Investigation Interoperability Problems in Pharmacy Automation: A Case Study in Saudi Arabia

The aim of this case study is to investigate the nature of interoperability problems in hospital systems automation. One of the advanced healthcare providers in Saudi Arabia is the host of the study. The interaction between the pharmacy system and automated medication dispensing cabinets is the focus of the case system. The research method is a detailed case study where multiple data collection methods are used. The modelling of the processes of inpatient pharmacy systems is presented using Business Process Model Notation. The data collected is analysed to study the different interoperability problems. This paper presents a framework that classifies health informatics interoperability implementation problems into technical, semantic, organisational levels. The detailed study of the interoperability problems in this case illustrates the challenges to the adoption of health information system automation which could help other healthcare organisations in their system automation projects

A strategic approach to making sense of the “wicked” problem of ERM

Purpose – The purpose of this paper is to provide an approach to viewing the “wicked” problem of electronic records management (ERM), using the Cynefin framework, a sense-making tool. It re-conceptualises the ERM challenge by understanding the nature of the people issues. This supports decision making about the most appropriate tactics to adopt to effect positive change. Design/methodology/approach – Cynefin was used to synthesise qualitative data from an empirical research project that investigated strategies and tactics for improving ERM. Findings – ERM may be thought of as a dynamic, complex challenge but, viewed through the Cynefin framework, many issues are not complex; they are simple or complicated and can be addressed using best or good practice. The truly complex issues need a different approach, described as emergent practice. Cynefin provides a different lens through which to view, make sense of and re-perceive the ERM challenge and offers a strategic approach to accelerating change. Research limitations/implications – Since Cynefin has been applied to one data set, the findings are transferrable not generalisable. They, and/or the approach, can be used to further test the propositions. Practical implications – The resultant ERM framework provides a practical example for information and records managers to exploit or use as a starting point to explore the situation in particular organisational contexts. It could also be used in other practical, teaching and/or research-related records contexts. Originality/value – This paper provides a new strategic approach to addressing the wicked problem of ERM, which is applicable for any organisational context

Seeing and holding baby: Systematic review of clinical management and parental outcomes following stillbirth

Background - In 2009 there were an estimated 2.6 million stillbirths worldwide. In the United States, a 2007 systematic review found little consensus about professional behaviours perceived by parents to be most helpful or most distressing. In the United Kingdom a bereaved parents’ organisation has highlighted discordance between parental views and clinical guidelines that recommend clinicians’ do not encourage parents to see and hold their baby. The objective of this review was to identify and synthesise available research reporting parental outcomes relating to seeing and holding. Method(s) - We undertook a systematic review. We included studies of any design, reporting parental experiences and outcomes. Electronic searches (PubMed, PsychINFO) were conducted in January 2014. Three authors independently screened and assessed the quality of the studies, before abstracting data and undertaking thematic analysis. Results - We reviewed 741 records and included 23 studies (10 quantitative,12 qualitative,1 mixed-method). Twenty-one studies suggested positive outcomes for parents who saw or held their baby. Increased psychological morbidity was associated with current pregnancy, choice not to see their baby, lack of time with their baby and/or insufficient mementos. Three themes were formulated “Positive effects of contact within a traumatic life event”, “Importance of role of health professionals”; and “Impact on Mothers and Fathers: Similarities and differences”. Conclusions - Stillbirth is a risk factor for increased psychological morbidity. Parents’ seeing and holding their stillborn baby can be beneficial to their future wellbeing. Since 2007, there has been a proliferation of studies that challenge clinical guidelines recommending clinicians do not encourage parental contact

What does it take to make integrated care work? A ‘cookbook’ for large-scale deployment of coordinated care and telehealth

