scholarly journals Utilizing Electronic Medical Records to Standardize Handoffs in Academic Ophthalmology

2020 ◽  
Vol 12 (02) ◽  
pp. e205-e213
Author(s):  
Lynn W. Sun ◽  
Andrea L. Stahulak ◽  
Deborah M. Costakos
Keyword(s):  
Patient Care ◽  
Ease Of Use ◽  
Resident Perceptions ◽  
Medical Centers ◽  
Resident Physicians ◽  
Major Metropolitan Area ◽  
Academic Medical ◽  
Before And After ◽  
Measured Efficiency ◽  
Inpatient Settings

Abstract Purpose Formalized handoff procedures have been shown to increase patient safety and quality of care across multiple medical and surgical specialties,1–4 but literature regarding handoffs in ophthalmology remains sparse. We instituted a standardized handoff utilizing an electronic medical record (EMR) system to improve care for patients shared by multiple resident physicians across weekday, weeknight, and weekend duty shifts. We measured efficiency, efficacy, and resident satisfaction before and after the standardized handoff was implemented. Methods Resident physicians surveyed were primarily responsible for patient care on consult and call services at two quaternary academic medical centers in a major metropolitan area. Patient care was performed in outpatient, emergency, and inpatient settings. Annual anonymous questionnaires consisting of 6 questions were used to collect pre- and postintervention impressions of the standardized EMR handoff process from ophthalmology resident physicians (9 per year; 3 preintervention years and 1 postintervention year). An additional anonymous postintervention questionnaire consisting of 12 questions was used to further characterize resident response to the newly implemented handoff procedure. Results Prior to implementation of a standardized EMR-based handoff procedure, residents unanimously reported incomplete, infrequently updated handoff reports that did not include important clinical and/or psychosocial information. Following implementation, residents reported a statistically significant increase in completeness and timeliness of handoff reports. Additionally, resident perception of EMR handoff utility, efficiency, and usability were comprehensively favorable. Residents reported handoffs only added a mean of 6.5 minutes to a typical duty shift. Conclusion Implementation of our protocol dramatically improved resident perceptions of the handoff process at our institution. Improvements included increased quality, ease-of-use, and efficiency. Our standardized EMR-based handoff procedure may be of use to other ambulatory-based services.

Yesterday a Learner, Today a Teacher Too: Residents as Teachers in 2000

PEDIATRICS ◽  
2000 ◽  
Vol 105 (Supplement_2) ◽  
pp. 238-241
Author(s):  
Elizabeth H. Morrison ◽  
Janet Palmer Hafler
Keyword(s):  
Medical Students ◽  
Rating Scales ◽  
Clinical Teaching ◽  
Teaching Skills ◽  
Learning Needs ◽  
Educational Benefits ◽  
Medical Centers ◽  
Resident Physicians ◽  
Academic Medical ◽  
Rigorous Research

Resident physicians spend numerous hours every week teaching medical students and fellow residents, and only rarely are they taught how to teach. They can, however, be taught to teach more effectively. Teaching skills improvement initiatives for residents are taking a more prominent place in the educational literature. Limited evidence now suggests that better resident teachers mean better academic performance by learners. A small but important body of research supports selected interventions designed to improve residents' teaching skills, but not all studies have demonstrated significant educational benefits for learners. An increasing number of valid and reliable instruments are available to assess residents' clinical teaching, including objective structured teaching examinations and rating scales. In all specialties, rigorous research in evidence-based teacher training for residents will help prepare academic medical centers to meet the diverse and changing learning needs of today's physicians-in-training.resident physicians, medical students, fellow residents, teaching, graduate medical education.

scholarly journals 2540. Targeting ID Education for Advanced Practice Providers: A Growing Learning Group in Academic Medical Centers

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S883-S883
Author(s):  
Matthew S L Lee ◽  
Wendy Stead
Keyword(s):  
Patient Care ◽  
Educational Intervention ◽  
Educational Background ◽  
Educational Opportunities ◽  
Academic Medical Centers ◽  
Online Video ◽  
Advanced Practice ◽  
Post Intervention ◽  
Medical Centers ◽  
Academic Medical

