Jefferson Digital Commons quarterly report: January-March 2020

This quarterly report includes: New Look for the Jefferson Digital Commons Articles COVID-19 Working Papers Educational Materials From the Archives Grand Rounds and Lectures JeffMD Scholarly Inquiry Abstracts Journals and Newsletters Master of Public Health Capstones Oral Histories Posters and Conference Presentations What People are Saying About the Jefferson the Digital Common

Clinical handover within the emergency care pathway and the potential risks of clinical handover failure (ECHO) : primary research

Background and objectives: Handover and communication failures are a recognised threat to patient safety. Handover in emergency care is a particularly vulnerable activity owing to the high-risk context and overcrowded conditions. In addition, handover frequently takes place across the boundaries of organisations that have different goals and motivations, and that exhibit different local cultures and behaviours. This study aimed to explore the risks associated with handover failure in the emergency care pathway, and to identify organisational factors that impact on the quality of handover. Methods: Three NHS emergency care pathways were studied. The study used a qualitative design. Risks were explored in nine focus group-based risk analysis sessions using failure mode and effects analysis (FMEA). A total of 270 handovers between ambulance and the emergency department (ED), and the ED and acute medicine were audio-recorded, transcribed and analysed using conversation analysis. Organisational factors were explored through thematic analysis of semistructured interviews with a purposive convenience sample of 39 staff across the three pathways. Results: Handover can serve different functions, such as management of capacity and demand, transfer of responsibility and delegation of aspects of care, communication of different types of information, and the prioritisation of patients or highlighting of specific aspects of their care. Many of the identified handover failure modes are linked causally to capacity and patient flow issues. Across the sites, resuscitation handovers lasted between 38 seconds and 4 minutes, handovers for patients with major injuries lasted between 30 seconds and 6 minutes, and referrals to acute medicine lasted between 1 minute and approximately 7 minutes. Only between 1.5% and 5% of handover communication content related to the communication of social issues. Interview participants described a range of tensions inherent in handover that require dynamic trade-offs. These are related to documentation, the verbal communication, the transfer of responsibility and the different goals and motivations that a handover may serve. Participants also described the management of flow of patients and of information across organisational boundaries as one of the most important factors influencing the quality of handover. This includes management of patient flows in and out of departments, the influence of time-related performance targets, and the collaboration between organisations and departments. The two themes are related. The management of patient flow influences the way trade-offs around inner tensions are made, and, on the other hand, one of the goals of handover is ensuring adequate management of patient flows. Conclusions: The research findings suggest that handover should be understood as a sociotechnical activity embedded in clinical and organisational practice. Capacity, patient flow and national targets, and the quality of handover are intricately related, and should be addressed together. Improvement efforts should focus on providing practitioners with flexibility to make trade-offs in order to resolve tensions inherent in handover. Collaborative holistic system analysis and greater cultural awareness and collaboration across organisations should be pursued

Public Service Delivery: Role of Information and Communication Technology in Improving Governance and Development Impact

The focus of this paper is on improving governance through the use of information and communication technology (ICT) in the delivery of services to the poor, i.e., improving efficiency, accountability, and transparency, and reducing bribery. A number of papers recognize the potential benefits but they also point out that it has not been easy to harness this potential. This paper presents an analysis of effective case studies from developing countries where the benefits have reached a large number of poor citizens. It also identifies the critical success factors for wide-scale deployment. The paper includes cases on the use of ICTs in the management of delivery of public services in health, education, and provision of subsidized food. Cases on electronic delivery of government services, such as providing certificates and licenses to rural populations, which in turn provide entitlements to the poor for subsidized food, fertilizer, and health services are also included. ICT-enabled provision of information to enhance rural income is also covered

The Boston University Photonics Center annual report 2014-2015

This repository item contains an annual report that summarizes activities of the Boston University Photonics Center in the 2014-2015 academic year. The report provides quantitative and descriptive information regarding photonics programs in education, interdisciplinary research, business innovation, and technology development. The Boston University Photonics Center (BUPC) is an interdisciplinary hub for education, research, scholarship, innovation, and technology development associated with practical uses of light.This has been a good year for the Photonics Center. In the following pages, you will see that the center’s faculty received prodigious honors and awards, generated more than 100 notable scholarly publications in the leading journals in our field, and attracted $18.6M in new research grants/contracts. Faculty and staff also expanded their efforts in education and training, and were awarded two new National Science Foundation– sponsored sites for Research Experiences for Undergraduates and for Teachers. As a community, we hosted a compelling series of distinguished invited speakers, and emphasized the theme of Advanced Materials by Design for the 21st Century at our annual symposium. We continued to support the National Photonics Initiative, and are a part of a New York–based consortium that won the competition for a new photonics- themed node in the National Network of Manufacturing Institutes. Highlights of our research achievements for the year include an ambitious new DoD-sponsored grant for Multi-Scale Multi-Disciplinary Modeling of Electronic Materials led by Professor Enrico Bellotti, continued support of our NIH-sponsored Center for Innovation in Point of Care Technologies for the Future of Cancer Care led by Professor Catherine Klapperich, a new award for Personalized Chemotherapy Through Rapid Monitoring with Wearable Optics led by Assistant Professor Darren Roblyer, and a new award from DARPA to conduct research on Calligraphy to Build Tunable Optical Metamaterials led by Professor Dave Bishop. We were also honored to receive an award from the Massachusetts Life Sciences Center to develop a biophotonics laboratory in our Business Innovation Center

