Ambulatory Clinic Exam Room Design with respect to Computing Devices: A Laboratory Simulation Study

Background—Challenges persist regarding how to integrate computing effectively into the exam room, while maintaining patient-centered care. Purpose—Our objective was to evaluate a new exam room design with respect to the computing layout, which included a wall-mounted monitor for ease of (re)-positioning. Methods—In a lab-based experiment, 28 providers used prototypes of the new and older “legacy” outpatient exam room layouts in a within-subject comparison using simulated patient encounters. We measured efficiency, errors, workload, patient-centeredness (proportion of time the provider was focused on the patient), amount of screen sharing with the patient, workflow integration, and provider situation awareness. Results—There were no statistically significant differences between the exam room layouts for efficiency, errors, or time spent focused on the patient. However, when using the new layout providers spent 75% more time in screen sharing activities with the patient, had 31% lower workload, and gave higher ratings for situation awareness (14%) and workflow integration (17%). Conclusions—Providers seemed to be unwilling to compromise their focus on the patient when the computer was in a fixed position in the corner of the room and, as a result, experienced greater workload, lower situation awareness, and poorer workflow integration when using the old “legacy” layout. A thoughtful design of the exam room with respect to the computing may positively impact providers’ workload, situation awareness, time spent in screen sharing activities, and workflow integration

Ambulatory Clinic Exam Room Design with respect to Computing Devices: A Laboratory Simulation Study

OCCUPATIONAL APPLICATIONS When comparing a typical exam room layout to the Department of Veterans Affairs (VA's) new exam room design, with respect to the exam room computing, primary care providers experienced significantly less mental workload and greater situation awareness when using the new exam room design. Further, providers rated the new exam room layout significantly higher in terms of being integrated with their clinical workflow and spent significantly more time in screen sharing activities with the patient. A more thoughtful design of the exam room layout with respect to the placement and physical design of the computing set-up may reduce provider cognitive effort and enhance aspects of patient centeredness by viewing the computer and electronic health record (EHR) it displays as an important mediator between provider and patient. This was achieved by using an all-in-one computer attached to a wall mount that moves the monitor along three axes, allowing for optimal screen positioning and adjustable depending upon the scenario. TECHNICAL ABSTRACT Background: Challenges persist regarding how to integrate computing effectively into the exam room, while maintaining patient-centered care. Purpose: Our objective was to evaluate a new exam room design with respect to the computing layout, which included a wall-mounted monitor for ease of (re)-positioning. Methods: In a lab-based experiment, 28 providers used prototypes of the new and older "legacy" outpatient exam room layouts in a within-subject comparison using simulated patient encounters. We measured efficiency, errors, workload, patient-centeredness (proportion of time the provider was focused on the patient), amount of screen sharing with the patient, workflow integration, and provider situation awareness. Results: There were no statistically significant differences between the exam room layouts for efficiency, errors, or time spent focused on the patient. However, when using the new layout providers spent 75% more time in screen sharing activities with the patient, had 31% lower workload, and gave higher ratings for situation awareness (14%) and workflow integration (17%). Conclusions: Providers seemed to be unwilling to compromise their focus on the patient when the computer was in a fixed position in the corner of the room and, as a result, experienced greater workload, lower situation awareness, and poorer workflow integration when using the old "legacy" layout. A thoughtful design of the exam room with respect to the computing may positively impact providers' workload, situation awareness, time spent in screen sharing activities, and workflow integration.Agency for Health care Research and Quality (AHRQ), U.S. Department of Health and Human Services [1R03HS024488-01A1]12 month embargo; published online: 8 June 2018This item from the UA Faculty Publications collection is made available by the University of Arizona with support from the University of Arizona Libraries. If you have questions, please contact us at [email protected]

Financing U.S. Graduate Medical Education: A Policy Position Paper of the Alliance for Academic Internal Medicine and the American College of Physicians

In this position paper, the Alliance for Academic Internal Medicine and the American College of Physicians examine the state of graduate medical education (GME) financing in the United States and recent proposals to reform GME funding. They make a series of recommendations to reform the current funding system to better align GME with the needs of the nation's health care workforce. These recommendations include using Medicare GME funds to meet policy goals and to ensure an adequate supply of physicians, a proper specialty mix, and appropriate training sites; spreading the costs of financing GME across the health care system; evaluating the true cost of training a resident and establishing a single per-resident amount; increasing transparency and innovation; and ensuring that primary care residents receive training in well-functioning ambulatory settings that are financially supported for their training roles

