scholarly journals Saving Time for Patient Care by Optimizing Physician Note Templates: A Pilot Study

2022 ◽  
Vol 3 ◽  
Author(s):  
Rana Alissa ◽  
Jennifer A. Hipp ◽  
Kendall Webb
Keyword(s):  
Patient Care ◽  
Discharge Summary ◽  
Physician Satisfaction ◽  
Free Text ◽  
Provider Satisfaction ◽  
Knowing That ◽  
Hand Off ◽  
Pilot Investigation ◽  
One Year ◽  
Provider Surveys

Background: At times, electronic medical records (EMRs) have proven to be less than optimal, causing longer hours behind computers, shorter time with patients, suboptimal patient safety, provider dissatisfaction, and physician burnout. These concerning healthcare issues can be positively affected by optimizing EMR usability, which in turn would lead to substantial benefits to healthcare professionals such as increased healthcare professional productivity, efficiency, quality, and accuracy. Documentation issues, such as non-standardization of physician note templates and tedious, time-consuming notes in our mother-baby unit (MBU), were discussed during meetings with stakeholders in the MBU and our hospital's EMR analysts.Objective: The objective of this study was to assess physician note optimization on saving time for patient care and improving provider satisfaction.Methods: This quality improvement pilot investigation was conducted in our MBU where four note templates were optimized: History and Physical (H and P), Progress Note (PN), Discharge Summary (DCS), and Hand-Off List (HOL). Free text elements documented elsewhere in the EMR (e.g., delivery information, maternal data, lab result, etc.) were identified and replaced with dynamic links that automatically populate the note with these data. Discrete data pick lists replaced necessary elements that were previously free texts. The new note templates were given new names for ease of accessibility. Ten randomly chosen pediatric residents completed both the old and new note templates for the same control newborn encounter during a period of one year. Time spent and number of actions taken (clicks, keystrokes, transitions, and mouse-keyboard switches) to complete these notes were recorded. Surveys were sent to MBU providers regarding overall satisfaction with the new note templates.Results: The ten residents' average time saved was 23 min per infant. Reflecting this saved time on the number of infants admitted to our MBU between January 2016 and September, 2019 which was 9373 infants; resulted in 2.6 hours saved per day, knowing that every infant averages two days length of stay. The new note templates required 69 fewer actions taken than the old ones (H and P: 11, PN: 8, DCS: 18, HOL: 32). The provider surveys were consistent with improved provider satisfaction.Conclusion: Optimizing physician notes saved time for patient care and improved physician satisfaction.

After-Hours Telephone Coverage: The Application of an Area-Wide Telephone Triage and Advice System for Pediatric Practices

PEDIATRICS ◽  
1993 ◽  
Vol 92 (5) ◽  
pp. 670-679 ◽  
Author(s):  
Steven R. Poole ◽  
Barton D. Schmitt ◽  
Thea Carruth ◽  
Ann Peterson-Smith ◽  
Minnie Slusarski
Keyword(s):  
Home Care ◽  
Patient Care ◽  
Large Scale ◽  
Time Of Day ◽  
Physician Satisfaction ◽  
Telephone Triage ◽  
Total Cost ◽  
Phone Calls ◽  
After Hours ◽  
Telephone Calls

Background. After-hours telephone calls are a stressful and frustrating aspect of pediatric practice. At the request of private practice pediatricians in Denver, a metropolitan area-wide system was created to manage after-hours pediatric telephone calls and after-hours patient care. This system, the After-Hours Program (AHP), uses specially trained pediatric nurses with standardized protocols to provide after-hours telephone triage and advice for the patients of 92 Denver pediatricians, representing 56 practices. Objectives. This report describes the AHP, presents data from 4 years' experience with the program, and describes results of our evaluation of the following aspects of the program: subscribing physician satisfaction, parent satisfaction, the accuracy and appropriateness of telephone triage, and program costs. Methods. After-Hours Program records (including quality assurance data) for all 4 years of operation were retrospectively reviewed, tabulated, and analyzed. The results of two subscribing physician surveys and one parent caller satisfaction survey are presented. A retrospective review of after-hours patient care encounter forms assessed the necessity for after-hours visits triaged by the AHP. An analysis of the total cost of this program to 10 randomly selected subscribing physicians was conducted using current AHP data and a survey of the 10 physicians. Results. In 4 years, 107 938 calls have been successfully managed without an adverse clinical outcome. Minor errors in using protocols occurred in one call out of 1450 after-hours calls. After-hours phone calls necessitated an after-hours patient visit 20% of the time and generated one after-hours hospital admission out of every 88 calls. Just over half of the patients were managed with home care advice only, and 28% were given home care advice after-hours and seen the next day in the primary physician's office. Of all patients directed by the telephone triage nurses to be seen after hours, 78% were determined to have a condition necessitating after-hours care. Data are presented regarding call volumes by time of day, day of week, patient age, and patient's initial complaint. The 6 most common complaints accounted for more than one half of the calls, and 38 complaints accounted for more than 95% of all after-hours calls. Utilization by subscribing physicians is described. Satisfaction among subscribing pediatricians was 100%, and among parents was 96% to 99% on a variety of issues. The total cost to participating Denver pediatricians (which includes revenues "given up" as a result of not seeing patients after hours) ranged from 1% to 12% of their annual net income, depending on a variety of factors. Conclusions. Large-scale after-hours telephone coverage systems can be effective and well-received by patients, parents, and primary physicians. Data presented in this report can assist in planning the training of personnel who provide after-hours telephone advice and triage. Controversies associated with this type of program are discussed. Suggestions are made regarding the direction of future programs and research.

