A command centre implementation before and during the COVID-19 pandemic in a community hospital.

INTRODUCTION: The objective of the study was to assess the effects of high-reliability system by implementing a command centre (CC) on clinical outcomes in a community hospital before and during COVID-19 pandemic from the year 2016 to 2021. METHODS: A descriptive, retrospective study was conducted at an acute care community hospital. The administrative data included monthly average admissions, intensive care unit (ICU) admissions, average length of stay, total ICU length of stay, and in-hospital mortality. In-hospital acquired events were recorded and defined as one of the following: cardiac arrest, cerebral infarction, respiratory arrest, or sepsis after hospital admissions. A subgroup statistical analysis of patients with in-hospital acquired events was performed. In addition, a subgroup statistical analysis was performed for the department of medicine. RESULTS: The rates of in-hospital acquired events and in-hospital mortality among all admitted patients did not change significantly throughout the years 2016 to 2021. In the subgroup of patients with in-hospital acquired events, the in-hospital mortality rate also did not change during the years of the study, despite the increase in the ICU admissions during the COVID-19 pandemic.Although the in-hospital mortality rate did not increase for all admitted patients, the in-hospital mortality rate increased in the department of medicine. CONCLUSION: Implementation of CC and centralized management systems has the potential to improve quality of care by supporting early identification and real-time management of patients at risk of harm and clinical deterioration, including COVID-19 patients.

Reducing Hospital Harm: Establishing a Command Centre to Foster Situational Awareness.

Humber River Hospital (HRH) implemented the world's first Command Centre (Generation 2) tiles to support early identification and real-time management of patients at risk of harm and clinical deterioration. To rescue patients and mitigate patient safety threats, situational awareness must be maximized. The development of the Generation 2 tiles was aligned with 18 out of 31 categories and clinical groupings of the Hospital Harm framework. Results of the 2019/20 Hospital Harm report (CIHI 2021) revealed that the overall rate of harm score for HRH was lower than that of peer hospitals, suggesting that there may be an association between the tiles and these patient outcomes.

Use of High-Reliability Principles in the Evolution of a Hospital Command Centre.

Hospitals and health systems across the world strive to achieve consistently safe care delivery and reduce patient harm. In November 2017, Humber River Hospital became one of the first hospitals in North America to implement a hospital command centre to manage patient access and flow. The command centre outputs relevant real-time data that have been integrated from multiple automated systems and uses predictive analytics to support early identification of patients at risk of harm and deterioration. The aim of this descriptive article is to present the conceptual development of Humber River Hospital's Command Centre.

Experiences of Nurses Working in a Fully Digital Hospital: A Phenomenological Study.

BACKGROUND: With the increasing development and integration of information and communication technology (ICT) into hospitals, there remains a lack of understanding of the impact of these technologies on the hospital's largest core users: nurses. Humber River Hospital (HRH), one of the first hospitals to completely integrate technology across all hospital systems and workflows, has sought to understand how ICTs have transformed the clinical working environment. OBJECTIVE: The aim of the study was to achieve a deeper understanding of the lived experiences of nurses practising in North America's first digital hospital. METHODS: The methodological approach was informed by van Manen's hermeneutic phenomenological methodology. Data were gathered through in-depth semi-structured interviews with eight nurses at HRH. Thematic analysis was conducted using the van Manen and Colaizzi methods of data analysis. RESULTS: Six thematic categories that formed the nurses' lived experiences of working in a digital environment were identified: safety, time, teamwork, technology failures, patient responses and adapting. CONCLUSION: Nurses at HRH identified six themes regarding their lived experiences working in a fully digital hospital that provide an insight into nurses' values and cause us to reflect on how we might use this information to further support nursing practice in the fully digital environment. Nurses at HRH seem to have normalized the nursing process within the fully digital environment. Technology appears to be viewed by nurses at HRH within the premise of nursing as an art, allowing patient responses to be acknowledged and incorporated into nursing workflows, and as a science, permitting safe care delivery. Overall, nurses perceived technology as being essential for patient safety and facilitating nursing practice. These findings offer insight into nurses' perception of ICTs, and as technological advancements continue to emerge, these findings will inform education, practice and policy.

