127 Electronic Collection of Patient-Reported Outcomes Following Discharge After Surgery: A Systematic Review

Aim Little is known about the electronic collection and clinical feedback of patient reported outcomes (ePROs) post-surgical discharge. This review summarised the evidence on the collection and uses of electronic systems to collect PROs after discharge from hospital following surgery. Method Systematic searches of Medline, Embase, PsycINFO, CINAHL and Cochrane Central were undertaken from database inception to July 2019 using terms for “patient reported outcomes”, “electronic”, “surgery” and “at home”. Primary research of all study designs was included if they used electronic systems to collect PRO data away from formal health care settings. Only studies in adult patients admitted for surgery then discharged from hospital were eligible. Results From 9,474 records identified, 15 studies were reviewed including three randomised controlled trials. Seven studies were in orthopaedic surgery. Most studies used commercial ePRO systems (n = 9/12). Six studies reported types of electronic devices used to collect data: tablets or other portable devices (n = 3), smartphones (n = 2), combination of smartphones, tablets/portable devices and computers (n = 1). Systems had limited features or functions such as real-time feedback to clinicians (n = 6) and messaging service for patients to communicate with care teams (n = 3). No studies described integration of the ePRO system with electronic health records to support clinical feedback. Conclusions There is limited reporting of ePRO systems in the surgical literature. ePRO systems lack integration with hospital clinical systems. Future research should describe the ePRO system and ePRO questionnaires used, and challenges encountered during the study, to support efficient upscaling of ePRO systems using tried and tested approaches.

How therapists and patients need to develop a clinical feedback system after 18 months of use in a practice-research network: a qualitative study

Background A personalized computer-adaptive system for clinical feedback and routine outcome monitoring in mental health, Norse Feedback aims to bridge the needs for standardized and idiographic measures in ordinary practice. Methods Item response theory analyses of completed treatment processes (n = 800) informed a qualitative study comprising individual in-depth interviews and focus groups with patients (n = 9) and clinicians (n = 10). The research question was: How do clinicians and patients contribute to developing a clinical feedback system in a continuous process aimed at refining its clinical usefulness? Results We conducted thematic analyses and found five themes: 1. Added clinical needs, 2. Needs for re-organizing the clinician report, 3.Needs for differentiation of clinical content, 4. User-interface needs, and 5. Item level suggestions. Conclusion In this article, we detail resulting needs for continuous adaptation to practice, and discuss implications of the concrete experiences with the Norse action research program for the larger field of ROM/CFS implementation.

De novo Powered Air-Purifying Respirator Design and Fabrication for Pandemic Response

Importance: The rapid spread of COVID-19 and disruption of normal supply chains resulted in severe shortages of personal protective equipment (PPE), particularly devices with few suppliers such as powered air-purifying respirators (PAPRs). A scarcity of information describing design and performance criteria represents a substantial barrier to new approaches. Objective: We sought to apply open-source product development to PAPRs to enable alternative sources of supply and further innovation. Design: We describe the design, prototyping, validation, and user testing of locally manufactured, modular, PAPR components, including filter cartridges and blower units, developed by the Greater Boston Pandemic Fabrication Team (PanFab). Two designs, one with a fully custom-made filter and housing, and the other with commercially available variants (the "Custom" and "Commercial: designs) were developed. Prototype testing was conducted at academic laboratories using equipment available during COVID-19. The designs and software are in the common domain for use or further modification. Setting: User feedback on the functionality and comfort of the design was obtained at a major US academic medical center. Participants: Feedback on designs was obtained from four individuals, including two clinicians working in an ambulatory clinical setting and two research technical staff for whom PAPR use is a standard part of occupational PPE. Main Outcomes and Measures: Engineering performance was measured using NIOSH-equivalent tests on an apparatus available in university laboratories. Clinical feedback was assessed by (1) comparison to existing PPE; (2) sense of security in a clinical setting; and (3) comfort. Results: Custom and Commercial Designs were developed for filter cartridges and blower units. The two PAPR variants passed testing for PAPR certification using an apparatus available under pandemic shortages. Respondents rated the PanFab Custom PAPR a 4 to 5 on a 5 Likert-scale across every survey question. The three other versions of the designs (with a commercial blower unit, filter, or both) also performed favorably, with survey scores of 3-5. Conclusions and Relevance: Engineering testing and clinical feedback demonstrate that the PanFab design represents a favorable alternative PAPR in terms of user comfort, mobility, and sense of security. A nonrestrictive license promotes innovation in respiratory protection for current and future medical emergencies.

