Evaluating the effect of distractions in the operating room on clinical decision-making and patient safety

2016 ◽  
Vol 30 (10) ◽  
pp. 4499-4504 ◽  
Author(s):  
Ally Murji ◽  
Lea Luketic ◽  
Mara L. Sobel ◽  
Kulamakan Mahan Kulasegaram ◽  
Nicholas Leyland ◽  
...  
Keyword(s):  
Decision Making ◽  
Patient Safety ◽  
Operating Room ◽  
Clinical Decision Making ◽  
Clinical Decision

Combined data mining techniques based patient data outlier detection for healthcare safety

2016 ◽  
Vol 9 (1) ◽  
pp. 42-68 ◽  
Author(s):  
Gebeyehu Belay Gebremeskel ◽  
Chai Yi ◽  
Zhongshi He ◽  
Dawit Haile
Keyword(s):  
Data Mining ◽  
Decision Making ◽  
Patient Safety ◽  
Outlier Detection ◽  
Clinical Data ◽  
Clinical Decision Making ◽  
Clinical Decision ◽  
Healthcare Services ◽  
Content Type ◽  
Outliers Detection

Purpose – Among the growing number of data mining (DM) techniques, outlier detection has gained importance in many applications and also attracted much attention in recent times. In the past, outlier detection researched papers appeared in a safety care that can view as searching for the needles in the haystack. However, outliers are not always erroneous. Therefore, the purpose of this paper is to investigate the role of outliers in healthcare services in general and patient safety care, in particular. Design/methodology/approach – It is a combined DM (clustering and the nearest neighbor) technique for outliers’ detection, which provides a clear understanding and meaningful insights to visualize the data behaviors for healthcare safety. The outcomes or the knowledge implicit is vitally essential to a proper clinical decision-making process. The method is important to the semantic, and the novel tactic of patients’ events and situations prove that play a significant role in the process of patient care safety and medications. Findings – The outcomes of the paper is discussing a novel and integrated methodology, which can be inferring for different biological data analysis. It is discussed as integrated DM techniques to optimize its performance in the field of health and medical science. It is an integrated method of outliers detection that can be extending for searching valuable information and knowledge implicit based on selected patient factors. Based on these facts, outliers are detected as clusters and point events, and novel ideas proposed to empower clinical services in consideration of customers’ satisfactions. It is also essential to be a baseline for further healthcare strategic development and research works. Research limitations/implications – This paper mainly focussed on outliers detections. Outlier isolation that are essential to investigate the reason how it happened and communications how to mitigate it did not touch. Therefore, the research can be extended more about the hierarchy of patient problems. Originality/value – DM is a dynamic and successful gateway for discovering useful knowledge for enhancing healthcare performances and patient safety. Clinical data based outlier detection is a basic task to achieve healthcare strategy. Therefore, in this paper, the authors focussed on combined DM techniques for a deep analysis of clinical data, which provide an optimal level of clinical decision-making processes. Proper clinical decisions can obtain in terms of attributes selections that important to know the influential factors or parameters of healthcare services. Therefore, using integrated clustering and nearest neighbors techniques give more acceptable searched such complex data outliers, which could be fundamental to further analysis of healthcare and patient safety situational analysis.

scholarly journals Health record systems that meet clinical needs

2012 ◽  
Author(s):  
Gabriella Negrini
Keyword(s):  
Health Care ◽  
Decision Making ◽  
Patient Safety ◽  
Health Care Professionals ◽  
Clinical Decision Making ◽  
Clinical Information ◽  
Clinical Decision ◽  
Health Record ◽  
Record System ◽  
Health Records

