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1.
Support Care Cancer ; 32(3): 197, 2024 Feb 28.
Artigo em Inglês | MEDLINE | ID: mdl-38416230

RESUMO

PURPOSE: Treatment decision-making for older adults with acute myeloid leukemia (AML) is complex and preference-sensitive. We sought to understand the patient experience of treatment decision-making to identify specific challenges in shared decision-making to improve clinical care and to inform the development of directed interventions. METHODS: We conducted in-depth interviews with newly diagnosed older (≥ 60 years) adults with AML and their caregivers following a semi-structured interview guide at a public safety net academic hospital. Interviews were digitally recorded, and qualitative thematic analysis was employed to synthesize findings. RESULTS: Eighteen in-depth interviews were conducted. Age ranged from 62 to 78 years. Patients received intermediate- (50%) or high-intensity (44%) chemotherapy or best supportive care only (6%). Six themes of patient experiences emerged from the analysis: patients (1) felt overwhelmed and in shock at diagnosis, (2) felt powerless to make decisions, (3) felt rushed and unprepared to make a treatment decision, (4) desired to follow oncologist recommendations for treatment, (5) balanced multiple competing factors during treatment decision-making, and (6) desired for ongoing engagement into their care planning. Patients reported many treatment outcomes that were important in treatment decision-making. CONCLUSIONS: Older adults with newly diagnosed AML feel devastated and in shock at their diagnosis which appears to contribute to a feeling of being overwhelmed, unprepared, and rushed into treatment decisions. Because no one factor dominated treatment decision-making for all patients, the use of strategies to elicit individual patient preferences is critical to inform treatment decisions. Interventions are needed to reduce distress and increase a sense of participation in treatment decision-making.


Assuntos
Leucemia Mieloide Aguda , Oncologistas , Humanos , Idoso , Pessoa de Meia-Idade , Leucemia Mieloide Aguda/terapia , Tomada de Decisão Compartilhada , Emoções , Preferência do Paciente
2.
N C Med J ; 79(4): 245-249, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-29991618

RESUMO

Interdisciplinary health care teams have numerous opportunities to investigate more efficient health care delivery mechanisms using technology that bridges information science and human-centered care. At the onset of team formation, technology can be strategically integrated to enhance health care delivery for patients and providers using multiple strategies.


Assuntos
Acessibilidade aos Serviços de Saúde , Equipe de Assistência ao Paciente , Telemedicina , Humanos , North Carolina , Estados Unidos
3.
J Surg Educ ; 81(8): 1105-1109, 2024 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-38853097

RESUMO

INTRODUCTION: Cornerstones of patient safety include reliable safety behaviors proposed by Team Strategies and Tools to Enhance Performance and Patient Safety (TeamSTEPPS) practices. A better quantification of these behaviors is needed to establish a baseline for future improvement efforts. METHODS: At one large academic medical center, OR Teams were prospectively assigned to be observed during surgical cases, and patient safety behaviors were quantified using the Teamwork Evaluation of Non-Technical Skills (TENTS) instrument. Mean scores of each TENTS behavior were calculated with 95% confidence intervals and compared using a paired t-test with a false discovery rate (FDR) control. Using the TENTS instrument, one hundred one surgical cases were observed by purposefully trained medical student volunteers. The average with 95% confidence interval (CI) of observed safety behaviors quantified using the TENTS instrument (including 20 types of safety behaviors scored 0 = expected but not observed, 1 = observed but poorly performed or counterproductive, 2 = observed and acceptable, and 3 = observed and excellent). RESULTS: All safety behaviors averaged slightly above 2, and the lower bound of 95% CI was above 2 for all behaviors except one. Statistically significant differences (p < 0.05) were detected between a few safety behaviors, with the lowest-rated safety behavior being "employs conflict resolution" (2.07, 95% CI: 1.96-2.18) and the highest-rated behavior being "willingness to support others across roles" (2.36, 95% CI: 2.27-2.45). There were no significant differences (p > 0.05) based on the number of persons present during the case, case duration, or by surgical department. CONCLUSIONS: Given the persistent patient safety incidents in ORs nationwide, it might be necessary to advance these behaviors from acceptable to exceptional to advance patient safety.


