Communication Outcomes in Audiologic Reporting

2011 ◽  
Vol 22 (04) ◽  
pp. 231-241 ◽  
Author(s):  
Virginia Ramachandran ◽  
James D. Lewis ◽  
Mahsa Mosstaghimi-Tehrani ◽  
Brad A. Stach ◽  
Kathleen L. Yaremchuk
Keyword(s):  
Health Care ◽  
Doctoral Students ◽  
Health Care Providers ◽  
Nurse Practitioners ◽  
Doctoral Student ◽  
Physician Assistants ◽  
Educational Background ◽  
Care Providers ◽  
Provider Type ◽  
Improvement Program

Background: Audiologists often work collaboratively with other health professionals—particularly otolaryngology providers. Some form of written reporting of audiologic outcomes is typically the vehicle by which communication among providers occurs. Quality patient care is dependent on both accurate interpretation of outcomes and effectiveness of communication between providers. Audiologic reporting protocols tend to vary among clinics and providers, with most methods being based on preference rather than standardized definitions. Purpose: As part of an ongoing quality-improvement program, audiologic communication was reviewed by comparing written audiometric reports to descriptions of the audiometric results dictated by otolaryngology providers to evaluate the agreement of communication between provider groups. Research Design: Retrospective chart review. Study Sample: The study sample consisted of 6000 randomly selected charts from a total of 15,625 for the years 2004 and 2008 in the electronic medical record system of a large academic health-care system. Data Collection and Analysis: Audiogram reports and associated otolaryngology reports were reviewed by an audiologist and two audiology doctoral students. Communication occurred among 37 audiology providers and 39 otolaryngology providers. Data collected included rating of congruence or incongruence between reports, normal versus abnormal audiologic outcomes, and the nature of communication disparities. Data also included provider type (audiologist, audiology doctoral student, or trainee in clinical fellowship year [CFY]; otolaryngologist, otolaryngology resident, physician assistant, or nurse practitioner). Results: Incongruent results were higher among the sample of audiologic evaluations with abnormal outcomes (29.2%) compared with normal outcomes (9.5%). Of those cases rated as incongruent, differences in reporting audiometric results stemmed largely from variance in reporting of numerical values from the audiogram (20%), apparent dictation errors (10.1%), and communication of the ear tested (8.6%). Of those cases in which the interpretations of audiology providers differed from those of otolaryngology providers, incongruent results occurred in the interpretation of degree (29.4%), tympanometric results (28.2%), type of hearing loss (12.8%), acoustic reflex results (4.0%), symmetry (3.3%), and other domains (4.2%). Rates of incongruent results were similar regardless of experience level of the audiology provider (audiologist or audiology doctoral student/CFY) but differed depending on the educational background and experience of the otolaryngology provider. The highest incongruent interpretations were found among residents (32.5%), followed by otolaryngologists (25.2%) and physician assistants and nurse practitioners (21%). Conclusions: This study highlights the need for audiologists to critically evaluate the effectiveness of their communication with other health-care providers and demonstrates the need for evidence-based approaches for interpreting audiologic information and reporting audiologic information to others.

scholarly journals Endoscopy by Nonphysicians

2007 ◽  
Vol 21 (1) ◽  
pp. 17-18 ◽  
Author(s):  
Elaine R Gossman
Keyword(s):  
Health Care ◽  
Health Care Providers ◽  
Nurse Practitioners ◽  
Physician Assistants ◽  
The United States ◽  
Current Status ◽  
Care Providers ◽  
Kaiser Permanente ◽  
Efficient System ◽  
Effective Manner

In 1945, Henry J Kaiser organized a group of physicians to provide health care for shipyard workers and their families. His foundation, Kaiser Permanente (USA), has developed into a prepaid health plan facility serving 8.4 million members in nine states and in Washington, DC, within the United States. It aspires to provide high quality, affordable, integrated health care within an organized, efficient system. A focus on preventive care in a cost-effective manner is a high priority. The Kaiser Permanente northwest region (covering northwest Oregon and southwest Washington) serves nearly one-half of a million members. Our region has utilized nurse practitioners (NPs) and physician assistants (PAs) (allied health care providers) in a variety of capacities for many years. The present paper reviews the background and current status of their role in endoscopy.

scholarly journals Is It “True” Pain? Pain Treatment Discharge Planning for Seriously Injured Patients

2021 ◽  
Vol 31 (1) ◽  
pp. 139-148
Author(s):  
Shoshana V. Aronowitz ◽  
Therese S. Richmond ◽  
Peggy Compton ◽  
Sara F. Jacoby
Keyword(s):  
Health Care ◽  
Health Care Providers ◽  
Nurse Practitioners ◽  
Trauma Care ◽  
Pain Treatment ◽  
Physician Assistants ◽  
The United States ◽  
Opioid Overdose ◽  
Care Providers ◽  
Injured Patients