Introduction Increased attention has recently been focused on health record systems as a result of accreditation programs, a growing emphasis on patient safety, and the increase in lawsuits involving allegations of malpractice. Health-care professionals frequently express dissatisfaction with the health record systems and complain that the data included are neither informative nor useful for clinical decision making. This article reviews the main objectives of a hospital health record system, with emphasis on its roles in communication and exchange among clinicians, patient safety, and continuity of care, and asks whether current systems have responded to the recent changes in the Italian health-care system.Discussion If health records are to meet the expectations of all health professionals, the overall information need must be carefully analyzed, a common data set must be created, and essential specialist contributions must be defined. Working with health-care professionals, the hospital management should define how clinical information is to be displayed and organized, identify a functionally optimal layout, define the characteristics of ongoing patient assessment in terms of who will be responsible for these activities and how often they will be performed. Internet technology can facilitate data retrieval and meet the general requirements of a paper-based health record system, but it must also ensure focus on clinical information, business continuity, integrity, security, and privacy.Conclusions The current health records system needs to be thoroughly revised to increase its accessibility, streamline the work of health-care professionals who consult it, and render it more useful for clinical decision making—a challenging task that will require the active involvement of the many professional classes involved.

scholarly journals Emotionally evocative patients in the emergency department: a mixed methods investigation of providers’ reported emotions and implications for patient safety

2020 ◽  
Vol 29 (10) ◽  
pp. 1.3-2 ◽  
Author(s):  
Linda M Isbell ◽  
Julia Tager ◽  
Kendall Beals ◽  
Guanyu Liu
Keyword(s):  
Mental Health ◽  
Decision Making ◽  
Emergency Department ◽  
Patient Safety ◽  
Qualitative Data ◽  
Clinical Decision Making ◽  
Quality Care ◽  
Clinical Decision ◽  
Safety Risks ◽  
Recent Patient

BackgroundEmergency department (ED) physicians and nurses frequently interact with emotionally evocative patients, which can impact clinical decision-making and behaviour. This study introduces well-established methods from social psychology to investigate ED providers’ reported emotional experiences and engagement in their own recent patient encounters, as well as perceived effects of emotion on patient care.MethodsNinety-four experienced ED providers (50 physicians and 44 nurses) vividly recalled and wrote about three recent patient encounters (qualitative data): one that elicited anger/frustration/irritation (angry encounter), one that elicited happiness/satisfaction/appreciation (positive encounter), and one with a patient with a mental health condition (mental health encounter). Providers rated their emotions and engagement in each encounter (quantitative data), and reported their perception of whether and how their emotions impacted their clinical decision-making and behaviour (qualitative data).ResultsProviders generated 282 encounter descriptions. Emotions reported in angry and mental health encounters were remarkably similar, highly negative, and associated with reports of low provider engagement compared with positive encounters. Providers reported their emotions influenced their clinical decision-making and behaviour most frequently in angry encounters, followed by mental health and then positive encounters. Emotions in angry and mental health encounters were associated with increased perceptions of patient safety risks; emotions in positive encounters were associated with perceptions of higher quality care.ConclusionsPositive and negative emotions can influence clinical decision-making and impact patient safety. Findings underscore the need for (1) education and training initiatives to promote awareness of emotional influences and to consider strategies for managing these influences, and (2) a comprehensive research agenda to facilitate discovery of evidence-based interventions to mitigate emotion-induced patient safety risks. The current work lays the foundation for testing novel interventions.

scholarly journals MP40: What are the factors contributing to medico-legal risk of procedural interventions performed by physicians practicing emergency medicine?

CJEM ◽  
2020 ◽  
Vol 22 (S1) ◽  
pp. S57-S57
Author(s):  
K. Lemay ◽  
P. Finestone ◽  
R. Liu ◽  
R. De Gorter ◽  
L. Calder
Keyword(s):  
Decision Making ◽  
Emergency Medicine ◽  
Patient Safety ◽  
Clinical Decision Making ◽  
Life Support ◽  
Improve Patient Safety ◽  
Clinical Decision ◽  
Wound Management ◽  
Contributing Factors ◽  
Orthopedic Injury

