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1.
Dis Colon Rectum ; 63(2): 190-199, 2020 02.
Artigo em Inglês | MEDLINE | ID: mdl-31914112

RESUMO

BACKGROUND: The National Accreditation Program for Rectal Cancer is a collaborative effort to improve the quality of rectal cancer care, including multidisciplinary assessment, treatment planning, and documentation using synoptic radiology, pathology, and operative reports. OBJECTIVE: The purpose of this study was to examine the implementation and use of a synoptic operative report for rectal cancer. DESIGN: This was a convergent mixed-methods implementation study of electronic medical record data, surveys, and qualitative interviews. SETTINGS: The study was conducted at US medical centers. PARTICIPANTS: Colorectal surgeons were included. INTERVENTION: After development, the synoptic operative report was iteratively revised and ultimately approved by the American Society of Colon and Rectal Surgeons Executive Council and the National Accreditation Program for Rectal Cancer and then implemented into participants' institutional electronic medical record systems. MAIN OUTCOME MEASURES: Change in fidelity to documentation of 19 critical items after implementation of synoptic reports and in-depth details and perspectives about the synoptic operative report were measured. RESULTS: Thirty-seven surgeons from 14 institutions submitted preimplementation operative reports (n = 180); 32 of 37 surgeons submitted postimplementation reports (n = 118). The operation type, approach, and formation of a stoma were present in >70% of preimplementation reports; however, the location of the tumor, the type of reconstruction, and the distal margin were reported in <50%. Each item was present in ≥89% of postimplementation reports. Twenty eight of 37 participants completed the survey, and 21 of 37 participants completed qualitative interviews. Emergent themes included concerns for additional burden and time constraints using the synoptic report themselves, as well as errors or absent information in traditional narrative operative reports of other surgeons. LIMITATIONS: The study was limited by its sample size, cross-sectional nature, specialized centers, and inclusion of colorectal surgeons only. CONCLUSIONS: Although fidelity to the 19 items substantially increased after implementation of the synoptic report, reactions to the synoptic report varied among surgeons. Many indicated concerns that it would hinder workflow or add extra time burden. Others felt the synoptic report could indirectly improve rectal cancer quality of care and provide useful data for quality improvement and research. More work is needed to update and improve the synoptic operative report and streamline the workflow. See Video Abstract at http://links.lww.com/DCR/B100. IMPLEMENTACIÓN DE UN INFORME OPERATIVO SINÓPTICO PARA EL CÁNCER DE RECTO: UN ESTUDIO UTILIZANDO MÉTODOS MIXTOS: El Programa Nacional de Acreditación para el Cáncer Rectal es una iniciativa de colaboración para mejorar la calidad de la atención del cáncer rectal, utilizando evaluación multidisciplinaria, planificación del tratamiento y documentación mediante radiología sinóptica, patología e informes quirúrgicos.Examinar la implementación y el uso de un informe operativo sinóptico para el cáncer de recto.Estudio de implementación de métodos mixtos convergentes de datos de registros médicos electrónicos, encuestas y entrevistas cualitativas.Centros médicos de los Estados Unidos.Cirujanos colorrectales.Después de su formulación, el informe operativo sinóptico fue revisado de forma iterativa y finalmente aprobado por el Consejo Ejecutivo de la Sociedad Americana de Cirujanos de Colon y Rectal y el Programa Nacional de Acreditación para el Cáncer Rectal. Posteriormente, se implementó en los sistemas de registros médicos electrónicos institucionales de los participantes.Cambios en la precisión de documentación de 19 ítems críticos después de la implementación de informes sinópticos; Revisión de detalles y perspectivas en a profundidad sobre el informe operativo sinóptico.Treinta y siete cirujanos de 14 instituciones presentaron informes operativos previos a la implementación (n = 180); 32/37 cirujanos presentaron informes posteriores a la implementación (n = 118). El tipo de operación, el enfoque y la formación de un estoma estuvieron presentes en > 70% de los informes previos a la implementación; sin embargo, la ubicación del tumor, el tipo de reconstrucción y el margen distal se informaron en <50%. Cada ítem estuvo presente en > 89% de los informes posteriores a la implementación. 28/37 participantes completaron la encuesta y 21/37 participantes completaron entrevistas cualitativas. Los temas emergentes incluyeron preocupaciones por la carga adicional y las limitaciones de tiempo usando el informe sinóptico en sí, y errores o información ausente en los informes operativos narrativos tradicionales de otros cirujanos.Tamaño de la muestra, estudio transversal, centros especializados, cirujanos colorrectales solamente.Aunque la fidelidad a los 19 ítems aumentó sustancialmente después de la implementación del informe sinóptico, las reacciones al informe sinóptico variaron entre los cirujanos. Muchos indicaron preocupaciones de que obstaculizaría el flujo de trabajo o agregaría una carga de tiempo adicional. Otros consideraron que el informe sinóptico podría mejorar indirectamente la calidad de la atención del cáncer de recto y proporcionar datos útiles para la mejora de la calidad y la investigación. Se necesita más trabajo para actualizar y mejorar el informe operativo sinóptico y agilizar el flujo de trabajo. Consulte Video Resumen en http://links.lww.com/DCR/B100. (Traducción-Dr. Adrian E. Ortega).