Abstract 125: Natural Language Processing Identifies an Association Between Canadian Cardiovascular Society Angina Severity and Mortality Within the Department of Veterans Affairs

2017 ◽  
Vol 10 (suppl_3) ◽  
Author(s):  
Mina Owlia ◽  
John A Dodson ◽  
Scott L DuVall ◽  
Joanne LaFleur ◽  
Olga Patterson ◽  
...  
Keyword(s):  
Natural Language Processing ◽  
Natural Language ◽  
Language Processing ◽  
Stable Angina ◽  
Class I ◽  
Free Text ◽  
Health Administration ◽  
Canadian Cardiovascular Society ◽  
All Cause Mortality ◽  
One Year

Background: Stable angina is estimated to affect more than 10 million Americans and is the presenting symptom in half of patients diagnosed with coronary disease. Documentation of angina severity resides as unstructured data and is often unavailable in large datasets. We used natural language processing (NLP) to identify Canadian Cardiovascular Society (CCS) angina class and determine the association with all-cause mortality in an integrated health system’s electronic records (EHR). Methods: We performed a historic cohort study using national Veterans Health Administration data between 1/1/06 and 12/31/13. Veterans with incident stable angina were identified by ICD-9-CM codes. We developed an NLP tool to extract CCS class from free text notes. Risk ratios (RR) for all-cause mortality at one year associated with CCS class were calculated using Poisson regression. Results: There were 299,577 Veterans with angina, of which 14,216 had at least one CCS class extracted via NLP. Mean age was 66.6 years, 98% were male sex, and 82% were white. Diabetes increased with CCS class, but other comorbidities were stable (Table). There were 719 deaths at one year follow-up. The adjusted RR for all-cause mortality at one-year comparing Class III to Class I and Class IV to Class I was 1.40 (95% CI 1.16 - 1.68) and 1.52 (95% CI 1.13 - 2.04), respectively. Conclusion: NLP-derived CCS class was independently associated with one year all-cause mortality. Its application may be limited by inadequate EHR documentation of angina severity.

scholarly journals P078: Handover education in Canadian adult and pediatric emergency medicine residencies: a national survey and needs assessment

CJEM ◽  
2016 ◽  
Vol 18 (S1) ◽  
pp. S104-S105
Author(s):  
P. Lee ◽  
I. Rigby ◽  
S.J. McPherson
Keyword(s):  
Emergency Department ◽  
Emergency Medicine ◽  
Patient Care ◽  
Pediatric Emergency ◽  
Cross Sectional Survey ◽  
Cross Sectional ◽  
Risk Period ◽  
Hand Off ◽  
Pediatric Inpatient ◽  
Didactic Lecture

