scholarly journals How To Hospital: barriers to developing a patient ‘Hospital Survival Guide’ to support information transfer during ward-rounds on the patient journey from admission to hospital to discharge

2022 ◽  
Vol 11 (1) ◽  
pp. e001556
Author(s):  
Swyn Lewis ◽  
Gwenlli Mai Jones ◽  
Paul Barach ◽  
Hawys Tomos ◽  
Mari Davies ◽  
...  
Keyword(s):  
Information Transfer ◽  
Patient Specific ◽  
Information Retention ◽  
Patient Journey ◽  
Acute Medical Unit ◽  
Summary Sheet ◽  
Basic Set ◽  
Ward Rounds ◽  
Initial Survey ◽  
Communication And Coordination

Clinicians can enable patients to actively participate in their care but communication with patients is often poor and highly variable. The aim of this study was to explore patients’ understanding of their current illness while in hospital and using a codesign process to create prototype tools to facilitate better communication during ward rounds.A mixed-methods, multistep design with step 1: Application of a questionnaire addressing domains of care in the acute medical unit; step 2: Development of communication aids that were codesigned with active help of patients, students and a specialist in user centric design to address patient needs and step 3: Evaluation of tools with patients in four Plan–Do–Study–Act cycles.In the initial survey of 30 patients 12 (40%) patients did not know what their diagnosis was and 5 (17%) did not know the results of recent key tests. 20 (67%) patients felt that staff communication and coordination could be improved.An intervention was prototyped with four variations: (1) An A6 ward-round summary sheet completed by doctors during ward rounds. The system worked well but was highly person dependent. (2) An A4 patient-owned diary (‘How to Hospital’) that contained information about key processes in hospital and space to document conversations from rounds and prompts for questions. 10 patients read the diary and commented favourably but did not complete any pages. (3) ‘Diary-cards’: a basic set of information cards was given to patients on admission to hospital. (4) Patient specific ‘diary-cards’ were completed by clinicians—10 forms were piloted during rounds and improved subsequent day information retention of diagnosis to 80%.Our study identified interventions that were feasible but remained person-dependent. The patients’ ownership of information in relation to their care might facilitate retention and satisfaction but the optimal format for these interventions for enhancing communication remains unclear.

scholarly journals Predicting comorbidities of epilepsy patients using big data from Electronic Health Records combined with biomedical knowledge

2017 ◽  
Author(s):  
Thomas Gerlach ◽  
Chao Lu ◽  
Holger Fröhlich
Keyword(s):  
Big Data ◽  
Electronic Health Records ◽  
Biological Effects ◽  
Patient Specific ◽  
Medication History ◽  
Biomedical Knowledge ◽  
Brain Disorder ◽  
Patient Journey ◽  
Health Records ◽  
Electronic Health

Epilepsy is a complex brain disorder characterized by repetitive seizure events. Epilepsy patients often suffer from various and severe physical and psychological comorbidities. While general comorbidity prevalence and incidences can be estimated from epidemiological data, such an approach does not take into account that actual patient specific risks can depend on various individual factors, including medication. This motivates to develop a machine learning approach for predicting individual comorbidities. To address these needs we used Big Data from electronic health records (~100 Million raw observations),which provide a time resolved view on an individual's disease and medication history. A specific contribution of this work is an integration of these data with information from 14 biomedical sources (DisGeNET, TTD, KEGG, Wiki Pathways, DrugBank, SIDER, Gene Ontology, Human Protein Atlas, ...) to capture putative biological effects of observed diseases and applied medications. In consequence we extracted >165,000 features describing the longitudinal patient journey of >10,000 adult epilepsy patients. We used maximum-relevance-minimum-redundancy feature selection in combination with Random Survival Forests (RSF) for predicting the risk of 9 major comorbidities after first epilepsy diagnosis with high cross-validated C-indices of 76 - 89% and analyzed the influence of medications on the risk to develop specific comorbidities. Altogether we see our work as a first step towards earlier detection and better prevention of common comorbidities of epilepsy patients. Supplementary material: https://drive.google.com/file/d/0B4OhgVPeWvGTeUNFQVJLai1HRlk/view?usp=sharing , code: https://github.com/thomasmooon/GCB2017

scholarly journals An Evaluation of a Formative Assessment Process used on Post Take Ward Rounds

