scholarly journals Safe use of the EHR by medical scribes: a qualitative study

2020 ◽  
Author(s):  
Joan S Ash ◽  
Sky Corby ◽  
Vishnu Mohan ◽  
Nicholas Solberg ◽  
James Becton ◽  
...  
Keyword(s):  
Patient Safety ◽  
Best Practices ◽  
Clinical Training ◽  
Rapid Assessment ◽  
Data Gathering ◽  
Assessment Process ◽  
Healthcare Organizations ◽  
Safety Risks ◽  
The Us ◽  
Medical Scribes

Abstract Objective Hiring medical scribes to document in the electronic health record (EHR) on behalf of providers could pose patient safety risks because scribes often have no clinical training. The aim of this study was to investigate the effect of scribes on patient safety. This included identification of best practices to assure that scribe use of the EHR is not a patient safety risk. Materials and Methods Using a sociotechnical framework and the Rapid Assessment Process, we conducted ethnographic data gathering at 5 purposively selected sites. Data were analyzed using a grounded inductive/hermeneutic approach. Results We conducted site visits at 12 clinics and emergency departments within 5 organizations in the US between 2017 and 2019. We did 76 interviews with 81 people and spent 80 person-hours observing scribes working with providers. Interviewees believe and observations indicate that scribes decrease patient safety risks. Analysis of the data yielded 12 themes within a 4-dimension sociotechnical framework. Results about the “technical” dimension indicated that the EHR is not considered overly problematic by either scribes or providers. The “environmental” dimension included the changing scribe industry and need for standards. Within the “personal” dimension, themes included the need for provider diligence and training when using scribes. Finally, the “organizational” dimension highlighted the positive effect scribes have on documentation efficiency, quality, and safety. Conclusion Participants perceived risks related to the EHR can be less with scribes. If healthcare organizations and scribe companies follow best practices and if providers as well as scribes receive training, safety can actually improve.

scholarly journals Essential activities for electronic health record safety: A qualitative study

2019 ◽  
Vol 26 (4) ◽  
pp. 3140-3151 ◽  
Author(s):  
Joan S Ash ◽  
Hardeep Singh ◽  
Adam Wright ◽  
Dian Chase ◽  
Dean F Sittig
Keyword(s):  
Best Practices ◽  
Electronic Health Record ◽  
Rapid Assessment ◽  
Clinical Decision ◽  
Assessment Process ◽  
Health Record ◽  
Healthcare Organizations ◽  
Safety Risks ◽  
Electronic Health ◽  
Clinical Systems

Electronic health record-caused safety risks are an unintended consequence of the implementation of clinical systems. To identify activities essential to assuring that the electronic health record is managed and used safely, we used the Rapid Assessment Process, a collection of qualitative methods. A multidisciplinary team conducted visits to five healthcare sites to learn about best practices. Although titles and roles were very different across sites, certain tasks considered necessary by our subjects were remarkably similar. We identified 10 groups of activities/tasks in three major areas. Area A, decision-making activities, included overseeing, planning, and reviewing to assure electronic health record safety. Area B, organizational learning activities, involved monitoring, testing, analyzing, and reporting. Finally, Area C, user-related activities, included training, communication, and building clinical decision support. To minimize electronic health record-related patient safety risks, leaders in healthcare organizations should ensure that these essential activities are performed.

SOLVING THE US HEALTHCARE PROBLEMS: THE ACTION STRATEGY

2013 ◽  
Vol 10 (03) ◽  
pp. 1340008 ◽  
Author(s):  
C. M. CHANG
Keyword(s):  
Best Practices ◽  
Healthcare System ◽  
Cost Reduction ◽  
Healthcare Organizations ◽  
Decision Factors ◽  
Action Strategy ◽  
Industrialized Nations ◽  
The Us ◽  
Critical Problems ◽  
The Cost

The US healthcare system costs more and delivers less service quality, in comparison with several industrialized nations. This paper describes the critical problems facing the US healthcare system, offers a comprehensive review of various best practices and emerging solutions to address the cost and quality issues, identifies a set of empirical observations from this review, and outlines a rational strategy, the ACTION strategy, to solve some of the noted US healthcare problems. The ACTION strategy, as proposed, takes into account the decision factors, which are important to any healthcare organizations, such as economic viability, technological feasibility, ease of implementation, operational efficiency, as well as being patient-focused, regulatory compliant and risk optimized. When adopted, this strategy should allow a majority of healthcare organizations to achieve steady progress toward cost reduction, quality enhancement, cycle time shortening and patient satisfaction. Practitioners in technology management are well prepared to assist healthcare organizations in implementing the elements of this strategy.

