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Chockalingam L, Keniston A, McBeth L, Mutter M. A patient follow-up intervention to improve medical decision making at an internal medicine residency program. Diagnosis (Berl) 2024; 11:142-150. [PMID: 38310520 DOI: 10.1515/dx-2023-0135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2023] [Accepted: 01/11/2024] [Indexed: 02/06/2024]
Abstract
OBJECTIVES Practice-based learning and improvement (PBLI) is an ACGME (Accreditation Council for Graduate Medical Education) core competency. Learning and reflecting on patients through follow-up is one method to help achieve this competency. We therefore designed a study evaluating a structured patient follow-up intervention for senior internal medicine (IM) residents at the University of Colorado Hospital (UCH). METHODS Trainees completed structured reflections after performing chart review of prior patients during protected educational time. Two-month follow-up surveys evaluated the exercise's potential influence on clinical and reflective practices. RESULTS Forty out of 108 (37 %) eligible residents participated in the exercise. Despite 62.5 % of participants lacking specific questions about patient outcomes before chart review, 81.2 % found the exercise at least moderately helpful. 48.4 % of participants believed that the review would change their practice, and 60.9 % felt it reinforced their existing clinical practices. In our qualitative data, residents learned lessons related to challenging clinical decisions, improving transitions of care, the significance of early goals of care conversations, and diagnostic errors/strategies. CONCLUSIONS Our results indicate that IM residents found a structured patient follow-up intervention educational, even when they lacked specific patient outcomes questions. Our results underscore the importance of structured self-reflection in the continuous learning process of trainees and suggest the benefit of dedicated educational time for this process.
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Affiliation(s)
- Leela Chockalingam
- Department of Hospital Medicine, University of Colorado School of Medicine, Aurora, CO, USA
| | - Angela Keniston
- Department of Hospital Medicine, University of Colorado School of Medicine, Aurora, CO, USA
| | - Lauren McBeth
- Department of Hospital Medicine, University of Colorado School of Medicine, Aurora, CO, USA
| | - Marina Mutter
- Department of Hospital Medicine, University of Colorado School of Medicine, Aurora, CO, USA
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Burden M, McBeth L, Keniston A. The development and pilot of a novel mobile application to assess clinician perception of workload and work environment. J Hosp Med 2024. [PMID: 38634753 DOI: 10.1002/jhm.13366] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2023] [Revised: 03/25/2024] [Accepted: 03/31/2024] [Indexed: 04/19/2024]
Abstract
BACKGROUND Traditional measures of workload such as wRVUs may not be adequate to understand the impact of workload on key outcomes. OBJECTIVE The objective of this study was to develop a mobile application to assess, in near real time, clinicians' perception of workload and work environment. DESIGNS, SETTINGS AND PARTICIPANTS We developed the GrittyWork™ application (GW App) using the Chokshi and Mann process model for user-centered digital development. Study occured at a single academic medical center with hospitalist clinicians. MAIN OUTCOME MEASURES AND MEASURES Measures included the System Usability Scale (SUS), use measures from GW App, electronic health record (EHR) event log data and note counts, and qualitative interviews. RESULTS From October 28, 2022 to November 3, 2022, six hospitalist clinicians provided feedback on the early prototype of the GW App, and from February 28, 2023 to June 8, 2023, 30 hospitalist clinicians participated in the pilot while on clinical service. All 30 clinicians (100%) participated in the pilot submitting data for a total of 122 shifts. Participants reported working 10 ± 1 h per day (mean ± SD) and were responsible for an average of 11 ± 3 patients per day. The postpilot evaluation of the GW App showed a SUS score of 86 ± 11 and a participant preference toward mobile application-based surveys (73% of participants). Regarding workload measures, EHR event log data and notes data correlated with physician-reported workloads. Applying user-centered design techniques, we successfully developed a mobile application with high usability. These data can be paired with EHR event log data and outcomes to provide insights into the impact of workloads and work environments on outcomes.
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Affiliation(s)
- Marisha Burden
- Division of Hospital Medicine, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Lauren McBeth
- Division of Hospital Medicine, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Angela Keniston
- Division of Hospital Medicine, University of Colorado School of Medicine, Aurora, Colorado, USA
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Gallant A, Erdman L, McBeth L, Ngov LK, Misky G. Peer feedback: A tool to improve PA, NP, and physician collaboration and clinical practice. JAAPA 2024; 37:1-4. [PMID: 38349079 DOI: 10.1097/01.jaa.0001005628.16104.53] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/24/2024]
Abstract
ABSTRACT The increasing use of physician associates/assistants (PAs) and NPs on clinical teams creates an opportunity for colleagues to provide feedback that can drive growth and improvement in PA and NP clinical skills. Through a needs assessment, month-long pilot, and buy-in from our academic hospital medicine group, we initiated a peer feedback platform that sought to highlight individual faculty strengths, facilitate thoughtful and constructive feedback, and create effective collaboration among colleagues. Three months after implementation, results indicated that the platform provided important information on clinical skills and identified areas for growth and opportunities for additional training. Peer feedback can also improve working relationships among PAs, NPs, and physicians by highlighting the clinical skill sets and value of all team members.
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Affiliation(s)
- Alexandra Gallant
- At the University of Colorado Anschutz Medical Campus in Aurora, Colo., Alexandra Gallant is an assistant professor of hospital medicine, Laura Erdman is an assistant professor in the Division of Hospital Medicine, Lauren McBeth is a project coordinator and data analyst in the Division of Hospital Medicine, Li-Kheng Ngov is an associate professor of clinical practice, and Gregory Misky is an associate professor of medicine. The authors have disclosed no potential conflicts of interest, financial or otherwise
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Callister C, Porter S, Vatterott P, Keniston A, McBeth L, Mann S, Calcaterra SL, Limes J. The Impact of Completing X-Waiver Training and Clinical Addiction Exposure on Internal Medicine Residents Treating Patients With Opioid Use Disorder. Subst Use Addctn J 2024:29767342231221004. [PMID: 38258815 DOI: 10.1177/29767342231221004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/24/2024]
Abstract
BACKGROUND Treating opioid use disorder (OUD) with buprenorphine or methadone significantly reduces overdose and all-cause mortality. Prior studies demonstrate that clinicians and residents reported a lack of preparedness to diagnose or treat OUD. Little is known about how clinical exposure or buprenorphine X-waiver training impacts OUD care delivery by resident physicians. OBJECTIVE Distinguish the effects of X-waiver training and clinical exposure with OUD on resident's knowledge, attitudes, feelings of preparedness, and practices related to OUD treatment provision. METHODS From August 2021 to April 2022, we distributed a cross-sectional survey to internal medicine residents at a large academic training program. We analyzed associations between self-reported clinical exposure and X-waiver training across 4 domains: knowledge about best practices for OUD treatment, attitudes about patients with OUD, preparedness to treat OUD, and clinical experience with OUD. RESULTS Of the 188 residents surveyed, 91 responded (48%). A majority of respondents had not completed X-waiver training (60%, n = 55) while many had provided clinical care to patients with OUD (65%, n = 59). Most residents had favorable attitudes about OUD treatment (97%). Both residents with clinical exposure to treating OUD and X-waiver training, and residents with clinical exposure without X-waiver training, felt more prepared to treat OUD (P < .0008) compared to residents with neither clinical exposure or X-waiver training or only X-waiver training. CONCLUSIONS Residents with clinical exposure to treating OUD are more prepared to treat patients with OUD than those without clinical exposure. Greater efforts to incorporate clinical exposure to the treatment of OUD and education in internal medicine residency programs is imperative to address the opioid epidemic.
