scholarly journals Qualitative investigation of trace-based communication: how are traces conceptualised in healthcare teamwork?

BMJ Open ◽  
2020 ◽  
Vol 10 (11) ◽  
pp. e038406
Author(s):  
Sayra Cristancho ◽  
Emily Field
Keyword(s):  
Internal Medicine ◽  
Healthcare Providers ◽  
Constructivist Grounded Theory ◽  
Teaching Hospitals ◽  
Secondary Outcome ◽  
Qualitative Investigation ◽  
Qualitative Nature ◽  
Saving Face ◽  
Critical Process ◽  
Biological Literature

ObjectivesThis interview-based qualitative study aims to explore how healthcare providers conceptualise trace-based communication and considers its implications for how teams work. In the biological literature, trace-based communication refers to the non-verbal communication that is achieved by leaving ‘traces’ in the environment and other members sensing them and using them to drive their own behaviour. Trace-based communication is a key component of swam intelligence and has been described as a critical process that enables superorganisms to coordinate work and collectively adapt. This paper brings awareness to its existence in the context of healthcare teamwork.DesignInterview-based study using Constructivist Grounded Theory methodology.SettingThis study was conducted in multiple team contexts at one of Canada’s largest acute-care teaching hospitals.Participants25 clinicians from across professions and disciplines. Specialties included surgery, anesthesiology, psychiatry, internal medicine, geriatrics, neonatology, paramedics, nursing, intensive care, neurology and emergency medicine.InterventionNot relevant due to the qualitative nature of the study.Primary and secondary outcomeNot relevant due to the qualitative nature of the study.ResultsThe dataset was analysed using the sensitising concept of ‘traces’ from Swarm Intelligence. This study brought to light novel and unique elements of trace-based communication in the context of healthcare teamwork including focused intentionality, successful versus failed traces and the contextually bounded nature of the responses to traces. While participants initially felt ambivalent about the idea of using traces in their daily teamwork, they provided a variety of examples. Through these examples, participants revealed the multifaceted nature of the purposes of trace-based communication, including promoting efficiency, preventing mistakes and saving face.ConclusionsThis study demonstrated that clinicians pervasively use trace-based communication despite differences in opinion as to its implications for teamwork and safety. Other disciplines have taken up traces to promote collective adaptation. This should serve as inspiration to at least start exploring this phenomenon in healthcare.

Evaluation of a New Integrated Discharge Prescription Form

2001 ◽  
Vol 35 (7-8) ◽  
pp. 953-958 ◽  
Author(s):  
Nicolas Paquette-Lamontagne ◽  
William M McLean ◽  
Lysanne Besse ◽  
Jean Cusson
Keyword(s):  
Internal Medicine ◽  
Community Pharmacy ◽  
Healthcare Providers ◽  
Teaching Hospitals ◽  
Control Group ◽  
Patient Profile ◽  
Prescription Form ◽  
Patient Profiles ◽  
Internal Medicine Wards ◽  
Discharge Prescription

OBJECTIVE: To determine whether a new discharge prescription form which integrates admission medications, in-hospital changes, and discharge medications could enhance the accuracy of information in patient profiles in community pharmacies after hospital discharge. DESIGN: Nonrandomized, prospective, multi-site study. SETTINGS: Internal medicine wards of the three teaching hospitals (1200 beds) of the Centre Hospitalier de l'Université de Montréal. SUBJECTS: Patients admitted to the internal medicine wards between January 4 and 31, 1999, at St.-Luc and Notre-Dame Hospitals formed the control group and received a usual discharge form (UD). Those admitted between February 1 and 28, 1999, received the new discharge prescription form (DPF) capturing the list of admission medications and revisions during hospitalization; they served as the experimental group. METHODS: Patient profiles were reviewed to calculate conformity rates of community pharmacy patient profiles after discharge and the rate of overall conformity for each group in the study. Each drug in the patient profile was assessed according to six criteria. Healthcare providers' satisfaction with the DPF was assessed via a written questionnaire. RESULTS: Eighty-nine patients and 669 discharge medications were studied. The patient profiles had a higher conformity rate in the DPF group than in the UD group (82% vs. 40%; p < 0.001); improvement could be attributed to higher conformity rates, particularly for two criteria (medications stopped in hospital and dose changes in hospital). CONCLUSIONS: Integration of admission medications, in-hospital changes, and discharge medications on a single form increases the conformity rates of community pharmacy patient profiles after hospitalization. This tool is well accepted by both pharmacists and physicians and may lead to a major decrease in drug-related problems.