Assuntos
Salas Cirúrgicas , Equipe de Assistência ao Paciente , Segurança do Paciente , Humanos , Equipe de Assistência ao Paciente/organização & administração , Estudos Prospectivos , Masculino , Feminino , Centros Médicos Acadêmicos
4.
Front Health Serv ; 4: 1337840, 2024.
Artigo em Inglês | MEDLINE | ID: mdl-38628575

RESUMO

Given the persistent safety incidents in operating rooms (ORs) nationwide (approx. 4,000 preventable harmful surgical errors per year), there is a need to better analyze and understand reported patient safety events. This study describes the results of applying the Team Strategies and Tools to Enhance Performance and Patient Safety (TeamSTEPPS) supported by the Teamwork Evaluation of Non-Technical Skills (TENTS) instrument to analyze patient safety event reports at one large academic medical center. Results suggest that suboptimal behaviors stemming from poor communication, lack of situation monitoring, and inappropriate task prioritization and execution were implicated in most reported events. Our proposed methodology offers an effective way of programmatically sorting and prioritizing patient safety improvement efforts.

5.
BMJ Open ; 14(2): e082834, 2024 Feb 19.
Artigo em Inglês | MEDLINE | ID: mdl-38373857

RESUMO

INTRODUCTION: The burden of mental health-related visits to emergency departments (EDs) is growing, and agitation episodes are prevalent with such visits. Best practice guidance from experts recommends early assessment of at-risk populations and pre-emptive intervention using de-escalation techniques to prevent agitation. Time pressure, fluctuating work demands, and other systems-related factors pose challenges to efficient decision-making and adoption of best practice recommendations during an unfolding behavioural crisis. As such, we propose to design, develop and evaluate a computerised clinical decision support (CDS) system, Early Detection and Treatment to Reduce Events with Agitation Tool (ED-TREAT). We aim to identify patients at risk of agitation and guide ED clinicians through appropriate risk assessment and timely interventions to prevent agitation with a goal of minimising restraint use and improving patient experience and outcomes. METHODS AND ANALYSIS: This study describes the formative evaluation of the health record embedded CDS tool. Under aim 1, the study will collect qualitative data to design and develop ED-TREAT using a contextual design approach and an iterative user-centred design process. Participants will include potential CDS users, that is, ED physicians, nurses, technicians, as well as patients with lived experience of restraint use for behavioural crisis management during an ED visit. We will use purposive sampling to ensure the full spectrum of perspectives until we reach thematic saturation. Next, under aim 2, the study will conduct a pilot, randomised controlled trial of ED-TREAT at two adult ED sites in a regional health system in the Northeast USA to evaluate the feasibility, fidelity and bedside acceptability of ED-TREAT. We aim to recruit a total of at least 26 eligible subjects under the pilot trial. ETHICS AND DISSEMINATION: Ethical approval by the Yale University Human Investigation Committee was obtained in 2021 (HIC# 2000030893 and 2000030906). All participants will provide informed verbal consent prior to being enrolled in the study. Results will be disseminated through publications in open-access, peer-reviewed journals, via scientific presentations or through direct email notifications. TRIAL REGISTRATION NUMBER: NCT04959279; Pre-results.