2013 ◽  
Vol 12 (4) ◽  
pp. 208-213
Author(s):  
Gordon Caldwell ◽  
Keyword(s):  
Formative Assessment ◽  
Clinical Training ◽  
Clinical Care ◽  
Clinical Excellence ◽  
Assessment Process ◽  
Online Surveys ◽  
Positive Effects ◽  
Acute Medical Unit ◽  
Ward Rounds ◽  
Case Based

The purpose of clinical training is to develop doctors capable of delivering professional, personal, effective, high quality, safe clinical care with Intelligent Kindness. The processes supporting training must promote development towards excellence. In 2004 a formative assessment process for use on medical post take ward rounds was introduced based on a model of a Driving Instructor and Learner Driver. This process has been evaluated in comparison with the Case based Discussion (CbD) and mini-Cex by 140 of 369 trainees, using online surveys. Ten trainees were interviewed in depth. The majority of trainees reported that this process had helped them more in their development as doctors than the CbD or mini-CEX. Trainees were able to describe positive effects in areas such as diagnosis, prescribing and confidence in their work. In the NHS the assessments are meant to be “trainee driven”, however all but one of the trainees stated that they preferred the routine provision of an assessment to having to ask for an assessment. This evaluation of a truly formative assessment process shows that the trainees benefit in their progression towards clinical excellence. Effective formative feedback can be provided on an Acute Medical Unit even within the constraints of busy post take ward rounds. Within a team of Consultants one should be allowed time to develop an extended Clinical Supervisor role.

Anaesthesia and analgesia considerations in breast surgery

2021 ◽  
pp. 1151-1158
Author(s):  
Glenda Rudkin ◽  
Sarah Gardiner
Keyword(s):  
Breast Surgery ◽  
Anaesthetic Techniques ◽  
Management Plan ◽  
Careful Consideration ◽  
Patient Specific ◽  
Tissue Quality ◽  
Patient Journey ◽  
Psychosocial Profile ◽  
Surgical Setting

Breast surgery is most commonly conducted for a suspected diagnosis or treatment of cancer. Additionally, cosmetic breast surgery is an increasingly common field particularly in the day-case setting. Both oncological and plastic surgery of the breast varies in site, extent of dissection, surgical technique, and duration of procedure in the context of diverse patient factors (premorbid psychosocial profile, physical habitus, tissue quality, comorbidities). These elements all require careful consideration for the attending anaesthetist and surgical team in order to optimize the patient journey through their recovery in both the acute and long-term periods. In addition to systemic administration, improved postoperative analgesia and subsequent recovery in breast surgery incorporates regional and local anaesthetic techniques. Integral to any surgical setting is a patient-specific pain management plan. This should commence at the time of anaesthesia and continue into the postoperative period. Any risk factors for chronic pain need to be identified and managed early.

scholarly journals Patient journey following lumbar discectomy surgery: protocol for a single-centre qualitative analysis of the patient rehabilitation experience (DiscJourn)

BMJ Open ◽  
2019 ◽  
Vol 9 (8) ◽  
pp. e025814
Author(s):  
Louise White ◽  
Nicola R Heneghan ◽  
Navin Furtado ◽  
Annabel Masson ◽  
Alison B Rushton
Keyword(s):  
Current Knowledge ◽  
Postoperative Management ◽  
Practice Variation ◽  
Lumbar Discectomy ◽  
Patient Specific ◽  
Research Approach ◽  
Structured Interviews ◽  
Topic Guide ◽  
Patient Journey ◽  
The Impact

