Hospital-Medical Staff Relations in the Face of Shifting Institutional Business Strategies: A Legal Analysis

This Article will explore, from a legal perspective, the dynamics of the changing relationships between hospitals and their medical staffs. Specifically, the Article will discuss hospital strategies for maximizing the efficiency of their medical staff operations. In this regard, the discussion will encompass two general areas: (1) the use of agreements and policies that restrict access to medical staff membership; and, (2) the development of economic criteria to assess physicians for appointment and reappointment to medical staffs. Both of these general areas of discussion entail significant legal issues that have never been extensively explored and hold the potential to reshape the balance of hospital operations

Usability analysis of contending electronic health record systems

In this paper, we report measured usability of two leading EHR systems during procurement. A total of 18 users participated in paired-usability testing of three scenarios: ordering and managing medications by an outpatient physician, medicine administration by an inpatient nurse and scheduling of appointments by nursing staff. Data for audio, screen capture, satisfaction rating, task success and errors made was collected during testing. We found a clear difference between the systems for percentage of successfully completed tasks, two different satisfaction measures and perceived learnability when looking at the results over all scenarios. We conclude that usability should be evaluated during procurement and the difference in usability between systems could be revealed even with fewer measures than were used in our study. © 2019 American Psychological Association Inc. All rights reserved.Peer reviewe

Doctor of Philosophy

dissertationPreventable adverse events are one of the leading causes of hospitalized patient deaths. Many of these adverse events occur in Intensive Care Units (ICUs) where nurses often work under cognitive, perceptual, and physical overloads. Contributing to these overloads are spatially separated devices which display treatment relevant information such as orders, monitoring information, and equipment status on numerous displays. If essential information of these separate devices was integrated into a single display at the bedside, nurses could potentially reduce their workload and improve their awareness of the patients' treatment plans and physiological status. We conducted a set of three studies for the purpose of designing an efficient and effective ICU display. We observed ICU nurses during their shifts and found that task-relevant information was often presented in the wrong format, unavailable at the point of care or laborious to obtain. Additionally, nurses were sometimes unaware of significant changes in their patient's status and equipment operation. Based on nurses' feedback, we designed an integrated information display that presents all of the information that nurses need at the patient bedside. Nurses selected a display based on the information organization of existing patient monitors, with added medication management and team communication features. The evaluation of paper-based prototypes of both the integrated display and existing ICU displays showed that nurses could answer questions about the patient's status and treatment faster (p<<0.05) and more accurately (p<<0.05) using the integrated display. The number of adverse events in the ICU could potentially be reduced by integrated displays, but to implement them into clinical practice will require significant engineering efforts

Healthcare Management Primer

This primer was written by students enrolled in HMP 721.01, Management of Health Care Organizations, in the Health Management & Policy Program, College of Health and Human Services, University of New Hampshire. This course was taught by Professor Mark Bonica in Fall 2017

Designing Clinical Data Presentation Using Cognitive Task Analysis Methods

Despite the many decades of research on effective use of clinical systems in medicine, the adoption of health information technology to improve patient care continues to be slow especially in ambulatory settings. This applies to dentistry as well, a primary care discipline with approximately 137,000 practicing dentists in the United States. One critical reason is the poor usability of clinical systems, which makes it difficult for providers to navigate through the system and obtain an integrated view of patient data during patient care. Cognitive science methods have shown significant promise to meaningfully inform and formulate the design, development and assessment of clinical information systems. Most of these methods were applied to evaluate the design of systems after they have been developed. Very few studies, on the other hand, have used cognitive engineering methods to inform the design process for a system itself. It is this gap in knowledge – how cognitive engineering methods can be optimally applied to inform the system design process – that this research seeks to address through this project proposal. This project examined the cognitive processes and information management strategies used by dentists during a typical patient exam and used the results to inform the design of an electronic dental record interface. The resulting 'proof of concept' was evaluated to determine the effectiveness and efficiency of such a cognitively engineered and application flow design. The results of this study contribute to designing clinical systems that provide clinicians with better cognitive support during patient care. Such a system will contribute to enhancing the quality and safety of patient care, and potentially to reducing healthcare costs

CPA\u27s guide to medical, dental and other healthcare practices;

CD-ROM files converted to PDF and included after main texthttps://egrove.olemiss.edu/aicpa_guides/1128/thumbnail.jp

Knowledge-Based Medication Administration: Program Evaluation and Optimization

It has been reported by members of The Institute of Medicine that a patient is at risk for one medication administration error per day when hospitalized, thus prevention of medication administration errors is a priority patient safety goal. One recommendation to reduce the prevalence of medication administration errors is the use of barcoded medication administration (BCMA) systems. While there are many benefits to BCMA, there are also issues with existing systems. Suboptimal BCMA design and implementation has resulted in medication administration workarounds. A hospital located in southern New Hampshire, implemented a Knowledge Based Medication Administration (KBMA) system in January 2014. Shortly after implementation, inefficiencies within the system were identified, resulting in KBMA nursing workarounds. The aim of this program evaluation quality improvement project using mixed methods was to identify the system’s issues, and processes resulting in workarounds to find solutions that optimize the KBMA system and ensure patient safety. Override drug scan tracking reports were monitored for specific KBMA nurse workarounds during four phases from January 2014 to December 10, 2014. Simultaneously structured observations of registered nurses using KBMA (N = 52) were conducted over a three-month period. System process changes and educational interventions were provided during the first three phases and withdrawn during the fourth phase. During the evaluation period, there was an overall decrease in KBMA workaround totals from (N = 12, 231) in Phase 1, to (N = 5,321) in Phase 4

A T2 Translational Science Modified Delphi Study: Spinal Motion Restriction in a Resource-Scarce Environment.

AbstractIntroduction:Emerging evidence is guiding changes in prehospital management of potential spinal injuries. The majority of settings related to current recommendations are in resource-rich environments (RREs), whereas there is a lack of guidance on the provision of spinal motion restriction (SMR) in resource-scarce environments (RSEs), such as: mass-casualty incidents (MCIs); low-middle income countries; complex humanitarian emergencies; conflict zones; and prolonged transport times. The application of Translational Science (TS) in the Disaster Medicine (DM) context was used to develop this study, leading to statements that can be used in the creation of evidence-based clinical guidelines (CGs).Objective:What is appropriate SMR in RSEs?Methods:The first round of this modified Delphi (mD) study was a structured focus group conducted at the World Association for Disaster and Emergency Medicine (WADEM) Congress in Brisbane Australia on May 9, 2019. The result of the focus group discussion of open-ended questions produced ten statements that were added to ten statements derived from Fischer (2018) to create the second mD round questionnaire.Academic researchers and educators, operational first responders, or first receivers of patients with suspected spinal injuries were identified to be mD experts. Experts rated their agreement with each statement on a seven-point linear numeric scale. Consensus amongst experts was defined as a standard deviation ≤1.0. Statements that were in agreement reaching consensus were included in the final report; those that were not in agreement but reached consensus were removed from further consideration. Those not reaching consensus advanced to the third mD round.For subsequent rounds, experts were shown the mean response and their own response for each of the remaining statements and asked to reconsider their rating. As above, those that did not reach consensus advanced to the next round until consensus was reached for each statement.Results:Twenty-two experts agreed to participate with 19 completing the second mD round and 16 completing the third mD round. Eleven statements reached consensus. Nine statements did not reach consensus.Conclusions:Experts reached consensus offering 11 statements to be incorporated into the creation of SMR CGs in RSEs. The nine statements that did not reach consensus can be further studied and potentially modified to determine if these can be considered in SMR CGs in RSEs