Reclaim lost time with better organization.
Better desktop organization and time management can improve a new manager's workflow.
Humans↗
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Results for “Workflow”
Explore indexed PubMed citations for clinical trials, systematic reviews and public health research. Read source abstracts and follow each citation to its original PubMed record.
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Improving physician communication through an automated, integrated sign-out system.
Communication failures among physicians are a leading cause of medical errors. The resident sign-out sheet is the primary tool used by house staff to facilitate the sign-out process. The resident sign-out sheet is a structured report, with patient-specific information including demographics, such a patient's name, age, sex, room number, and attending physician; problem list; medications; and allergies. Some physicians use handwritten notes to keep track of this information, while others use freestanding word processor or database programs. In a previous study, the authors described serious inaccuracies in a manually updated word-processor based resident sign-out sheet used by pediatric residents at a tertiary-care children's hospital. An automated and integrated sign-out system (AISS) was subsequently developed that retrieves pertinent patient information from a computerized provider order entry (CPOE) system. The AISS generates a resident sign-out sheet, which includes demographic information, weight, current medications, allergies, and diet orders, as well as optional free-text information. The AISS has proven to be enormously popular, increasing physician acceptance of CPOE throughout the organization. This paper discusses lessons learned, including technical, design, and workflow aspects of an integrated resident sign-out sheet. The authors recommend that all future commercial CPOE systems incorporate physician sign-out tools such as the one described in this article.
Communication↗
Emergency department overcrowding: the impact of resource scarcity on physician job satisfaction.
Emergency departments in most developed countries have been experiencing significant overcrowding under a regime of severe resource constraints. Physicians in emergency departments increasingly find themselves toiling in workplaces that are characterized by diminished availability of, limited access to, and decreased stability of critical resources. Severe resource constraints have the potential to greatly weaken the overall job satisfaction of emergency physicians. This article examines the impact of hospital resource constraints on the job satisfaction of a large sample of emergency physicians in Canada. After controlling for workflow and patient characteristics and for various institutional and physician characteristics, institutional resource constraints are found to be major contributors to emergency physician job dissatisfaction. Resource factors that have the greatest impact on job satisfaction include availability of emergency room physicians, access to hospital technology and emergency beds, and stability of financial (investment) resources.
Adult↗
A comprehensive system for washing, pre-disinfecting and sterilizing of dental and surgical instruments.
PURPOSE: The purpose of this study was to test and describe in detail a newly developed comprehensive system for washing, pre-disinfecting and sterilizing of dental and surgical instruments. MATERIALS AND METHODS: The system consists of a combined washing and steam-operated pre-disinfection apparatus and newly developed trays, in which assorted instruments can be washed and disinfected without handling individual instruments. The system was subjected to a large number of tests. RESULTS: The cleaning efficiency of blood-soiled instruments was found to be excellent. The disinfection of dental instruments contaminated with bacteria, yeast and non-enveloped virus showed decimal reduction factors that were equivalent to sterilization. The trays had optimal sealing qualities. Their steam permeability was perfect even after prolonged use in N-, S- and B-type autoclaves. However, long-term tests in a clinic revealed shortcomings with regard to insufficient drying of instruments in the wash/disinfection apparatus. Furthermore, the mechanical stability of the polysulfonate tray covers needs to be improved. Occasionally, after extended use, the fit of the filters in metal trays became inadequate, in particular when trays were sterilized for 18 min at 134 degrees C for a prolonged period of time. CONCLUSION: In spite of the above-mentioned shortcomings, the system shows great labor and cost-saving potential, allowing a new approach to instrument recirculation and workflow in the dental office.
Dental Instruments↗
Reinventing Veterans Health Administration: focus on primary care.
Can we improve access in primary care without compromising the quality of care? The purpose of this article is to demonstrate how timely access to primary care can be achieved without compromising the quality of the care being delivered. The Veterans Health Administration (VHA) is an integrated healthcare system that has implemented change to improve primary care access to the veterans it serves, while not only maintaining but also actually improving the quality of care. Many healthcare executives are struggling with achieving desirable access to care and continuity of care. To confront this problem, many large and small practices have initiated an approach known as advanced clinic access, open access, or same-day scheduling, introduced by the Institute for Healthcare Improvement (IHI). This approach has increasingly been used to reduce waits and delays in primary care without adding resources. To measure quality of care, specific performance measures were developed to quantify the effectiveness of primary care in VHA. Although it was initially viewed with concern and suspicion and was seen as a symptom of unnecessary micromanagement, healthcare team members were encouraged to use performance feedback as an opportunity for systems improvement as well as self-assessment and performance improvement for the team. All quality data are posted quarterly on VHA's internal web site, providing visible accountability at all levels of the organization. Clinical workflow redesign leads to reduced wait times without compromising quality of care. These large system improvements are applicable to large and small organizations looking to tackle change through the use of a collaborative model.