IntroductionLumbar discectomy is a widely used surgical procedure internationally with the majority of patients experiencing significant benefit. However, approximately 20% of patients report suboptimal functional recovery and quality of life. The impact and meaning of the surgical experience from the patients’ perspective are not fully understood. Furthermore, there is limited evidence guiding postoperative management with significant clinical practice variation and it is unclear if current postoperative support is valued, beneficial or meets patients’ needs and expectations. This study aims to address the evidence gap by moving beyond current knowledge to gain insight into the lived experiences relating to patients’ lumbar discectomy surgery journey. Results will inform more meaningful and specific care, thus, enhance rehabilitation and outcomes.Methods and analysisA qualitative investigation using interpretative phenomenology analysis (IPA) will provide a flexible inductive research approach. A purposive sample (n=20) of patients undergoing primary discectomy will be recruited from one UK NHS secondary care centre. Semi-structured interviews will be conducted postsurgery discharge. A topic guide, developed from the literature and our previous work with input from two patient co-investigators, will guide interviews with the flexibility to explore interesting or patient-specific points raised. Providing longitudinal data, patients will keep weekly diaries capturing experiences and change over time throughout 12 months following surgery. A second interview will be completed 1 year postsurgery with its topic guide informed by initial findings. This combination of patient interviews and diaries will capture patients’ attitudes and beliefs regarding surgery and recovery, facilitators and barriers to progress, experiences regarding return to activities/function and interactions with healthcare professionals. The rich density of data will be thematically analysed in accordance with IPA, supported by NVivo software.Ethics and disseminationEthical approval has been granted by the London-Bloomsbury Research Ethics Committee (18/LO/0459; IRAS 241345). Conclusions will be disseminated through conferences and peer-reviewed journals.

The impact of standardised perioperative handover protocols

2018 ◽  
Vol 28 (10) ◽  
pp. 258-262 ◽  
Author(s):  
Ashley McFarlane
Keyword(s):  
Literature Review ◽  
Information Transfer ◽  
Best Practice ◽  
Patient Journey ◽  
Inaccurate Information ◽  
Vulnerable Period ◽  
The Impact

The handover of the care of patients is acknowledged as a vulnerable period in the perioperative patient journey, and handovers given within the perioperative environment present the risk of potentially harmful errors occurring. These errors can result from poor communication and inaccurate information transfer, and may be avoided through the implementation of standardised protocols. This article presents an in depth literature review and discussion allowing for the examination of best practice in the delivery of a handover within the perioperative environment, drawing clear conclusions and presenting recommendations for best practice.

scholarly journals Improving clinical documentation: introduction of electronic health records in paediatrics

2021 ◽  
Vol 10 (1) ◽  
pp. e000918
Author(s):  
Justin Koh ◽  
Mansoor Ahmed
Keyword(s):  
Medical Care ◽  
Medical Records ◽  
Clinical Documentation ◽  
Electronic Patient Records ◽  
Patient Journey ◽  
Improvement Project ◽  
Record Keeping ◽  
Imaging Results ◽  
Electronic Health ◽  
Ward Rounds

Medical records are crucial facet of a patient’s journey. These provide the clinician with a permanent record of the patient’s illness and ongoing medical care, thus enabling informed clinical decisions. In many hospitals, patient medical records are written on paper. However, written notes are liable to misinterpretation due to illegibility and misplacement. This can affect the patient’s medical care and has medico-legal implications. Electronic patient records (EPR) have been gradually introduced to replace patient’s paper notes with the aim of providing a more reliable record-keeping system. It is perceived that EPR improve the quality and efficiency of patient care. The paediatric department at Queen’s Hospital Burton uses a mix of paper notes and computerised medical records. Clinicians primarily use paper notes for admission clerking, ward rounds, ward reviews and outpatient clinic consultations. Laboratory tests, imaging results and prescription requests are executed via the EPR system. Documentation by nurses is also carried out electronically. We aimed to improve and standardise clinical documentation of paediatric admissions and ward round notes by developing electronic proforma for initial paediatric clerking, ward rounds and patient reviews. This quality improvement project improved clinical documentation on the paediatric wards and enhanced patient record-keeping, boosted clinical information-sharing and streamlined patient journey. It fulfilled various generic multidisciplinary record keeping audit tool standards endorsed by the Royal College of Physicians by 100%. We undertook a staff survey to investigate the opinion before and after implementing the electronic health record. Doctors, nurses and healthcare support workers overwhelmingly supported the quality, usefulness, completeness of specified fields and practicality of the electronic records.

