The Modified Early Warning System (MEWS) is based on a patient score that helps the medical team
monitor patients to identify a patient that may be experiencing a sudden decline in care. This study consists
of a detailed review of clinical data and patient outcomes to assess impact of technology and patient care.
There are a total of thirteen hospitals included in this review. These facilities have implemented vitals
capture and the MEWS scoring system.
1) Electronic medical records have the potential to transform medicine by serving as a platform for clinical decision support, personalized medicine, and precision medicine approaches through integration of diverse data sources.
2) Registries built from EMR data can be used to study conditions, compare treatment effectiveness, and recruit for clinical trials, with the goal of reducing the lag time between research and practice.
3) Advances in predictive modeling, diagnostic and treatment algorithms, and artificial intelligence may help optimize clinical decision making if effectively integrated into clinical workflow and EMRs.
This randomized clinical trial compared medication administration error rates between dedicated medication nurses and general nurses across two hospitals. The main findings were:
1) Overall error rates were similar between medication nurses (15.7%) and general nurses (14.9%).
2) At one hospital, medication nurses had a significantly lower error rate than general nurses in surgical units but not medical units.
3) Differences in medication processes and settings highlighted the role of systems design in errors. The study suggests simple interventions may not reduce errors without broader system changes.
- A study compared rates of preventable adverse drug events (ADEs) in intensive care units (ICUs) vs. non-ICUs at two hospitals over 6 months.
- The unadjusted ADE rate was twice as high in ICUs, but when adjusted for number of drugs, there was no difference between ICUs and non-ICUs.
- Preventable ADEs occurred due to normal systems failures like poor communication rather than overworked individuals, showing the need for systems solutions over blaming individuals.
The document proposes implementing a new triage system called the Comprehensive Triage Acuity System at a VA walk-in clinic to improve patient flow and outcomes. The system uses a 5-level scale to assess physical, social, and health needs and prioritize patients needing emergent, urgent, or non-urgent care. All clinic staff will receive training. The proposal aims to compare utilization rates and homeless veteran numbers before and after implementation to evaluate the system's effects.
The document summarizes 15 research articles that evaluated the accuracy of the Confusion Assessment Method for the ICU (CAM-ICU) in identifying delirium in adult ICU patients compared to practitioner judgment. The majority of studies were quasi-experimental and found that the CAM-ICU more accurately identified delirium than practitioner judgment alone. However, the CAM-ICU had lower sensitivity than specificity, so it could potentially under-identify delirium. The studies concluded that while the CAM-ICU is currently the most accurate tool, it should be used along with practitioner judgment until a screening tool with higher sensitivity is developed.
The document summarizes 5 studies on adverse drug reaction (ADR) reporting rates among healthcare professionals. A retrospective study found an ADR reporting rate of 57.14% among ICU patients. A questionnaire revealed barriers to reporting like lack of training and awareness. Healthcare professionals were then educated on ADR reporting. A prospective study post-education found an increased ADR reporting rate of 72.72%, indicating education improved reporting. The document concludes education is needed to enhance pharmacovigilance among healthcare professionals.
Numerous studies have shown that using disposable bed bath wipes soaked in chlorhexidine gluconate (CHG) reduces hospital acquired infections (HAIs) more effectively than traditional bed baths. Multiple randomized control trials found that CHG wipes reduced infections caused by multidrug-resistant organisms and bloodstream infections. Implementing the use of CHG wipes for bathing patients would help meet patients' hygienic needs and prevent infections while improving nursing efficiency.
1) Electronic medical records have the potential to transform medicine by serving as a platform for clinical decision support, personalized medicine, and precision medicine approaches through integration of diverse data sources.
2) Registries built from EMR data can be used to study conditions, compare treatment effectiveness, and recruit for clinical trials, with the goal of reducing the lag time between research and practice.
3) Advances in predictive modeling, diagnostic and treatment algorithms, and artificial intelligence may help optimize clinical decision making if effectively integrated into clinical workflow and EMRs.
This randomized clinical trial compared medication administration error rates between dedicated medication nurses and general nurses across two hospitals. The main findings were:
1) Overall error rates were similar between medication nurses (15.7%) and general nurses (14.9%).
2) At one hospital, medication nurses had a significantly lower error rate than general nurses in surgical units but not medical units.
3) Differences in medication processes and settings highlighted the role of systems design in errors. The study suggests simple interventions may not reduce errors without broader system changes.
- A study compared rates of preventable adverse drug events (ADEs) in intensive care units (ICUs) vs. non-ICUs at two hospitals over 6 months.
- The unadjusted ADE rate was twice as high in ICUs, but when adjusted for number of drugs, there was no difference between ICUs and non-ICUs.
- Preventable ADEs occurred due to normal systems failures like poor communication rather than overworked individuals, showing the need for systems solutions over blaming individuals.
The document proposes implementing a new triage system called the Comprehensive Triage Acuity System at a VA walk-in clinic to improve patient flow and outcomes. The system uses a 5-level scale to assess physical, social, and health needs and prioritize patients needing emergent, urgent, or non-urgent care. All clinic staff will receive training. The proposal aims to compare utilization rates and homeless veteran numbers before and after implementation to evaluate the system's effects.
The document summarizes 15 research articles that evaluated the accuracy of the Confusion Assessment Method for the ICU (CAM-ICU) in identifying delirium in adult ICU patients compared to practitioner judgment. The majority of studies were quasi-experimental and found that the CAM-ICU more accurately identified delirium than practitioner judgment alone. However, the CAM-ICU had lower sensitivity than specificity, so it could potentially under-identify delirium. The studies concluded that while the CAM-ICU is currently the most accurate tool, it should be used along with practitioner judgment until a screening tool with higher sensitivity is developed.
The document summarizes 5 studies on adverse drug reaction (ADR) reporting rates among healthcare professionals. A retrospective study found an ADR reporting rate of 57.14% among ICU patients. A questionnaire revealed barriers to reporting like lack of training and awareness. Healthcare professionals were then educated on ADR reporting. A prospective study post-education found an increased ADR reporting rate of 72.72%, indicating education improved reporting. The document concludes education is needed to enhance pharmacovigilance among healthcare professionals.
Numerous studies have shown that using disposable bed bath wipes soaked in chlorhexidine gluconate (CHG) reduces hospital acquired infections (HAIs) more effectively than traditional bed baths. Multiple randomized control trials found that CHG wipes reduced infections caused by multidrug-resistant organisms and bloodstream infections. Implementing the use of CHG wipes for bathing patients would help meet patients' hygienic needs and prevent infections while improving nursing efficiency.
Medical and Health-Related Errors - The Impact of Recordkeeping upon Patient ...Andrew Sexton
This document summarizes a research proposal that examines whether the conversion to electronic medical recordkeeping will reduce medical errors. The proposal includes a literature review discussing studies that found errors were reduced with computerized billing systems compared to hard copy forms. Other studies found that standardized electronic records improved care coordination, patient safety, and quality. The proposal puts forth several hypotheses to test, including that males and those with less education will be more correlated with errors, while younger individuals and those with more education will be less correlated. The proposed methodology would survey a sample of US adults to collect data to analyze the hypotheses through regression analyses. The goal is to understand how recordkeeping impacts patient well-being and quality of care through medical errors.