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Chronic care manages long-term, progressive conditions, while acute care addresses short-term conditions. Chronic conditions increasingly strain health systems, which are often unprepared for these demands. This study examines the burden of conditions requiring acute versus chronic care, including sequelae. Conditions and sequelae from the Global Burden of Diseases Study 2019 were classified into acute or chronic care categories. Data were analysed by age, sex, and socio-demographic index, presenting total numbers and contributions to burden metrics such as Disability-Adjusted Life Years (DALYs), Years Lived with Disability (YLD), and Years of Life Lost (YLL). Approximately 68% of DALYs were attributed to chronic care, while 27% were due to acute care. Chronic care needs increased with age, representing 86% of YLDs and 71% of YLLs, and accounting for 93% of YLDs from sequelae. These findings highlight that chronic care needs far exceed acute care needs globally, necessitating health systems to adapt accordingly

Effect of Permeation Velocity on Flow Behavior and Pressure Drop in Feed Channels of Membranes

The computational fluid dynamics (CFD) simulations are carried out for the membrane feed channel. The results are obtained with two different conditions defined at the membrane surface: (i) impermeable wall and (ii) permeable surface with specified velocity. From simulations, the cases in which both boundary conditions yield similar results are indicate

Modeling of Temperature and Aifflow Pattern In a Refrigerator

Several researchers have shown that Computerized Fluid Dynamics (CFD) can be successfully used for mathematical modeling of refrigeration systems. In this paper authors developed a CFD model for a domestic no-frost refrigerator. The conservation equations of energy mass and momentum are solved by using Finite Volume Method in an environment of three dimensional unstructured mesh. Experiments were conducted on a no-frost domestic refrigerator to compare and validate the results of the CFD model. Both the results from the CFD model and experiment are qualitatively similar even though there are certain discrepancies due to some insufficient information available for the numerical model

Performance of a Domestic Refrigerator Using Nanoparticles-Based Polyolester Oil Lubricant

The performance of a domestic refrigerator with the addition of nanoparticles in the lubricant was experimentally investigated. Different sizes of nanoparticles of Al2O3 and TiO2 were added to the polyolester (POE) oil in two different volume concentrations (0.05 and 0.1 vol.%). Energy consumption tests and freeze capacity tests were then performed on the refrigerator. The investigation results showed that the refrigerator worked normally and safely with the nanolubricants. The results of the experiments indicated that the refrigerator performed better with nanolubricants as compared to pure POE oil. The COP of the systems was increased by 19% and 22% when 0.05% and 0.1% Al2O3 nanoparticles were added to the POE oil respectively. The system with 0.1% volume concentration of Al2O3 and TiO2 nanoparticles added to the POE oil consumed 27.73% and 14.19% less energy as compared to the pure POE oil system. Hence, this study showed that the addition of nanoparticles in the lubricant oil of the refrigerator is practical and it enhanced the performance of the refrigerato

Preparation and Characterization of Modified Nylon 66 Membrane for Blood Purification

Membranes were synthesized using polyamide (nylon 66) and monosodium glutamate (MSG) additive. The membranes with higher concentration of MSG additive were found to be thermally more stable and of porous structure. Due to porous structure, the permeation rate of impurities in blood through the membrane was increased. The effect of coagulant liquid temperature was also investigated and it was shown that increasing/decreasing the temperature does not significantly affect the performance of the polyamide-MSG membrane

Predicting Airflow and Temperature Pattern Inside A Refrigerator Through CFD

An optimized Computerized Fluid Dynamics (CFD) model for frost-free refrigerators is reported A steady-state simulation model was devised and its predictions for temperature and air flow were compared with experimental data. The conservation equations of energy, mass and momentum are solved by using Finite Volume Method in an environment of three dimensional unstructured meshes. Experiments were conducted on a no-frost domestic refrigerator to compare and validate the results of the CFD model. For the refrigerator under analysis it was found that results from the CFD model and experiment are qualitatively similar even though there are certain discrepancies due to some insufficient information available for the numerical model

A CFD study of heat transfer through spacer channels of membrane distillation modules

The computational fluid dynamics modeling in this paper examines transient flow and temperature patterns in spacer-filled membrane distillation channels. The instantaneous velocity profiles at various time steps show that at higher Reynolds number the vortices emerge behind spacer filaments, move along with the flow and then finally diminish. This unsteady behavior causes variation in local temperatures and heat transfer coefficients with time. The temperature polarization is usually low near the locations where high velocity region hits the top or attaches to the bottom surface. The region near the filament at the bottom is a stagnant zone and an area of higher temperature polarization at all times. The effect of filament spacing is also investigated. At low Reynolds number and a small filament spacing of 2 mm, maximum values for average shear stress and heat transfer coefficient are obtained. When Reynolds number is high, this spacer becomes unsuitable due to smaller magnitudes of these parameters. The overall analysis shows that the spacers with relatively higher spacing, such as 3 or 4 mm are more appropriate for use in membrane distillation channels