Such a workflow perspective that is based on the continuity of care model provides a framework required to Identify and support an Interconnected trajectory of care events affecting handcuff communication. To this end, we propose a new methodology, referred to as the clinician-centered approach that allows us to investigate and represent the entire clinician workflow prior to, during and, after handcuff communication. This representation of clinician activities supports a comprehensive analysis of the Interdependencies In the handcuff process cross the care continuum, as opposed to a single discrete, information sharing activity.
The clinician-centered approach is supported by multifaceted methods for data collection such as observations, shadowing of clinicians, audio recording of handcuff communication, semi-structured Interviews and artifact identification and collection. The analysis followed a two-stage mixed Inductive-deductive method. The iterative development of clinician-centered approach was realized using a multi- faceted study conducted in the Medical Intensive Care Unit (MIMIC) of an academic hospital. Ins the clinician-centered approach, we (a) Identify the nature, inherent characteristics and the Interdependencies between three phases of the handcuff process and (b) develop a descriptive framework of handcuff communication in critical care that captures the non-linear, recursive and interactive nature of collaboration and decision-making.
The results reported in this paper serve as a “proof of concept” of our approach, emphasizing the Importance of capturing a coordinated and uninterrupted succession of clinician information management and transfer activities in relation to patient care events.
Cashbook, L. , Moral, M. , & Shall, N. (2013). Communicating discharge instructions to patients: A survey of nurse, intern, and hospital practices. Journal of Hospital Medicine, 8(1136-41. Application to Review: Nurse-physician Communication, Informing Patients, Discharge Abstract Comprehensive discharge education can improve patient understanding and may reduce unnecessary rationalization. OBJECTIVES: To understand nurse and physician communication practices around patient discharge education. SETTING: university of California, San Francisco Medical center (SCUFFS). PARTICIPANTS:
Nurses, interns, and hospitality caring for hospitalized medicine patients. MEASUREMENTS: Participants were surveyed regarding discharge education practices. The survey asked respondents about 13 elements of discharge education found in the literature. For each element, participants were queried regarding: 1) the provider responsible for this element of patient education; 2) the frequency with which they communicate this teaching to patients; 3) how often they directly communicate with the nurse or physician caring for the patient about each element; and 4) tools to improve nurse- Hispanic communication.
RESULTS: A total of 129/184 (70%) nurses, interns, and hospitality responded to the survey. The majority of respondents in all 3 groups felt that 9 of 13 elements were a combined responsibility. Nurses reported educating patients on these 9 items significantly more often than physicians (P < 0. 05). All groups also agreed that instruction on 2 of the elements, summary of hospital findings and pending results, should be primarily the physicians' responsibility; these were the elements least often discussed by any provider.
Despite the majority of items being agreed upon as shared responsibility, communication between nurses and physicians regarding discharge education was low. Standardized verbal communication on the day of discharge was supported most strongly by all providers. CONCLUSIONS: Ambiguous responsibility for providing discharge education and poor communication between nurses and physicians offers an opportunity for improvement. Brady, P. W. , & Goldenrod, L. M. (2013). A qualitative study examining the influences on situation awareness and the identification, mitigation and escalation of recognized patient risk. BUM Quality & Safety, bombs-2012.
Application to Review: Interdisciplinary Collaboration, Situational Awareness, Patient Safety (Recognition of the Deteriorating Patient) Background Situation awareness (AS)?the perception of data elements, comprehension of their meaning and projection of their status in the near future? has been associated with human performance in high-risk environments, including aviation and the operating room. The influences on AS in inpatient medicine are unknown. Methods We conducted seven focus groups with nurses, respiratory therapists and resident physicians using a standardized semiconductors focus group guide to promote discussion.
Recordings of the focus groups were transcribed verbatim, and transcripts were qualitatively analyses by two independent reviewers team-based care, (2) availability of standardized data and (3) standardized processes and procedures. We categorized these into social, technological and organizational influences on AS. Subsystems that emerged from each focus group were shared language to describe at-risk patients, provider experience in critical care/ deterioration and interdisciplinary huddles to identify and plan for at-risk patients.
