Journal articles on the topic 'Handoff impact evaluation'

Introduction: A physician handoff is the process through which physicians transfer the primary responsibility of a care unit. The emergency department (ED) is a fast-paced and crowded environment where the risk of information loss between shifts is significant. Yet, the impact of handoffs between emergency physicians on patient outcomes remains understudied. We performed a retrospective cohort study in the ED to determine if handed-off patients, when compared to non-handed-off patients, were at higher risk of negative outcomes. Methods: We included every adult patient first assessed by an emergency physician and subsequently admitted to hospital in one of the five sites of the CHU de Québec-Université Laval during fiscal year 2016-17. Data were extracted from the local hospital discharge database and the ED information system. Primary outcome was mortality. Secondary outcomes were incidence of ICU admission and surgery and hospital length of stay. We conducted multilevel multivariate regression analyses, accounting for patient and hospital clusters and adjusting for demographics, CTAS score, comorbidities, admitting department delay before evaluation by an emergency physician and by another specialty, emergency department crowding, initial ED orientation and handoff timing. We conducted sensitivity analyses excluding patients that had an ED length of stay > 24 hours or events that happened after 72 hours of hospitalization. Results: 21,136 ED visits and 17,150 unique individuals were included in the study. Median[Q1-Q3] age, Charlson index score, door-to-emergency-physician time and ED length of stay were 71[55-83] years old, 3[1-4], 48 [24,90] minutes, 20.8[9.9,32.7] hours, respectively. In multilevel multivariate analysis (OR handoff/no handoff [CI95%] or GMR[SE]), handoff status was not associated with mortality 0.89[0.77,1.02], surgery 0.95[0.85,1.07] or hospital length of stay (-0.02[0.03]). Non-handed-off patients had an increased risk of ICU admission (0.75[0.64,0.87]). ED occupancy rate was an independent predictor of mortality and ICU admission rate irrespectively of handoff status. Sensitivity and sub-group based analyses yielded no further information. Conclusion: Emergency physicians’ handoffs do not seem to increase the risk of severe in-hospital adverse events. ED occupancy rate is an independent predictor of mortality. Further studies are needed to explore the impact of ED handoffs on adverse events of low and moderate severity.

247 Background: Failures in communication lead to serious medical errors particularly during transitions of care. A standardized handoff of patients requiring admission to the inpatient setting between the Emergency Center (EC) and the Hospitalist Inpatient Service (HIS) at a comprehensive cancer center was lacking during this vulnerable time. Methods: A quality pilot study using Plan, Do, Study, Act methodology was conducted. First, root cause analysis and process mapping of the current state was performed to identify pitfalls of the handoff process between the EC and the Hospitalist Service. Second, a validated standardized handoff tool, “I-PASS” (Illness severity, Patient summary, Action list, Situational awareness and contingency planning, and Synthesis by receiver) was selected and then transformed to DE-PASS, where D stands for Decisive problem requiring admission and E for Evaluation, to suit the EC workflow. The DE-PASS identified patients at higher risk for complications as urgent and emergent in the evaluation section and required a verbal communication in addition to an email using DE-PASS format. Third, we measured pre versus post intervention impact metrics. ICU transfers and Rescue Team calls within 24 hours were obtained from 822 patients. Time interval between EC admission physician order and HIS order was analyzed in a population of 174 randomly selected patients. Provider satisfaction with handoffs was surveyed. Results: The DE-PASS utilization ranged from 75% to 100% by the end of the pilot. The data analysis revealed a 60% reduction in the number of ICU transfers and a 64% reduction of Rescue Team calls post intervention. There was an 18% reduction in the interval time for an inpatient order in the medical record. EC Physicians satisfaction with DE-PASS increased by 10% and the Hospitalists increased by 40%. Conclusions: Implementation of the standardized handoff tool DE-PASS led to improved communication between two clinical services of a major cancer center. Patients’ safety improved by designation of risk stratification and reducing the time to evaluate unstable patients by the receiving HIS. Physician’s satisfaction with the handoff process increased.