Assuntos
Sistemas de Apoio a Decisões Clínicas , Adulto , Humanos , Projetos de Pesquisa , Consentimento Livre e Esclarecido , Serviço Hospitalar de Emergência , Ensaios Clínicos Controlados Aleatórios como Assunto
6.
Appl Ergon ; 106: 103884, 2023 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-36030734

RESUMO

BACKGROUND: Hospitalists are physicians trained in internal medicine and play a critical role in delivering care in in-patient settings. They work across and interact with a variety of sub-systems of the hospital, collaborate with various specialties, and spend their time exclusively in hospitals. Research shows that hospitalists report burnout rates above the national average for physicians and thus, it is important to understand the key factors contributing to hospitalists' burnout and identify key priorities for improving hospitalists' workplace. METHODS: Hospitalists at an academic medical center and a community hospital were recruited to complete a survey that included demographics, rating the extent to which socio-technical (S-T) factors contributed to burnout, and 22-item Maslach Burnout Inventory - Human Services Survey (MBI-HSS). Twelve contextual inquiries (CIs) involving shadowing hospitalists for ∼60 h were conducted varied by shift type, length of tenure, age, sex, and location. Using data from the survey and CIs, an affinity diagram was developed and presented during focus groups to 12 hospitalists to validate the model and prioritize improvement efforts. RESULTS: The overall survey participation rate was 68%. 76% of hospitalists reported elevated levels on at least one sub-component within the MBI. During CIs, key breakdowns were reported in relationships, communication, coordination of care, work processes in electronic healthcare records (EHR), and physical space. Using data from CIs, an affinity diagram was developed. Hospitalists voted the following as key priorities for targeted improvement: improve relationships with other care team members, improve communication systems and prevent interruptions and disruptions, facilitate coordination of care, improve workflows in EHR, and improve physical space. CONCLUSIONS: This mixed-method study utilizes participatory and data-driven approaches to provide evidence-based prioritization of key factors contributing to hospitalists' burnout. Healthcare systems may utilize this approach to identify workplace factors contributing to provider burnout and consider targeting the factors identified by providers to best optimize scarce resources.


Assuntos
Esgotamento Profissional , COVID-19 , Médicos Hospitalares , Humanos , Local de Trabalho , COVID-19/epidemiologia , Pandemias
7.
Adv Radiat Oncol ; 8(6): 101234, 2023.
Artigo em Inglês | MEDLINE | ID: mdl-37205277

RESUMO

Purpose: Pretreatment quality assurance (QA) of treatment plans often requires a high cognitive workload and considerable time expenditure. This study explores the use of machine learning to classify pretreatment chart check QA for a given radiation plan as difficult or less difficult, thereby alerting the physicists to increase scrutiny on difficult plans. Methods and Materials: Pretreatment QA data were collected for 973 cases between July 2018 and October 2020. The outcome variable, a degree of difficulty, was collected as a subjective rating by physicists who performed the pretreatment chart checks. Potential features were identified based on clinical relevance, contribution to plan complexity, and QA metrics. Five machine learning models were developed: support vector machine, random forest classifier, adaboost classifier, decision tree classifier, and neural network. These were incorporated into a voting classifier, where at least 2 algorithms needed to predict a case as difficult for it to be classified as such. Sensitivity analyses were conducted to evaluate feature importance. Results: The voting classifier achieved an overall accuracy of 77.4% on the test set, with 76.5% accuracy on difficult cases and 78.4% accuracy on less difficult cases. Sensitivity analysis showed features associated with plan complexity (number of fractions, dose per monitor unit, number of planning structures, and number of image sets) and clinical relevance (patient age) were sensitive across at least 3 algorithms. Conclusions: This approach can be used to equitably allocate plans to physicists rather than randomly allocate them, potentially improving pretreatment chart check effectiveness by reducing errors propagating downstream.