Assuntos
Registros Eletrônicos de Saúde/organização & administração , Qualidade da Assistência à Saúde/normas , Neoplasias Retais/cirurgia , Cirurgiões/organização & administração , Estudos Transversais , Documentação/métodos , Registros Eletrônicos de Saúde/normas , Feminino , Humanos , Masculino , Melhoria de Qualidade , Neoplasias Retais/epidemiologia , Cirurgiões/estatística & dados numéricos , Inquéritos e Questionários , Estados Unidos/epidemiologia
4.
BMC Health Serv Res ; 19(1): 716, 2019 Oct 21.
Artigo em Inglês | MEDLINE | ID: mdl-31639002

RESUMO

BACKGROUND: Patients with cardiovascular diseases (CVD) are treated over a long period of time by physicians and therapists from various institutions collaborating within a multidisciplinary team. Usually, medical records detailing the diagnoses and treatment regimens are long and extensive. Brief overviews of relevant diagnostic and treatment data in the form of a patient passport are currently missing in routine care for patients with CVD. This study aimed to develop and evaluate a patient passport (the Kardio-Pass) based on the needs of patients who had undergone cardiac rehabilitation, and of healthcare professionals. METHODS: A mixed method design was adopted consisting of an explorative qualitative phase followed by a quantitative evaluation phase. Interviews with patients and experts were conducted to develop the Kardio-Pass. CVD rehabilitees (N = 150) were asked to evaluate the passport using a semi-standardized written questionnaire. RESULTS: Patients and experts who were interviewed in the qualitative study phase considered the following passport contents to be particularly important: documentation of findings and diagnoses, cardiac diagnostics and intervention, medication plan, risk factors for heart disease, signs of a heart attack and what to do in an emergency. During the evaluation phase, 93 rehabilitees (response rate: 62%) completed the questionnaire. The Kardio-Pass achieved high overall approval: All respondents considered the information contained in the passport to be trustworthy. The professionalism and the design of the passport were rated very highly by 93 and 92% of participants, respectively. Use of the Kardio-Pass prompted 53% of participants to regularly attend follow-up appointments. The most common reasons for non-use were a lack of support from the attending doctor, failure by the patient to make entries in the passport, and loss of the passport. CONCLUSIONS: By documenting the course of cardiac diseases, the patient passport pools all medical data-from diagnosis to treatment and aftercare-in a concise manner. Rehabilitees who used the cardiac passport rated it as a helpful tool for documenting follow-up data. However, with regard to this explorative study there is a need for further research, particularly on whether the patient passport can improve heart patient care.


Assuntos
Documentação/métodos , Cardiopatias/reabilitação , Autogestão , Idoso , Continuidade da Assistência ao Paciente , Feminino , Humanos , Masculino , Registros Médicos , Pessoa de Meia-Idade , Desenvolvimento de Programas , Avaliação de Programas e Projetos de Saúde , Pesquisa Qualitativa
5.
Int J Med Inform ; 132: 103981, 2019 12.
Artigo em Inglês | MEDLINE | ID: mdl-31605881