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Affiliation(s)
| | - Samuel Porter
- Division of Hospital Medicine, University of Colorado, Aurora, CO, USA
| | - Phillip Vatterott
- Division of Hospital Medicine, University of Colorado, Aurora, CO, USA
| | - Angela Keniston
- Division of Hospital Medicine, University of Colorado, Aurora, CO, USA
| | - Lauren McBeth
- Division of Hospital Medicine, University of Colorado, Aurora, CO, USA
| | - Sarah Mann
- Division of Hospital Medicine, University of Colorado, Aurora, CO, USA
| | - Susan L Calcaterra
- Division of Hospital Medicine, University of Colorado, Aurora, CO, USA
- Division of General Internal Medicine, University of Colorado, Aurora, CO, USA
| | - Julia Limes
- Division of Hospital Medicine, University of Colorado, Aurora, CO, USA
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Mistry N, Knoeckel J, McBeth L, Johnson A, Bredenberg E, Raffel K, Cunningham J, Sarcone E, Misky G, Stella SA. Prevalence of homelessness among hospitalized patients: A point-in-time survey. J Hosp Med 2024; 19:45-50. [PMID: 38058085 DOI: 10.1002/jhm.13241] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2023] [Revised: 10/24/2023] [Accepted: 11/04/2023] [Indexed: 12/08/2023]
Abstract
Although homelessness is associated with increased acute healthcare utilization and poorer health outcomes, the prevalence of homelessness and housing insecurity in hospitalized patients is poorly characterized. We conducted an in-person survey to determine the prevalence of housing insecurity and homelessness among hospitalized patients at two hospitals in metropolitan Denver in conjunction with the Housing and Urban Development point-in-time count on January 24, 2022. Of the 271 surveyed patients, 79 (29.2%) reported experiencing either housing insecurity (17.3%) or homelessness (11.8%). Of those experiencing housing insecurity or homelessness, 69.6% reported chronic health conditions, 55.7% reported multiple hospitalizations in the preceding year, 38% reported mental health concerns and 39.2% reported substance use. The prevalence of homelessness among a hospitalized patient population was over 20-fold higher than community prevalence estimates. Housing insecurity also impacted a substantial proportion of hospitalized patients and was associated with high rates of co-morbid conditions.
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Affiliation(s)
- Neelam Mistry
- Division of Hospital Medicine, Department of Medicine, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Julie Knoeckel
- Division of Hospital Medicine, Department of Medicine, Denver Health Medical Center, Denver, Colorado, USA
| | - Lauren McBeth
- Division of Hospital Medicine, Department of Medicine, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Amanda Johnson
- Division of Hospital Medicine, Department of Medicine, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Erin Bredenberg
- Division of Hospital Medicine, Department of Medicine, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Katie Raffel
- Division of Hospital Medicine, Department of Medicine, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - John Cunningham
- Division of Hospital Medicine, University of Texas Health Science Center at San Antonio, San Antonio, Texas, USA
| | - Ellen Sarcone
- Division of Hospital Medicine, Department of Medicine, Denver Health Medical Center, Denver, Colorado, USA
| | - Gregory Misky
- Division of Hospital Medicine, Department of Medicine, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Sarah A Stella
- Division of Hospital Medicine, Department of Medicine, Denver Health Medical Center, Denver, Colorado, USA
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Morrison KT, Jensen KM, Keniston A, McBeth L, Vermeesch AL, O’Connor K“N. Evaluation of a Guided Nature and Forest Therapy Walk for Internal Medical Residents - A Brief Report. Glob Adv Integr Med Health 2024; 13:27536130241228181. [PMID: 38250708 PMCID: PMC10798121 DOI: 10.1177/27536130241228181] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Revised: 12/08/2023] [Accepted: 01/02/2024] [Indexed: 01/23/2024]
Abstract
Background Medical residents commonly face compassion fatigue, burnout, anxiety, and depression. Studies of nature-based interventions show improved mental and physical health; few focus on healthcare providers. Objective To explore potential benefits of forest bathing for medical residents' wellbeing. Methods Using the Association of Nature and Forest Therapy's framework, we piloted a forest bathing intervention among medical residents with pre/post-participation surveys assessing perceptions of mindfulness and psychological wellbeing. Responses were analyzed using a Fisher's exact test and Student's t-test for independent samples. Results Fourteen of fifteen participants completed both surveys. We observed significantly improved mindfulness scores and expressions of feeling calm, vital, or creative, as well as a decreased sense of anxiety and depression. Nonsignificant trends towards decreased burnout and irritability were seen. Conclusion This quality improvement pilot demonstrates trends that forest bathing can improve medical residents' psychological wellbeing and mindfulness. Further exploration of this intervention for healthcare providers is warranted.