Introduction: Physicians who practice emergency medicine (EM) often perform procedural interventions, which can occasionally result in unintended patient harm. Our study's objective was to identify and describe the interventions and contributing factors associated with medico-legal (ML) cases involving emergency physicians performing procedural interventions. Methods: The Canadian Medical Protective Association (CMPA) is a not-for-profit, ML organization which represented over 99,000 physicians at the time of this study. We extracted five years (2014-2018) of CMPA data describing closed ML cases involving procedural interventions (e.g. suturing, reducing a dislocated joint) and excluding interventions related to pharmacotherapy (e.g. injection of local anesthetic), diagnosis (electrocardiograms) and physical assessments (e.g. ear exams), performed by physicians practicing EM. We then applied an internal contributing factor framework to identify themes. We analysed the data using descriptive statistics. Results: We identified 145 cases describing 145 patients who had 205 procedures performed in the course of their EM care. The three most common interventions were orthopedic injury management (47/145, 32.4%), wound management (43/145, 29.7%), and Advanced Cardiac Life Support (24/145, 16.6%). Out of 145 patients, 93.8% (136/145) experienced a patient safety event, and 55.9% (76/136) suffered an avoidable harmful incident. One quarter of patients suffered mild harm (34/76, 25.0%), 18.4% of patients died, 14.5% suffered severe harm, and 13.2% moderate harm. Peer experts were critical of 86/145 cases (59.3%) where the following provider contributing factors were found: a lack of situational awareness (20/68, 29.4%), and deficient physician clinical decision-making (54/68, 79.7%). Clinical decision-making issues included a lack of thoroughness of assessment (33/54, 61.1%), failure to perform tests or interventions (21/54, 38.9%), and a delay or failure to seek help from another physician (17/54, 31.2%). Peer experts were also critical of 48.8% of cases containing team factors (42/86) due to deficient medical record keeping (26/42, 61.9%), and communication breakdown with patients or other team members (25/42, 59.5%). Conclusion: Both provider and team factors contributed to ML cases involving EM physicians performing procedural interventions. Addressing these factors may improve patient safety and reduce ML risk for physicians.

scholarly journals What do emergency department physicians and nurses feel? A qualitative study of emotions, triggers, regulation strategies, and effects on patient care

2020 ◽  
Vol 29 (10) ◽  
pp. 1.5-2 ◽  
Author(s):  
Linda M Isbell ◽  
Edwin D Boudreaux ◽  
Hannah Chimowitz ◽  
Guanyu Liu ◽  
Emma Cyr ◽  
...  
Keyword(s):  
Decision Making ◽  
Emergency Department ◽  
Patient Safety ◽  
Patient Care ◽  
Clinical Decision Making ◽  
Negative Emotions ◽  
Clinical Decision ◽  
System Level ◽  
Emotional Suppression ◽  
Regulation Strategies

BackgroundDespite calls to study how healthcare providers’ emotions may impact patient safety, little research has addressed this topic. The current study aimed to develop a comprehensive understanding of emergency department (ED) providers’ emotional experiences, including what triggers their emotions, the perceived effects of emotions on clinical decision making and patient care, and strategies providers use to manage their emotions to reduce patient safety risks.MethodsEmploying grounded theory, we conducted 86 semi-structured qualitative interviews with experienced ED providers (45 physicians and 41 nurses) from four academic medical centres and four community hospitals in the Northeastern USA. Constant comparative analysis was used to develop a grounded model of provider emotions and patient safety in the ED.ResultsED providers reported experiencing a wide range of emotions in response to patient, hospital, and system-level factors. Patients triggered both positive and negative emotions; hospital and system-level factors largely triggered negative emotions. Providers expressed awareness of possible adverse effects of negative emotions on clinical decision making, highlighting concerns about patient safety. Providers described strategies they employ to regulate their emotions, including emotional suppression, distraction, and cognitive reappraisal. Many providers believed that these strategies effectively guarded against the risk of emotions negatively influencing their clinical decision making.ConclusionThe role of emotions in patient safety is in its early stages and many opportunities exist for researchers, educators, and clinicians to further address this important issue. Our findings highlight the need for future work to (1) determine whether providers’ emotion regulation strategies are effective at mitigating patient safety risk, (2) incorporate emotional intelligence training into healthcare education, and (3) shift the cultural norms in medicine to support meaningful discourse around emotions.