Background: The United States is experi­encing an opioid overdose crisis accounting for as many as 130 deaths per day. As a result, health care providers are increas­ingly aware that prescribed opioids can be misused and diverted. Prescription of pain medication, including opioids, can be in­fluenced by how health care providers per­ceive the trustworthiness of their patients. These perceptions hinge on a multiplicity of characteristics that can include a patient’s race, ethnicity, gender, age, and present­ing health condition or injury. The purpose of this study was to identify how trauma care providers evaluate and plan hospital discharge pain treatment for patients who survive serious injuries.Methods: Using a semi-structured guide from November 2018 to January 2019, we interviewed 12 providers (physicians, nurse practitioners, physician assistants) who pre­scribe discharge pain treatment for injured patients at a trauma center in Philadelphia, PA. We used thematic analysis to interpret these data.Results: Participants identified the impor­tance of determining “true” pain, which was the overarching theme that emerged in analysis. Subthemes included perceptions of the influence of reliable methods for pain assessment, the trustworthiness of their patient population, and the consequences of not getting it right.Conclusions: Trauma care providers de­scribed a range of factors, beyond patient-elicited pain reports, in order to interpret their patients’ analgesic needs. These included consideration of both the risks of under treatment and unnecessary suffering, and overtreatment and contribution to opi­oid overdoses.Ethn Dis. 2021;31(1):139- 148; doi:10.18865/ed.31.1.139

Nurse Practitioner Challenges to the Orthodox Structure of Health Care Delivery: Regulation and Restraints on Trade

1985 ◽  
Vol 11 (2) ◽  
pp. 195-225
Author(s):  
Karla Kelly
Keyword(s):  
Health Care ◽  
Health Care Providers ◽  
Health Care Delivery ◽  
Nurse Practitioners ◽  
Nurse Practitioner ◽  
Allied Health ◽  
Care Delivery ◽  
The United States ◽  
Care Providers ◽  
Allied Health Care

AbstractUntil recently, physicians have been the primary health care providers in the United States. In response to the rising health care costs and public demand of the past decade, allied health care providers have challenged this orthodox structure of health care delivery. Among these allied health care providers are nurse practitioners, who have attempted to expand traditional roles of the registered nurse.This article focuses on the legal issues raised by several major obstacles to the expansion of nurse practitioner services: licensing restrictions, third party reimbursement policies, and denial of access to medical facilities and physician back-up services. The successful judicial challenges to discriminatory practices against other allied health care providers will be explored as a solution to the nurse practitioners’ dilemma.

scholarly journals Is Video Laryngoscopy the Optimal Tool for Successful Intubation in a Neonatal Simulation Setting? A Single-Center Experience

2020 ◽  
Vol 10 (01) ◽  
pp. e5-e10 ◽  
Author(s):  
Iram Musharaf ◽  
Sibasis Daspal ◽  
John Shatzer
Keyword(s):  
Health Care ◽  
Success Rate ◽  
Health Care Providers ◽  
Nurse Practitioners ◽  
Clinical Training ◽  
Video Laryngoscopy ◽  
Care Providers ◽  
Group 3 ◽  
Group 2 ◽  
Group 1

Abstract Background Endotracheal intubation is a skill required for resuscitation. Due to various reasons, intubation opportunities are decreasing for health care providers. Objective To compare the success rate of video laryngoscopy (VL) and direct laryngoscopy (DL) for interprofessional neonatal intubation skills in a simulated setting. Methods This was a prospective nonrandomized simulation crossover trial. Twenty-six participants were divided into three groups based on their frequency of intubation. Group 1 included pediatric residents; group 2 respiratory therapists and transport nurses; and group 3 neonatal nurse practitioners and physicians working in neonatology. We compared intubation success rate, intubation time, and laryngoscope preference. Results Success rates were 100% for both DL and VL in groups 1 and 2, and 88.9% for DL and 100% for VL in group 3. Median intubation times for DL and VL were 22 seconds (interquartile range [IQR] 14.3–22.8 seconds) and 12.5 seconds (IQR 10.3–38.8 seconds) in group 1 (p = 0.779); 17 seconds (IQR 8–21 seconds) and 12 seconds (IQR 9–16.5 seconds) in group 2 (p = 0.476); and 11 seconds (IQR 7.5–15.5 seconds) and 15 seconds (IQR 11.5–36 seconds) in group 3 (p = 0.024). Conclusion We conclude that novice providers tend to perform better with VL, while more experienced providers perform better with DL. In this era of decreased clinical training opportunities, VL may serve as a useful tool to teach residents and other novice health care providers.