ObjectiveTo conduct a systematic review and meta-analysis to ascertain the impact of operating room (OR) to intensive care unit (ICU) handoff interventions on process-based and clinical outcomes.MethodWe included all English language, prospective evaluation studies of OR to ICU handoff interventions published as original research articles in peer-reviewed journals. The search was conducted on 11 November 2019 on MEDLINE, CINAHL, EMBASE, Scopus and the Cochrane Central Register of Controlled Trials databases, with no prespecified criteria for the type of comparison or outcome. A meta-analysis of similar outcomes was conducted using a random effects model. Quality was assessed using a modified Downs and Black (D&B) checklist.Results32 studies were included for review. 31 studies were conducted at a single site and 28 studies used an observational study design with a control. Most studies (n=28) evaluated bundled interventions which comprised information transfer/communication checklists and protocols. Meta-analysis showed that the handoff intervention group had statistically significant improvements in time to analgesia dosing (mean difference (MD)=−42.51 min, 95% CI −60.39 to −24.64), fewer information omissions (MD=−2.22, 95% CI −3.68 to –0.77), fewer technical errors (MD=−2.38, 95% CI −4.10 to –0.66) and greater information sharing scores (MD=30.03%, 95% CI 19.67% to 40.40%). Only 15 of the 32 studies scored above 9 points on the modified D&B checklist, indicating a lack of high-quality studies.DiscussionBundled interventions were commonly used to support OR to ICU handoff standardisation. Although the meta-analysis showed significant improvements for a number of clinical and process outcomes, the statistical and clinical heterogeneity must be accounted for when interpreting these findings. Implications for OR to ICU handoff practice and future research are discussed.

ObjectiveThere have been increased efforts to implement medical ethics curricula at the student and resident levels; however, practising physicians are often left unconsidered. Therefore, we sought to pilot an ethics and professionalism curriculum for faculty in obstetrics and gynaecology to remedy gaps in the formal, informal and hidden curriculum in medical education.MethodsAn ethics curriculum was developed for faculty within the Department of Obstetrics and Gynaecology at a tertiary care, academic hospital. During the one-time, 4-hour, mandatory in-person session, the participants voluntarily completed the Oldenburg Burnout Inventory, Handoff Clinical Evaluation Exercise, University of Missouri-Kansas City School of Medicine and overall course evaluation. Patient satisfaction survey scores in both the hospital and ambulatory settings were compared before and after the curriculum.ResultsTwenty-eight faculty members attended the curriculum. Overall, respondents reported less burnout and performed at the same level or better in terms of patient handoff than the original studies validating the instruments. Faculty rated the professionalism behaviours as well as teaching of professionalism much lower at our institution than the validation study. There was no change in patient satisfaction after the curriculum. However, overall, the course was well received as meeting its objectives, being beneficial and providing new tools to assess professionalism.ConclusionThis pilot study suggests that an ethics curriculum can be developed for practising physicians that is mindful of pragmatic concerns while still meeting its objectives. Further study is needed regarding long term and objective improvements in ethics knowledge, impact on the education of trainees and improvement in the care of patients as a result of a formal curriculum for faculty.

Abstract Background: This study describes anesthesiologists’ practice improvements undertaken during the first 3 yr of simulation activities for the Maintenance of Certification in Anesthesiology Program. Methods: A stratified sampling of 3 yr (2010–2012) of participants’ practice improvement plans was coded, categorized, and analyzed. Results: Using the sampling scheme, 634 of 1,275 participants in Maintenance of Certification in Anesthesiology Program simulation courses were evaluated from the following practice settings: 41% (262) academic, 54% (339) community, and 5% (33) military/other. A total of 1,982 plans were analyzed for completion, target audience, and topic. On follow-up, 79% (1,558) were fully completed, 16% (310) were partially completed, and 6% (114) were not completed within the 90-day reporting period. Plans targeted the reporting individual (89% of plans) and others (78% of plans): anesthesia providers (50%), non-anesthesia physicians (16%), and non-anesthesia non-physician providers (26%). From the plans, 2,453 improvements were categorized as work environment or systems changes (33% of improvements), teamwork skills (30%), personal knowledge (29%), handoff (4%), procedural skills (3%), or patient communication (1%). The median word count was 63 (interquartile range, 30 to 126) for each participant’s combined plans and 147 (interquartile range, 52 to 257) for improvement follow-up reports. Conclusions: After making a commitment to change, 94% of anesthesiologists participating in a Maintenance of Certification in Anesthesiology Program simulation course successfully implemented some or all of their planned practice improvements. This compares favorably to rates in other studies. Simulation experiences stimulate active learning and motivate personal and collaborative practice improvement changes. Further evaluation will assess the impact of the improvements and further refine the program.

