds Faculty of Social Sciences, Leeds, UK
| | - Jonathan Benn
- Bradford Royal Infirmary, Wolfson Centre for Applied Health Research, Bradford, UK
- School of Psychology, University of Leeds Faculty of Social Sciences, Leeds, UK
| | - Ibrahim Habli
- Department of Computer Science, University of York, York, UK
| | - Tom Lawton
- Bradford Royal Infirmary, Bradford Teaching Hospitals NHS Foundation Trust, Bradford, UK
| | - Teumzghi F Mebrahtu
- School of Computing, University of Leeds Faculty of Engineering and Physical Sciences, Leeds, UK
| | - Rebecca Randell
- Bradford Royal Infirmary, Wolfson Centre for Applied Health Research, Bradford, UK
- Faculty of Health Studies, University of Bradford, Bradford, UK
| | - Naeem Sheikh
- Bradford Royal Infirmary, Wolfson Centre for Applied Health Research, Bradford, UK
| | - Owen Johnson
- School of Computing, University of Leeds Faculty of Engineering and Physical Sciences, Leeds, UK
- Bradford Royal Infirmary, Wolfson Centre for Applied Health Research, Bradford, UK
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Garling KA. Revitalization of a communication pharmacy course: The journey of reframing student perceptions. CURRENTS IN PHARMACY TEACHING & LEARNING 2022; 14:138-144. [PMID: 35190154 DOI: 10.1016/j.cptl.2021.12.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/29/2020] [Revised: 11/02/2021] [Accepted: 12/24/2021] [Indexed: 06/14/2023]
Abstract
INTRODUCTION Despite the conveniences and logistical safety benefits of health information technology, there is an increasing public need for improved communication in live and virtual encounters with healthcare providers, including pharmacists. Increasingly, the digital world necessitates the need for pharmacy curricula to improve healthcare professional students' fundamental professional communication skills. PERSPECTIVE A new clinical faculty member's journey through revitalizing a pharmacy professional communication course is presented. The project utilized reframing and perception recalibration while adding experiential learning to add curricular application opportunities both face-to-face and virtually. IMPLICATIONS Doctor of pharmacy programs require continued prioritization of the development and teaching of communication curricula to optimize future healthcare providers' effectiveness in improving patient health outcomes. Student perception of pertinence is improved by presenting clear subject matter progression, adapting materials to fit an empathy-based healthcare-specific aim, and pairing didactic material with a community introductory pharmacy practice experience.
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Affiliation(s)
- K Ashley Garling
- University of Texas, Austin College of Pharmacy, 2409 University Avenue, Austin, TX 78712, United States.
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Lafferty M, Harrod M, Krein S, Manojlovich M. It's like sending a message in a bottle: A qualitative study of the consequences of one-way communication technologies in hospitals. J Am Med Inform Assoc 2021; 28:2601-2607. [PMID: 34569593 PMCID: PMC8763228 DOI: 10.1093/jamia/ocab191] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2021] [Revised: 08/16/2021] [Accepted: 08/24/2021] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVE We examine how physicians and nurses use available communication technologies and identify the implications for communication and patient care based on the theory of workarounds. MATERIALS AND METHODS We conducted a qualitative study at 4 U.S. hospitals during 2017. Researchers spent 2 weeks at each hospital conducting unit-based observation, shadowing, interviews, and focus groups with nurses and physicians. Using an iterative process, we inductively coded and thematically analyzed data to derive preliminary themes. The theory of workarounds provides an organizational lens on workarounds, consisting of 5 components: antecedents, types, effects, managerial stance, and organizational challenges of workarounds. The first 3 components of the theory helped us to organize and explain our findings. RESULTS Communication technologies consisted of pagers and telephones. Antecedents to workarounds included one-way information flow, differential access related to differences in technology types, and technology mismatch. Types of workarounds included bypassing a variety of obstacles and substituting for unavailable resources. Direct effects of workarounds included pager fatigue, interruptions in patient care, and potential errors. DISCUSSION One-way communication technologies created an environment where workarounds could flourish. By placing results within the context of the theory of workarounds, we extend what we know about why and how workarounds develop, and offer strategies to minimize workarounds' adverse effects. CONCLUSIONS Through the theory of workarounds, we see that there is a trajectory to workarounds with potential consequences for clinicians and patients. Two-way communication technologies could minimize workarounds and gaps in information exchange, and reduce unnecessary interruptions and the potential for adverse events.