The Advancing Care Coordination & Telehealth Deployment (ACT) Programme is the first to explore the organisational and structural processes needed to successfully implement care coordination and telehealth (CC&TH) services on a large scale. A number of insights and conclusions were identified by the ACT programme. These will prove useful and valuable in supporting the large-scale deployment of CC&TH. Targeted at populations of chronic patients and elderly people, these insights and conclusions are a useful benchmark for implementing and exchanging best practices across the EU. Examples are: Perceptions between managers, frontline staff and patients do not always match; Organisational structure does influence the views and experiences of patients: a dedicated contact person is considered both important and helpful; Successful patient adherence happens when staff are engaged; There is a willingness by patients to participate in healthcare programmes; Patients overestimate their level of knowledge and adherence behaviour; The responsibility for adherence must be shared between patients and health care providers; Awareness of the adherence concept is an important factor for adherence promotion; The ability to track the use of resources is a useful feature of a stratification strategy, however, current regional case finding tools are difficult to benchmark and evaluate; Data availability and homogeneity are the biggest challenges when evaluating the performance of the programmes

Emergency Stroke Calls: Obtaining Rapid Telephone Triage (ESCORTT) - a programme of research to facilitate recognition of stroke by emergency medical dispatchers

Background: Rapid access to emergency stroke care can reduce death and disability by enabling immediate provision of interventions such as thrombolysis, physiological monitoring and stabilisation. One of the ways that access to services can be facilitated is through emergency medical service (EMS)dispatchers. The sensitivity of EMS dispatchers for identifying stroke is < 50%. Studies have shown that activation of the EMSs is the single most important factor in the rapid triage and treatment of acute stroke patients. Objectives: To facilitate recognition of stroke by emergency medical dispatchers (EMDs). Design: An eight-phase mixed-methods study. Phase 1: a retrospective cohort study exploring stroke diagnosis. Phase 2: semi-structured interviews exploring public and EMS interactions. Phases 3 and 4: a content analysis of 999 calls exploring the interaction between the public and EMDs. Phases 5–7: development and implementation of stroke-specific online training (based on phases 1–4). Phase 8: an interrupted time series exploring the impact of the online training. Setting: One ambulance service and four hospitals. Participants: Patients arriving at hospital by ambulance with stroke suspected somewhere on the stroke pathway (phases 1 and 8). Patients arriving at hospital by ambulance with a final diagnosis of stroke (phase 2). Calls to the EMSs relating to phase 1 patients (phases 3 and 4). EMDs (phase 7). Interventions: Stroke-specific online training package, designed to improve recognition of stroke for EMDs. Main outcome measures: Phase 1: symptoms indicative of a final and dispatch diagnosis of stroke. Phase 2: factors involved in the decision to call the EMSs when stroke is suspected. Phases 3 and 4: keywords used by the public when describing stroke and non-stroke symptoms to EMDs. Phase 8: proportion of patients with a final diagnosis of stroke correctly dispatched as stroke by EMDs. Results: Phase 1: for patients with a final diagnosis of stroke, facial weakness and speech problems were significantly associated with an EMD code of stroke. Phase 2: four factors were identified – perceived seriousness; seeking and receiving lay or professional advice; caller’s description of symptoms and emotional response to symptoms. Phases 3 and 4: mention of ‘stroke’ or one or more Face Arm Speech Test (FAST) items is much more common in stroke compared with non-stroke calls. Consciousness level was often difficult for callers to determine and/or communicate. Phase 8: there was a significant difference (p = 0.003) in proportions correctly dispatched as stroke – before the training was implemented 58 out of 92 (63%); during implementation of training 42 out of 48 (88%); and after training implemented 47 out of 59 (80%). Conclusions: EMDs should be aware that callers are likely to describe loss of function (e.g. unable to grip) rather than symptoms (e.g. weakness) and that callers using the word ‘stroke’ or describing facial weakness, limb weakness or speech problems are likely to be calling about a stroke. Ambiguities and contradictions in dialogue about consciousness level arise during ambulance calls for suspected and confirmed stroke. The online training package improved recognition of stroke by EMDs. Recommendations for future research include testing the effectiveness of the Emergency Stroke Calls: Obtaining Rapid Telephone Triage (ESCORTT) training package on the recognition of stroke across other EMSs in England; and exploring the impact of the early identification of stroke by call handlers on patient and process outcomes. Funding: The National Institute for Health Research Programme Grants for Applied Research programme

Hazard and risk assessment for indirect potable reuse schemes: An approach for use in developing Water Safety Plans

