What Makes the "Perfect" Inpatient Consultation? A Qualitative Analysis of Resident and Fellow Perspectives.

PURPOSE: To characterize the methods of inpatient consult communication, given new communication modalities; to explore residents' and fellows' perspectives on the ideal consult and how this consult could affect their teaching, learning, and patient safety; and to identify barriers to and strategies for optimizing consultations. METHOD: Using qualitative grounded theory, the authors conducted semistructured focus groups with pediatric residents and fellows at Lucile Packard Children's Hospital at Stanford University from October 2016 to September 2017, using questions developed by expert consensus to address study objectives. Sessions were audiorecorded and transcribed verbatim. Two authors independently coded the transcripts and reconciled codes to develop categories and themes using constant comparison. The third author validated the codes, categories, and themes. To ensure trustworthiness, participants edited the themes for accuracy. RESULTS: Twenty-seven residents and 16 fellows participated in 7 focus groups (3 with residents, 4 with fellows). Four themes emerged: (1) Many forms of communication are successfully used for initial inpatient consult recommendations (in person, phone, text messages, notes in electronic medical records); (2) residents and fellows prefer in-person communication for consults, believing it leads to improved teaching, learning, and patient safety; (3) multiple strategies can optimize consults regardless of communication modality; and (4) how residents frame the initial consult affects the interaction and can increase fellow engagement, which leads to more fellow teaching, residents' improved understanding, and better patient care. CONCLUSIONS: Residents and fellows believe that structured initial consults conducted in person improve teaching, learning, and patient care. Several strategies exist to optimize this process.

Perspectives of nurse managers on information communication technology and e-Leadership.

AIM: We sought nurse managers' perspectives on challenges and opportunities with technology and how it may influence communication and leadership. BACKGROUND: e-Leadership is a conceptual framework used to understand and teach organisational leaders about the application of technology to leadership. Technology is integral to leadership, yet little is understood about how nurse managers may use this technology and how they negotiate the complexity of the multiple communication systems currently in use. METHODS: Sixteen nurse managers from individual hospitals within a large US healthcare system participated in qualitative open-ended interviews and focus groups. RESULTS: Four themes emerged from the qualitative data regarding the nurse managers' perspectives of e-Leadership and their use of information and communication technologies: (a) Can't live without it, (b) Too much, too many, (c) Poor onboarding education and (d) Difficulty maintaining virtual relationships. IMPLICATIONS FOR NURSING MANAGEMENT: Effective and safe patient care is dependent on multiple technology applications that require significant knowledge and practice. Nursing leadership may consider the need for more supported mentorship, and engaging programs to educate nurse managers about the dozens of applications required to effectively manage and lead. For technology to be used to its full potential it should be designed with nursing involvement.

Entropy Measures of Human Communication Dynamics.

Human communication is commonly represented as a temporal social network, and evaluated in terms of its uniqueness. We propose a set of new entropy-based measures for human communication dynamics represented within the temporal social network as event sequences. Using real world datasets and random interaction series of different types we find that real human contact events always significantly differ from random ones. This human distinctiveness increases over time and by means of the proposed entropy measures, we can observe sociological processes that take place within dynamic communities.

The Fate of Radical Cystectomy Patients after Hospital Discharge: Understanding the Black Box of the Pre-readmission Interval.

BACKGROUND: Radical cystectomy has one of the highest 30-d hospital readmission rates but circumstances leading to readmission remain poorly understood. OBJECTIVE: To examine the postdischarge period and better understand hospital readmission after radical cystectomy. DESIGN, SETTING, AND PARTICIPANTS: We conducted a retrospective cohort study of patients treated with radical cystectomy for bladder cancer from 2005 to 2012 using our institutional database. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS: We assessed patient communication with any healthcare system after hospital discharge based on timing, methods, and concern types. Logistic regression and Cox proportional-hazards analyses were used to compare postdischarge concerns among readmitted and nonreadmitted patients. We internally validated the logistic model using a bootstrap resampling technique. RESULTS AND LIMITATIONS: One-hundred patients (23%) were readmitted within 30 d of index discharge. Readmitted patients were more likely to use the emergency department with initial concerns compared with nonreadmitted patients (27% vs 1.0%, p<0.001). Patients who took longer to first communicate their concerns and who were able to tolerate their symptoms longer had lower odds of readmission. Patients who reported infection (adjusted hazard ratio: 2.8, 95% confidence interval: 1.4-5.8) and failure to thrive concerns (adjusted hazard ratio: 4.4, 95% confidence interval: 2.0-9.3) were more likely to be readmitted compared with those who communicated noninfectious wounds and/or urinary concerns. CONCLUSIONS: Radical cystectomy patients who contact the health system soon after discharge or communicated infectious or failure to thrive symptoms (fever, poor oral intake, or vomiting) are more likely to experience readmission as opposed to those that endorse pain, constipation, or ostomy issues. Better understanding of this pre-readmission interval can optimize postdischarge practices. PATIENT SUMMARY: We looked at bladder cancer patients who had surgery and the reasons why they were readmitted to hospital. We found patients who had a fever or difficulty with eating and maintaining their weight had the highest chance of being readmitted.