Abstract Background Advanced Practice Providers (APPs), including nurse practitioners (NPs) and physician assistants (PAs), increasingly provide patient care in inpatient settings at academic medical centers. However, little is known about their medical education. We sought to describe current APP educational experiences at our institution and to implement and evaluate an educational intervention aimed at decreasing inappropriate antimicrobial use for asymptomatic bacteriuria (ASB) amongst this group. Methods 33 inpatient-based APPs participated in the educational intervention consisting of in-person sessions and an online video reviewing diagnosis and management of ASB. Pre- and post-intervention surveys assessed knowledge before and after the intervention. Surveys also assessed APP’s educational background, opportunities, and barriers. Results 17 APPs completed the pre-intervention survey. 59% estimated less than 10 hours of antimicrobial education during their training. 88% reported that the majority of their current learning is independent. All APPs reported desiring more educational opportunities. 76% felt current opportunities are designed for medical students or housestaff. Commonly reported barriers included patient care, rounding obligations, and lack of protected time. 8 APPs attended the in-person sessions and there were 21 views of the online video. 10 APPs completed the post-intervention survey. All reported interest in similar sessions in the future. 70% planned to prescribe fewer antimicrobials for ASB; however, the same number also reported “Attending or fellow decision” as the main barrier to decreasing prescriptions. Mean knowledge scores significantly increased after the intervention from 2.5 to 4.125 (P < 0.05). Conclusion APPs within an academic medical center have unique educational backgrounds and needs. APPs identified current educational opportunities as student/resident directed and incompatible with their work schedules. More APPs utilized the video session than attended in-person lectures. This intervention improved immediate knowledge acquisition; however, retention and impact on clinical outcomes are still being evaluated. Disclosures All authors: No reported disclosures.

scholarly journals Use of a 90-Minute Admission Window and Front-Fill System to Reduce Work Compression on a General Medicine Inpatient Teaching Service

2017 ◽  
Vol 9 (2) ◽  
pp. 245-249 ◽  
Author(s):  
Youngjee Choi ◽  
Daniel Kim ◽  
Hyemi Chong ◽  
Christopher Mallow ◽  
Jason Bill ◽  
...  
Keyword(s):  
Internal Medicine ◽  
Patient Care ◽  
General Medicine ◽  
General Ward ◽  
Timely Manner ◽  
Training Experience ◽  
Resident Perceptions ◽  
Before And After ◽  
Time To Learn ◽  
Resident Learning

ABSTRACT Background Duty hour limits have shortened intern shifts without concurrent reductions in workload, creating work compression. Multiple admissions during shortened shifts can result in poor training experience and patient care. Objective To relieve work compression, improve resident satisfaction, and improve duty hour compliance in an academic internal medicine program. Methods In 2014, interns on general ward services were allotted 90 minutes per admission from 3 pm to 7 pm, when the rate of admissions was high. Additional admissions arriving during the protected period were directed to hospitalists. Resident teams received 2 patients admitted by the night float team to start the call day (front-fill). Results Of the 51 residents surveyed before and after the implementation of the intervention, 39 (77%) completed both surveys. Respondents reporting an unmanageable workload fell from 14 to 1 (P &lt; .001), and the number of residents reporting that they felt unable to admit patients in a timely manner decreased from 14 to 2 (P &lt; .001). Reports of adequate time with patients increased from 16 to 36 (P &lt; .001), and residents indicating that they had time to learn from patients increased from 19 to 35 (P &lt; .001). Reports of leaving on time after call days rose from 12 to 33 (P &lt; .01), and overall satisfaction increased from 26 to 35 (P = .002). Results were similar when residents were resurveyed 6 months after the intervention. Conclusions Call day modifications improved resident perceptions of their workload and time for resident learning and patient care.