Feasibility evaluation of a pilot scribe-training program in an Australian emergency department

2018 ◽  
Vol 42 (2) ◽  
pp. 210 ◽  
Author(s):  
Katherine Walker ◽  
Matthew Johnson ◽  
William Dunlop ◽  
Margaret Staples ◽  
Hamish Rodda ◽  
...  
Keyword(s):  
Emergency Department ◽  
Training Program ◽  
Clinical Training ◽  
Hospital Setting ◽  
Training Course ◽  
The Us ◽  
Feasibility Evaluation ◽  
Observational Cohort ◽  
Medical Scribes ◽  
Preclinical Training

Objective Medical scribes have an emerging and expanding role in health, particularly in Emergency Medicine in the US. Scribes assist physicians with documentation and clerical tasks at the bedside while the physician consults with his or her patient. Scribes increase medical productivity. The aim of the present study was to examine the feasibility of a pilot hospital-administered scribe-training program in Australia and to evaluate the ability of an American training course (Medical Scribe Training Systems) to prepare trainee scribes for clinical training in an emergency department in Australia. Methods The present study was a pilot, prospective, observational cohort study from September 2015 to February 2016 at Cabrini Emergency Department, Melbourne. Scribe trainees were enrolled in the pre-work course and then trained clinically. Feasibility of training scribes and limited efficacy testing of the course was undertaken. Results The course was acceptable to users and demand for training exists. There were many implementation tasks and issues experienced and resources were required to prepare the site for scribe implementation. Ten trainees were enrolled for preclinical training. Six candidates undertook clinical training, five achieved competency (required seven to 16 clinical shifts after the preclinical course). The training course was helpful and provided a good introduction to the scribe role. The course required adaptation to a non-US setting and the specific hospital setting. In addition, it needed more detail in some common emergency department topics. Conclusion Training scribes at a hospital in Australia is feasible. The US training course used can assist with preclinical training. Course modification is required. What is known about the topic? Scribes increase emergency physician productivity in Australia. There is no previous work on how to train scribes in Australia. What does this paper add? We show that implementing a scribe-training program is feasible and that a training package can be purchased from the US to train scribes in Australia and that it is useful. We also show the adaptation that the course may require to meet Australian emergency department needs. What are the implications for practitioners? Scribes could become an additional member of the emergency department team in Australia and can be trained locally.

Cybersecurity in healthcare: Comparing cybersecurity maturity and experiences across global healthcare organizations (Preprint)

2020 ◽  
Author(s):  
Niki O'Brien ◽  
Guy Martin ◽  
Emilia Grass ◽  
Mike Durkin ◽  
Ara Darzi ◽  
...  
Keyword(s):  
Patient Safety ◽  
Electronic Health Records ◽  
Digital Technology ◽  
Data Security ◽  
Healthcare Organizations ◽  
Health Records ◽  
Cyber Threats ◽  
Raising Awareness ◽  
The World ◽  
Service Disruption

BACKGROUND Health systems around the world are increasingly reliant on digital technology. Such reliance requires that healthcare organizations consider effective cybersecurity and digital resilience as a fundamental component of patient safety, with recent cyberattacks highlighting the risks to patients and targeted organizations. OBJECTIVE The purpose of this study was to explore the current global cybersecurity landscape and maturity in healthcare. METHODS We developed and administered a survey to examine the current cybersecurity landscape and preparedness level across global healthcare organizations. RESULTS Cyber threats were a common concern for the 17 healthcare organizations who participated. The principal concerns highlighted were data security, including the manipulation or loss of electronic health records; loss of trust in the organization; and risks of service disruption. Cybersecurity maturity scoring showed that despite the majority of organizations having established cybersecurity practices, levels of awareness and education were universally poor. CONCLUSIONS Policymakers should consider raising awareness and improving education/training on cybersecurity as a fundamental tenet of patient safety.