An objective early warning score, proactive assessment and planning, adequate lancing staffing and tools for entering, displaying and monitoring data trends were identified by six of seven groups. Our data better reflected the concepts of team AS and shared AS than individual AS. Conclusions Team-based care and standardization support AS and the identification and treatment of patient risk in the complex environment of inpatient care. These findings can be used to guide the development and implementation of targeted interventions such as huddles to proactively scan for risk and electronic health record displays of data trends. Brady, P. W. Mouthing, S. , Coastal, IS. , Shabby, M. Gallagher, R. , Hall, D. , & Wheeler, D. S. (2013). Improving situation awareness to reduce unrecognized clinical deterioration and serious safety events. Pediatrics, 131 (1), IEEE-IEEE. BACKGROUND AND OBJECTIVE: Failure to recognize and treat clinical deterioration remains a source of serious preventable harm for hospitalized patients. We designed a system to identify, mitigate, and escalate patient risk by using principles of high-reliability organizations. We hypothesized that our novel care system would decrease transfers determined to be unrecognized situation awareness failures events (UNSAFE).
These ere defined as any transfer from an acute care floor to an ICC where the patient received intubations, interlopes, or 3 fluid boluses in first hour after arrival or before transfer. METHODS: The setting for our observational time series study was a quaternary care children’s hospital. Before initiating tests of change, 2 investigators reviewed recent serious safety events (Sees) and floor-to-ICC transfers. Collectively, 5 risk factors were associated with each event: family concerns, high-risk therapies, presence of an elevated early warning score, watcher/clinician gut feeling, and communication concerns.
Using the model for improvement, an intervention was developed and tested to reliably and proactively identify patient risk and mitigate that risk through unit-based huddles. A 3-times daily inpatient huddle was added to ensure risks were escalated and addressed. Later, a “robust” and explicit plan for at-risk patients was developed and spread. RESULTS: The rate of UNSAFE transfers per 10,000 non-ICC inpatient days was significantly reduced from 4. 4 to 2. 4 over the study period. The days between inpatient Sees also increased significantly.
CONCLUSIONS: 50% reduction in UNSAFE transfers and Sees. Collins, S. A. , Manikin, L. Jordan, D. , Stein, D. M. , Shine, A. , Refrain, P. , & Kaufman, D. (2012). In search of common ground in handcuff documentation in an Intensive Care Unit. Journal of biomedical informatics, 45(2), 307-315. Application to Review: Handcuff, Technology, Tools, Interdisciplinary, Behavior Objective Handcuff is an intra-disciplinary process, yet the flow of critical handcuff information spans multiple disciplines.
Understanding this information flow is important for the development of computer-based tools that supports the communication and coordination of patient care in a multi-disciplinary and highly specialized critical care dieting. We aimed to understand the structure, functionality, and content of nurses’ and physicians’ handcuff artifacts. Design We analyzed 22 nurses’ and physicians’ handcuff artifacts from a Chiropractic Intensive Care Unit (STICK) at a large urban medical center.
We combined artifact analysis with semantic coding based on our published Interdisciplinary Handcuff Information Coding (CHIC) framework for a novel two-step data analysis approach. Results We found a high degree of structure and overlap in the content of nursing and physician artifacts. Our findings demonstrated a non-technical, yet sophisticated, yester with a high degree of structure for the organization and communication of patient data that functions to coordinate the work of multiple disciplines in a highly specialized unit of patient care. Limitations This study took place in one STICK.
Further work is needed to determine the generalization of the results. Conclusions Our findings indicate that the development of semi-structured patient-centered interdisciplinary handcuff tools with discipline specific views customized for specialty settings may effectively support handcuff communication and patient safety. Colitis, S. A. , stem, D. M. Bawdier, D. K. , Stetson, P. D. , & Baked, S. (2011). Content overlap in nurse and physician handcuff artifacts and the potential role of electronic health records: a systematic review. Journal of biomedical informatics, 44(4), 704-712.
