Improving communication in intensive care unit to ward transitions: Protocol for multisite national implementation of the ICU-PAUSE handoff tool

BACKGROUND: The intensive care unit (ICU)-ward transfer poses a particularly high-risk period for patients. The period after transfer has been associated with adverse events and additional work for care teams related to miscommunication or omission of information. Standardized handoff processes have been found to reduce communication errors and adverse patient events in other clinical environments but are understudied at the ICU-ward interface. We previously developed an electronic ICU-ward transfer tool, ICU-PAUSE, which embeds the key elements and diagnostic reasoning to facilitate a safe transfer of care at ICU discharge. OBJECTIVE: The aim of this study is to evaluate the implementation process of the ICU-PAUSE handoff tool across 10 academic medical centers, including the rate of adoption and acceptability, as perceived by clinical care teams. METHODS: ICU-PAUSE will be implemented in the medical ICU across 10 academic hospitals, with each site customizing the tool to their institution\u27s needs. Our mixed methods study will include a combination of a chart review, quantitative surveys, and qualitative interviews. After a 90-day implementation period, we will conduct a retrospective chart review to evaluate the rate of uptake of ICU-PAUSE. We will also conduct postimplementation surveys of providers to assess perceptions of the tool and its impact on the frequency of communication errors and adverse events during ICU-ward transfers. Lastly, we will conduct semistructured interviews of faculty stakeholders with subsequent thematic analysis with the goal of identifying benefits and barriers in implementing and using ICU-PAUSE. RESULTS: ICU-PAUSE was piloted in the medical ICU at Barnes-Jewish Hospital, the teaching hospital of Washington University School of Medicine in St. Louis, in 2019. As of July 2022, implementation of ICU-PAUSE is ongoing at 6 of 10 participating sites. Our results will be published in 2023. CONCLUSIONS: Our process of ICU-PAUSE implementation embeds each step of template design, uptake, and customization in the needs of users and key stakeholders. Here, we introduce our approach to evaluate its acceptability, usability, and impact on communication errors according to the tenets of sociotechnical theory. We anticipate that ICU-PAUSE will offer an effective handoff tool for the ICU-ward transition that can be generalized to other institutions. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/40918

Doctor of Philosophy

DissertationHealth information technology (HIT) in conjunction with quality improvement (QI) methodologies can promote higher quality care at lower costs. Unfortunately, most inpatient hospital settings have been slow to adopt HIT and QI methodologies. Successful adoption requires close attention to workflow. Workflow is the sequence of tasks, processes, and the set of people or resources needed for those tasks that are necessary to accomplish a given goal. Assessing the impact on workflow is an important component of determining whether a HIT implementation will be successful, but little research has been conducted on the impact of eMeasure (electronic performance measure) implementation on workflow. One solution to addressing implementation challenges such as the lack of attention to workflow is an implementation toolkit. An implementation toolkit is an assembly of instruments such as checklists, forms, and planning documents. We developed an initial eMeasure Implementation Toolkit for the heart failure (HF) eMeasure to allow QI and information technology (IT) professionals and their team to assess the impact of implementation on workflow. During the development phase of the toolkit, we undertook a literature review to determine the components of the toolkit. We conducted stakeholder interviews with HIT and QI key informants and subject matter experts (SMEs) at the US Department of Veteran Affairs (VA). Key informants provided a broad understanding about the context of workflow during eMeasure implementation. Based on snowball sampling, we also interviewed other SMEs based on the recommendations of the key informants who suggested tools and provided information essential to the toolkit development. The second phase involved evaluation of the toolkit for relevance and clarity, by experts in non-VA settings. The experts evaluated the sections of the toolkit that contained the tools, via a survey. The final toolkit provides a distinct set of resources and tools, which were iteratively developed during the research and available to users in a single source document. The research methodology provided a strong unified overarching implementation framework in the form of the Promoting Action on Research Implementation in Health Services (PARIHS) model in combination with a sociotechnical model of HIT that strengthened the overall design of the study

Examining Nurse Satisfaction with a Bedside Handover Report Process

Nurses\u27 job satisfaction affects work performance at the point of care in hospitals. The incoming nurses who are able to receive a comprehensive patient report at shift change are more prepared in comparison to incoming nurses who are not able to receive a comprehensive patient report to provide care that is safe. The purpose of this project, guided by the theory of organization change, was to explore whether the use of a bedside handover process impacts nurses\u27 satisfaction in an adult postoperative orthopedic and spine unit. A post-implementation survey of the bedside handover process was conducted after one month and two months to examine registered nurses\u27 (RN) (n = 50) satisfaction using a 7-question self-designed instrument with a reliability coefficient of 0.80. The Bedside Handover Report Staff Nurses\u27 Satisfaction Survey consisted of 5-item Likert scale with scores ranging from 1 (strongly disagree) to 5 (strongly agree). The survey results found that RNs were satisfied with the bedside handover report process. Matched-pair t tests revealed significant differences between the first and second months after the handover report process was implemented. Specifically, \u27Bedside handover report provides time for the incoming RN to verify patient\u27s health issues\u27 (p = .05),\u27 I am satisfied with the handover report process conducted at the patient\u27s bedside\u27 (p = .01), and total score (p = .03) improved from the first to second month. A longitudinal study spanning 6 months to a year is recommended when the project will be implemented in the entire facility. A bedside handover report increases nurse satisfaction because the process allows the nurses to verify and address patient health issues that are essential for positive social change

