Immediate Decision-Making and Information Needs in Intensive Care Coordination

The aim of this study was to develop a theoretical model for information integration to support the deci¬sion making of intensive care charge nurses, and physicians in charge – that is, ICU shift leaders. The study focused on the ad hoc decision-making and immediate information needs of shift leaders during the management of an intensive care unit’s (ICU) daily activities. The term ‘ad hoc decision-making’ was defined as critical judgements that are needed for a specific purpose at a precise moment with the goal of ensuring instant and adequate patient care and a fluent flow of ICU activities. Data collection and research analysis methods were tested in the identification of ICU shift leaders’ ad hoc decision-making. Decision-making of ICU charge nurses (n = 12) and physicians in charge (n = 8) was observed using a think-aloud technique in two university-affiliated Finnish ICUs for adults. The ad hoc decisions of ICU shift leaders were identified using an application of protocol analysis. In the next phase, a structured online question¬naire was developed to evaluate the immediate information needs of ICU shift leaders. A national survey was conducted in all Finnish, university-affiliated hospital ICUs for adults (n = 17). The questionnaire was sent to all charge nurses (n = 515) and physicians in charge (n = 223). Altogether, 257 charge nurses (50%) and 96 physicians in charge (43%) responded to the survey. The survey was also tested internationally in 16 Greek ICUs. From Greece, 50 charge nurses out of 240 (21%) responded to the survey. A think-aloud technique and protocol analysis were found to be applicable for the identification of the ad hoc decision-making of ICU shift leaders. During one day shift leaders made over 200 ad hoc decisions. Ad hoc decisions were made horizontally, related to the whole intensive care process, and vertically, concerning single intensive care incidents. Most of the ICU shift leaders’ ad hoc decisions were related to human resources and know-how, patient information and vital signs, and special treatments. Commonly, this ad hoc decision-making involved several multiprofessional decisions that constituted a bundle of immediate decisions and various information needs. Some of these immediate information needs were shared between the charge nurses and the physicians in charge. The majority of which concerned patient admission, the organisation and management of work, and staff allocation. In general, the information needs of charge nurses were more varied than those of physicians. It was found that many ad hoc deci-sions made by the physicians in charge produced several information needs for ICU charge nurses. This meant that before the task at hand was completed, various kinds of information was sought by the charge nurses to support the decision-making process. Most of the immediate information needs of charge nurses were related to the organisation and management of work and human resources, whereas the information needs of the physicians in charge mainly concerned direct patient care. Thus, information needs differ between professionals even if the goal of decision-making is the same. The results of the international survey confirmed these study results for charge nurses. Both in Finland and in Greece the information needs of charge nurses focused on the organisation and management of work and human resources. Many of the most crucial information needs of Finnish and Greek ICU charge nurses were common. In conclusion, it was found that ICU shift leaders make hundreds of ad hoc decisions during the course of a day related to the allocation of resources and organisation of patient care. The ad hoc decision-making of ICU shift leaders is a complex multi-professional process, which requires a lot of immediate information. Real-time support for information related to patient admission, the organisation and man¬agement of work, and allocation of staff resources is especially needed. The preliminary information integration model can be applied when real-time enterprise resource planning systems are developed for intensive care daily managementSiirretty Doriast

Potilaspalautetta QR‐koodilla ‐ Käyttöönottopilotti Varsinais‐Suomen sairaanhoitopiirissä

