Technology Target Studies: Technology Solutions to Make Patient Care Safer and More Efficient

Presents findings on technologies that could enhance care delivery, including patient records and medication processes; features and functionality nurses require, including tracking, interoperability, and hand-held capability; and best practices

Complex Care Management Program Overview

This report includes brief updates on various forms of complex care management including: Aetna - Medicare Advantage Embedded Case Management ProgramBrigham and Women's Hospital - Care Management ProgramIndependent Health - Care PartnersIntermountain Healthcare and Oregon Health and Science University - Care Management PlusJohns Hopkins University - Hospital at HomeMount Sinai Medical Center -- New York - Mount Sinai Visiting Doctors Program/ Chelsea-Village House Calls ProgramsPartners in Care Foundation - HomeMeds ProgramPrinceton HealthCare System - Partnerships for PIECEQuality Improvement for Complex Chronic Conditions - CarePartner ProgramSenior Services - Project Enhance/EnhanceWellnessSenior Whole Health - Complex Care Management ProgramSumma Health/Ohio Department of Aging - PASSPORT Medicaid Waiver ProgramSutter Health - Sutter Care Coordination ProgramUniversity of Washington School of Medicine - TEAMcar

Reducing Sepsis Mortality: A Cloud-Based Alert Approach

The aim of this study is to examine the impact of a cloud-based CDS alerting system for SIRS, a precursor to sepsis, and sepsis itself, on adult patient and process outcomes at VCU Health System. The two main hypotheses are: 1) the implementation of cloud-based SIRS and sepsis alerts will lead to lower sepsis-related mortality and lower average length of stay, and 2) the implementation of cloud-based SIRS and sepsis alerts will lead to more frequent ordering of the Sepsis PowerPlan and more recording of sepsis diagnoses. To measure these outcomes, a pre-post study was conducted. A pre-implementation group diagnosed with sepsis within the year leading up to the alert intervention consisted of 1,551 unique inpatient visits, and the three-year post-implementation sample size was 9,711 visits, for a total cohort of 11,262 visits. Logistic regression and multiple linear regression were used to test the hypotheses. Study results showed that sepsis-related mortality was slightly higher after the implementation of SIRS alerts, but the presence of sepsis alerts did not have a significant relationship to mortality. The average length of stay and the total number of recorded sepsis diagnoses were higher after the implementation of both SIRS and sepsis alerts, while ordering of the Sepsis Initial Resuscitation PowerPlan was lower. There is preliminary evidence from this study that more sepsis diagnoses are made as a result of alert adoption, suggesting that clinicians can consider the implementation of these alerts in order to capture a higher number of sepsis diagnoses

MS

thesisThe objective of the study was to develop a computerized reminder system to ensure that preoperative deep vein thrombosis (DVT) prophylaxis (anticoagulation or compression devices) was provided for eligible patients. The study design was a prospective trial with historic controls. The setting was LDS Hospital in Salt Lake City, Utah, a tertiary care teaching center. The alternate hypothesis stated that a computerized reminder system would increase the rate of DVT prophylaxis in surgical patients. A local consensus was developed among surgeons as to which procedures should receive DVT prophylaxis. The historic rate of DVT prophylaxis was measured for these procedures at 83.8% (794 of 948 eligible cases). A computerized reminder system was implemented on the hospital's computer system, which flagged patients scheduled for a procedure for which DVT prophylaxis was indicated. The rate of DVT prophylaxis was then remeasured. For the 3 months after the introduction of the reminder, compliance with DVT prophylaxis rose to 99.3% (1118 out of 1126 eligible cases). Fourteen of 54 types of procedures showed statistically significant improvement in the rate of DVT prophylaxis between the study group and the historic controls. The procedures which did not show improvement had a small number of cases (n90%). When individual procedures were combined into groups of similar surgeries, 7 of 10 groups showed statistically significant improvement. Similarly, 3 of 4 surgical divisions showed statistically significant improvement. For all cases combined, the rate of DVT prophylaxis showed highly significant improvement (p<.001) between the historic controls (83.8%) and the study group (99.3%). The conclusion of the study was that a computerized reminder appeared to be an effective method of increasing the rate of DVT prophylaxis in surgical patient

An investigation of healthcare professionals’ experiences of training and using electronic prescribing systems: four literature reviews and two qualitative studies undertaken in the UK hospital context