scholarly journals Identifying Patterns of Symptom Distress in Pregnant Women: A Pilot Study

2021 ◽  
Vol 18 (12) ◽  
pp. 6333
Author(s):  
Ching-Fang Lee ◽  
Fur-Hsing Wen ◽  
Yvonne Hsiung ◽  
Jian-Pei Huang ◽  
Chun-Wei Chang ◽  
...  
Keyword(s):  
Pregnant Women ◽  
Healthcare Providers ◽  
First Trimester ◽  
Symptom Distress ◽  
Teaching Hospitals ◽  
Lower Back ◽  
Distress Symptoms ◽  
Related Symptom ◽  
Experienced Symptom

During pregnancy, a woman’s enlarged uterus and the developing fetus lead to symptom distress; in turn, physical and psychological aspects of symptom distress are often associated with adverse prenatal and birth outcomes. This study aimed to identify the trends in the trajectory of these symptoms. This longitudinal study recruited 95 pregnant women, with a mean age of 32 years, from the prenatal wards of two teaching hospitals in northern Taiwan. Symptom distress was measured by a 22-item scale related to pregnancy-induced symptoms. The follow-up measurements began during the first trimester and were taken every two to four weeks until childbirth. More than half of the pregnant women experienced symptom distress manifested in a pattern depicted to be “Decreased then Increased” (56.8%). Other noticeable patterns were “Continuously Increased” (28.4%), “Increased then Decreased” (10.5%) and “Continuously Decreased” (4.2%), respectively. It is worth noting that most pregnant women recorded a transit and increase in their symptom distress, revealed by their total scores, at the second trimester (mean 22.02 weeks) of pregnancy. The participants’ major pregnancy-related distress symptoms were physical and included fatigue, frequent urination, lower back pain, and difficulty sleeping. The mean scores for individual symptoms ranged from 2.32 to 3.61 and were below the “moderately distressful” level. This study provides evidence that could be used to predict women’s pregnancy-related symptom distress and help healthcare providers implement timely interventions to improve prenatal care.

scholarly journals 980. Drexel Medicine Resident Knowledge, Practices and Attitudes Regarding Pre-exposure prophylaxis (PrEP)

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S518-S518
Author(s):  
Jen E Mainville ◽  
Ed Gracely ◽  
Zsofia Szep
Keyword(s):  
Internal Medicine ◽  
Male Partner ◽  
Healthcare Providers ◽  
Cross Sectional Study ◽  
Cross Sectional ◽  
Major Barrier ◽  
Medicine Resident ◽  
Highly Effective ◽  
Prevention Method ◽  
Exposure Prophylaxis