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Affiliation(s)
- Megan Lafferty
- United States Department of Veterans Affairs, Center to Improve Veteran Involvement in Care, VA Medical Center, Portland, Oregon, USA
| | - Molly Harrod
- United States Department of Veterans Affairs, Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, Michigan, USA
| | - Sarah Krein
- Center for Clinical Management Research, VA Ann Arbor Healthcare System and Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, Michigan, USA
| | - Milisa Manojlovich
- School of Nursing, Department of Systems, Populations, and Leadership, University of Michigan, Ann Arbor, Michigan, USA
- Corresponding Author: Milisa Manojlovich, PhD, RN, Department of Systems, Populations, and Leadership, University of Michigan School of Nursing, 400 N. Ingalls, Ann Arbor, MI 48103, USA;
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Manojlovich M, Harrod M, Hofer T, Lafferty M, McBratnie M, Krein SL. Factors influencing physician responsiveness to nurse-initiated communication: a qualitative study. BMJ Qual Saf 2020; 30:747-754. [PMID: 33168635 PMCID: PMC8140397 DOI: 10.1136/bmjqs-2020-011441] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Revised: 10/15/2020] [Accepted: 10/23/2020] [Indexed: 11/03/2022]
Abstract
BACKGROUND How quickly physicians respond to communications from bedside nurses is important for the delivery of safe inpatient care. Delays in physician responsiveness can impede care or contribute to patient harm. Understanding contributory factors to physician responsiveness can provide insights to promote timely physician response, possibly improving communication to ensure safe patient care. The purpose of this study was to describe the factors contributing to physician responsiveness to text or numeric pages, telephone calls and face-to-face messages delivered by nurses on adult general care units. METHODS Using a qualitative design, we collected data through observation, shadowing, interviews and focus groups of bedside registered nurses and physicians who worked in four hospitals in the Midwest USA. We analysed the data using inductive content analysis. RESULTS A total of 155 physicians and nurses participated. Eighty-six nurses and 32 physicians participated in focus groups or individual interviews; we shadowed 37 physicians and nurses across all sites. Two major inter-related themes emerged, message and non-message related factors. Message-related factors included the medium nurses used to convey messages, physician preference for notification via one communication medium over another and the clarity of the message, all of which could cause confusion and thus a delayed response. Non-message related factors included trust and interpersonal relationships, and different perspectives between nurses and physicians on the same clinical issue that affected perceptions of urgency, and contributed to delays in responsiveness. CONCLUSIONS Physician responsiveness to communications from bedside nurses depends on a complex combination of factors related to the message itself and non-message related factors. How quickly physicians respond is a multifactorial phenomenon, and strategies to promote a timely response within the context of a given situation must be directed to both groups.
