Marshfield Clinic: Health Information Technology Paves the Way for Population Health Management

Highlights Fund-defined attributes of an ideal care delivery system and best practices, including an internal electronic health record, primary care teams, physician quality metrics and mentors, and standardized care processes for chronic care management

Organizing the U.S. Health Care Delivery System for High Performance

Analyzes the fragmentation of the healthcare delivery system and makes policy recommendations -- including payment reform, regulatory changes, and infrastructure -- for creating mechanisms to coordinate care across providers and settings

Montefiore Medical Center: Integrated Care Delivery for Vulnerable Populations

Describes a system of hospitals and community- and school-based clinics tailored to low-income patients through systemwide strategies, high-quality specialty and hospital care, and integrated care delivery via care management and information technology

Scott & White Healthcare: Opening Up and Embracing Change to Improve Performance

Offers a case study of a multispeciality system with the attributes of an ideal healthcare delivery system as defined by the Fund. Describes a culture of continuous improvement, collaboration and peer accountability, and a comprehensive approach to care

Improving Patient Satisfaction with the Virtual Handoff Process through the Utilization of Educational Pamphlets in the Emergency Department

Boarding patients in the emergency room while waiting to transfer the patient to the proper unit can be harmful to clinical care and have significant financial opportunity costs. At one local hospital it was found that on average patients were being boarded in the emergency room (ED) for approximately 85 minutes waiting to be transferred. Several barriers that caused this delay were found including, delay in room cleaning, nurse staff shortage, and inability to give report to the nurse receiving the patient. In an attempt to combat this delay which may be caused by a difficulty in giving patient report, this organization is rolling out a virtual bedside handoff process. While virtual technology is not a new concept, there are many patients that may not be comfortable with the technology. The purpose of the evidence-based project was to provide a written educational pamphlet that details the how’s and why’s of the virtual handoff process to the patient to be given upon admission. The goal of the educational pamphlet was to increase the patients’ satisfaction with the process. A pre-survey was given to a group of patients after they experienced the virtual handoff process to assess their comfort level. These results were compared to the post-survey results of patients that received the educational pamphlet prior to experiencing the virtual handoff process. Ten pre-surveys and seven post-surveys were analyzed utilizing SPSS and descriptive statistics. The analysis concluded that the participants who received the educational pamphlet felt more prepared for the virtual handoff process

Gundersen Lutheran Health System: Performance Improvement Through Partnership

Highlights Fund-defined attributes of an ideal system and best practices such as using data for benchmarking, increasing transparency, and driving improvement; investing in primary care and disease management; and hiring engineers to improve operations

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.

The use of professional portfolios and profiles for career enhancement.

Since 1995, registered nurses and midwives have been obliged to develop and maintain a professional portfolio of evidence reflecting the learning activities that they have undertaken and how these have informed and influenced their practice. The aim of this article is to demonstrate that rather then just a retrospective account of continuing professional development activities, a portfolio can be used as a vehicle for engaging in self-assessment and personal development planning. Possible structures and type of evidence are explored and portfolios in the context of gaining accreditation for prior experiential learning, and in particular for those nurses in advanced clinical roles, are discussed

Systematic review of therapeutic leave in inpatient mental health services

AimTo identify, critically evaluate, and synthesise the empirical evidence about therapeutic leave from mental health inpatient settings.Background“Leave” occurs when a mental health inpatient exits the hospital ward with the appropriate authorisation alone, or accompanied by staff, family, or friends. Limited research has previously addressed therapeutic as opposed to unauthorised leave, and the evidence-base has not been systematically evaluated.DesignSystematic review methodology following relevant Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement guidance.Data SourcesMultiple electronic databases (CINAHL; Criminal Justice database; PsycARTICLES; Scopus; OpenGrey; Cochrane; GoogleScholar) for papers published from January 1967 to July 2017.Review MethodsInformation was extracted under the following headings: study, purpose/aims, sample, country, setting, design and data collection method(s), data collection instrument, and results. Papers were assessed, as per the hierarchy of scientific evidence, and where there was sufficient data, we calculated a range of standardised rates of leave incidence.ResultsStandardised leave rates in forensic settings reflect security level. There was little meaningful information on which to base calculation of rates for civil settings. The strongest evidence supports leave used for supervised discharge; other forms of leave lack an evidence base and decisions appear to be made on the basis of heuristic rules and unsupported assumptions. Clinical decision making about therapeutic leave cannot claim to be evidence-based.ConclusionResearch is urgently needed to provide information about how leave is managed, the best ways to support leave, and what happens on leave

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