Application to Review: Handcuff, Nurse-physician Communication, Tool, Computer, Continuity of Care Documentation, Multidisciplinary Purpose The aims of this systematic review were: (1) to analyze the content overlap between developing a list of interdisciplinary handcuff information for use in the future development of shared and tailored computer-based handcuff tools, and (2) to valuate the utility of the Continuity of Care Document (CDC) standard as a framework for organizing hospital-based handcuff information for use in electronic health records (Errs).
Methods We searched Pumped for studies published through July 2010 containing the indexed terms: handcuff(s), hand-off, handover(s), shift-report, shift report, signpost, and sign- out. Original, hospital-based studies of acute care nursing or physician handcuff were included. Handcuff information content was organized into lists of nursing, physician, and interdisciplinary handcuff information elements. These information element lists ere organized using CDC sections, with additional sections being added as needed.
Analysis of 36 studies resulted in a total of 95 handcuff information elements. Forty-six percent (44/95) of the information overlapped between the nurse and physician handcuff lists. Thirty-six percent (34/95) were specific to the nursing list and 18% (17/95) were specific to the physician list. The CDC standard was useful for categorizing 80% of the terms in the lists and 12 category names were developed for the remaining 20%.
Conclusion Standardized interdisciplinary, nursing-specific, and physician-specific handcuff information elements that are organized around the CDC standard and incorporated into Errs in a structured narrative format may increase the consistency of data shared across all handouts, facilitate the establishment of common ground, and increase interdisciplinary communication. Coleman, E. A. (2003). Falling through the cracks: challenges and opportunities for improving transitional care for persons with continuous complex care needs.
Journal of the American Geriatrics Society, 51(4), 549-555. Application to Review: Transition Challenges, Plan of Care, Knowledge Development Persons with continuous complex care needs frequently require care in multiple settings. During transitions between settings, this population is particularly vulnerable to experiencing poor care quality and problems of care fragmentation. Despite how common these transitions have become, the challenges of improving care transitions have received little attention from policy makers, clinicians, and quality improvement entities.
This article begins with a definition of transitional care and then discusses the nature of the problem, its prevalence, manifestations of poorly executed transitions, and potentially remediable barriers. Necessary elements for effective transitions are then presented, followed by promising new directions for quality improvement at the level of the delivery system, information technology, and national health policy. The article concludes with a proposed research agenda designed to advance the science of high-quality transitional care.
Systematic review of involving patients in the planning and development of health care. Arm, 325(7375), 1263. Application to Review: Patients, Care Plan, Engagement Knowledge, Behaviors, and Attitudes Objective: To examine the effects of involving patients in the planning and placement of health care. Data sources: Published and grey literature. Study selection: Systematic search for worldwide reports written in English between January 1966 and October 2000. Data extraction: Qualitative review of papers describing the effects of involving patients in the planning and development of health care.
Results: Of 42 papers identified, 31 (74%) were case studies. Papers often described changes to services that were attributed to involving patients, including attempts to make services more accessible and producing information leaflets for patients. Changes in the attitudes of organizations to involving patients and positive responses from patients who took part in initiatives were also reported. Conclusions: Evidence supports the notion that involving patients has contributed to changes in the provision of services across a range of different settings.
An evidence base for the effects on use of services, quality of care, satisfaction, or health of patients does not exist. Derringer, S. , Johnston, L. C. , & Chocoholic, K. (2011, April). Multidisciplinary teamwork and communication training. In Seminars in peregrination (Volvo. 35, No. 2, up. 89-96). WEB Saunders. Application to Review: Interdisciplinary Teamwork, Training, Communication, Coordination, Intervention, Knowledge, Behavior, Attitudes Every delivery is a multidisciplinary event, involving nursing, obstetricians, anesthesiologists, and pediatricians.
Patients are often in labor across multiple provider shifts, necessitating numerous handouts between teams. Each handcuff provides an opportunity for errors. Although a traditional approach to improving patient outcomes has been to address individual knowledge and skills, it is now recognized that a significant number of complications result from team, rather than individual, failures. In 2004, a Sentinel Alert issued by the Joint Commission revealed that most cases of perennial death and injury are caused by problems with an organization’s culture and communication failures.