scholarly journals 41 A New Ambulatory Frailty Pathway at Barnsley Hospital

2021 ◽  
Vol 50 (Supplement_1) ◽  
pp. i12-i42
Author(s):  
W Rycroft ◽  
B Madi
Keyword(s):  
Geriatric Assessment ◽  
Comprehensive Geriatric Assessment ◽  
Discharge Rate ◽  
Patient Journey ◽  
Acute Medical Unit ◽  
Frail Patients ◽  
Standard Management ◽  
Same Day Discharge ◽  
Ambulatory Patients ◽  
Advance Care

Abstract Topic At Barnsley Hospital we targeted an improvement in the care of frail patients. The first objective was to improve the patient journey by reducing the amount of time that frail patients spend in busy acute environments. The second objective was to deliver more effective Comprehensive Geriatric Assessment which is recognised as gold standard management (Ellis, G. BMJ 2011;343:d6553). Intervention A new frailty chaired area was opened in July 2018 with capacity to receive up to 6 patients per day from acute admission areas and aim for same day discharge. We developed our own bespoke criteria to ensure that suitable ambulatory patients were identified to access this new pathway. This was called “FACT” Criteria- Frail, Ambulatory, Clinically stable, Time to call. Patients received an MDT model of care which was documented using a newly developed electronic tool called electronic Comprehensive Geriatric Assessment (eCGA). Improvement To evaluate the patient journey we measured the average time between the Acute Medical Unit (AMU) Post Take Ward Round (PTWR) and onward move. Comparison was made between the 2 month periods July—August and November—December 2018. This demonstrated that the average time reduced from 10.3 to 5.1 hours. Between July 2018 and April 2019 a total of 689 patients were assessed in the frailty chaired area of which 60.8% were discharged from the hospital the same day. Discussion The patient journey for frail ambulatory patients now involves significantly less time on AMU awaiting onward move. Comprehensive Geriatric Assessment is delivered more effectively and documented electronically using eCGA. This tool promotes better information sharing and has a specific section for advance care planning. This new pathway has a high same day discharge rate of 60.8% which reduces length of stay for our frail patients.

scholarly journals Predicting comorbidities of epilepsy patients using big data from Electronic Health Records combined with biomedical knowledge

2017 ◽  
Author(s):  
Thomas Gerlach ◽  
Chao Lu ◽  
Holger Fröhlich
Keyword(s):  
Big Data ◽  
Electronic Health Records ◽  
Biological Effects ◽  
Patient Specific ◽  
Medication History ◽  
Biomedical Knowledge ◽  
Brain Disorder ◽  
Patient Journey ◽  
Health Records ◽  
Electronic Health

Epilepsy is a complex brain disorder characterized by repetitive seizure events. Epilepsy patients often suffer from various and severe physical and psychological comorbidities. While general comorbidity prevalence and incidences can be estimated from epidemiological data, such an approach does not take into account that actual patient specific risks can depend on various individual factors, including medication. This motivates to develop a machine learning approach for predicting individual comorbidities. To address these needs we used Big Data from electronic health records (~100 Million raw observations),which provide a time resolved view on an individual's disease and medication history. A specific contribution of this work is an integration of these data with information from 14 biomedical sources (DisGeNET, TTD, KEGG, Wiki Pathways, DrugBank, SIDER, Gene Ontology, Human Protein Atlas, ...) to capture putative biological effects of observed diseases and applied medications. In consequence we extracted >165,000 features describing the longitudinal patient journey of >10,000 adult epilepsy patients. We used maximum-relevance-minimum-redundancy feature selection in combination with Random Survival Forests (RSF) for predicting the risk of 9 major comorbidities after first epilepsy diagnosis with high cross-validated C-indices of 76 - 89% and analyzed the influence of medications on the risk to develop specific comorbidities. Altogether we see our work as a first step towards earlier detection and better prevention of common comorbidities of epilepsy patients. Supplementary material: https://drive.google.com/file/d/0B4OhgVPeWvGTeUNFQVJLai1HRlk/view?usp=sharing , code: https://github.com/thomasmooon/GCB2017

scholarly journals Information gain in environmental monitoring through bioindi-cation and biomonitoring methods ("B & B technologies") and phytoremediation processes – with special reference to the Biological System of Chemical Elements (BSCE) under specific consideration