RESUMO

OBJECTIVES: To determine the effect of a domain-specific ontology and machine learning-driven user interfaces on the efficiency and quality of documentation of presenting problems (chief complaints) in the emergency department (ED). METHODS: As part of a quality improvement project, we simultaneously implemented three interventions: a domain-specific ontology, contextual autocomplete, and top five suggestions. Contextual autocomplete is a user interface that ranks concepts by their predicted probability which helps nurses enter data about a patient's presenting problems. Nurses were also given a list of top five suggestions to choose from. These presenting problems were represented using a consensus ontology mapped to SNOMED CT. Predicted probabilities were calculated using a previously derived model based on triage vital signs and a brief free text note. We evaluated the percentage and quality of structured data captured using a mixed methods retrospective before-and-after study design. RESULTS: A total of 279,231 consecutive patient encounters were analyzed. Structured data capture improved from 26.2% to 97.2% (p < 0.0001). During the post-implementation period, presenting problems were more complete (3.35 vs 3.66; p = 0.0004) and higher in overall quality (3.38 vs. 3.72; p = 0.0002), but showed no difference in precision (3.59 vs. 3.74; p = 0.1). Our system reduced the mean number of keystrokes required to document a presenting problem from 11.6 to 0.6 (p < 0.0001), a 95% improvement. DISCUSSION: We demonstrated a technique that captures structured data on nearly all patients. We estimate that our system reduces the number of man-hours required annually to type presenting problems at our institution from 92.5 h to 4.8 h. CONCLUSION: Implementation of a domain-specific ontology and machine learning-driven user interfaces resulted in improved structured data capture, ontology usage compliance, and data quality.


Assuntos
Algoritmos , Transtorno Depressivo Maior/diagnóstico , Transtorno Depressivo Maior/terapia , Documentação/normas , Serviço Hospitalar de Emergência/normas , Controle de Formulários e Registros/métodos , Aprendizado de Máquina , Estudos de Casos e Controles , Sistemas de Apoio a Decisões Clínicas , Documentação/métodos , Feminino , Humanos , Masculino , Melhoria de Qualidade , Estudos Retrospectivos , Interface Usuário-Computador
6.
Int J Med Inform ; 130: 103938, 2019 10.
Artigo em Inglês | MEDLINE | ID: mdl-31442847

RESUMO

OBJECTIVE: To assess the role of speech recognition (SR) technology in clinicians' documentation workflows by examining use of, experience with and opinions about this technology. MATERIALS AND METHODS: We distributed a survey in 2016-2017 to 1731 clinician SR users at two large medical centers in Boston, Massachusetts and Aurora, Colorado. The survey asked about demographic and clinical characteristics, SR use and preferences, perceived accuracy, efficiency, and usability of SR, and overall satisfaction. Associations between outcomes (e.g., satisfaction) and factors (e.g., error prevalence) were measured using ordinal logistic regression. RESULTS: Most respondents (65.3%) had used their SR system for under one year. 75.5% of respondents estimated seeing 10 or fewer errors per dictation, but 19.6% estimated half or more of errors were clinically significant. Although 29.4% of respondents did not include SR among their preferred documentation methods, 78.8% were satisfied with SR, and 77.2% agreed that SR improves efficiency. Satisfaction was associated positively with efficiency and negatively with error prevalence and editing time. Respondents were interested in further training about using SR effectively but expressed concerns regarding software reliability, editing and workflow. DISCUSSION: Compared to other documentation methods (e.g., scribes, templates, typing, traditional dictation), SR has emerged as an effective solution, overcoming limitations inherent in other options and potentially improving efficiency while preserving documentation quality. CONCLUSION: While concerns about SR usability and accuracy persist, clinicians expressed positive opinions about its impact on workflow and efficiency. Faster and better approaches are needed for clinical documentation, and SR is likely to play an important role going forward.


Assuntos
Documentação/métodos , Registros Eletrônicos de Saúde/estatística & dados numéricos , Registros Eletrônicos de Saúde/normas , Pessoal de Saúde/estatística & dados numéricos , Erros Médicos/estatística & dados numéricos , Interface para o Reconhecimento da Fala/estatística & dados numéricos , Fala/fisiologia , Adulto , Idoso , Boston , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Percepção , Inquéritos e Questionários , Fluxo de Trabalho
7.
BMC Complement Altern Med ; 19(1): 223, 2019 Aug 22.
Artigo em Inglês | MEDLINE | ID: mdl-31438954