The 6C model for accurately capturing the patient’s medical history

Diagnosis ◽  
2021 ◽  
Vol 0 (0) ◽  
Author(s):  
Taro Shimizu
Keyword(s):  
Artificial Intelligence ◽  
Differential Diagnosis ◽  
Patient Safety ◽  
Information Processing ◽  
Safety Concern ◽  
Data Gathering ◽  
Diagnostic Errors ◽  
Accurate Diagnosis ◽  
History Taking ◽  
Novel Approach

Abstract Diagnostic errors are an internationally recognized patient safety concern, and leading causes are faulty data gathering and faulty information processing. Obtaining a full and accurate history from the patient is the foundation for timely and accurate diagnosis. A key concept underlying ideal history acquisition is “history clarification,” meaning that the history is clarified to be depicted as clearly as a video, with the chronology being accurately reproduced. A novel approach is presented to improve history-taking, involving six dimensions: Courtesy, Control, Compassion, Curiosity, Clear mind, and Concentration, the ‘6 C’s’. We report a case that illustrates how the 6C approach can improve diagnosis, especially in relation to artificial intelligence tools that assist with differential diagnosis.

scholarly journals Acute care nurses’ perceptions of leadership, teamwork, turnover intention and patient safety – a mixed methods study

BMC Nursing ◽  
2021 ◽  
Vol 20 (1) ◽  
Author(s):  
Shahram Zaheer ◽  
Liane Ginsburg ◽  
Hannah J. Wong ◽  
Kelly Thomson ◽  
Lorna Bain ◽  
...  
Keyword(s):  
Patient Safety ◽  
Mixed Methods ◽  
Turnover Intention ◽  
Interactive Effect ◽  
Mixed Methods Study ◽  
Senior Leadership ◽  
Healthcare Organizations ◽  
Staff Perceptions ◽  
Leadership Support ◽  
The Impact

Abstract Background This study contributes to a small but growing body of literature on how context influences perceptions of patient safety in healthcare settings. We examine the impact of senior leadership support for safety, supervisory leadership support for safety, teamwork, and turnover intention on overall patient safety grade. Interaction effects of predictors on perceptions of patient safety are also examined. Methods In this mixed methods study, cross-sectional survey data (N = 185) were collected from nurses and non-physician healthcare professionals. Semi-structured interview data (N = 15) were collected from nurses. The study participants worked in intensive care, general medicine, mental health, or the emergency department of a large community hospital in Southern Ontario. Results Hierarchical regression analyses showed that staff perceptions of senior leadership (p < 0.001), teamwork (p < 0.01), and turnover intention (p < 0.01) were significantly associated with overall patient safety grade. The interactive effect of teamwork and turnover intention on overall patient safety grade was also found to be significant (p < 0.05). The qualitative findings corroborated the survey results but also helped expand the characteristics of the study’s key concepts (e.g., teamwork within and across professional boundaries) and why certain statistical relationships were found to be non-significant (e.g., nurse interviewees perceived the safety specific responsibilities of frontline supervisors much more broadly compared to the narrower conceptualization of the construct in the survey). Conclusions The results of the current study suggest that senior leadership, teamwork, and turnover intention significantly impact nursing staff perceptions of patient safety. Leadership is a modifiable contextual factor and resources should be dedicated to strengthen relational competencies of healthcare leaders. Healthcare organizations must also proactively foster inter and intra-professional collaboration by providing teamwork educational workshops or other on-site learning opportunities (e.g., simulation training). Healthcare organizations would benefit by considering the interactive effect of contextual factors as another lever for patient safety improvement, e.g., lowering staff turnover intentions would maximize the positive impact of teamwork improvement initiatives on patient safety.

Lessons in clinical reasoning – pitfalls, myths, and pearls: the contribution of faulty data gathering and synthesis to diagnostic error

Diagnosis ◽  
2021 ◽  
Vol 0 (0) ◽  
Author(s):  
Martin A. Schaller-Paule ◽  
Helmuth Steinmetz ◽  
Friederike S. Vollmer ◽  
Melissa Plesac ◽  
Felix Wicke ◽  
...  
Keyword(s):  
Patient Safety ◽  
Clinical Reasoning ◽  
Data Gathering ◽  
Diagnostic Errors ◽  
Diagnostic Error ◽  
Care Physician ◽  
Diagnostic Process ◽  
Myasthenic Crisis ◽  
Hospital Organization ◽  
Substantial Impact