Abstract Background Pre-exposure prophylaxis (PrEP) is a highly effective daily oral antiretroviral medication that was approved by the FDA in 2012 and has been shown to reduce the risk of HIV by 95% in real-world studies. Despite this, many healthcare providers are not offering PrEP to their patients who are at risk for HIV. Methods We performed a cross-sectional study among Drexel Internal Medicine, Family Medicine, and Obstetrics and Gynecology residents. The survey included questions about experience, knowledge, attitudes toward and barriers to using PrEP. The survey was adapted from previous studies regarding medical providers’ attitudes and knowledge about PrEP (Petroll, 2016; Seifman, 2016; Blumenthal, 2105). A Likert 5-point scale was used for attitude and barriers questions. Results Among 143 participants, 80% specialized in Internal Medicine. 43% of participants were in their first year of training and the mean age (+ SD) was 28.8 + 2. 76% reported never initiating a conversation about PrEP with a patient and only 18% reported ever prescribing PrEP to their patients. 92% reported being very or extremely willing to prescribe PrEP to a male with a current male partner known to be HIV positive. Only 43% of residents reported being moderately likely to prescribe PrEP to a patient coming in for a STI exposure. 68% of residents reported their knowledge about PrEP was a major barrier to prescribing PrEP. Conclusion We found that most residents have minimal experience with prescribing PrEP, and knowledge was identified as the largest barrier. Additional education and a better understanding of PrEP indications is necessary to ensure eligible PrEP patients have access to this highly effective HIV prevention method. Disclosures All Authors: No reported disclosures

scholarly journals 139. Impact of Pharmacist Driven Outpatient Fluoroquinolone Stewardship Initiative in Community Based Setting

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S81-S81
Author(s):  
Sarah Norman ◽  
Sara Jones ◽  
Cara Acklin ◽  
Christian Cheatham
Keyword(s):  
Antimicrobial Stewardship ◽  
Healthcare Providers ◽  
Hospital Setting ◽  
Secondary Outcome ◽  
Quality Improvement Initiative ◽  
Oral Antibiotic ◽  
Ambulatory Care Setting ◽  
Community Based ◽  
Before And After ◽  
Physician Network

Abstract Background Antimicrobial stewardship initiatives and efforts have historically had a greater emphasis in the inpatient hospital setting. There is a need for outpatient stewardship, and additionally, accreditation standards are starting to require antimicrobial stewardship efforts in the ambulatory care setting. Fluoroquinolones are a target for antimicrobial stewardship based on their broad-spectrum activity, pharmacokinetics/pharmacodynamics, safety profile, downstream resistance, and risk of super infections. The objective of this study was to compare outpatient fluoroquinolone prescribing rates before and after pharmacist led initiative. Methods This was a prospective, quality improvement initiative between October 1, 2019 to June 1, 2020 at a community-based physician network across Indiana. The pharmacist initiative incorporated a live, educational presentation with intervention 1 and an informational letter to healthcare providers across the outpatient physician network with intervention 2. Data was collected from a computer-generated, prescription report. The primary outcome was fluoroquinolone prescribing rates at Central Indiana (CI) sites before and after pharmacist led interventions. Rate of fluoroquinolone prescribing was defined as total number of fluoroquinolone prescriptions per month. The secondary outcome included percentage of fluoroquinolone use at CI sites. Percentage of fluoroquinolone use was defined as monthly number of fluoroquinolones prescriptions compared to monthly number of all oral antibiotic prescriptions. Results There was a 29.8% decrease (382 vs 268 prescriptions) in outpatient fluoroquinolone prescriptions at CI sites after intervention 1 compared to same month of previous year. There was a 43.7% decrease (428 vs 241 prescriptions) in outpatient fluoroquinolone prescriptions at CI sites after intervention 2. There was an overall 2.4% decrease (4.9% vs 2.5%) in percentage of fluoroquinolone use compared to all oral antibiotics at CI sites after intervention 2 compared to same month of previous year. Conclusion These findings suggest the pharmacist led outpatient antimicrobial stewardship initiative successfully decreased fluoroquinolone prescribing rates across the network. Disclosures Christian Cheatham, PharmD, BCIDP, Antimicrobial Resistance Solutions (Shareholder)

Drug Alert Experience and Salience during Medical Residency at Two Healthcare Institutions

2021 ◽  
Vol 12 (02) ◽  
pp. 355-361
Author(s):  
Kinjal Gadhiya ◽  
Edgar Zamora ◽  
Salim M. Saiyed ◽  
David Friedlander ◽  
David C. Kaelber
Keyword(s):  
Internal Medicine ◽  
Residency Training ◽  
Medical Center ◽  
Internal Medicine Resident ◽  
Clinical Decision ◽  
University Of Pennsylvania ◽  
Teaching Hospitals ◽  
Medicine Resident ◽  
Internal Medicine Residents ◽  
The University