253 Background: Provider handoffs are prone to medical errors which in turn impact patient outcomes. Standardized signout tools have helped address this issue, however not in oncology. Methods: A pre-intervention survey (S1) was used to evaluate the current inpatient signout process and identify flaws by querying inpatient hematology/oncology fellows, attendings, nurse practitioners, and physician assistants. This data informed the development of a standardized electronic signout tool which was subsequently piloted on our bone marrow transplant unit. A post-intervention survey (S2) is currently evaluating the impact of this tool. Results: Of S1 respondents (54%, 71/131), 75% felt the signout process needs improvement, largely due to outdated (70%) or incomplete (24%) information and general disorganization (49%). Nearly half felt the signout contains too much (28%) or too little (18%) information. 18% felt that patient care had been compromised or delayed due to poor signout. Items requested for inclusion in the signout tool by more than half of respondents included patient identifiers, health care proxy, code status/goals of care, active issues summary, cancer details and treatment history, and a to-do list. Full S1 results are shown in Table; S2 results are pending. Conclusions: Use of a standardized, electronic signout tool can further enhance the inpatient handoff process in terms of safety and efficiency. [Table: see text]

Abstract Introduction A burn center with a high volume of burn admissions was looking for ways to decrease the pain and anxiety experienced by patients during wound care. Patients requiring surgical dressing removal or demonstrating difficulty in coping during wound care were of particular concern. Discussions between anesthesia providers and the burn team led to the concept of anesthesia safely providing deep sedation in the inpatient wound care center for select dressing changes. Nursing management began to work through the challenges of implementing the Burn Center Deep Sedation Program. Methods Processes for identifying, scheduling, and recovering patients were established. All Burn Acute Care Unit (BACU) patients requiring a surgical dressing removal or demonstrating poor coping during wound care would qualify for deep sedation. Nursing management worked to create an online scheduling system, and designated a room which was set up with anesthesia equipment and supplies. Candidates were reviewed for deep sedation and a schedule created for the following day. All patients required a Burn Intensive Care Unit (BICU) nurse during the recovery period. A BICU room adjacent to the wound care center became the deep sedation recovery room, and was staffed by the BICU charge nurse. BICU nurses received additional training in post anesthesia care prior to the program implementation. Once all educational needs and logistical changes were addressed, the deep sedation program began operating seven days per week. Results Starting in January 2016 deep sedation has been provided to approximately 400 cases per year. No additional staff was required, only shifting responsibilities of existing nursing personnel. Designating a specific room for deep sedation has ensured that anesthesia providers have access to the appropriate equipment and has minimized disruptions to the flow of other dressing changes occurring throughout the day. The impact of the program on pain and anxiety is currently under evaluation. Informal feedback from patients and staff members has been very positive. Conclusions The challenge in developing this program was the amount of education and planning required prior to implementation. Once the program was active, the challenges that occurred involved the scheduling system. An additional benefit of the program was the teamwork required between BICU and BACU nurses to safely handoff patients. The deep sedation program has also strengthened the burn team’s relationship with the anesthesia providers, whose commitment to the project was appreciated by all involved. A team approach and a collective mission to improve care for burn patients have driven this project to its current success. Applicability of Research to Practice The collaboration between the burn team and anesthesia has resulted in an improved wound care experience for the patient.

ABSTRACT Introduction The objective of this study was to assess the effectiveness of the Saudi national accreditation program on patient safety culture in a secondary-tertiary public hospital in Saudi Arabia. Methods Three hundred health professionals were randomly selected to participate in a survey. The survey was used in three phases: baseline, before accreditation, and after accreditation. Primary and secondary outcome measures were teamwork within hospital units, feedback and communication about errors, hospital handoffs and transitions, overall perceptions of safety, frequency of event reporting, and perception of patient safety grade. Results The survey response rate was 100%. A statistically significant impact of accreditation was found for teamwork within hospital units, feedback and communication about errors, and hospital handoffs and transitions (p = 0.002, 0.009, and 0.010, respectively). Ordinal logistic regression confirmed that the accreditation program had a significant effect on overall perceptions of safety (odds ratio [OR] [1.42–13.56], p = 0.010), frequency of event reporting (OR [0.91–7.96], p = 0.073), and staff awareness of grading safety culture (OR [0.02–0.70]) and reporting behavior (OR 0.10 [0.03–0.37]). Conclusion The Saudi national accreditation program had a significant positive impact on some patient safety culture dimensions and outcomes. These findings provide local empirical evidence on the benefits of implementing national accreditation programs. Further research on a larger scale is highly recommended.

