5,098 research outputs found

    Validation of the Work Observation Method By Activity Timing (WOMBAT) method of conducting time-motion observations in critical care settings: an observational study

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    <p>Abstract</p> <p>Background</p> <p>Electronic documentation handling may facilitate information flows in health care settings to support better coordination of care among Health Care Providers (HCPs), but evidence is limited. Methods that accurately depict changes to the workflows of HCPs are needed to assess whether the introduction of a Critical Care clinical Information System (CCIS) to two Intensive Care Units (ICUs) represents a positive step for patient care. To evaluate a previously described method of quantifying amounts of time spent and interruptions encountered by HCPs working in two ICUs.</p> <p>Methods</p> <p>Observers used PDAs running the Work Observation Method By Activity Timing (WOMBAT) software to record the tasks performed by HCPs in advance of the introduction of a Critical Care clinical Information System (CCIS) to quantify amounts of time spent on tasks and interruptions encountered by HCPs in ICUs.</p> <p>Results</p> <p>We report the percentages of time spent on each task category, and the rates of interruptions observed for physicians, nurses, respiratory therapists, and unit clerks. Compared with previously published data from Australian hospital wards, interdisciplinary information sharing and communication in ICUs explain higher proportions of time spent on professional communication and documentation by nurses and physicians, as well as more frequent interruptions which are often followed by professional communication tasks.</p> <p>Conclusions</p> <p>Critical care workloads include requirements for timely information sharing and communication and explain the differences we observed between the two datasets. The data presented here further validate the WOMBAT method, and support plans to compare workflows before and after the introduction of electronic documentation methods in ICUs.</p

    The Role of Patient Room-Type, Interruptions, and Intrapersonal Resources in Nurse Performance and Well-Being

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    Interruptions create a complex challenge in health care. Because some interruptions are necessary in health care, they cannot be completely eliminated. Thus, their effects must be appropriately mitigated. To better understand predictors and consequences of interruptions, as well as factors that may mitigate their negative effects, I employed Job Demands-Resources (JD-R) theory, supplemented by additional constructs from organizational behavior and psychology to develop a model of predictors and mitigators of interruptions. Twenty registered nurses providing care on a progressive acute care unit with single- and double-occupancy patient rooms volunteered to participate in this study. The study incorporated nurse-level questionnaires, event-level surveys, observation, and medical record review to test a mediated, moderation multi-level model. Double-occupancy rooms were a significant predictor of interruptions. Interruptions mediated the effect of room-type on perceived stress, but not on the other five dependent variables (task completion rate, medication administration errors, positive affect, and negative affect). While the full mediated, moderation models were not supported, the individual nurse characteristic of conscientiousness was found to have a significant moderating effect on the effect of room-type on perceived stress. Other nurse characteristics tested, but not found to have a significant effect, were stress mindset and psychological resilience. This study fills significant gaps in interruption research by using theory to develop a single conceptual model that identifies predictors of interruptions and nurse characteristics that may mitigate their effects. Future applications of this research should expand this approach to support nurse selection and training for working in interruptive patient care environment

    DNP FINAL REPORT: SEDATION PROTOCOL COMPLIANCE FOR IMPROVED OUTCOMES IN INTENSIVE CARE

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    Background: Current evidence-based practice guidelines show that lighter sedation reduces mechanical ventilator days (MVD) and intensive care (ICU) length of stay (LOS). Guidelines (2018) for the management of pain, agitation, delirium, immobility, and sleep were released to direct appropriate high-quality care to achieve positive outcomes. However, studies demonstrated there were barriers to compliance of these guidelines. Objective: To improve compliance with an existing evidence-based sedation protocol in an intensive care, and, thereby, improve patient outcomes (MVD and ICU LOS). Methods: The three-month quality improvement (QI) project evaluated processes leading to compliance with the guideline. First, nurses were surveyed to determine knowledge and comfort with the guideline. Based on the guideline and data from nurses, education was provided on sedation medications, mechanical ventilation, the EBP sedation protocol, and focused on spontaneous awakening and breathing trials. Protocol comfort and compliance was evaluated. Results: Primary compliance issues were lack of experience and education. Despite education, MVD increased by 23% and ICU LOS by 7%. Implications for Practice: Staff education concerning sedation guidelines is key to achieving compliance and optimal MVD and ICU LOS