RESUMO

BACKGROUND: We aimed to compare patients' and physicians' safety reporting using data from large acupuncture trials (44,818 patients) and to determine associations between patient characteristics and reporting of adverse reactions. METHODS: Six pragmatic randomized trials with an additional non-randomized study arm that included those patients who refused randomization were evaluated. Patients received acupuncture treatment for osteoarthritis of the hip or knee, chronic neck pain, chronic low back pain, chronic headache, dysmenorrhea, or allergic rhinitis or asthma. Safety outcomes were evaluated by questionnaires from both the physicians and the patients. To determine level of agreement between physicians and patients on the prevalence of adverse reactions, Cohen's kappa was used. With multilevel models associations between patient characteristics and reporting of adverse reactions were assessed. RESULTS: Patients reported on average three times more adverse reactions than the study physicians: for bleeding/haematoma, 6.7% of patients (n = 2458) vs. 0.6% of physicians (n = 255) and for pain, 1.7% of patients (n = 636) vs. 0.5% of physicians (n = 207). We found only minor agreements between patients and physicians (maximum Cohen's kappa: 0.50, 95% confidence interval [0.49;0.51] for depressive mood). Being a female and participation in the randomization were associated with higher odds of reporting an adverse reaction. CONCLUSIONS: In our study, patients' and physicians' reports on adverse reactions of acupuncture differed substantially, possibly due to differences in patients' and physicians' questionnaires and definitions. For the assessment of safety, we strongly support the inclusion of patients' and physicians' reports while ensuring standardization of data collection and definitions.


Assuntos
Terapia por Acupuntura/efeitos adversos , Documentação/estatística & dados numéricos , Pacientes/estatística & dados numéricos , Médicos/estatística & dados numéricos , Ensaios Clínicos Controlados Aleatórios como Assunto , Adulto , Documentação/métodos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Reprodutibilidade dos Testes , Autorrelato
8.
Work ; 64(1): 43-54, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31450529

RESUMO

BACKGROUND: There is a trend in higher education towards the use of digital or electronic portfolios (ePortfolios) to collect evidence that demonstrates learning and skill development. There are very few papers that examine the key features and what to include in an occupational therapy ePortfolio. OBJECTIVE: This study presents an approach to developing a graduate entry ePortfolio to prepare occupational therapy students for transition to work. METHODS: An e-Delphi approach was used to gather the opinions of eight categories of experts. Three rounds of questionnaires were used to explore the purpose, terminology, content, structure, and development phases of a graduate entry ePortfolio. RESULTS: Key stakeholders indicated that the purpose of a professional portfolio is to create a professional profile, record experiences, skills and behaviours, and promote recording of lifelong learning and achievements. Delphi expert panel members emphasised the importance of personal choice in selecting evidence recorded in each collection, which must be guided by ethical decision-making. CONCLUSIONS: The findings of the study are important to students who wish to build an ePortfolio to organise and display evidence of competence prior to graduation in readiness to enter the workforce. The recommendations also will be of value to occupational therapy educators in curriculum development.


Assuntos
Documentação/métodos , Terapeutas Ocupacionais/educação , Austrália , Técnica Delfos , Avaliação Educacional/métodos , Humanos , Internet , Candidatura a Emprego , Estudantes de Ciências da Saúde
9.
Isr J Health Policy Res ; 8(1): 57, 2019 07 02.
Artigo em Inglês | MEDLINE | ID: mdl-31266536

RESUMO

BACKGROUND: In recent years, it has become increasingly prevalent internationally to record and archive digital recordings of endoscopic procedures. This emerging documentation tool raises weighty educational, ethical and legal issues - which are viewed as both deterrents and incentives to its adoption. We conducted a survey study aimed at evaluating the use of DRD in endoscopic procedures, to examine physicians' support of this practice and to map the considerations weighed by physicians when deciding whether or not to support a more extensive use of DRD. METHODS: Israeli physicians from specialties that employ endoscopic technics were surveyed anonymously for demographic background, existence and use of recording equipment, existence of institutional guidelines regarding DRD, and self-ranking (on a scale from 1 to 7) of personal attitudes regarding DRD. RESULTS: 322 physicians were surveyed. 84% reported performing routine endoscopic procedures, 78% had the required equipment for digital recording, and 64% of them stated that they never or only rarely actually recorded the procedure. General surgeons had the second highest rate of DRD equipment (96.5%) but the lowest rates of DRD practice (17.5%). The average ranking of support of DRD by all participants was 5.07 ± 1.9, indicating a moderately high level of support. Significant positive correlation exists between actual DRD rates and average support of DRD (p < 0.001). Based on mediation models, for all specialties and with no exceptions, having routine recording guidelines and positive support of DRD were found to increase the probability of actual recording. Being a surgeon or an urologist negatively correlated with support of DRD, and decreased actual recording rates. The argument "Recording might cause more lawsuits" was ranked significantly higher than all other arguments against DRD (p < 0.001), and "Recording could aid teaching of interns" was ranked higher than all other arguments in favor of DRD (p < 0.001). CONCLUSIONS: While DRD facilities and equipment are fairly widespread in Israel, the actual recording rate is generally low and varies among specialties. Having institutional guidelines requiring routine recording and a positive personal support of DRD correlated with actual DRD rates, with general surgeons being markedly less supportive of DRD and having the lowest actual recording rates. Physicians in all specialties were very much concerned about DRD's potential to enhance lawsuits, and this greatly influenced their use of DRD. These findings should be addressed by educational efforts, centering on professionals from reluctant specialties, as well as by the issuing of both professional and institutional guidelines endorsing DRD as well as requiring it where applicable.