Potilaspalautteet ovat yksi tärkeä menetelmä terveydenhuollon asiakaslähtöisen toimintakulttuurin luomisessa ja hoidon laadun jatkuvassa kehittämisessä. Vahva perusta potilaspalautteen merkitykselle tulee muun muassa terveydenhuoltolaista ja sosiaali- ja terveydenhuollon kansallisesta kehittämisohjelmasta.  Potilaspalautetta kerätään terveydenhuollossa yleisesti manuaalisesti erilaisilla kyselyillä. Useimmat terveydenhuollon yksiköt keräävät palautetta myös sähköisesti internetsivujen kautta. Potilaille ja heidän läheisilleen palautteen antamisen tulisi olla mahdollisimman helppoa. Terveydenhuollon ammattilaisille puolestaan palautteen reaaliaikaisuus ja raportointijärjestelmän sujuva hyödyntäminen hoidon kehittämisessä ovat tärkeitä tekijöitä.Tämän artikkelin tarkoituksena on kuvata uuden potilaspalautemenetelmän, QR-koodin käyttöönottopilottia sekä verrata palautteenkeräysmenetelmää nykykäytäntöön Varsinais-Suomen sairaanhoitopiirissä (VSSHP). Käyttöönottopilotti tehtiin yhteistyössä VSSHP:n kehittämispalveluiden, sydäntoimialueen, sairaanhoidollisten palveluiden, lasten ja nuorten klinikan sekä TapIn Solutions Oy:n kanssa. Pilotti toteutettiin Turun yliopistollisen keskussairaalan neljässä toimipisteessä: kuvantamisessa, lasten päiväsairaalassa, sydänpoliklinikalla ja -vuodeosastolla. Käyttöönottopilotti kesti noin 1,5 kuukautta. Pilotti tukee erilaisten potilaspalautemenetelmien käytettävyyden ja hyödynnettävyyden arviointia tulevaisuudessa.Arvioimme tuloksissa uuteen palautemenetelmään liittyviä käyttäjäkokemuksia loppukäyttäjien, henkilökunnan ja lähiesimiesten näkökulmasta suhteessa nykykäytäntöön. Pilotoitu menetelmä näyttäisi lisäävän palautteiden määrää. Muita uuden menetelmän vahvuuksia ovat palautteiden reaaliaikaisuus, palauteväittämien sujuva muokattavuus ja niiden liittäminen osaksi kehittämistä ja laadun parantamista, manuaalisen työn väheneminen ja kustannustehokkuus sekä reaaliaikaiset valmiit raportit. Suurin este potilaspalautteen keräämiselle ja hyödyntämiselle näyttäisi liittyvän enemmän henkilökunnan asenteisiin kuin käytettyihin menetelmiin. Potilaat ja / tai heidän läheisensä näkevät palautteen tärkeänä osana toiminnan kehittämistä. Patient feedback is an important tool in creating customer-oriented culture of public health services and in constant development of the quality of care. The health care act and the national development program for social welfare and public health service form a strong foundation for the significance of patient feedback. Quite often patient feedback is manually collected with different questionnaires in the public health care. In addition, most public health service units collect patient feedback electronically through their web pages. Giving feedback should be as easy as possible for the patients and their next of kin. As for the professionals of the public health services, the most important factors are real time feedback and the fluent use of the feedback reports in the development of patient care.The purpose of this article is to describe the implementation of a new patient feedback tool, QR code, and to compare it to the present practice in the hospital district of South West Finland (VSSHP). This pilot study was made in cooperation with the hospital district’s Development Unit, Cardiological Clinic, Medical Services, Children and Adolescent Clinic, and with TapIn Solutions Inc. The pilot was carried out in four units of the University Central Hospital of Turku: in the imaging unit, in the children’s day hospital, in the heart outpatient department and in the cardiological ward. The pilot study lasted about one and a half months and will support future evaluation of the usability and usefulness of different methods on gathering patient feedback.We evaluate the user experience of the new feedback tool from the end users', staff's and managers’ point of view in relation to the present practice. The piloted tool seems to increase the amount of patient feedback. Other strengths of the new method are: real time feedback, fluent revise of statements in order to develop and improve the quality of care, decrease of manual work and cost efficiency, and real time reports. One of the biggest impediments for collecting and utilizing patient feedback seems to be more connected to the attitudes of the staff than to the methods used. The patients and/or their next of kin see the feedback as an important part of the process of developing the care.

