PICT-DPA: A Quality-Compliance Data Processing Architecture to Improve the Performance of Integrated Emergency Care Clinical Decision Support System

Emergency Care System (ECS) is a critical component of health care systems by providing acute resuscitation and life-saving care. As a time-sensitive care operation system, any delay and mistake in the decision-making of these EC functions can create additional risks of adverse events and clinical incidents. The Emergency Care Clinical Decision Support System (EC-CDSS) has proven to improve the quality of the aforementioned EC functions. However, the literature is scarce on how to implement and evaluate the EC-CDSS with regard to the improvement of PHOs, which is the ultimate goal of ECS. The reasons are twofold: 1) lack of clear connections between the implementation of EC-CDSS and PHOs because of unknown quality attributes; and 2) lack of clear identification of stakeholders and their decision processes. Both lead to the lack of a data processing architecture for an integrated EC-CDSS that can fulfill all quality attributes while satisfying all stakeholders’ information needs with the goal of improving PHOs. This dissertation identified quality attributes (PICT: Performance of the decision support, Interoperability, Cost, and Timeliness) and stakeholders through a systematic literature review and designed a new data processing architecture of EC-CDSS, called PICT-DPA, through design science research. The PICT-DPA was evaluated by a prototype of integrated PICT-DPA EC-CDSS, called PICTEDS, and a semi-structured user interview. The evaluation results demonstrated that the PICT-DPA is able to improve the quality attributes of EC-CDSS while satisfying stakeholders’ information needs. This dissertation made theoretical contributions to the identification of quality attributes (with related metrics) and stakeholders of EC-CDSS and the PICT Quality Attribute model that explains how EC-CDSSs may improve PHOs through the relationships between each quality attribute and PHOs. This dissertation also made practical contributions on how quality attributes with metrics and variable stakeholders could be able to guide the design, implementation, and evaluation of any EC-CDSS and how the data processing architecture is general enough to guide the design of other decision support systems with requirements of the similar quality attributes

An Evalution of Sepsis Initiatives to Reduce the Severity of Severe Sepsis in a Two-Hospital System

Sepsis is the most expensive clinical condition to treat, with a very high mortality rate (Torio & Moore, 2016). The goal of sepsis treatment is to intervene as early as possible utilizing established criteria. Several evidence-based approaches in the literature address early identification of sepsis, decreasing sepsis severity and reducing morbidity and mortality. Clinical Decision Support (CDS) are tools within certified electronic health records that provide clinicians with patient-specific knowledge presented at appropriate times that enhance decision-making and improve patient outcomes (Villegas & Moore, 2018). Electronic sepsis alerts are examples of CDS that are developed to monitor changes indicative of sepsis in the patient’s condition and alerting providers to expedite early intervention. Health care systems have invested millions of dollars in expanding electronic health record tools, including the CDS sepsis alert, in increasing the early identification of sepsis and implement early interventions. Yet, despite all these improvement initiatives, sepsis rates continue to rise. Yet, the opportunity for improving their use is missed due to the lack of evaluation of its effectiveness. This project was a program evaluation of one health care system’s sepsis CDS and associated improvement initiatives that are focused on the prevention of sepsis among adult medical-surgical patients. The W.K. Kellogg Step by Step Guide to Evaluation (2017) was used to conduct the program evaluation of their sepsis CDS, including electronic sepsis order sets, sepsis education, and an overhead code sepsis process. Despite these initiatives, the organization’s Medicare quality sepsis scores demonstrate that a large percentage of their patients are not receiving evidence-based sepsis care, as documented in the electronic health record (EHR). The analysis and recommendations provide needed information to guide future quality improvements in sepsis care to improve sepsis prevention, improve patient outcomes, and reduce health care costs. The use of systematic program evaluation methods can be used as a strategy to determine the improvement gains from a quality improvement project

The Effect of a Multifaceted Reminder Intervention on Nursing Documentation Completeness