Assuntos
Documentação/métodos , Endoscopia Gastrointestinal/métodos , Padrões de Prática Médica/tendências , Gravação em Vídeo/métodos , Adulto , Idoso , Idoso de 80 Anos ou mais , Atitude do Pessoal de Saúde , Documentação/normas , Documentação/estatística & dados numéricos , Endoscopia Gastrointestinal/estatística & dados numéricos , Endoscopia Gastrointestinal/tendências , Feminino , Humanos , Israel , Masculino , Pessoa de Meia-Idade , Inquéritos e Questionários , Gravação em Vídeo/tendências
10.
Am Surg ; 85(6): 611-619, 2019 Jun 01.
Artigo em Inglês | MEDLINE | ID: mdl-31267902

RESUMO

The Medicare Severity Diagnosis Related Group (MS-DRG) weight, as derived from the MS-DRG assigned at discharge, is in part determined by the physician-documented diagnoses. However, the terminology associated with MS-DRG determination is often not aligned with typical physician language, leading to inaccurate coding and decreased hospital reimbursements. The goal of this study was to evaluate the impact of a diagnosis picklist within a paper-based history and physical examination (H&P) on the average MS-DRG weight and the Case-mix index (CMI). Our trauma center implemented a paper H&P form for trauma patients featuring picklist diagnoses aligned with the MS-DRG terminology and arranged by the physiologic system. To evaluate its impact, we conducted a cohort study using data from our trauma registry between July 2015 and November 2017. Our cohort included 442 (26.0%) paper and 1,261 (74.0%) dictated H&Ps. Average CMI (2.56 vs 2.15) and expected patients ($25,057 vs $19,825) were higher for the paper group (P < 0.001, P = 0.002). Adjusted regression models demonstrated paper coding to be associated with 0.265 CMI points, translating to an average increase in expected payment of 6.5 per cent per patient. Utilization of a standardized, paper-based H&P template with picklist diagnoses was associated with a higher trauma service CMI and higher expected payments. Preprinted diagnoses that align with the MS-DRG terminology lead to clinical documentation improvement.


Assuntos
Grupos Diagnósticos Relacionados/tendências , Documentação/tendências , Alta do Paciente/tendências , Melhoria de Qualidade , Centros de Traumatologia/organização & administração , Ferimentos e Lesões/diagnóstico , Centros Médicos Acadêmicos/organização & administração , Arizona , Intervalos de Confiança , Bases de Dados Factuais , Grupos Diagnósticos Relacionados/normas , Documentação/métodos , Feminino , Humanos , Masculino , Medicare/economia , Admissão do Paciente/normas , Admissão do Paciente/tendências , Alta do Paciente/normas , Alta do Paciente/estatística & dados numéricos , Exame Físico/normas , Exame Físico/tendências , Sistema de Pagamento Prospectivo/normas , Sistema de Pagamento Prospectivo/tendências , Análise de Regressão , Estudos Retrospectivos , Estados Unidos , Ferimentos e Lesões/classificação
11.
Res Q Exerc Sport ; 90(4): 712-719, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31282787

RESUMO

Purpose: Quality physical education (PE) reaches many objectives (e.g., knowledge, physical fitness, and physical skills) and could provide at least half the dose of recommended daily physical activity for youths if their opportunity to learn is provided according to national professional recommendations (min/week) and related state mandates. A 2015 California class-action lawsuit required affected schools to post data indicating they scheduled PE time meeting the state mandate of 200 min per 10-day period. The extent to which schools posted PE schedules on their websites and demographic factors related to their compliance was investigated in this study. Method: We performed a quantitative, cross-sectional content analysis of the websites of 37 school districts plus a random sample of 860 elementary schools in them. Z tests were used to analyze frequencies/proportions and associations among demographic (e.g., Hispanic enrollment, PE specialist) and PE schedule variables (e.g., schools meeting state-mandated PE time). Results: Twenty-two districts (59.4%) had websites with ≥1 page/document related to PE opportunities. Only 11% of schools posted PE schedules, an event that was associated with employing a PE specialist (p = .01). Of schools posting schedules, 68% specified a PE volume that met the state mandate. Meeting the mandate was independently associated with enrolling a minority of Hispanic students (p = .02). Conclusion: Websites can provide information about the importance/occurrence of PE; however, schools in the lawsuit did not use the potential of their websites to inform constituents either about the lawsuit or their PE programs. Non-compliant schools should adjust PE schedules to meet statutory requirements.