It was recommended that hospitals implement teamwork training programs in an effort to improve outcomes. Instituting a multidisciplinary teamwork training program that uses simulation offers and mutual support. This experience should improve patient safety and outcomes, as well as enhance employee morale. Goldenrod, L. M. , Brady, P. W. , Stifle, K. M. , & Mouthing, S. E. 2013). Huddling for high reliability and situation awareness. BUM quality & safety.
Application to Review: Interdisciplinary Communication, Patient Safety, Intervention (Huddles) Background Studies show that implementing huddles in healthcare can improve a variety of outcomes. Yet little is known about the mechanisms through which huddles exert their effects. To help remedy this gap, our study objectives were to explore hospital administrator and frontline staff perspectives on the benefits and challenges of implementing a tiered huddle system; and propose a model based on our findings evicting the mediating pathways through which implementing a huddle system may reduce patient harm.
Methods Using qualitative methods, we conducted semi- structured interviews and focus groups to obtain a deeper understanding of the huddle system and its outcomes as implemented in an academic tertiary care children’s hospital with 539 inpatient beds. We recruited healthcare providers representing all levels using a snowball sampling technique (10 interviews), and emails, flyers, and paper invitations (six focus groups). We transcribed recordings and analyses the data using established techniques.
Results Five themes emerged and provided the foundational constructs of our model. Specifically we propose that huddle implementation leads to improved efficiencies and quality of information sharing, increased levels of accountability, empowerment, and sense of community, which together create a culture of collaboration and collegiality that increases the staffs quality of collective awareness and enhanced capacity for eliminating patient harm.
Conclusions While each construct in the proposed model is itself a beneficial outcome of implementing huddles, conceptualizing the pathways by which they may ark allows us to design ways to evaluate other huddle implementation efforts designed to help reduce failures and eliminate patient harm. Hall, J. , peat, M. , Bitts, Y. , Golden, S. , Entitles, V. , Gilded, S. , & Wright, J. (2010).
Effectiveness of interventions designed to promote patient involvement to enhance safety: a systematic review. Quality and Safety in Health Care, 19(5), ell-eye. Application to Review: Patient Engagement, Patient Safety, Intervention, Knowledge, Behaviors, Attitudes Background There is growing international interest in involving patients in interventions to promote and support them in securing their own safety.
This paper have been used with the explicit intention of promoting patient involvement in patient safety in healthcare. Methods The authors searched Cochrane Database of Systematic Reviews, Database of Abstracts of Reviews of Effects, CENTRAL, CANAL, EMBASSY, WHIM, MEDICINE, MEDICINE in-process, PSYCHING and ASIA to August 2008. We also searched databases of reports, conference proceedings, grey literature, ongoing research and relevant patient safety organizations, and hand-searched two journals.
Meta-analysis of the data was not appropriate; therefore, studies were categorized according to how the interventions encouraged patients’ actions to improve safety?informing the management plan, monitoring and ensuring safe delivery of treatment (by health professional and by self), making systems safer?and were critiqued in a narrative manner. Findings The authors identified 14 individual experimental and experimentalist studies plus one systematic review. The majority of studies fell into the monitoring and ensuring safe delivery of treatment by self category and were all related to enhancing medication safety.
Authors reported improved patient safety incident outcomes for the intervention groups compared with controls where the interventions aimed to encourage patient involvement in: (1) monitoring and ensuring safe delivery of treatment by self (self-management of anticoagulation, ‘easy read information leaflet, nurse-led education to promote self- medication in hospital, patient package insert using lay terminology); (2) informing the management plan/monitoring and ensuring safe delivery of treatment by self (individualized teaching plan by nurse, pharmacist counseling).
It was not possible to raw any clear conclusions as to the effectiveness of the interventions (with the exception of one specific aspect of self-medication, that is, self-management of anticoagulation) due to concerns about the methodological quality of the studies. Conclusions There is limited evidence for the effectiveness of interventions designed to promote patient involvement on patient safety incidents and in general is poor quality. Existing evidence is confined to the promotion of safe self-management of medication, most notably relating to the self-management of oral anticoagulants.