Introduction: Emergency department handover is a high-risk period for patient safety. A recent study showed a decreased rate of preventable adverse events and errors after implementation of a resident hand-off bundle on pediatric inpatient wards. In a 2013 survey by the Canadian Associations of Internes and Residents, only 11% of residents in any discipline stated they received a formal teaching session on handover. Recently, the CanMEDS 2015 Physician Competency Framework has added safe and skillful transfer of patient care as a new proficiency within the collaborator role. We hypothesize that significant variation exists in the current delivery and evaluation of handover education in Canadian EM residencies. Methods: We conducted a descriptive, cross-sectional survey of Canadian residents enrolled in the three main training streams of Emergency Medicine (FRCP CCFP-EM, PEM). The primary outcome was to determine which educational modalities are used to teach and assess handover proficiency. Secondarily, we described current sign-over practices and perceived competency at patient handover. Results: 130 residents completed the survey (73% FRCP, 19% CCFP-EM, 8% PEM). 6% of residents were aware of handover proficiency objectives within their curriculum, while 15% acknowledged formal evaluation in this area. 98% of respondents were taught handover by observation of staff or residents on shift, while 55% had direct teaching on the job. Less than 10% of respondents received formal sessions in didactic lecture, small group or simulation formats. Evaluation of handover skills occurred primarily by on shift observation (100% of respondents), while 3% of residents had received assessment through simulation. Local centre handover practices were variable; less than half of residents used mnemonic tools, written or electronic adjuncts. Conclusion: Canadian EM residents receive variable and sparse formal training and assessment on emergency department handover. The majority of training occurs by on shift observation and few trainees receive instruction on objective tools or explicit patient care standards. There exists potential for further development of standardized objectives, utilization of other educational modalities and formal assessments to better prepare residents to conduct safer patient handoffs.

Use of self-reporting outcomes to inform patient care.

2014 ◽  
Vol 32 (30_suppl) ◽  
pp. 176-176
Author(s):  
Brandon Bosch ◽  
Diane Denny ◽  
Maurie Markman
Keyword(s):  
Patient Care ◽  
Real Time ◽  
Treatment Plan ◽  
Symptom Burden ◽  
Assessment Instrument ◽  
Free Text ◽  
Data Set ◽  
Symptom Inventory ◽  
Starting Point ◽  
E Mail

176 Background: Cancer Treatment Centers of America, Inc (CTCA) is a national network of hospitals that specialize in the treatment of patients fighting complex or advanced-stage cancer. The Symptom Inventory Tool (SIT) is an assessment tool that captures the patients’ perceived symptom burden for real-time clinical intervention, from the point of no intervention (baseline) and every 21 days or greater. The SIT is comprised of 27 questions utilizing the MD Anderson Symptom Inventory tool, a validated assessment instrument with eight questions added and a free text box by CTCA. The SIT became an integral part of patient care at CTCA beginning in 2012. Methods: Non-clinical stakeholders administer the SIT via an electronic tablet. Upon completion of the assessment, a trending graph known as Symptoms-at-a-Glance (SAG) report is auto populated and available to clinicians in the EHR or may be printed at the point of care. The SAG provides run graphs for each symptom including arrows identifying clinically relevant changes in score. An accompanying e-mail notification system was created for physicians to review specific symptoms of interest at a threshold of their choosing, and refer patients to other specialties deemed integral for the patient’s treatment plan. Results: The SIT assessment is utilized by the nurse as a starting point from which they can initiate a more pointed conversation with the patient including the need for appropriate intervention including follow-up with the oncologist and/or referral to a member of the extended integrative care team. The percentage of new and returning patients completing an assessment is at 94.94% and 84.81%, respectively, for patients (1/1/14-6/9/14) across CTCA suggesting this process is useful for both patient and clinicians. Patients comment that the time for self-reflection is a healthy exercise enabled by the user-friendly tablet. Clinicians value both the ease of administration/use as well as the ability to create a large data set for quality improvement. Conclusions: With a majority of new and returning patients participating in the SIT, the SAG report fully implemented into the EHR along with the use of an e-mail functionality, clinicians and physicians can now better manage symptom burden real time

scholarly journals Privately practising nurse practitioners' provision of care subsidised through the Medicare Benefits Schedule and the Pharmaceutical Benefits Scheme in Australia: results from a national survey

2019 ◽  
Vol 43 (1) ◽  
pp. 55 ◽  
Author(s):  
Jane Currie ◽  
Mary Chiarella ◽  
Thomas Buckley
Keyword(s):  
Patient Care ◽  
Nurse Practitioners ◽  
Health Care Services ◽  
Care Delivery ◽  
Free Text ◽  
Fee For Service ◽  
Text Data ◽  
Legislative Changes ◽  
Provision Of Care ◽  
Pharmaceutical Benefits Scheme

