1539 Flexible Nasoendoscopy – Is It Clean? Can You Prove It?

Aim Flexible Nasoendoscope (FNE) is an essential device routinely used to assess patients who present acutely to the Ear, Nose and Throat (ENT) department with signs and symptoms of ENT pathologies that may compromise the patient’s airway. It is imperative the scope is decontaminated before and after each use. The “Tristel Trio Wipe” decontamination methodology is employed by most ENT departments in UK and the process utilises an audit logbook to correctly document the sterilisation process as well as allowing accurate patient traceability. The audit aim was to conduct a review of documentation of patient traceability and FNE sterilisation after each use on ENT patients in the acute setting. Method Retrospective audit over one-month periods 11/10/2019 –10/11/2019 (Audit 1) and 26/12/2019 – 21/01/2020 (audit 2). Tristel audit logbook and electronic patient note on PPM+ were used for data collection. Data was analysed using Microsoft excel. Results 100% of FNE decontaminations used correct Tristel Trio Wipes. However, audit one demonstrated 54.5% compliance with correct documentation of FNE sterilisation process and 0% had recorded all traceability information. Following intervention of easier identification of FNE scopes and their storage; as well teaching ENT Senior House Officers and registrar about the correct documentation of decontamination process, compliance improved to 81%, while traceability increased to 39% during the re-audit. Conclusions As a department, we have significantly improved our compliance with both correct documentation of FNE sterilisation and patient traceability information following the intervention above. A further 3rd audit cycle is planned.

Literature Review: Peran CPPT dalam Meningkatkan Komunikasi Efektif Pada Pelaksanaan Kolaborasi Interprofesional di Rumah Sakit

Effective communication between health professionals is the main key in the implementation of interprofessional collaboration, so hospitals must have solutions that communication is not interrupted on one side. To facilitate the communication process in monitoring the patient's medical history, every care professional is required to make a medical record. This study uses a Literature Review design with the PICO Framework. Search articles using the Google Scholar database, Garua Referral Digital (Garuda), and Proquest using keywords such as medical records, interprofessional collaboration, effective communication, and keywords with synonyms for the main keywords. The inclusion criteria are articles related to the role of medical records in the implementation of interprofessional collaboration, methods used to improve effective communication in the implementation of interprofessional collaboration, factors that affect communication in the implementation of interprofessional collaboration, articles in Indonesian and English, and published in 2015-2020. The exclusion criteria are criteria that do not want to be raised, among others, a review of direct verbal communication between professions, a review of interprofessional readiness in collaborating. The results of the study found medical records as effective communication can integrate or compile patient health service data in a comprehensive manner as a source of information for health professionals when making a health decision and actions to patients next. The conclusion is the form of medical records that describes collaboration between health professionals is an Integrated Progress Patient Note or CPPT.Keywords: medical records, interprofessional collaboration, effective communicationAbstrakKomunikasi efektif diantara para profesional kesehatan merupakan kunci utama dalam pelaksanaan kolaborasi interprofesional sehingga rumah sakit wajib memiliki solusi agar komunikasi tidak terputus di satu pihak. Untuk mempermudah proses komunikasi dalam memantau riwayat kesehatan pasien, setiap profesional pemberi asuhan diwajibkan untuk membuat rekam medis. Penelitian ini menggunakan desain Literature Review dengan Framework PICO. Pencarian artikel menggunakan database Google scholar, Garua Rujukan Digital (Garuda) dan Proquest dengan menggunakan kata kunci seperti rekam medis, kolaborasi interprofesi, komunikasi efeketif serta kata kunci dengan sinonim dari kata kunci utama. Kriteria inklusi yaitu artikel yang berkaitan dengan peran rekam medis pada pelaksanaan kolaborasi interprofesional, metode yang digunakan dalam meningkatkan komunikasi yang efektif pada pelaksanaan kolaborasi interprofesional, faktor yang mempengaruhi komunikasi pada pelaksanaan kolaborasi interprofesional, artikel berbahasa indonesia dan inggris dan terpublikasi pada tahun 2015-2020. Adapun kriteria eksklusi yaitu kriteria yang tidak ingin diangkat antara lain tinjauan komunikasi verbal langsung antar profesi, tinjauan kesiapan interprofessional dalam berkolaborasi. Hasil penelitian ditemukan Rekam medis sebagai media komunikasi efektif yang dapat mengintegrasikan atau menyatukan data pelayanan kesehatan pasien secara komprehensif sebagai sumber informasi bagi profesional pemberi asuhan sehingga dapat memudahkan dalam pengambilan keputusan dan tindakan yang dilakukan berikutnya terhadap pasien. Simpulan penelitian ini adalah lembar rekam medis yang menggambarkan kolaborasi antara para profesional kesehatan yakni pada lembar catatan perkembangan terintegrasi atau CPPT.Kata Kunci: rekam medis, kolaborasi interprofesional, komunikasi efektif

Improvement in the quality of patient notes: A report of a closed loop audit quality improvement project at a neurosurgical department in Pakistan.