Abstract Background Drug alerts are clinical decision support tools intended to prevent medication misadministration. In teaching hospitals, residents encounter the majority of the drug alerts while learning under variable workloads and responsibilities that may have an impact on drug-alert response rates. Objectives This study was aimed to explore drug-alert experience and salience among postgraduate year 1 (PGY-1), postgraduate year 2 (PGY-2), and postgraduate year 3 (PGY-3) internal medicine resident physicians at two different institutions. Methods Drug-alert information was queried from the electronic health record (EHR) for 47 internal medicine residents at the University of Pennsylvania Medical Center (UPMC) Pinnacle in Pennsylvania, and 79 internal medicine residents at the MetroHealth System (MHS) in Ohio from December 2018 through February 2019. Salience was defined as the percentage of drug alerts resulting in removal or modification of the triggering order. Comparisons were made across institutions, residency training year, and alert burden. Results A total of 126 residents were exposed to 52,624 alerts over a 3-month period. UPMC Pinnacle had 15,574 alerts with 47 residents and MHS had 37,050 alerts with 79 residents. At MHS, salience was 8.6% which was lower than UPMC Pinnacle with 15%. The relatively lower salience (42% lower) at MHS corresponded to a greater number of alerts-per-resident (41% higher) compared with UPMC Pinnacle. Overall, salience was 11.6% for PGY-1, 10.5% for PGY-2, and 8.9% for PGY-3 residents. Conclusion Our results are suggestive of long-term drug-alert desensitization during progressive residency training. A higher number of alerts-per-resident correlating with a lower salience suggests alert fatigue; however, other factors should also be considered including differences in workload and culture.

scholarly journals Disease characteristics and management of hospitalised adolescents and adults with community-acquired pneumonia in China: a retrospective multicentre survey

BMJ Open ◽  
2018 ◽  
Vol 8 (2) ◽  
pp. e018709 ◽  
Author(s):  
Liang Chen ◽  
Fei Zhou ◽  
Hui Li ◽  
Xiqian Xing ◽  
Xiudi Han ◽  
...  
Keyword(s):  
Southern China ◽  
Pneumonia Severity Index ◽  
Community Acquired Pneumonia ◽  
Teaching Hospitals ◽  
Secondary Outcome ◽  
Standard Case ◽  
Risk Class ◽  
Illness Onset ◽  
Hospitalised Patients ◽  
Clinical Stability

ObjectivesTo describe the clinical characteristics and management of patients hospitalised with community-acquired pneumonia (CAP) in China.DesignThis was a multicentre, retrospective, observational study.Setting13 teaching hospitals in northern, central and southern China from 1 January 2014 to 31 December 2014ParticipantsInformation on hospitalised patients aged ≥14 years with radiographically confirmed pneumonia with illness onset in the community was collected using standard case report forms.Primary and secondary outcome measuresResource use for CAP management.ResultsOf 14 793 patients screened, 5828 with radiographically confirmed CAP were included in the final analysis. Low mortality risk patients with a CURB-65 score 0–1 and Pneumonia Severity Index risk class I–II accounted for 81.2% (4434/5594) and 56.4% (2034/3609) patients, respectively. 21.7% (1111/5130) patients had already achieved clinical stability on admission. A definite or probable pathogen was identified only in 12.7% (738/5828) patients. 40.9% (1575/3852) patients without pseudomonal infection risk factors received antimicrobial overtreatment regimens. The median duration between clinical stability to discharge was 5.0 days with 30-day mortality of 4.2%.ConclusionsThese data demonstrated the overuse of health resources in CAP management, indicating that there is potential for improvement and substantial savings to healthcare systems in China.Trial registration numberNCT02489578; Results.