8.
J Patient Saf ; 19(1): e18-e24, 2023 01 01.
Artigo em Inglês | MEDLINE | ID: mdl-35948321

RESUMO

OBJECTIVES: Stereotactic body radiation therapy (SBRT) can improve therapeutic ratios and patient convenience, but delivering higher doses per fraction increases the potential for patient harm. Incident learning systems (ILSs) are being increasingly adopted in radiation oncology to analyze reported events. This study used an ILS coupled with a Human Factor Analysis and Classification System (HFACS) and barriers management to investigate the origin and detection of SBRT events and to elucidate how safeguards can fail allowing errors to propagate through the treatment process. METHODS: Reported SBRT events were reviewed using an in-house ILS at 4 institutions over 2014-2019. Each institution used a customized care path describing their SBRT processes, including designated safeguards to prevent error propagation. Incidents were assigned a severity score based on the American Association of Physicists in Medicine Task Group Report 275. An HFACS system analyzed failing safeguards. RESULTS: One hundred sixty events were analyzed with 106 near misses (66.2%) and 54 incidents (33.8%). Fifty incidents were designated as low severity, with 4 considered medium severity. Incidents most often originated in the treatment planning stage (38.1%) and were caught during the pretreatment review and verification stage (37.5%) and treatment delivery stage (31.2%). An HFACS revealed that safeguard failures were attributed to human error (95.2%), routine violation (4.2%), and exceptional violation (0.5%) and driven by personnel factors 32.1% of the time, and operator condition also 32.1% of the time. CONCLUSIONS: Improving communication and documentation, reducing time pressures, distractions, and high workload should guide proposed improvements to safeguards in radiation oncology.


Assuntos
Radioterapia (Especialidade) , Radiocirurgia , Humanos , Instalações de Saúde , Aprendizagem
9.
Health Informatics J ; 28(3): 14604582221113439, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35852472

RESUMO

This study synthesized the available evidence of simulation-based electronic health records (EHRs) training in educational and clinical environments for healthcare providers in the literature. The Arksey and O'Malley methodological framework was employed. A systematic search was carried out in relevant databases from inception to January 2020, identifying 24 studies for inclusion. Three themes emerged: (a) role of simulation-based EHR training in evaluating improvement interventions, (b) debriefing and feedback methods used, and (c) challenges of evaluating simulation-based EHR training. The majority of the studies aimed to emphasize the practical skills of individual medical trainees and employed post-simulation feedback as the feedback method. Future research should focus on (a) using simulation-based EHR training to achieve specific learning goals, (b) investigating aspects of clinical performance that are susceptible to skill decay, and (c) examining the influence of simulation-based EHR training on team dynamics.


Assuntos
Registros Eletrônicos de Saúde , Treinamento por Simulação , Retroalimentação , Pessoal de Saúde/educação , Humanos , Aprendizagem
10.
Stud Health Technol Inform ; 294: 58-62, 2022 May 25.
Artigo em Inglês | MEDLINE | ID: mdl-35612016

RESUMO

Burnout in healthcare professionals (HCPs) is a multi-factorial problem. There are limited studies utilizing machine learning approaches to predict HCPs' burnout during the COVID-19 pandemic. A survey consisting of demographic characteristics and work system factors was administered to 450 HCPs during the pandemic (participation rate: 59.3%). The highest performing machine learning model had an area under the receiver operating curve of 0.81. The eight key features that best predicted burnout are excessive workload, inadequate staffing, administrative burden, professional relationships, organizational culture, values and expectations, intrinsic motivation, and work-life integration. These findings provide evidence for resource allocation and implementation of interventions to reduce HCPs' burnout and improve the quality of care.


Assuntos
Esgotamento Profissional , COVID-19 , Esgotamento Profissional/diagnóstico , Esgotamento Profissional/prevenção & controle , Esgotamento Psicológico , Atenção à Saúde , Pessoal de Saúde , Humanos , Pandemias , Aprendizado de Máquina Supervisionado
11.
Stud Health Technol Inform ; 290: 809-813, 2022 Jun 06.
Artigo em Inglês | MEDLINE | ID: mdl-35673130

RESUMO

Cognitive Workload (CWL) is a fundamental concept in predicting healthcare professionals' (HCPs) objective performance. The study aims to compare the accuracy of the classical model (utilizes all six dimensions of the National Aeronautics and Space Administration Task Load Index (NASA-TLX)) and novel models (utilize four or five dimensions of NASA-TLX) in predicting HCPs' objective performance. We use a dataset from our previous human factors research studies and apply a broad selection of supervised machine learning classification techniques to develop data-driven computational models and predict objective performance. The study findings confirm that classical models are better predictors of objective performance than novel models. This has practical implications for research in health informatics, human factors and ergonomics, and human-computer interaction in healthcare. Findings, although promising, cannot be generalized as they are based on a small dataset. Future studies may investigate additional subjective and physiological measures of CWL to predict HCPs' objective performance.


