scholarly journals A web-based and mobile patient-centered ‘‘microblog’’ messaging platform to improve care team communication in acute care

2016 ◽  
Vol 24 (e1) ◽  
pp. e178-e184 ◽  
Author(s):  
Anuj K Dalal ◽  
Jeffrey Schnipper ◽  
Anthony Massaro ◽  
John Hanna ◽  
Eli Mlaver ◽  
...  
Keyword(s):  
Acute Care ◽  
Medical Intensive Care Unit ◽  
Care Team ◽  
Health Record ◽  
Barriers To Adoption ◽  
Patient Centered ◽  
Web Based ◽  
Team Collaboration ◽  
Team Members ◽  
Medical Intensive Care

Communication in acute care settings is fragmented and occurs asynchronously via a variety of electronic modalities. Providers are often not on the same page with regard to the plan of care. We designed and developed a secure, patient-centered “microblog” messaging platform that identifies care team members by synchronizing with the electronic health record, and directs providers to a single forum where they can communicate about the plan of care. The system was used for 35% of patients admitted to a medical intensive care unit over a 6-month period. Major themes in messages included care coordination (49%), clinical summarization (29%), and care team collaboration (27%). Message transparency and persistence were seen as useful features by 83% and 62% of respondents, respectively. Availability of alternative messaging tools and variable use by non-unit providers were seen as main barriers to adoption by 83% and 62% of respondents, respectively. This approach has much potential to improve communication across settings once barriers are addressed.

scholarly journals A web-based, patient-centered toolkit to engage patients and caregivers in the acute care setting: a preliminary evaluation

2015 ◽  
Vol 23 (1) ◽  
pp. 80-87 ◽  
Author(s):  
Anuj K Dalal ◽  
Patricia C Dykes ◽  
Sarah Collins ◽  
Lisa Soleymani Lehmann ◽  
Kumiko Ohashi ◽  
...  
Keyword(s):  
Intensive Care ◽  
Preliminary Evaluation ◽  
Test Results ◽  
Barriers To Adoption ◽  
Health Care Proxy ◽  
Patient Centered ◽  
Web Based ◽  
Average System ◽  
Patient Provider Communication ◽  
Medical Intensive Care

Abstract We implemented a web-based, patient-centered toolkit that engages patients/caregivers in the hospital plan of care by facilitating education and patient-provider communication. Of the 585 eligible patients approached on medical intensive care and oncology units, 239 were enrolled (119 patients, 120 caregivers). The most common reason for not approaching the patient was our inability to identify a health care proxy when a patient was incapacitated. Significantly more caregivers were enrolled in medical intensive care units compared with oncology units (75% vs 32%; P < .01). Of the 239 patient/caregivers, 158 (66%) and 97 (41%) inputted a daily and overall goal, respectively. Use of educational content was highest for medications and test results and infrequent for problems. The most common clinical theme identified in 291 messages sent by 158 patients/caregivers was health concerns, needs, preferences, or questions (19%, 55 of 291). The average system usability scores and satisfaction ratings of a sample of surveyed enrollees were favorable. From analysis of feedback, we identified barriers to adoption and outlined strategies to promote use.

Outcomes of Care Managed by an Acute Care Nurse Practitioner/Attending Physician Team in a Subacute Medical Intensive Care Unit

2005 ◽  
Vol 14 (2) ◽  
pp. 121-130 ◽  
Author(s):  
Leslie A. Hoffman ◽  
Frederick J. Tasota ◽  
Thomas G. Zullo ◽  
Carmella Scharfenberg ◽  
Michael P. Donahoe
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Acute Care ◽  
Nurse Practitioners ◽  
Nurse Practitioner ◽  
Medical Intensive Care Unit ◽  
Care Nurse ◽  
Medical Intensive Care ◽  
Acute Care Nurse Practitioner ◽  
Attending Physician

• Background Many academic medical centers employ nurse practitioners as substitutes to provide care normally supplied by house staff.• Objective To compare outcomes in a subacute medical intensive care unit of patients managed by a team consisting of either an acute care nurse practitioner and an attending physician or an attending physician and critical care/pulmonary fellows.• Methods During a 31-month period, in 7-month blocks of time, 526 consecutive patients admitted to the unit for more than 24 hours were managed by one or the other of the teams. Patients managed by the 2 teams were compared for a variety of outcomes.• Results Patients managed by the 2 teams did not differ significantly for any workload, demographic, or medical condition variable. The patients also did not differ in readmission to the high acuity unit (P = .25) or subacute unit (P = .44) within 72 hours of discharge or in mortality with (P = .25) or without (P = .89) treatment limitations. Among patients who had multiple weaning trials, patients managed by the 2 teams did not differ in length of stay in the subacute unit (P = .42), duration of mechanical ventilation (P = .18), weaning status at time of discharge from the unit (P = .80), or disposition (P = .28). Acute Physiology Scores were significantly different over time (P = .046). Patients managed by the fellows had more reintubations (P=.02).• Conclusions In a subacute intensive care unit, management by the 2 teams produced equivalent outcomes.

