Improving Clinical Communication and Collaboration Through Technology

Problem: Over the last 30 years, clinical communication methodologies in healthcare have evolved to become such disparate systems that they lead to confusion, wasted time, and clinician dissatisfaction. The Joint Commission (2016) reports up to 78% of sentinel events in hospitals are linked to communication failures, which have obvious implications for hospital systems in the quality and safety of their current communication systems. Context: The purpose of this project was to determine the effectiveness of implementing a unified clinical communication technology platform in an acute care hospital setting and to make recommendations from that implementation to the organization’s larger health system. Its purpose was also to determine if the creation of a clinical communication technology implementation guide for nurse leaders would positively impact future implementations of such platforms throughout the larger health system. Interventions: This project introduced smartphone communication technologies to inpatient nurses and other clinicians in a 352-bed hospital in California, which is part of a larger 39-hospital, multi-state system. Analysis was then performed by collecting data before and after implementation of the clinical communication platform. While not part of the original plan, elements of the platform were subsequently deployed to help with clinical communication during the height of the SARs CoV (COVID-19) pandemic, and this implementation was also analyzed for the project. The intention was also to determine if the creation of a clinically focused implementation guide for clinical leaders could positively impact the application of such a communication platform throughout the larger health system. Measures: Measures in this study included productivity, efficiency, quality of care, communication, and staff satisfaction with the newly implanted technology. Measurement regarding the usefulness of the implementation guide was gauged through the perceived satisfaction of nurse leaders who reviewed the guide and gave feedback. Results: Mixed results were realized from the implementation of this technology, but the work yielded valuable information for future implementations within the organization. Frontline staff and physician satisfaction with the whole platform was low, but leadership satisfaction with the elements implemented for COVID-19 was high. For the implementation guide, nurse leaders gave valuable feedback and determined it would be a highly useful document for facility implementation leads in the future. Conclusion: The implementation of new clinical communication technology and methodologies has the opportunity to improve productivity, efficiency, quality of care, communication, and staff satisfaction, but only if barriers to implementation are mitigated before, during, and immediately after go-live. A comprehensive implementation guide for nurse leaders can be the tool designed specifically to mitigate these barriers and prepare nurse leaders and facilities for the new technology and associated workflow changes that accompany the technology

Transactions of 2015 International Conference on Health Information Technology Advancement Vol.3, No. 1

The Third International Conference on Health Information Technology Advancement Kalamazoo, Michigan, October 30-31, 2015 Conference Chair Bernard Han, Ph.D., HIT Pro Department of Business Information Systems Haworth College of Business Western Michigan University Kalamazoo, MI 49008 Transactions Editor Dr. Huei Lee, Professor Department of Computer Information Systems Eastern Michigan University Ypsilanti, MI 48197 Volume 3, No. 1 Hosted by The Center for Health Information Technology Advancement, WM

Mediating ICU patient situation-awareness with visual and tactile notifications

Indiana University-Purdue University Indianapolis (IUPUI)Healthcare providers in hospital intensive care units (ICUs) maintain patient situation awareness by following task management and communication practices. They create and manipulate several paper-based and digital information sources, with the overall aim to constantly inform themselves and their colleagues of dynamically evolving patient conditions. However, when increased communication means that healthcare providers potentially interrupt each other, enhanced patient-situation awareness comes at a price. Prior research discusses both the use of technology to support increased communication and its unintended consequence of (wanted and unwanted) notification interruptions. Using qualitative research techniques, I investigated work practices that enhance the patient-situation awareness of physicians, fellows, residents, nurses, students, and pharmacists in a medical ICU. I used the Locales Framework to understand the observed task management and communication work practices. In this study, paper notes were observed to act as transitional artifacts that are later digitized to organize and coordinate tasks, goals, and patient-centric information at a team and organizational level. Non digital information is often not immediately digitized, and only select information is communicated between certain ICU team members through synchronous mechanisms such as face-to-face or telephone conversations. Thus, although ICU providers are exceptionally skilled at working together to improve a critically ill patient’s condition, the use of paper-based artifacts and synchronous communication mechanisms induces several interruptions while contextually situating a clinical team for patient care. In this dissertation, I also designed and evaluated a mobile health technology tool, known as PANI (Patient-centered Notes and Information Manager), guided by the Locales framework and the participatory involvement of ICU healthcare providers as co designers. PANI-supported task management induces minimal interruptions by: (1) rapidly generating, managing, and sharing clinical notes and action-items among clinicians and (2) supporting the collaboration and communication needs of clinicians through a novel visual and tactile notification system. The long-term contribution of this research suggests guidelines for designing mobile health technology interventions that enhance ICU patient situation-awareness and reduce unwanted interruptions to clinical workflow