Assuntos
Análise e Desempenho de Tarefas , Carga de Trabalho , Cognição , Atenção à Saúde , Humanos , Aprendizado de Máquina , Carga de Trabalho/psicologia
12.
Stud Health Technol Inform ; 290: 1112-1113, 2022 Jun 06.
Artigo em Inglês | MEDLINE | ID: mdl-35673231

RESUMO

We present evidence on the current state of utilizing co-design approaches involving older adults in developing electronic healthcare tools (EHTs). Research gaps were identified in defining the stages, involvement processes, and levels of participation using existing theoretical frameworks. Future studies should explore both involvement processes and levels of participation to optimally empower and collaborate with older adults in developing EHTs.


Assuntos
Atenção à Saúde , Instalações de Saúde , Eletrônica
13.
Appl Clin Inform ; 13(5): 1015-1023, 2022 10.
Artigo em Inglês | MEDLINE | ID: mdl-36104159

RESUMO

BACKGROUND: Health care providers are now required to provide their patients access to their consultation and progress notes. Early research of this concept, known as "OpenNotes," showed promising results in terms of provider acceptability and patient adoption, yet objective evaluations relating to patients' interactions with the notes are limited. OBJECTIVES: To assess the effect of the complexity level of notes and number of accesses (initial read vs. continuous access) on the user's performance, perceived usability, cognitive workload, and satisfaction with the notes. METHODS: We used a 2*2 mixed subjects experimental design with two independent variables: (1) note's complexity at two levels (simple vs. complex) and (2) number of accesses to notes at two levels (initial vs. continuous). Fifty-three participants were randomly assigned to receive a simple versus complex radiation oncology clinical note and were tested on their performance for understanding the note content after an initial read, and then with continuous access to the note. Performance was quantified by comparing each participant's answers to the ones developed by the research team and assigning a score of 0 to 100 based on participants' understanding of the notes. Usability, cognitive workload, and satisfaction scores of the notes were quantified using validated tools. RESULTS: Performance for understanding was significantly better in simple versus complex notes with continuous access (p = 0.001). Continuous access to the notes was also positively associated with satisfaction scores (p = 0.03). The overall perceived usability, cognitive workload, and satisfaction scores were considered low for both simple and complex notes. CONCLUSION: Simplifying notes can improve understanding of notes for patients/families. However, perceived usability, cognitive workload, and satisfaction with even the simplified notes were still low. To make notes more useful for patients and their families, there is a need for dramatic improvements to the overall usability and content of the notes.


Assuntos
Registros Eletrônicos de Saúde , Carga de Trabalho , Humanos
14.
Stud Health Technol Inform ; 290: 400-404, 2022 Jun 06.
Artigo em Inglês | MEDLINE | ID: mdl-35673044

RESUMO

A majority of healthcare workers (HCWs) experience workplace violence (WPV) but most WPV events go unreported. Underreporting of WPV is well documented in the literature as a barrier to identifying underlying causes and to evaluating the effectiveness of WPV interventions. Previous studies suggest that WPV reporting data is fragmentary, unreliable, and inconsistent. Also, WPV reporting systems are suboptimally designed making it difficult for healthcare workers to report WPV incidents. This study aims to assess the usability of an electronic WPV report in a large academic medical center and the perceived cognitive workload (CWL) and performance of HCWs associated with reporting WPV events. Findings from this study suggest that our institutional WPV report has suboptimal perceived usability and suboptimal perceived cognitive workload. Further, participants with training reported lower error rates in comparison to participants without training on performance.