Delivery of Health Care↗
Bootstrapped ultrasound calibration.
This paper introduces an enhanced (bootstrapped) method for tracked ultrasound probe calibration. Prior to calibration, a position sensor is used to track an ultrasound probe in 3D space, while the US image is used to determine calibration target locations within the image. From this information, an estimate of the transformation matrix of the scan plane with respect to the position sensor is computed. While all prior calibration methods terminate at this phase, we use this initial calibration estimate to bootstrap an additional optimization of the transformation matrix on independent data to yield the minimum reconstruction error on calibration targets. The bootstrapped workflow makes use of a closed-form calibration solver and associated sensitivity analysis, allowing for rapid and robust convergence to an optimal calibration matrix. Bootstrapping demonstrates superior reconstruction accuracy.
Calibration↗
Gestalt operating room display design for perioperative team situation awareness.
The perioperative environment is a complex, high risk environment that requires real-time coordination by all perioperative team members and accurate, up-to-date information for situation assessment and decision-making. There is the need for a "Gestalt" holistic awareness of the perioperative environment to enable synthesis and contextualization of the salient information such as: patient information, case and procedure information, staff information, operative site view, physiological data, resource availability. One potential approach is to augment the medical toolkit with a large screen wall display that integrates and makes accessible information that currently resides in different data systems and care providers. The objectives are to promote safe workflows, team coordination and communication, and to enable diagnosis, anticipation of events, and information flow from upstream to downstream care providers. We used the human factors engineering design process to design and develop a display that provides a common operational picture for shared virtual perioperative team situation awareness to enhance patient safety.
Awareness↗
Integrating surgical robots into the next medical toolkit.
Surgical robots hold much promise for revolutionizing the field of surgery and improving surgical care. However, despite the potential advantages they offer, there are multiple barriers to adoption and integration into practice that may prevent these systems from realizing their full potential benefit. This study elucidated some of the most salient considerations that need to be addressed for integration of new technologies such as robotic systems into the operating room of the future as it evolves into a complex system of systems. We conducted in-depth interviews with operating room team members and other stakeholders to identify potential barriers in areas of workflow, teamwork, training, clinical acceptance, and human-system interaction. The findings of this study will inform an approach for the design and integration of robotics and related computer-assisted technologies into the next medical toolkit for "computer-enhanced surgery" to improve patient safety and healthcare quality.
Robotics↗
Keeping it real--building an ROI model for an ambulatory EMR initiative that the physician practices espouse.
The ambulatory electronic medical record initiative at Magic Valley Regional Medical Center (MVRMC) in South Central Idaho underwent a rigorous product evaluation process that resulted in one of the market-leading EMR products being selected for implementation. MVRMC includes four business entities, including a 213-bed regional hospital and a 19-practice management services organization. Early in the process, the organization viewed buy-in from its physicians as a critical success factor. The physicians had been integral to product selection, and it was equally important for them to trust the economic model for its acquisition-especially because it was likely that they would be asked to put "some skin in the game." To make this initiative economically feasible, MVRMC received a grant from Agency for Healthcare Research and Quality based on the potential impact of the endeavor on healthcare delivery in the region. However, because the functional analysis did not result in the selection of the least expensive product, the AHRQ grant would only help defray the startup expenses, but not ongoing support and maintenance expenses after implementation; these costs would be borne by anticipated increases in the practice's revenue or reduction in its operating expenses. The ROI model would need to explain how each practice, from the single physician specialist to an almost 20-physician family practice, could pay for the desirable outcomes discussed during the selection phase of the project. The physicians, who had participated in technology initiatives in the past, were skeptical that cost-justifying an IT system was realistic, even though they recognized the potential benefits it could have on the quality and consistency of the care. Because some process standardization within and between practices would be needed to use electronic charting effectively, it was important that the ROI model did not outweigh the benefits of an as-yet untested operational workflow that leveraged interoperability. In addition, one of the key benefits of the initiative was the integration of ambulatory and inpatient information into a common patient-centric view of care. This outcome needed to be appropriately considered in the determination of the value of the initiative. To make the ROI model real, the physicians needed to be willing to take on the responsibility of delivering on the benefits. This report highlights the key aspects of using an ROI model in support of an electronic medical system implementation emphasizing improvements in intra-practice efficiencies, interoperability between multi-specialty practices and ambulatory and inpatient care events for a patient while ensuring that all stakeholders consider its mathematical estimates as accurate and achievable in the real world.