Henries, K. , Battles, J. B. , Keyes, M. A. , Grady, M. L. , Dingles, C. , Daugherty, K. , & Peering, R. (2008). Improving Patient Safety Through Provider Communication Strategy Enhancements. Application to Review: Interdisciplinary teams, Communication tools, Interventions, Behaviors and Attitudes Excerpt The purpose of this study was to develop, implement, and evaluate a comprehensive provider/team communication strategy, resulting in a toolkit generalize to other settings of care.
The specific aims included implementation of a structured communication tool; a standardized escalation process; daily multidisciplinary tenant-centered rounds using a daily goals sheet; and team huddles. The study setting was the 477-bed medical center of the Denver Health and Hospital Authority, an integrated, urban safety-net system. Utilizing a pre-test/post-test design, baseline and post-intervention data were collected on pilot units (medical intensive care unit, acute care unit, and inpatient behavioral health units).
Analysis of 495 treatment, increased nurse satisfaction with communication, and higher rates of resolution of patient issues post-intervention. The resultant toolkit provides health care organizations with the means to implement teamwork and communication tragedies in their own settings. Johnson, S. , & Kiering, D. (2011). Nurses’ perceptions of nurse-physician relationships: medical-surgical vs.. Intensive care. Mediums nursing: official Journal of the Academy of Medical-surgical Nurses, 21(6), 343-347.
Application to Review: Nurse-physician, Setting Specific, Relationship, Collaboration Effective collaboration between nurses and physicians (URN-MD) is essential in facilitating improved patient care outcomes. A pilot study was conducted among nurses on medical-surgical and intensive care units to identify differences in nurses’ receptions of URN-MD collaborative efforts. INTRODUCTION: Collaboration between nurses and physicians is essential in fostering interdisciplinary relationships. Specialty practice may influence the quality of this collaboration.
Effective communication and collegial URN-MD relationships are critical to improved patient outcomes. PURPOSE: The purpose of this study was to identify differences in nurses’ perceptions of collaborative efforts between nurses and physicians in medical-surgical (Muss) units versus intensive care units (CICS). RESULTS: A descriptive survey methodology was employed. Nurses in three CICS and eight Muss within a 975-bed Magnet hospital completed a 25-item Nurse-physician Relationship survey, used in previous studies on URN-MD communication. The sample (N = 170) consisted of 54% medical-surgical nurses and 46% ICC nurses.
No statistically significant differences were found in the demographic variables between the MS and ICC nurses except for educational degree. A greater percentage of ICC nurses held a bachelor’s degree. This study found that although some differences existed in ICC and MS nurses’ perceptions of URN-MD collaboration, there are more molarities between the two areas. Overall, nurses were satisfied with URN-MD relationships, with 75% of ICC and 65% of MISS nurses reporting satisfaction (p ? 0. 110). MS nurses were less likely to participate in interdisciplinary rounds than ICC nurses (p < 0. 001).
ICC nurses were more likely than MS nurses to report that physicians treat nurses as handmaidens (p = 0. 056) and that physicians displayed unprofessional behavior (p = 0. 019). CONCLUSIONS: Certain nursing specialty areas are not immune to problems with URN-MD relationships. Rather, all clinical service lines should be concerned with fostering illegality between nurses and their physician partners. Sarsaparilla, D. , Baldwin, 1. , Denunciate, G. , Knott, C. , Eastward, G. , Organ, J. , & Jones, D. (2013). Improving communication of the daily care plan in a teaching hospital intensive care unit.
Critical care and resuscitation: Journal of the Australian Academy of Critical Care Medicine, 15(2), 97-102. Checklist, Intervention, Documentation, ICC, Knowledge and Behaviors BACKGROUND: Patients admitted to intensive care units have complex care needs. Accordingly, communication and handover of the medical care plan is very important. OBJECTIVE: To assess changes in ICC nurses’ understanding of the medical daily care plan after development and implementation of a pro formal to improve documentation and communication of the plan.
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