Assuntos
Violência no Trabalho , Cognição , Eletrônica , Pessoal de Saúde/psicologia , Humanos , Inquéritos e Questionários , Carga de Trabalho , Local de Trabalho/psicologia , Violência no Trabalho/psicologia
15.
BMJ Open ; 12(7): e058390, 2022 07 06.
Artigo em Inglês | MEDLINE | ID: mdl-35793923

RESUMO

OBJECTIVE: The primary aim was to review and synthesise the current evidence of how older adults are involved in codesign approaches to develop electronic healthcare tools (EHTs). The secondary aim was to identify how the codesign approaches used mutual learning techniques to benefit older adult participants. DESIGN: Systematic review following the Preferred Reporting Items for Systematic Reviews 2020 checklist. DATA SOURCES: PubMed, Embase and Scopus databases were searched for studies from January 2010 to March 2021. ELIGIBILITY CRITERIA: Inclusion criteria were studies employing codesign approaches to develop an EHTs, and the study population was aged 60 years and older. DATA EXTRACTION AND SYNTHESIS: Data were extracted for analysis and risk of bias. We evaluated the quality of studies using the Agency for Healthcare Research and Quality Evidence-based Practice Center approach. RESULTS: Twenty-five studies met the inclusion criteria for this review. All studies used at least two involvement processes, with interviews and prototypes used most frequently. Through cross-classification, we found an increased utilisation of functional prototypes in studies reaching the 'empower' level of participation and found that studies which benefitted from mutual learning had a higher utilisation of specific involvement processes such as focus groups and functional prototyping. CONCLUSIONS: We found gaps to support which involvement processes, participation levels and learning models should be employed when codesigning with older adults. This is important because higher levels of participation may increase the user's knowledge of technology, enhance learning and empower participants. To ensure studies optimise participation and learning of older adults when developing EHTs, there is a need to place more emphasis on the approaches promoting mutual learning. PROSPERO REGISTRATION NUMBER: CRD42021240013.


Assuntos
Prática Clínica Baseada em Evidências , Instalações de Saúde , Idoso , Atenção à Saúde , Eletrônica , Humanos , Pessoa de Meia-Idade , Estados Unidos
16.
J Surg Educ ; 79(3): 614-623, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-34836841

RESUMO

OBJECTIVE: The consequences of burnout remain prevalent within general surgery training programs, yet there is no comprehensive description of the factors associated with burnout. Using sociotechnical systems theory, this review aims to qualitatively evaluate the factors associated with burnout in surgical residents. DESIGN: A systematic review of the literature was performed according to The Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. The review was conducted using PubMed, Web of Science, Scopus, and Embase. Two reviewers independently selected studies, extracted data, and assessed quality, with a third reviewer acting as a moderator to resolve conflicts. The Systems Engineering Initiative for Patient Safety framework was utilized to categorize factors as either contributing to or mitigating burnout. The study was registered with PROSPERO (CRD42021237448). SETTING: Included studies were conducted within the United States and published prior to November 11, 2020. PARTICIPANTS: Included studies were peer-reviewed primary data, that were written in English and evaluated the sociotechnical factors associated with burnout in surgical residents. RESULTS: A total of 4387 articles were identified and after review, 15 studies were included for analysis. Reported burnout rates ranged from 17 to 94%, with a total mean rate of 57%. Factors found to contribute to burnout include financial stress, work-life imbalance, excessive charting, insufficient job resources, poor social support, and mistreatment. Mitigating factors include having time away from work, increased didactics, supportive faculty, attending social events, and the presence of program-based wellness initiatives. Consequences of burnout include depression, substance abuse, and decreased job satisfaction. CONCLUSIONS: Reported burnout rates among surgical residents are high. A complex number of sociotechnical factors were found to contribute to burnout, yet many factors are also shown to mitigate burnout. Surgical residencies may address burnout by making changes based on the presence or absence of these factors within their program.


