scholarly journals Reducing Violations to the 80-hour Work Rule with Electronic Health Record to Establish Rapid Culture Change, Does It Work?

2021 ◽  
Vol 73 ◽  
Author(s):  
Enoch Yeung ◽  
Daniel Golden ◽  
Jean Miner ◽  
Silviu Marica ◽  
Burt Cagir
Keyword(s):  
Learning Environment ◽  
Electronic Health Record ◽  
Residency Program ◽  
Work Hours ◽  
Health Record ◽  
Pass Rates ◽  
Improvement Project ◽  
Management Software ◽  
Work Hour ◽  
Electronic Health

Objectives: In our free-standing general surgery residency program, it was noted over the past decade that we had an exorbitant number of resident work hours violations. This resulted in multiple citations from the Accreditation Council for Graduate Medical Education (ACGME) with subsequent probation. To restore accreditation requirements and provide trainees with a balanced learning environment, work hours were restructured. Reporting of work hours in the residency management software was authenticated by the organizational Electronic Health Record (EHR). This quality improvement project evaluated the effectiveness of compliance to the 80-hour work rules in a single rural surgical training residency program with the aid of EHR. Methods: The hours are actively monitored in the residency management software, New-Innovations (NI) and cumulative weekly reports were created. With the design, residents were scheduled to work a maximum of 13 hours per day beginning at 0600 and operating room (OR) time concluding by 1700. During each 4-week rotation, residents were assigned one Friday call, one Saturday call and four hours of transitional call. The primary outcome of this project was the number of resident violations to the 80 hours rule before and after implementation of those measures. The secondary outcomes were the residents’ comparative academic and clinical performances. This project also evaluated the overall cultural change and satisfaction with the program using ACGME survey data. Results: Compared with the non EHR era (2013-2015), the number of violations during the EHR era decreased significantly. (Mean non EHR= 167.3, EHR = 24.6) (p =0.0009) Case volumes and board pass rates were a central focus throughout the changes. No decrease in operative volume was noted for graduating residents (N = 8, non EHR= 1,062, Mean EHR = 1,110) (p = 0.5). Over the three years since the changes, the board pass rates have improved from 64% to 80% in Certifying Examination (CE) (N = 8, Passing % non EHR = 64%, EHR = 80%) (p = 0.03) Qualifying Examination (QE) (N = 8, Passing % non EHR = 100%, EHR = 93%) (p =0.1). Conclusion: Reduction in work hour violations can be achieved with a reliable schedule, promotion of accurate reporting by residents, and monitoring through EHR reports. Adherence to work hour guidelines is essential for resident well-being and a healthy and conducive clinical learning environment without diminishing operative experience.

scholarly journals Development of a Cancer Care Summary Through the Electronic Health Record

2016 ◽  
Vol 12 (2) ◽  
pp. e231-e240 ◽  
Author(s):  
Laurie L. Carr ◽  
Pearlanne Zelarney ◽  
Sarah Meadows ◽  
Jeffrey A. Kern ◽  
M. Bronwyn Long ◽  
...  
Keyword(s):  
Electronic Health Record ◽  
Cancer Care ◽  
Query Language ◽  
Primary Care Providers ◽  
Urgent Care ◽  
Health Record ◽  
Patient Portal ◽  
Care Providers ◽  
Improvement Project ◽  
Electronic Health

Introduction: Our objective was to improve communication concerning lung cancer patients by developing and distributing a Cancer Care Summary that would provide clinically useful information about the patient’s diagnosis and care to providers in diverse settings. Methods: We designed structured, electronic forms for the electronic health record (EHR), detailing tumor staging, classification, and treatment. To ensure completeness and accuracy of the information, we implemented a data quality cycle, composed of reports that are reviewed by oncology clinicians. The data from the EHR forms are extracted into a structured query language database system on a daily basis, from which the Summaries are derived. We conducted focus groups regarding the utility, format, and content of the Summary. Cancer Care Summaries are automatically generated 4 months after a patient’s date of diagnosis, then every 6 months for those receiving treatment, and on an as-needed basis for urgent care or hospital admission. Results: The product of our improvement project is the Cancer Care Summary. To date, 102 individual patient Summaries have been generated. These documents are automatically entered into the National Jewish Health (NJH) EHR, attached to correspondence to primary care providers, available to patients as electronic documents on the NJH patient portal, and faxed to emergency departments and admitting physicians on patient evaluation. Conclusion: We developed a sustainable tool to improve cancer care communication. The Cancer Care Summary integrates information from the EHR in a timely manner and distributes the information through multiple avenues.