Assuntos
Documentação/métodos , Fidelidade a Diretrizes/organização & administração , Internet , Educação Física e Treinamento/legislação & jurisprudência , Instituições Acadêmicas/organização & administração , California , Estudos Transversais , Hispano-Americanos/estatística & dados numéricos , Humanos
12.
J Glob Health ; 9(2): 020411, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31360449

RESUMO

Background: Improving the quality of facility-based births is a critical strategy for reducing the high burden of maternal and neonatal mortality and morbidity across all settings. Accurate data on childbirth care is essential for monitoring progress. In northeastern Nigeria, we assessed the validity of childbirth care indicators in a rural primary health care context, as documented by health workers and reported by women at different recall periods. Methods: We compared birth observations (gold standard) to: (i) facility exit interviews with observed women; (ii) household follow-up interviews 9-22 months after childbirth; and (iii) health worker documentation in the maternity register. We calculated sensitivity, specificity, and area under the receiver operating curve (AUC) to determine individual-level reporting accuracy. We calculated the inflation factor (IF) to determine population-level validity. Results: Twenty-five childbirth care indicators were assessed to validate health worker documentation and women's self-reports. During exit interviews, women's recall had high validity (AUC≥0.70 and 0.75

Assuntos
Parto Obstétrico/normas , Documentação/métodos , Atenção Primária à Saúde , Serviços de Saúde Rural , Adolescente , Adulto , Feminino , Humanos , Recém-Nascido , Registros Médicos , Pessoa de Meia-Idade , Nigéria , Gravidez , Reprodutibilidade dos Testes , Autorrelato , Adulto Jovem
13.
BMC Med Educ ; 19(1): 251, 2019 Jul 08.
Artigo em Inglês | MEDLINE | ID: mdl-31286945

RESUMO

BACKGROUND: In South Africa it is compulsory to submit a satisfactory portfolio of learning to gain entrance to the national exit examination of the College of Family Physicians and to qualify as a family physician. A paper-based portfolio has been implemented thus far and the need for an electronic portfolio (e-portfolio) was identified. The aim of the study was to describe and evaluate the implementation of an e-portfolio for the training of family medicine registrars in the Western Cape province of South Africa. METHODS: Mixed methods were used. A quasi-experimental study evaluated paper- and e-portfolios from the same 28 registrars in 2015 compared to 2016. Semi-structured interviews were conducted with 11 registrars or supervisors to explore their experiences of using the e-portfolio. Quantitative data was analysed in the Statistical Package for Social Sciences and qualitative data in Atlas.ti. RESULTS: Most respondents found the e-portfolio easier to use and more accessible. It made progress easier to monitor and provided sufficient evidence of learning. Feedback was made easier and more explicit. There were concerns regarding face-to-face feedback being negatively affected. It was suggested to have a feedback template to further improve feedback. Several aspects were significantly better in the e-portfolio such as feedback on the registrar's general behaviour, alignment with learning outcomes, less feedback based on hearsay and acknowledgement of the feedback by the registrar. Although not statistically significant, there was an increase in the usage of the e-portfolio, compared to the paper portfolio. CONCLUSION: In general, the e-portfolio is an improvement on the paper-based portfolio. It is easier to access, more user-friendly and less cumbersome. It makes feedback and monitoring of progress and development of registrars easier and more visible and provides sufficient evidence of learning. Its implementation throughout South Africa is recommended.