Application of a smartphone nurse call system for nursing care.

BACKGROUND: Traditionally, a patient presses the nurse call button and alerts the central nursing station. This system cannot reach the primary care nurse directly. The aim of this study was to apply a new smartphone system through the cloud system and information technology that linked a smartphone and a mobile nursing station for nursing care service. MATERIALS AND METHODS: A smartphone and mobile nursing station were integrated into a smartphone nurse call system through the cloud and information technology for better nursing care. RESULTS: Waiting time for a patient to contact the most responsible nurse was reduced from 3.8 min to 6 s. The average time for pharmacists to locate the nurse for medication problem was reduced from 4.2 min to 1.8 min by the new system. CONCLUSIONS: After implementation of the smartphone nurse call system, patients received a more rapid response. This improved patients' satisfaction and reduced the number of complaints about longer waiting time due to the shortage of nurses.

Numerous ways to answer the call.

Like other communications technology, nurse call systems have evolved considerably over the past 10-15 years, and now offer far more than just their primary function. HEJ editor Jonathan Baillie discussed, with several leading UK-based suppliers, some of the available technologies, considered their pros and cons, and asked senior personnel how they see nurse call systems developing in the short to medium term as demand for an ever wider range of features, and convergence with other equipment, continue to grow.

Sociotechnical changing in healthcare.

This paper discusses a conceptual approach to the study of the implementation of ICTs in healthcare organizations. The paper uses some fundamental concepts from sociotechnical studies to address the complex process of change--the changing--that accompanies ICT innovations. The paper argues for the importance of the perspective of changing as a way to account for the dynamics as technology and people, organizations and institutions co-constitutively work-out their future together.

Implementation and evaluation of an alpha-numeric paging system on a resident inpatient teaching service.

BACKGROUND: Numeric pagers are commonly used communication devices in healthcare, but cannot convey important information such as the reason for or urgency of the page. Alphanumeric pagers can display both numbers and text, and may address some of these communication problems. OBJECTIVE: Our primary aim was to implement an alphanumeric paging system. DESIGN: Continuous quality improvement study using rapid-cycle change methods. SETTING: General Internal Medicine (GIM) inpatient wards at 1 tertiary care academic teaching hospital. PARTICIPANTS: All residents, attending physicians, nurses, and allied health staff working on the general medicine (GM) wards. MEASUREMENTS: We measured: (1) the proportion of pages sent as text pages, (2) the source of the pages, (3) the content of the text pages, (4) the pages that disrupted scheduled education activities, and (5) satisfaction with the alphanumeric paging system. RESULTS: After implementation, 52% of pages sent from physicians or the GM wards were sent as text pages (P < 0.001). 93% of pages between physicians were text pages, compared to 27% of pages from the GM wards to physicians (P < 0.001). The most common reason for text paging among physicians was to arrange work or teaching rounds (33%). The most common reason for text paging from the GM wards was to request a patient assessment or for notification of a patient's clinical status (25%). There was a 29% reduction in disruptive pages sent during scheduled educational rounds (P < 0.001). CONCLUSIONS: We successfully implemented an alphanumeric paging system that reduced disruptive pages on a GM inpatient service.

Beyond paging: building a web-based communication tool for nurses and physicians.

INTRODUCTION: The traditional means of communication between nurses and physicians is through paging. This method is disruptive to the workflow of both professions and is too non-specific to be used for all types of messages. AIMS: We undertook a quality improvement project to streamline communication between nurses and trainees for urgent and non-urgent matters. We assessed user uptake and satisfaction with the new method. SETTING: A General Internal Medicine teaching unit in a tertiary care academic centre. METHODS: Through collaborative techniques, we developed a novel communication method that sends non-urgent messages to a Web-based task list and urgent messages to an alphanumeric pager. We implemented this new technology using a collaborative process between nurses and physicians to address all concerns. EVALUATION: Post-implementation surveillance indicated a high degree of uptake of the new practice. User surveys and focus groups showed a high level of satisfaction and a perceived decrease in interruptions to the workflow of both nurses and physicians with the new system. Usage data indicated that the new system may increase overall non-urgent communication. CONCLUSION: A Web-based system to triage urgent and non-urgent messages between nurses and physicians was developed collaboratively and implemented successfully to improve workflow for both groups.

Hospital sees success by the dashboard light.

These days, interactive media is all the rage. It seems no business is complete without an online presence. Crouse Hospital has gone one step further, creating an interactive informational Web site that puts its employees in the driver's seat.