Objective: To identify the deficiencies in patient note record-taking with the aim of improving the quality to meet international standards. Methods: The prospective clinical quality improvement audit study was conducted at the department of Neurosurgery, Allama Iqbal Medical College, Jinnah Hospital Lahore from January 219 to February 2020. The first audit cycle was carried out in July 2019, after data anonymisation, the notes from 1st January to 31st June were analysed in the first audit cycle against a hybrid proforma containing entries deemed essential in operative notes according to the guidelines of the Royal College of Surgeons of England. The guidelines were subsequently disseminated among postgraduate trainees using various methods. Post-intervention, randomly selected patient-notes from 1st August to 31st December 2019 were analysed in the second audit which was done in February 2020. The result of the two audits were compared to assess significance of association between the cycles for each categorical variable. Results: Of the 100 patient-notes audited, 50(50%) were part of each of the two cycles. Significant improvements (p<0.05) were seen between the two cycles in time of operation, pre-op status, post-op care: monitoring instruction, mobilisation, feeding instructions, wound care and position. There was 100% improvement in entries including name, age and sex, date of operation, elective/emergency, name of the procedure and name of operating surgeon and assistant, and the name of anaesthetist. Overall, marked improvement was observed in all parameters except in ‘use of antibiotic prophylaxes’. Conclusion: Regular audits are needed to monitor and improve, Continuous..

Patient Perception of Plain-Language Medical Notes Generated Using Artificial Intelligence Software: Pilot Mixed-Methods Study

Background Clinicians’ time with patients has become increasingly limited due to regulatory burden, documentation and billing, administrative responsibilities, and market forces. These factors limit clinicians’ time to deliver thorough explanations to patients. OpenNotes began as a research initiative exploring the ability of sharing medical notes with patients to help patients understand their health care. Providing patients access to their medical notes has been shown to have many benefits, including improved patient satisfaction and clinical outcomes. OpenNotes has since evolved into a national movement that helps clinicians share notes with patients. However, a significant barrier to the widespread adoption of OpenNotes has been clinicians’ concerns that OpenNotes may cost additional time to correct patient confusion over medical language. Recent advances in artificial intelligence (AI) technology may help resolve this concern by converting medical notes to plain language with minimal time required of clinicians. Objective This pilot study assesses patient comprehension and perceived benefits, concerns, and insights regarding an AI-simplified note through comprehension questions and guided interview. Methods Synthea, a synthetic patient generator, was used to generate a standardized medical-language patient note which was then simplified using AI software. A multiple-choice comprehension assessment questionnaire was drafted with physician input. Study participants were recruited from inpatients at the University of Colorado Hospital. Participants were randomly assigned to be tested for their comprehension of the standardized medical-language version or AI-generated plain-language version of the patient note. Following this, participants reviewed the opposite version of the note and participated in a guided interview. A Student t test was performed to assess for differences in comprehension assessment scores between plain-language and medical-language note groups. Multivariate modeling was performed to assess the impact of demographic variables on comprehension. Interview responses were thematically analyzed. Results Twenty patients agreed to participate. The mean number of comprehension assessment questions answered correctly was found to be higher in the plain-language group compared with the medical-language group; however, the Student t test was found to be underpowered to determine if this was significant. Age, ethnicity, and health literacy were found to have a significant impact on comprehension scores by multivariate modeling. Thematic analysis of guided interviews highlighted patients’ perceived benefits, concerns, and suggestions regarding such notes. Major themes of benefits were that simplified plain-language notes may (1) be more useable than unsimplified medical-language notes, (2) improve the patient-clinician relationship, and (3) empower patients through an enhanced understanding of their health care. Conclusions AI software may translate medical notes into plain-language notes that are perceived as beneficial by patients. Limitations included sample size, inpatient-only setting, and possible confounding factors. Larger studies are needed to assess comprehension. Insight from patient responses to guided interviews can guide the future study and development of this technology.

Improving patient diary use in intensive care: A quality improvement report

Background Patients surviving critical illness are at risk of developing psychological symptoms that affect quality of life and recovery. Patient diaries may improve psychological outcomes by reducing gaps in memory and contextualising what has happened during admission. Factors including lack of guidelines, lack of awareness and time constraints may lead to poor diary use. Aims This quality improvement project aimed to increase diary provision and overall multidisciplinary team engagement with diaries for all patients admitted for over 72 h to an intensive care unit. Methods Trialled changes implemented via the ‘Plan-Do-Study-Act’ method included adding alerts to the online patient note system, providing education sessions and introducing a guidance document to facilitate entry completion. Results A ‘diary provision’ target of 100% was achieved (from a baseline of 26.1%). Simple changes have proven effective in establishing routine engagement with diaries, and lessons may be used to improve diary systems elsewhere.

