scholarly journals Clinical Informatics during the COVID-19 Pandemic: Lessons Learned and Implications for Emergency Department and Inpatient Operations

2020 ◽  
Author(s):  
Hanson Hsu ◽  
Peter W Greenwald ◽  
Matthew R Laghezza ◽  
Peter Steel ◽  
Richard Trepp ◽  
...  
Keyword(s):  
Decision Making ◽  
Emergency Department ◽  
Medical Care ◽  
Clinical Decision Making ◽  
Clinical Decision ◽  
Lessons Learned ◽  
Clinical Informatics ◽  
Security And Privacy ◽  
Care Pathways ◽  
Provider Education

Abstract In response to a pandemic, hospital leaders can use clinical informatics to aid clinical decision-making, virtualizing medical care, coordinating communication, and defining workflow and compliance. Clinical informatics procedures need to be implemented nimbly, with governance measures in place to properly oversee and guide novel patient care pathways, diagnostic and treatment workflows, and provider education and communication. The authors’ experience recommends: (1) creating flexible ordersets that adapt to evolving guidelines that meet needs across specialties (2) enhancing and supporting inherent telemedicine capability (3) electronically enabling novel workflows quickly and suspending non-critical administrative or billing functions in the EHR and (4) using communication platforms based on tiered urgency that do not compromise security and privacy.

scholarly journals Integrating Patient-Generated Health Data Into Clinical Care Settings or Clinical Decision-Making: Lessons Learned From Project HealthDesign

2016 ◽  
Vol 3 (2) ◽  
pp. e26 ◽  
Author(s):  
Deborah J Cohen ◽  
Sara R Keller ◽  
Gillian R Hayes ◽  
David A Dorr ◽  
Joan S Ash ◽  
...  
Keyword(s):  
Decision Making ◽  
Clinical Decision Making ◽  
Clinical Care ◽  
Clinical Decision ◽  
Health Data ◽  
Lessons Learned

scholarly journals Clinical decision making in the emergency department setting using rapid PCR: Results of the CLADE study group

2018 ◽  
Vol 102 ◽  
pp. 42-49 ◽  
Author(s):  
Glen T. Hansen ◽  
Johanna Moore ◽  
Emily Herding ◽  
Tami Gooch ◽  
Diane Hirigoyen ◽  
...  
Keyword(s):  
Decision Making ◽  
Emergency Department ◽  
Clinical Decision Making ◽  
Clinical Decision ◽  
Study Group ◽  
Rapid Pcr ◽  
Emergency Department Setting

Using Intelligent Tools to Support Clinical Decision Making

2021 ◽  
pp. 555-567
Author(s):  
Nilmini Wickramasinghe ◽  
Jonathan L Schaffer
Keyword(s):  
Decision Making ◽  
Clinical Case ◽  
Clinical Decision Making ◽  
Clinical Decision ◽  
Care Pathways ◽  
Detection Model ◽  
Risk Detection ◽  
Intelligent Tools ◽  
Specific Care ◽  
Decision Efficiency

Intelligent tools and collaborative systems can be used in healthcare contexts to support clinical decision making. Such an approach is concerned with identifying the way in which information is gathered and decisions are made along specific care pathways. This study develops a real-time collaborative system using an intelligent risk detection model (IRD) to improve decision efficiency in the clinical case of patients undergoing hip or knee arthroplasty. The benefits of adopting this improved clinical decision-making solution include increasing awareness, supporting communication, improving the decision making process for patients and caregivers while also improving information sharing between surgeons as key collaborative parties in the research case. This in turn leads to higher levels of patient and clinical satisfaction and better clinical outcomes.