A Quality Improvement Initiative to Engage Older Adults in the Discharge Process Using the IDEAL Discharge Protocol

Background: Readmissions are costly and adversely affect patient outcomes. Readmissions significantly impact older adults’ ability to manage post-discharge. Older adults are more likely to have challenges with understanding newly prescribed medications after discharge and therefore are less compliant with medications. Older adults are also less likely to follow-up with their primary care physician after discharge. Engaging patients and families in a collaborative discharge process is a key foundational element needed to improve patient outcomes and reduce avoidable readmission rates. Purpose: This quality improvement initiative engaged patients and families in an evidence-based discharge protocol to reduce avoidable readmission over three months. Methods: The Define, Measure, Analyze, Design, and Verify (DMADV) improvement process was used to implement the initiative. The IDEAL Discharge Protocol was piloted on one medical-surgical unit targeting adults 65 years or older with no cognitive deficits and discharged home. The IDEAL Discharge Protocol focused on implementing a structured process to include patients and their families in a collaborative care process focused on discussion, education, and post-discharge follow-up. Results: Forty-four participants engaged in the study. A 4 percent decrease in the pilot unit readmission rate was observed. Before implementation, the readmission rate was 17 percent. After implementation, the readmission rate was 13 percent. Post-discharge follow-up resulted in the completion of 52.2 percent follow-up calls and 45.5 percent follow-up appointments scheduled. Of the 44 participants engaged in the intervention, two were readmitted, resulting in a 4.5 readmission rate for the study participants. Medication compliance was assessed and found to be 93.3 percent, and 100 percent of participants received education while engaged in the study. Conclusion: The IDEAL intervention aided in improving the discharge process to better equip patients with the tools to successfully transition home after discharge and showed a trend toward reducing the pilot unit’s readmission rate

Care Management of Patients With Complex Health Care Needs

Explores how patients' complexity of healthcare needs, vulnerability, and age affect the cost and quality of their health care. Examines the potential for care management to improve quality of care and reduce costs, elements of success, and challenges

Nurses\u27 Response to a Heart Failure Video to Teach Patients Self-Management

Numerous scholars have examined multiprocessors and techniques to decrease the heart failure readmission rate and to improve heart failure patient self-management. This project examined a new teaching method to create the experts\u27 awareness of possible solutions to improve heart failure education in a small community hospital. The purpose of this project was the assessment of a new iPad heart failure patient pre-discharge education program video HFPDEV). Pender\u27s health care model (PHM) served as a framework for this project. Five local nursing educator experts (master prepared) were asked to view a new iPad HFPDEV. After reviewing the 15-minute iPad HFPDEV, the local experts were asked to evaluate the video by completing a Likert-type survey, which evaluated the content, process, design, time, and functionality of the iPad HFPDEV along with a section for comments and recommendations. Descriptive analysis was used to analyze the survey results. Four of the experts defined the content, process, design, and functionality of the iPad HFPDEV as \u27excellent.\u27 One defined the content, process, design, and functionality of the iPad HFPDEV as \u27adequate.\u27 All experts expressed recommendations to improve the IPad HFPDEV by doubling the iPad size with an enlargement of print for easy reading and erecting all teaching iPads on mobile stands. A future pilot project will evaluate the relationship of HF readmission rate to the iPad HFPDEV. Social change will occur when the organization provides HF patients with iPad HFPDEV that will increase HF self-management skills and decrease HF readmissions