Closed-Loop Medication System: Leveraging Technology to Elevate Safety.

BACKGROUND: Healthcare organizations have long been dependent on the vigilance of nurses to identify and intercept medication errors before they can adversely affect patients. New technologies have been implemented in an effort to reduce medication errors; however, few studies have evaluated the long-term effects of technology-based interventions in reducing medication errors. AIM: The aim of this study was to evaluate the effects of barcode medication administration (BCMA) and the closed-loop medication system (CLMS) interventions on medication errors and adverse drug event (ADE) rates. METHODS: An autoregressive integrated moving average model for interrupted time series design was used to evaluate the impact of the BCMA and CLMS interventions on the monthly reported medication error and ADE rates at Humber River Hospital between September 2013 and August 2018. Descriptive statistics were generated to evaluate the types of error and their gravity. RESULTS: A total of 1,712 medication errors and ADEs were reported in the five-year study period. The results of the interrupted time series indicated that the introduction of the BCMA intervention was associated with a statistically significant gradual decrease in reported medication error and ADE rates at 0.002 percentage points per month (p = 0.003). The introduction of the CLMS intervention was associated with an immediate absolute decrease in reported medication error and ADE rates of 0.010% (p = 0.020). CONCLUSIONS: The findings from this study support the adoption of both BCMA and CLMS interventions to prevent medication errors. Staged implementation of CLMS allows time for learning and incorporating barcode scanning. Interprofessional and cross-functional collaboration is necessary to successfully integrate the requirements of each respective discipline and service in the CLMS.

Smartphone Technology: Enabling Prioritization of Patient Needs and Enhancing the Nurse-Patient Relationship.

BACKGROUND: Mobile health (mHealth) is a rapidly growing field with the potential to transform healthcare delivery. Smartphone technologies have been developed and integrated into the patient call bell system for healthcare staff to receive calls; however, there is a lack of high-quality evidence to support the implementation and evaluate the effectiveness of these devices in a healthcare setting. AIM: The aim of this study is to explore nurses' perceptions of smartphone technology devices in enhancing the nurse-patient relationship and improving nursing workflows. METHODS: A semi-structured focus group and interviews were used to illicit nurses' experiences with smartphone technology. Interviews were audio recorded, transcribed and subjected to a content analysis to identify emerging themes from the data. RESULTS: Interviews with nurses provided insight into the benefits and challenges of smartphone use in the clinical setting. Multiple benefits were identified by nurse participants, including time management and convenience, prioritization, patient safety and enhancement of the nurse-patient relationship. CONCLUSION: There are multiple benefits of smartphone technology for both nurses and patients. Hospitals proposing to introduce smartphone technology need to educate patients and families about the clinical use of smartphones to avoid unfavourable perceptions. Smartphone technology must be interoperable with the electronic medical record to optimize interprofessional communication and exchange of patient information.

Patient Empowerment and Nursing Clinical Workflows Enhanced by Integrated Bedside Terminals.

BACKGROUND: Integrated bedside terminals (IBTs) were implemented at Humber River Hospital with the goal of supporting patient independence and autonomy and improving nursing workflows. The IBTs provide access to a range of convenience and entertainment services as well as access to personal health information. Due to the novelty of the technology, there is a paucity of empirical data on patients' use of, satisfaction with and perceptions of bedside terminals. AIM: The purpose of this study was to evaluate the impact of IBTs on patient empowerment and nursing workflows. METHODS: A mixed methods design was employed using a cross-sectional patient survey and semi-structured interviews with nurses. The patient survey assessed patient empowerment and satisfaction with the range of services offered through the IBT. Patient scores were summarized using descriptive statistics. Additionally, face-to-face interviews with nurses were used to illicit feedback regarding the IBTs' impacts on nursing workflows. RESULTS: In total, 113 patients and 11 nurses participated in the study. Analysis of patient satisfaction surveys indicated that the IBTs enhanced the patient experience and increased self-care management. Nurses reported that the IBTs helped patients feel comfortable and entertained and helped enhance the nurse-patient relationship. However, nurses also expressed concern that elderly patients were less inclined to use the IBT. CONCLUSION: The results from the present study suggest that the IBT system has the potential to empower patients and decrease demands on nurses. Patients' notes incorporated into the IBT may provide the necessary level of involvement to garner a greater sense of patient empowerment. The IBT does not replace the need for nurses to deliver information to patients in a manner that supports their trust.