This document presents a literature review and proposal for a study to evaluate the effectiveness of home telemonitoring using an ECG monitor in reducing hospital readmission rates among patients aged 65 and older with heart failure. Heart failure results in many hospitalizations and readmissions that cost the healthcare system billions each year. The literature suggests that telemonitoring allows for early detection of exacerbations and improved management of heart failure symptoms, leading to fewer hospitalizations. The proposed study would compare readmission rates over 4 months for heart failure patients who use home ECG telemonitoring versus the standard telemonitoring system, with the hypothesis that ECG telemonitoring would reduce readmission rates.
951023 Electronically Screening Discharge Summaries For Adverse Medical Eventsplokm1580
1) The study aimed to evaluate using electronic screening of discharge summaries to detect adverse medical events, defined as injuries caused by medical care rather than underlying conditions.
2) The study used trigger words related to adverse events to electronically screen discharge summaries and found 191 cases of potential adverse events out of 424 summaries.
3) Combining electronic screening with manual review of a random sample improved specificity for detecting adverse events compared to relying solely on manual review. The study demonstrated the feasibility of using electronic screening of discharge summaries to help identify adverse medical events.
This document provides an outline for a presentation on electronic medical records (EMRs). It begins with defining the components of an EMR, including labs, admissions/discharge/transfer data, orders, radiology, notes, and billing. It then discusses the history and adoption of EMRs from the 1960s to present. The document reviews studies showing the effectiveness of EMRs in improving quality of care and achieving treatment standards. It also outlines how EMR data is structured in databases and data warehouses and describes common health data standards like ICD, CPT, LOINC, SNOMED, and HL7. The presentation covers meaningful use incentives and provides examples of using EMR data for research studies.
This document discusses the debate between randomized clinical trials (RCTs) and observational studies using big data. While RCTs are better for minimizing bias, observational studies can include more patients and answer questions RCTs cannot. The document outlines several large cancer databases that can help learn from every patient, including SEER and NCDB registries. It describes how these databases are being enriched with additional data sources like EHRs, genomic data, and mobile devices. This evolving use of big data from numerous sources can improve outcomes by better understanding toxicity, costs, and quality of cancer care.
This document presents a literature review and proposal to reduce medication errors in a 28-bed rehabilitation unit through the use of an electronic medication administration record (EMAR) over a 30-day period. Studies have shown EMARs can significantly reduce transcription and administration errors compared to handwritten records. The proposal is for physicians to enter all medication orders via the existing EMAR system for 30 days to evaluate if it decreases transcription errors versus the current paper method. Implementing EMARs has been shown to potentially prevent 84% of dosing, frequency and route errors.
surgical nurses in teaching hospitals in Ireland understanding painNiamh Vickers
This document summarizes a study examining the knowledge and attitudes of surgical nurses regarding pain management in three teaching hospitals in Ireland. The study found:
1) Nurses had inadequate knowledge about pain management, with a mean score of 65.7% on a pain assessment tool, and only 3% scoring 80% or higher.
2) Knowledge deficits were found across pharmacological and non-pharmacological pain management.
3) Nurses overestimated their own knowledge, though results showed widespread gaps.
4) Educational initiatives are needed to enhance nurses' knowledge and improve pain management practices.
The document examines the implementation of patient safety and patient-centeredness strategies in 84 Iranian hospitals based on a survey completed by hospital and nursing managers in 2009-2010. It finds that the majority of hospitals reported implementing 84% of patient safety strategies and 72% of patient-centeredness strategies. Implementation of most strategies was generally unrelated to hospital characteristics like type, ownership, teaching status, or annual evaluation grade, with some exceptions. Overall implementation of strategies was substantial but there is still room for improvement, including enforcing standards, increasing organizational responsiveness, and partnering with patients.
Using the Bigtown Simulation Model to Predict the Impact of Enhanced Seven Day Services on Hospital Performance and Patient Outcomes
Poster from the 'Delivering NHS services, seven days a week' event held in Birmingham on 16 November 2013
More information about this event can be found at
http://www.nhsiq.nhs.uk/news-events/events/nhs-services-seven-days-a-week.aspx
Ht ai 2015 poster 238 - Efficiency of the Artificial Urinary SphincterREBRATSoficial
The document summarizes research on the artificial urinary sphincter (AS) for treating urinary incontinence following prostatectomy. It finds that while AS has success rates of around 79% and patient satisfaction, the evidence is limited as only one randomized controlled trial exists. Systematic reviews call for more studies directly comparing AS to other surgical therapies. Health technology assessments in Brazil did not recommend AS for public insurance due to low evidence, but private insurance does cover it. More high-quality research is needed to determine the effectiveness and costs of AS versus other options.
The Paperless partograph – The new user-friendly and simpler tool for monitor...iosrjce
IOSR Journal of Dental and Medical Sciences is one of the speciality Journal in Dental Science and Medical Science published by International Organization of Scientific Research (IOSR). The Journal publishes papers of the highest scientific merit and widest possible scope work in all areas related to medical and dental science. The Journal welcome review articles, leading medical and clinical research articles, technical notes, case reports and others.
Vaccines are an essential method for preventing infectious diseases. While vaccination programs have reduced disease rates, vaccine safety continues to be monitored. An extensive vaccine safety review found limited understanding of adverse events due to insufficient research. Improving research capacity is needed so future reviews are not handicapped. Both pre-licensure clinical trials and post-licensure surveillance systems aim to monitor vaccine safety, though assessing rare adverse events poses challenges requiring large studies and international collaboration. Standardized methods and ongoing evaluation aim to maintain public confidence in vaccination.
Evidence Based Practice Lecture 7_slidesZakCooper1
This document discusses how evidence-based practice is used in clinical settings through clinical practice guidelines and decision analysis. It defines clinical practice guidelines as a series of steps for providing clinical care and decision analysis as a formal structure for integrating evidence about treatment options. Clinical practice guidelines aim to standardize and improve care but have limitations such as not applying to complex patients. Decision analysis allows for elucidating optimal individual decisions but requires significant time and resources. Overall, evidence-based practice provides tools and approaches to inform clinical decision-making.
ePCR Research Paper for Western Journal for EMlarry_johnson
1) The survey found that most emergency physicians (EPs) prefer electronic prehospital patient care reports (PCRs) over handwritten ones, but electronic PCRs are often unavailable for medical decision-making.
2) While EPs felt PCRs were important to their practice, 79.6% reported electronic PCRs were available ≤50% of the time compared to only 22.4% for handwritten PCRs.
3) The study suggests strategies are needed to improve the accuracy of PCRs and ensure electronic versions are delivered in a timely manner to aid in emergency department medical decision-making.
Running head CRITIQUE QUANTITATIVE, QUALITATIVE, OR MIXED METHODS.docxtodd271
Running head: CRITIQUE QUANTITATIVE, QUALITATIVE, OR MIXED METHODS DESIGN
5
CRITIQUE OF QUANTITATIVE, QUALITATIVE, OR MIXED METHODS DESIGN
Critiquing Quantitative, Qualitative, or Mixed Methods Studies
Adenike George
Walden University
NURS 6052: Essentials of Evidence-Based Practice
April 11, 2019
Critique of Quantitative, Qualitative, or Mixed Method Design
Both quantitative and qualitative methods play a pivotal role in nursing research. Qualitative research helps nurses and other healthcare workers to understand the experiences of the patients on health and illness. Quantitative data allows researchers to use an accurate approach in data collection and analysis. When using quantitative techniques, data can be analyzed using either descriptive statistics or inferential statistics which allows the researchers to derive important facts like demographics, preference trends, and differences between the groups. The paper comprehensively critiques quantitative and quantitative techniques of research. Furthermore, the author will also give reasons as to why qualitative methods should be regarded as scientific.