scholarly journals Summary Care Records in Urgent and Emergency Care in England

2013 ◽  
Vol 12 (3) ◽  
pp. 178-180
Author(s):  
Emyr Wyn Jones ◽  
Keyword(s):  
Decision Making ◽  
Patient Safety ◽  
Emergency Care ◽  
Adverse Reactions ◽  
Clinical Decision Making ◽  
Clinical Decision ◽  
Healthcare Staff ◽  
Additional Information ◽  
Patient Medication

Summary Care Records (SCRs) have been created for more than 50% of the population of England. The number is increasing at about 100,000 records a week. Fewer than 1.5% of people have elected not to have a SCR. SCRs contain updated details of patient medication, allergies and adverse reactions, electronically extracted from the GP record. A patient and their GP can also agree to have additional information included. SCRs are being viewed by authorised healthcare staff in urgent and emergency care settings all over England. Benefits are being reported in relation to increased patient safety, improved clinical decision making, improved efficiency and improved quality of care. NHS England strongly supports the uptake and adoption of SCRs by Trusts in England.

scholarly journals Evaluating simplified web interfaces of risk models for clinical use (Preprint)

2020 ◽  
Author(s):  
Louis Beaubien ◽  
Colin Conrad ◽  
Janet Music ◽  
Sandra Toze
Keyword(s):  
Decision Making ◽  
Patient Safety ◽  
Clinical Setting ◽  
Clinical Decision Making ◽  
Information Overload ◽  
Clinical Decision ◽  
Intention To Use ◽  
Regression Equations ◽  
Risk Models ◽  
The Impact

BACKGROUND Information overload negatively affects clinicians’ decision effectiveness and ultimately impacts patient safety. Clinicians who are tasked with assessing patient outcomes are often required to use complex outcome and risk models in a spreadsheet format. In response to this challenge, we developed a mobile web model which simplifies the information presented to clinicians and expedites the decision process. However, new electronic technologies often face barriers to adoption which inhibits their use in clinical settings. OBJECTIVE This pilot study investigated sociotechnical factors that affect intention to use a simplified WebModel to support clinical decision making. We investigated factors from the UTAUT2 model, which are known to affect technology adoption. METHODS A WebModel is developed based on the results from a previously published work, to allow users to work with regression equations and their predictions to evaluate the impact of various characteristics or treatments on key outcomes (e.g. survival time) for chronic obstructive pulmonary disease (COPD). To test the WebModel a questionnaire was designed to probe the efficacy of the WebModel and to assess the usability and usefulness of the system. The questionnaire was administered online, and data from 550 clinical users who had access to the WebModel was captured. SPSS and R were used for statistical analysis. RESULTS The regression model developed from UTAUT2 constructs was found to be a fit, with five variables found to significantly predicts behavioural intention to sue the WebModel: Performance Expectancy, Effort Expectancy, Facilitating Conditions, Hedonic Motivation and Habit. Social Influence was not a significant factor, while Value had a significant negative influence on intention to use the WebModel. Multiple influences were found to impact the positive response to the system, many of which related to the efficiency of the interface to provide clear information. Given that this was a pilot test, and that the system was not used in a clinical setting factors related to actual workflow, or patient safety could not be examined. CONCLUSIONS This study proves that the concept of a simplified WebModel could be effective and efficient in reducing information overload in complex clinical decision making. Further study to test this in a clinical setting, and gather qualitative data from users regarding the value of the tool in practice is recommended.

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