    Emergency departments as complex adaptive systems

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    Introduction Globally, emergency departments (ED) are confronted with yearly rises in visit numbers and an increasingly older and multimorbid patient population. Several work system factors were associated with employee well-being and patient safety in previous literature. This thesis reports results of a mixed-methods intervention study investigating interrelationships between psychosocial ED work system factors, employee well-being and quality of patient care under consideration of the concept of resilient health care and complex adaptive systems (CAS). Methods A before and after study including an interrupted time-series (ITS) design was established in the multidisciplinary ED of a tertiary referral hospital in Southern Germany between 2015 and 2017. Applied methods and data sources included (1) standardized employee surveys, (2) structured work observations, (3) patient surveys, (4) register data, and (5) qualitative interviews. Additional data on employees’ activity and interruption patterns was collected in one US-American ED in 2016. Results Assessment of psychosocial work factors indicated considerable work demands for ED employees before and after the participative intervention comprising ten health circles. Inconsistent longitudinal intervention effects were found for changes in psychosocial work factors and employee mental wellbeing, e.g., increase in job control but decline in job satisfaction. Improvements in patient satisfaction were observed over time. Interviews revealed facilitators (e.g., comprehensive approach, employee participation) and barriers (e.g., understaffing, organizational constraints) for intervention implementation. Further associations between work interruptions and ED patient satisfaction as well as cross-national differences in ED work activity patterns were observed. Conclusions Reasons for inconsistent intervention results stem from the complexity of the ED work system including profession- and institution-specific challenges and individual stress experiences of employees. Studies should further consider employee health as a concurrent determinant as well as outcome in the theoretical concepts of CAS and resilient health care.Einleitung Notaufnahmen (NA) sind mit jährlich steigenden Besuchszahlen und einer älter werdenden und multimorbiden Patientenpopulation konfrontiert. Psychosoziale Arbeitsbedingungen wurden in der Literatur mit der Gesundheit von Beschäftigten und der Qualität der Versorgung assoziiert. Diese Dissertation berichtet die Ergebnisse einer Mixed-Methods-Interventionsstudie, die diese Zusammenhänge unter Berücksichtigung der Theorie komplexer adaptiver Systeme adressiert. Methode In der interdisziplinären NA eines süddeutschen Maximalversorgers wurde zwischen 2015 und 2017 eine Vorher-Nachher-Studie mit einem sog. Interrupted Time-Series Design durchgeführt. Methoden und Datenquellen umfassten (1) standardisierte Mitarbeiterbefragungen, (2) strukturierte Arbeitsbeobachtungen, (3) Patientenbefragungen, (4) Sekundärdaten und (5) qualitative Interviews. Ergänzende Daten zu Arbeitsbedingungen wurden 2016 in einer US-amerikanischen NA erhoben. Ergebnisse Vor und nach der partizipativen Intervention – bestehend aus 10 Gesundheitszirkeln – wurden erhebliche psychosoziale Arbeitsbelastungen für in der NA Beschäftigte identifiziert. Inkonsistente Längsschnitteffekte zeigten Veränderungen in psychosozialen Arbeitsbedingungen und im psychischen Wohlbefinden, z.B. Zunahme der Autonomie jedoch verringerte Arbeitszufriedenheit. Die Patientenzufriedenheit verbesserte sich im Laufe der Zeit. Unterstützende Faktoren für die Implementierung der Intervention waren ihr umfassender Ansatz und die Mitarbeiterbeteiligung wohingegen personelle Unterbesetzung und organisatorische Einschränkungen Barrieren darstellten. Weitere Zusammenhänge zwischen Arbeitsunterbrechungen und der Patientenzufriedenheit sowie länderübergreifende Unterschiede in NA-Arbeitsabläufen wurden beobachtet. Schlussfolgerungen Gründe für inkonsistente Interventionsergebnisse liegen in der Komplexität des NA-Arbeitssystems einschließlich berufs- und institutionsspezifischer Herausforderungen und individueller Beanspruchungserfahrungen der Beschäftigten begründet, welche in zukünftigen Studien zur arbeitsbezogenen Gesundheit im Rahmen der CAS-Theorie berücksichtigt werden sollten