THE VALUE OF IN VITRO DIAGNOSTIC TESTING IN THE PROVISION OF MEDICAL CARE TO ELDERLY PATIENTS WITH CARDIOVASCULAR DISEASES

2020 ◽  
Vol 65 (3) ◽  
pp. 191-196
Author(s):  
A. S. Pushkin ◽  
O. V. Lyang ◽  
T. A. Ahmedov ◽  
S. A. Rukavishnikova
Keyword(s):  
Decision Making ◽  
Medical Care ◽  
Laboratory Tests ◽  
Clinical Decision Making ◽  
Diagnostic Testing ◽  
Clinical Decision ◽  
Initial Examination ◽  
Attending Physicians ◽  
The Impact

In vitro diagnostics are used at all stages of patient care. The aim of this study was to assess the impact of laboratory examination on clinical decision-making in providing medical care to patients with a cardiovascular profile. We also took into account the level of financing for the laboratory industry in the Russian Federation. We divided our study on three sequential steps: literature review, survey of clinicians and test-survey of clinicians. The share of costs for the laboratory tests in 2017 amounted to about 8% of the total funding for Russian health care. About 80% (70; 90) of the visits of the attending physicians are associated with the appointment of laboratory tests. Among patients who were prescribed any laboratory test - in 62.1% (95% CI 16.9-24.9) cases, the results of these tests influenced clinical decision making related to the initiation, modification or termination of any treatment. All visits of clinicians were divided by purpose: tests were prescribed in almost 100% (90; 100) cases during the initial examination, in 40% (20; 60) cases during repeated visits, and in 40% (15; 40) cases when patients were examined before discharge. In more than half of cases (57,4%; n=31), doctors correctly assumed about the about the share of financing of the laboratory industry. The majority of respondents considered the amount of expenses adequate and recommended to maintain the current level in the future. According to attending physicians, new laboratory markers should demonstrate additional information about clinical relevance to improve patient outcomes. Thus, in current economic realities, future laboratory tests should be financially maximally available and at the same time be clinically highly effective auxiliary instruments. It creates new challenges in finding laboratory biomarkers and putting them into clinical practice.

scholarly journals Utility and Acceptability of Influenza Surveillance amongst Emergency Providers

2015 ◽  
Vol 7 (1) ◽  
Author(s):  
Andrea F. Dugas ◽  
Howard Burkom ◽  
Anna L. DuVal ◽  
Richard Rothman
Keyword(s):  
Decision Making ◽  
Emergency Department ◽  
Real Time ◽  
Clinical Decision Making ◽  
Clinical Decision ◽  
Surveillance Data ◽  
Influenza Surveillance ◽  
Additional Information ◽  
Provider Surveys

We provided emergency department providers with a real-time laboratory-based influenza surveillance tool, and evaluated the utility and acceptability of the surveillance information using provider surveys. The majority of emergency department providers found the surveillance data useful and indicated the additional information impacted their clinical decision making regarding influenza testing and treatment.

scholarly journals Recovery from profound acidosis (pH 6.685) in multi-organ dysfunction syndrome

2019 ◽  
pp. 175114371987010
Author(s):  
Eryl A Davies ◽  
Christopher Saleh ◽  
Jonathan Bannard-Smith
Keyword(s):  
Decision Making ◽  
Emergency Department ◽  
Cardiac Arrest ◽  
Critical Care ◽  
Organ Dysfunction ◽  
Clinical Decision Making ◽  
Clinical Decision ◽  
Circulatory Shock ◽  
Arterial Ph ◽  
Multi Organ Dysfunction Syndrome

Acidosis is a common feature of patients referred to critical care from the emergency department. We present the case of a 49-year-old female with multi-organ dysfunction syndrome (MODS) and an arterial pH of 6.685 on arrival to the emergency department. This case is unique as the patient was in circulatory shock with MODS from rhabdomyolysis on arrival and had not suffered a cardiac arrest. We believe this to be the first reported case of full recovery from such an extreme metabolic disturbance in this context, and discuss the relevance of profound acidosis to early clinical decision-making.

scholarly journals Emotionally evocative patients in the emergency department: a mixed methods investigation of providers’ reported emotions and implications for patient safety

2020 ◽  
Vol 29 (10) ◽  
pp. 1.3-2 ◽  
Author(s):  
Linda M Isbell ◽  
Julia Tager ◽  
Kendall Beals ◽  
Guanyu Liu
Keyword(s):  
Mental Health ◽  
Decision Making ◽  
Emergency Department ◽  
Patient Safety ◽  
Qualitative Data ◽  
Clinical Decision Making ◽  
Quality Care ◽  
Clinical Decision ◽  
Safety Risks ◽  
Recent Patient

