Studies in health technology and informatics
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Stud Health Technol Inform · Jan 2011
Healthcare professionals' experiences with EHR-system access control mechanisms.
Access control mechanisms might influence on the information seeking and documentation behavior of clinicians. In this study, we have surveyed healthcare professionals in nursing homes and hospitals on their attitudes to, and experiences with using access control mechanisms. ⋯ Not all clinicians logged out of the system when they left a workstation, and some clinicians reported to do some of their documentation work in the name of others. The reported practices might have implications for the safety of the patient.
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Stud Health Technol Inform · Jan 2011
Impact of admission and discharge peak times on hospital overcrowding.
The ability of hospital staff to get a patient to the right bed at the right time is dependent on bed occupancy, and is a key issue in all acute hospitals. This paper seeks to identify the impact of admission and discharge timing on hospital occupancy with reference to the peak in daily admissions and discharges. ⋯ We found statistically significant differences in mean and peak occupancy and patient length of stay between categories (one-way univariate ANOVA p<0.0001). The results support early patient discharge initiatives to reduce hospital occupancy rates.
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Stud Health Technol Inform · Jan 2010
Finite element comparison of different growth sparring instrumentation systems for the early treatment of idiopathic scoliosis.
Fusionless growth sparring implants seek to restore spinal alignment through the early intervention of pediatric scoliosis. Amongst a growing number of concepts, the stainless steel (SS) staple, flexible tether and shape memory alloy (SMA) staple have demonstrated their validity by retarding convex vertebral growth while modifying spinal alignment. The purpose of this study was to explore the biomechanics of these devices in a human scoliotic finite element model (FEM) constructed from patient data. ⋯ Initial and long term modifications of coronal spinal alignment following simulated growth was respectfully 28 degrees to 62 degrees in non-instrumented model and patient data, 28 degrees to 31 degrees with SS staple, 23 degrees to 31 degrees with flexible tether, and 27 degrees to 34 degrees with SMA staple. The interpretation of such methods suggests that the long term correction, achieved via growth modulation, would benefit from improved control of asymmetrical stresses within the growth plates. From a biomechanical perspective, fusionless growth sparring techniques for the early treatment of idiopathic scoliosis show promising preliminary results.
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Hospitalized patients receive countless doses of medications through manually programmed infusion pumps. Many medication errors are the result of programming incorrect pump settings. When used appropriately, smart pumps have the potential to detect some programming errors. ⋯ Acceptable programming limits of dose rate increases in addition to initial drug doses for 23 high-risk medications are monitored. During 22.5 months in a 24 bed ICU, 970 alerts (4% of 25,040 doses, 1.4 alerts per day) were generated for pump settings programmed outside acceptable limits of which 137 (14%) were found to have prevented potential harm. Monitoring pump programming at the system level rather than the pump provides access to additional patient data in the EMR including previous dosage levels, other concurrent medications and caloric intake, age, gender, vitals and laboratory results.
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Stud Health Technol Inform · Jan 2010
Socio-technical challenges in implementing safe patient handovers.
Ineffective handovers in patient care, including those where information loss occurs between care providers, have been identified as a risk to patient safety. Computerization of health information is often offered as a solution to improve the quality of care handovers and decrease adverse events related to patient safety. Drawing on three ethnographic case studies we identify and discuss socio-technical issues which must be addressed if computerized health information systems are to achieve improvements in patient safety related to handovers in care. We suggest that the contextual nature of information, ethical and medico-legal issues arising in relation to information handover and data standards and system integration warrant ongoing research in socio-technical aspects of care handovers.