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Affiliation(s)
| | - Molly Harrod
- Center for Clinical Management Research, Department of Veterans Affair, Ann Arbor Healthcare System, Ann Arbor, Michigan, USA
| | - Timothy Hofer
- Center for Clinical Management Research, Department of Veterans Affair, Ann Arbor Healthcare System, Ann Arbor, Michigan, USA.,Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, Michigan, USA
| | - Megan Lafferty
- School of Nursing, University of Michigan, Ann Arbor, Michigan, USA
| | | | - Sarah L Krein
- Center for Clinical Management Research, Department of Veterans Affair, Ann Arbor Healthcare System, Ann Arbor, Michigan, USA
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Dehnavieh R, Khosravi S, Mehrolhassani MH, Haghdoost A, Amini S. Future Trends of the Primary Healthcare System in Iran: A Qualitative Study. Int J Prev Med 2020; 10:158. [PMID: 32133076 PMCID: PMC6826581 DOI: 10.4103/ijpvm.ijpvm_334_18] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2018] [Accepted: 01/21/2019] [Indexed: 01/03/2023] Open
Abstract
Background Primary healthcare system in Iran has played an extensive role in promoting people health in the past decades. However, regarding universal developments in the different global aspects effective on health, the performance of this system has been influenced significantly. The aim of the present research is to identify the future trends of the primary health care in Iran. Methods The participants of this qualitative case study were experts in primary healthcare, which were selected and interviewed through purposive sampling method. The interview process was saturated after 25 interviews, so we stopped the process at this point. Framework analysis based on STEEP model used to analysis the interviews. Results The most important social/value, technological, economic, environmental, and political future trends of primary healthcare in Iran included demographic transition, epidemiological transition, social and cultural changes, emergence of modern and advanced technologies, internet and cyberspace, budgeting limitations, resource management, changing paradigm from volume to value in providing health services, environmental pollutions, natural disasters, health governance, intellectual paradigm of senior officials, regional security, international development, and other internal factors of the health system. Conclusions The identified factors can be turned into opportunities for Iran primary healthcare system if health planners and policymakers have a deep and accurate look at these influential factors and manage them properly.
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Affiliation(s)
- Reza Dehnavieh
- Medical Informatics Research Center, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
| | - Sajad Khosravi
- Department of Health Services Management, School of Public Health, Bam University of Medical Sciences, Bam, Iran
| | - Mohammad Hossein Mehrolhassani
- Health Services Management Research Center, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
| | - AliAkbar Haghdoost
- Modeling in Health Research Center, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
| | - Saeed Amini
- Department of Health Services Management, Health School, Arak University of Medical Sciences, Arak, Iran
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Using Qualitative Methods to Explore Communication Practices in the Context of Patient Care Rounds on General Care Units. J Gen Intern Med 2020; 35:839-845. [PMID: 31832929 PMCID: PMC7080921 DOI: 10.1007/s11606-019-05580-9] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2019] [Accepted: 11/25/2019] [Indexed: 10/25/2022]
Abstract
BACKGROUND Poor communication between physicians and nurses is a significant contributor to adverse events for hospitalized patients. Overcoming communication difficulties requires examining communication practices to better understand some of the factors that affect the nurse-physician communication process. OBJECTIVE To develop a more detailed understanding of communication practices between nurses and physicians on general care units. We focused on patient care rounds as an important activity in the care delivery process for communication. DESIGN Qualitative study design PARTICIPANTS: A total of 163 physicians, registered nurses, and nurse practitioners who worked on pre-specified general care units in each of four hospitals in the Midwest. APPROACH On each unit, data collection consisted of 2 weeks of observing and shadowing clinicians during rounds and at other times, as well as asking clinicians questions about rounds and communication during interviews and focus groups. A directed content analysis approach was used to code and analyze the data. KEY RESULTS Workflow differences contributed to organizational complexity, affecting rounds and subsequently communication practices, both across and within provider types. Nurse and patient participation during rounds appeared to reduce interruptions and hence cognitive load for physicians and nurses. Physicians adopted certain behaviors within the social context to improve communication, such as socializing and building relationships with the nurses, which contributed to nurse participation in rounds. When rapport was lacking, some nurses felt uncomfortable joining physicians during rounds unless they were explicitly invited. CONCLUSIONS Improving communication requires bringing attention to three contextual dimensions of communication: organizational complexity, cognitive load, and the social context. Initiatives that seek to improve communication may be more successful if they acknowledge the complexity of communication and the context in which it occurs.
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Cornett JA, Kuziemsky C. Team based communication and the healthcare communication space. J Health Organ Manag 2018; 32:825-840. [DOI: 10.1108/jhom-07-2017-0189] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose
While previous studies have described structural, process and social aspects of the healthcare communication space there is no overall model of it. Such a model is an essential first step to improving the operationalization and management of healthcare communication. The paper aims to discuss these issues.
Design/methodology/approach
This paper used a case study approach to study team-based communication on a palliative care unit. Non-participant observation, interviews and documents were analyzed using qualitative content analysis.