QIM19-121: Improving Testing for Hepatitis B Before Treatment With Rituximab Through Automated Electronic Health Record Alert System: A Single Institutional Retrospective Review and Quality Improvement Project

2019 ◽  
Vol 17 (3.5) ◽  
pp. QIM19-121
Author(s):  
Sowmya Boddhula ◽  
Satish Kumar Boddhula ◽  
Bishesh Shrestha ◽  
Kelly Morris ◽  
Rosana Gnanajothy
Keyword(s):  
Hepatitis B ◽  
Electronic Health Record ◽  
Chart Review ◽  
Screening Tests ◽  
Health Record ◽  
Alert System ◽  
Improvement Project ◽  
Chronic Hepatitis B Virus ◽  
Electronic Health ◽  
Hbv Screening

Introduction: Individuals with chronic hepatitis B virus infection (HBV) or previous infection with HBV are at increased risk of HBV exacerbation or reactivation when they receive treatment with anti-CD20 monoclonal antibodies like rituximab (RTX). HBV screening and appropriate use of prophylactic antiviral therapy is recommended to prevent reactivation. A software program named Beacon Oncology was integrated into Epic, which creates an automated alert for HBV screening before starting first dose of chemotherapy with RTX and results the previously resulted HBV test results. Retrospective data analysis for screening was done after implementation of the software and its impact was assessed. Methods: We conducted retrospective chart review on screening for HBV before starting treatment with RTX before and after implementation of the electronic health record (EHR) alert system. Results: A baseline review (before software introduction) of 165 patients showed that only 40 (24%) had screening tests for HBV (hepatitis B surface antigen [HBsAg] and hepatitis B core antibody [anti-HBcAb]) before receiving rituximab. Following introduction of the automated electronic alert system, chart review for HBV testing rates among patients being initiated onto rituximab was performed. There was a marked increase in pre-rituximab testing for HBsAg from 24% to 88% and for anti-HBcAb from 24% to 76%. The remainder cases also had the HBV screening done but after the first dose of the RTX chemotherapy between 1.3 to 7.5 days. There was one patient identified as anti-HBcAb-positive after the implementation of the protocol. Conclusions: This retrospective single-institution study clearly indicates that simple strategies can markedly improve appropriate HBV screening. There was a more than 3-fold increase in HBV testing before the first dose of HBV after implementation of the EHR alert system. There has been increased use of EHR alert systems recently to improve implementation of clinical guidelines, and they have been shown to improve patient outcomes. In conclusion, an automated EHR alert directed toward screening for HBV before initiating RTX effectively increased the number of HBV screening tests completed, and similar protocols could be implemented to identify other at-risk patient groups.

scholarly journals Physician Stress During Electronic Health Record Inbox Work: In Situ Measurement With Wearable Sensors (Preprint)

2020 ◽  
Author(s):  
Fatema Akbar ◽  
Gloria Mark ◽  
Stephanie Prausnitz ◽  
E Margaret Warton ◽  
Jeffrey A East ◽  
...  
Keyword(s):  
Heart Rate ◽  
Electronic Health Record ◽  
Physiological Stress ◽  
Work Hours ◽  
Health Record ◽  
Work Patterns ◽  
Work Duration ◽  
Electronic Health ◽  
Physician Stress ◽  
Stress Patterns

