Health Care Systems, Technology / 15.10.2024

  With medical needs escalating and technology advancing at an incredible pace, the speed of patient care is about to become much faster and more effective. Healthcare organizations are under pressure to do more with less. Businesses are finally able to leave their tech logjam behind when they plug into lean IT project services. Suddenly, the thorny vines of procedure fall away, and genuine innovation gets a second wind. Low costs don't mean low-quality care.. What if healthcare operations could run like a well-oiled machine? For that to happen, they need to corral their IT projects, but that's a tall order given the specific challenges they face.

Streamlining Operations Through Digital Transformation

Hospitals and clinics are constantly faced with the challenge of reducing costs without sacrificing the level of care their patients receive. Efficient IT project services facilitate the implementation of digital tools and technologies that improve operational workflows and processes. One area where IT project services provide critical support is electronic health record (EHR) integration. Healthcare goes high-tech when EHR systems are properly set up. It's like having a bird’s-eye view of a patient's entire journey, allowing doctors to spot connections and make swift, informed decisions. Under the watchful eye of regulatory authorities like HIPAA, IT project managers expertly integrate these systems, implementing checks and balances to prevent malfunctions and mishaps. When automation technologies are properly integrated, they morph administrative tasks into background noise, allowing healthcare professionals to redirect their attention to the ones who need it most: their patients. Think of automation as a behind-the-scenes team player. By handing over the routine tasks, healthcare pros can refocus on what matters most: providing top-notch care. (more…)
Legal-Malpractice, Technology / 05.09.2024

Medical negligence claims can have serious financial and reputational consequences for hospitals and medical businesses. In recent years, there has been a concerted effort within the healthcare industry to mitigate these risks by improving practices, upgrading equipment, and implementing more robust training programs. By taking proactive measures, hospitals and medical businesses aim to reduce the likelihood of medical errors, enhance patient safety, and provide the highest standard of care. This article explores the various strategies that healthcare providers are adopting to prevent potential medical negligence claims and ensure patient trust and safety. One of the most significant ways hospitals and medical businesses are leveling up is by investing in state-of-the-art medical equipment. Modern, reliable equipment is crucial for accurate diagnosis, effective treatment, and overall patient safety. Outdated or malfunctioning equipment can lead to misdiagnosis, delayed treatment, and, ultimately, medical negligence claims. (more…)
Author Interviews, Health Care Systems, Sleep Disorders / 16.02.2023

MedicalResearch.com Interview with: Michael R. Schutz, Ph.D. Professor of Music Cognition/Percussion at McMaster University Founding director of the MAPLE Lab and Core member of the McMaster Institute for Music and the Mind. Prof. Schutz is also a professional musician and directs McMaster’s percussion ensemble.   MedicalResearch.com: What is the background for this study? Response: Hospitals around the world are filled with devices generating aconstant stream of tones conveying information to medical staff.overburdened healthcare professionals, and contributes to burnout inmedical staff.  The Emergency Care Research Institute (ECRI) regularlyincludes problems with auditory alarms in their list of "Top 10 HealthTechnology Hazards" and they  are so problematic an FDA surveyimplicated them in hundreds of patient deaths.While there is currently a lot of interest in how to improve alarmmanagement protocols, this study is different in that it looks atimproving the quality of the alarm sounds themselves.  For historicalreasons many default to simplistic "beeps" which are generallyannoying.  While annoying is useful for critical alarms requiringimmediate action, the vast majority of these messages are merelyintended to update medical staff of changes (i.e. blood pressure isrising) or indicate other situations that do not require immediateaction. Unfortunately, many machines use the same simplistic andannoying "beeps" regardless of whether the messages are urgent ornon-urgent.  This constant flood of annoying beeps negatively affectsboth patients (extending recovery time due to interrupted rest) andstaff (who can develop "alarm fatigue" from the constant cacophony). (more…)
Author Interviews, Health Care Systems, JAMA, Sleep Disorders, Yale / 18.01.2023