Generational Differences in Hospital Technology Adoption: A Cross-Sectional Study.

BACKGROUND: The advancement of technological change within healthcare means that it is essential for nurses to have the necessary technological skills to deliver safe and efficient nursing care. Few studies have examined whether generational differences affect the adoption of technology within the healthcare system. AIM: The primary purpose of this study was to explore predictors that influence the adoption of technology. METHODS: In this cross-sectional study, nurses were asked to rate their level of competency on 20 key skills related to clinical technological devices (CTDs) in a self-administered questionnaire. Participants' demographic data and level of proficiency related to personal computer skills were also collected. Multiple linear regression analysis was used to examine whether demographic characteristics and personal computer skills predicted higher scores related to CTDs. RESULTS: Sixty-three nurses completed the questionnaires. Overall mean score for skills related to CTD was high at 3.74 (SD = 0.75) out of 5. Length of employment at the hospital and previous exposure to the technology used at the hospital (ß = 0.06, p = 0.021; ß = 0.054, p = 0.011, respectively) were the only variables significantly associated with higher CTD skills scores. Generational cohort, gender, years of nursing experience and self-rated proficiency related to personal computer skills were not related to higher CTD skills scores. CONCLUSION: The results of this study emphasize that consistent exposure to technology enhances its adoption. Generational cohort did not play a role in the perception of nurses' technology competency at Humber River Hospital.

Optimizing Nursing Practice through Integration of Best Practice Guidelines into Electronic Medical Records.

A commitment to best practice guidelines (BPGs) is crucial for ensuring the safety of patients. Recognizing the power of information technology, Humber River Hospital has integrated BPGs into the electronic medical record (EMR) infrastructure. The large-scale implementation institutes a uniform standard of care and ensures adherence to BPGs through a forcing function designed to require nurses to complete and document the necessary assessments. The initiative strengthens the audit process and provides the opportunity to identify long-term trends. The implications of the quality improvement initiative are discussed. Due to the widespread use of EMRs, the replication of this initiative is economically feasible in other healthcare settings.

Violence Prevention: Technology-Enabled Therapeutic Intervention.

BACKGROUND: Nurses are disproportionately prone to experience incidents of violent victimization. Despite the vast literature on violence in healthcare settings, few studies have identified effective violence prevention interventions. AIM: The aim of the study was to explore the experiences of nurses regarding the implementation of technology-based violence prevention interventions. METHODS: Qualitative data were collected through semi-structured focus groups and interviews with 11 nurses at Humber River Hospital. Interviews were audiotaped, transcribed and subjected to a content analysis to identify core themes from the data. RESULTS: Three themes were identified: reassurance of safety, an increase in proactive measures and limitations of technology. Nurses held positive perceptions of the impact of technology-based interventions on violent incidents. The interventions were regarded as effective for the detection of potentially violent patients as well as for providing assistance from security staff when a violent incident occurs or appears imminent. However, nurses also acknowledged that patient-related violence was "unavoidable" and that technology cannot fully prevent violence from occurring. CONCLUSION: The findings from this study support the replication of these interventions in other healthcare facilities. Engaging staff, patients and families in this unique digital and technology-enriched environment has been critical for the successful implementation of the violence prevention electronic flagging system. Patient and family education and communication were essential for addressing concerns related to "labelling."