Wireless communication technology is progressing very vastly. With this change in technology customer services for multimedia and non-multimedia are increasing day by day. But due to limited resources of the wireless network, we need to design an efficient CAC algorithm to enhance QoS levels for end users. The Quality of service (QoS) enhancement in the wireless network is related to making an efficient use of current network resources and the optimization of the users. Call acceptance in CAC is one of the challenge in mobile cellular networks to ensure that the acceptance of a new call into a resource limited wireless network should not deviate the service level Agreement (SLAs) at the time of conversations. In the next generation wireless network, CAC has the direct impact on QoS for user calls & overall system performance. To handle handoff calls and new calls in cellular network channel reservation scheme have been already proposed to reserve system bandwidth for higher priority call for CAC. This earlier proposed scheme is not as per the required level of satisfaction because the available reversed bandwidth is not allocated properly in case of least handoff rate. In this, the authors like to present a new channel borrowing scheme where new non real time (NRT) calls can make use of reserved channels. It can borrow this reserved channel on a temporary basis and after this immediately if any handoff call enters the current cell and no any other channels are available, then it will pre-empt the channel from an earlier borrowed NRT user if exists. This pre-empted NRT call is kept in the priority queue to consider its service when any channel becomes free. The number of NRT calls in the queue should not be large to avoid delayed service. The fundamental objective of the proposed scheme to design of the system for evaluating the results and comparing with the results of the existing system. From the results of current research work, it is observed that proposed scheme decreases call dropping probability which increase slightly in call blocking rate over high-density handoff call rate.

Purpose A performance-improvement service project consisting of a series of drug information interventions was developed for pharmacy staff to improve the quality and consistency of drug information provided by clinical pharmacists at a university medical center. The impact of interventions was primarily assessed by attendee satisfaction; a secondary measurement was the use of the Stanford Drug Information Center (the center). Methods Five interventions reviewing different electronic drug-information references were presented in September and October 2005. The 1hour presentations consisted of live demonstrations to pharmacy staff. A handout with step-by-step instructions on how to access and search each reference was created and distributed along with a follow-up evaluation. At the end of the interventions, all of the handouts were compiled into a permanent drug-information resource manual. In addition, data regarding inhouse pharmacist call volume to the center and the type of questions asked by inhouse pharmacists were collected for 6 months before and after the interventions. Results Evaluations of the interventions were positive and indicated that the learning objectives for each session had been met. The number of requests from inhouse pharmacists actually increased for the 6-month period after the interventions, as compared to the 6-month period prior to the interventions. Conclusion Feedback from pharmacy staff was positive, and the performance improvement goal was met through the intervention program, as well as the development of a permanent drug-information resource manual. However, further education of pharmacy staff did not translate into decreased requests (lower call volume) to the center.

Summary Background: Early involvement of stakeholders in the design of medical software is particularly important due to the need to incorporate complex knowledge and actions associated with clinical work. Standard user-centered design methods include focus groups and participatory design sessions with individual stakeholders, which generally limit user involvement to a small number of individuals due to the significant time investments from designers and end users. Objectives: The goal of this project was to reduce the effort for end users to participate in co-design of a software user interface by developing an interactive web-based crowd- sourcing platform. Methods: In a randomized trial, we compared a new web-based crowdsourcing platform to standard participatory design sessions. We developed an interactive, modular platform that allows responsive remote customization and design feedback on a visual user interface based on user preferences. The responsive canvas is a dynamic HTML template that responds in real time to user preference selections. Upon completion, the design team can view the user’s interface creations through an administrator portal and download the structured selections through a REDCap interface. Results: We have created a software platform that allows users to customize a user interface and see the results of that customization in real time, receiving immediate feedback on the impact of their design choices. Neonatal clinicians used the new platform to successfully design and customize a neonatal handoff tool. They received no specific instruction and yet were able to use the software easily and reported high usability. Conclusions: VandAID, a new web-based crowdsourcing platform, can involve multiple users in user-centered design simultaneously and provides means of obtaining design feedback remotely. The software can provide design feedback at any stage in the design process, but it will be of greatest utility for specifying user requirements and evaluating iterative designs with multiple options.