The Student Athlete Wellness Portal: Translating Student Athletes’ Prescription Opioid Use Narratives into a Targeted Public Health Intervention

Background and Objectives: The opioid epidemic has permeated all strata of society over the last two decades, especially within the adolescent student athletic environment, a group particularly at risk and presenting their own challenges for science and practice. This paper (a) describes the development of a web-based intervention called the Student Athlete Wellness Portal that models effective opioid misuse resistance strategies and (b) details the findings of a single-group design to test its effectiveness. Materials and Methods: Formative research included 35 student athletes residing in the United States, ages 14 to 21, who had been injured in their school-based sport. They participated in in-depth qualitative interviews to explore narratives relating to their injuries and pain management plans. Inductive analyses of interview transcripts revealed themes of the challenges of being a student athlete, manageable vs. unmanageable pain, and ways to stay healthy. These themes were translated into prevention messages for the portal, which was then tested in a single-group design. Results: Users of the portal (n = 102) showed significant decreases in their willingness to misuse opioids and increases in their perceptions of opioid risks. Conclusions: This manuscript illuminates the processes involved in translating basic research knowledge into intervention scripts and reveals the promising effects of a technology-based wellness portal

Virtual Reality Applications and Development

Virtual Reality (VR) has existed for many years; however, it has only recently gained wide spread popularity and commercial use. This change comes from the innovations in head mounted displays (HMDs) and from the work of many software engineers making quality user experiences (UX). In this thesis, four areas are explored inside of VR. One area of research is within the use of VR for virtual environments and fire simulations. The second area of research is within the use of VR for eye tracking and medical simulations. The third area of research is within multiplayer development for more immersive collaborative simulations. Finally, the fourth area of research is within the development of typing in 3D for virtual reality. Extending from this final area of research, this thesis details an application that details more practical and granular details about developing for VR and using the real-time development platform, Unity

Implementing a Surgical Infection Prevention Practice in an Integrated Healthcare System

Problem: One of the most preventable health care associated infections (HAI) is surgical site infection (SSI). Approximately sixty percent of SSI’s could be prevented. The devastation of an SSI to the patient can be catastrophic. The cost to the health care system for treating SSI’s can be substantial (Ban et al., 2017). Context: The rate of surgical site infections has been on the increase over the past three years. The concern for the amount of harm affecting our patients was worrisome. The cost of reputation and the bottom line to the organization was recognized by senior leadership. The support from all key stakeholders was steadfast. Intervention: An evidenced based change of practice was designed and implemented across 21 medical centers to prevent surgical site infection. Measures: There were six process measures: The use of chlorhexidine wipes preoperatively, hair clipping outside the operating room, weight based antibiotics, normothermia, antibiotic re-dosing, surgical skin prep. An additional process measure was added half way through the project and that was smoking cessation. There was one outcome measure, surgical site infection rate. Conclusions: The aim of the project was a 30 percent increase in compliance of the process measures. This aim was realized after the role out of the project. The reduction of SSI across all surgical lines was the proposed outcome measure. The outcome measures are expected to correlate with the increased standardization of the process measures hardwired into the nursing workflows

Usability analysis of contending electronic health record systems

In this paper, we report measured usability of two leading EHR systems during procurement. A total of 18 users participated in paired-usability testing of three scenarios: ordering and managing medications by an outpatient physician, medicine administration by an inpatient nurse and scheduling of appointments by nursing staff. Data for audio, screen capture, satisfaction rating, task success and errors made was collected during testing. We found a clear difference between the systems for percentage of successfully completed tasks, two different satisfaction measures and perceived learnability when looking at the results over all scenarios. We conclude that usability should be evaluated during procurement and the difference in usability between systems could be revealed even with fewer measures than were used in our study. © 2019 American Psychological Association Inc. All rights reserved.Peer reviewe