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Affiliation(s)
- Katherine T. Morrison
- Division of General Internal Medicine, Section of Palliative Care, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
- Division of General Internal Medicine, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Kristin M. Jensen
- Division of General Internal Medicine, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
- Division of General Academic Pediatrics, Department of Pediatrics, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Angela Keniston
- Division of Hospital Medicine, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Lauren McBeth
- Division of Hospital Medicine, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Amber L. Vermeesch
- School of Nursing, Advanced Nursing Education Department, University of North Carolina Greensboro, Greensboro, NC, USA
| | - Kerry “Nellie” O’Connor
- Division of General Internal Medicine, Section of Palliative Care, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
- Division of General Internal Medicine, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
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Patel V, Keniston A, McBeth L, Arogyaswamy S, Callister C, Dayton K, Mistry N, Mann S, Burden M. Impact of Clinical Demands on the Educational Mission in Hospital Medicine at 17 Academic Medical Centers : A Qualitative Analysis. Ann Intern Med 2023; 176:1526-1535. [PMID: 37956429 DOI: 10.7326/m23-1497] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2023] Open
Abstract
BACKGROUND Clinical growth is outpacing the growth of traditional educational opportunities at academic medical centers (AMCs). OBJECTIVE To understand the impact of clinical growth on the educational mission for academic hospitalists. DESIGN Qualitative study using semistructured interviews that were analyzed using a mixed inductive and deductive method at the semantic level. SETTING Large AMCs across the United States that experienced clinical growth in the past 5 years. PARTICIPANTS Division heads, section heads, and other hospital medicine (HM) leaders who oversaw and guided academic and clinical efforts of HM programs. MEASUREMENTS Themes and subthemes. RESULTS From September 2021 to January 2022, HM leaders from 17 AMCs participated in the interviews, and 3 key themes emerged. First, AMCs' disproportionate clinical growth highlighted the tension between clinical and educational missions. This included a mismatch in supply and demand for traditional teaching time, competing priorities, and clinical growth being seen as both an opportunity and a threat. Second, amid the shifting landscape of high clinical demands and evolving educational opportunities, hospitalists still strongly prefer traditional teaching. To address this mismatch, HM groups have had to alter recruitment strategies and create innovative solutions to help build academic careers. Third, participants noted a need to reimagine the role and identity of an academic hospitalist, emphasizing tailored career pathways and educational roles spanning well beyond traditional house staff teaching teams. LIMITATION The study focused on large AMCs. CONCLUSION Although HM groups have implemented many creative strategies to address clinical growth and keep education front and center, challenges remain, particularly heavy clinical workloads and a continued dilution of traditional teaching opportunities. PRIMARY FUNDING SOURCE Society of Hospital Medicine Student Scholar Grant.
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Affiliation(s)
- Vishruti Patel
- University of Colorado School of Medicine, Aurora, Colorado (V.P.)
| | - Angela Keniston
- Division of Hospital Medicine, University of Colorado School of Medicine, Aurora, Colorado (A.K., L.M., C.C., K.D., N.M., S.M., M.B.)
| | - Lauren McBeth
- Division of Hospital Medicine, University of Colorado School of Medicine, Aurora, Colorado (A.K., L.M., C.C., K.D., N.M., S.M., M.B.)
| | - Sagarika Arogyaswamy
- California University of Science and Medicine School of Medicine, and Department of Psychiatry, Arrowhead Regional Medical Center, Colton, California (S.A.)
| | - Catherine Callister
- Division of Hospital Medicine, University of Colorado School of Medicine, Aurora, Colorado (A.K., L.M., C.C., K.D., N.M., S.M., M.B.)
| | - Khooshbu Dayton
- Division of Hospital Medicine, University of Colorado School of Medicine, Aurora, Colorado (A.K., L.M., C.C., K.D., N.M., S.M., M.B.)
| | - Neelam Mistry
- Division of Hospital Medicine, University of Colorado School of Medicine, Aurora, Colorado (A.K., L.M., C.C., K.D., N.M., S.M., M.B.)
| | - Sarah Mann
- Division of Hospital Medicine, University of Colorado School of Medicine, Aurora, Colorado (A.K., L.M., C.C., K.D., N.M., S.M., M.B.)
| | - Marisha Burden
- Division of Hospital Medicine, University of Colorado School of Medicine, Aurora, Colorado (A.K., L.M., C.C., K.D., N.M., S.M., M.B.)
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Bredenberg EL, Knoeckel J, Havranek K, McBeth L, Stella S, Garcia M, Sarcone E, Misky G. Hospitalization and Housing: A Qualitative Study Exploring the Perspectives of Hospitalized Patients Experiencing Housing Insecurity. Cureus 2023; 15:e46367. [PMID: 37920645 PMCID: PMC10619708 DOI: 10.7759/cureus.46367] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/29/2023] [Indexed: 11/04/2023] Open
Abstract
Although housing insecurity has clear negative impacts on health, little is known about how it impacts patients' experience of hospitalization. In this qualitative study, we interviewed 22 hospitalized patients experiencing housing insecurity. The following three major themes emerged: 1) adverse social and environmental factors directly contribute to hospitalization, 2) lack of tailored care during hospitalization leaves patients unprepared for discharge, and 3) patients have difficulty recuperating after a hospital stay, leading to the risk of rehospitalization. Within these themes, participants described the roles of extreme physical and psychological hardship, chaotic interpersonal relationships, substance use, and stigma affecting participants' experiences before, during, and following hospitalization. Our results, based directly on the patient experience, suggest a need for hospital systems to invest in universal in-hospital screening for housing insecurity, incorporation of trauma-informed care, and robust partnerships with community organizations. Future research should explore the feasibility and impact of these interventions.