Assuntos
Esgotamento Profissional , Internato e Residência , Especialidades Cirúrgicas , Esgotamento Profissional/epidemiologia , Esgotamento Psicológico , Humanos , Satisfação no Emprego , Estados Unidos
17.
Stud Health Technol Inform ; 290: 460-464, 2022 Jun 06.
Artigo em Inglês | MEDLINE | ID: mdl-35673057

RESUMO

Chart checking is a time intensive process with high cognitive workload for physicists. Previous studies have partially automated and standardized chart checking, but limited studies implement data-driven approaches to reduce cognitive workload for quality assurance processes. This study aims to evaluate feature selection methods to improve the interpretability and transparency of machine learning models in predicting the degree of difficulty for a pretreatment physics chart check. We compare chi-square, mutual information, feature importance thresholding, and greedy feature selection for four different classifiers. Random forest has the highest performance with SMOTE oversampling using mutual information for feature selection (accuracy 84.0%, AUC 87.0%, precision 80.0%, recall 80.0%). This study demonstrates that feature selection methods can improve model interpretability and transparency.


Assuntos
Radioterapia (Especialidade) , Engenharia , Aprendizado de Máquina
18.
JMIR Res Protoc ; 11(6): e39586, 2022 Jun 29.
Artigo em Inglês | MEDLINE | ID: mdl-35767340

RESUMO

BACKGROUND: The approval of novel therapies for patients diagnosed with hematologic malignancies have improved survival outcomes but increased the challenge of aligning chemotherapy choices with patient preferences. We previously developed paper versions of a discrete choice experiment (DCE) and a best-worst scaling (BWS) instrument to quantify the treatment outcome preferences of patients with hematologic malignancies to inform shared decision making. OBJECTIVE: We aim to develop an electronic health care tool (EHT) to guide clinical decision making that uses either a BWS or DCE instrument to capture patient preferences. The primary objective of this study is to use both qualitative and quantitative methods to evaluate the perceived usability, cognitive workload (CWL), and performance of electronic prototypes that include the DCE and BWS instrument. METHODS: This mixed methods study includes iterative co-design methods that will involve healthy volunteers, patient-caregiver pairs, and health care workers to evaluate the perceived usability, CWL, and performance of tasks within distinct prototypes. Think-aloud sessions and semistructured interviews will be conducted to collect qualitative data to develop an affinity diagram for thematic analysis. Validated assessments (Post-Study System Usability Questionnaire [PSSUQ] and the National Aeronautical and Space Administration's Task Load Index [NASA-TLX]) will be used to evaluate the usability and CWL required to complete tasks within the prototypes. Performance assessments of the DCE and BWS will include the evaluation of tasks using the Single Easy Questionnaire (SEQ), time to complete using the prototype, and the number of errors. Additional qualitative assessments will be conducted to gather participants' feedback on visualizations used in the Personalized Treatment Preferences Dashboard that provides a representation of user results after completing the choice tasks within the prototype. RESULTS: Ethical approval was obtained in June 2021 from the Institutional Review Board of the University of North Carolina at Chapel Hill. The DCE and BWS instruments were developed and incorporated into the PRIME (Preference Reporting to Improve Management and Experience) prototype in early 2021 and prototypes were completed by June 2021. Heuristic evaluations were conducted in phase 1 and completed by July 2021. Recruitment of healthy volunteers began in August 2021 and concluded in September 2021. In December 2021, our findings from phase 2 were accepted for publication. Phase 3 recruitment began in January 2022 and is expected to conclude in September 2022. The data analysis from phase 3 is expected to be completed by November 2022. CONCLUSIONS: Our findings will help differentiate the usability, CWL, and performance of the DCE and BWS within the prototypes. These findings will contribute to the optimization of the prototypes, leading to the development of an EHT that helps facilitate shared decision making. This evaluation will inform the development of EHTs to be used clinically with patients and health care workers. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/39586.