BackgroundEmergency department (ED) physicians and nurses frequently interact with emotionally evocative patients, which can impact clinical decision-making and behaviour. This study introduces well-established methods from social psychology to investigate ED providers’ reported emotional experiences and engagement in their own recent patient encounters, as well as perceived effects of emotion on patient care.MethodsNinety-four experienced ED providers (50 physicians and 44 nurses) vividly recalled and wrote about three recent patient encounters (qualitative data): one that elicited anger/frustration/irritation (angry encounter), one that elicited happiness/satisfaction/appreciation (positive encounter), and one with a patient with a mental health condition (mental health encounter). Providers rated their emotions and engagement in each encounter (quantitative data), and reported their perception of whether and how their emotions impacted their clinical decision-making and behaviour (qualitative data).ResultsProviders generated 282 encounter descriptions. Emotions reported in angry and mental health encounters were remarkably similar, highly negative, and associated with reports of low provider engagement compared with positive encounters. Providers reported their emotions influenced their clinical decision-making and behaviour most frequently in angry encounters, followed by mental health and then positive encounters. Emotions in angry and mental health encounters were associated with increased perceptions of patient safety risks; emotions in positive encounters were associated with perceptions of higher quality care.ConclusionsPositive and negative emotions can influence clinical decision-making and impact patient safety. Findings underscore the need for (1) education and training initiatives to promote awareness of emotional influences and to consider strategies for managing these influences, and (2) a comprehensive research agenda to facilitate discovery of evidence-based interventions to mitigate emotion-induced patient safety risks. The current work lays the foundation for testing novel interventions.

scholarly journals FUTURES: Forecasting the Unexpected Transfer to Upgraded Resources in Sepsis

2019 ◽  
Vol 8 (1) ◽  
pp. 187-191
Author(s):  
Alexa Profozich ◽  
Trevor Sytsma ◽  
Ryan Arnold ◽  
Kristen Miller ◽  
Muge Capan
Keyword(s):  
Decision Making ◽  
Emergency Department ◽  
Clinical Decision Making ◽  
Point Of Care ◽  
Initial Point ◽  
Clinical Decision ◽  
Sepsis Management ◽  
Insight Into

Sepsis is one of the most deadly and costly diseases. The Emergency Department (ED) is the initial point of care for most patients who become hospitalized due to sepsis. Quantifying the accuracy of ED clinician forecasting regarding patients’ clinical trajectories and outcomes can provide insight into clinical decision making and inform sepsis management.

scholarly journals Perceptions of critical and emergency department nurses regarding changes in their professional role

2018 ◽  
Vol 51 (0) ◽  
Author(s):  
Maria NK Karanikola ◽  
Margarita Giannakopoulou ◽  
Meropi Mpouzika ◽  
Christiana Nicolaou ◽  
George Tsiaousis ◽  
...  
Keyword(s):  
Decision Making ◽  
Emergency Department ◽  
Clinical Decision Making ◽  
Clinical Skills ◽  
Preliminary Investigation ◽  
Clinical Decision ◽  
Professional Role ◽  
Professional Autonomy ◽  
Emergency Department Nurses ◽  
Participation In Decision Making

ABSTRACT Objective Preliminary investigation of the way Greek critical and emergency department nurses conceptualize changes in their professional role. Method A qualitative focus-group methodology was applied. Following purposeful sampling and informed consent of participants. Results Participated eight individuals. The need for enhancement of nurses’ participation in decision-making in order for an actual change in their professional role to be achieved was the central theme of participants’ narratives. Perceived advancements in professional role performance regarded: evidence-based practice; technology; education, knowledge; clinical skills; research; heightened nurse-physician collaboration. Perceived reasons why these advancements failed to enhance nurses’ professional role were lack of meritocracy; competitive relationships; lack of support among nurses; insufficient managerial support; budget limitations. Conclusion Despite advancements in clinical practice, participants did not deem that their professional role was enhanced significantly, as participation in decision-making and control over practice remain limited. Interventions targeted to enhance nurses’ participation in clinical decision-making, and overall professional autonomy are recommended.

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