Implementation of Bedside Technology May Influence Satisfaction with Nurse-Patient Communication

Health care consumers expect high quality care and outcomes that are cost effective, while hospitals focus on improving patient engagement and satisfaction and optimizing reimbursement. The nurse-patient communication process is a critical component of care for hospitalized patients. Use of technology applications to communicate patient needs may increase patient engagement in their own care while improving patient satisfaction. An expanded use of the electronic record capability has been implementation of a new patient-centric application embedded in the electronic record technology known as MyChart Bedside©. The objective of this study was to determine if there was an association between hospitalized patients using the MyChart Bedside© application and Hospital Consumer Assessment of Healthcare Providers and Systems survey (HCAHPS) nurse-patient communication scores. This was a retrospective cohort study. The setting was an acute care hospital with 415 beds and the application was studied on three medical-surgical nursing units. There were 1520 patients who responded to HCAHPS surveys over a three-year time period, of which 290 patients (14%) activated the bedside application. The measurements were patient satisfaction scores for three questions related to the Communication with Nurses domain on the survey. The results of the study demonstrated a statistically significant association between the patients who activated the MyChart Bedside© application and satisfaction with nurse-patient communication compared to the satisfaction scores for those who did not activate the application during hospitalization. The activators had.26 higher satisfaction scores than non-activators (p value \u3c.005). There was no significant association with the bedside application and satisfaction scores with age, race, or gender. In conclusion, the activation of MyChart Bedside© application, as an interactive application for patients, was associated with improved patient satisfaction and may be considered a strategy to enhance patient engagement in their own healthcare, improve satisfaction with nurse-patient communication, and support hospital reimbursement through meeting Value-Based Purchasing (VBP) initiatives

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

Inpatients' information needs about medication:A narrative systematic literature review

OBJECTIVE: To provide an overview of inpatients' information needs about medication, including the best moment to provide this information, how, by whom and what patient characteristics influence these needs.METHODS: A systematic literature review was conducted. Studies that reported the information needs from inpatients about medication were included from Medline and Embase. The Crowe critical appraisal tool (CCAT) was used to assess the quality of the studies.RESULTS: Initially, 710 records were retrieved from Medline and Embase. After the forward search, another 609 records were screened and in total, 26 articles were included. The CCAT scores ranged from 17 to 34 points on a 40 point scale and two articles received 0 points.CONCLUSION: Inpatients main needs about medicine information are information about adverse and beneficial effects of medication, and general rules about how to take medication. Preferably, this information is printed and provided at the time of prescribing by a physician that already has a relationship with the patient. The most recent studies show that patients are open to the use of modern technology.PRACTICE IMPLICATIONS: This review provides a starting point for providing medicine information to inpatients. Further research should focus on patient characteristics influencing these information needs.</p