MedicalResearch.com Interview with: César Caraballo-Cordovez, MD Postdoctoral Associate Yale/YNHH Center for Outcomes Research and Evaluation (CORE) New Haven, CT 06511 MedicalResearch.com: What is the background for this study? What are the main findings? Response: Our group has been interested in how patients’ experience during hospitalization impacts their recovery and their health for a while. In 2013, Dr. Harlan Krumholz (senior author of the current study) identified that patients who were recently hospitalized experienced a period of generalized risk for myriad adverse health events, a condition that he named ‘post-hospital syndrome’. One of the possible explanations for this observation is that the stress from being hospitalized negatively impacts patients’ health during their stay in the hospital and after being discharged. The stress in a hospital may come from different sources–including sleep deprivation. Sleep is fundamental for recovery, and there are many challenges for patients to have adequate sleep while being hospitalized. Among the many sources of sleep interruption are early morning blood draws. Blood draws are often performed in the early morning in order to have recent lab tests results available during morning medical rounds. However, this common practice may disrupt patients’ recovery by interrupting their sleep. We were interested in determining to what extent blood draws contribute to early morning sleep disruptions and whether there has been recent progress in reducing them. We used data from Yale New Haven Hospital from 2016 to 2019 and found that nearly 4 in 10 of total daily blood draws were collected between 4:00am and 7:00am–a proportion that was persistently high over the 3 years we studied. Importantly, we found that this occurred across patients with different sociodemographic characteristics, including older individuals who are at highest risk of adverse health events from sleep deprivation. (more…)
Author Interviews, BMJ, Brigham & Women's - Harvard, Education, Health Care Systems, Sleep Disorders / 20.05.2022

MedicalResearch.com Interview with: Dr Matthew D Weaver M.P.H., Ph.D. Division of Sleep and Circadian Disorders Departments of Medicine and Neurology Brigham and Women's Hospital Boston, Massachusetts MedicalResearch.com:  What is the background for this study?  Response: The name “resident” stems from the historical practice of resident-physicians residing in hospitals as part of their training. Even after that practice abated, it was common for resident physicians to work 36 consecutive hours followed by 12 or fewer hours of rest. In 1989, the state of New York restricted resident physicians to work no more than 24 consecutive hours and no more than 80 hours per week as part of collective intervention to improve patient safety. The Accreditation Council for Graduate Medical Education (ACGME) then followed in 2003 by limiting work hours to an average of 80 per week over a month and no more than 30 consecutive hours of work. Evidence accumulated demonstrating an association between shifts lasting ≥24 hours and adverse resident and patient safety. As a result, the Institute of Medicine convened a review and report on the issue, ultimately concluding that no resident should work more than 16 consecutive hours without sleep. This recommendation, combined with evidence following the 2003 rules, led the ACGME to issue new rules in 2011 that limited first-year resident physicians to work no more than 16 consecutive hours. Our study compares resident-reported patient safety outcomes before and after this 2011 policy change. (more…)
Technology / 08.10.2021

Three way hospitals have changedThe evolution of hospitals is truly something to marvel at. Modern-day hospitals perform ground-breaking procedures, unearth new and improved ways of caring for patients, and constantly evolve thanks to regular inspections. Hospitals have had to advance because of the ever-growing demands of the public - and the Guardian reported there are still 5.6 million people waiting for treatment. With so many people waiting, how are hospitals coping with the increased demand? They're evolving - and here's how. (more…)
Author Interviews, CDC, COVID -19 Coronavirus, Emory, JAMA, Occupational Health / 12.03.2021