Objective Since legislative changes in 2010, certain health care services provided by privately practising nurse practitioners (PPNPs) in Australia have been eligible for reimbursement under the Medicare Benefits Schedule (MBS) and the Pharmaceutical Benefits Scheme (PBS). The aim of the present study was to describe survey results relating to the care provided by PPNPs subsidised through the MBS and PBS. Methods PPNPs in Australia were invited to complete an electronic survey exploring their practice activities. Quantitative data were analysed using descriptive statistics and 95% confidence intervals were calculated for percentages where relevant. Free text data were analysed using thematic analysis. Results Seventy-three PPNPs completed the survey. The most common form of payment reported (34%; n=25) was payment by direct fee for service (MBS rebate only, also known as bulk billing). Seventy-five per cent of participants (n=55) identified that there were aspects of care delivery not adequately described and compensated by the current nurse practitioner (NP) MBS item numbers. 87.7% (n=64) reported having a PBS prescriber authorisation number. Themes identified within the free text data that related to the constraints of the MBS and PBS included ‘duplication of services’ and ‘level of reimbursement’. Conclusion The findings of the present study suggest that PPNPs are providing subsidised care through the MBS and PBS. The PPNPs in the present study reported challenges with the current structure and breadth of the NP MBS and PBS items, which restrict them from providing complete episodes of patient care. What is known about the topic? Since the introduction of legislative changes in 2010, services provided by PPNPs in Australia have been eligible for subsidisation through the MBS and PBS. What does this paper add? This paper provides data on PPNPs’ provision of care subsidised through the MBS and PBS. What are the implications for practitioners? Eligibility to provide care subsidised through the MBS and PBS has enabled the establishment of PPNP services. The current breadth and structure of the NP MBS and PBS item numbers have restricted the capacity of PPNPs to provide complete episodes of patient care.

scholarly journals Novel combined patient instruction and discharge summary tool improves timeliness of documentation and outpatient provider satisfaction

2017 ◽  
Vol 5 ◽  
pp. 205031211770105 ◽  
Author(s):  
Meredith Gilliam ◽  
Sarah L Krein ◽  
Karen Belanger ◽  
Karen E Fowler ◽  
Derek E Dimcheff ◽  
...  
Keyword(s):  
Discharge Summary ◽  
Provider Satisfaction ◽  
Patient Instruction ◽  
Outpatient Provider

scholarly journals Multidisciplinary Cancer Care: Development of an Infectious Diseases Physician Assistant Workforce at a Comprehensive Cancer Center

2010 ◽  
Vol 6 (6) ◽  
pp. e31-e34 ◽  
Author(s):  
Candice N. White ◽  
Roy A. Borchardt ◽  
Mary L. Mabry ◽  
Kathleen M. Smith ◽  
Victor E. Mulanovich ◽  
...  
Keyword(s):  
Infectious Diseases ◽  
Patient Care ◽  
Cancer Care ◽  
Physician Assistant ◽  
Physician Assistants ◽  
Physician Satisfaction ◽  
Comprehensive Cancer Center ◽  
Cancer Center ◽  
Care Services ◽  
Care Development

The authors outline the process through which the infectious diseases department at The M. D. Anderson Cancer Center successfully integrated physician assistants into patient care services, as judged by an overall increase in departmental productivity, broadened patient care coverage, and physician satisfaction with midlevel services.

Assessing the true nature of unplanned cancer care.

2014 ◽  
Vol 32 (30_suppl) ◽  
pp. 183-183
Author(s):  
Suzanne Tamang ◽  
Manali I. Patel ◽  
Sam Finlayson ◽  
Xuemei Chen ◽  
Julie Lawrence Kuznetsov ◽  
...  
Keyword(s):  
Text Mining ◽  
Cancer Patients ◽  
Cancer Care ◽  
Clinical Effectiveness ◽  
Free Text ◽  
Breast Cancer Patients ◽  
True Nature ◽  
Clinical Text ◽  
Additional Information ◽  
One Year

183 Background: Unplanned care can result in poor outcomes that are potentially preventable. The design of effective interventions to improve outcomes for cancer patients requires a better understanding of the true nature of unplanned care. Although cancer care teams document each patient’s care trajectory in detailed free-text notes, care outcomes are typically measured from structured patient record data and do not contain key information necessary for quality improvement efforts, such as the etiology of emergent events, or events that occur at outside facilities. To inform clinical effectiveness work at Stanford’s Cancer Institute, we describe our application of text-mining to improve the assessment of post-diagnosis morbidity outcomes. Methods: We conducted a retrospective study of unplanned care among 3,318 patients with a new diagnosis of breast, gastrointestinal, or thoracic cancer during 2010-13. Using a validated framework for clinical text-mining, we analyzed 308,000 notes for two tasks. First, we extract information on external unplanned events that are documented by providers. Second, we profile symptom mentions in Emergency Department (ED) notes. Results: For all cancer patients, text-mining detected over 400 unplanned events (93% PPV) at outside facilities, resulting in patient rates of 5% in the first 30 days, and 11% up to one year post-diagnosis. Among breast cancer patients, the top three symptoms reported in ED notes are pain (89%), nausea (37%) and fever (18%). Pain is consistently the most prevalent symptom up to one year after diagnosis, other symptoms exhibit more dynamic trends; wound related disorders and nausea are more prevalent among ED admissions in the first three months, whereas fever, cognitive impairment and mental health issues become more prevalent among admissions after the first three months of cancer care. Conclusions: The application of text-mining methods can improve the quantification of morbidity outcomes by improving the estimation of unplanned care rates and by providing continued learning for symptom-driven interventions to mitigate preventable emergent care. Although additional information gaps in care trajectories may continue to exist, text-mining can aid in assessing the true nature of unplanned care.