OBJECTIVES/SPECIFIC AIMS: Community-associated methicillin-resistant Staphylococcus aureus (CA-MRSA) skin and soft tissue infections (SSTIs) recurrence ranges from 16% to 43% and presents significant challenges to clinicians, patients, and families. This comparative effectiveness research study aims to disseminate, implement and evaluate whether an existing intervention, consisting of decolonization and decontamination procedures, which has been determined to be effective in hospital intensive care unit settings, can be implemented by Community Health Workers (CHWs) or “promotoras” conducting home visits prevent recurrence of CA-MRSA and transmission within their households for patients presenting to primary care with SSTIs. METHODS/STUDY POPULATION: In partnership with 3 Community Health Centers and 4 community hospitals in NYC, this study will recruit patients (n=278) with confirmed MRSA SSTIs and their household members. Participants are randomized to receive either a CHW/Promotora-delivered decolonization-decontamination intervention or usual care, which includes hygiene education. The highly engaged stakeholder team meets monthly to review interim results, identify areas for refinement and new research questions, and develop and implement strategies to improve participant engagement and retention. RESULTS/ANTICIPATED RESULTS: MRSA and MSSA were found in 19% and 21.1% of wound cultures, respectively. 59.5% with MRSA+ wound culture had one or more MRSA+ surveillance culture; 67.8% with MSSA+ wound culture had one or more MSSA+ surveillance culture. The “warm handoff” approach, developed and implemented by the stakeholder team to engage patients from their initial consent to return of lab results and scheduling of the home visits, helped improve completion of baseline home visits by 14%, from 45% to 59% of eligible participants. Home visits have demonstrated that 60% of households had at least one surface contaminated with S. aureus. Of the surfaces that tested positive in the households, nearly 20% were MRSA and 81% were MSSA; 32.5% of household members had at least one surveillance culture positive for S. aureus (MRSA: 7.7%, MSSA: 92.3%). DISCUSSION/SIGNIFICANCE OF IMPACT: This study aims to understand the systems-level, patient-level, and environmental-level factors associated with SSTI recurrence and household transmission, and to examine the interactions between bacterial genotypic and clinical/phenotypic factors on decontamination, decolonization, SSTI recurrence and household transmission. This study will evaluate the barriers and facilitators of implementation of home visits by CHWs in underserved populations, and aims to strengthen the weak evidence base for implementation of strategies to reduce SSTI recurrence and household transmission.

AbstrakNilai-nilai kepahlawanan merupakan representasi nilai sikap yang harusnya didapati siswa dalam pembelajaran sejarah. Konten buku paket sejarah di Sekolah belum memberikan porsi cukup guna pembahasan mengenai tokoh kepahlawanan. Kompleksitas dan monotonnya buku ajar sejarah memberi sumbangsih pada minimnya minat belajar siswa. Era digitalisasi visual setidaknya menjadi sebuah tantangan yang harus direspon demi mengembangkan konten pembelajaran yang inovatif. Konten pembelajaran sejarah merupakan salah satu ranah kognitif yang harus mampu diserap siswa secara maksimal, sehingga perlu adanya metode maupun media agar konten tersebut terserap secara maksimal. Metode yang digunakan dalam penelitian ini adalah metode pengembangan atau Research and Development dengan mengacu pada model perancangan ADDIE (Analyze, Design, Development, Implementation and Evaluation). Metode pengambilan data lapangan didapat dari hasil wawancara dan observasi pada analisis kebutuhan. Pre test dan post test digunakan untuk mendapatkan data prestasi belajar dan kesadaran sejarah siswa. Penilaian yang diberikan oleh para ahli dapat disimpulkan bahwa bahan ajar sejarah biografi pahlawan dinyatakan layak untuk diterapkan dalam pembelajaran sejarah, dan terdapat perbedaan tingkat kesadaran sejarah antara kelas yang tidak menggunakan bahan ajar biografi pahlawan sejarah berbasis infografis dengan yang menerapkannya. Kata Kunci: bahan ajar, biografi, infografis, pahlawan AbstractHeroes values are the representation of attitude that students must acquire in learning history. The history book content in the school has not provided enough portion for the discussion about heroism. The complexity of history textbooks has an impact on students' decreased interest in learning. The era of visual digitalization is a challenge that must be responded to develop innovative learning content. Historical learning content is a cognitive domain that students must be able to receive optimally, so there is a need for methods and media to solve it. The method used in this research is the Research and Development method with reference to the ADDIE design model (Analyze, Design, Development, Implementation, and Evaluation). Needs analysis obtained by using interview and observation methods. Pretest and posttest were used to obtain data on student achievement and historical awareness. Conclusion The assessment given by experts that the historical teaching material of the hero biography is declared deserve to be applied in historical learning, and also there are differences in the level of historical awareness between classes that do not use teaching materials based on infographic historical heroes with those who apply them. Keywords: biography, handout, heroism, infographic