MedicalResearch.com Interview with: Jesse T. Jacob, MD School of Medicine Director, Antibiotic Stewardship Program Emory University, Atlanta, Georgia MedicalResearch.com: What is the background for this study? Response: Since coronavirus disease 2019 (COVID-19) was recognized in the United States in January 2020, the risk of infection with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) attributed to exposures in the health care workplace has been studied with conflicting results, and the role of job functions (such as nurse) or specific workplace activities, including care for individuals with known and unknown SARS-CoV-2 positivity, increase the risk of SARS-CoV-2 infection. We assessed more than 24,000 healthcare providers between April and August 2020 across four large academic medical systems (Emory, Johns Hopkins, Rush University Medical Center, and University of Maryland) which collaborate in the CDC’s Prevention Epicenter Program and conduct innovative infection prevention research. Each site conducted voluntary COVID-19 antibody testing on its health care workers, as well as offered a questionnaire/survey on the employees’ occupational activities and possible exposures to individuals with COVID-19 infection both inside and outside the workplace. We also looked at three-digit residential zip-code prefixes to determine COVID-19 prevalence in communities.   (more…)
Author Interviews, Brigham & Women's - Harvard, Cost of Health Care, COVID -19 Coronavirus, Electronic Records, JAMA, Technology / 04.03.2021

MedicalResearch.com Interview with: Carlo Giovanni Traverso, MB, BChir, PhD Associate Physician, Brigham and Women's Hospital Assistant Professor, Peter R. Chai, MD, MMS Emergency Medicine Physician and Medical Toxicologist Harvard Medical School Brigham and Women's Hospital Department of Medicine   Dr-Spot-HealthCare-Assistant.jpgMedicalResearch.com: What is the background for this study? What are some of the functions that Dr. Spot can facilitate? Response: During the COVID-19 pandemic, we wanted to consider innovative methods to provide additional social distance for physicians evaluating low acuity individuals who may have COVID-19 disease in the emergency department. While other health systems had instituted processes like evaluating patients from outside of emergency department rooms or calling patients to obtain a history, we considered the use of a mobile robotic system in collaboration with Boston Dynamics to provide telemedicine triage on an agile platform that could be navigated around a busy emergency department. Dr. Spot was built with a camera system to help an operator navigate it through an emergency department into a patient room where an on-board tablet would permit face-to-face triage and assessment of individuals. (more…)
Author Interviews, COVID -19 Coronavirus, Hospital Acquired, Infections, JAMA / 10.09.2020

MedicalResearch.com Interview with: Chanu Rhee MD MPH Associate Hospital Epidemiologist Attending Physician, Infectious Diseases and Critical Care Medicine Assistant Professor of Medicine Brigham and Women's Hospital MedicalResearch.com: What is the background for this study?   Response: Many patients have been avoiding essential care during the COVID-19 pandemic due to fear of contracting SARS-CoV-2 in healthcare settings. Little is known, however about the adequacy of infection control practices in preventing nosocomial COVID-19 in U.S. acute care hospitals. We therefore conducted this observational study to determine the incidence of nosocomial COVID-19 in patients hospitalized at a large academic medical center in Boston (Brigham and Women’s Hospital) during the first 12 weeks of the surge in Massachusetts.    (more…)
Author Interviews, Health Care Systems, JAMA / 22.07.2020

MedicalResearch.com Interview with: Reshma Jagsi, M.D., D.Phil. Newman Family Professor and Deputy Chair Department of Radiation Oncology Director of the Center for Bioethics and Social Sciences in Medicine University of Michigan  MedicalResearch.com: What is the background for this study? Response: Hospitals and health care institutions often rely on philanthropy for support to be able to pursue their missions to serve the public health. Little is known about public perspectives, which are needed to inform ethical guidelines. (more…)
Abuse and Neglect, COVID -19 Coronavirus, Infections / 10.06.2020

MedicalResearch.com Interview with: Edmond A. Hooker, MD, DrPH Professor, Department of Health Services Administration MHSA Associate Director for Accreditation Xavier University Cincinnati, Ohio  MedicalResearch.com: What is the background for this study? Response: Healthcare acquired infections are still a huge problem in the US. Most hospitals are not following the hospital bed manufacturers guidelines for cleaning these mattresses and bed decks (the metal bed frame). Many use only a single step, when the manufacturers recommend a 5-6 step process (pre-clean any obvious soil, clean, rinse off cleaner, disinfect, rinse off disinfectant, inspect mattress for damage). The problem is that, if done, this takes 45 minutes to 1 hours. Most hospitals turn over a hospital room in less than 30 minutes. The launderable bed cover allows the bed to be cleaned and turned over in minutes, not an hours.  (more…)
Author Interviews, Cancer Research, JAMA, Yale / 28.05.2020