BACKGROUND Increased work through electronic health record (EHR) messaging is frequently cited as a factor of physician burnout. However, studies to date have relied on anecdotal or self-reported measures, which limit the ability to match EHR use patterns with continuous stress patterns throughout the day. OBJECTIVE The aim of this study is to collect EHR use and physiologic stress data through unobtrusive means that provide objective and continuous measures, cluster distinct patterns of EHR inbox work, identify physicians’ daily physiologic stress patterns, and evaluate the association between EHR inbox work patterns and physician physiologic stress. METHODS Physicians were recruited from 5 medical centers. Participants (N=47) were given wrist-worn devices (Garmin Vivosmart 3) with heart rate sensors to wear for 7 days. The devices measured physiological stress throughout the day based on heart rate variability (HRV). Perceived stress was also measured with self-reports through experience sampling and a one-time survey. From the EHR system logs, the time attributed to different activities was quantified. By using a clustering algorithm, distinct inbox work patterns were identified and their associated stress measures were compared. The effects of EHR use on physician stress were examined using a generalized linear mixed effects model. RESULTS Physicians spent an average of 1.08 hours doing EHR inbox work out of an average total EHR time of 3.5 hours. Patient messages accounted for most of the inbox work time (mean 37%, SD 11%). A total of 3 patterns of inbox work emerged: inbox work mostly outside work hours, inbox work mostly during work hours, and inbox work extending after hours that were mostly contiguous to work hours. Across these 3 groups, physiologic stress patterns showed 3 periods in which stress increased: in the first hour of work, early in the afternoon, and in the evening. Physicians in group 1 had the longest average stress duration during work hours (80 out of 243 min of valid HRV data; <i>P</i>=.02), as measured by physiological sensors. Inbox work duration, the rate of EHR window switching (moving from one screen to another), the proportion of inbox work done outside of work hours, inbox work batching, and the day of the week were each independently associated with daily stress duration (marginal <i>R<sup>2</sup></i>=15%). Individual-level random effects were significant and explained most of the variation in stress (conditional <i>R<sup>2</sup></i>=98%). CONCLUSIONS This study is among the first to demonstrate associations between electronic inbox work and physiological stress. We identified 3 potentially modifiable factors associated with stress: EHR window switching, inbox work duration, and inbox work outside work hours. Organizations seeking to reduce physician stress may consider system-based changes to reduce EHR window switching or inbox work duration or the incorporation of inbox management time into work hours. CLINICALTRIAL

scholarly journals Automatic Detection of Front-Line Clinician Hospital Shifts: A Novel Use of Electronic Health Record Timestamp Data

2019 ◽  
Vol 10 (01) ◽  
pp. 028-037 ◽  
Author(s):  
Adam Dziorny ◽  
Evan Orenstein ◽  
Robert Lindell ◽  
Nicole Hames ◽  
Nicole Washington ◽  
...  
Keyword(s):  
Electronic Health Record ◽  
Work Hours ◽  
Self Report ◽  
Health Record ◽  
Front Line ◽  
Hours Worked ◽  
Inpatient Settings ◽  
Electronic Health ◽  
End Times ◽  
Junior Residents

Objective Excess physician work hours contribute to burnout and medical errors. Self-report of work hours is burdensome and often inaccurate. We aimed to validate a method that automatically determines provider shift duration based on electronic health record (EHR) timestamps across multiple inpatient settings within a single institution. Methods We developed an algorithm to calculate shift start and end times for inpatient providers based on EHR timestamps. We validated the algorithm based on overlap between calculated shifts and scheduled shifts. We then demonstrated a use case by calculating shifts for pediatric residents on inpatient rotations from July 1, 2015 through June 30, 2016, comparing hours worked and number of shifts by rotation and role. Results We collected 6.3 × 107 EHR timestamps for 144 residents on 771 inpatient rotations, yielding 14,678 EHR-calculated shifts. Validation on a subset of shifts demonstrated 100% shift match and 87.9 ± 0.3% overlap (mean ± standard error [SE]) with scheduled shifts. Senior residents functioning as front-line clinicians worked more hours per 4-week block (mean ± SE: 273.5 ± 1.7) than senior residents in supervisory roles (253 ± 2.3) and junior residents (241 ± 2.5). Junior residents worked more shifts per block (21 ± 0.1) than senior residents (18 ± 0.1). Conclusion Automatic calculation of inpatient provider work hours is feasible using EHR timestamps. An algorithm to assess provider work hours demonstrated criterion validity via comparison with scheduled shifts. Differences between junior and senior residents in calculated mean hours worked and number of shifts per 4-week block were also consistent with differences in scheduled shifts and duty-hour restrictions.

scholarly journals Duly noted: Lessons from a two-site intervention to assess and improve the quality of clinical documentation in the electronic health record

2016 ◽  
Vol 07 (03) ◽  
pp. 653-659 ◽  
Author(s):  
Donglin Yan ◽  
Rosemarie Conigliaro ◽  
Laura Fanucchi
Keyword(s):  
Quality Improvement ◽  
Electronic Health Record ◽  
Albert Einstein College ◽  
Quality Improvement Project ◽  
Health Record ◽  
Clinical Documentation ◽  
Improvement Project ◽  
Significant Difference ◽  
Electronic Health