The overall value of quantitative and Qualitative Research
Quantitative studies allow the researchers to present data in terms of numbers. Since data is in numeric form, researchers can apply statistical techniques in analyzing it. These include descriptive statistics like mean, mode, median, standard deviation and inferential statistics such as ANOVA, t-tests, correlation and regression analysis. Statistical analysis allows us to derive important facts from data such as preference trends, demographics, and differences between groups. For instance, by conducting a mixed methods study to determine the feeding experiences of infants among teen mothers in North Carolina, Tucker and colleagues were able to compare breastfeeding trends among various population groups. The multiple groups compared were likely to initiate breastfeeding as follows: Hispanic teens 89%, Black American teens 41%, and White teens 52% (Tucker et al., 2011).
The high strength of quantitative analysis lies in providing data that is descriptive. The descriptive statistics helps us to capture a snapshot of the population. When analyzed appropriate, the descriptive data enables us to make general conclusions concerning the population. For instance, through detailed data analysis, Tucker and co-researchers were able to observe that there were a large number of adolescents who ceased breastfeeding within the first month drawing the need for nurses to conduct individualized follow-ups the early days after hospital discharge. These follow-ups would significantly assist in addressing the conventional technical problems and offer support in managing back to school transition (Tucker et al., 2011).
Qualitative research allows researchers to determine the client’s perspective on healthcare. It enables researchers to observe certain behaviors and experiences amo.
The Use of Health Information Technology to Improve Care and .docxpelise1
The Use of Health Information Technology to Improve Care and
Outcomes for Older Adults
Kathryn H. Bowles, PhD, FAAN, FACMI,
van Ameringen Professor in Nursing Excellence, Director of the Center for Integrative Science in
Aging, University of Pennsylvania School of Nursing, Philadelphia, PA
Patricia Dykes, PhD, FAAN, FACMI, and
Senior Nurse Scientist, Director of the Center for Patient Safety Research and Practice; Director
of the Center for Nursing Excellence, Brigham and Women’s Hospital, Boston, MA
George Demiris, PhD, FACMI
Alumni Endowed Professor in Nursing; Professor in Biomedical and Health Informatics, School of
Medicine; Director, Clinical Informatics and Patient Centered Technologies; Graduate Program
Director, Biomedical and Health Informatics University of Washington, Seattle, Washington
Introduction
Using health information technology (HIT) to improve care and outcomes for older adults is
a growing program of research propelled by recent transformative policies such as the
Health Information Technology for Economic and Clinical Health (HITECH) Act
(Blumenthal, 2010; Institute of Medicine, 2011) and the Institute of Medicine report, "The
Future of Nursing: Leading Change, Advancing Health." (Institute of Medicine, 2010). Both
documents call for the implementation of electronic health records (EHR) and HIT solutions
to improve the safety, quality and efficiency of care. Several nurse scientists are at the
forefront of advancing this work, particularly using electronic health records, decision
support and telehealth. This commentary highlights examples of recent research (2010–
2014) led by nurse scientists using HIT to improve patient safety, and the quality and
efficiency of patient care. We also discuss future opportunities for Gerontological nurse
scientists interested in blending the care of older adults and HIT and suggest strategies to
increase our capacity to engage in such innovative research.
Using the EHR to improve outcomes for older adults
Recent incentives provided by the HITECH Act have resulted in rapid growth in the
development and implementation of the EHR. Nurse led studies are beginning to
demonstrate that effective use of the EHR can improve outcomes of relevance to older
adults such as pressure ulcers and falls. Dowding and colleagues evaluated the impact of an
integrated EHR in 29 Kaiser Permanente hospitals on process and outcome indicators for
patient falls and hospital acquired pressure ulcers (Dowding, Turley, & Garrido, 2012).
They found that the EHR system was associated with improved documentation of both fall
and pressure ulcer risk assessments and statistically significant improvements for pressure
ulcer risk assessment documentation. They demonstrated that improved documentation
using the EHR was associated with a 13% decrease in hospital acquired pressure ulcer rates.
HHS Public Access
Author manuscript
Res Gerontol Nurs. Author manuscript; avai.
An emergency department quality improvement projectyasmeenzulfiqar
The document discusses improving vital sign documentation during triage in emergency departments. It aims to investigate factors affecting vital sign data quality during measurement and documentation, and provide recommendations for improvement. A literature review found that timely and accurate vital sign documentation is important for identifying deteriorating patients. However, studies on nursing workflows and documentation of vital signs are limited. The objective is to study nurses' vital sign documentation process through a questionnaire of nurses and analysis of the data. Results showed teamwork and quality improvement efforts like education and training can enhance compliance with vital sign documentation standards during triage. Recommendations include departments addressing challenges in measurement time and reviewing results to improve performance.
826 Unertl et al., Describing and Modeling WorkflowResearch .docxevonnehoggarth79783
826 Unertl et al., Describing and Modeling Workflow
Research Paper �
Describing and Modeling Workflow and Information Flow in
Chronic Disease Care
KIM M. UNERTL, MS, MATTHEW B. WEINGER, MD, KEVIN B. JOHNSON, MD, MS,
NANCY M. LORENZI, PHD, MA, MLS
A b s t r a c t Objectives: The goal of the study was to develop an in-depth understanding of work practices,
workflow, and information flow in chronic disease care, to facilitate development of context-appropriate
informatics tools.
Design: The study was conducted over a 10-month period in three ambulatory clinics providing chronic disease
care. The authors iteratively collected data using direct observation and semi-structured interviews.
Measurements: The authors observed all aspects of care in three different chronic disease clinics for over 150
hours, including 157 patient-provider interactions. Observation focused on interactions among people, processes,
and technology. Observation data were analyzed through an open coding approach. The authors then developed
models of workflow and information flow using Hierarchical Task Analysis and Soft Systems Methodology. The
authors also conducted nine semi-structured interviews to confirm and refine the models.
Results: The study had three primary outcomes: models of workflow for each clinic, models of information flow
for each clinic, and an in-depth description of work practices and the role of health information technology (HIT)
in the clinics. The authors identified gaps between the existing HIT functionality and the needs of chronic disease
providers.
Conclusions: In response to the analysis of workflow and information flow, the authors developed ten guidelines
for design of HIT to support chronic disease care, including recommendations to pursue modular approaches to
design that would support disease-specific needs. The study demonstrates the importance of evaluating workflow
and information flow in HIT design and implementation.
� J Am Med Inform Assoc. 2009;16:826 – 836. DOI 10.1197/jamia.M3000.
