A Team-Based Approach to Studying Complex Healthcare Processes

Communication is a critical aspect of clinical work. In 2010, the Joint Commission (JC) found that gaps in communication were among leading factors contributing to medical errors. Healthcare processes, such as patient discharge, depend on interdisciplinary communication to be successful. Electronic health records (EHRs) have the potential to facilitate communication and information sharing between interdisciplinary care team members; however, challenges remain in designing tools for team-based care and questions remain in understanding how EHRs impact interdisciplinary team communication. This dissertation focuses on understanding how EHRs can be designed to support communication and information sharing within interdisciplinary patient care teams. The first aim of the dissertation investigated how EHRs impact interdisciplinary clinical teams’ communication, shared mental models, and information sharing activities. The results showed that implementing new EHR tools appeared to have little impact on communication and shared mental models, but new information sharing activities mediated by EHR developed. These changes and lack thereof suggest that new EHR tools will be specifically needed to facilitate interdisciplinary team information sharing activities. The second aim of the dissertation investigates the information sharing activities and information needs of interdisciplinary team members during patient discharge. The results showed that the information clinicians sought out during discharge depended on the roles that person played as well as the progress of the discharge process. Future EHR tools should be aware of how patient care teams are progressing through the patient discharge process in order to provide information contextualized to their current tasks. In conclusion, interdisciplinary team communication and information sharing remain poorly supported by current EHRs and new tools designed specifically for interdisciplinary teams should provide information based on the completion of team activities

Health Information Systems Affordances: How the Materiality of Information Technology Enables and Constrains the Work Practices of Clinicians

The IT artifact is at the core of the information systems (IS) discipline and yet most IS research does not directly theorize the IT artifact or its nomological network (Benbasat and Zmud 2003; Orlikowski and Iacono 2001). This research seeks to answer a repeated call for more direct engagement with the IT artifact and its nomological net with affordance theory adopted as the basis for this theoretical work. An exploratory case study was conducted to answer the research question, how do the material properties of health information systems enable and constrain the work practices of clinicians? The study was conducted at a large urban acute care hospital in the Midwestern United States with registered nurses working on inpatient care units as the clinicians of interest. Through interviews with nurses and other clinical stakeholders and the observation of nurse’s work practices on three patient care units in the hospital, theoretical insights were developed on the nature of affordances for information systems research. IS affordances are defined in this study as relationships between abilities of an individual and features of an information systems within the context of the environment in which they function. The concepts of an affordance range and an affordance threshold are proposed as theoretical constructs in the nomological network of affordances that help to explain the use of information systems as a function of the difficulty of acting on IS affordances. The relationship between affordances and constraints is theorized and linked to the affordance range and threshold with the assertion that constraints are closely associated with the difficulties experienced by users in acting on IS affordances. The challenge of studying IS affordances in all their complexity is discussed with the suggestion that researchers take the user’s perspective of affordances to alleviate the need for repeated decomposition. Finally, the role of information systems in facilitating social interaction is emphasized through the concept of affordances for sociality. The contribution of this research to the IS field is a more nuanced understanding of the nature of the IT artifact and its relationship to the users of that technology

Master of Science

thesisThere is a high risk for communication failures at the hospital discharge. Discharge summaries (DCS) can mitigate these risks by describing not only the hospital course but also follow-up plans. Improvement in the DCS may play a crucial role to improve communication at this transition of care. This research identifies gaps between the local standard of practice and best practices reported in the literature. It also identifies specific components of the DCS that could be improved through enhanced use of health information technology. A manual chart review of 188 DCS was performed. The medication reconciliations were analyzed for completeness and for medical reasoning. The pending results reported in the DCS were compared to those identified in the enterprise data warehouse (EDW). Documentation of follow-up arrangements was analyzed. Report of patient preferences, patient goals, lessons learned, and the overall handover tone were also noted. Patients were discharged on an average of 9.8 medications. Only 3% of the medication reconciliations were complete regarding which medications were continued, changed, new, and discontinued; 94% were incomplete and medical reasoning was frequently absent. There were 358 pending results in 188 hospital discharges. 14% of those results were in the DCS while 86% were only found in the EDW. Less than 50% iv of patients had clear documentation of scheduled follow-up. Patient preferences, patient goals, and lessons learned were rarely (6%, 1%, and 3% respectively) included. There was a handover tone in only 17% of the DCS. The quality gaps in the DCS are consistent with the literature. Medication reconciliations were frequently incomplete, pending results were rarely available, and documentation of follow-up care occurred less than half of the time. Evaluating the DCS primarily as a clinical handover is novel. Information necessary for safe handovers and to promote continuity of care is frequently missing. Future improvements should reshape the DCS to improve continuity of care