MedicalResearch.com Interview with: Daniel J. Boffa, MD Associate Professor of Thoracic Surgery Yale School of Medicine MedicalResearch.com: What is the background for this study? Response: The study examined networks that formed around hospitals that had been previously ranked in the top-50 by US News and World Report.  These top-ranked hospitals have shared their brand with hospitals in their network, which leads some people to believe that the care is the same at top-ranked hospitals and their affiliate hospitals.  We wanted to determine if outcomes after complex surgical procedures were truly the same at affiliate hospitals and top-ranked hospitals.  (more…)
Author Interviews, Cost of Health Care, JAMA, Opiods / 01.04.2020

MedicalResearch.com Interview with: Aparna Soni PhD, Assistant Professor Department of Public Administration and Policy School of Public Affairs American University Washington, DC MedicalResearch.com: What is the background for this study? Response: The United States is in the midst of an opioid epidemic. Opioids are responsible for nearly 50,000 deaths per year and present a substantial financial burden on hospitals. The rate of opioids-related hospital events has tripled since 2005. We are particularly concerned about rising hospitalizations because they may stem from a lack of access to treatment for individuals with opioid use disorder. Medication-assisted treatment is effective in treating opioid use disorder but can be unaffordable for people without health insurance. (more…)
Author Interviews, Health Care Systems, JAMA, Social Issues / 14.01.2020

MedicalResearch.com Interview with: Elizabeth Tung MD MS Section of General Internal Medicine Instructor of Medicine University of Chicago MedicalResearch.com: What is the background for this study? Response: Medicare provides hospital ratings for all Medicare-certified hospitals in the U.S. based on quality metrics, including mortality, patient experience, hospital readmissions, and others. While ratings are important for comparing hospitals, there's been some concern that some of these quality metrics are outside a hospital's control, especially for hospitals taking care of vulnerable or socially complex patient populations. Take "timeliness of care" as a quality metric, for instance--this measure includes emergency room wait times. But in places that are medically underserved and have very few emergency rooms, these wait times will inevitably be much higher. What this means is that hospitals taking care of medically underserved populations end up getting lower quality ratings, even though they're addressing health disparities by filling an access gap. (more…)
Author Interviews, Health Care Systems, JAMA / 30.12.2019

MedicalResearch.com Interview with: Maryam Guiahi MD, MSc Associate Professor of Obstetrics and Gynecology University of Colorado Denver School of Medicine MedicalResearch.com: What is the background for this study? Response: The composition of the U.S health care system is shifting; between 2001 to 2016 the number of Catholic-owned or affiliated health facilities grew by 22% in contrast to the overall number of acute care hospitals that decreased by 6% and the number of other nonprofit religious hospitals that decreased by 38%. This is relevant as Catholic health care systems enforce religious directives that restrict many aspects of reproductive care and certain aspects of end-of-life care.  Yet little is known about the extent to which U.S. patients consider religious affiliation when selecting a health care facility.  (more…)
Author Interviews, Cost of Health Care, Health Care Systems / 06.09.2019

MedicalResearch.com Interview with: Vivian Ho, PhD The James A. Baker III Institute Chair in Health Economics Director of the Center for Health and Biosciences Rice's Baker Institute for Public Policy MedicalResearch.com: What is the background for this study? Response: In 2003, approximately 29% of U.S. hospitals employed physicians, a number that rose to 42% by 2012. The share of physician practices owned by hospitals rose from 14% in 2012 to 29% in 2016. Economists refer to these relationships between hospitals and physicians as vertical integration, because they represent hospitals exerting more control over physicians as an essential part of inpatient care. As hospitals gain more control over physicians, they may incentivize delivery of more services but not necessarily higher quality care. When we launched this study, we hypothesized that tighter integration of physicians with hospitals would improve care coordination. (more…)
Author Interviews, Brigham & Women's - Harvard, JAMA, Medicare / 28.08.2019