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Affiliation(s)
- Erin L Bredenberg
- Hospital Medicine, University of Colorado School of Medicine, Aurora, USA
| | - Julie Knoeckel
- Hospital Medicine, Denver Health and Hospitals, Denver, USA
- Hospital Medicine, University of Colorado School of Medicine, Aurora, USA
| | - Kathryn Havranek
- Internal Medicine, New York University (NYU) Langone Health, New York, USA
| | - Lauren McBeth
- Hospital Medicine, University of Colorado School of Medicine, Aurora, USA
| | - Sarah Stella
- Hospital Medicine, Denver Health and Hospitals, Denver, USA
- Hospital Medicine, University of Colorado School of Medicine, Aurora, USA
| | - Mackenzie Garcia
- Internal Medicine, Emory University School of Medicine, Atlanta, USA
| | - Ellen Sarcone
- Hospital Medicine, Denver Health and Hospitals, Denver, USA
- Hospital Medicine, University of Colorado School of Medicine, Aurora, USA
| | - Greg Misky
- Hospital Medicine, University of Colorado School of Medicine, Denver, USA
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Burden M, McBeth L, Keniston A. Salient Measures of Hospitalist Workload. JAMA Netw Open 2023; 6:e2328165. [PMID: 37561462 PMCID: PMC10415953 DOI: 10.1001/jamanetworkopen.2023.28165] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Accepted: 06/29/2023] [Indexed: 08/11/2023] Open
Abstract
Importance The ideal hospitalist workload and optimal way to measure it are not well understood. Objective To obtain expert consensus on the salient measures of hospitalist workload. Design, Setting, and Participants This qualitative study used a 3-round Delphi technique between April 5 and July 13, 2022, involving national experts within and external to the field. Experts included hospitalist clinicians, leaders, and administrators, as well as researchers with expertise in human factors engineering and cognitive load theory. Main Outcomes and Measures Three rounds of surveys were conducted, during which participants provided input on the salient measures of hospitalist workload across various domains. In the first round, free-text data collected from the surveys were analyzed using a directed qualitative content approach. In the second and third rounds, participants rated each measure's relevance on a Likert scale, and consensus was evaluated using the IQR. Percentage agreement was also calculated. Results Seventeen individuals from 14 organizations, encompassing clinicians, leaders, administrators, and researchers, participated in 3 rounds of surveys. In round 1, participants provided 135 unique qualitative comments across 10 domains, with 192 unique measures identified. Of the 192 measures presented in the second round, 6 (3%) were considered highly relevant, and 25 (13%) were considered moderately relevant. In round 3, 161 measures not meeting consensus were evaluated, with 25 (16%) considered highly relevant and 95 (59%) considered moderately relevant. Examples of measures considered highly relevant included a patient complexity score and outcome measures such as savings from hospital days avoided and clinician turnover. Conclusions and Relevance In this qualitative study measuring hospitalist workload, multiple measures, including those quantifying work demands and the association of those demands with outcomes, were considered relevant for measuring and understanding workloads. The findings suggest that relying on traditional measures, such as productivity-related measures and financial measures, may offer an incomplete understanding of workloads and their association with key outcomes. By embracing a broader range of measures, organizations may be able to better capture the complexity and nuances of hospitalist work demands and their outcomes on clinicians, patients, and organizations.
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Affiliation(s)
- Marisha Burden
- Division of Hospital Medicine, University of Colorado School of Medicine, Aurora
| | - Lauren McBeth
- Division of Hospital Medicine, University of Colorado School of Medicine, Aurora
| | - Angela Keniston
- Division of Hospital Medicine, University of Colorado School of Medicine, Aurora
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Burden M, Keniston A, Gundareddy VP, Kauffman R, Keach JW, McBeth L, Raffel KE, Rice JD, Washburn C, Kisuule F. Discharge in the a.m.: A randomized controlled trial of physician rounding styles to improve hospital throughput and length of stay. J Hosp Med 2023; 18:302-315. [PMID: 36797598 PMCID: PMC10874597 DOI: 10.1002/jhm.13060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Revised: 01/18/2023] [Accepted: 01/26/2023] [Indexed: 02/18/2023]
Abstract
BACKGROUND To relieve hospital capacity strain, hospitals often encourage clinicians to prioritize early morning discharges which may have unintended consequences. OBJECTIVE We aimed to test the effects of hospitalist physicians prioritizing discharging patients first compared to usual rounding style. DESIGN, SETTING AND PARTICIPANTS Prospective, multi-center randomized controlled trial. Three large academic hospitals. Participants were Hospital Medicine attending-level physicians and patients the physicians cared for during the study who were at least 18 years of age, admitted to a Medicine service, and assigned by standard practice to a hospitalist team. INTERVENTION Physicians were randomized to: (1) prioritizing discharging patients first as care allowed or (2) usual practice. MAIN OUTCOME AND MEASURES Main outcome measure was discharge order time. Secondary outcomes were actual discharge time, length of stay (LOS), and order times for procedures, consults, and imaging. RESULTS From February 9, 2021, to July 31, 2021, 4437 patients were discharged by 59 physicians randomized to prioritize discharging patients first or round per usual practice. In primary adjusted analyses (intention-to-treat), findings showed no significant difference for discharge order time (13:03 ± 2 h:31 min vs. 13:11 ± 2 h:33 min, p = .11) or discharge time (15:22 ± 2 h:50 min vs. 15:21 ± 2 h:50 min, p = .45), for physicians randomized to prioritize discharging patients first compared to physicians using usual rounding style, respectively, and there was no significant change in LOS or on order times of other physician orders. CONCLUSIONS Prioritizing discharging patients first did not result in significantly earlier discharges or reduced LOS.
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Affiliation(s)
- Marisha Burden
- University of Colorado, Division of Hospital Medicine, Aurora, CO
| | - Angela Keniston
- University of Colorado, Division of Hospital Medicine, Aurora, CO
| | - Venkat P. Gundareddy
- Division of Hospital Medicine, Johns Hopkins Bayview, Johns Hopkins School of Medicine, Baltimore, MD
| | - Regina Kauffman
- Division of Hospital Medicine, Johns Hopkins Bayview, Johns Hopkins School of Medicine, Baltimore, MD
| | - Joseph Walker Keach
- University of Colorado, Division of Hospital Medicine, Aurora, CO
- Denver Health Medical Center, Denver, CO
| | - Lauren McBeth
- University of Colorado, Division of Hospital Medicine, Aurora, CO
| | - Katie E. Raffel
- University of Colorado, Division of Hospital Medicine, Aurora, CO
- Denver Health Medical Center, Denver, CO
| | - John D. Rice
- Department of Biostatistics and Informatics, Colorado School of Public Health, Aurora, CO
| | - Catherine Washburn
- Division of Hospital Medicine, Johns Hopkins Bayview, Johns Hopkins School of Medicine, Baltimore, MD
| | - Flora Kisuule
- Division of Hospital Medicine, Johns Hopkins Bayview, Johns Hopkins School of Medicine, Baltimore, MD
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Smith EM, Keniston A, Welles CC, Vukovic N, McBeth L, Harnke B, Burden M. Inpatient clinician workload: a scoping review protocol to understand the definition, measurement and impact of non-procedural clinician workloads. BMJ Open 2022; 12:e062878. [PMID: 36523243 PMCID: PMC9748947 DOI: 10.1136/bmjopen-2022-062878] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
INTRODUCTION Clinicians that care for hospitalised patients face unprecedented work conditions with exposure to highly infectious disease, exceedingly high patient numbers, and unpredictable work demands, all of which have resulted in increases in stress and burnout. Preliminary studies suggest that increasing workloads negatively affect inpatient clinician well-being and may negatively affect job performance; yet high workloads may be prioritised secondary to financial drivers or from workforce shortages. Despite this, the correlation between workload and these negative outcomes has not been fully quantified. Additionally, there are no clear measures for inpatient clinician workload and no standards to define ideal workloads. Using the protocol described here, we will perform a scoping review of the literature to generate a comprehensive understanding of how clinician workload of medical patients is currently defined, measured in clinical settings and its impact on the workforce, patients and institutional outcomes. METHODS AND ANALYSIS We will follow the methodology outlined by Joanna Briggs Institute and Arksey and O'Malley to conduct a comprehensive search of major electronic databases including Ovid Medline (PubMed), Embase (Embase.com), PsycINFO, ProQuest Dissertations and Google Scholar. All relevant published peer-reviewed and dissertaion grey literature will be included. Data will be extracted using a standardised form to capture key article information. Results will be presented in a descriptive narrative format. ETHICS AND DISSEMINATION This review does not require ethics approval though all included studies will be screened to ensure appropriate approval. The synthesis of this literature will provide a better understanding of the current state of work for inpatient clinicians, associated outcomes, and will identify gaps in the literature. These findings will be used in conjunction with an expert Delphi panel to identify measures of inpatient clinician workload to then guide the development of a novel workforce mobile application to actively track clinician work. We aim to lay the groundwork for future workforce studies to understand the optimal workloads that drive key outcomes for clinicians, patients and institutions.