The Boston University Photonics Center annual report 2013-2014

This repository item contains an annual report that summarizes activities of the Boston University Photonics Center in the 2013-2014 academic year. The report provides quantitative and descriptive information regarding photonics programs in education, interdisciplinary research, business innovation, and technology development. The Boston University Photonics Center (BUPC) is an interdisciplinary hub for education, research, scholarship, innovation, and technology development associated with practical uses of light.This annual report summarizes activities of the Boston University Photonics Center in the 2013–2014 academic year.This has been a good year for the Photonics Center. In the following pages, you will see that the center’s faculty received prodigious honors and awards, generated more than 100 notable scholarly publications in the leading journals in our field, and attracted $14.5M in new research grants and contracts this year. Faculty and staff also expanded their efforts in education and training, through National Science Foundation–sponsored sites for Research Experiences for Undergraduates and for Teachers. As a community, we hosted a compelling series of distinguished invited speakers, and emphasized the theme of Innovations at the Intersections of Micro/Nanofabrication Technology, Biology, and Biomedicine at our annual Future of Light Symposium. We took a leadership role in running national workshops on emerging photonic fields, including an OSA Incubator on Controlled Light Propagation through Complex Media, and an NSF Workshop on Noninvasive Imaging of Brain Function. Highlights of our research achievements for the year include a distinctive Presidential Early Career Award for Scientists and Engineers (PECASE) for Assistant Professor Xue Han, an ambitious new DoD-sponsored grant for Multi-Scale Multi-Disciplinary Modeling of Electronic Materials led by Professor Enrico Bellotti, launch of our NIH-sponsored Center for Innovation in Point of Care Technologies for the Future of Cancer Care led by Professor Cathy Klapperich, and successful completion of the ambitious IARPA-funded contract for Next Generation Solid Immersion Microscopy for Fault Isolation in Back-Side Circuit Analysis led by Professor Bennett Goldberg. These three programs, which represent more than$20M in research funding for the University, are indicative of the breadth of Photonics Center research interests: from fundamental modeling of optoelectronic materials to practical development of cancer diagnostics, from exciting new discoveries in optogenetics for understanding brain function to the achievement of world-record resolution in semiconductor circuit microscopy. Our community welcomed an auspicious cohort of new faculty members, including a newly hired assistant professor and a newly hired professor (and Chair of the Mechanical Engineering Department). The Industry/University Cooperative Research Center—the centerpiece of our translational biophotonics program—continues to focus on advancing the health care and medical device industries, and has entered its fourth year of operation with a strong record of achievement and with the support of an enthusiastic industrial membership base

Getting to Zero: Creating an Infrastructure to Support Fall Prevention in a Medical–Surgical Unit

Problem: Hospital falls are a growing national patient safety concern that cause anxiety, pain, distress, serious injuries, and increased health care utilization. Despite the presence of a well-developed falls prevention protocol since 2017. Internal data from an inpatient medical-surgical telemetry (MST) unit indicate the largest number of fall-related events among the hospital’s departments. Context: Practice improvement project was initiated in a 217-bed community hospital to determine barriers and potential success factors. This MST is a dynamic, 48-bed unit providing care to mainly geriatric patients who require continuous telemetry monitoring and complex medical, trauma, and surgical services. Senior leaders in the hospital consider falls and fall-related injuries to be a top priority and therefore support the implementation for a cost-effective plan to improve clinical, quality, and fiscal outcomes. Intervention: A unit based Clinical Nurse Leader (CNL) led the team to achieve the unit goal of a 20% reduction in falls by the end of the performance year 2019 utilizing improvement activities to foster the development of both a nursing and patient-centered approach. The primary intervention included the formation of a long-term Fall Prevention Safety Committee (FPSC) to develop, oversee and test a new and multifaceted intervention (or change package) consisting of several best practices. The re-introduction of a well-organized, committed fall prevention team was implemented to enhance the organizational infrastructure and oversight of unit-based fall prevention initiatives. Measures: To evaluate the effectiveness of the FPSC and the change package, three “metrics that matter” were assessed including a quarterly patient and team satisfaction survey, monthly fall rates and an annual analysis of the MST fall rate. These metrics will continue to be monitored and compared with benchmarks and baseline data in order to assess progress toward a yearly reduction of 20% in fall rates. Results: Implementation testing has been ongoing since June 03, 2019. Based on the preliminary data, the FPSC help reduced the rates of falls during the initial stage of the implementation testing through a collaborative team effort to identify problem areas and implement solutions. Only one fall event has occurred since the test of change began over 8 weeks. The change package significantly impacted the knowledge and behaviors of the staff, patients and their families, thus resulting in heightened awareness and engagement about fall prevention. The result is limited at this time; however, the change is clinically relevant and continues to trend downward. Conclusion: Improving the identification of at-risk patients and decreasing falls is a complex process in the acute care setting. Lack of sustainable organization infrastructure contributes to inconsistent monitoring and interventions to ensure patient safety and decrease fall rates. Unit-based interprofessional teams that are highly motivated and well organized can significantly decrease fall rates through proactive approaches to anticipate risk and implement change strategies