MedicalResearch.com Interview with: Jose F. Figueroa, MD, MPH Instructor , Harvard Medical School, Department of Medicine Brigham and Women’s Hospital  MedicalResearch.com: What is the background for this study? Response: Hospitalizations related to ambulatory-care sensitive conditions are widely considered a key measure of access to high-quality ambulatory care. It is included as a quality measure in many national value-based care programs. To date, we do not really know whether rates of these avoidable hospitalizations are meaningfully improving for Medicare beneficiaries over time. (more…)
Author Interviews, Critical Care - Intensive Care - ICUs, JAMA, Mental Health Research, Outcomes & Safety / 16.07.2019

MedicalResearch.com Interview with: MedicalResearch.com Interview with: Regis Goulart Rosa, MD, PhD Responsabilidade Social - PROADI Hospital Moinhos de Vento MedicalResearch.com: What is the background for this study? Response: The debate about visiting policies in adult ICUs is of broad and current interest in critical care, with strong advocacy in favour of flexible family visitation models in order to promote patient- and family-centred care. However, the proportion of adult ICUs with unrestricted visiting hours is very low. Data from the literature show that 80% of hospitals in the United Kingdom and USA adopt restrictive ICU visiting policies. Among ICUs with restrictive visiting hours, published studies show that the daily visiting time ranges from a median of 1 hour in Italy to a mean of 4.7 hours in France. In agreement with this scenario, most adult ICUs in Brazil follow a restrictive visitation model, in which family members are allowed to visit the critically ill patient from 30 minutes to 1 hour, once or twice a day. These restrictive visitation models have been justified by the theoretical risks associated with unrestricted visiting hours, mainly infectious complications, disorganization of care, and burnout. Controversially, these risks have not been consistently confirmed by the scarce literature on the subject, and flexible ICU visiting hours have been proposed as a means to prevent delirium among patients and improve family satisfaction. MedicalResearch.com: What are the main findings? Response: Disappointingly, studies evaluating the effectiveness and safety of flexible ICU visiting hours are scarce. To date, no large randomized trials have assessed the impact of a flexible visiting model on patients, family members, and ICU staff, and this evidence gap may constitute a barrier to the understanding of the best way to implement and improve ICU visiting policies. In the present pragmatic cluster-randomized crossover trial (The ICU Visits Study), we engaged 1,685 patients, 1,295 family members, and 826 ICU professionals from 36 adult ICUs in Brazil to compare a flexible visitation model (12 hours/day plus family education) vs. the standard restricted visitation model (median 90 minutes per day). We found that the flexible visitation did not significantly reduce the incidence of delirium among patients, but was associated with fewer symptoms of anxiety and depression and higher satisfaction with care among family members in comparison to the usual restricted visitation. Also, the flexible visitation did not increase the incidence of ICU-acquired infections and ICU staff burnout, which are major concerns when adopting this intervention. MedicalResearch.com: What should readers take away from your report? Response: Considering the evidence suggesting that most adult ICUs restrict the presence of family members, our results provide useful and relevant information that may influence the debate about current ICU visitation policies around the world. First, a flexible visitation policy that permits flexible family visitation in ICU (up to 12 hour per day) is feasible, given the high adherence of participant ICUs to implementation in The ICU Visits Study. Second, the flexible family supported by family education is safe regarding the occurrence of infections, disorganization of care or staff burnout. Third, family members - a commonly missing piece of the critical care puzzle - seem to benefit from the flexible visitation model through higher satisfaction with care and less symptoms of anxiety and depression. MedicalResearch.com: What recommendations do you have for future research as a result of this work? Response: Future research might focus on the following topics: 1) methods of implementation of flexible visiting models in ICUs; 2) Family support interventions in the context of flexible ICU visiting hours (e.g.: psychological and social support, support for shared decision making, peer support, and comfort); and 3) How flexible ICU visiting hours affects patient, family member and staff outcome at long-term. Disclosures: The ICU Visits study was funded by the Brazilian Ministry of Health through the Brazilian Unified Health System Institutional Development Program (PROADI-SUS). Citation: Effect of Flexible Family Visitation on Delirium Among Patients in the Intensive Care Unit [wysija_form id="3"] [last-modified] The information on MedicalResearch.com is provided for educational purposes only, and is in no way intended to diagnose, cure, or treat any medical or other condition. Always seek the advice of your physician or other qualified health and ask your doctor any questions you may have regarding a medical condition. In addition to all other limitations and disclaimers in this agreement, service provider and its third party providers disclaim any liability or loss in connection with the content provided on this website.Regis Goulart Rosa, MD, PhD Responsabilidade Social - PROADI Hospital Moinhos de Vento  MedicalResearch.com: What is the background for this study? Response: The debate about visiting policies in adult ICUs is of broad and current interest in critical care, with strong advocacy in favour of flexible family visitation models in order to promote patient- and family-centred care. However, the proportion of adult ICUs with unrestricted visiting hours is very low. Data from the literature show that 80% of hospitals in the United Kingdom and USA adopt restrictive ICU visiting policies. Among ICUs with restrictive visiting hours, published studies show that the daily visiting time ranges from a median of 1 hour in Italy to a mean of 4.7 hours in France. In agreement with this scenario, most adult ICUs in Brazil follow a restrictive visitation model, in which family members are allowed to visit the critically ill patient from 30 minutes to 1 hour, once or twice a day. These restrictive visitation models have been justified by the theoretical risks associated with unrestricted visiting hours, mainly infectious complications, disorganization of care, and burnout. Controversially, these risks have not been consistently confirmed by the scarce literature on the subject, and flexible ICU visiting hours have been proposed as a means to prevent delirium among patients and improve family satisfaction.  (more…)
Author Interviews, JAMA, Outcomes & Safety, Surgical Research / 19.06.2019