Development of Electronic Medical Record-Based “Rounds Report” Results in Improved Resident Efficiency, More Time for Direct Patient Care and Education, and Less Resident Duty Hour Violations

2016 ◽  
Vol 82 (9) ◽  
pp. 853-859 ◽  
Author(s):  
Phillip B. Ham ◽  
Toby Anderton ◽  
Ryan Gallaher ◽  
Mike Hyrman ◽  
Erika Simmerman ◽  
...  
Keyword(s):  
Patient Care ◽  
Medical Record ◽  
Electronic Medical Record ◽  
Academic Medical Centers ◽  
Educational Activity ◽  
Direct Patient Care ◽  
Activity Time ◽  
Medical Centers ◽  
Academic Medical ◽  
American Board Of Surgery

Surgeons frequently report frustration and loss of efficiency with electronic medical record (EMR) systems. Together, surgery residents and a programmer at Augusta University created a rounds report (RR) summarizing 24 hours of vitals, intake/output, labs, and other values for each inpatient that were previously transcribed by hand. The objective of this study was to evaluate the RR's effect on surgery residents. Surgery residents were queried to assess the RR's impact. Outcome measures were time spent preparing for rounds, direct patient care time, educational activity time, rates of incorrect/incomplete data on rounds, and rate of duty hour violations. Hospital wide, 17,200 RRs were generated in the 1-month study. Twenty-three surgery residents participated. Time spent preparing for rounds decreased per floor patient (15.6 ± 3.0 vs 6.0 ± 1.2, P < 0.0001) and per intensive care unit patient (19.9 ± 2.9 vs 7.5 ± 1.2 P < 0.0001). The work day spent in direct patient care increased from 45.1 ± 5.6 to 54.0 ± 5.7 per cent ( P = 0.0044). Educational activity time increased from 35.2 ± 5.4 to 54.7 ± 7.1 minutes per resident per day ( P = 0.0004). Reported duty hour violations decreased 58 per cent ( P < 0.0001). American Board of Surgery in Training exam scores trended up, and estimates of departmental annual financial savings range from $66,598 to $273,141 per year. Significant improvements occur with surgeon designed EMR tools like the RR. Hospitals and EMR companies should pair interested surgeons with health information technology developers to facilitate EMR enhancements. Improvements like RRs can have broad ranging, multidisciplinary impact and should be standard in all EMRs used for inpatient care at academic medical centers.

scholarly journals Evaluation of a Yoga-Based Mind-Body Intervention for Resident Physicians: A Randomized Clinical Trial

2021 ◽  
Vol 10 ◽  
pp. 216495612110010
Author(s):  
Julia Loewenthal ◽  
Natalie L Dyer ◽  
Marla Lipsyc-Sharf ◽  
Sara Borden ◽  
Darshan H Mehta ◽  
...  
Keyword(s):  
Clinical Trial ◽  
Randomized Clinical Trial ◽  
Psychological Health ◽  
Well Being ◽  
Academic Medical Centers ◽  
Controlled Study ◽  
Medical Centers ◽  
Resident Physicians ◽  
Academic Medical

Background and Objective Mind-body interventions (MBIs) have been shown to be effective individual-level interventions for mitigating physician burnout, but there are no controlled studies of yoga-based MBIs in resident physicians. We assessed the feasibility of a yoga-based MBI called RISE (resilience, integration, self-awareness, engagement) for residents among multiple specialties and academic medical centers. Methods We conducted a waitlist controlled randomized clinical trial of the RISE program with residents from multiple specialty departments at three academic medical centers. The RISE program consisted of six weekly sessions with suggested home practice. Feasibility was assessed across six domains: demand, implementation, practicality, acceptability, adaptation, and integration. Self-reported measures of psychological health were collected at baseline, post-program, and two-month follow-up. Results Among 2,000 residents contacted, 75 were assessed for eligibility and 56 were enrolled. Forty-four participants completed the study and were included in analysis. On average, participants attended two of six sessions. Feasibility of in-person attendance was rated as 28.9 (SD 25.6) on a 100-point visual analogue scale. Participants rated feasibility as 69.2 (SD 26.0) if the program was offered virtually. Those who received RISE reported improvements in mindfulness, stress, burnout, and physician well-being from baseline to post-program, which were sustained at two-month follow-up. Conclusion This is the first controlled study of a yoga-based MBI in residents. While the program was not feasible as delivered in this pilot study, initial analyses showed improvement in multiple measures of psychological health. Residents reported that virtual delivery would increase feasibility.

