Electronic Health Records and Support For Primary Care Teamwork

This study examined primary care practices' experiences using electronic health records (EHRs) as they strive to function as teams in patientcentered medical homes (PCMHs). We identify how EHRs facilitate and pose challenges to teamwork and how practices overcame such challenges. We describe solutions and identify opportunities to improve care processes as well as EHR functionalities and policies, to support teamwork

Supporting Collaborative Health Tracking in the Hospital: Patients' Perspectives

The hospital setting creates a high-stakes environment where patients' lives depend on accurate tracking of health data. Despite recent work emphasizing the importance of patients' engagement in their own health care, less is known about how patients track their health and care in the hospital. Through interviews and design probes, we investigated hospitalized patients' tracking activity and analyzed our results using the stage-based personal informatics model. We used this model to understand how to support the tracking needs of hospitalized patients at each stage. In this paper, we discuss hospitalized patients' needs for collaboratively tracking their health with their care team. We suggest future extensions of the stage-based model to accommodate collaborative tracking situations, such as hospitals, where data is collected, analyzed, and acted on by multiple people. Our findings uncover new directions for HCI research and highlight ways to support patients in tracking their care and improving patient safety

Quality of Health Care for Medicare Beneficiaries: A Chartbook

Provides the results of a review of recently published studies and reports about the quality of health care for elderly Medicare beneficiaries. Includes examples of deficiencies and disparities in care, and some promising quality improvement initiatives

Standardizing Handoff Report in a Medsurg Telemetry Floor

Problem: Hospital A’s 9th floor telemetry units lacked a standardized method of handoff and required investigation. Current practices were evaluated, and an intervention was designed based on weak communication areas. Context: Using a 5 P’s assessment the key stakeholders included unit nurses, the nursing director, nurse educators, and unit nurse managers, and the patients were medsurg telemetry patients. The process included handoff in care and the pattern evaluated was methods of reporting with the purpose of providing high quality evidence-based patient centered care. A SWOT analysis revealed strong teamwork, interdisciplinary collaboration, and proficiency in health record technologies as strengths and driving forces that would aid change. Short staffing, burnout, poor leader buy-in and limited time acted as barriers to implementing change. Interventions: An education presentation was developed highlighting and providing examples of critical SBAR, TRACER, and centralized EHR reporting tools. The slideshow was designed to allow for nurse educators to further develop a communication education plan for unit nurses. Measures: Initial data collection included using a survey, observing, and individual interviews. A post survey accompanied the education intervention so impact can be evaluated. Results: 10 survey responses were collected. Main themes from data collection included a need for clarity, efficiency, and conciseness. Unit nurses utilized a variety of evidenced-based communication methods; however, there lacked consistency and there was little bedside reporting. Conclusions: Based on similar quality improvement studies further development of this handoff education intervention is likely to show better standardization in communication, more satisfactory handoff reporting between nurses, and fewer patient care errors related to miscommunication

Improving Patient Care Outcomes to Reduce Recurrent Admissions of Patients with Chronic Obstructive Pulmonary Disease