Findings
The analysis developed an overall model of the healthcare communication space that consists of five stages: purpose, practices and workflows, structures, implementation, and the development of common ground to support team-based communication. The authors’ findings emphasized that implicit communication remains a predominant means of communication and workflow issues at the individual level are a frequent cause of unnecessary group communication tasks.
Originality/value
To improve team-based communication we first need to develop protocols that support team communication needs such as loop closing of group communication tasks in order to minimize unnecessary individual communication tasks. We also need to develop common ground at the protocol, document and terminology levels as part of supporting team-based communication.
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Burnett S, Brown L, Pettis DD, Jordan C, Pettus S. Implementation of an Interdisciplinary Communication Workgroup on an Acute Psychiatric Unit. Issues Ment Health Nurs 2018; 39:641-646. [PMID: 29648918 DOI: 10.1080/01612840.2018.1445323] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
Communication among Interdisciplinary Healthcare Teams is an essential component of providing optimal patient care. Staff members at one U. S. Department of Veterans Affairs on an Acute Psychiatric Unit identified fragmented communication on the unit and expressed interest in forming an interdisciplinary communication workgroup. This quality improvement (QI) project was designed to enhance communication among the Interdisciplinary Healthcare Team on the Acute Psychiatric Unit. A workgroup was formed and met four times at 1-hour intervals. A pre/post-test was used to determine the initial effectiveness of the intervention. The results of the intervention suggested increased communication among the Interdisciplinary Healthcare Team as an upward trend of the mean scores was noted.
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Affiliation(s)
- Stephanie Burnett
- a Central Arkansas Veterans Healthcare System , North Little Rock , Arkansas , USA
| | - Lana Brown
- b Central Arkansas Veterans Healthcare System , Little Rock , Arkansas , USA
| | - Darla Dee Pettis
- a Central Arkansas Veterans Healthcare System , North Little Rock , Arkansas , USA
| | - Connie Jordan
- a Central Arkansas Veterans Healthcare System , North Little Rock , Arkansas , USA
| | - Stacy Pettus
- a Central Arkansas Veterans Healthcare System , North Little Rock , Arkansas , USA
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Silvera-Tawil D, Pocock C, Bradford D, Donnell A, Harrap K, Freyne J, Brinkmann S. CALD Assist-Nursing: Improving communication in the absence of interpreters. J Clin Nurs 2018; 27:4168-4178. [PMID: 29968388 DOI: 10.1111/jocn.14604] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2018] [Revised: 05/10/2018] [Accepted: 06/24/2018] [Indexed: 11/28/2022]
Abstract
AIMS AND OBJECTIVES To develop a communication app to support nursing staff during the provision of standard care of patients from non-English-speaking backgrounds (NESBs), when an interpreter is not available. This paper reports on the user needs analysis phase that informed the development, content and functionality of the app. BACKGROUND In 2014 we developed CALD Assist, a communication app to support patient interactions with allied health clinicians when interpreters are not present. It includes 95 commonly used phrases professionally interpreted into 10 languages and grouped by discipline. This work expands upon our previous app to meet the needs of the nursing workforce. DESIGN Qualitative through focus groups, observations and interviews, with a quantitative component from observational data and staff surveys. METHODS Four focus groups with hospital staff, ten interviews with patients from NESBs and 85 observation sessions of everyday patient-staff interactions followed by staff surveys (n = 85) were held between January and June 2017. RESULTS Baseline data prior to app development revealed that staff confidence of the patients' level of understanding and the success of the interaction were significantly greater for English-speaking (ES) patients, than for non-English-speaking patients. A total of 143 phrases were identified and subdivided into 16 categories for inclusion in the new app. CONCLUSION Staff participants highlighted that patients from NESBs are a challenging patient group to interact with. Patient and staff participants identified a range of areas where the nursing app could benefit, including pain management, mobility, hygiene and nutrition. RELEVANCE TO CLINICAL PRACTICE The proposed app can be used to reduce variances in practice and provide a timely and positive patient experience for patients from NESBs who are unable to communicate in English during hospital admissions.