Patient Engagement to Improve Medication Safety in the Hospital

Purpose: There is a pressing need to enhance patient safety in the hospital environment. While there are many initiatives that focus on improving patient safety, few have studied engaging patients themselves to participate in patient safety efforts. This work was motived by the belief that patients can contribute valuable information to their care and when equipped with the right tools, can play a role in improving medication safety in the hospital. Methods: This research had three aims and used a mixed-methods approach to better understand the concept of engaging patients to improve medication safety. In order to gain insight into whether patients could beneficially contribute to the safety of their hospital care, my first aim was to understand current perspectives on the sharing of clinical information with patients while they were in the hospital. To accomplish this aim, I conducted surveys with clinicians and enrolled patients in a short field study in which they received full access to their clinical chart. In Aim 2, I conducted a study to establish that the Patient Activation Measure (PAM), a common measure of patient engagement in the outpatient setting, showed reliability and validity in the inpatient setting. Building on the knowledge from Aim 1 and using the PAM instrument from Aim 2, my third aim evaluated the impact of providing patients with access to a medication review tool while they were preparing to be admitted to the hospital. Aim 3 was achieved through a randomized controlled trial (RCT) involving 65 patients I recruited from the emergency department at Columbia University Medical Center. I also conducted a survey of admitting clinicians who had patients participate in the trial to identify the impact on clinician practices and to elicit feedback on their perceptions of the intervention. Results: My research findings suggest that increased patient information sharing in the inpatient setting is beneficial and desirable to patients, and generally acceptable to clinicians. The clinician survey from Aim 1 showed that most respondents were comfortable with the idea of providing patients with their clinical information. Some expressed reservations that patients might misunderstand information and become unnecessarily alarmed or offended. In the patient field study from Aim 1, patients reported perceiving the information they received as highly useful, even if they did not fully understand complex medical terms. My primary contribution in Aim 2 was to provide sound evidence that the Patient Activation Measure is a valid and reliable tool for use in the inpatient setting. Establishing the validity and reliability of the PAM instrument in inpatient setting was essential for conducting the RCT in Aim 3, and it will provide a foundation for future clinicians and research investigators to measure and understand hospital patients’ levels of engagement. The results from the RCT in Aim 3 did not support my primary hypothesis that clinicians who had patients participate in their medication review process using an informatics tool would make more changes to the home medication list than clinicians who had patients in the control group. However, the results did suggest that most hospital patients are knowledgeable, willing, and able to contribute useful and important information to the medication reconciliation process. Interestingly, the clinicians I surveyed seemed far less convinced that their patients would be able to beneficially participate in the medication reconciliation process due to low health literacy and other barriers. Nevertheless, the clinicians did seem to believe that in theory, at least, patient involvement in the medication reconciliation process could have positive impacts on their workflow and potentially save them time. Conclusion: The overall theme resulting from my research is that patients can be a valuable resource to improve patient safety in the hospital. Patients are generally knowledgeable and willing to more actively participate in their hospital care. By developing the structures and processes to facilitate greater patient engagement, hospitals can provide an extra layer of safety and error prevention, particularly with respect to the medications patients take at home. As with any medical treatment, active participation in patient safety efforts may not be possible for all patients. However, I believe that if the culture of a hospital encourages openness and transparency, and if patients are given the proper tools and information, the quality and safety of hospital care will improve

Embracing Technology as the Extension of Nursing Practice to Enhance the Patient Experience

https://digitalcommons.unmc.edu/state_pres/1000/thumbnail.jp

The Development of a Patient Portal for Use During Hospitalization: Pediatric Registered Nurses' Perspectives

Patient portals are innovative digital health technologies that are impacting nursing practice. A patient portal is an electronic tool that allows patients and parents to access personal health information. There has been a recent focus to implement patient portal technology when children are hospitalized. This manuscript style thesis examines pediatric registered nurses (RNs) perspectives of new technology including patient portals and its impact on nursing care. The first manuscript is a thematic literature review that was conducted to determine pediatric health care providers perceptions of patient portal implementation. Five articles were included in the analysis and only two articles focused exclusively on health care providers views. Four themes summarize the pediatric practitioner’s experiences with a portal technology: The Benefits of the Patient Portal; Impact on Provider Workload; User-Friendliness of the Patient Portal; and Health Care Providers Needs with Portal Implementation. Pediatric RNs voices are limited in currently published research. Therefore, the second manuscript is an interpretive description study conducted to explore pediatric RNs perspectives of new technology, including a proposed patient portal, on patient care. A total of 10 nurses participated in a semi-structured individual interview. Six themes represent the RNs views of new technology, including a proposed patient portal, and the impact on nursing care during a child’s hospitalization. The first three themes: Standing in Both Worlds, Reshaping the Care Triad, and Needing Support embody the nurses’ views on the implementation of technology in the pediatric inpatient units they work. The RNs previous experience with health technology implementation informs their perspectives of a new portal technology and its potential impact on patient care. The last three themes encompass the RNs views on the development of a patient portal: Improving Family Centred Care, Connecting with Care, and Anticipating Nursing Implications. Overall, the RNs are anticipating a positive impact the portal can have on the hospital experience for children and their family members. Even though the nurses report a feeling of standing in both worlds in regards to technology and its varied implementation, they are still optimistic. The RNs are also bringing awareness to the impact of all the new technology, not just a single piece, on patient care and the art of nursing. The integrated discussion provides recommendations to a larger ongoing study and discusses the impact on nursing practice, education, and research. Recruiting and involving pediatric RNs can take considerable time and effort but they can provide valuable insight and feedback on new technology, including patient portals, which may result in more sustained use.

