Comparing user acceptance of a computer system in two pediatric offices: a qualitative study.

The purpose of this qualitative study was to examine user acceptance of a clinical computer system in two pediatric practices in the southeast. Data were gathered through interviews with practice and IS staff, observations in the clinical area, and review of system implementation records. Five months after implementation, Practice A continued to use the system but Practice B had quit using it because it was unacceptable to the users. The results are presented here, in relation to a conceptual framework, which was originally developed to describe the process of successful implementation of research findings into practice. Five main themes were identified relative to the differences in user acceptance at the two practices: 1) Benefits versus expense of system use varied, 2) Organizational cultures differed, 3) IS staff's relationship with practices differed, 4) Post-implementation experiences differed, and 5) Transfer of technology from the academic center to private practice proved challenging in Practice B. The findings indicate a need for the development and validation of tools to measure healthcare organizational climate and readiness for change.

Physicians' experiences with prehospital do-not-resuscitate orders in North Carolina.

INTRODUCTION: Many states are implementing prehospital do-not-resuscitate (DNR) programs through legislation or by state or local protocol. There are no outcome studies in the literature regarding the utilization of, access to, or barriers to prehospital DNR programs, nor are there studies that evaluated whether they meet the patients' needs. STUDY OBJECTIVE: To explore physicians' perceptions of the utilization of, access to, and barriers to a southeastern state's prehospital DNR program, and to identify key professional groups needing information about prehospital DNR issues. METHODS: A convenience sample survey and a descriptive review using retrospective, self-report questionnaires sent to all physicians who requested and obtained a supply of the state's out-of-facility DNR forms in 1993. RESULTS: Respondents reported that the most common terminal conditions for patients with prehospital DNR orders are cancer and multiple chronic diseases in elderly patients. More than half of the physicians recalled that enrolled patients had engaged the services of emergency medical services (EMS), most often because the patients' conditions worsened, and the families were uncertain about what to do. Most of the enrolled patients have at least one other DNR order in another health-care setting, and are at home with hospice care or home-health care at the time of the prehospital DNR order implementation. The most frequent barrier to honoring dying patients' wishes in the prehospital environment is a lack of knowledge of prehospital issues by patients, families, primary care physicians, and nursing home staff. Ninety-eight percent of the respondents support a single, universal DNR order that would apply across all health-care settings. CONCLUSIONS: Patients, families, and key health-care professional groups need to be targeted with educational programs regarding prehospital DNR issues. Primary care physicians, using the current prehospital DNR program, support more comprehensive approaches to DNR orders across health-care settings.

The status of air medical quality assurance.

In February of 1989, the AAMS Quality Assurance (QA) Committee surveyed 177 flight programs regarding their QA activities. There was a 58% return rate, with the majority of the respondents being single hospital-based programs. Eighty-nine percent of those surveyed stated that they wanted assistance with their QA programs. The majority of the respondents (95%) review patient care issues, with most performing regular flight record review (88%) and monitoring of the timeliness of care delivered (85%), such as scene/response times. The information generated by the survey has been used by the AAMS QA Committee in planning QA seminars, and may also be helpful to individual air medical programs in designing their QA programs, as well as a tool for use in comparing themselves to other programs. Specific areas needing improvement are mentioned and AAMS is challenged to offer leadership and support in these efforts.

Determining appropriate use of an air medical program.

The Therapeutic Intervention Scoring System (TISS) was evaluated as an instrument to determine appropriate use of an air medical program (AMP) from a retrospective standpoint. TISS scores of 376 consecutive patient transports to the sponsor institution were compared to two other methods of judging appropriateness of air transport: a chart review and a review of patient outcome which included length of hospital stay, need for emergency surgery, mortality rates, and Trauma Scores. Statistically significant correlations were found between the TISS and the other two methods. We concluded that the TISS is a valid instrument for use in determining the appropriateness of air medical transports. The TISS is used as a quality assurance tool during retrospective, bi-weekly patient review sessions; and follow-up on appropriate use of the helicopter is provided to referring and receiving agencies accordingly.