Continuous quality improvement in measure development: Lessons from building a novel clinical feedback system

Purpose While the use of clinical feedback systems has become commonplace in psychological treatment, many of the most common instruments used for this purpose have not changed in decades. This paper describes the first four cycles of a measure development method designed to embrace continuous quality improvement. Methods Using techniques and philosophies developed in business management and academia—lean continuous quality improvement, action research, and practice research networks—we iterated through multiple cycles of development with the goal of creating an optimal clinical feedback system. These cycles emphasize building capacity to receive and implement feedback from a variety of stakeholders, especially patients and providers of behavioral health services, while also being responsive to quantitative findings from measure development. Results Iterating measure development with stakeholder feedback over the course of 5 years has resulted in a novel measurement system with 19 subscales administered via branching logic, and a supporting practice research network to sustain development. Conclusion In developing a new clinical feedback system, the less-frequently-discussed practical aspects of measure development require close attention. Specifically, being willing to embrace change, planning for iteration, and systematically seeking stakeholder feedback are identified as central methods for improving clinical feedback systems.

Consistency in dental clinical feedback to students: clinical teachers’ perspectives

Purpose: In dental education, feedback from clinical teachers is critical for developing students’ clinical competence. However, students have identified inconsistency of clinical feedback from clinical teachers as a major area of concern. Compared to research on the student perspective of consistency in clinical feedback, dental clinical teachers’ own views of the consistency of their feedback is not as thoroughly researched. The purpose of this study is to redress that balance.Methodology: This qualitative study explored dental clinical teachers’ views of the clinical feedback process during the 2017 academic year, with a focus on their perceptions of consistency of their own feedback.Findings: Our results show that clinical teachers use a number of parameters in judging students’ performance and giving feedback, and were aware that their feedback may not be consistent with other clinical teachers’ feedback. Teachers also recognised that this inconsistency could lead to an adverse effect on students’ learning and clinical competence. Research implications: To improve the consistency of their feedback and calibrate their judgement of students’ performance, clinical teachers recommended that their Dental School should provide opportunities for them to engage in collegial discussion and interactive, case-based teaching development programs. They also believed clinical teaching and its significance to dental student learning and competence should be recognised and valued more highly by the School.Practical implications: Implementation of professional development initiatives endorsed by clinical teachers has the potential to improve the consistency of teachers’ feedback and the quality of clinical dental education, and ultimately the quality of oral health care.Originality: This is the first study to explore clinical teachers’ views of how they judge students’ performance and the consistency of their feedback.Limitations: A limitation of this study is that clinical teachers who volunteered to participate may have different opinions compared to teachers who did not participate.

Clinical teachers’ motivations for feedback provision in busy emergency departments: a multicentre qualitative study

BackgroundFeedback is an effective pedagogical tool in clinical teaching and learning, but the actual perception by learners of clinical feedback is often described as unsatisfactory. Unlike assessment feedback or teaching sessions, which often happen within protected time and space, clinical feedback is influenced by numerous clinical factors. Little is known about clinical teachers’ motivations to provide feedback in busy clinical settings. We aimed to investigate the motivations behind feedback being given in emergency departments (EDs).MethodsA qualitative analysis of semi-structured interview data was conducted between August 2015 and June 2016. Eighteen attending physicians were purposively sampled from three teaching hospital EDs in Taiwan. Data were thematically analysed, both inductively (from the data) and deductively (using self-determination theory (SDT)). Themes were mapped to the different motivation types identified by the SDT.Results and discussionDespite working in busy clinical settings, Taiwanese ED clinical teachers reported being motivated to provide feedback when they felt responsible for their learners, when they understood the importance of feedback (patient safety and partner building), or simply because they were committed to following a tradition of passing on their clinical knowledge to their juniors. Suggestions to facilitate the internalisation of external motivations are proposed.ConclusionsIn this qualitative study, motivations for clinical feedback were identified. Although the motivations are mostly extrinsic, the elicitation of internal motivation is possible once true satisfaction is fostered during the feedback-giving process. This understanding can be used to develop interventions to enable clinical feedback to be provided in a sustained manner.