Providers' assessment of a novel interactive health information technology in a pediatric intensive care unit

Objective: To explore perceptions of critical care providers about a novel collaborative inpatient health information technology (HIT) in a pediatric intensive care unit (PICU) setting. Methods: This cross-sectional, concurrent mixed methods study was conducted in the PICU of a large midwestern children's hospital. The technology, the Large Customizable Interactive Monitor (LCIM), is a flat panel touch screen monitor that displays validated patient information from the electronic health record. It does not require a password to login and is available in each patient's room for viewing and interactive use by physicians, nurses, and families. Quantitative data were collected via self-administered, standardized surveys, and qualitative data via in-person, semistructured interviews between January and April 2015. Data were analyzed using descriptive statistics and inductive thematic analysis. Results: The qualitative analysis showed positive impacts of the LCIM on providers' workflow, team interactions, and interactions with families. Providers reported concerns regarding perceived patient information overload and associated anxiety and burden for families. Sixty percent of providers thought that LCIM was useful for their jobs at different levels, and almost 70% of providers reported that LCIM improved information sharing and communication with families. The average overall satisfaction score was 3.4 on a 0 to 6 scale, between "a moderate amount" and "pretty much." Discussion and Conclusion: This study provides new insight into collaborative HIT in the inpatient pediatric setting and demonstrates that using such technology has the potential to improve providers' experiences with families and just-in-time access to EHR information in a format more easily shared with families

Patient engagement or information overload: patient and physician views on sharing the medical record in the acute setting.

BACKGROUND: Patient and professional views about the impact of providing full real-time access to the medical record in the in-hospital setting are unknown. METHODS: Likert-scale and free-text validated questionnaire survey of physicians and patients from acute medical units in two hospitals. The questionnaire explored recent experiences; views on the formation of trust, and views on sharing either the entire medical record or a summary. RESULTS: Two-hundred and forty-eight patient questionnaires (62% response rate) and 32 physician questionnaires (21% response rate) were returned. Twenty-seven per cent of patients did not recall being told their diagnosis. Doctors and patients differed on what practices that they believed built trust.Eighty-one per cent of patients supported the idea of having access to the full medical record (for empowerment; the right to information about oneself; as an aide-memoire for discussion). Doctors feared it might provoke anxiety and change the nature of what was written. A written lay summary record was preferred by doctors and patients. CONCLUSIONS: The current system of providing information verbally to patients is inadequate. Patients want more information and are less concerned than physicians about potential negative effects of real-time access to their records. Patient access to medical records (in both full and summary forms) should be evaluated

Benefits of Information Technology in Healthcare: Artificial Intelligence, Internet of Things, and Personal Health Records

Objectives Systematic evaluations of the benefits of health information technology (HIT) play an essential role in enhancing healthcare quality by improving outcomes. However, there is limited empirical evidence regarding the benefits of IT adoption in healthcare settings. This study aimed to review the benefits of artificial intelligence (AI), the internet of things (IoT), and personal health records (PHR), based on scientific evidence. Methods The literature published in peer-reviewed journals between 2016 and 2022 was searched for systematic reviews and meta-analysis studies using the PubMed, Cochrane, and Embase databases. Manual searches were also performed using the reference lists of systematic reviews and eligible studies from major health informatics journals. The benefits of each HIT were assessed from multiple perspectives across four outcome domains. Results Twenty-four systematic review or meta-analysis studies on AI, IoT, and PHR were identified. The benefits of each HIT were assessed and summarized from a multifaceted perspective, focusing on four outcome domains: clinical, psycho-behavioral, managerial, and socioeconomic. The benefits varied depending on the nature of each type of HIT and the diseases to which they were applied. Conclusions Overall, our review indicates that AI and PHR can positively impact clinical outcomes, while IoT holds potential for improving managerial efficiency. Despite ongoing research into the benefits of health IT in line with advances in healthcare, the existing evidence is limited in both volume and scope. The findings of our study can help identify areas for further investigation