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Affiliation(s)
- Erica Mitchell Smith
- Division of Hospital Medicine, University of Colorado-Anschutz Medical Campus, Aurora, Colorado, USA
| | - Angela Keniston
- Division of Hospital Medicine, University of Colorado-Anschutz Medical Campus, Aurora, Colorado, USA
| | - Christine Cara Welles
- Division of Hospital Medicine, University of Colorado-Anschutz Medical Campus, Aurora, Colorado, USA
| | - Nemanja Vukovic
- Division of Hospital Medicine, University of Colorado-Anschutz Medical Campus, Aurora, Colorado, USA
| | - Lauren McBeth
- Division of Hospital Medicine, University of Colorado-Anschutz Medical Campus, Aurora, Colorado, USA
| | - Ben Harnke
- Strauss Health Sciences Library, University of Colorado-Anschutz Medical Campus, Aurora, Colorado, USA
| | - Marisha Burden
- Division of Hospital Medicine, University of Colorado-Anschutz Medical Campus, Aurora, Colorado, USA
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12
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Baduashvili A, McBeth L, Baird A, Burden M. Understanding the Shades of Gray in Diagnosis-An Online Course in Bayesian Reasoning. J Grad Med Educ 2022; 14:349-350. [PMID: 35754627 PMCID: PMC9200255 DOI: 10.4300/jgme-d-21-01029.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Affiliation(s)
- Amiran Baduashvili
- Visiting Associate Professor of Medicine, University of Colorado School of Medicine Program Director, Advanced Hospital Medicine Clinical Scholars, Division of Hospital Medicine, University of Colorado School of Medicine
| | - Lauren McBeth
- Research Coordinator and Data Analyst, Division of Hospital Medicine, University of Colorado School of Medicine
| | - Andrew Baird
- Instructor of Medicine, Division of Hospital Medicine, University of Colorado School of Medicine
| | - Marisha Burden
- Associate Professor of Medicine, University of Colorado School of Medicine Division Head, Division of Hospital Medicine, University of Colorado School of Medicine
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13
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Arogyaswamy S, Vukovic N, Keniston A, Apgar S, Bowden K, Kantor MA, Diaz M, McBeth L, Burden M. The Impact of Hospital Capacity Strain: a Qualitative Analysis of Experience and Solutions at 13 Academic Medical Centers. J Gen Intern Med 2022; 37:1463-1474. [PMID: 34902096 PMCID: PMC8667526 DOI: 10.1007/s11606-021-07106-8] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2021] [Accepted: 08/19/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND Hospital capacity strain impacts quality of care and hospital throughput and may also impact the well being of clinical staff and teams as well as their ability to do their job. Institutions have implemented a wide array of tactics to help manage hospital capacity strain with variable success. OBJECTIVE Through qualitative interviews, our study explored interventions used to address hospital capacity strain and the perceived impact of these interventions, as well as how hospital capacity strain impacts patients, the workforce, and other institutional priorities. DESIGN, SETTING, AND PARTICIPANTS Qualitative study utilizing semi-structured interviews at 13 large urban academic medical centers across the USA from June 21, 2019, to August 22, 2019 (pre-COVID-19). Interviews were recorded, professionally transcribed verbatim, coded, and then analyzed using a mixed inductive and deductive method at the semantic level. MAIN OUTCOME MEASURES Themes and subthemes of semi-structured interviews were identified. RESULTS Twenty-nine hospitalist leaders and hospital leaders were interviewed. Across the 13 sites, a multitude of provider, care team, and institutional tactics were implemented with perceived variable success. While there was some agreement between hospitalist leaders and hospital leaders, there was also some disagreement about the perceived successes of the various tactics deployed. We found three main themes: (1) hospital capacity strain is complex and difficult to predict, (2) the interventions that were perceived to have worked the best when facing strain were to ensure appropriate resources; however, less costly solutions were often deployed and this may lead to unanticipated negative consequences, and (3) hospital capacity strain and the tactics deployed may negatively impact the workforce and can lead to conflict. CONCLUSIONS While institutions have employed many different tactics to manage hospital capacity strain and see this as a priority, tactics seen as having the highest yield are often not the first employed.
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Affiliation(s)
| | | | - Angela Keniston
- Division of Hospital Medicine, University of Colorado School of Medicine, Aurora, CO, 80045, USA
| | - Sarah Apgar
- Division of Hospital Medicine, University of California, San Francisco, CA, USA
| | - Kasey Bowden
- Division of Hospital Medicine, University of Colorado School of Medicine, Aurora, CO, 80045, USA
| | - Molly A Kantor
- Division of Hospital Medicine, University of California, San Francisco, CA, USA
| | - Manuel Diaz
- Division of Hospital Medicine, University of Colorado School of Medicine, Aurora, CO, 80045, USA
| | - Lauren McBeth
- Division of Hospital Medicine, University of Colorado School of Medicine, Aurora, CO, 80045, USA
| | - Marisha Burden
- Division of Hospital Medicine, University of Colorado School of Medicine, Aurora, CO, 80045, USA.