MedicalResearch.com Interview with: William Cooper, M.D., M.P.H. Cornelius Vanderbilt Professor Pediatrics and Health Policy Associate Dean for Faculty Affairs Director, Center for Patient and Professional Advocacy Vanderbilt University Medical Center MedicalResearch.com: What is the background for this study?   Response: For surgical teams, high reliability and optimal performance are dependent on effective communication, mutual respect, and continuous situational awareness. Surgeons who model unprofessional behaviors may contribute to undermining a culture of safety, threaten teamwork, and thereby increase risk for medical errors and surgical complications. (more…)
Author Interviews, Frailty, Hospital Readmissions, JAMA, Stanford, Surgical Research / 27.05.2019

MedicalResearch.com Interview with: hospital-frailty-surgeryKara Anne Rothenberg.MD Postdoctoral Research Fellow, Vascular Surgery Shipra Arya, MD SM FACS Associate Professor of Surgery Stanford University School of Medicine MedicalResearch.com: What is the background for this study? Response: There is a growing body of literature showing that frailty, a syndrome where patients have increased vulnerability to a stressor (such as surgery), is associated with increased postoperative complications, failure to rescue, and hospital readmissions. The Risk Analysis Index (RAI), is an easy to use frailty measurement tool that better predicts postoperative mortality than age or comorbidities alone. As the rates of outpatient surgeries rise nationwide, we noted that most of the surgical frailty studies focus only on inpatient surgeries. Elective, outpatient surgery is generally considered low risk for complications and unplanned readmissions, however we hypothesized that for frail patients, it might not be. (more…)
Author Interviews, Education, Outcomes & Safety / 08.05.2019

MedicalResearch.com Interview with: Veronica Toffolutti PhD Postdoctoral researcher working with Professor David Stuckler Department of Sociology Bocconi University MedicalResearch.com: What is the background for this study? What are the main findings? Response: Openness has been linked with better patient safety and better understanding of patients’ care goals. In addition, more open environments appear to be linked with positively ranked quality of teamwork, which in turns lead to better health care. Yet if the expected benefits are to be achieved, it is necessary to show that greater openness actually corresponds to improvements in performance or lower mortality rates. To the best of our knowledge our is the first study to show an association between hospital mortality and openness and more precisely one point increase in the standardized openness score leads to a decrease of 6.48% in the hospital mortality rates. With the term openness we refer to an environment in which communication among patients, staff members and managers is open and transparent.  (more…)
Author Interviews, Hospital Acquired, Infections / 07.05.2019