Identifying nurse managers' essential information needs in daily unit operation in perioperative settings

Aim To identify nurse managers' essential information needs in daily unit operation in perioperative settings. Design Qualitative and quantitative descriptive design. Methods The study consisted of (I) generation of an item pool of potential information needs, (II) assessment of the item pool by an expert panel and (III) confirming the essential information needs of nurse managers in daily unit operation with a survey (N = 288). Content validity index values were calculated for the assessments by expert panel and in the survey. Internal consistency of the final item pool was explored with Cronbach's alpha. The data were collected from 2011-2015. Results During the study process, the number of essential information needs decreased from 92-41. The final item pool consisted of 12 subthemes, and they were categorized into four main themes: patient's care process, surgical procedure, human resources and tangible resources. The findings can be used to create a knowledge map for information system purposes.Peer reviewe

An integrative literature review of organisational factors associated with admission and discharge delays in critical care

The literature shows that delayed admission to the intensive care unit (ICU) and discharge delays from the ICU are associated with increased adverse events and higher costs. Identifying factors related to delays will provide information to practice improvements, which contribute to better patient outcomes. The aim of this integrative review was to explore the incidence of patients’ admission and discharge delays in critical care and to identify organisational factors associated with these delays. Seven studies were included. The major findings are as follows: (1) explanatory research about discharge delays is scarce and one study on admission delays was found, (2) delays are a common problem mostly due to organisational factors, occurring in 38% of admissions and 22–67% of discharges, and (3) redesigning care processes by improving information management and coordination between units and interdisciplinary teams could reduce discharge delays. In conclusion, patient outcomes can be improved through efficient and safe care processes. More exploratory research is needed to identify factors that contribute to admission and discharge delays to provide evidence for clinical practice improvements. Shortening delays requires an interdisciplinary and multifaceted approach to the whole patient flow process. Conclusions should be made with caution due to the limited number of articles included in this review

Identifying nurse managers' essential information needs in daily unit operation in perioperative settings

Aim To identify nurse managers' essential information needs in daily unit operation in perioperative settings.Design Qualitative and quantitative descriptive design.Methods The study consisted of (I) generation of an item pool of potential information needs, (II) assessment of the item pool by an expert panel and (III) confirming the essential information needs of nurse managers in daily unit operation with a survey (N = 288). Content validity index values were calculated for the assessments by expert panel and in the survey. Internal consistency of the final item pool was explored with Cronbach's alpha. The data were collected from 2011-2015.Results During the study process, the number of essential information needs decreased from 92-41. The final item pool consisted of 12 subthemes, and they were categorized into four main themes: patient's care process, surgical procedure, human resources and tangible resources. The findings can be used to create a knowledge map for information system purposes

An Integrative Literature Review of Organisational Factors Associated with Admission and Discharge Delays in Critical Care

The literature shows that delayed admission to the intensive care unit (ICU) and discharge delays from the ICU are associated with increased adverse events and higher costs. Identifying factors related to delays will provide information to practice improvements, which contribute to better patient outcomes. The aim of this integrative review was to explore the incidence of patients’ admission and discharge delays in critical care and to identify organisational factors associated with these delays. Seven studies were included. The major findings are as follows: (1) explanatory research about discharge delays is scarce and one study on admission delays was found, (2) delays are a common problem mostly due to organisational factors, occurring in 38% of admissions and 22–67% of discharges, and (3) redesigning care processes by improving information management and coordination between units and interdisciplinary teams could reduce discharge delays. In conclusion, patient outcomes can be improved through efficient and safe care processes. More exploratory research is needed to identify factors that contribute to admission and discharge delays to provide evidence for clinical practice improvements. Shortening delays requires an interdisciplinary and multifaceted approach to the whole patient flow process. Conclusions should be made with caution due to the limited number of articles included in this review