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14
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Bowden K, Keniston A, McBeth L, Perica K, Burden M. Discharge Today: the Efficacy of a Multi-disciplinary Discharge Team. J Gen Intern Med 2022; 37:1578-1581. [PMID: 34581983 PMCID: PMC9085992 DOI: 10.1007/s11606-021-07043-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Accepted: 07/14/2021] [Indexed: 11/24/2022]
Affiliation(s)
- Kasey Bowden
- Division of Hospital Medicine, University of Colorado School of Medicine, Aurora, CO, USA
| | - Angela Keniston
- Division of Hospital Medicine, University of Colorado School of Medicine, Aurora, CO, USA
| | - Lauren McBeth
- Division of Hospital Medicine, University of Colorado School of Medicine, Aurora, CO, USA
| | | | - Marisha Burden
- Division of Hospital Medicine, University of Colorado School of Medicine, Aurora, CO, USA.
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15
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Keniston A, Patel V, McBeth L, Bowden K, Gallant A, Burden M. The impact of surge adaptations on hospitalist care teams during the COVID-19 pandemic utilizing a rapid qualitative analysis approach. Arch Public Health 2022; 80:57. [PMID: 35177114 PMCID: PMC8851813 DOI: 10.1186/s13690-022-00804-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2021] [Accepted: 01/17/2022] [Indexed: 11/25/2022] Open
Abstract
Background Hospital systems have rapidly adapted to manage the influx of patients with COVID-19 and hospitalists, specialists in inpatient care, have been at the forefront of this response, rapidly adapting to serve the ever-changing needs of the community and hospital system. Institutional leaders, including clinical care team members and administrators, deployed many different strategies (i.e. adaptations) to manage the influx of patients. While many different strategies were utilized in hospitals across the United States, it is unclear how frontline care teams experienced these strategies and multifaceted changes. As these surge adaptations likely directly impact clinical care teams, we aimed to understand the perceptions and impact of these clinical care and staffing adaptations on hospitalists and care team members in order to optimize future surge plans. Methods Qualitative, semi-structured interviews and focus groups with hospitalist physicians, advanced practice providers (APPs), and hospital nursing and care management staff at a quaternary academic medical center. Interviews focused on the impact of COVID-19 surge practices on the following areas: (1) the experience of clinical care teams with the adaptations used to manage the surge (2) the perception and experience with the communication strategies utilized (3) the personal experience with the adaptations (i.e. how they impacted the individual) and (4) if participants had recommendations on strategies for future surges. We utilized rapid qualitative analysis methods to explore themes and subthemes. Results We conducted five focus groups and 21 interviews. Three themes emerged from the work including (1) dynamic clinical experience with a lot of uncertainty, (2) the importance of visible leadership with a focus on sense-making, and (3) the significant emotional toll on care team members. Subthemes included sufficient workforce, role delineation and training, information sharing, the unique dichotomy between the need for flexibility and the need for structure, the importance of communication, and the emotional toll not only on the provider but their families. Several recommendations came from this work. Conclusions COVID-19 surge practices have had direct impact on hospitalists and care team members. Several tactics were identified to help mitigate the many negative effects of COVID-19 on frontline hospitalist providers and care teams. Supplementary Information The online version contains supplementary material available at 10.1186/s13690-022-00804-7.
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Affiliation(s)
- Angela Keniston
- Division of Hospital Medicine, University of Colorado School of Medicine, Aurora, USA
| | | | - Lauren McBeth
- Division of Hospital Medicine, University of Colorado School of Medicine, Aurora, USA
| | - Kasey Bowden
- Division of Hospital Medicine, University of Colorado School of Medicine, Aurora, USA
| | - Alexandra Gallant
- Division of Hospital Medicine, University of Colorado School of Medicine, Aurora, USA
| | - Marisha Burden
- Division of Hospital Medicine, University of Colorado School of Medicine, Aurora, USA.
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16
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Keniston A, Frank M, McBeth L, Barkoudah E, Pavon J, Rohatgi N, Vaughn V, Bhandari S, Burden M. Utilization of a National Writing Challenge to Promote Scholarly Work: A Pilot Study. Cureus 2022; 14:e21935. [PMID: 35273876 PMCID: PMC8900829 DOI: 10.7759/cureus.21935] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/08/2022] [Indexed: 11/12/2022] Open
Abstract
Background Hospitalists value mentorship and scholarly work, yet often struggle to find time and mentors amid busy clinical workloads. Objective To help catalyze writing for hospitalists nationally, we created a Writing Challenge, where we asked hospitalists to commit to the goal of writing 400 words a day, four days a week, for four weeks. Methods Prospective, programmatic evaluation with daily logs followed by a survey at the completion of the project. The four-week Writing Challenge occurred between June 7 and July 5, 2021. Email invitations to participate in the challenge were disseminated to peer networks, and the challenge was promoted using social media. Participants agreed to attempt to write 400 words per day, four days per week, for four weeks. Results Seventy-four individuals from 28 institutions registered for the Writing Challenge, with 36 (49%) participating in the challenge by logging their writing. Participants wrote an average of 4,372 +/- 4,324 words during the challenge. Sixty-eight percent of the participants reported that their amount of writing increased during the challenge and 50% of the participants stated they planned to publish their work, though many participants (46%) reported struggling to write each day. Conclusions The Writing Challenge is one way to generate increased writing and may result in increased scholarly output for academic hospitalists.
