Mapping and assessing clinical handover training interventions

BACKGROUND: The literature reveals a patchwork of knowledge about the effectiveness of handover and transfer of care-training interventions, their influence on handover practices and on patient outcomes. We identified a range of training interventions, defined their content, and then proposed practical measures for improving the training effectiveness of handover practices. METHODS: We applied the Group Concept Mapping approach to identify objectively the shared understanding of a group of experts about patient handover training interventions. We collected 105 declarative statements about handover training interventions from an exhaustive literature review, and from structured expert interviews. The statements were then given to 21 healthcare and training design specialists to sort the statements on similarity in meaning, and rate them on their importance and feasibility. RESULTS: We used multidimensional scaling and hierarchical cluster analysis to depict the following seven clusters related to various handover training issues: standardisation, communication, coordination of activities, clinical microsystem care, transfer and impact, training methods and workplace learning. CONCLUSIONS: Ideas on handover training interventions, grouped in thematic clusters, and prioritised on importance and feasibility creates a repository of approaches. This allows healthcare institutions to design and test concrete solutions for improving formal training and workplace learning related to handovers, and addressing informal social learning at the organisational level, with the aim of increasing impact on handover practice and patient outcomes. Measures need to be taken to assure a continuum of handover training interventions from formal training through workplace learning through less formal social learning, and to embed this training in the design of the clinical microsystem

FACTORS THAT FACILITATE OR LIMIT THE INCORPORATION OF EMERGING TECHNOLOGIES IN THE CLASSROOM

This study explores the perceptions of the teachers from the District Education Secretariat (Bogotá-Colombia) on the factors that facilitate or limit the incorporation of Emerging Technologies in the classroom. The sample used for this research was based on 241 teachers from different educational institutions. The data were collected through an anonymous survey with quantitative and qualitative questions. Open and axial coding was used to identify the different factors in contextual levels, such as microsystem, mesosystem, exosystem and macrosystem. It was found that sociodemographic variables do not influence the incorporation of technology in the classroom, in addition, there are three necessary and basic conditions for teachers to begin to incorporate technology in the classroom: motivation, infrastructure and information and communication technologies skills, but for any processes to be successful the teacher must be aware of what he is doing but any attempt to incorporate technology will fail. On the other hand, government entities must be responsible to generate policies or strategies in order to improve infrastructure, as well as design training plans according to the needs of each teacher and each institution

Improving Communication in a Virtual Team: A Quality Improvement Project

Problem: Data analysis based on two surveys revealed team communication, interdependence, technology interfaces, and integration as the quality gaps in the Virtual Surveillance Team. When compared with traditional in-person teams, a virtual working team faces different types of communication challenges. Context: The virtual surveillance team in the regional quality department at Oakland monitors both Advance Alert Monitor (AAM), a statistical model developed by the Kaiser Permanente (KP) Division of Research (DOR) that is used to predict an individual’s likelihood of deterioration, and eHospital care gaps for Kaiser Foundation Hospitals in Northern California (KFH, NCAL). The latest evaluation from DOR of the AAM intervention in the pilot site from August 2016-February 2017 showed mean 35.5 hour reduction in hospital length of stay (LOS), and mean 19.1 hour reduction in Intensive Care Unit (ICU) LOS (Kaiser Permanente, 2017). As a result of the AAM implementation, the KP NCAL region planned to implement AAM intervention in all 21 facilities of KFH. To achieve this goal, the virtual surveillance team which includes the Clinical Nurse Leader (CNL) student has expanded rapidly. Communication failures have been frequently attributed to harmful events in healthcare for nearly two decades (Clarke, 2016). For this reason, better communication strategies, knowledge sharing among the team members, and collaborative technologies are critical for the CNL student’s team, where patient safety is the primary goal. Interventions: The quality improvement project aims at two interventions with the purpose of streamlining the workflow, and improving communication among the team. One intervention is to create a SharePoint team communication platform. A second is to develop an online training module of the SharePoint site for the team. Measures: The outcome measures are to improve the percentage of interdependence responses, and the percentage of integration of technology used to support the work of the virtual team. The outcome measures are analyzed through pre, intermediate, and post implementation surveys. Results: Trust and collaboration among team members increased from 58% to 72%. Integration of information and technology used to support the work of the team increased from 47% to 60%. With the implementation of SharePoint communication platform an increase in staff productivity is expected, due to decrease in time spent at the start of the shift to 15 mins per team member. The cost avoidance accrued through increase in staff productivity is estimated to be $21,040. The long term cost savings attributable to this project through enhanced communication and with AAM implementation is an estimated 4.5 hour mean reduction in hospital length of stay and a 0.9 mean hour reduction in ICU length of stay. This would generate an annual cost savings of$14,160 per facility in 2018 with an estimated annual savings of $142,000 for the healthcare organization. The team effectiveness, and the ease of use of technology is expected to improve once the SharePoint site has been implemented. Conclusions: The implications for practice are pending based on feedback from team members after using the site. Enhanced team communication with this project implementation is predicted to improve quality outcomes and increase cost savings