2020 ◽  
Vol 3 (11) ◽  
pp. 215
Author(s):  
Bernd Markert ◽  
Naglaa Abdallah ◽  
Ahmed Aksoy ◽  
Tarek Ammari ◽  
Andres Arias ◽  
...  
Keyword(s):  
Biological System ◽  
Information Transfer ◽  
Information Gain ◽  
Chemical Elements ◽  
Neurological Diseases ◽  
Strong Relationship ◽  
Point Of View ◽  
Patient Specific ◽  
Human Society ◽  
Chemical Substances

Different definitions for the concepts of information, information transfer, i.e. communication and its effect and efficiency of false, but also correct information, especially from the environmental sector, are given. "THE TEN ECOLOGICAL COMMANDMENTS" developed by Menke-Glückert at the end of the 1960s and the 9th commandment "Do not pollute information", in particular, are examined in more detail and understood practically as a currently unchanging law in our existing world societies. The "Ethics Consensus", derived from "THE TEN ECOLOGICAL COMMANDMENTS" and developed by Markert at the end of the 1990s, reflects both theoretical and practical levels of action that many people in our highly diverse world societies can support. From a scientific point of view, this article deals in particular with the so-called B & B technologies, i.e. bioindication and biomonitoring of chemical elements, their chemical speciation as well as organic substances.In particular, B & B technologies, which deal with the biological detection of atmospheric deposition of chemical substances on a regional, national and international level, are taken into account. From both an academic and a practical point of view, mosses have prevailed here in the last decades in addition to lichens. The use of mosses is a major focus of international air monitoring, especially in Europe. Furthermore, the phytoremediation of chemical substances in water, soil and air is described as a biological and sustainable biological process, which does not "yet" have the full scope as it is used in bioindication and biomonitoring, as shown in the example of mosses. However, the phytoremediation considers to be an excellent tool to have the leading role in the sustainable pollutant "fight". In the future qualitative and quantitative approaches have been further on developed to fit scientifically and practically B&B Technologies as well the different form of phytotechnological approaches. Finally, the example of lithium, which is optionally derived from the Biological System of Chemical Elements (BSCE), becomes a chemical example that the administration of lithium to ALL mentally conditioned diseases such as manic depression up to smoking of cigarettes  become one of the most valuable service for the recovery of our human society on a global level.As a conclusion of these tremendous effects of lithium can be considered: pulled out, in order to make clear that only this chemical element beside a psychiatric care and the involvement of family members, friends, physicians, psychologists and psychiatrists. In addition it is a must, that there is a strong relationship in between patient, psychiatrist(s) and strongly related persons to the patient. First an intensive information transfer via communication has to be guaranteed. After it a psychological support by doctors and, only if it seems necessary Lithium is to be given in a patient specific dose.Keywords. Bioindication, Biomonitoring, B&B Technology, Phytotechnology, The Biological System of Chemical Elements (BSCE), Lithium. Neurological diseases, Functional Food.

Determination of the Best Emulsion for the Microscopy of Crystals

1981 ◽  
Vol 39 ◽  
pp. 32-33
Author(s):  
David A. Grano ◽  
Kenneth H. Downing
Keyword(s):  
Spatial Frequency ◽  
Information Transfer ◽  
Signal To Noise Ratio ◽  
Experimental Situation ◽  
Photographic Emulsion ◽  
Modulation Transfer ◽  
Signal To Noise ◽  
Frequency Space ◽  
Noise Ratio

The retrieval of high-resolution information from images of biological crystals depends, in part, on the use of the correct photographic emulsion. We have been investigating the information transfer properties of twelve emulsions with a view toward 1) characterizing the emulsions by a few, measurable quantities, and 2) identifying the “best” emulsion of those we have studied for use in any given experimental situation. Because our interests lie in the examination of crystalline specimens, we've chosen to evaluate an emulsion's signal-to-noise ratio (SNR) as a function of spatial frequency and use this as our critereon for determining the best emulsion.The signal-to-noise ratio in frequency space depends on several factors. First, the signal depends on the speed of the emulsion and its modulation transfer function (MTF). By procedures outlined in, MTF's have been found for all the emulsions tested and can be fit by an analytic expression 1/(1+(S/S0)2). Figure 1 shows the experimental data and fitted curve for an emulsion with a better than average MTF. A single parameter, the spatial frequency at which the transfer falls to 50% (S0), characterizes this curve.

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