Purpose:Transitional care is time-limited, with the goal of ensuring safety and health continuity for at-risk patients with chronic obstructive pulmonary disease (COPD) as they move from one setting to the next. An acute care episode of COPD ranges from relatively healthy adults to adults with multiple chronic conditions or those in the end-of-life phase. The primary quality concern of an urgent need to improve health care is in response to the gaps of sufficient experience to manage patients with COPD, leading to hospital readmissions. Implementation of standards of care for the improvement of health-related quality of life (HRQL) of COPD patients is intended to reduce the rate of adverse events and hospital readmissions. Method: The project was implemented in collaboration with the transitional health care team at a local medical hospital. For the challenge of high levels of readmissions, coaching models for patient advocacy required continued tracking to decrease readmissions within 30 days to avoid penalties. The goal was to reduce the all-cause readmission rate by 20%. A detailed plan of action customized for the purpose of designing strategic interventions addressed health care reform. Practical education aimed at staff, patients, and family members are the standard for the delivery of health care for patients with COPD. Decision supports for a change of behavior and adaptations had a significant role in client care. Case managers, nurse practitioners, physicians, nurses, pharmacists, and dieticians formulated solutions in patient safety during the acute phase. As a result, cost-effective care reduced medical costs, decreased recurrent hospital stays, and improved patient satisfaction. Findings: Cultures, socioeconomics, and gender had an effect on the transitional approach. Coach status had positive effects on the population’s shared decision-making requirements. Religion and health disparities considered, patients had universal needs across the REDUCING RECURRENT COPD ADMISSIONS 8 population. The biggest impact made was with pharmacy involvement and elderly polypharmacy involving potential adverse drug events. The pharmacist counseled patients on medication with accuracy. Case studies and preliminary results identified gaps. Results identified multiple errors per patient. Intervention scores had a greater improvement over a nine month period. Conclusions: Citizen ties to a community-based organization (CBO) are critical for the improvement of the quality of life in low-income areas. Services and resources with strategies expand the legitimacy of low-income communities with a devoted effort for goal accomplishment (Walker & McCarthy, 2010). Implementing cost containment and competitive strategies for an alternate health care delivery system generates savings and improves the management of chronic disease. Determining costs associated with exacerbations of COPD and an acute exacerbation of chronic bronchitis (AECB) is specific to controlling costs derived from treatment failure and hospitalization. The leading preventable risk factor associated with chronic lung disease for further study is smoking. Determining the underlying addiction and further education may also be an area for further research to consider. Treatment failure causes further medical visits, emergency room visits, and potentially extended hospital stays (Miravitlles et al., 2002). Access to clinical excellence for the successful transition from the hospital, across settings, prevented readmissions. The impact of reducing recurrent admissions for patients discharged with chronic obstructive pulmonary disease improved patient care outcomes

Medically Complex Child: Best Practice Toolkit for Improving Coordination of Care Between Parents, Providers, and Support Systems

Children with special health care needs face multiple challenges within the educational realm due to missing school days from illness. The purpose of this paper was to explore an electronic toolkit that would allow for improved communication and care coordination between teachers, principals, social workers, school nurses, parents, and healthcare professionals to maximize in classroom learning opportunities. The project was guided by the following PICOT question, for interprofessional staff supporting the medically complex child (P), how does the development of a best practice for coordination of care toolkit (I) compared to no structured program strategy (C) influence the efficacy of interprofessional staff coordination of care between parents, providers, and support systems? Communication and lack of coordination of care between health care providers and school personnel is deficient as evidenced within the literature. Utilization of action plans for chronic health conditions, primarily for asthma and food allergies, have been shown to decrease school absenteeism. Incorporation of existing action plans for chronic health conditions, that are individually modifiable, into an electronic coordination of care toolkit, allowed for improved communication, stronger bonds and relationships developed with the aim of maximizing the full classroom experience for the student, defining best practice

HealthPartners: Consumer-Focused Mission and Collaborative Approach Support Ambitious Performance Improvement Agenda

Presents a case study of a nonprofit healthcare organization that exhibits the six attributes of an ideal healthcare delivery system as defined by the Fund, including information continuity, care coordination and transitions, and system accountability

Development of Evidence-Based Scenario with High Fidelity Simulation to Improve Nursing Care of Chest Pain Patients

Cardiovascular disease remains the leading cause of mortality in the United States, and a primary educational objective is to develop professional competency among nurses to ensure the provision of safe and effective care to the cardiac patient. Benner\u27s theory of novice-to-expert led to the development of an evidence-based scenario for the care of the patient with chest pain using risk-free high-fidelity simulation environments that focused on assessment, history taking, and communication, while evaluating improvements in the competency of nurses providing care to chest pain patients. Thirty-six nurses volunteered in the study. Feedback from nurse educators, which led to modifications to the scenario, preceptor evaluation of participants during simulation, and post simulation feedback of participants, were analyzed using an inductive and exploratory theme analysis. Participants reported they learned meaningful information but felt somewhat confused regarding the correct course of action when multiple events occurred simultaneously. Preceptors\u27 feedback identified participant failure to meet stated scenario expectations. Quantitative analysis of data, using one sample t test, compared the pre- and post-test scores measuring participant knowledge on assessment, history taking, and communication. Although knowledge scores increased, the difference was not clinically significant based on the negative feedback from both preceptor and participants. Accurate appraisal of nurses\u27 competency in assessment, history-taking, and communication skills is needed prior to exposure to simulation. Simulation scenarios may be more clinically significant when tailored to an individual participant\u27s competency levels