Abstract Objectives Errors in clinical reasoning are a major factor for delayed or flawed diagnoses and put patient safety at risk. The diagnostic process is highly dependent on dynamic team factors, local hospital organization structure and culture, and cognitive factors. In everyday decision-making, physicians engage that challenge partly by relying on heuristics – subconscious mental short-cuts that are based on intuition and experience. Without structural corrective mechanisms, clinical judgement under time pressure creates space for harms resulting from systems and cognitive errors. Based on a case-example, we outline different pitfalls and provide strategies aimed at reducing diagnostic errors in health care. Case presentation A 67-year-old male patient was referred to the neurology department by his primary-care physician with the diagnosis of exacerbation of known myasthenia gravis. He reported shortness of breath and generalized weakness, but no other symptoms. Diagnosis of respiratory distress due to a myasthenic crisis was made and immunosuppressive therapy and pyridostigmine were given and plasmapheresis was performed without clinical improvement. Two weeks into the hospital stay, the patient’s dyspnea worsened. A CT scan revealed extensive segmental and subsegmental pulmonary emboli. Conclusions Faulty data gathering and flawed data synthesis are major drivers of diagnostic errors. While there is limited evidence for individual debiasing strategies, improving team factors and structural conditions can have substantial impact on the extent of diagnostic errors. Healthcare organizations should provide the structural supports to address errors and promote a constructive culture of patient safety.

Moving the Needle: Cultivating Systemic Change in Juvenile Services

2021 ◽  
pp. 89-100
Author(s):  
Kellie Rhodes ◽  
Aisland Rhodes ◽  
Wayne Bear ◽  
Larry Brendtro
Keyword(s):  
Best Practices ◽  
Direct Care ◽  
Clinical Services ◽  
Juvenile Courts ◽  
Community Based ◽  
Complex Needs ◽  
Entry Level ◽  
Community Based Programs ◽  
The Us ◽  
National Partnership

Approximately 1.7 million delinquency cases are disposed in juvenile courts annually (Puzzanchera, Adams, & Sickmund, 2011). Of these youth, tens of thousands experience confinement in the US (Sawyer, 2019), while hundreds of thousands experience probation or are sentenced to community based programs (Harp, Muhlhausen, & Hockenberry, 2019). These youth are placed in the care of programs overseen by directors and clinicians. A survey of facility directors and clinicians from member agencies of the National Partnership for Juvenile Services (NPJS) Behavioral Health Clinical Services (BHCS) committee identified three primary concerns practitioners face in caring for these youth; 1) low resources to recruit and retain quality staff, 2) training that is often not a match for, and does not equip staff to effectively manage the complex needs of acute youth, and 3) the perspective of direct care as an unskilled entry-level position with limited impact on youth’s rehabilitation. This article seeks to address these issues and seeks to highlight potential best practices to re-solve for those obstacles within juvenile services.

Capital budgeting practices: evidence from Korea

2020 ◽  
Vol ahead-of-print (ahead-of-print) ◽  
Author(s):  
Taeyeon Kim ◽  
Hongbok Lee ◽  
Kwangwoo Park ◽  
Doug Waggle
Keyword(s):  
Best Practices ◽  
Capital Budgeting ◽  
Developed Countries ◽  
Financial Advisors ◽  
Cost Of Equity ◽  
Content Type ◽  
Capital Costs ◽  
Developed Markets ◽  
The Us ◽  
Ceo Age

PurposeThe authors present the results of a survey on how Korean firms evaluate new projects and estimate their capital costs. The authors report how Korean firms’ capital budgeting practices compare to other developed countries and to best practices in the field of finance.Design/methodology/approachThe authors survey CFOs of major Korean firms on their capital budgeting practices. The authors then compare the results against the US and European firms and best practices of leading firms and financial advisors.FindingsThe authors find that the capital budgeting practices of Korean firms are as strong as or stronger than firms in developed markets. A majority of Korean firms use best practices techniques such as NPV, IRR and the CAPM for project evaluation and cost of equity estimation. Chaebol affiliation results in somewhat stronger capital budgeting practices. The authors also find that other factors, such as company size, leverage, CEO age and CEO education, impact capital budgeting practices.Originality/valueThis paper is the first article that comprehensively examines Korean firms' capital budgeting practices.

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