scholarly journals The impact on patient flow after the integration of nurse practitioners and physician assistants in 6 Ontario emergency departments

CJEM ◽  
2009 ◽  
Vol 11 (05) ◽  
pp. 455-461 ◽  
Author(s):  
James Ducharme ◽  
Robert J. Alder ◽  
Cindy Pelletier ◽  
Don Murray ◽  
Joshua Tepper
Keyword(s):  
Health Care ◽  
Nurse Practitioners ◽  
Emergency Departments ◽  
Patient Flow ◽  
Physician Assistants ◽  
Wait Times ◽  
Care Providers ◽  
Lengths Of Stay ◽  
Left Without Being Seen ◽  
The Impact

ABSTRACT Objective: We sought to assess the impact of the integration of the new roles of primary health care nurse practitioners (NPs) and physician assistants (PAs) on patient flow, wait times and proportions of patients who left without being seen in 6 Ontario emergency departments (EDs). Methods: We performed a retrospective review of health records data on patient arrival time, time of initial assessment by a physician, time of discharge from the ED and discharge status. Results: Whether a PA or NP was directly involved in the care of patients or indirectly involved by being on duty, the wait times, lengths of stay and proportion of patients who left without being seen were significantly reduced. When a PA or NP were directly involved in patients' care, patients were 1.6 (95% confidence interval [CI] 1.3–2.1, p < 0.05) and 2.1 (95% CI 1.6–2.8, p < 0.05) times more likely to be seen within the wait time benchmarks, respectively. Lengths of stay were 30.3% (95% CI 21.6%–39.0%, p < 0.01) and 48.8% (95% CI 35.0%–62.7%, p < 0.01) lower when PAs and NPs, respectively, were involved. When PAs and NPs were not on duty, the proportion of patients who left without being seen were 44% (95% CI 31%–63%, p < 0.01) and 71% (95% CI 53%–96%, p < 0.05), respectively. Conclusion: The addition of PAs or NPs to the ED team can improve patient flow in medium-sized community hospital EDs. Given the ongoing shortage of physicians, use of alternative health care providers should be considered. These results require validation, as their generalizability to other locations or types of EDs is not known.

scholarly journals Health Care Providers’ Performance, Mindset, and Attitudes Toward a Neonatal Resuscitation Computer-Based Simulator: Empirical Study

10.2196/21855 ◽  
2020 ◽  
Vol 8 (4) ◽  
pp. e21855
Author(s):  
Maria Cutumisu ◽  
Simran K Ghoman ◽  
Chang Lu ◽  
Siddhi D Patel ◽  
Catalina Garcia-Hidalgo ◽  
...  
Keyword(s):  
Health Care ◽  
Health Care Providers ◽  
Nurse Practitioners ◽  
Neonatal Resuscitation ◽  
Growth Mindset ◽  
Care Providers ◽  
Actual Performance ◽  
Action Sequence ◽  
Resuscitation Training ◽  
Computer Based

Background Neonatal resuscitation involves a complex sequence of actions to establish an infant’s cardiorespiratory function at birth. Many of these responses, which identify the best action sequence in each situation, are taught as part of the recurrent Neonatal Resuscitation Program training, but they have a low incidence in practice, which leaves health care providers (HCPs) less prepared to respond appropriately and efficiently when they do occur. Computer-based simulators are increasingly used to complement traditional training in medical education, especially in the COVID-19 pandemic era of mass transition to digital education. However, it is not known how learners’ attitudes toward computer-based learning and assessment environments influence their performance. Objective This study explores the relation between HCPs’ attitudes toward a computer-based simulator and their performance in the computer-based simulator, RETAIN (REsuscitation TrAINing), to uncover the predictors of performance in computer-based simulation environments for neonatal resuscitation. Methods Participants were 50 neonatal HCPs (45 females, 4 males, 1 not reported; 16 respiratory therapists, 33 registered nurses and nurse practitioners, and 1 physician) affiliated with a large university hospital. Participants completed a demographic presurvey before playing the game and an attitudinal postsurvey after completing the RETAIN game. Participants’ survey responses were collected to measure attitudes toward the computer-based simulator, among other factors. Knowledge on neonatal resuscitation was assessed in each round of the game through increasingly difficult neonatal resuscitation scenarios. This study investigated the moderating role of mindset on the association between the perceived benefits of understanding the terminology used in the computer-based simulator, RETAIN, and their performance on the neonatal resuscitation tasks covered by RETAIN. Results The results revealed that mindset moderated the relation between participants’ perceived terminology used in RETAIN and their actual performance in the game (F3,44=4.56, R2=0.24, adjusted R2=0.19; P=.007; estimate=–1.19, SE=0.38, t44=–3.12, 95% CI –1.96 to –0.42; P=.003). Specifically, participants who perceived the terminology useful also performed better but only when endorsing more of a growth mindset; they also performed worse when endorsing more of a fixed mindset. Most participants reported that they enjoyed playing the game. The more the HCPs agreed that the terminology in the tutorial and in the game was accessible, the better they performed in the game, but only when they reported endorsing a growth mindset exceeding the average mindset of all the participants (F3,44=6.31, R2=0.30, adjusted R2=0.25; P=.001; estimate=–1.21, SE=0.38, t44=−3.16, 95% CI –1.99 to –0.44; P=.003). Conclusions Mindset moderates the strength of the relationship between HCPs’ perception of the role that the terminology employed in a game simulator has on their performance and their actual performance in a computer-based simulator designed for neonatal resuscitation training. Implications of this research include the design and development of interactive learning environments that can support HCPs in performing better on neonatal resuscitation tasks.