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Keniston A, McBeth L, Pell J, Bowden K, Metzger A, Nordhagen J, Anthony A, Rice J, Burden M. The Effectiveness of a Multidisciplinary Electronic Discharge Readiness Tool: Prospective, Single-Center, Pre-Post Study. JMIR Hum Factors 2021; 8:e27568. [PMID: 34747702 PMCID: PMC8663627 DOI: 10.2196/27568] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Revised: 05/23/2021] [Accepted: 06/06/2021] [Indexed: 11/13/2022] Open
Abstract
Background In the face of hospital capacity strain, hospitals have developed multifaceted plans to try to improve patient flow. Many of these initiatives have focused on the timing of discharges and on lowering lengths of stay, and they have met with variable success. We deployed a novel tool in the electronic health record to enhance discharge communication. Objective The aim of this study is to evaluate the effectiveness of a discharge communication tool. Methods This was a prospective, single-center, pre-post study. Hospitalist physicians and advanced practice providers (APPs) used the Discharge Today Tool to update patient discharge readiness every morning and at any time the patient status changed throughout the day. Primary outcomes were tool use, time of day the clinician entered the discharge order, time of day the patient left the hospital, and hospital length of stay. We used linear mixed modeling and generalized linear mixed modeling, with team and discharging provider included in all the models to account for patients cared for by the same team and the same provider. Results During the pilot implementation period from March 5, 2019, to July 31, 2019, a total of 4707 patients were discharged (compared with 4558 patients discharged during the preimplementation period). A total of 352 clinical staff had used the tool, and 84.85% (3994/4707) of the patients during the pilot period had a discharge status assigned at least once. In a survey, most respondents reported that the tool was helpful (32/34, 94% of clinical staff) and either saved time or did not add additional time to their workflow (21/24, 88% of providers, and 34/34, 100% of clinical staff). Although improvements were not observed in either unadjusted or adjusted analyses, after including starting morning census per team as an effect modifier, there was a reduction in the time of day the discharge order was entered into the electronic health record by the discharging physician and in the time of day the patient left the hospital (decrease of 2.9 minutes per additional patient, P=.07, and 3 minutes per additional patient, P=.07, respectively). As an effect modifier, for teams that included an APP, there was a significant reduction in the time of day the patient left the hospital beyond the reduction seen for teams without an APP (decrease of 19.1 minutes per patient, P=.04). Finally, in the adjusted analysis, hospital length of stay decreased by an average of 3.7% (P=.06). Conclusions The Discharge Today tool allows for real time documentation and sharing of discharge status. Our results suggest an overall positive response by care team members and that the tool may be useful for improving discharge time and length of stay if a team is staffed with an APP or in higher-census situations.
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Affiliation(s)
- Angela Keniston
- Anschutz Medical Campus, Division of Hospital Medicine, University of Colorado, Aurora, CO, United States
| | - Lauren McBeth
- Anschutz Medical Campus, Division of Hospital Medicine, University of Colorado, Aurora, CO, United States
| | - Jonathan Pell
- Anschutz Medical Campus, Division of Hospital Medicine, University of Colorado, Aurora, CO, United States
| | - Kasey Bowden
- Anschutz Medical Campus, Division of Hospital Medicine, University of Colorado, Aurora, CO, United States
| | - Anna Metzger
- Colorado School of Public Health, University of Colorado, Aurora, CO, United States
| | | | | | - John Rice
- Adult and Child Center for Health Outcomes Research and Delivery Science, University of Colorado, Aurora, CO, United States
| | - Marisha Burden
- Anschutz Medical Campus, Division of Hospital Medicine, University of Colorado, Aurora, CO, United States
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18
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Gottenborg E, Yu A, Naderi R, Keniston A, McBeth L, Morrison K, Schwartz D, Burden M. COVID-19's impact on faculty and staff at a School of Medicine in the US: what is the blueprint for the future? BMC Health Serv Res 2021; 21:395. [PMID: 33910541 PMCID: PMC8079230 DOI: 10.1186/s12913-021-06411-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2020] [Accepted: 04/19/2021] [Indexed: 11/25/2022] Open
Abstract
Background The Coronavirus Disease 2019 (COVID-19) caused unprecedented challenges within medical centers, revealing inequities embedded in the medical community and exposing fragile social support systems. While faculty and staff faced extraordinary demands in workplace duties, personal responsibilities also increased. The goal of this study was to understand the impact of the COVID-19 pandemic on personal and professional activities of faculty and staff in order to illuminate current challenges and explore solutions. Methods Qualitative, semi-structured group interviews involved faculty and staff at four affiliate sites within the Department of Medicine at the University of Colorado, School of Medicine. Focus groups addressed the impact of COVID-19 on (1) Changes to roles and responsibilities at work and at home, (2) Resources utilized to manage these changes and, (3) Potential strategies for how the Department could assist faculty and staff. Thematic analysis was conducted using an inductive method at the semantic level to form themes and subthemes. Results Qualitative analysis of focus group transcripts revealed themes of: (1) Challenges and disparities experienced during the pandemic, (2) Disproportionate impact on women personally and professionally, (3) Institutional factors that contributed to wellness and burnout, and (4) Solutions and strategies to support faculty and staff. Within each of these themes were multiple subthemes including increased professional and personal demands, concern for personal safety, a sense of internal guilt, financial uncertainty, missed professional opportunities, and a negative impact on mentoring. Solutions were offered and included an emphasis on addressing preexisting inequities, the importance of community, and workplace flexibility. Conclusions The COVID-19 pandemic created burdens for already challenged faculty and staff in both their personal and professional lives. Swift action and advocacy by academic institutions is needed to support the lives and careers of our colleagues now and in the future.
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Affiliation(s)
- Emily Gottenborg
- Department of Medicine, Division of Hospital Medicine, University of Colorado School of Medicine, 12401 E. 17th Avenue, Aurora, CO, 80045, USA. .,Department of Medicine, University of Colorado School of Medicine, 12605 E. 16th Avenue, Aurora, CO, 80045, USA.