Introduction
Health information technology (HIT) can enhance efficiency,
increase patient safety, and improve patient outcomes.1,2
However, features of HIT intended to improve patient care
can lead to rejection of HIT,3 or can produce unexpected
negative consequences or unsafe workarounds if poorly
aligned with workflow.4,5
More than 90 million people in the United States, or 30% of
the population, have chronic diseases.6 HIT can assist with
longitudinal management of chronic disease by, for exam-
Affiliations of the authors: Department of Biomedical Informatics
(KMU, MBW, KBJ, NML), Center for Perioperative Research in
Quality (KMU, MBW, KBJ), Institute of Medicine and Public Health,
VA Tennessee Valley Healthcare System and the Departments of
Anesthesiology and Medical Education (MBW), Department of
Pediatrics (KBJ), Vanderbilt University, Nashville, TN.
This research was supported by a National Library of Medicine
Training Grant, Number T15 .
Mining Health Examination Records A Graph Based Approachijtsrd
This document presents a graph-based approach for mining health examination records to predict future health risks. It proposes a semi-supervised heterogeneous graph (SHG-Health) algorithm to handle classification with large amounts of unlabeled data. The SHG-Health algorithm constructs a graph (HeteroHER) from health examination records, where different item types are modeled as different node types. It then applies semi-supervised learning to classify nodes and predict risks. The authors evaluate the approach on real and synthetic health examination datasets, showing it can effectively predict risks from live data streams and handle heterogeneous and unlabeled data.
Measuring to Improve Medication Reconciliationin a Large Sub.docxalfredacavx97
Measuring to Improve Medication Reconciliation
in a Large Subspecialty Outpatient Practice
Elizabeth Kern, MD, MS; Meg B. Dingae, MHSA; Esther L. Langmack, MD; Candace Juarez, MT; Gary Cott, MD;
Sarah K. Meadows, MS
Background: To assess performance in medication reconciliation (med rec)—the process of comparing and reconciling
patients’ medication lists at clinical transition points—and demonstrate improvement in an outpatient setting, sustainable
and valid measures are needed.
Methods: An interdisciplinary team at National Jewish Health (Denver) attempted to improve med rec in an ambulatory
practice serving patients with respiratory and related diseases. Interventions, which were aimed at physicians, nurses (RNs),
and medical assistants, involved changes in practice and changes in documentation in the electronic health record (EHR).
New measures designed to assess med rec performance, and to validate the measures, were derived from EHR data.
Results: Across 18 months, electronic attestation that med rec was completed at clinic visits increased from 9.8% to 91.3%
(p < 0.0001). Consistent with this improvement, patients with medication lists missing dose/frequency for at least one prescription-
type medication decreased from 18.1% to 15.8% (p < 0.0001). Patients with duplicate albuterol inhalers on their list decreased
from 4.0% to 2.6% (p < 0.0001). Percentages of patients increased for printing of the medication list at the visit (18.7% to
94.0%; p < 0.0001) and receipt of the printed medication list at the visit (52.3% to 67.0%; p = 0.0074). Documentation
that patient education handouts were offered increased initially then declined to an overall poor performance of 32.4% of
clinic visits. Investigation of this result revealed poor buy-in and a highly redundant process.
Conclusion: Deriving measures reflecting performance and quality of med rec from EHR data is feasible and sustainable
over the time periods necessary to demonstrate change. Concurrent, complementary measures may be used to support the
validity of summary measures.
Medication reconciliation (med rec) is the process of sys-tematically and comprehensively reviewing the
medications a patient is taking, to ensure that medications
added, changed, or discontinued are evaluated for poten-
tial safety concerns. One of the three current Joint
Commission National Patient Safety Goals (NPSGs) on med-
ication safety (Goal 3), concerns medication reconciliation,
which ambulatory care organizations have been expected to
perform since 2005. The current version of the goal
(NPSG.03.06.01), effective July 1, 2011, stipulates that am-
bulatory care organizations maintain and communicate
accurate patient medication information.1 One require-
ment is that the organization obtain the patient’s medication
information at the beginning of an episode of care, with the
information to be updated when the patient’s medications
change. Ideally, med rec should occur at each transition of
care or han.
Automated weaning systems aim to improve adaptation of mechanical ventilation support based on continuous patient monitoring. This systematic review and meta-analysis evaluated 21 randomized controlled trials comparing automated weaning systems to non-automated weaning. Pooled results found that automated systems reduced the duration of mechanical ventilation by 10% and time spent in the intensive care unit by 8%. Automated systems also decreased weaning duration by 30%, with the greatest effect seen in mixed or medical intensive care unit populations and when using the Smartcare/PSTM system. There was no strong evidence of impact on mortality or hospital length of stay. Overall, automated weaning systems can reduce ventilation and intensive care unit times.
Medical and Health-Related Errors - The Impact of Recordkeeping upon Patient ...Andrew Sexton
This document summarizes a research proposal that examines whether the conversion to electronic medical recordkeeping will reduce medical errors. The proposal includes a literature review discussing studies that found errors were reduced with computerized billing systems compared to hard copy forms. Other studies found that standardized electronic records improved care coordination, patient safety, and quality. The proposal puts forth several hypotheses to test, including that males and those with less education will be more correlated with errors, while younger individuals and those with more education will be less correlated. The proposed methodology would survey a sample of US adults to collect data to analyze the hypotheses through regression analyses. The goal is to understand how recordkeeping impacts patient well-being and quality of care through medical errors.
This document presents a literature review and proposal for a study to evaluate the effectiveness of home telemonitoring using an ECG monitor in reducing hospital readmission rates among patients aged 65 and older with heart failure. Heart failure results in many hospitalizations and readmissions that cost the healthcare system billions each year. The literature suggests that telemonitoring allows for early detection of exacerbations and improved management of heart failure symptoms, leading to fewer hospitalizations. The proposed study would compare readmission rates over 4 months for heart failure patients who use home ECG telemonitoring versus the standard telemonitoring system, with the hypothesis that ECG telemonitoring would reduce readmission rates.
951023 Electronically Screening Discharge Summaries For Adverse Medical Eventsplokm1580
1) The study aimed to evaluate using electronic screening of discharge summaries to detect adverse medical events, defined as injuries caused by medical care rather than underlying conditions.
2) The study used trigger words related to adverse events to electronically screen discharge summaries and found 191 cases of potential adverse events out of 424 summaries.
3) Combining electronic screening with manual review of a random sample improved specificity for detecting adverse events compared to relying solely on manual review. The study demonstrated the feasibility of using electronic screening of discharge summaries to help identify adverse medical events.
This document provides an outline for a presentation on electronic medical records (EMRs). It begins with defining the components of an EMR, including labs, admissions/discharge/transfer data, orders, radiology, notes, and billing. It then discusses the history and adoption of EMRs from the 1960s to present. The document reviews studies showing the effectiveness of EMRs in improving quality of care and achieving treatment standards. It also outlines how EMR data is structured in databases and data warehouses and describes common health data standards like ICD, CPT, LOINC, SNOMED, and HL7. The presentation covers meaningful use incentives and provides examples of using EMR data for research studies.
This document discusses the debate between randomized clinical trials (RCTs) and observational studies using big data. While RCTs are better for minimizing bias, observational studies can include more patients and answer questions RCTs cannot. The document outlines several large cancer databases that can help learn from every patient, including SEER and NCDB registries. It describes how these databases are being enriched with additional data sources like EHRs, genomic data, and mobile devices. This evolving use of big data from numerous sources can improve outcomes by better understanding toxicity, costs, and quality of cancer care.
