Implementing clinical process management of vascular wounds in a tertiary facility: Impact evaluation of a performance improvement project

BACKGROUND: Chronic vascular wounds have a significant economic and social impact on our society calling for allocation of a great deal of attention and resources. Efforts should be oriented toward the achievement of the most effective and efficient clinical management. The Angiology Unit at the University Hospital of Padova, Italy, developed a performance improvement project to enhance the quality of practice for vascular ulcers. METHODS: The project consisted in a multistep process comprising a critical revision of the previous clinical process management, staff education, tightening connections between operators and services, and creation of a position for a wound care nurse. The previous standard of practice was modified according to the results of revision and the current evidence-based practice. RESULTS: The new standard of practice reached its full application in September 2015. The number of patients treated and the number of visits in 2015 remained almost unvaried from 2014. However, the total annual expenditure for treating vascular ulcers was reduced by ~60% from the previous year. CONCLUSION: Standardization of guidelines and practice is effective in creating an efficient clinical management and in reducing the economic burden of vascular ulcers

A Measurement of Readiness for Tennessee Hospitals to Implement “Meaningful Use” Criteria Resulting from the American Recovery and Reinvestment Act, 2009

In 2009, the American Recovery and Reinvestment Act was signed into law. This legislation provided for monetary rewards for those acute-care hospitals that meet meaningful use computerization and reporting criteria. The study used a descriptive, nonexperimental design to answer three research questions (1) What is the level of readiness to meet meaningful use criteria in the Tennessee Hospital Association (THA) member hospitals; (2) What is the level of readiness to meet meaningful use criteria in the rural THA member hospitals; and (3) Is there a difference in the readiness to meet meaningful use criteria between rural and urban THA member hospitals?. A survey was sent to 115 THA member hospital, with a return rate of 83% (N=95). The inclusion criteria focused on acute-care hospitals, with rehabilitation, psychiatric and long-term care hospitals falling into the exclusion criteria. The Readiness Score was determined for the total survey respondents (N=95), as well as for the rural (N=41) hospitals and urban (N=54) hospitals in the Tennessee Hospital Association member hospitals meeting the inclusion criteria. Z-scores of the readiness score were examined and indicated that there was one outlier with z\u3e3.0. Therefore, that case was removed from the comparison in the t-test (N=94). The t-test comparison of rural and urban hospital found a significant difference at (p=.002), two tailed. To ensure that the slightly nonnormal distribution of the readiness scores did not explain the difference found with the t-test, an additional nonparametric test was also conducted. The Mann Whitney U-test showed that even with the assumption of a normal distribution is not made, the difference in readiness between urban and rural hospitals is still statistically significant at p=0.026

Computer Charting: An Evaluation of a Respiratory Care Computer System

journal articleBiomedical Informatic

Nursing resource management--: current practices and alternatives.

by Chan Wai Han, Florence, Hui Wendy Wan Yee.Thesis (M.B.A.)--Chinese University of Hong Kong, 2000.Includes bibliographical references (leaf [44])

Nursing process: systematization of the nursing care instrument in the perception of nurses

Objective: this study aimed to identify the perception of nurses about the contribution of the nursing process for the systematization of nursing care performed in a Teaching Hospital in the South of Brazil. Methods: descriptive and exploratory qualitative study. The study participants were 38 nurses. The qualitative analysis was of the content and with the resources of the Atlas Ti® software. Results: after the analysis the following thematic categories were found: operational aspects of the nursing process; the nursing process and its practical application; facilities and difficulties in implementing the Nursing Process. Conclusion: the use of a care model to guide nursing practice for more than three decades has reflected positively on the quality of the assistance provided, as well as the satisfaction of nurses to perceive their work as recognized. The nursing process improves the systematization of nursing care, with the philosophy of the institution and of the Nursing Service aligned to a permanent education policy

Nurses' Knowledge, Attitude and Practices of Nursing Informatics System in Outpatient Clinics of Children's Cancer Hospital (57357) at Cairo

Technology in health care is increasingly becoming an integral part of the Egypt. Health care delivery system and is declared by strategists as a means whereby sustained improvement in health-care outcomes may be attained. This study was carried out aiming to assess nurses` Knowledge, attitude and practice about the nursing informatics system at out -patient clinics of Children's Cancer Hospital (57357), at Cairo. A descriptive research design will be utilized in this study was carried out in this hospital during April 2013. Sample consists of nineteen male and female nurses who are working in out-patient clinics. This study was conducted at the different out-patient clinics at Children Cancer Hospital (57357) at Cairo. Two tools were utilized to collect data pertinent to the study; one of them is a socio demographic data sheet and the second tool is a structured interview questioner schedule developed by investigator. Findings of this study showed that the majority of the sample was females and more than half of them were single. In addition to, it was found that, more than half of them academic faculties. Also, there was highly statistical significant difference between total knowledge of nursing informatics system according to total practice and total attitude of nursing informatics system. This study concluded that nurses are responsible for a substantial part of the patient record and hence are particularly affected by the computerization. The appliance of information system into nursing provides important advantages of the nursing personnel’s data and contributing to the improvement of the operating effectiveness of the nursing service. Recommendation: In Egypt (2013), nursing informatics is a new specialty and therefore should cover major sectors of the healthcare system where nurses work; this includes the clinical, administrative, research and education areas. Keywords: Knowledge, Attitude and practices nursing informatics, Nursing Informatics System, Hospital Information System

Electronic unified therapy record as a clinical risk management tool in the Italian healthcare system

Digitization of health records is still struggling to take hold in the Italian healthcare context, where medical records are still largely kept manually on paper. Besides being anachronistic, this practice is particularly critical if applied to the drug chart. Poor handwriting and transcription errors can generate medication errors and thus represent a potential source of adverse events. In the present study, we attempt to test the hypothesis that the application of a computerizedmedical recordmodelmay represent a useful tool formanaging clinical risk and medical expenditure. We shall do so through the analysis of the preliminary results of the application of such a model in two private hospitals in Northern Italy. The results, although preliminary, are encouraging. Among the benefits of digitizing drug records, we recorded a greater accuracy and adequacy of prescriptions, a reduction in the overall workload for nurses (no longer required to manually transcribe the list of drugs from one chart to another), as well as an optimization of the management of drug stocks by hospital pharmacies. The results in terms of clinical risk reduction will be monitored through a prospective cohort study that will take place in the coming months

Computerization of workflows, guidelines and care pathways: a review of implementation challenges for process-oriented health information systems

There is a need to integrate the various theoretical frameworks and formalisms for modeling clinical guidelines, workflows, and pathways, in order to move beyond providing support for individual clinical decisions and toward the provision of process-oriented, patient-centered, health information systems (HIS). In this review, we analyze the challenges in developing process-oriented HIS that formally model guidelines, workflows, and care pathways. A qualitative meta-synthesis was performed on studies published in English between 1995 and 2010 that addressed the modeling process and reported the exposition of a new methodology, model, system implementation, or system architecture. Thematic analysis, principal component analysis (PCA) and data visualisation techniques were used to identify and cluster the underlying implementation ‘challenge’ themes. One hundred and eight relevant studies were selected for review. Twenty-five underlying ‘challenge’ themes were identified. These were clustered into 10 distinct groups, from which a conceptual model of the implementation process was developed. We found that the development of systems supporting individual clinical decisions is evolving toward the implementation of adaptable care pathways on the semantic web, incorporating formal, clinical, and organizational ontologies, and the use of workflow management systems. These architectures now need to be implemented and evaluated on a wider scale within clinical settings

Computers in the Intensive Care Unit: A Match Meant To Be!

book chapterBiomedical Informatic