Background: Identification of the factors contributing to the errors of medical staff and examining the causal relationships among those factors can help better manage and design more effective policies and practices. Objectives: This study aimed to identify the causes and factors affecting medical error management and determine a model for better management of such errors. Methods: This descriptive-analytical study was conducted in two qualitative and quantitative phases. In the quantitative part of the study, the factors related to medical error management were identified and validated through reviewing previous studies and interviewing some specialists. Following that, the fuzzy decision-making trial and evaluation method was used for structural modeling of the factors and investigating the causal relationships among them in the quantitative part. Results: In this study, the results showed that the "education and learning from error" subfactor had the most significant impact on the system. The second highly effective subfactors in the management of medical errors were "organizational communication and improved information access", "safety culture and climate", and "policies, procedures, and guidelines". In addition, the "safety culture and climate" was the most important factor that had the most critical impact on the system. Moreover, the "handoff conversations and communication" subfactor was mostly influenced by the other factors, followed by the "incident reporting system", "error prevention and corrective measures", "safety culture and climate", and "individuals' participation". Conclusions: According to the results of this study, the health care industry should take into consideration both organizational and individual factors in error management. In order to achieve better planning and higher performance in error management, increase patient safety, and ultimately improve the quality of hospital services, it is suggested to consider the causes and factors affecting the system.

This study is part of a mixed methods evaluation of a large urban medical center transitional care practice (NMG-TC). The NMG-TC provides integrated physical and behavioral health care for high need patients referred from the hospital emergency department or inpatient units and who lack a usual source of primary care. The study was designed for internal quality improvement and sought to evaluate staff perceptions of successful transitions for their medically and socially complex patients, and alternatively, the obstacles most likely to negatively impact patient outcomes. All 16 NMG-TC patient care staff were interviewed in a collaborative effort to produce empowered testimony that might go beyond expected clinical narratives. The interview schedule included questions on risk stratification, integrated mental health care, provider to provider handoffs, and how staff deal with key social determinates of patients’ health. The constant comparative method was used to deductively derive themes reflecting key domains of transitional care practice. Seven themes emerged: i) the need to quickly assess patient complexity; ii) emphasizing caring for major mental health and substance use issues; iii) obstacles to care for uninsured, often undocumented patients; iv) the intractability of homelessness; v) expertise in advancing patients’ health literacy, engagement and activation; vi) fragmented handoffs from hospital care and vii) to primary care in the community. Respondent stories emphasized methods of nurturing patients’ self-efficacy in a very challenging urban health environment. Findings will be used to conceptualize pragmatic, potentially high-impact transitional care quality improvement initiatives capable of better addressing frequent hospital use.

Tujuan dari penelitian ini yaitu untuk menganalisis pengaruh persepsi kualitas, sikap pada iklan tv, dan brand image terhadap niat beli ulang pada konsumen mie instan merek indomie di Kota Pontianak. Berdasarkan tujuan penelitian ini, maka jenis penelitian yang diambil oleh peneliti adalah kuantitatif, yaitu penelitian yang data-datanya berupa angka. Pengumpulan data menggunakan data primer berupa kuesioner dan wawancara, pada penelitian ini menggunakan sampel sebanyak 100 orang. Penelitian ini menggunakan analisis Regresi Linear Berganda. 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