Assuntos
Competência Clínica/normas , Documentação/métodos , Educação de Pós-Graduação em Medicina , Medicina de Família e Comunidade/educação , Médicos de Família/educação , Atitude do Pessoal de Saúde , Computação em Nuvem , Documentação/tendências , Avaliação Educacional , Estudos de Avaliação como Assunto , Retroalimentação , Humanos , Internet , Aprendizagem , Desenvolvimento de Programas , África do Sul
15.
Crit Care Nurse ; 39(3): 20-32, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31154328

RESUMO

BACKGROUND: Brain injury with changes in clinical neurological signs and symptoms can develop while children are undergoing treatment in the intensive care unit. Critical care nurses routinely screen for neurological decline by using serial bedside neurological assessments. However, assessment components, frequency, and communication thresholds are not standardized. OBJECTIVES: To standardize neurological assessment procedures used by nurses, improve compliance with physicians' ordering and nurses' documentation of neurological assessments, and explore the frequency with which changes from preillness neurological status and previous assessments can be detected by using the assessment tool developed. METHODS: A quality improvement intervention was implemented during a 1-year period in a 55-bed pediatric intensive care unit with 274 nurses. Procedures for neurological assessment by nurses were standardized, a system for physicians to order neurological assessments by nurses at a frequency based on the patient's risk for brain injury was developed and implemented, and a system to compare patients' current neurological status with their preillness neurological status was developed and implemented. RESULTS: Process metrics that focused on compliance of ordering and documenting the standardized neurological assessments indicated improvement and sustained compliance greater than 80%. Exploratory analyses indicated that 29% of patients had an episode of neurological decline and that these episodes were more common in patients with developmental disabilities than in patients without such disabilities. CONCLUSIONS: Compliance with physicians' ordering and nurses' documentation of standardized neurological assessments significantly increased and had excellent sustainability. Further work is needed to determine the sensitivity of standardized nurses' neurological assessment tools for clinically meaningful neurological decline.


Assuntos
Lesões Encefálicas/enfermagem , Enfermagem de Cuidados Críticos/métodos , Unidades de Terapia Intensiva Pediátrica/organização & administração , Exame Neurológico/enfermagem , Avaliação em Enfermagem/normas , Melhoria de Qualidade , Lesões Encefálicas/diagnóstico , Criança , Pré-Escolar , Testes Diagnósticos de Rotina , Documentação/métodos , Feminino , Humanos , Lactente , Masculino , Monitorização Fisiológica/enfermagem , Exame Neurológico/normas
16.
J Grad Med Educ ; 11(3): 295-300, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31210860

RESUMO

Background: Identification of surrogate decision makers (SDMs) is an important part of advance care planning for hospitalized patients. Despite its importance, the best methods for engaging residents to sustainably improve SDM documentation have not been identified. Objective: We implemented a hospital-wide quality improvement initiative to increase identification and documentation of SDMs in the electronic health record (EHR) for hospitalized patients, utilizing a Housestaff Quality and Safety Council (HQSC). Methods: EHR documentation of SDMs for all adult patients admitted to a tertiary academic hospital, excluding psychiatry, were tracked and grouped by specialty in a weekly run chart during the intervention period (July 2015 through April 2016). This also continued postintervention. Interventions included educational outreach for residents, monthly plan-do-study-act cycles based on performance feedback, and a financial incentive of a one-time payment of 0.75% of a resident's salary put into the retirement account of each resident, contingent on meeting an SDM documentation target. Comparisons were made using statistical process control and chi-square tests. Results: At baseline, SDMs were documented for 11.1% of hospitalized adults. The intervention period included 9146 eligible admissions. Hospital-wide SDM documentation increased significantly and peaked near the financial incentive deadline at 48% (196 of 407 admissions, P < 001). Postintervention, hospital-wide SDM documentation declined to 30% (134 of 446 admissions, P < .001), but remained stable. Conclusions: This resident-led intervention sustainably increased documentation of SDMs, despite a decline from peak rates after the financial incentive period and notable differences in performance patterns by specialty admitting service.


Assuntos
Planejamento Antecipado de Cuidados/organização & administração , Documentação/métodos , Internato e Residência/normas , Centros Médicos Acadêmicos/métodos , Centros Médicos Acadêmicos/organização & administração , Adulto , Tomada de Decisões , Registros Eletrônicos de Saúde , Planos para Motivação de Pessoal , Humanos , Oregon , Melhoria de Qualidade/organização & administração
17.
Australas Emerg Care ; 22(2): 103-106, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31042529

RESUMO

BACKGROUND: A self-administered patient medication history form may improve efficiency of workflow in the emergency department. The objective of this study was to evaluate the patient perspective of completing a self-administered medication history form in the emergency department. METHODS: This was a cross-sectional survey of patients who presented to an urban emergency department in Australia. Face and content validity of the survey was established via an iterative process that included pharmacists and patients. After completing a self-administered medication history form, patients were surveyed regard their perspective of this approach. The results of each survey question were evaluated descriptively. RESULTS: A total of 113 completed the survey. The mean age was 59±19 years, and 52% were male. Most patients (87%, n=98) did not think there were any problems completing a self-administered list while waiting to be seen by a physician or pharmacist in the emergency department. Some patients preferred other modalities for clinicians to obtain the list due to their lack of recollection or confusion (4%, n=4), preferred that clinicians utilised existing lists or evaluated medications brought with them (2%, n=2), preferred the convenience of answering questions rather than writing (1%, n=1), or did not list a reason (1%, n=1). CONCLUSION: Most patients who present to the emergency department view a self-administered medication history form positively.