Genetically Fast-Changing Superbugs at Hospitals Require More Stringent Cleaning MethodsThe number of deaths caused by resistant bacteria is expected to reach 10 million by 2025, according to the Centers of Disease Control and Prevention. A highly resistant bacteria found in hospitals - Klebsiella pneumoniae - is now a big global threat, according to a recent (April, 2019) study published by researchers from University College London. Researchers have issued a warning that more stringent cleaning of infectious wards and new air disinfection protocols are key to battling the bug. This is because this bacteria possesses the ability to change genetically at an alarming rate, adapting and essentially nullifying the effect of all current antibiotics. (more…)
Author Interviews, Education, Health Care Systems / 14.03.2019

MedicalResearch.com Interview with: Nicholas A. Rattray, Ph.D. Research Scientist/Investigator VA HSR&D Center for Health Information and Communication Implementation Core, Precision Monitoring to Transform Care (PRISM) QUERI Richard L. Roudebush Veterans Affairs Medical Center Indiana University Center for Health Services & Outcomes Research Regenstrief Institute, Inc. Indianapolis, Indiana on behalf of study co-authors re: Rattray NA, Flanagan ME, Militello LG, Barach P, Franks Z, Ebright P, Rehman SU, Gordon HS, Frankel RM MedicalResearch.com: What is the background for this study? What are the main findings?  Response: End-of-shift handoffs pose a substantial patient safety risk. The transition of care from one doctor to another has been associated with delays in diagnosis and treatment, duplication of tests or treatment and patient discomfort, inappropriate care, medication errors and longer hospital stays with more laboratory testing. Handoff education varies widely in medical schools and residency training programs. Although there have been efforts to improve transfers of care, they have not shown meaningful improvement. Led for the last decade by Richard Frankel, Ph.D., a senior health scientist at Regenstrief Institute and Indiana University and professor at Indiana University School of Medicine, our team has studied how health practitioners communicate during end-of-shift handoffs. In this current study, funded by VA Health Services and Research Development, we conducted interviews with 35 internal medicine and surgery residents at three VA medical centers about a recent handoff and analyzed the responses. Our team also video-recorded and analyzed more than 150 handoffs. Published in the Journal of General Internal Medicine, this study explains how the person receiving the handoff can affect the interaction. Medical residents said they changed their delivery based on the doctor or resident who was taking over (i.e., training level, preference for fewer details, day or night shift). We found that handoff communication involves a complex combination of socio-technical information where residents balance relational factors against content and risk. It is not a mechanistic process of merely transferring clinical data but rather is based on learned habits of communication that are context-sensitive and variable, what we refer to as “recipient design”. In another paper led by Laura Militello, we focus on how residents cognitively prepare for handoffs. In the paper published in The Joint Commission Journal of Quality and Patient Safety®, researchers detailed the tasks involved in cognitively preparing for handoffs. A third paper, published in BMC Medical Education, reports on the limited training that physicians receive during their residency. Residents said they were only partially prepared for enacting handoffs as interns, and clinical experience and enacting handoffs actually taught them the most.   (more…)
Author Interviews, Health Care Systems, Opiods / 28.02.2019

MedicalResearch.com Interview with: Cory E. Cronin PhD Department of Social and Public Health Ohio University College of Health Sciences and Professions Athens, Ohio MedicalResearch.com: What is the background for this study? What are the main findings?  Response: One of my primary areas of research is exploring how hospitals interact with their local communities. My own background is in health administration and sociology, and I have been working with colleagues in the Heritage College of Osteopathic Medicine here at Ohio University (Berkeley Franz, Dan Skinner and Zelalem Haile) to conduct a series of studies looking at questions related to these hospital-community interactions. This particular question occurred to us because of the timeliness of the opioid epidemic. In analyzing data collected from the American Hospital Association and other sources, we identified that the number of hospitals offering in-patient and out-patient substance use disorder services actually dropped in recent years, in spite of the rising number of overdoses due to opioid use. Other factors seemed to matter more in regard to whether a hospital offered these services or not. (more…)
Author Interviews, Hospital Readmissions, JAMA, Nursing / 29.01.2019