This document presents a literature review and proposal to reduce medication errors in a 28-bed rehabilitation unit through the use of an electronic medication administration record (EMAR) over a 30-day period. Studies have shown EMARs can significantly reduce transcription and administration errors compared to handwritten records. The proposal is for physicians to enter all medication orders via the existing EMAR system for 30 days to evaluate if it decreases transcription errors versus the current paper method. Implementing EMARs has been shown to potentially prevent 84% of dosing, frequency and route errors.
surgical nurses in teaching hospitals in Ireland understanding painNiamh Vickers
This document summarizes a study examining the knowledge and attitudes of surgical nurses regarding pain management in three teaching hospitals in Ireland. The study found:
1) Nurses had inadequate knowledge about pain management, with a mean score of 65.7% on a pain assessment tool, and only 3% scoring 80% or higher.
2) Knowledge deficits were found across pharmacological and non-pharmacological pain management.
3) Nurses overestimated their own knowledge, though results showed widespread gaps.
4) Educational initiatives are needed to enhance nurses' knowledge and improve pain management practices.
The document examines the implementation of patient safety and patient-centeredness strategies in 84 Iranian hospitals based on a survey completed by hospital and nursing managers in 2009-2010. It finds that the majority of hospitals reported implementing 84% of patient safety strategies and 72% of patient-centeredness strategies. Implementation of most strategies was generally unrelated to hospital characteristics like type, ownership, teaching status, or annual evaluation grade, with some exceptions. Overall implementation of strategies was substantial but there is still room for improvement, including enforcing standards, increasing organizational responsiveness, and partnering with patients.
Using the Bigtown Simulation Model to Predict the Impact of Enhanced Seven Day Services on Hospital Performance and Patient Outcomes
Poster from the 'Delivering NHS services, seven days a week' event held in Birmingham on 16 November 2013
More information about this event can be found at
http://www.nhsiq.nhs.uk/news-events/events/nhs-services-seven-days-a-week.aspx
Ht ai 2015 poster 238 - Efficiency of the Artificial Urinary SphincterREBRATSoficial
The document summarizes research on the artificial urinary sphincter (AS) for treating urinary incontinence following prostatectomy. It finds that while AS has success rates of around 79% and patient satisfaction, the evidence is limited as only one randomized controlled trial exists. Systematic reviews call for more studies directly comparing AS to other surgical therapies. Health technology assessments in Brazil did not recommend AS for public insurance due to low evidence, but private insurance does cover it. More high-quality research is needed to determine the effectiveness and costs of AS versus other options.
The Paperless partograph – The new user-friendly and simpler tool for monitor...iosrjce
IOSR Journal of Dental and Medical Sciences is one of the speciality Journal in Dental Science and Medical Science published by International Organization of Scientific Research (IOSR). The Journal publishes papers of the highest scientific merit and widest possible scope work in all areas related to medical and dental science. The Journal welcome review articles, leading medical and clinical research articles, technical notes, case reports and others.
Vaccines are an essential method for preventing infectious diseases. While vaccination programs have reduced disease rates, vaccine safety continues to be monitored. An extensive vaccine safety review found limited understanding of adverse events due to insufficient research. Improving research capacity is needed so future reviews are not handicapped. Both pre-licensure clinical trials and post-licensure surveillance systems aim to monitor vaccine safety, though assessing rare adverse events poses challenges requiring large studies and international collaboration. Standardized methods and ongoing evaluation aim to maintain public confidence in vaccination.
Evidence Based Practice Lecture 7_slidesZakCooper1
This document discusses how evidence-based practice is used in clinical settings through clinical practice guidelines and decision analysis. It defines clinical practice guidelines as a series of steps for providing clinical care and decision analysis as a formal structure for integrating evidence about treatment options. Clinical practice guidelines aim to standardize and improve care but have limitations such as not applying to complex patients. Decision analysis allows for elucidating optimal individual decisions but requires significant time and resources. Overall, evidence-based practice provides tools and approaches to inform clinical decision-making.
ePCR Research Paper for Western Journal for EMlarry_johnson
1) The survey found that most emergency physicians (EPs) prefer electronic prehospital patient care reports (PCRs) over handwritten ones, but electronic PCRs are often unavailable for medical decision-making.
2) While EPs felt PCRs were important to their practice, 79.6% reported electronic PCRs were available ≤50% of the time compared to only 22.4% for handwritten PCRs.
3) The study suggests strategies are needed to improve the accuracy of PCRs and ensure electronic versions are delivered in a timely manner to aid in emergency department medical decision-making.
Running head CRITIQUE QUANTITATIVE, QUALITATIVE, OR MIXED METHODS.docxtodd271
Running head: CRITIQUE QUANTITATIVE, QUALITATIVE, OR MIXED METHODS DESIGN
5
CRITIQUE OF QUANTITATIVE, QUALITATIVE, OR MIXED METHODS DESIGN
Critiquing Quantitative, Qualitative, or Mixed Methods Studies
Adenike George
Walden University
NURS 6052: Essentials of Evidence-Based Practice
April 11, 2019
Critique of Quantitative, Qualitative, or Mixed Method Design
Both quantitative and qualitative methods play a pivotal role in nursing research. Qualitative research helps nurses and other healthcare workers to understand the experiences of the patients on health and illness. Quantitative data allows researchers to use an accurate approach in data collection and analysis. When using quantitative techniques, data can be analyzed using either descriptive statistics or inferential statistics which allows the researchers to derive important facts like demographics, preference trends, and differences between the groups. The paper comprehensively critiques quantitative and quantitative techniques of research. Furthermore, the author will also give reasons as to why qualitative methods should be regarded as scientific.
The overall value of quantitative and Qualitative Research
Quantitative studies allow the researchers to present data in terms of numbers. Since data is in numeric form, researchers can apply statistical techniques in analyzing it. These include descriptive statistics like mean, mode, median, standard deviation and inferential statistics such as ANOVA, t-tests, correlation and regression analysis. Statistical analysis allows us to derive important facts from data such as preference trends, demographics, and differences between groups. For instance, by conducting a mixed methods study to determine the feeding experiences of infants among teen mothers in North Carolina, Tucker and colleagues were able to compare breastfeeding trends among various population groups. The multiple groups compared were likely to initiate breastfeeding as follows: Hispanic teens 89%, Black American teens 41%, and White teens 52% (Tucker et al., 2011).
The high strength of quantitative analysis lies in providing data that is descriptive. The descriptive statistics helps us to capture a snapshot of the population. When analyzed appropriate, the descriptive data enables us to make general conclusions concerning the population. For instance, through detailed data analysis, Tucker and co-researchers were able to observe that there were a large number of adolescents who ceased breastfeeding within the first month drawing the need for nurses to conduct individualized follow-ups the early days after hospital discharge. These follow-ups would significantly assist in addressing the conventional technical problems and offer support in managing back to school transition (Tucker et al., 2011).
Qualitative research allows researchers to determine the client’s perspective on healthcare. It enables researchers to observe certain behaviors and experiences amo.