    Emergency departments as complex adaptive systems

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    Introduction Globally, emergency departments (ED) are confronted with yearly rises in visit numbers and an increasingly older and multimorbid patient population. Several work system factors were associated with employee well-being and patient safety in previous literature. This thesis reports results of a mixed-methods intervention study investigating interrelationships between psychosocial ED work system factors, employee well-being and quality of patient care under consideration of the concept of resilient health care and complex adaptive systems (CAS). Methods A before and after study including an interrupted time-series (ITS) design was established in the multidisciplinary ED of a tertiary referral hospital in Southern Germany between 2015 and 2017. Applied methods and data sources included (1) standardized employee surveys, (2) structured work observations, (3) patient surveys, (4) register data, and (5) qualitative interviews. Additional data on employees’ activity and interruption patterns was collected in one US-American ED in 2016. Results Assessment of psychosocial work factors indicated considerable work demands for ED employees before and after the participative intervention comprising ten health circles. Inconsistent longitudinal intervention effects were found for changes in psychosocial work factors and employee mental wellbeing, e.g., increase in job control but decline in job satisfaction. Improvements in patient satisfaction were observed over time. Interviews revealed facilitators (e.g., comprehensive approach, employee participation) and barriers (e.g., understaffing, organizational constraints) for intervention implementation. Further associations between work interruptions and ED patient satisfaction as well as cross-national differences in ED work activity patterns were observed. Conclusions Reasons for inconsistent intervention results stem from the complexity of the ED work system including profession- and institution-specific challenges and individual stress experiences of employees. Studies should further consider employee health as a concurrent determinant as well as outcome in the theoretical concepts of CAS and resilient health care.Einleitung Notaufnahmen (NA) sind mit jährlich steigenden Besuchszahlen und einer älter werdenden und multimorbiden Patientenpopulation konfrontiert. Psychosoziale Arbeitsbedingungen wurden in der Literatur mit der Gesundheit von Beschäftigten und der Qualität der Versorgung assoziiert. Diese Dissertation berichtet die Ergebnisse einer Mixed-Methods-Interventionsstudie, die diese Zusammenhänge unter Berücksichtigung der Theorie komplexer adaptiver Systeme adressiert. Methode In der interdisziplinären NA eines süddeutschen Maximalversorgers wurde zwischen 2015 und 2017 eine Vorher-Nachher-Studie mit einem sog. Interrupted Time-Series Design durchgeführt. Methoden und Datenquellen umfassten (1) standardisierte Mitarbeiterbefragungen, (2) strukturierte Arbeitsbeobachtungen, (3) Patientenbefragungen, (4) Sekundärdaten und (5) qualitative Interviews. Ergänzende Daten zu Arbeitsbedingungen wurden 2016 in einer US-amerikanischen NA erhoben. Ergebnisse Vor und nach der partizipativen Intervention – bestehend aus 10 Gesundheitszirkeln – wurden erhebliche psychosoziale Arbeitsbelastungen für in der NA Beschäftigte identifiziert. Inkonsistente Längsschnitteffekte zeigten Veränderungen in psychosozialen Arbeitsbedingungen und im psychischen Wohlbefinden, z.B. Zunahme der Autonomie jedoch verringerte Arbeitszufriedenheit. Die Patientenzufriedenheit verbesserte sich im Laufe der Zeit. Unterstützende Faktoren für die Implementierung der Intervention waren ihr umfassender Ansatz und die Mitarbeiterbeteiligung wohingegen personelle Unterbesetzung und organisatorische Einschränkungen Barrieren darstellten. Weitere Zusammenhänge zwischen Arbeitsunterbrechungen und der Patientenzufriedenheit sowie länderübergreifende Unterschiede in NA-Arbeitsabläufen wurden beobachtet. Schlussfolgerungen Gründe für inkonsistente Interventionsergebnisse liegen in der Komplexität des NA-Arbeitssystems einschließlich berufs- und institutionsspezifischer Herausforderungen und individueller Beanspruchungserfahrungen der Beschäftigten begründet, welche in zukünftigen Studien zur arbeitsbezogenen Gesundheit im Rahmen der CAS-Theorie berücksichtigt werden sollten

    A Day in the Life of a Hospital Bedside Nurse: A Different Look at Nurse Stressors

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    This project is intended to be an example of the affects on the nursing work environment after years of technological advancement, healthcare reform, and process improvement. The bedside nurse work environment is riddled with a multitude of interruptions, intricate processes, and complicated documentation to prove quality care and compliance to regulatory agencies and for tracking purposes. These demands are significant as nurses are continuously reprioritizing work to meet the needs of the patient while also meeting the organizational and regulatory demands. The demands on nurses often lead to delays in patient care and sometimes omission of certain less acute patient care needs. This omission of patient care needs is misaligned with the role of a nurse as a helping profession. This, in conjunction with the repetitive documentation, tasks, technology troubleshooting, and other daily frustrations leads to a lack of accomplishment for the nurse and a less than optimal patient care experience. The goal of this project was to exemplify some stresses that often go unnoticed during the daily work of a nurse. Personal data during 12-hour shifts was collected to examine medication administration demands, interruptions due to phone advancements, order reviews during a shift, and physical walking demands. These findings are some of the stressors that are difficult to capture by nonclinical observers and may help identify areas in need of further investigation and improvement

    A Prospective Investigation to Develop Data-Driven Interventions and Improve Process Efficiency at a Level II Trauma Center

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    INTRODUCTION: The purpose of this investigation was to better understand process inefficiencies in a Level II trauma center through the identification and classification of flow disruptions. Data-driven interventions were systematically developed and introduced in an effort to reduce disruptions threatening the optimal delivery of trauma care. METHOD: Medical human factors researchers observed disruptions during resuscitation and imaging in 117 trauma cases. Data was classified using the human factors taxonomy Realizing Improved Patient Care through Human-centered Operating Room Design for Threat Window Analysis (RIPCHORD-TWA). Interdisciplinary subject matter experts (SMEs) utilized a human factors intervention matrix (HFIX) to generate targeted interventions designed to address the most detrimental disruptions. A multiple-baseline interrupted time-series (ITS) design was used to gauge the effectiveness of the interventions introduced. RESULTS: Significant differences were found in the frequency of disruptions between the pre-intervention (n=65 cases, 1137 disruptions) and post-intervention phases (n=52 cases, 939 disruptions). Results revealed significant improvements related to ineffective communication (x2 (1, n=2076) = 24.412, p=0.00, x2 (1, n=1031) = 9.504, p=0.002, x2 (1, n=1045) = 12.197, p=0.000); however, similar levels of improvement were not observed in the other targeted areas. CONCLUSION: This study provided a foundation for a data-driven approach to investigating precursor events and process inefficiencies in trauma care. Further, this approach allowed individuals on the front lines to generate specific interventions aimed at mitigating systemic weaknesses and inefficiencies frequently encountered in their work environment
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