Nationwide, nurses must withstand growing patient assignments and increased workloads. The consistency between nursing documentation and technical nursing interventions performed indicates that registered nurses provide much more care than they record. This incongruence has the potential to impact patient safety, but also has significant financial implications, since reimbursement is linked to documented services. The purpose of this EBP project was to implement a multifaceted reminder intervention (including a 10-minute PowerPoint and visual reminder) in an IMCU setting to assist the nursing staff (n = 38) in completing the HAPU documentation components. John Kotter’s Eight-Stage Process and the Iowa Model of EBP were used to guide this project. Retrospective HAPU audit scores from May, June and July 2015 were compared to audit scores from the intervention implementation months of September, October, and November 2015. Statistically signification improvements (p = .05) were found in ‘documentation of Braden scale on admission and every shift’ (p = .000) and ‘wound preventions supplies in room and in use with documentation’ (p = .002). Statistically significant decreases were also noted in ‘full body assessments on admissions and transfers’ (p = .000) and ‘ear protectors applied and documented’ (p = .000). Because there is limited published data regarding strategies to enhance nursing documentation, the results of this EBP project will add to the current literature and highlights the need for further intervention. Furthermore, changes could to be made to current electronic health record systems to meet the workflow requirements of nurses

Improving the Quality of Electronic Documentation in Critical Care Nursing

Electronic nursing documentation systems can facilitate complete, accurate, timely documentation practices, but without effective policies and procedures in place, a gap in practice exists and quality of care may be impacted. This systematic review of literature examined current evidence regarding electronic nursing documentation quality. General systems theory and the Donabedian model of health care quality provided the framework for the project. Electronic databases PubMed and the Cumulative Index of Nursing and Allied Health were searched for articles addressing electronic nursing documentation practices. The Cochrane systematic review methodology was used to analyze the articles. Articles were excluded if published before 2001 or not in the English language. The search revealed 860 articles of which 35 were included in the final review. Most studies were quasi-experimental involving multiple interventions such as clinical decision support (CDSS), education, and audit and feedback specific documentation foci. The most reported outcomes were an improvement in documentation completeness and correctness. A multifaceted intervention strategy consisting of CDSS, education, and audit and feedback can be used to improve electronic documentation completeness and correctness. Policies and procedures regarding documentation practice should support the intended outcomes. Electronic documentation systems can improve completeness, but care should be taken not to depend on the quantity of documentation alone. Further research may shed light on the importance of concordance or plausibility, and the truth of documentation and ultimately how that can impact social determinates of health and social change

Patient Monitoring Systems

book chapterBiomedical Informatic

Evaluation of the System Attributes of Timeliness and Completeness of the West Virginia Electronic Disease Surveillance System\u27 NationalEDSS Based System

Despite technological advances in public health informatics, the evaluation of infectious disease surveillance systems data remains incomplete. In this study, a thorough evaluation was performed of the West Virginia Electronic Disease Surveillance System (WVEDSS, 2007-2010) and the West Virginia Electronic Disease Surveillance System NationalEDSS -Based System (WVEDSS-NBS; March 2012 - March 2014) for Category II infectious diseases in West Virginia. The purpose was to identify key areas in the surveillance system process from disease diagnosis to disease prevention that need improvement. Grounded in the diffusion of innovation theory, a quasi-experimental, interrupted, time-series design was used to evaluate the 2 data sets. Research questions examined differences in mean reporting time, the 24-hour standard, and comparison of complete fields (DOB, gender etc.) of the data sets using independent samples t tests. The study found (a) that the mean reporting times were shorter for WVEDSS compared to WVEDSS-NBS (p \u3c .05) for all vaccine-preventable infectious diseases (VPID) in Category II except for mumps; (b) that the 24-hour standard was not met for WVEDSS compared to WVEDSS-NBS (p \u3c .05) for all VPID in Category II except for mumps, and (c) that most fields were complete for WVEDSS compared to WVEDSS-NBS (p \u3c .05) for all VPID in Category II except for meningococcal disease. Healthcare professionals in the state can use the results of this research to improve the system attributes of timeliness and completeness. Implications for positive social change included improved access to public health data to better understand health disparities, which, in turn could reduce morbidity and mortality within the population