19.
Jt Comm J Qual Patient Saf ; 48(12): 642-652, 2022 12.
Artigo em Inglês | MEDLINE | ID: mdl-36153293

RESUMO

BACKGROUND: The objective of this research was to evaluate the effect of implementing a system-level tiered huddle system (THS) on the reporting of patient safety events into the official event reporting system. METHODS: A quasi-experimental study using interrupted time series was conducted to assess the impact and changes to trends in the reporting of patient safety events pre- (February-July 2020; six months) and post- (September 2020-February 2021; six months) THS implementation within one health care system (238 clinics and 4 hospitals). The severity of harm was analyzed in July 2021 using a modified Agency for Healthcare Research and Quality (AHRQ) harm score classification. The primary outcome measure was the number of patient safety events reported per month. Secondary outcomes included the number of patient safety events reported per month by each AHRQ harm score classification. RESULTS: The system-level THS implementation led to a significant and immediate increase in the total number of patient safety events reported per month (777.73, 95% confidence interval [CI] 310.78-1,244.68, p = 0.004). Similar significant increases were seen for reported numbers of unsafe conditions, near misses, no-harm events that reached patients, and temporary harm (p < 0.05 for each). Reporting of events with permanent harm and deaths also increased but was not statistically significant, likely due to the small number of reported events involving actual harm. CONCLUSION: These findings suggest that system-level THS implementation may increase reporting of patient safety events in the official event reporting system.


Assuntos
Erros Médicos , Gestão de Riscos , Humanos , Segurança do Paciente , Análise de Séries Temporais Interrompida , Hospitais
20.
JMIR Res Protoc ; 11(8): e40445, 2022 Aug 24.
Artigo em Inglês | MEDLINE | ID: mdl-36001370

RESUMO

BACKGROUND: Preventable surgical errors of varying degrees of physical, emotional, and financial harm account for a significant number of adverse events. These errors are frequently tied to systemic problems within a health care system, including the absence of necessary policies/procedures, obstructive cultural hierarchy, and communication breakdown between staff. We developed an innovative, theory-based virtual reality (VR) training to promote understanding and sensemaking toward the holistic view of the culture of patient safety and high reliability. OBJECTIVE: We aim to assess the effect of VR training on health care workers' (HCWs') understanding of contributing factors to patient safety events, sensemaking of patient safety culture, and high reliability organization principles in the laboratory environment. Further, we aim to assess the effect of VR training on patient safety culture, TeamSTEPPS behavior scores, and reporting of patient safety events in the surgery department of an academic medical center in the clinical environment. METHODS: This mixed methods study uses a pre-VR versus post-VR training study design involving attending faculty, residents, nurses, technicians of the department of surgery, and frontline HCWs in the operation rooms at an academic medical center. HCWs' understanding of contributing factors to patient safety events will be assessed using a scale based on the Human Factors Analysis and Classification System. We will use the data frame theory framework, supported by a semistructured interview guide to capture the sensemaking process of patient safety culture and principles of high reliability organizations. Changes in the culture of patient safety will be quantified using the Agency for Healthcare Research and Quality surveys on patient safety culture. TeamSTEPPS behavior scores based on observation will be measured using the Teamwork Evaluation of Non-Technical Skills tool. Patient safety events reported in the voluntary institutional reporting system will be compared before the training versus those after the training. We will compare the Agency for Healthcare Research and Quality patient safety culture scores and patient safety events reporting before the training versus those after the training by using descriptive statistics and a within-subject 2-tailed, 2-sample t test with the significance level set at .05. RESULTS: Ethics approval was obtained in May 2021 from the institutional review board of the University of North Carolina at Chapel Hill (22-1150). The enrollment of participants for this study will start in fall 2022 and is expected to be completed by early spring 2023. The data analysis is expected to be completed by July 2023. CONCLUSIONS: Our findings will help assess the effectiveness of VR training in improving HCWs' understanding of contributing factors of patient safety events, sensemaking of patient safety culture, and principles and behaviors of high reliability organizations. These findings will contribute to developing VR training to improve patient safety culture in other specialties.

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