Implementation of a Medical Intensive Care Unit Acute-Care Nurse Practitioner Service

2011 ◽  
Vol 39 (2) ◽  
pp. 32-39 ◽  
Author(s):  
Janna S. Landsperger ◽  
Kristina Jill Williams ◽  
Susan M. Hellervik ◽  
Cherry B. Chassan ◽  
Lisa N. Flemmons ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Acute Care ◽  
Nurse Practitioner ◽  
Medical Intensive Care Unit ◽  
Care Nurse ◽  
Medical Intensive Care ◽  
Acute Care Nurse Practitioner

An Analysis of Electronic Health Record Work to Manage Asynchronous Clinical Messages among Breast Cancer Care Teams

2021 ◽  
Vol 12 (04) ◽  
pp. 877-887
Author(s):  
Bryan D. Steitz ◽  
Kim M. Unertl ◽  
Mia A. Levy
Keyword(s):  
Breast Cancer ◽  
Electronic Health Record ◽  
Cancer Care ◽  
Medical Center ◽  
Asynchronous Communication ◽  
Care Team ◽  
Health Record ◽  
Breast Cancer Care ◽  
Team Members ◽  
Electronic Health

Abstract Objective Asynchronous messaging is an integral aspect of communication in clinical settings, but imposes additional work and potentially leads to inefficiency. The goal of this study was to describe the time spent using the electronic health record (EHR) to manage asynchronous communication to support breast cancer care coordination. Methods We analyzed 3 years of audit logs and secure messaging logs from the EHR for care team members involved in breast cancer care at Vanderbilt University Medical Center. To evaluate trends in EHR use, we combined log data into sequences of events that occurred within 15 minutes of any other event by the same employee about the same patient. Results Our cohort of 9,761 patients were the subject of 430,857 message threads by 7,194 employees over a 3-year period. Breast cancer care team members performed messaging actions in 37.5% of all EHR sessions, averaging 29.8 (standard deviation [SD] = 23.5) messaging sessions per day. Messaging sessions lasted an average of 1.1 (95% confidence interval: 0.99–1.24) minutes longer than nonmessaging sessions. On days when the cancer providers did not otherwise have clinical responsibilities, they still performed messaging actions in an average of 15 (SD = 11.9) sessions per day. Conclusion At our institution, clinical messaging occurred in 35% of all EHR sessions. Clinical messaging, sometimes viewed as a supporting task of clinical work, is important to delivering and coordinating care across roles. Measuring the electronic work of asynchronous communication among care team members affords the opportunity to systematically identify opportunities to improve employee workload.

Interdisciplinary Palliative Care Teams

2019 ◽  
pp. 89-97
Author(s):  
Polly Mazanec ◽  
Rebekah Reimer ◽  
Jessica Bullington ◽  
Patrick J. Coyne ◽  
Herman Harris ◽  
...  
Keyword(s):  
Palliative Care ◽  
Care Delivery ◽  
Medical Center ◽  
Academic Medical Center ◽  
Interdisciplinary Team ◽  
Palliative Care Team ◽  
Care Team ◽  
Patient Centered ◽  
Team Members ◽  
Palliative Care Teams

This chapter defines the composition and roles of interdisciplinary team members on a palliative care team. The team has the responsibility to deliver patient-centered, family-focused care based on the recommendations from the National Consensus Project Guidelines for Quality Palliative Care. Within this chapter, interdisciplinary team members from an academic medical center discuss their respective roles on the team and describe how these roles supported a patient and family case study. The chapter provides an overview of the four most common models of palliative care delivery: inpatient consult teams, with or without a palliative care unit; ambulatory palliative care teams; community-based palliative care teams; and hospice teams. An introduction to essential considerations in the development of a palliative care team and the important components for maintaining a healthy, functional team are described.

scholarly journals Empowering Patients during Hospitalization: Perspectives on Inpatient Portal Use

2019 ◽  
Vol 10 (01) ◽  
pp. 103-112 ◽  
Author(s):  
Ann McAlearney ◽  
Naleef Fareed ◽  
Alice Gaughan ◽  
Sarah MacEwan ◽  
Jaclyn Volney ◽  
...  
Keyword(s):  
Health Information ◽  
Care Team ◽  
Care Providers ◽  
Patient Centeredness ◽  
Patient Centered ◽  
Secure Messaging ◽  
Team Members ◽  
Centered Care ◽  
Adult Inpatient

Background Patients have demonstrated an eagerness to use portals to access their health information and connect with care providers. While outpatient portals have been extensively studied, there is a recognized need for research that examines inpatient portals. Objective We conducted this study to improve our understanding about the role of a portal in the context of inpatient care. Our study focused on a large sample of the general adult inpatient population and obtained perspectives from both patients and care team members about inpatient portal use. Methods We interviewed patients (n = 120) who used an inpatient portal during their hospitalization at 15 days or 6 months after discharge to learn about their portal use. We also interviewed care team members (n = 331) 4 weeks, 6 months, and 12 months after inpatient portal implementation to collect information about their ongoing perspectives about patients' use of the portal. Results The perspectives of patients and care team members generally converged on their views of the inpatient portal. Three features—(1) ordering meals, (2) looking up health information, and (3) viewing the care team—were most commonly used; the secure messaging feature was less commonly used and of some concern to care team members. The inpatient portal benefited patients in four main ways: (1) promoted independence, (2) reduced anxiety, (3) informed families, and (4) increased empowerment. Conclusion Inpatient portals are recognized as a tool that can enhance the delivery of patient-centered care. In addition to empowering patients by increasing their sense of control, inpatient portals can support family members and caregivers throughout the hospital stay. Given the consistency of perspectives about portal use across patients and care team members, our findings suggest that inpatient portals may facilitate shifts in organizational culture that increase the patient centeredness of care and improve patient experience in the hospital context.

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