| | - Amy Yu
- Department of Medicine, Division of Hospital Medicine, University of Colorado School of Medicine, 12401 E. 17th Avenue, Aurora, CO, 80045, USA.,Department of Medicine, University of Colorado School of Medicine, 12605 E. 16th Avenue, Aurora, CO, 80045, USA
| | - Roxana Naderi
- Department of Medicine, Division of Hospital Medicine, University of Colorado School of Medicine, 12401 E. 17th Avenue, Aurora, CO, 80045, USA.,Department of Medicine, University of Colorado School of Medicine, 12605 E. 16th Avenue, Aurora, CO, 80045, USA
| | - Angela Keniston
- Department of Medicine, Division of Hospital Medicine, University of Colorado School of Medicine, 12401 E. 17th Avenue, Aurora, CO, 80045, USA.,Department of Medicine, University of Colorado School of Medicine, 12605 E. 16th Avenue, Aurora, CO, 80045, USA
| | - Lauren McBeth
- Department of Medicine, Division of Hospital Medicine, University of Colorado School of Medicine, 12401 E. 17th Avenue, Aurora, CO, 80045, USA.,Department of Medicine, University of Colorado School of Medicine, 12605 E. 16th Avenue, Aurora, CO, 80045, USA
| | - Katherine Morrison
- Department of Medicine, University of Colorado School of Medicine, 12605 E. 16th Avenue, Aurora, CO, 80045, USA.,Department of Medicine, Division of General Internal Medicine, University of Colorado, 12605 E. 16th Avenue, Aurora, CO, 80045, USA
| | - David Schwartz
- Department of Medicine, University of Colorado School of Medicine, 12605 E. 16th Avenue, Aurora, CO, 80045, USA.,Division of Pulmonary Sciences and Critical Care Medicine, University of Colorado School of Medicine, Aurora, USA
| | - Marisha Burden
- Department of Medicine, Division of Hospital Medicine, University of Colorado School of Medicine, 12401 E. 17th Avenue, Aurora, CO, 80045, USA.,Department of Medicine, University of Colorado School of Medicine, 12605 E. 16th Avenue, Aurora, CO, 80045, USA
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19
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Keniston A, McBeth L, Pell J, Bowden K, Ball S, Stoebner K, Scherzberg E, Moore SL, Nordhagen J, Anthony A, Burden M. Development and Implementation of a Multidisciplinary Electronic Discharge Readiness Tool: User-Centered Design Approach. JMIR Hum Factors 2021; 8:e24038. [PMID: 33890860 PMCID: PMC8105757 DOI: 10.2196/24038] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2020] [Revised: 01/16/2021] [Accepted: 03/29/2021] [Indexed: 01/29/2023] Open
Abstract
BACKGROUND Typical solutions for improving discharge planning often rely on one-way communication mechanisms, static data entry into the electronic health record (EHR), or in-person meetings. Lack of timely and effective communication can adversely affect patients and their care teams. OBJECTIVE Applying robust user-centered design strategies, we aimed to design an innovative EHR-based discharge readiness communication tool (the Discharge Today tool) to enable care teams to communicate any barriers to discharge, the status of patient discharge readiness, and patient discharge needs in real time across hospital settings. METHODS We employed multiple user-centered design strategies, including exploration of the current state for documenting discharge readiness and directing discharge planning, iterative low-fidelity prototypes, multidisciplinary stakeholder meetings, a brainwriting premortem exercise, and preproduction user testing. We iteratively collected feedback from users via meetings and surveys. RESULTS We conducted 28 meetings with 20 different stakeholder groups. From these stakeholder meetings, we developed 14 low-fidelity prototypes prior to deploying the Discharge Today tool for our pilot study. During the pilot study, stakeholders requested 46 modifications, of which 25 (54%) were successfully executed. We found that most providers who responded to the survey reported that the tool either saved time or did not change the amount of time required to complete their discharge workflow (21/24, 88%). Responses to open-ended questions offered both positive feedback and opportunities for improvement in the domains of efficiency, integration into workflow, avoidance of redundancies, expedited communication, and patient-centeredness. CONCLUSIONS Survey data suggest that this electronic discharge readiness tool has been successfully adopted by providers and clinical staff. Frequent stakeholder engagement and iterative user-centered design were critical to the successful implementation of this tool.
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Affiliation(s)
- Angela Keniston
- Division of Hospital Medicine, Anschutz Medical Campus, University of Colorado, Aurora, CO, United States
| | - Lauren McBeth
- Division of Hospital Medicine, Anschutz Medical Campus, University of Colorado, Aurora, CO, United States
| | - Jonathan Pell
- Division of Hospital Medicine, Anschutz Medical Campus, University of Colorado, Aurora, CO, United States
| | - Kasey Bowden
- Division of Hospital Medicine, Anschutz Medical Campus, University of Colorado, Aurora, CO, United States
| | | | | | | | - Susan L Moore
- Colorado School of Public Health, University of Colorado, Aurora, CO, United States
| | | | | | - Marisha Burden
- Division of Hospital Medicine, Anschutz Medical Campus, University of Colorado, Aurora, CO, United States
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20
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Nepal S, Keniston A, Indovina KA, Frank MG, Stella SA, Quinzanos-Alonso I, McBeth L, Moore SL, Burden M. What Do Patients Want? A Qualitative Analysis of Patient, Provider, and Administrative Perceptions and Expectations About Patients' Hospital Stays. J Patient Exp 2020; 7:1760-1770. [PMID: 33457641 PMCID: PMC7786759 DOI: 10.1177/2374373520942403] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Patient experience is increasingly recognized as a measure of health care quality and patient-centered care and is currently measured through the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS). The HCAHPS survey may miss key factors important to patients, and in particular, to underserved patient populations. We performed a qualitative study utilizing semi-structured interviews with 45 hospitalized English- and Spanish-speaking patients and 6 focus groups with physicians, nurses, and administrators at a large, urban safety-net hospital. Four main themes were important to patients: (1) the hospital environment including cleanliness and how hospital policies and procedures impact patients’ perceived autonomy, (2) whole-person care, (3) communication with and between care teams and utilizing words that patients can understand, and (4) responsiveness and attentiveness to needs. We found that several key themes that were important to patients are not fully addressed in the HCAHPS survey and there is a disconnect between what patients and care teams believe patients want and what hospital policies drive in the care environment.
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Affiliation(s)
- Sansrita Nepal
- Division of Hospital Medicine, Denver Health, Denver, CO, USA.,Division of Hospital Medicine, University of Colorado School of Medicine, Aurora, CO, USA.,Both the authors are first co-authors
| | - Angela Keniston
- Division of Hospital Medicine, Denver Health, Denver, CO, USA.,Division of Hospital Medicine, University of Colorado School of Medicine, Aurora, CO, USA.,Both the authors are first co-authors
| | - Kimberly A Indovina
- Division of Hospital Medicine, Denver Health, Denver, CO, USA.,Division of Hospital Medicine, University of Colorado School of Medicine, Aurora, CO, USA
| | - Maria G Frank
- Division of Hospital Medicine, Denver Health, Denver, CO, USA.,Division of Hospital Medicine, University of Colorado School of Medicine, Aurora, CO, USA
| | - Sarah A Stella
- Division of Hospital Medicine, Denver Health, Denver, CO, USA.,Division of Hospital Medicine, University of Colorado School of Medicine, Aurora, CO, USA
| | - Itziar Quinzanos-Alonso
- Division of Hospital Medicine, Denver Health, Denver, CO, USA.,Division of Hospital Medicine, University of Colorado School of Medicine, Aurora, CO, USA
| | - Lauren McBeth
- Division of Hospital Medicine, Denver Health, Denver, CO, USA.,Division of Hospital Medicine, University of Colorado School of Medicine, Aurora, CO, USA
| | - Susan L Moore
- Community and Behavioral Health, Colorado School of Public Health, Aurora, CO, USA.,Division of General Internal Medicine, University of Colorado, Aurora, CO, USA
| | - Marisha Burden
- Division of Hospital Medicine, University of Colorado School of Medicine, Aurora, CO, USA
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