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Affiliation(s)
- David Silvera-Tawil
- Australian e-Health Research Centre, CSIRO, Marsfield, New South Wales, Australia
| | - Courtney Pocock
- Speech Pathology Department, Western Health, St Albans, Victoria, Australia
| | - DanaKai Bradford
- Australian e-Health Research Centre, CSIRO, Marsfield, New South Wales, Australia
| | - Andrea Donnell
- Nursing and Midwifery, Western Health, St Albans, Victoria, Australia
| | - Karen Harrap
- Australian e-Health Research Centre, CSIRO, Marsfield, New South Wales, Australia
| | - Jill Freyne
- Australian e-Health Research Centre, CSIRO, Marsfield, New South Wales, Australia
| | - Sally Brinkmann
- Speech Pathology Department, Western Health, St Albans, Victoria, Australia
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Dalal AK, Schnipper J, Massaro A, Hanna J, Mlaver E, McNally K, Stade D, Morrison C, Bates DW. A web-based and mobile patient-centered ''microblog'' messaging platform to improve care team communication in acute care. J Am Med Inform Assoc 2018; 24:e178-e184. [PMID: 27539201 DOI: 10.1093/jamia/ocw110] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2016] [Accepted: 06/17/2016] [Indexed: 11/14/2022] Open
Abstract
Communication in acute care settings is fragmented and occurs asynchronously via a variety of electronic modalities. Providers are often not on the same page with regard to the plan of care. We designed and developed a secure, patient-centered "microblog" messaging platform that identifies care team members by synchronizing with the electronic health record, and directs providers to a single forum where they can communicate about the plan of care. The system was used for 35% of patients admitted to a medical intensive care unit over a 6-month period. Major themes in messages included care coordination (49%), clinical summarization (29%), and care team collaboration (27%). Message transparency and persistence were seen as useful features by 83% and 62% of respondents, respectively. Availability of alternative messaging tools and variable use by non-unit providers were seen as main barriers to adoption by 83% and 62% of respondents, respectively. This approach has much potential to improve communication across settings once barriers are addressed.
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Affiliation(s)
- Anuj K Dalal
- Brigham and Women's Hospital, Boston, Massachusetts.,Harvard Medical School, Boston
| | - Jeffrey Schnipper
- Brigham and Women's Hospital, Boston, Massachusetts.,Harvard Medical School, Boston.,Partners HealthCare, Boston
| | - Anthony Massaro
- Brigham and Women's Hospital, Boston, Massachusetts.,Harvard Medical School, Boston
| | - John Hanna
- Brigham and Women's Hospital, Boston, Massachusetts
| | - Eli Mlaver
- Brigham and Women's Hospital, Boston, Massachusetts
| | | | - Diana Stade
- Brigham and Women's Hospital, Boston, Massachusetts
| | | | - David W Bates
- Brigham and Women's Hospital, Boston, Massachusetts.,Harvard Medical School, Boston.,Partners HealthCare, Boston
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Freyne J, Bradford D, Pocock C, Silvera-Tawil D, Harrap K, Brinkmann S. Developing Digital Facilitation of Assessments in the Absence of an Interpreter: Participatory Design and Feasibility Evaluation With Allied Health Groups. JMIR Form Res 2018; 2:e1. [PMID: 30684405 PMCID: PMC6334691 DOI: 10.2196/formative.8032] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2017] [Revised: 10/16/2017] [Accepted: 11/19/2017] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND To ensure appropriate and timely care, interpreters are often required to aid communication between clinicians and patients from non-English speaking backgrounds. In a hospital environment, where care is delivered 24 hours a day, interpreters are not always available. Subsequently, culturally and linguistically diverse (CALD) patients are sometimes unable to access timely assessment because of clinicians' inability to communicate directly with them. OBJECTIVE The aim of this study was to design and evaluate CALD Assist, a tablet app to assist communication between patients and allied health clinicians in the absence of an interpreter. CALD Assist uses key phrases translated into common languages and uses pictorial, written, and voice-over prompts to facilitate communication during basic patient assessment. METHODS CALD Assist's design, functionality, and content were determined through focus groups with clinicians and informed by interpreting and cultural services. An evaluation was conducted in a live trial phase on eight wards across 2 campuses of a hospital