The Use of Health Information Technology to Improve Care and .docxpelise1
The Use of Health Information Technology to Improve Care and
Outcomes for Older Adults
Kathryn H. Bowles, PhD, FAAN, FACMI,
van Ameringen Professor in Nursing Excellence, Director of the Center for Integrative Science in
Aging, University of Pennsylvania School of Nursing, Philadelphia, PA
Patricia Dykes, PhD, FAAN, FACMI, and
Senior Nurse Scientist, Director of the Center for Patient Safety Research and Practice; Director
of the Center for Nursing Excellence, Brigham and Women’s Hospital, Boston, MA
George Demiris, PhD, FACMI
Alumni Endowed Professor in Nursing; Professor in Biomedical and Health Informatics, School of
Medicine; Director, Clinical Informatics and Patient Centered Technologies; Graduate Program
Director, Biomedical and Health Informatics University of Washington, Seattle, Washington
Introduction
Using health information technology (HIT) to improve care and outcomes for older adults is
a growing program of research propelled by recent transformative policies such as the
Health Information Technology for Economic and Clinical Health (HITECH) Act
(Blumenthal, 2010; Institute of Medicine, 2011) and the Institute of Medicine report, "The
Future of Nursing: Leading Change, Advancing Health." (Institute of Medicine, 2010). Both
documents call for the implementation of electronic health records (EHR) and HIT solutions
to improve the safety, quality and efficiency of care. Several nurse scientists are at the
forefront of advancing this work, particularly using electronic health records, decision
support and telehealth. This commentary highlights examples of recent research (2010–
2014) led by nurse scientists using HIT to improve patient safety, and the quality and
efficiency of patient care. We also discuss future opportunities for Gerontological nurse
scientists interested in blending the care of older adults and HIT and suggest strategies to
increase our capacity to engage in such innovative research.
Using the EHR to improve outcomes for older adults
Recent incentives provided by the HITECH Act have resulted in rapid growth in the
development and implementation of the EHR. Nurse led studies are beginning to
demonstrate that effective use of the EHR can improve outcomes of relevance to older
adults such as pressure ulcers and falls. Dowding and colleagues evaluated the impact of an
integrated EHR in 29 Kaiser Permanente hospitals on process and outcome indicators for
patient falls and hospital acquired pressure ulcers (Dowding, Turley, & Garrido, 2012).
They found that the EHR system was associated with improved documentation of both fall
and pressure ulcer risk assessments and statistically significant improvements for pressure
ulcer risk assessment documentation. They demonstrated that improved documentation
using the EHR was associated with a 13% decrease in hospital acquired pressure ulcer rates.
HHS Public Access
Author manuscript
Res Gerontol Nurs. Author manuscript; avai.
An emergency department quality improvement projectyasmeenzulfiqar
The document discusses improving vital sign documentation during triage in emergency departments. It aims to investigate factors affecting vital sign data quality during measurement and documentation, and provide recommendations for improvement. A literature review found that timely and accurate vital sign documentation is important for identifying deteriorating patients. However, studies on nursing workflows and documentation of vital signs are limited. The objective is to study nurses' vital sign documentation process through a questionnaire of nurses and analysis of the data. Results showed teamwork and quality improvement efforts like education and training can enhance compliance with vital sign documentation standards during triage. Recommendations include departments addressing challenges in measurement time and reviewing results to improve performance.
826 Unertl et al., Describing and Modeling WorkflowResearch .docxevonnehoggarth79783
826 Unertl et al., Describing and Modeling Workflow
Research Paper �
Describing and Modeling Workflow and Information Flow in
Chronic Disease Care
KIM M. UNERTL, MS, MATTHEW B. WEINGER, MD, KEVIN B. JOHNSON, MD, MS,
NANCY M. LORENZI, PHD, MA, MLS
A b s t r a c t Objectives: The goal of the study was to develop an in-depth understanding of work practices,
workflow, and information flow in chronic disease care, to facilitate development of context-appropriate
informatics tools.
Design: The study was conducted over a 10-month period in three ambulatory clinics providing chronic disease
care. The authors iteratively collected data using direct observation and semi-structured interviews.
Measurements: The authors observed all aspects of care in three different chronic disease clinics for over 150
hours, including 157 patient-provider interactions. Observation focused on interactions among people, processes,
and technology. Observation data were analyzed through an open coding approach. The authors then developed
models of workflow and information flow using Hierarchical Task Analysis and Soft Systems Methodology. The
authors also conducted nine semi-structured interviews to confirm and refine the models.
Results: The study had three primary outcomes: models of workflow for each clinic, models of information flow
for each clinic, and an in-depth description of work practices and the role of health information technology (HIT)
in the clinics. The authors identified gaps between the existing HIT functionality and the needs of chronic disease
providers.
Conclusions: In response to the analysis of workflow and information flow, the authors developed ten guidelines
for design of HIT to support chronic disease care, including recommendations to pursue modular approaches to
design that would support disease-specific needs. The study demonstrates the importance of evaluating workflow
and information flow in HIT design and implementation.
� J Am Med Inform Assoc. 2009;16:826 – 836. DOI 10.1197/jamia.M3000.
Introduction
Health information technology (HIT) can enhance efficiency,
increase patient safety, and improve patient outcomes.1,2
However, features of HIT intended to improve patient care
can lead to rejection of HIT,3 or can produce unexpected
negative consequences or unsafe workarounds if poorly
aligned with workflow.4,5
More than 90 million people in the United States, or 30% of
the population, have chronic diseases.6 HIT can assist with
longitudinal management of chronic disease by, for exam-
Affiliations of the authors: Department of Biomedical Informatics
(KMU, MBW, KBJ, NML), Center for Perioperative Research in
Quality (KMU, MBW, KBJ), Institute of Medicine and Public Health,
VA Tennessee Valley Healthcare System and the Departments of
Anesthesiology and Medical Education (MBW), Department of
Pediatrics (KBJ), Vanderbilt University, Nashville, TN.
This research was supported by a National Library of Medicine
Training Grant, Number T15 .
Mining Health Examination Records A Graph Based Approachijtsrd
This document presents a graph-based approach for mining health examination records to predict future health risks. It proposes a semi-supervised heterogeneous graph (SHG-Health) algorithm to handle classification with large amounts of unlabeled data. The SHG-Health algorithm constructs a graph (HeteroHER) from health examination records, where different item types are modeled as different node types. It then applies semi-supervised learning to classify nodes and predict risks. The authors evaluate the approach on real and synthetic health examination datasets, showing it can effectively predict risks from live data streams and handle heterogeneous and unlabeled data.
Measuring to Improve Medication Reconciliationin a Large Sub.docxalfredacavx97
Measuring to Improve Medication Reconciliation
in a Large Subspecialty Outpatient Practice
Elizabeth Kern, MD, MS; Meg B. Dingae, MHSA; Esther L. Langmack, MD; Candace Juarez, MT; Gary Cott, MD;
Sarah K. Meadows, MS
Background: To assess performance in medication reconciliation (med rec)—the process of comparing and reconciling
patients’ medication lists at clinical transition points—and demonstrate improvement in an outpatient setting, sustainable
and valid measures are needed.
Methods: An interdisciplinary team at National Jewish Health (Denver) attempted to improve med rec in an ambulatory
practice serving patients with respiratory and related diseases. Interventions, which were aimed at physicians, nurses (RNs),
and medical assistants, involved changes in practice and changes in documentation in the electronic health record (EHR).