Perceptions of Teams in Providing Safe Handoffs

Background: Pediatric hematology/oncology patients are highly complex and providing care to these patients requires effective communication and coordination. Purpose: This project explored the perceptions of handoffs and transitions of team, at a quaternary pediatric health care system, with a descriptive, cross-sectional, non-experimental survey using convenient sampling. The goal was to identify the three top themes of team member perceptions to drive improvement efforts. Sample: 411 team members were invited to participate in survey; 124 completed the survey, a 29% participation rate. Methodology: The project employed quantitative methodology using quantitative data collection with a Likert-style survey to rank handoff experiences within the service line. Sixteen questions were divided into four domains, information, responsibility, accountability, and teamwork. The survey tool was validated by a 10 member panel of subject-matter experts. The tool exceeded Lawshe’s Content Validity Index (\u3e0.70- 0.80) with the score 0.9375. Two open-ended questions probed barriers to handoffs, and ideal characteristics of handoffs. Data Analysis: Descriptive findings considered role, focus of work, location of work, and years of work. Nonparametric testing in SPSS used Kendall’s tau (τ), Friedman’s (χ²) ANOVA, and Cronbach’s alpha for analysis. Findings: Two strengths were identified: 1. Team members frequently consider risk to patients of harm during transitions and 2. Team members demonstrate a personal accountability to get the information in handoffs. Shared goals and shared plan of care were identified as low performers. Conflict resolution and role understanding emerged as needs from open-ended comments. Recommendation: These findings support three themes for future work to improve handoffs. The data supports developing a shared mental model of how goals and plan of care moves with the patient across the service line, and care continuum, along with clear contact information for clarification needs. Handoffs are not just about the transfer of information, there are many correlating factors that influence this process. Attending to the relationships and the team dynamics will be an important focus of this project

Utilization of automated location tracking for clinical workflow analytics and visualization

abstract: The analysis of clinical workflow offers many challenges to clinical stakeholders and researchers, especially in environments characterized by dynamic and concurrent processes. Workflow analysis in such environments is essential for monitoring performance and finding bottlenecks and sources of error. Clinical workflow analysis has been enhanced with the inclusion of modern technologies. One such intervention is automated location tracking which is a system that detects the movement of clinicians and equipment. Utilizing the data produced from automated location tracking technologies can lead to the development of novel workflow analytics that can be used to complement more traditional approaches such as ethnography and grounded-theory based qualitative methods. The goals of this research are to: (i) develop a series of analytic techniques to derive deeper workflow-related insight in an emergency department setting, (ii) overlay data from disparate sources (quantitative and qualitative) to develop strategies that facilitate workflow redesign, and (iii) incorporate visual analytics methods to improve the targeted visual feedback received by providers based on the findings. The overarching purpose is to create a framework to demonstrate the utility of automated location tracking data used in conjunction with clinical data like EHR logs and its vital role in the future of clinical workflow analysis/analytics. This document is categorized based on two primary aims of the research. The first aim deals with the use of automated location tracking data to develop a novel methodological/exploratory framework for clinical workflow. The second aim is to overlay the quantitative data generated from the previous aim on data from qualitative observation and shadowing studies (mixed methods) to develop a deeper view of clinical workflow that can be used to facilitate workflow redesign. The final sections of the document speculate on the direction of this work where the potential of this research in the creation of fully integrated clinical environments i.e. environments with state-of-the-art location tracking and other data collection mechanisms, is discussed. The main purpose of this research is to demonstrate ways by which clinical processes can be continuously monitored allowing for proactive adaptations in the face of technological and process changes to minimize any negative impact on the quality of patient care and provider satisfaction.Dissertation/ThesisDoctoral Dissertation Biomedical Informatics 201

Edge Computing for Extreme Reliability and Scalability

The massive number of Internet of Things (IoT) devices and their continuous data collection will lead to a rapid increase in the scale of collected data. Processing all these collected data at the central cloud server is inefficient, and even is unfeasible or unnecessary. Hence, the task of processing the data is pushed to the network edges introducing the concept of Edge Computing. Processing the information closer to the source of data (e.g., on gateways and on edge micro-servers) not only reduces the huge workload of central cloud, also decreases the latency for real-time applications by avoiding the unreliable and unpredictable network latency to communicate with the central cloud

Share Hand Off Patient Transfer Communication Dalam Pelayanan Kesehatan

Hand off disebut adalah mekanisme transfer informasi, tanggungjawab dan otoritas dari dokter, perawat sebagai pemberi pelayanan atau staf yang lain. Proses hand off meliputi pengirim pesan dari pemberi perawatan dan transisi perawatan ke unit perawatan yang lain sebagai penerima yang menerima informasi dan merawat pasien untuk waktu selanjutnya. Metode yang digunakan dalam penulisan artikel ini adalah literature review. Hasil penelitian dengan metode SHARE hand off ditemukan kepuasan dan harapan yang berbeda antara pengirim (pemberi perawatan yang mentransfer data dan pasien) dan penerima (pemberi perawatan yang menerima data dan perawatan pasien selanjutnya). Komunikasi dalam hand off adalah kunci ketika transfer pasien sehingga diharapkan komunikasi yang terjadi dalam wakti krisis tersebut dimanfaatkan dengan baik oleh penyedia pelayanan kesehatan sehingga terwujud sinkronisasi perawatan dan keselamatan pasien

2022 - The Third Annual Fall Symposium of Student Scholars

The full program book from the Fall 2022 Symposium of Student Scholars, held on November 17, 2022. Includes abstracts from the presentations and posters.https://digitalcommons.kennesaw.edu/sssprograms/1026/thumbnail.jp