in Victoria, Australia. RESULTS A commercial grade CALD Assist mobile app for five disciplines within allied health was developed and evaluated. The app includes a total of 95 phrases in ten different languages to assist clinicians during their initial assessment. Evaluation results show that clinicians' confidence in their assessment increased with use of the CALD Assist app: clinicians' reports of "complete confidence" increased from 10% (3/30) to 42% (5/12), and assessment reports of "no confidence" decreased from 57% (17/30) to 17% (2/12). Average time required to complete an assessment with patients from non-English speaking backgrounds reduced from 42.0 to 15.6 min. CONCLUSIONS Through the use of CALD Assist, clinician confidence in communicating with patients from non-English speaking backgrounds in the absence of an interpreter increased, providing patients from non-English speaking backgrounds with timely initial assessments and subsequent care in line with their English speaking peers. Additionally, the inclusion of images and video demonstrations in CALD Assist increased the ability to communicate with patients and overcome literacy-related barriers. Although a number of hurdles were faced, user uptake and satisfaction were positive, and the app is now available in the Apple App Store.
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Affiliation(s)
- Jill Freyne
- Australian eHealth Research Centre, Commonwealth Scientific and Industrial Research Organisation, Marsfield, Australia
| | - Dana Bradford
- Australian eHealth Research Centre, Commonwealth Scientific and Industrial Research Organisation, Pullenvale, Australia
| | | | - David Silvera-Tawil
- Australian eHealth Research Centre, Commonwealth Scientific and Industrial Research Organisation, Marsfield, Australia
| | - Karen Harrap
- Australian eHealth Research Centre, Commonwealth Scientific and Industrial Research Organisation, Herston, Australia
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Holmgren AJ, Pfeifer E, Manojlovich M, Adler-Milstein J. A Novel Survey to Examine the Relationship between Health IT Adoption and Nurse-Physician Communication. Appl Clin Inform 2016; 7:1182-1201. [PMID: 27999841 DOI: 10.4338/aci-2016-08-ra-0145] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2016] [Accepted: 11/04/2016] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND As EHR adoption in US hospitals becomes ubiquitous, a wide range of IT options are theoretically available to facilitate physician-nurse communication, but we know little about the adoption rate of specific technologies or the impact of their use. OBJECTIVES To measure adoption of hardware, software, and telephony relevant to nurse-physician communication in US hospitals. To assess the relationship between non-IT communication practices and hardware, software, and telephony adoption. To identify hospital characteristics associated with greater adoption of hardware, software, telephony, and non-IT communication practices. METHODS We conducted a survey of 105 hospitals in the National Nursing Practice Network. The survey captured adoption of hardware, software, and telephony to support nurse-physician communication, along with non-IT communication practices. We calculated descriptive statistics and then created four indices, one for each category, by scoring degree of adoption of technologies or practices within each category. Next, we examined correlations between the three technology indices and the non-IT communication practices index. We used multivariate OLS regression to assess whether certain types of hospitals had higher index scores. RESULTS The majority of hospitals surveyed have a range of hardware, software, and telephony tools available to support nurse-physician communication; we found substantial heterogeneity across hospitals in non-IT communication practices. More intensive non-IT communication was associated with greater adoption of software (r=0.31, p=0.01), but was not correlated with hardware or telephony. Medium-sized hospitals had lower adoption of software (r =-1.14,p=0.04) in comparison to small hospitals, while federally-owned hospitals had lower software (r=-2.57, p=0.02) and hardware adoption (r=-1.63, p=0.01). CONCLUSIONS The positive relationship between non-IT communication and level of software adoption suggests that there is a complementary, rather than substitutive, relationship. Our results suggest that some technologies with the potential to further enhance communication, such as CPOE and secure messaging, are not being utilized to their full potential in many hospitals.
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