AMIA ... Annual Symposium proceedings / AMIA Symposium. AMIA Symposium
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AMIA Annu Symp Proc · Jan 2014
Characterization of a handoff documentation tool through usage log data.
Handoffs are a critical component of coordinated patient care; however, poor handoffs have been associated with near misses and adverse events. To address this, national agencies have recommended standardizing handoffs, for example through the use of handoff documentation tools. Recent research suggests that handoff tools, typically designed for physicians, are often used by non-physician providers as information sources. ⋯ This further reiterates the view of electronic handoff tools as facilitators of team communication and coordination. However, the study also showed considerable variability in the frequency of updates between different units and across different patients. Further research is required to understand what factors drive such diversity in the use of electronic handoff tool and whether this diversity can be used to make inferences about patients' conditions.
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AMIA Annu Symp Proc · Jan 2014
Identification and management of information problems by emergency department staff.
Patient-care teams frequently encounter information problems during their daily activities. These information problems include wrong, outdated, conflicting, incomplete, or missing information. Information problems can negatively impact the patient-care workflow, lead to misunderstandings about patient information, and potentially lead to medical errors. ⋯ However, there is limited research on how patient-care teams currently identify and manage information problems that they encounter during their work. Through qualitative observations and interviews in an emergency department (ED), we identified the types of information problems encountered by ED staff, and examined how they identified and managed the information problems. We also discuss the impact that these information problems can have on the patient-care teams, including the cascading effects of information problems on workflow and the ambiguous accountability for fixing information problems within collaborative teams.
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Being a hospital patient can be isolating and anxiety-inducing. We conducted two experiments to better understand clinician and patient perceptions about giving patients access to their medical records during hospital encounters. The first experiment, a survey of physicians, nurses, and other care providers (N=53), showed that most respondents were comfortable with the idea of providing patients with their clinical information. ⋯ In the second experiment, we provided eight hospital patients with a daily copy of their full medical record-including physician notes and diagnostic test results. From semi-structured interviews with seven of these patients, we found that they perceived the information as highly useful even if they did not fully understand complex medical terms. Our results suggest that increased patient information sharing in the inpatient setting is beneficial and desirable to patients, and generally acceptable to clinicians.
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AMIA Annu Symp Proc · Jan 2014
Development, Implementation and Use of Electronic Surveillance for Ventilator-Associated Events (VAE) in Adults.
Mechanical ventilation provides an important, life-saving therapy for severely ill patients, but ventilated patients are at an increased risk for complications, poor outcomes, and death during hospitalization.1 The timely measurement of negative outcomes is important in order to identify potential issues and to minimize the risk to patients. The Centers for Disease Control and Prevention (CDC) created an algorithm for identifying Ventilator-Associated Events (VAE) in adult patients for reporting to the National Healthcare Safety Network (NHSN). Currently, the primarily manual surveillance tools require a significant amount of time from hospital infection prevention (IP) staff to apply and interpret. This paper describes the implementation of an electronic VAE tool using an internal clinical data repository and an internally developed electronic surveillance system that resulted in a reduction of labor efforts involved in identifying VAE at Barnes Jewish Hospital (BJH).
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AMIA Annu Symp Proc · Jan 2014
Medical alert management: a real-time adaptive decision support tool to reduce alert fatigue.
With the adoption of electronic medical records (EMRs), drug safety alerts are increasingly recognized as valuable tools for reducing adverse drug events and improving patient safety. However, even with proper tuning of the EMR alert parameters, the volume of unfiltered alerts can be overwhelming to users. In this paper, we design an adaptive decision support tool in which past cognitive overriding decisions of users are learned, adapted and used for filtering actions to be performed on current alerts. ⋯ The decision support system facilitates filtering of non-essential alerts and adaptively learns critical alerts and highlights them prominently to catch providers' attention. The tool can be plugged into an existing EMR system as an add-on, allowing real-time decision support to users without interfering with existing EMR functionalities. By automatically filtering the alerts, the decision support tool mitigates alert fatigue and allows users to focus resources on potentially vital alerts, thus reducing the occurrence of adverse drug events.