scholarly journals Guiding Academic Clinician Educators at Research-Intensive Institutions: a Framework for Chairs, Chiefs, and Mentors

2021 ◽  
Author(s):  
Anna Chang ◽  
Brian S. Schwartz ◽  
Elizabeth Harleman ◽  
Meshell Johnson ◽  
Louise C. Walter ◽  
...  
Keyword(s):  
Patient Care ◽  
Career Success ◽  
Department Chairs ◽  
Academic Medical Centers ◽  
High Quality ◽  
Quality Patient Care ◽  
Medical Centers ◽  
Clinician Educator ◽  
Academic Medical ◽  
Clinician Educators

AbstractDepartment chairs and division chiefs at research-intensive academic medical centers often find mentoring clinician educators challenging. These faculty constitute the majority of academic physicians. Supporting excellent clinician educators is key to ensuring high-quality patient care and developing tomorrow’s physicians. Little has been written for leaders on strategies to advance academic clinician educators’ career success. We present a framework to guide chairs, chiefs, and mentors seeking to address clinician educator retention and satisfaction in academic medical centers.

scholarly journals Brief Report: Identifying common pharmacotherapies associated with reduced COVID-19 morbidity using electronic health records

2020 ◽  
Author(s):  
Victor M. Castro ◽  
Rachel A. Ross ◽  
Sean M. McBride ◽  
Roy H. Perlis
Keyword(s):  
Mechanical Ventilation ◽  
Electronic Health Records ◽  
Electronic Prescribing ◽  
Inpatient Hospitalization ◽  
Health Records ◽  
Medical Centers ◽  
Academic Medical ◽  
Key Points ◽  
Inpatient Settings ◽  
Electronic Health

AbstractImportanceAbsent a vaccine or any established treatments for the novel and highly infectious coronavirus-19 (COVID-19), rapid efforts to identify potential therapeutics are required.ObjectiveTo identify commonly-prescribed medications that may be associated with lesser risk of morbidity with COVID-19 across 5 Eastern Massachusetts hospitals.DesignIn silico cohort using electronic health records between 7/1/2019 and 4/07/2020. Setting: Outpatient, emergency department and inpatient settings from 2 academic medical centers and 3 community hospitals.ParticipantsAll individuals presenting to a clinical site and undergoing COVID-19 testing.Main Outcome or MeasureInpatient hospitalization; documented requirement for mechanical ventilation.ResultsAmong 12,818 individuals with COVID-19 testing results available, 2271 (17.7%) were test-positive, and 707/2271 (31.1%) were hospitalized in one of 5 hospitals. Based on a comparison of ranked electronic prescribing frequencies, medications enriched among test-positive individuals not requiring hospitalization included ibuprofen, valacyclovir, and naproxen. Among individuals who were hospitalized, mechanical ventilation was documented in 213 (30.1%); ibuprofen and naproxen were also more commonly prescribed among individuals not requiring ventilation.Conclusions and RelevanceThese preliminary findings suggest that electronic health records may be applied to identify medications associated with lower risk of morbidity with COVID-19, but larger cohorts will be required to address confounding by indication. Larger scale efforts at repositioning may help to identify FDA-approved medications meriting study for prevention of COVID-19 morbidity and mortality.Fundingnone.Key PointsQuestionCan electronic health records identify medications that may be associated with diminished risk of COVID-19 morbidity?FindingsThis cohort study across 5 hospitals identified medications enriched among individuals who did not require hospitalization for COVID-19 despite a positive test.MeaningWhile preliminary and subject to confounding, our results suggest that electronic health records may complement efforts to identify novel therapeutics for COVID-19 by identifying FDA-approved compounds with potential benefit in reducing COVID-19-associated morbidity.

scholarly journals Spectrum of tablet computer use by medical students and residents at an academic medical center

