Critical care outreach: impacts of electronic observations and alerting technology

Information technology is an increasingly pervasive aspect of the healthcare environment, but introduction of new technology into complex systems like healthcare can create new opportunities for failure. Whilst literature on the unintended consequences of technology is extensive, less is known about the impacts it has on clinical work and patient safety. This paper reports the findings of a case study conducted at a large National Health Service trust in England, where electronic observations and alerting technology was introduced to replace paper charts. Using a qualitative approach, the study aimed to explore the impacts of this technology on a critical care outreach team’s performance and patient safety. Data from observation and 10 semi-structured interviews with critical care outreach nurses were thematically analysed. The new technology has not only changed the way that patient observations data is recorded, displayed and viewed, it has also introduced a new mode of communication between groups of clinical staff: electronic alerts. Four main themes emerged that characterise the main changes brought about by the technology: communication, situation awareness, professional issues and workload. The relationship between aspects of these themes and patient safety was not perceived to be straightforward

Towards pervasive computing in health care – A literature review

<p>Abstract</p> <p>Background</p> <p>The evolving concepts of pervasive computing, ubiquitous computing and ambient intelligence are increasingly influencing health care and medicine. Summarizing published research, this literature review provides an overview of recent developments and implementations of pervasive computing systems in health care. It also highlights some of the experiences reported in deployment processes.</p> <p>Methods</p> <p>There is no clear definition of pervasive computing in the current literature. Thus specific inclusion criteria for selecting articles about relevant systems were developed. Searches were conducted in four scientific databases alongside manual journal searches for the period of 2002 to 2006. Articles included present prototypes, case studies and pilot studies, clinical trials and systems that are already in routine use.</p> <p>Results</p> <p>The searches identified 69 articles describing 67 different systems. In a quantitative analysis, these systems were categorized into project status, health care settings, user groups, improvement aims, and systems features (i.e., component types, data gathering, data transmission, systems functions). The focus is on the types of systems implemented, their frequency of occurrence and their characteristics. Qualitative analyses were performed of deployment issues, such as organizational and personnel issues, privacy and security issues, and financial issues. This paper provides a comprehensive access to the literature of the emerging field by addressing specific topics of application settings, systems features, and deployment experiences.</p> <p>Conclusion</p> <p>Both an overview and an analysis of the literature on a broad and heterogeneous range of systems are provided. Most systems are described in their prototype stages. Deployment issues, such as implications on organization or personnel, privacy concerns, or financial issues are mentioned rarely, though their solution is regarded as decisive in transferring promising systems to a stage of regular operation. There is a need for further research on the deployment of pervasive computing systems, including clinical studies, economic and social analyses, user studies, etc.</p

Otorrinolaringologia na era tecnológica : contribuição dos novos dispositivos móveis

Trabalho Final do Curso de Mestrado Integrado em Medicina, Faculdade de Medicina, Universidade de Lisboa, 2019A Medicina está em constante evolução e tal progresso só foi permitido pelos avanços nas mais diversas áreas científicas, sendo a Tecnologia uma das que mais fortemente a influenciou. Desde o desenvolvimento das Telecomunicações até ao surgimento dos pagers passaram cerca de oito décadas. No entanto, devido ao rápido desenvolvimento tecnoló-gico, em menos de vinte anos surgiram aparelhos completamente inovadores e com múltiplas funções: o Smartphone e o Tablet. Estes aparelhos portáteis, práticos e intuitivos permitem ajudar o Médico nas suas mais variadas responsabilidades clínicas e formativas. A utilização destes novos aparelhos dota-se de múltiplas vantagens, mas também alguns inconvenientes podem advir do seu uso. Sendo a Otorrinolaringologia uma especialidade médica, não iria ficar aleada ao desenvolvimento tecnológico, sendo cada vez maior o número de Aplicações para dispositivos móveis a surgir para auxiliar os Profissionais de Saúde, especialistas ou não, nesta área da Medicina. Estas têm inúmeras aplicabilidades, tais como o auxílio no Exame Objetivo, o acesso rápido e facilitado da pesquisa de referência, o estudo de doenças cró-nicas e seu controlo, entre outras. Assim, com esta Revisão, pretende-se dar a conhecer o contributo dos novos Dispositivos Móveis na saúde, mais especificamente na área de Otorrinolaringologia.Medicine is in a constant evolution, a progress enabled by the advances in the most diversified scientific areas, with Technology being one of its’ strongest influencers. Eight decades have past since the advent of Telecommunications until the first pager. However, due to the fast development of technology, in less than twenty years, innovative devices and with multiples functions have storm the market: the Smarthphones and the Tablets. These portable, practical and intuitive devices have been a major help to Doctors in their most varied clinical and educative responsibilities. There are several advantages in the use of these devices, but there are also some disadvantages. Being Otolaryngology a medical specialty, it hasn’t become unaware of all this technological development, and there is a growing number of Applications for the Mo-bile Devices that can help Doctors, specialists or not, in this health area. They have a massive applicability, such as helping in the Physical Examination, a quick and easy re-search in trustworthy sources, the study and control of chronic disabilities, among others. In this revision, we will go through the contribute of the new Mobile Devices in health, and specifically in the area of Otolaryngology

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