Documenting presence: A descriptive study of chaplain notes in the intensive care unit

2016 ◽  
Vol 15 (2) ◽  
pp. 190-196 ◽  
Author(s):  
Brittany M. Lee ◽  
Farr A. Curlin ◽  
Philip J. Choi
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Patient Care ◽  
Medical Record ◽  
Medical Center ◽  
Academic Medical Center ◽  
Retrospective Chart Review ◽  
Relevant Information ◽  
Patient Care Team ◽  
Free Text

AbstractObjective:To clarify and record their role in the care of patients, hospital chaplains are increasingly called on to document their work in the medical record. Chaplains' documentation, however, varies widely, even within single institutions. Little has been known, however, about the forms that documentation takes in different settings or about how clinicians interpret chaplain documentation. This study aims to examine how chaplains record their encounters in an intensive care unit (ICU).Method:We performed a retrospective chart review of the chaplain notes filed on patients in the adult ICUs at a major academic medical center over a six-month period. We used an iterative process of qualitative textual analysis to code and analyze chaplains' free-text entries for emergent themes.Results:Four primary themes emerged from chaplain documentation. First, chaplains frequently used “code language,” such as “compassionate presence,” to recapitulate interventions already documented elsewhere in a checklist of ministry interventions. Second, chaplains typically described what they observed rather than interpreting its clinical significance. Third, chaplains indicated passive follow-up plans, waiting for patients or family members to request further interaction. Fourth, chaplains sometimes provided insights into particular relationship dynamics.Significance of results:As members of the patient care team, chaplains access the medical record to communicate clinically relevant information. The present study suggests that recent emphasis on evidence-based practice may be leading chaplains, at least in the medical center we studied, to use a reduced, mechanical language insufficient for illuminating patients' individual stories. We hope that our study will promote further consideration of how chaplain documentation can enhance patient care and convey the unique value that chaplains add to the clinical team.

scholarly journals Responding to disruptive behaviors in nursing: One-year follow-up of quasi-experimental research measuring links to turnover, intent to leave, and patient care quality

2020 ◽  
Vol 10 (7) ◽  
pp. 9
Author(s):  
Ericka Sanner-Stiehr
Keyword(s):  
Patient Care ◽  
Self Efficacy ◽  
Intent To Leave ◽  
Positive Impact ◽  
Disruptive Behaviors ◽  
Care Quality ◽  
Second Phase ◽  
Longitudinal Impact ◽  
Quasi Experimental ◽  
One Year

Background and objectives: Disruptive behaviors among nurses are a prevalent problem in health care, contributing to nursing staff turnover and compromising patient care. Newly licensed nurses may be unprepared to respond to disruptive behaviors effectively, negatively impacting them, patients, and organizations. Cognitive rehearsal can increase self-efficacy to respond effectively to disruptive behaviors. The purpose of this study was to determine the longitudinal impact of a cognitive rehearsal intervention delivered to nursing students during the final semester of their pre-licensure program on self-efficacy to respond to disruptive behaviors, turnover and intent to stay in a job, frequency of disruptive behaviors, and perceived impact on patient care.Methods: Design: This study was the second phase in a quasi-experimental, longitudinal project. Participants and Setting: In Phase 1, 129 participants were recruited from three pre-licensure nursing programs in the Midwestern United States. All participants received the intervention. In Phase 2, one year after graduating, 95 remained enrolled. Methods: An electronic survey was used to collect data. Paired t-tests were used to detect changes in self-efficacy; bi-variate correlations were utilized to determine relationships between outcome variables.Results: Multiple measures of self-efficacy to respond remained statistically significantly increased one year after graduating (p < .05). Experiencing (r = .489; p < .000) and witnessing (r = .432; p < .000) disruptive behaviors was significantly linked to patient care.Conclusions: Cognitive rehearsal had a sustained, positive impact on self-efficacy to respond to disruptive behaviors and should be included in pre-licensure curricula.

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