Assuntos
Documentação/normas , Pacientes/estatística & dados numéricos , Autoadministração/instrumentação , Adulto , Idoso , Idoso de 80 Anos ou mais , Estudos Transversais/estatística & dados numéricos , Documentação/métodos , Documentação/estatística & dados numéricos , Serviço Hospitalar de Emergência/organização & administração , Serviço Hospitalar de Emergência/estatística & dados numéricos , Feminino , Humanos , Masculino , Reconciliação de Medicamentos/métodos , Pessoa de Meia-Idade , Estudos Prospectivos , Autoadministração/métodos , População Urbana/estatística & dados numéricos
19.
J Trauma Acute Care Surg ; 87(2): 483-490, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31045725

RESUMO

BACKGROUND: Electric shocks are common, and victims report difficulty in finding practitioners with knowledge of the injury. Medical Practitioners, especially in private practice, report lack of knowledge of the injury and lack of expertise in assessing and treating the injury. The authors are often requested to suggest investigation protocols, assessment protocols, and treatment protocols, and to provide educational information. METHODS: The international body establishing electrical standards on the effects of current on the body (International Electrotechnical Commission, Maintenance Team 4 (MT4) of Technical Committee 64 (TC64)) have established protocols for the factors which require documentation and reporting of the injury. This article provides a narrative approach to using these protocols in accord with the standards (IEC 60479). The level of evidence is Level III (US/Canada classification). TYPE: This article collects together and collates physical and medical aspects of investigating electric shocks, and summarizes those of importance, and which are potentially forgotten. The thoroughness of initial assessment is emphasized. SUBSTANCE: Summaries are set out to guide first attenders and emergency medical personnel as to findings and observations which must be recorded for later comprehensive medicolegal reporting and which are often overlooked. CONCLUSION: Wider teaching in the nature of electric shocks will enhance assessment of victims and thorough recording of pertinent information and thus will enhance later medicolegal reporting. Many such factors are initially overlooked and lead to inadequate reporting for forensic purposes.


Assuntos
Documentação/normas , Traumatismos por Eletricidade/etiologia , Serviços Médicos de Emergência/normas , Segurança/normas , Protocolos Clínicos/normas , Documentação/métodos , Traumatismos por Eletricidade/diagnóstico , Traumatismos por Eletricidade/prevenção & controle , Traumatismos por Eletricidade/terapia , Humanos
20.
Comput Inform Nurs ; 37(5): 260-265, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-31094915

RESUMO

The objective of this quality improvement study was to evaluate whether electronic health record system timers and event logs can measure the efficiency and quality of a clinical process in an electronic health record. Using an experimental pre- and post-nonrandomized prospective cohort design, the researchers introduced a newly defined admission patient history essential data set and examined the electronic health record event files and timers to analyze the nursing experience from an efficiency and quality perspective. The researchers evaluated efficiency by measuring the time and clicks required to complete an admission history. The average active time spent documenting the admission patient history decreased by 72% from the preintervention measure (mean = 9.30 minutes) to the postintervention measure (mean = 2.55 minutes). The number of clicks decreased by 76% from the preintervention number of clicks (mean = 151.5) to the postintervention number of clicks (mean = 35.93). The quality of documentation was measured as the proportion of completed essential items and the frequency of completing an assessment in one sequence. The capture of essential data elements improved by almost 6%, and admission patient history data completed in one sequence increased by 24%. These study results demonstrate that system timers and event logs can measure the preintervention and postintervention changes in efficiency and quality of a defined clinical workflow into an electronic health record.


Assuntos
Documentação/normas , Registros Eletrônicos de Saúde , Anamnese/métodos , Enfermeiras e Enfermeiros/normas , Conjuntos de Dados como Assunto , Documentação/métodos , Humanos , Anamnese/normas , Enfermeiras e Enfermeiros/estatística & dados numéricos , Admissão do Paciente/normas , Melhoria de Qualidade
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