Understanding subscription-based automated electronic notification usage in hospitals: a qualitative study

Introduction: The potential exists for patient harm when clinicians do not respond to clinical results in a timely manner. Much of the research on asynchronous electronic notifications (pager, cellphone or wearable devices) comes from home-grown electronic health records (EHR). Little is known about factors influencing notifications from vendor-based EHRs and the effect of subscription-based notifications, where providers select which results for notification. This study investigates what factors influence a clinician’s decision to order result notifications, the perceived role of these notifications in the clinical setting, and ways to improve notifications in a vendor-based EHR. Methods: We queried the EHR to identify clinicians using the “bell” notification functionality of Epic (Epic Systems, Verona WI) in an academic health system comprised of one tertiary care center and one community hospital. We distributed an online survey to individuals identified to have used the functionality via retrospective review of clinical results over a 12-month period. We received completed surveys from a diverse group of clinical staff, and we used descriptive statistics to analyze the survey data. Results: Via retrospective review, we identified 874 individuals who used the system. Of these, we received 67 (7.7%) survey responses. Of those who responded, 72% reported the functionality is “likely to help” patients, and 66% of respondents believe the functionality “speeds up workflow.” Additionally, 41% of clinicians stated they had experiences where the “bell” notification “improved patient outcomes.” Discussion: A majority of clinicians viewed the subscription-based “bell” notification functionality favorably, would recommend it to other clinicians, and stated that it has a positive impact on workflow. However, only a minority of clinicians identified specific instances where the functionality improved patient care. Further research should prospectively identify what factors impact how and why healthcare providers use subscription-based notifications and if use of these systems can improve patient outcomes

Provider Use of Risk Stratification Tools for PE and CTA Ordering Practices

Aims for Improvement Quantify utilization of clinical decision tools, D-dimer and CTA-PE at TJUH and compare to benchmark and implement the logic seen in the adjacent QR code to an EPIC pop-u

Hepatitis A Vaccination Program in Jefferson Emergency Departments

Aims for Improvement Increase the rate of hepatitis A vaccination in high-risk patients (homeless and drug users) who present to Thomas Jefferson University Hospital and Jefferson Methodist emergency departments over a 5 month period starting on 9/4/2019

Assessing Sentiment Towards Opioid Use Disorder at Jefferson: Characterizing Non-Clinical Emergency Department Staff

Purpose: To characterize emergency department (ED) staff regard toward opioid use disorder (OUD) and analyze variation based on job category. The closure of Hahnemann Hospital, in combination with the increasing prevalence of OUD, is exacerbating the previously inadequate network of resources for these patients. Jefferson is strategically positioned to improve the care provided to this patient population, especially in an ED setting, and ultimately increase linkage to long-term recovery programs. Methods: Sentiment toward this patient population was measured utilizing the Medical Condition Regard Survey (MCRS). This questionnaire was previously validated to subjectively, but quantitatively, assess regard toward a defined patient population with scores ranging from 11 (lowest regard) to 66 (highest regard). Scores were collected for 425 ED employees, of which 303 were classified as providers and 70 as non-clinical staff. Given the variety of healthcare professionals involved in treating patients in the ED, the targeted population of potential learners is broad and encompassing. Results and Conclusions: While the average MCRS score of 47.3 ± 8.4 is relatively positive and generally consistent across job categories, there is significant variation in scores between individuals. The inconsistency of sentiment toward OUD among Jefferson ED staff is highlighted by MCRS scores at both the positive and negative extremes. Interestingly, most patients usually only interact with a single individual in each job role, reinforcing the potential for inconsistent care. This information will inform the development of educational materials to target shortcomings, highlight strengths and improve staff competency in successfully treating these patients

Understanding Clinical Staff Attitudes Towards Patients Presenting to the Emergency Department with Opioid Use Disorder

Purpose: Significant stigma surrounds patients with opioid use disorder (OUD). This stigma repeatedly follows patients into the ED and negatively influences care. All ED staff impact the patient journey in the ED and the success with which OUD patients receive a warm handoff to a recovery organization. What is the current attitude of Jefferson’s clinical staff towards patients with OUD? Methods: The authors developed and deployed a survey to Jefferson’s ED clinical staff members through Qualtrics. The survey was informed by the validated Medical Condition Regard Scale (MCRS) to capture staff sentiments towards patients with OUD. Respondents job category, job description, campus key and name were collected at the start of each survey. Results and Conclusions: Results are in progress. To date, 398 ED clinical staff members completed the survey. The average MCRS score is 47.3 (66 max). The average of most job categories surveyed exhibited an MCRS score close to the global mean with the exception of the “Pharmacy” and “Patient Access” categories in which the MCRS score was higher (low 50s). The results suggest that there is room for improvement of clinical staff attitudes towards this vulnerable patient population. As the epidemic continues to escalate, educators will need to identify methods to engage staff members in order to improve outcomes of patients with OUD who present to the ED

Initial Response to the Opioid Crisis: Availability of Buprenorphine and Warm Handoff in the ED

Background: The United States is in the midst of an opioid crisis. The Centers for Disease Control and Prevention has cited Emergency Departments (ED) as important centers for treatment and referral, including medication assisted treatment (MAT), which has been shown to be superior to motivational interviewing and referral alone.1,2 While direct linkage to outpatient programs via the ED may be an opportunity to better serve this population, data on such “warm handoff” interventions are sparse. Objective: We initiated an ED opioid use disorder (OUD) pathway, which aimed to initiate buprenorphine therapy and perform warm handoff directly into the community for treatment.https://jdc.jefferson.edu/patientsafetyposters/1149/thumbnail.jp