Electronic prescribing (ePrescribing) is the process of ordering medicines electronically for a patient and has been associated with reduced medication errors and improved patient safety. However, these systems have also been associated with unintended adverse consequences. There is a lack of published research about users’ experiences of these systems in UK hospitals. The aim of this research was therefore to firstly describe the literature pertaining to the recent developments and persisting issues with ePrescribing and clinical decision support systems (CDS) (chapter 2). Two further systematic literature reviews (chapters 3 and 4) were then conducted to understand the unintended consequences of ePrescribing and clinical decision support (CDS) systems across both adult and paediatric patients. These revealed a taxonomy of factors, which have contributed to errors during use of these systems e.g., the screen layout, default settings and inappropriate drug-dosage support. The researcher then conducted a qualitative study (chapters 7-10) to explore users’ experiences of using and being trained to use ePrescribing systems. This study involved conducting semi-structured interviews and observations, which revealed key challenges facing users, including issues with using the ‘Medication List’ and how information was presented. Users experienced benefits and challenges when customising the system, including the screen display; however, the process was sometimes overly complex. Users also described the benefits and challenges associated with different forms of interruptive and passive CDS. Order sets, for instance, encouraged more efficient prescribing, yet users often found them difficult to find within the system. A lack of training resulted in users failing to use all features of the ePrescribing system and left some healthcare staff feeling underprepared for using the system in their role. A further literature review (chapter 5) was then performed to complement emerging themes relating to how users were trained to use ePrescribing systems, which were generated as part of a qualitative study. This review revealed the range of approaches used to train users and the need for further research in this area. The literature review and qualitative study-based findings led to a follow-on study (chapter 10), whereby the researcher conducted semi-structured interviews to examine how users were trained to use ePrescribing systems across four NHS Hospital Trusts. A range of approaches were used to train users; tailored training, using clinically specific scenarios or matching the user’s profession to that of the trainer were preferred over lectures and e-learning may offer an efficient way of training large numbers of staff. However, further research is needed to investigate this and whether alternative approaches such as the use of students as trainers could be useful. This programme of work revealed the importance of human factors and user involvement in the design and ongoing development of ePrescribing systems. Training also played a role in users’ experiences of using the system and hospitals should carefully consider the training approaches used. This thesis provides recommendations gathered from the literature and primary data collection that can help inform organisations, system developers and further research in this area

Master of Science

thesisAnnually, 46 million patients, or 37% of patients seen in the emergency department (ED), receive laboratory testing in the U.S.; thus, making efficient lab order and result management critical to improving ED throughput, clinical efficacy, and safety. In order to manage labs and other processes, electronic emergency department tracking systems (EDTS) or electronic whiteboards have evolved features that support clinical, operational, and administrative needs. EDTSs have often augmented manual data entry with interfaces and/or integration with other systems such as registration, laboratory, radiology, and clinical information systems (CIS). One such integration evaluated in this study, EDTS/CIS context sharing, was added to automatically pass all necessary user, patient, and application parameters between the two systems in order to open the CIS lab module for a selected patient when the user is notified in the EDTS that laboratory test results for that patient are available for review. Therefore, context sharing eliminated multiple user steps needed to log-on, search, select, and navigate to the lab viewing module in order to view a patient's lab results. This study evaluates the effects of adding EDTS/CIS context sharing to an EDTS with lab notifications on ED process times. These effects were measured utilizing a pre- and post-intervention design for all ED encounters where specific common labs were resulted. A method of analyzing CIS audit logs in combination with EDTS and laboratory information system timestamps was implemented to measure patient management processes for quality improvement. After adding context sharing to lab notification features, the median interval between the availability of lab results and review of those results by the ordering provider decreased from 22.7 min., by 25% or 5.7 min. (p-value < 0.001), to 17.0 min. However, median time from resulting of labs to patient discharge were essentially unchanged, decreasing from 106.6 min. to 105.0 min. (p-value = 0.080). The proportion of lab results reviewed by physicians in the CIS integrated with the EDTS increased from 66% to 86% after the intervention (p-value < 0.001). EDTS/CIS context sharing and passive lab notification features improved the timeliness and completion of lab result review in the CIS and increased system adoption in this setting. However, reductions in the time intervals to review of lab results in the CIS did not result in an operationally or statistically significant improvement in time to discharge after the availability of results

Information systems in clinical research : categorization and evaluation of information systems and development of a guide for choosing the appropriate information system

Διπλωματική εργασία--Πανεπιστήμιο Μακεδονίας, Θεσσαλονίκη, 2019.The development of information systems used in clinical research is constantly increasing, as their advantages are widely acknowledged. Although many researchers have introduced information systems which can be used during a clinical study’s process, a scarcity of information systems accommodating the complete process has been detected. Based on this finding, twenty-three (23) information systems and ontologies used in clinical research were retrieved, based on certain criteria. The information systems and ontologies were then categorized and evaluated based on categorization and evaluation tools. Finally, the result was the synthesis of the eligible-for-evaluation information systems and the development of a guide for choosing the appropriate information system during each step of a clinical trial; the data provided by each information system were identified. Unfortunately, some information systems and ontologies were excluded from the synthesis due to lack of information regarding the evaluation criteria. Therefore, future research should proceed with retrieving this information and developing a guide which will consider more information systems, especially for conducting observational studies