MedicalResearch.com Interview with: Marianne Weiss DNSc RN READI study Principal Investigator Professor of Nursing and Wheaton Franciscan Healthcare / Sister Rosalie Klein Professor of Women’s Health Marquette University College of Nursing Milwaukee Wi, 53201-1881 MedicalResearch.com: What is the background for this study? What are the main findings? Response: Our team of researchers has been studying the association of patient readiness for discharge and readmission for several years. We have previously documented that patients who had ‘low readiness’ on our Readiness for Hospital Discharge Scale were more likely to be readmitted. In this study we added structured protocols for discharge readiness assessment and nurse actions to usual discharge care practices to determine the optimal protocol configuration to achieve improved post-discharge utilization outcomes. In our primary analysis that included patients from a broad range of patient diagnoses, we did not find a significant effect on readmission from adding any of the discharge readiness assessment protocols. The patient sample came from Magnet hospitals, known for high quality care, and the average all-cause readmission rates were low (11.3%). In patients discharged from high-readmission units (>11.3%), one of the protocols was effective in reducing the likelihood of readmission. In this protocol, the nurse obtained the patients self-report of discharge readiness to inform the nurse’s discharge readiness assessment and actions in finalizing preparations for discharge. This patient-informed discharge readiness assessment protocol produced a nearly 2 percentage point reduction in readmissions. Not unexpectedly, in lower readmission settings, we did not see a reduction in readmission; not all readmissions are preventable. In the last phase of study, we informed nurses of a cut-off score for ‘low readiness’ and added a prescription for nurse action only in cases of ‘low readiness’; this addition to the protocol added burden to the nurses’ daily work and eliminated the beneficial effects, perhaps because it limited the nurse’s attention to only a subset of patients.  (more…)
Author Interviews, Hospital Readmissions, JAMA, Primary Care / 28.01.2019

MedicalResearch.com Interview with: Dr. Dawn Wiest, 7-day pledge after hospital admissionDawn Wiest, PhD Director, Action Research & Evaluation Camden Coalition of Healthcare Providers MedicalResearch.com: What is the background for this study? Response: Understanding the role of care transitions after hospitalization in reducing avoidable readmissions, the Camden Coalition launched the 7-Day Pledge in 2014 in partnership with primary care practices in Camden, NJ to address patient and provider barriers to timely post-discharge primary care follow-up. To evaluate whether our program was associated with lower hospital readmissions, we used all-payer hospital claims data from five regional health systems. We compared readmissions for patients who had a primary care follow-up within seven days with similar patients who had a later or no follow-up using propensity score matching. (more…)
Author Interviews, Health Care Systems / 17.01.2019

MedicalResearch.com Interview with: medicoreachLauren Williams Marketing Manager and  Research Analyst MedicoReach TwitterHandle: https://twitter.com/Lauren7321  MedicalResearch.com: What is the driving force behind the research and market study for estimating the hospitalist number in the US? Response: The existing physician’s database available in the industry comprises details that don’t specify the number of hospitalists in particular. As a result, it is turning out challenging to track and count the hospitalists amidst other specialties. There are a lot of incorrect estimations that are circulating, giving no clear picture. In a vast and growing industry like healthcare, there is no scope for wrong data as it can mislead others. Even the Physician Masterfile that the American Medical Association (AMA) offers do not cover the complete hospitalist population. This is because earlier the hospitalist specialty was not a part of the list of physicians. Hospitalists work as primary care providers specializing in inpatient medicine. They play a significant role, coordinating with specialist physicians and other healthcare professionals. As a caregiver, they provide quality hospital care and boosts efficiency through effective hospital resource allocation. And so, how can we let their presence go overlooked? Our research aimed to bring out their actual numbers before the industry. That is why our research team came up with the research and market study to fetch real facts.  (more…)