New measures designed to assess med rec performance, and to validate the measures, were derived from EHR data.
Results: Across 18 months, electronic attestation that med rec was completed at clinic visits increased from 9.8% to 91.3%
(p < 0.0001). Consistent with this improvement, patients with medication lists missing dose/frequency for at least one prescription-
type medication decreased from 18.1% to 15.8% (p < 0.0001). Patients with duplicate albuterol inhalers on their list decreased
from 4.0% to 2.6% (p < 0.0001). Percentages of patients increased for printing of the medication list at the visit (18.7% to
94.0%; p < 0.0001) and receipt of the printed medication list at the visit (52.3% to 67.0%; p = 0.0074). Documentation
that patient education handouts were offered increased initially then declined to an overall poor performance of 32.4% of
clinic visits. Investigation of this result revealed poor buy-in and a highly redundant process.
Conclusion: Deriving measures reflecting performance and quality of med rec from EHR data is feasible and sustainable
over the time periods necessary to demonstrate change. Concurrent, complementary measures may be used to support the
validity of summary measures.
Medication reconciliation (med rec) is the process of sys-tematically and comprehensively reviewing the
medications a patient is taking, to ensure that medications
added, changed, or discontinued are evaluated for poten-
tial safety concerns. One of the three current Joint
Commission National Patient Safety Goals (NPSGs) on med-
ication safety (Goal 3), concerns medication reconciliation,
which ambulatory care organizations have been expected to
perform since 2005. The current version of the goal
(NPSG.03.06.01), effective July 1, 2011, stipulates that am-
bulatory care organizations maintain and communicate
accurate patient medication information.1 One require-
ment is that the organization obtain the patient’s medication
information at the beginning of an episode of care, with the
information to be updated when the patient’s medications
change. Ideally, med rec should occur at each transition of
care or han.
Automated weaning systems aim to improve adaptation of mechanical ventilation support based on continuous patient monitoring. This systematic review and meta-analysis evaluated 21 randomized controlled trials comparing automated weaning systems to non-automated weaning. Pooled results found that automated systems reduced the duration of mechanical ventilation by 10% and time spent in the intensive care unit by 8%. Automated systems also decreased weaning duration by 30%, with the greatest effect seen in mixed or medical intensive care unit populations and when using the Smartcare/PSTM system. There was no strong evidence of impact on mortality or hospital length of stay. Overall, automated weaning systems can reduce ventilation and intensive care unit times.
The document recommends continuing to use the Post-Discharge Questionnaire (PDQ) on Unit P7 to assess patient satisfaction and gather data in real-time. Results from the PDQ administered in June 2011 to 101 discharged patients on Unit P7 showed high patient satisfaction scores above the 80th percentile for most discharge measures. Scores were below the 80th percentile for information provided in the discharge packet. The PDQ provided a larger sample size than other surveys and captured feedback that can be used to improve the discharge process.
Journal Club (Smartphone use for Paediatric calculations in emergencies)Ehab Zahran
1. The study compared the rate of error, time taken, and stress levels for healthcare professionals completing paediatric emergency drug and fluid calculations using a smartphone app, reference charts, or traditional methods.
2. It found that the smartphone app had significantly fewer errors, took less time, and caused less stress than traditional methods. Reference charts also had fewer errors than traditional methods.
3. The study recommends adopting the use of a smartphone app or reference charts over traditional methods for paediatric emergency calculations to improve accuracy, efficiency and reduce stress for healthcare professionals. Further research on medical apps is still needed to establish their full utility and safety.
EXAMINING THE EFFECT OF FEATURE SELECTION ON IMPROVING PATIENT DETERIORATION ...IJDKP
This document discusses examining the effect of feature selection on improving patient deterioration prediction in intensive care units. The authors apply feature selection techniques to laboratory test data from the MIMIC-II database to identify the most important laboratory tests for predicting patient deterioration. They find that feature selection can help reduce redundant tests, potentially saving costs and allowing earlier treatment. The selected features provide insights into critical tests without domain expertise. In future work, the authors plan to evaluate additional feature selection methods and classification algorithms on this task.
Running head PLANNING STAGE 2-(DESIGN PHASE) OF A RESEARCH PROJEC.docxjeanettehully
Running head: PLANNING STAGE 2-(DESIGN PHASE) OF A RESEARCH PROJECT 1
PLANNING STAGE 2- (DESIGN PHASE) OF A RESEARCH PROJECT 8
Planning Stage 2- (Design Phase) of a Research Project
Student name
Florida National University
Planning Stage 2- (Design Phase) of a Research Project
Heart failure is one of the most common types of chronic conditions among the elderly, which results into increased readmissions globally. This statistic is attributable to poor coordination and communication in the transition care settings. The various care settings include skilled nursing facilities, acute-care hospitals, long-standing care facilities and ambulatory stay (Naylor et al., 2017). This research paper is aimed at investigating the reason for poor continuity of care in transition care facilities. A detailed literature review was performed regarding the standard of care in such settings for patients with heart failure. The research methodologies used include case study methods, interviews, and administration of questionnaires. Probability and non-probability methods including stratified sampling and convenience sampling were used as the sampling methodologies. The necessary tools for data collection include questionnaires, interviews, schedules and observation techniques. In addition, an algorithm was created during this design phase. Thus, an insight into the design phase is sought and discussed herein.
Literature Review
Heart failure is a prolonged condition that has been highlighted as one of the top causes of public health complications in the world. The American Journal of Accountable care provides detailed information on heart failure as a public health problem. According to this journal, there are numerous causes of readmission of patients undergoing the transition care model (A Literature Review of Heart Failure Transitional Care Interventions, 2019). The journal highlights various issues, such as early discharge, poor management of underlying problems, poor coordination among key stakeholders and early discharge of patients as the major causes of readmission. All such issues can, however, be prevented and thus this research will discuss some of the coping methods. In addition, the US medical beneficiaries discuss the quality and safety in the transition care model (Teno et al. , 2018). Some of the beneficiaries state their experiences following being admitted into the transition care model. This article complements the previous article by adding real life case study analysis of patients who have been previously admitted to the transition care. Further, interviews of clinicians working in the transition care model are highlighted with an explanation of failure to conduct follow up visits of particular patients.
The American Journal of Public Health explores the affordability of the transition care and the quality of care that some patients can be able to afford. The article has explored the ...
Introduction Healthcare system is considered one of the busiest.pdfbkbk37
The document discusses the application of clinical information systems in nursing. It reviews 4 peer-reviewed articles on the topic. The articles found that clinical information systems can improve workflow and reduce medical errors. However, challenges remain around data integration and sharing patient data across healthcare systems. The document concludes that clinical systems provide opportunities to improve care if effectively implemented and regularly updated to support nurses.
Many molecules in nature have geometry, which enables
them to exist as non-superimposable mirror images, or enantiomers.
Modulation of toxicity of such molecules provides
possibility for therapeutics, since they target
multiple points in biochemical pathways. It was hypothesized
that toxicity of a chemical agent, could be counteracted
by a homeopathic preparation of the enantiomer of
the chemical agent
1) Chemotherapy patients commonly experience a variety of side effects ranging from mild to severe. However, clinicians often underestimate the side effects that patients report experiencing.