Trauma-Informed Care With Childhood Maltreatment Survivors: What Do Maternity Professionals Want to Learn?

2014 ◽  
Vol 4 (3) ◽  
pp. 191-201 ◽  
Author(s):  
Kristen Choi ◽  
Julia S. Seng
Keyword(s):  
Health Care ◽  
Health Care Providers ◽  
Nurse Practitioners ◽  
Health Care Professionals ◽  
Childhood Maltreatment ◽  
Perinatal Care ◽  
Care Providers ◽  
History Of ◽  
Maternity Health ◽  
Maternity Health Care

BACKGROUND: Posttraumatic stress disorder (PTSD) affects 8% of pregnant women, and the biggest risk factor for pregnancy PTSD is childhood maltreatment. The care they receive can lead to positive outcomes or to retraumatization and increased morbidity. The purpose of this study is to gather information from a range of clinicians about their continuing education needs to provide perinatal care to women with a maltreatment history and PTSD.METHOD: Maternity health care professionals were interviewed by telephone. Network sampling and purposive sampling were used to include physicians, nurse practitioners, midwives, nurses, and doulas (n = 20), and results were derived from content analysis.RESULTS: Most providers received little or no training on the issue of caring for women with a history of childhood maltreatment or PTSD during their original education but find working with this type of patient rewarding and wish to learn how to provide better care. Providers identified a range of educational needs and recommend offering a range of formats and time options for learning.CONCLUSIONS: Maternity health care providers desire to work effectively with survivor moms and want to learn best practices for doing so. Thus, educational programming addressing provider needs and preferences should be developed and tested to improve care experiences and pregnancy outcomes for women with a history of trauma or PTSD.

Development of an Instrument to Measure Community Acceptance of Nurse Practictioners and Physician Assistants

1999 ◽  
Vol 7 (1) ◽  
pp. 63-77 ◽  
Author(s):  
Lynn C. Baer ◽  
Kathleen A. Baldwin ◽  
Rebecca J. Sisk ◽  
Parris Watts ◽  
Margaret S. Grinslade ◽  
...  
Keyword(s):  
Factor Analysis ◽  
Rural Communities ◽  
Health Care Providers ◽  
Nurse Practitioners ◽  
Methodological Approach ◽  
Physician Assistants ◽  
Care Providers ◽  
Oblique Rotation ◽  
Survey Tool ◽  
Community Acceptance

The purpose of this study was to identify the significant dimensions of the concept of community acceptance of nurse practitioners/physician’s assistants and to construct areliable and valid instrument which would reflect these dimensions. The methodological approach included: conceptualization of categories, development of items for each category, development of the tool, administration of the tool, and psychometric analysis of results. Community input through focus-group interviews and post-administration questions provided qualitative data. The survey tool, consisting of items in four conceptualized categories (knowledge, access, competence, and trust), was administered in five rural communities. The responses of 967 residents were analyzed through factor analysis. The criterion, eigenvalue > 1.0, resulted in seven factors. Oblique rotation was applied to the seven factors and marker variables (loadings > .70) facilitated the identification of the underlying dimensions of each factor. Overall, 98% of the items assigned to the original categories were maintained after factor analysis. The identification of these dimensions helped to simplify the description and understanding of community acceptance of nurse practitioners and physicians’ assistants. Community acceptance of these advanced health care providers is a necessary precursor to use of services.

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