Ambulatory Care↗
Cassette based digital X-ray systems: evaluating the Konica Minolta Xpress CR.
Cassette-based digital x-ray systems--also called computed radiography (CR) systems--are flexible and affordable, qualities that have secured their continued use in clinical settings. In this follow-up to our August 2001 Evaluation of CR systems, we examine the Konica Minolta Xpress CR. Our testing examines the ability of the Xpress CR to provide at least the same amount of diagnostic information as screen-film systems, while significantly increasing the overall efficiency of a radiology department. This article also includes updated information on the new products now offered by the suppliers whose CR systems we examined in August 2001. In addition, it describes the general developments that have occurred in CR technology. These developments include the use of new phosphor types to increase image quality and the wider implementation of wall-mounted touchscreens to improve workflow.
Equipment Design↗
CR/DR systems: what each technology offers today; what is expected for the future.
Computed radiography (CR) is considered by some to be the work-horse for digital image capture of general radiography exams because it is affordable, offers excellent image quality and exposure latitude and utilizes existing x-ray systems. CR systems deliver digital imaging to general radiology departments and lower-volume areas that can include hospital floors and outpatient imaging centers. Digital radiography (DR) technology is more expensive, but some believe it earns its keep with significant productivity gains and the capacity for higher image quality or lower dose. DR systems are especially appropriate for emergency room settings and high-volume areas in general radiology departments, orthopedic clinics, imaging centers and other facilities. Facilities with growing patient volumes and limited space often choose to install DR systems in one or 2 exam rooms to double the productivity of those rooms, while one or more CR systems serve the remaining rooms or remote areas. Patients benefit from both faster image capture (it takes less time for each imaging exam) and hospitals achieve a digital distribution process that speeds delivery of radiology reports to referring physicians and a more efficient imaging workflow that can lead to increased revenues.
Forecasting↗
Patient-controlled analgesic infusion pumps.
Patient-controlled analgesic (PCA) infusion pumps allow patients to self-administer doses of pain-relieving medication as needed, rather than having to summon a caregiver. The most significant risk when using these pumps is overmedication leading to narcotic-induced respiratory depression. Several current PCA pumps offer advanced error-reduction features designed to minimize the odds of an accidental overdose: dose error reduction systems, bar-code readers, and computer-based pump-programming systems that entail downloading infusion protocols via a hardwired connection to a PC. The availability of these features plays a dominant role in our ratings. We tested 11 pumps from seven suppliers. Two pumps are rated Preferred because they offer easy-to-use advanced error-reduction features that have been proven effective in a hospital setting. Two other pumps offer computer-based programming and are rated Acceptable, although we note that not all facilities may be able to accommodate the workflow necessary to use the computer-based programming. The remaining pumps are rated Not Recommended because they lack advanced error-reduction features; although most of these pumps perform acceptably, better choices are available.
Analgesia, Patient-Controlled↗
Capitalizing on current technology to improve the electrocardiogram data management process.
Concord Hospital was able to use an existing electrocardiogram (ECG) data management system to greatly improve efficiency regarding the managing, interpreting, viewing, and reporting of ECGs. By taking advantage of the full capabilities of the current ECG data management system, Tracemaster, we were able to design a workflow process to allow any physician to view and interpret electronically any current or previous ECGs from any computer.
Efficiency, Organizational↗
Selective isolation of glycoproteins and glycopeptides for MALDI-TOF MS detection supported by magnetic particles.
Glycosylation is the most common form of posttranslational modification of proteins (50-80%). The isolation, discovery, and subsequent identification of glycosylated peptides and proteins is becoming more and more important in glycoproteomics and diagnosis. MALDI-TOF mass spectrometry is an ideal technique for identifying peptides and proteins and their corresponding modifications. The enrichment of glycosylated peptides and proteins from different sources can be attained by affinity chromatography supported by functionalized magnetic particles. Covalent coating of magnetic beads with Concanavalin A (ConA) and diboronic acid was performed by carbodiimide and poly-glutaraldehyde methods, respectively. The functionalized beads were employed to establish and optimize protocols for the binding and detection of glycosylated peptides and proteins with respect to an automated workflow and the subsequent detection and identification by MALDI-TOF mass spectrometry. For several model proteins, the capture and identification could be demonstrated by SDS-PAGE and MALDI-TOF mass spectrometry. According to the type of glycosylation (high man-nose, hybrid, or complex type) the different proteins were enriched by ConA or boronic acid-functionalized beads.
Animals↗
The Swiss Orthopaedic Registry.