Reducing Rehospitalizations of Nursing Home Residents through Telehealth: A Quality Improvement Program

Hospital readmissions in nursing home residents are a major problem affecting health care outcomes, resident quality of life, and costs. Telehealth has been shown to improve care delivery for persons with chronic conditions and has promise for reducing nursing home rehospitalizations. The purpose of this Doctor of Nursing Practice (DNP) project was to explore nurses’ knowledge, attitudes, beliefs, and self-reported use of telehealth in caring for Skilled Nursing Facility (SNF) residents with the goal of developing an evidence-based educational program for the facility. A convenience sampling approach was used. Participants, all registered nurses (RNs), were recruited from a local SNF. A 35-item online survey was developed and modified from Kowitlawakul’s (2008) eICU Acceptance Survey based on the Telehealth Acceptance Model (TAM). Twenty-four RNs of the eligible 75 RNs completed the survey (participation rate of 32%), a majority (75%, n = 18) were women, and worked the dayshift (75%, n = 18 ). Most of the nurses felt telehealth was easy to use (n =16, 72.7%), felt comfortable using telehealth (n= 17, 77.3%), and believed telehealth provides more time for patient care (n =14, 63.6%). Fifty percent (n =12) of the participants did not think telehealth would enhance job effectiveness and 48% (n =11) did not believe telehealth would increase job productivity. The primary finding from this quality improvement project (QIP) was that although most staff had a positive perspective toward the use of telehealth, approximately half of nurses reported telehealth does not increase productivity or enhance job effectiveness. These findings indicate staff may benefit from an evidence-based educational program focused on the value of telehealth in preventing SNF resident rehospitalizations

Learning in Enterprise System Support: Specialization, Task Type and Network Characteristics

In this paper, we introduce two contingency factors --task type and network characteristics—that examine how individuals learn from experience. We hypothesize that task specialization and variation have positive impacts on IS professionals’ learning from experience. We further hypothesize that this performance effect of learning is contingent upon task type and characteristics of domain-specific knowledge networks. In particular, specialized experience will be more beneficial to learning when a task is a locating task-type or when network centrality is high. In contrast, varied experience will be more beneficial when a task is a diagnosing task-type or when network betweenness is high. The research model will be validated in the context of postimplementation enterprise system support. The study incorporates a social network perspective to study learning by experience, and contributes to the knowledge management field. Findings will provide practical insights on managing IT human capital and improving IS support services

Investigating the Complexity of Organizational Digitization and Firm Performance: A Set-Theoretic Configurational Approach

This study investigates the causal complexity and diversity of the relationship between organizational digitization and firm performance. Digitization – defined as the penetration of IT in the organization – is a complex organizational phenomenon in that it involves changes in organizational strategy, business processes, organizational knowledge and eventually the whole socio-technical organizational system, thus influencing organizational performance. We adopt a holistic configuration theory lens and a set-theoretic method, fuzzy-set qualitative comparative analysis (fsQCA) to explain how such interdependent relationships among digitization and organizational strategic elements result in high firm performance. We apply the set-theoretic method to a longitudinal field data set collected from 1816 Canadian firms. We found multiple equifinal configurations that result in high performance. By comparing the similarities and differences within and between the configurations, we could explain the multifaceted roles that digitization plays in achieving high performance together with organizational strategies

Exploring the Path to ERP Implementation Success: In Retrospect after Rollout

Whereas numerous studies have examined critical success factors (CSFs) for Enterprise Resource Planning (ERP) implementation, little work has investigated the underlying causal links in the form of conceptual models. This study develops a casual model for ERP implementation success, using a two-stage approach. In Stage one, 27 online publications on ERP implementation in China were collected, and analyzed based on the grounded theory approach, to identify critical events and activities in the process of ERP implementation. In Stage two, a focus group study was conducted to create paths to ERP implementation success in the form of a conceptual model. The 48 critical factors identified in Stage one were mapped onto goals of ERP implementation, following the soft systems methodology (SSM). The result is a model including five high-order concepts: organizational impact, data quality, Normalization of processes, continuous improvement, and fit between business process and ERP systems

The Use of a Patient Mobility Sensor to Decrease Hospital-Acquired Pressure Ulcers

Pressure ulcers are a serious health condition that have negative consequences for patients and organizations. The primary cause of pressure ulcers is intense and/or prolonged pressure or pressure in combination with shear that results in damage to the skin and underlying soft tissue. Early identification of patients at risk for pressure ulcers and 2-hour repositioning to off-load pressure are key components in reducing pressure ulcer development. Despite ongoing efforts to prevent pressure ulcers, the incidence and prevalence of hospital-acquired pressure ulcers (HAPUs) at the practicum site exceeded the benchmark for Magnet hospitals and the health system\u27s goal of 1%. Patient mobility sensor technology will be implemented on all patients who are at risk for pressure ulcers and who require caregiver-assisted turns to reduce the incidence and prevalence of HAPUs and increase turn-schedule compliance. At risk patients are those with a Braden Scale score of 18 or less; however, nurses often score patients higher than actual. An educational activity, Braden Scale for Predicting Pressure Sore Risk: It\u27s only as effective as the scores suggest, will be presented to nurses to provide them with the knowledge and skills necessary to accurately perform a Braden assessment and correctly identify patients at risk for pressure ulcers. A pretest/posttest design will be used to evaluate the effectiveness of the program in improving the nurses\u27 accuracy when performing the Braden assessment. This project will help with the early identification of patients who will benefit from the patient mobility sensor technology and ultimately in decreasing HAPUs