This is the post-print version of the final paper published in Water Research. The published article is available from the link below. Changes resulting from the publishing process, such as peer review, editing, corrections, structural formatting, and other quality control mechanisms may not be reflected in this document. Changes may have been made to this work since it was submitted for publication. Copyright @ 2010 Elsevier B.V.This paper describes research undertaken to develop an approach for facilitating an initial hazard assessment and risk characterisation for a proposed indirect potable reuse scheme, as part of the water safety plan recommended by the World Health Organization. The process involved a description and evaluation of the catchment, which was the sewerage system supplying the sewage treatment works that would provide the effluent to supply the pilot scale indirect potable reuse water treatment plant. Hazards, sources and barriers throughout the proposed system were identified and evaluated. An initial assessment of the possible hazards, highlighted chemical hazards as predominating, and assessment of risks, using a heat map as output, categorised most hazards as medium or high risk. However, this outcome has been influenced by a precautionary approach which assigned a high likelihood to the occurrence of hazards where no data was available on their occurrence in the system. As more data becomes available, and the waster safety plan develops, it is anticipated that the risk heat map will become more specific. Additionally, high quality targets, to drinking water standards, have been set, although water from the potable reuse plant will be discharged to receiving waters where it will undergo natural attenuation prior to further treatment to potable standards before distribution. The assessment has demonstrated the usefulness of the approach where data is initially limited, in generating a heat map allowing for prioritisation of hazards to a practical level.Thames Water Utilities Ltd and Mexican Consejo Nacional de Ciencia y Tecnologıa

Acceptance model of electronic medical record

This paper discusses acceptance issues of Electronic Medical Record System (EMR), particularly in Malaysia. A detailed overview of EMR and its benefits are firstly discussed. A number of acceptance models are scrutinized. Then factors affecting EMR acceptance are put forward. Finally, before proposing an EMR acceptance model, an instrument formed by adapting and then finding its factors loading is presented

Protocol for a mixed-methods exploratory investigation of care following intensive care discharge: the REFLECT study

© Author(s) 2019. Re-use permitted under CC BY. Published by BMJ.INTRODUCTION: A substantial number of patients discharged from intensive care units (ICUs) subsequently die without leaving hospital. It is unclear how many of these deaths are preventable. Ward-based management following discharge from ICU is an area that patients and healthcare staff are concerned about. The primary aim of REFLECT (Recovery Following Intensive Care Treatment) is to develop an intervention plan to reduce in-hospital mortality rates in patients who have been discharged from ICU. METHODS AND ANALYSIS: REFLECT is a multicentre mixed-methods exploratory study examining ward care delivery to adult patients discharged from ICU. The study will be made up of four substudies. Medical notes of patients who were discharged from ICU and subsequently died will be examined using a retrospective case records review (RCRR) technique. Patients and their relatives will be interviewed about their post-ICU care, including relatives of patients who died in hospital following ICU discharge. Staff involved in the care of patients post-ICU discharge will be interviewed about the care of this patient group. The medical records of patients who survived their post-ICU stay will also be reviewed using the RCRR technique. The analyses of the substudies will be both descriptive and use a modified grounded theory approach to identify emerging themes. The evidence generated in these four substudies will form the basis of the intervention development, which will take place through stakeholder and clinical expert meetings. ETHICS AND DISSEMINATION: Ethical approval has been obtained through the Wales Research and Ethics Committee 4 (17/WA/0107). We aim to disseminate the findings through international conferences, international peer-reviewed journals and social media. TRIAL REGISTRATION NUMBER: ISRCTN14658054.Peer reviewedFinal Published versio

Randomised controlled trials of complex interventions and large-scale transformation of services

Complex interventions and large-scale transformations of services are necessary to meet the health-care challenges of the 21st century. However, the evaluation of these types of interventions is challenging and requires methodological development. Innovations such as cluster randomised controlled trials, stepped-wedge designs, and non-randomised evaluations provide options to meet the needs of decision-makers. Adoption of theory and logic models can help clarify causal assumptions, and process evaluation can assist in understanding delivery in context. Issues of implementation must also be considered throughout intervention design and evaluation to ensure that results can be scaled for population benefit. Relevance requires evaluations conducted under real-world conditions, which in turn requires a pragmatic attitude to design. The increasing complexity of interventions and evaluations threatens the ability of researchers to meet the needs of decision-makers for rapid results. Improvements in efficiency are thus crucial, with electronic health records offering significant potential