2015 ◽  
Author(s):  
Robert Robinson
Keyword(s):  
Medical Students ◽  
Patient Care ◽  
Computer Use ◽  
Response Rate ◽  
Medical Center ◽  
Academic Medical Center ◽  
Tablet Computer ◽  
Tablet Computers ◽  
Resident Physicians ◽  
Academic Medical

Introduction: The value of tablet computer use in medical education is an area of considerable interest, with preliminary investigations showing that the majority of medical trainees feel that tablet computers added value to the curriculum. This study investigated potential differences in tablet computer use between medical students and resident physicians. Materials & Methods: Data collection for this survey was accomplished with an anonymous online questionnaire shared with the medical students and residents at Southern Illinois University School of Medicine (SIU-SOM) in July and August of 2012. Results: There were 76 medical student responses (26% response rate) and 66 resident/fellow responses to this survey (21% response rate). Residents/fellows were more likely to use tablet computers several times daily than medical students (32% vs 20%, p = 0.035). The most common reported uses were for accessing medical reference applications (46%), e-Books (45%), and board study (32%). Residents were more likely than students to use a tablet computer to access an electronic medical record (41% vs 21%, p = 0.010), review radiology images (27% vs 12%, p = 0.019), and enter patient care orders (26% vs 3%, p < 0.001). Discussion: This study shows a high prevalence and frequency of tablet computer use among physicians in training at this academic medical center. Most residents and students use tablet computers to access medical references, e-books, and to study for board exams. Residents were more likely to use tablet computers to complete clinical tasks. Conclusions: Tablet computer use among medical students and resident physicians was common in this survey. All learners used tablet computers for point of care references and board study. Resident physicians were more likely to use tablet computers to access the EMR, enter patient care orders, and review radiology studies. This difference is likely due to the differing educational and professional demands placed on resident physicians. Further study is needed better understand how tablet computers and other mobile devices may assist in medical education and patient care.

scholarly journals Resident Physician Knowledge of Urine Testing and Treatment Over Four Years

2018 ◽  
Vol 39 (5) ◽  
pp. 616-618
Author(s):  
Shannon L. Andrews ◽  
Lilian M. Abbo ◽  
James R. Johnson ◽  
Michael A. Kuskowski ◽  
Bhavarth S. Shukla ◽  
...  
Keyword(s):  
Resident Physician ◽  
Clinical Vignette ◽  
Infect Control Hosp ◽  
Academic Medical Centers ◽  
Physician Knowledge ◽  
Medical Centers ◽  
Resident Physicians ◽  
Academic Medical ◽  
Urine Testing

We surveyed resident physicians at 2 academic medical centers regarding urinary testing and treatment as they progressed through training. Demographics and self-reported confidence were compared to overall knowledge using clinical vignette-based questions. Overall knowledge was 40% in 2011 and increased to 48%, 55%, and 63% in subsequent years (P<.001).Infect Control Hosp Epidemiol 2018;39:616–618

scholarly journals Using aggregate patient data at the bedside via an on-demand consultation service

2021 ◽  
Author(s):  
Alison Callahan ◽  
Saurabh Gombar ◽  
Eli M Cahan ◽  
Kenneth Jung ◽  
Ethan Steinberg ◽  
...  
Keyword(s):  
Patient Care ◽  
Information Needs ◽  
Medical Center ◽  
Academic Medical Center ◽  
Patient Data ◽  
Consultation Service ◽  
Institutional Practices ◽  
On Demand ◽  
Medical Centers ◽  
Academic Medical

Using evidence derived from previously collected medical records to guide patient care has been a long standing vision of clinicians and informaticians, and one with the potential to transform medical practice. As a result of advances in technical infrastructure, statistical analysis methods, and the availability of patient data at scale, an implementation of this vision is now possible. Motivated by these advances, and the information needs of clinicians in our academic medical center, we offered an on-demand consultation service to derive evidence from patient data to answer clinician questions and support their bedside decision making. We describe the design and implementation of the service as well as a summary of our experience in responding to the first 100 requests. Consultation results informed individual patient care, resulted in changes to institutional practices, and motivated further clinical research. We make the tools and methods developed to implement the service publicly available to facilitate the broad adoption of such services by health systems and academic medical centers.

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