Patient Perception of Plain-Language Medical Notes Generated Using Artificial Intelligence Software: Pilot Mixed-Methods Study (Preprint)

BACKGROUND Clinicians’ time with patients has become increasingly limited due to regulatory burden, documentation and billing, administrative responsibilities, and market forces. These factors limit clinicians’ time to deliver thorough explanations to patients. OpenNotes began as a research initiative exploring the ability of sharing medical notes with patients to help patients understand their health care. Providing patients access to their medical notes has been shown to have many benefits, including improved patient satisfaction and clinical outcomes. OpenNotes has since evolved into a national movement that helps clinicians share notes with patients. However, a significant barrier to the widespread adoption of OpenNotes has been clinicians’ concerns that OpenNotes may cost additional time to correct patient confusion over medical language. Recent advances in artificial intelligence (AI) technology may help resolve this concern by converting medical notes to plain language with minimal time required of clinicians. OBJECTIVE This pilot study assesses patient comprehension and perceived benefits, concerns, and insights regarding an AI-simplified note through comprehension questions and guided interview. METHODS Synthea, a synthetic patient generator, was used to generate a standardized medical-language patient note which was then simplified using AI software. A multiple-choice comprehension assessment questionnaire was drafted with physician input. Study participants were recruited from inpatients at the University of Colorado Hospital. Participants were randomly assigned to be tested for their comprehension of the standardized medical-language version or AI-generated plain-language version of the patient note. Following this, participants reviewed the opposite version of the note and participated in a guided interview. A Student <i>t</i> test was performed to assess for differences in comprehension assessment scores between plain-language and medical-language note groups. Multivariate modeling was performed to assess the impact of demographic variables on comprehension. Interview responses were thematically analyzed. RESULTS Twenty patients agreed to participate. The mean number of comprehension assessment questions answered correctly was found to be higher in the plain-language group compared with the medical-language group; however, the Student <i>t</i> test was found to be underpowered to determine if this was significant. Age, ethnicity, and health literacy were found to have a significant impact on comprehension scores by multivariate modeling. Thematic analysis of guided interviews highlighted patients’ perceived benefits, concerns, and suggestions regarding such notes. Major themes of benefits were that simplified plain-language notes may (1) be more useable than unsimplified medical-language notes, (2) improve the patient-clinician relationship, and (3) empower patients through an enhanced understanding of their health care. CONCLUSIONS AI software may translate medical notes into plain-language notes that are perceived as beneficial by patients. Limitations included sample size, inpatient-only setting, and possible confounding factors. Larger studies are needed to assess comprehension. Insight from patient responses to guided interviews can guide the future study and development of this technology.

Audit on the Effectiveness of Oral Cancer Screening in Primary Care

Introduction: Oral cancer is increasingly common. The need for early detection and promoting prevention is greater than ever. The main focus of this audit is to evaluate the completeness and quality of oral cancer screening checks within the practice. This was achieved by setting a standard using internal and external resources. Method: 90 clinical records were audited spanning three dentists over 3 months. These were chosen at random and were compared to the standard set to check if was being met. Action plan: A list of recommendations was drawn up for future improvements to ensure targets were being met. The results of the audit were discussed with all team members involved in patient note handling. A re-audit was carried out after 3 months to assess improvements which showed standards were being met. Conclusion: The standard was not being met.

Improving patient care through implementation of a QOPI-focused interactive patient note template.

197 Background: Participation in the ASCO Quality Oncology Practice Initiative (QOPI) has been shown to improve the quality and value of care provided by oncology practices. Our fellows’ oncology practice participates in QOPI. We sought to utilize QOPI metrics in conjunction with the documentation capabilities of our electronic medical record (EMR) to create a quality-focused standardized new patient note template to be used by all practitioners in our oncology clinic, in an effort to improve patient care through improved communication and efficiency. Methods: We examined the results from our most recent QOPI assessment cycle in spring of 2016 and identified areas where our practice met the metric less than 50% of the time. Oral chemotherapy, tobacco cessation, and fertility preservation counseling were identified as target areas. We surveyed the practitioners in the group to establish baseline knowledge of QOPI metrics and desire for a standardized note template. We then developed and implemented a note template incorporating QOPI metrics, pulling data directly from other areas within the medical record, and excluding extraneous information. Results: Only 58% of the fellows in our fellowship program responded that they had a general idea of the QOPI metrics, and only 37% believed their notes were QOPI-compliant; 84% were interested in a standardized note template that incorporates QOPI metrics. Through the assistance of EMR specialists, we created a standardized note that auto-populates information recorded elsewhere in the patient’s chart and allows physicians to select appropriate options from pre-populated lists based on the patient’s treatment. The physician cannot close the encounter until these selections are made Conclusions: QOPI metrics provide guideposts for oncology practitioners to provide quality care and communicate effectively. We created a note that encourages practitioners to complete recommended QOPI tasks in an effort to improve communication and patient care. Data collection regarding practitioner use and satisfaction with the new template and compliance with QOPI metrics is ongoing.