Community-Dwelling Older Adult Fall Prevention Improvement Project

Abstract Problem: Ground-level falls among community-dwelling adults 60 years and older are significant and contribute to adverse health outcomes such as fractures, functional decline, disability, and death. Additionally, falls among community-dwelling older adults are the number one mechanism of injury seen at a Northern California Level II trauma center. Falls often lead to post-fall fear, activity restriction, and physical deconditioning, further compounding fall risk. Context: When trauma centers provide targeted outreach and screening for unmanaged health risks such as falls, they reduce unnecessary disability and premature death in the local population. Reducing total fall victim numbers and fall recidivism also reduces resource utilization at the acute care hospital microsystem of care level, reduces organizational operating costs and optimizes trauma patient flow from a broader, systems-based approach. Intervention: This project improved the screening, referral, and enrollment of at-risk community-dwelling older adults into an evidence-based fall prevention program from a baseline of zero persons to ten persons per month by August 2021. The project occurred in three phases; (1) adult family medicine physician (AFMP) training and education on the existence of a quality gap, (2) AFMP education and training to address upstream, pre-fall determinants of health in older persons using the Centers for Disease Control and Prevention\u27s Stop Elderly Accidents, Deaths and Injuries (STEADI) Fall Risk Factors Checklist (2020), and (3) enrollment of the target population into an online fall prevention program, A Matter of Balance (AMOB), in the Spring of 2021. Measures: Process measures included self-reported or observed improvement in participants health status, fall-related confidence, or functional ability. Outcome measures included the percent of persons aged 60 years and older screened and referred by AFMP’s. Balancing measures included; (1) the percent of health plan members in the target population that had an eye exam in the last two years, and (2) fall prevention trainer fidelity to the AMOB program curriculum. Results: This project saw a 65% attrition rate prior to program commencement secondary to technology limitations of participants. The remaining participant\u27s self-reported and observed health status, fall-related confidence, and functional ability were evaluated at baseline and completion of the virtual program. At AMOB conclusion, 100% of participants reported a decreased fear of falling, 97.5% made environmental hazard reduction changes, 99.5% increased their physical activity and planned to continue exercising, and 100% would recommend the program to other older adults. Conclusion: Reducing falls will improve upstream determinants of health, reduce resource utilization at the hospital microsystem of care level, reduce hospital operational costs, and optimize trauma patient flow from a broader, systems-based approach. Keywords: Aging, exercise, fall prevention, falls, injury prevention, older adult

Internet use and child development: Validation of the ecological techno-subsystem

Johnson and Puplampu recently proposed the ecological techno-subsystem, a refinement to Bronfenbrenner's theoretical organization of environmental influences on child development. The ecological techno-subsystem includes child interaction with both living (e.g., peers) and nonliving (e.g., hardware) elements of communication, information, and recreation technologies in immediate or direct environments. The theoretical techno-subsystem requires empirical validation. Parents of 128 children in first through sixth grade consented to cognitive developmental assessment of their children and completed questionnaires on children’s use of the Internet at home and family socioeconomic characteristics. In general, indices of home Internet use accounted for more of the variance in children’s cognitive development than did indices of socioeconomic status. The ecological techno-subsystem furthers our understanding of environmental influences on child development by emphasizing the impact of digital technologies on cognitive growth during childhood

Micro-manufacturing : research, technology outcomes and development issues

Besides continuing effort in developing MEMS-based manufacturing techniques, latest effort in Micro-manufacturing is also in Non-MEMS-based manufacturing. Research and technological development (RTD) in this field is encouraged by the increased demand on micro-components as well as promised development in the scaling down of the traditional macro-manufacturing processes for micro-length-scale manufacturing. This paper highlights some EU funded research activities in micro/nano-manufacturing, and gives examples of the latest development in micro-manufacturing methods/techniques, process chains, hybrid-processes, manufacturing equipment and supporting technologies/device, etc., which is followed by a summary of the achievements of the EU MASMICRO project. Finally, concluding remarks are given, which raise several issues concerning further development in micro-manufacturing

Learning style and digital activity: an ecological study

In order to understand student engagement in higher education through the use of digital technologies, it is necessary to appreciate the broader use of differing technologies. Forty-eight first-year university students completed an online survey that queried patterns of digital activity across home, school and community contexts and that included rating scale items that measured learning style (i.e., active-reflective, sensing-intuitive, visual-verbal, sequential-global). Results suggest that students vary widely in digital activities and that such variation is related to differences in learning style. For example, active learners were more likely than reflective learners to engage in digital activities in the community and users of some specific application, as opposed to non-users, were more likely to be verbal than visual learners. Implications for instructional applications of digital technology in higher education are presented

Electronic Health Record Utilization and Education: Improving Role-Specific Confidence and Competence in the Outpatient Setting

The call for meaningful use of electronic health records (EHR) and its universal benefits are well known. Despite mandates for change resistance to adoption of paper-less system remains problematic. Non-use of the EHR has persisted in the outpatient specialty care setting in spite of 4 all-staff trainings and stakeholder backing. This project suggests that implementing team leadership and educational tools provides staff with confidence and supportive resources to achieve proficiency. Objectives for this project include (a) providing staff with training and tools to access self-guided troubleshooting videos, follow quick-guide checklists for crucial tasks, and provide handouts for patient portal access, (b) verifying competency to complete role specific tasks, and (c) enhance morale. As of August 2017, 100% of staff were able to able to demonstrate self-efficacy to perform basic EHR functions and access resources. Data comparison of pre-/post-implementation survey data reveals staff self-confidence in EHR use increased from 40% to 90%. Staff feelings of support related using the software platform increased from 60% to 95%. Further research is recommended to promote understanding of how microsystems with limited resources can achieve meaningful use of EHRs, promote staff engagement, and achieve financial benefits

A Model for Using Physiological Conditions for Proactive Tourist Recommendations

Mobile proactive tourist recommender systems can support tourists by recommending the best choice depending on different contexts related to herself and the environment. In this paper, we propose to utilize wearable sensors to gather health information about a tourist and use them for recommending tourist activities. We discuss a range of wearable devices, sensors to infer physiological conditions of the users, and exemplify the feasibility using a popular self-quantification mobile app. Our main contribution then comprises a data model to derive relations between the parameters measured by the wearable sensors, such as heart rate, body temperature, blood pressure, and use them to infer the physiological condition of a user. This model can then be used to derive classes of tourist activities that determine which items should be recommended