Following the tradition of the IDES European Hip Registry inaugurated by M. E. Müller in the 1960s, the Institute for Evaluative Research in Orthopaedic Surgery at the University of Bern started a new era of data collection using internet technology (www.memdoc.org). With support of the Swiss Orthopaedic Society, the pilot of the Swiss Orthopaedic Registry was conducted, and in cooperation with different academic and non-academic centers the practicability of integrating the various data collection instruments into the daily clinical workflow was evaluated. Three different sizes of hip and knee questionnaires were compiled, covering the individual demands of the participating hospitals whereby the smaller questionnaires always represent a subset of the next larger one. Different types of data collection instruments are available: the online interface, optical mark reader paper questionnaires, and barcode sheets. Precise implant tracking is implemented by scanning the implant barcodes directly in the operating theaters and linking them to the clinical data set via a central server. In addition, radiographic information can be linked with the clinical data set. The pilot clinics suggested enhancements to the user interface and additional features for data management. Also, recommendations were made to simplify content in some instances and diversify in others. With a new software release and adapted questionnaires the Swiss Orthopaedic Registry was officially launched in Summer 2005.
Arthroplasty, Replacement, Hip↗
A generic concept for large-scale microarray analysis dedicated to medical diagnostics.
BACKGROUND: The development of diagnostic procedures based on microarray analysis confronts the bioinformatician and the biomedical researcher with a variety of challenges. Microarrays generate a huge amount of data. There are many, not yet clearly defined, data processing steps and many clinical response variables which may not match gene expression patterns. OBJECTIVES: To design a generic concept for largescale microarray experiments dedicated to medical diagnostics; to create a system capable of handling several 1000 microarrays per analysis and more than 100 clinical response variables; to design a standardized workflow for quality control, data calibration, identification of differentially expressed genes and estimation of classification accuracy; and to provide a user-friendly interface for clinical researchers with respect to biomedical interpretation. METHODS: We designed a database structure suitable for the storage of microarray data and analysis results. We applied statistical procedures to identify differential genes and developed a technique to estimate classification accuracy of gene patterns with confidence intervals. RESULTS: We implemented a Gene Analysis Management System (GAMS) based on this concept, using MySQL for data storage, R/Bioconductor for analysis and PHP for a web-based front-end for the exploration of microarray data and analysis results. This system was utilized with large data sets from several medical disciplines, mainly from oncology (approximately 2000 microarrays). CONCLUSIONS: A systematic approach is necessary for the analysis of microarray experiments in a medical diagnostics setting to get comprehensible results. Due to the complexity of the analysis, data processing (by bioinformaticians) and interactive exploration of results (by biomedical experts) should be separated.
Adult↗
Clinical guidelines as plans--an ontological theory.
OBJECTIVE: Clinical guidelines are special types of plans realized by collective agents. We provide an ontological theory of such plans that is designed to support the construction of a framework in which guideline-based information systems can be employed in the management of workflow in health care organizations. METHOD: The framework we propose allows us to represent, in formal terms, how clinical guidelines are realized through the actions of individuals or ganized into teams. We provide various levels of implementation representing different levels of conformity on the part of health care organizations. RESULT: Implementations built in conformity with our framework are marked by two dimensions of flexibility that are designed to make them more likely to be accepted by health care professionals than standard guideline-based management systems. They do justice to the fact 1) that responsibilities within a health care organization are widely shared, and 2) that health care professionals may on different occasions be non-compliant with guidelines for a variety of well justified reasons. CONCLUSION: The advantage of the framework lies in its built-in flexibility, its sensitivity to clinical context, and its ability to use inference tools based on a robust ontology. One disadvantage lies in its complicated implementation.
Decision Support Systems, Clinical↗
Ask the experts. Single assessment process.
Person-centred assessments must reduce duplication of effort, promote effective communication between professionals and organisations, and lead to optimum, timely interventions with better patient outcomes. Wilson et al (2005) say: 'Successful implementation of SAP requires local agencies to develop effective approaches to whole system working and the delivery of integrated care. Little new seems to have been learnt about what makes integrated care work best since studies reported in the late 80s. However, in the implementation of SAP, effective improvements in joint working arrangements have been observed in areas where high level strategic understanding, commitment, and strong project leadership are present.' The benefits of an electronic system to support information exchange and workflow management are obvious. Some areas have managed to implement small scale IT pilots, but electronic versions of SAP are only a reality in those areas that are already piloting SAP solutions with their local service provider as part of the NPflT (National Programme for IT in the NHS). Nurse consultants have expressed frustration that the speed of IT development is not keeping pace with the appetite for SAP implementation. Contributors demonstrate how those not in the forefront of IT developments can make good use of the interim time by promoting the principles of the single assessment process and ensuring a commitment to SAP is maintained.
Aged↗