SummaryCommunication errors are identified as a root cause contributing to a majority of sentinel events. The clinical note is a cornerstone of physician communication, yet there are few published interventions on teaching note writing in the electronic health record (EHR). This is a prospective, two-site, quality improvement project to assess and improve the quality of clinical documentation in the EHR using a validated assessment tool.Internal Medicine (IM) residents at the University of Kentucky College of Medicine (UK) and Montefiore Medical Center/Albert Einstein College of Medicine (MMC) received one of two interventions during an inpatient ward month: either a lecture, or a lecture and individual feedback on progress notes. A third group of residents in each program served as control. Notes were evaluated with the Physician Documentation Quality Instrument 9 (PDQI-9).Due to a significant difference in baseline PDQI-9 scores at MMC, the sites were not combined. Of 75 residents at the UK site, 22 were eligible, 20 (91%) enrolled, 76 notes in total were scored. Of 156 residents at MMC, 22 were eligible, 18 (82%) enrolled, 40 notes in total were scored. Note quality did not improve as measured by the PDQI-9.This educational quality improvement project did not improve the quality of clinical documentation as measured by the PDQI-9. This project underscores the difficulty in improving note quality. Further efforts should explore more effective educational tools to improve the quality of clinical documentation in the EHR. Citation: Fanucchi L, Yan D, Conigliaro RL. Duly noted: Lessons from a two-site intervention to assess and improve the quality of clinical documentation in the electronic health record.

Implementation of hyperlinks to medication management policies and guidelines in the electronic health record

2019 ◽  
Vol 76 (Supplement_3) ◽  
pp. S69-S73 ◽  
Author(s):  
Andrew T Dwenger ◽  
Erin R Fox ◽  
Elyse A Macdonald ◽  
Bryan J Edvalson
Keyword(s):  
Electronic Health Record ◽  
Medication Management ◽  
Implementation Process ◽  
Direct Access ◽  
Health Record ◽  
Improvement Project ◽  
University Of Utah ◽  
Medication Therapy ◽  
Management Policies ◽  
Electronic Health

Abstract Purpose The implementation and maintenance of a process for adding and removing hyperlinks to medication management policies and guidelines approved by a pharmacy and therapeutics (P&T) committee into the electronic health record (EHR) are described. Summary Medication management policies and guidelines approved by the P&T committee are published on the University of Utah Health intranet, making it possible to add hyperlinks to this information within the EHR. Adding these hyperlinks allows policy and guideline information to be available to clinicians on the medication ordering, verification, and administration screens without requiring a separate search of the intranet. In a quality-improvement project, all medication management policies and guidelines posted on the intranet were reviewed for relevance to the medication ordering, verification, and administration processes. Hyperlinks to relevant policies and guidelines were implemented into the EHR for specific medications. At the beginning of the review, 100 unique drugs associated with 1 or more hyperlinks were identified. The hyperlinks referenced a total of 33 Web documents: 8 policies and 25 guidelines. There are 74 medication management policies and 78 medication management guidelines approved by the P&T committee at University of Utah Health. After investigator review, 12 of 74 policies (16%) and 41 of 78 guidelines (53%) were deemed relevant during the medication ordering, verification, and administration processes. The review and hyperlink implementation process took a total of 101 hours. A continual review process was developed to enable addition and removal of hyperlinks as appropriate. Conclusion Providing direct access to relevant medication management policies and guidelines approved by the P&T committee during the medication ordering, verification, and administration processes via hyperlinks in the EHR makes formulary information readily accessible by appropriate staff. These hyperlinks may also improve adherence to formulary information, reduce medication expenditure, and improve safety and therapeutic outcomes of medication therapy.

scholarly journals The Impact of Electronic Health Record Implementation and Use on Performance of the Surgical Care Improvement Project Measures

2014 ◽  
Vol 50 (1) ◽  
pp. 273-289 ◽  
Author(s):  
Caroline Pinto Thirukumaran ◽  
James G. Dolan ◽  
Patricia Reagan Webster ◽  
Robert J. Panzer ◽  
Bruce Friedman
Keyword(s):  
Electronic Health Record ◽  
Surgical Care ◽  
Health Record ◽  
Improvement Project ◽  
Electronic Health ◽  
Surgical Care Improvement Project ◽  
Care Improvement ◽  
The Impact
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