Abstract TP405: IV TPA Utilization and Outcomes in Young Stroke Patients

Stroke ◽  
2020 ◽  
Vol 51 (Suppl_1) ◽  
Author(s):  
Pamela Cheng ◽  
Ling Zheng ◽  
Steven Cen ◽  
Peggy Nguyen ◽  
Sebina Bulic ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Length Of Stay ◽  
Average Length ◽  
Pediatric Population ◽  
Cerebrovascular Disorders ◽  
Teaching Hospitals ◽  
Secondary Outcome ◽  
Total Charge ◽  
Inpatient Mortality ◽  
Stroke Patients

Objective: Cerebrovascular disorders are among the top ten causes of death in the pediatric population. The incidence is felt to be 1-2 per 100,000, although this number could be higher due to poor recognition. Our objective is to describe the incidence, tPA utilization, inpatient mortality, length of stay, and cost associated with stroke in pediatric population. Methods: Ischemic stroke cases between the ages of 1 and 17 years were obtained from the Nationwide Inpatient Sample (NIS) for the period from January 1, 2000 through December 31, 2014. The primary outcome was inpatient mortality. The secondary outcome was LOS and total cost per day. National trend estimate followed HCUP methodical standard which adopted the design change at 2012 with appropriate trend weight. Weighted estimates were made via SURVEYMEAN procedure and presented as national estimate ± standard error from sampling. SAS9.4 was used for the analysis. Results: From January 2000 through December 2014, there were an estimated 12908±1087 pediatric cases with ischemic stroke, 157±28 (1.2%±0.2%) had TPA. Pediatric ischemic stroke patients were predominantly discharged from urban, large-bed-size, teaching hospitals (40.7%±3.9%), more likely to be white (39.3%±1.8%) and male (52.5%±1.2%), most prevalent among those aged 16 years old (10.3%±0.8%). Overall inpatient mortality was 3.0±0.3 per 100 discharges. Median LOS was 4.0±0.1 days. Median total charge per day was $ 8162±348. Majority of pediatric ischemic stroke patients discharged routinely to home or self-care (75.8%±1.2%). Conclusion: This study highlights that during the prespecified time frame of four years there was an estimated 12908±1087 ischemic strokes in the pediatric population and less than 2% of children received alteplase. Hospital mortality was 3.0% ± 0.3%. The average length of stay was 4 days with an estimated cost of $8162+/- 348 per day. The majority of pediatric patients were discharged home.

scholarly journals Residents' Perspectives on Patient Safety in University and Community Teaching Hospitals

2014 ◽  
Vol 6 (3) ◽  
pp. 603-607 ◽  
Author(s):  
Deborah L. Jones
Keyword(s):  
Internal Medicine ◽  
Patient Safety ◽  
General Surgery ◽  
Health Care Professionals ◽  
Diagnostic Radiology ◽  
Transitions Of Care ◽  
Teaching Hospitals ◽  
Safety Issues ◽  
Communication Problems ◽  
Community Teaching

Abstract Background Patient safety is an important concept in resident education. To date, few studies have assessed resident perceptions of patient safety across different specialties. Objective The study explored residents' views on patient safety across the specialties of internal medicine, general surgery, and diagnostic radiology, focusing on common themes and differences. Methods In fall 2012, interviews of small groups of senior residents in internal medicine, general surgery, and diagnostic radiology were conducted at 3 academic medical centers and 3 community teaching hospitals in 3 major US metropolitan areas. In total, 33 residents were interviewed. Interviews used interactive discussion to explore multiple facets of patient safety. Results Residents identified lack of information, common errors, volume and acuity of patients, and inadequate supervision as major risks to patient safety. Specific threats to patient safety included communication problems, transitions of care, information technology interface issues, time constraints, and work flow. Residents disclosed that reporting safety issues was viewed as burdensome and carrying some degree of risk. There was variability as to whether residents would report safety threats they encountered. Conclusions Residents are aware of threats to patient safety and have a unique perspective compared with other health care professionals. Transitions of care and communication problems were the most common safety threats identified by the residents interviewed.

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