2) The use of electronic patient-reported outcomes (ePRO) tools has been shown to improve communication between patients and clinicians about side effects. This leads to earlier detection and management of side effects.
3) Implementing an ePRO app for patients to report side effects at home can help clinicians monitor symptoms in real-time and make timely adjustments to chemotherapy treatment plans. This may improve patients' quality of life and survival outcomes.
Evaluation of the Inpatient Hospital Experience while on PrecautionsKathryn Cannon
This study assessed patient satisfaction of those under contact/airborne isolation precautions versus those not under precautions at Yale-New Haven Hospital. 87 patients were interviewed using a survey measuring satisfaction with communication, treatment explanations, help from staff, pain control, and overall experience. Small variations were found between groups in nurse communication, timely help, pain control, and overall satisfaction. No significant difference was seen in doctor communication, but those under precautions expressed higher satisfaction with treatment explanations. The study aimed to understand differences to improve hospital processes and performance under new CMS reimbursement policies tied to patient satisfaction.
Standardized Bedside ReportingOne of the goals of h.docxwhitneyleman54422
Standardized Bedside Reporting
One of the goals of healthcare is to ensure that the patients get the best service possible while not compromising on the satisfaction and goodwill of the nurses and other healthcare professionals. A key aspect of ensuring quality healthcare is the consistent handling of patient information from nurse to nurse during shifts; information handled wrongly can jeopardize the patients’ health (Baker, 2010). It is important to implement procedures that ensure consistent and smooth handling of patient information from nurse to nurse to increase patient safety and improve nurse satisfaction. This paper will explore the merits of standardized bedside reporting as opposed to board reporting in ensuring a positive outcome and consistent quality healthcare.
Change model overview
A key aspect in determining whether bedside shift reporting has any merits over board reporting is the John Hopkins Nursing Evidence-Based Practice Process (JHNEBP). The John Hopkins Nursing Evidence-Based Practice Process is a framework for guiding the translation and synthesis of evidence into valid healthcare practice. JHNEBP has three cornerstones that include research, education, and practice; the framework ensures that research evidence is the basis of clinical decision-making. (Dearholt & Dang, 2012) The implementation of the John Hopkins Nursing Evidence-Based Practice Process has three key phases, the first phase is the identification of an important question, the second phase involves the systematic review of research evidence, and the third phase is translating the results into action. Nurses should use the JHNEBP process because it provides a clear way for healthcare professionals to translate research results into healthcare practice.
Practice Question
The team includes several key stakeholders who will benefit greatly from my research. Among the team members include myself as ER nurse, charge nurse, ERT ( Emergency room tech), nurse case manager, nurse supervisor, physician and hospital manager.
The evidence-based practice question that the team members will explore is "Does the use of a standardized bedside report versus board reporting help increase patient safety, nurse satisfaction, and positive outcome?" The evidence-based practice question assesses the ability of bedside shift reporting to improve healthcare provision. The practice area of the question is clinical. The practice issue came about because of assessing risk management concerns in ensuring good health practices. To answer the question, the team members gathered evidence from patient preferences, peer-reviewed journals, and clinical guidelines. The team members searched peer-reviewed journal databases to gather relevant information from previous research that could affect the results.
Understanding the merits of bedside shift reporting as opposed to board reporting is important as most healthcare organization use either strategy in collecting and passin.
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Critical Appraisal Tools Worksheet
Template
)
Evaluation Table
Use this document to complete the evaluation table requirement of the Module 4 Assessment,Evidence-Based Project, Part 4A: Critical Appraisal of Research
Full citation of selected article
Article #1
Article #2
Article #3
Article #4
Ashcroft, D., Lewis, P., Tully, M., Farragher, T., Taylor, D., & Wass, V., Williams, S. D., & Dornan, T. (2015). Prevalence, Nature, Severity and Risk Factors for Prescribing Errors in Hospital Inpatients: Prospective Study in 20 UK Hospitals. Drug Safety, 38(9), 833-843. DOI: 10.1007/s40264-015-0320-x
Carayon, P., Wetterneck, T., Cartmill, R., Blosky, M., Brown, R., & Kim, R., Kukreja, S., Johnson, M., Paris, B., Wood, K. E., & Walker, J. (2014). Characterising the complexity of medication safety using a human factors approach: an observational study in two intensive care units. BMJ Quality & Safety, 23(1), 56-65. DOI: 10.1136/bmjqs-2013-001828
Hines, S., Kynoch, K., & Khalil, H. (2018). Effectiveness of interventions to prevent medication errors. JBI Database Of Systematic Reviews And Implementation Reports, 16(2), 291-296. DOI: 10.11124/jbisrir-2017-003481
Khalil, H., Chambers, H., Sheikh, A., Bell, B., & Avery, A. (2017). Professional, structural and organisational interventions in primary care for reducing medication errors. Cochrane Database System Review, 10 (CD003942). DOI: 10.1002/14651858.CD003942.pub3.
Conceptual Framework
Describe the theoretical basis for the study
The study deduced the reasoning that doctors during their first year of post-graduate training are prone to making disproportionate errors in their prescription.
Safety during medication is a significant issue in healthcare more so in intensive care units (ICUs). Therefore, the complexity of the medication management process is reflected on the convolution of evaluating medication errors and adverse drug events in ICUs.
This study seeks to assess the effectiveness of interventions developed to avert medication error during administration of medication, medication-related death, and medication-related harms among acute care patients.
During primary care, there are adverse events associated with medication and they represent a significant cause of hospital admission and mortality and these events could be as a result of patient going through adverse drug reactions or medication errors and the latter is preventable.
Design/Method Describe the design and how the study
was carried out
The study used pharmacists as their subjects across 20 health facilities over 7 selected days and the data was collected based on the number of checked medication orders, details of the prescribing errors, and the prescriber’s grade.
As part of the study’s methodology, the research has assessed the effect of electronic medical record on the safety and quality across ICUs by having cross-sectional study which has reported on the medication safety before EHR was used in two ICU facilities ...
An AI-based Decision Platform built using unified data model, incorporating systems biology topics for unit analysis using semi-supervised learning models
Similar to IMPACT OF HEALTH INFORMATICS TECHNOLOGY ON THE IMPLEMENTATION OF A MODIFIED EARLY WARNING SCORE (MEWS) (20)
A PRACTICAL APPROACH TO PREDICTING DEPRESSION: VERBAL AND NON-VERBAL INSIGHTS...hiij
While global standards have been established for diagnosing depression, the reliance on expert judgement
and observation remains a challenge. This study delves into a potential approach of efficient data
collection to increase the practicability of machine learning models in accurately predicting depression
based on a comprehensive analysis of verbal and non-verbal cues exhibited by individuals.
Health Disparities: Differences in Veteran and Non-Veteran Populations using ...hiij
Introduction: This study investigated self-reported health status, health screenings, vision problems, and
vaccination rates among veteran and non-veteran groups to uncover health disparities that are critical for
informed health system planning for veteran populations.
Methods: Using public-use data from the National Health Interview Survey (2015-2018), this study adopts
an ecologic cross-sectional approach to conduct an in-depth analysis and visualization of the data assisted
by Generative AI, specifically ChatGPT-4. This integration of advanced AI tools with traditional
epidemiological principles enables systematic data management, analysis, and visualization, offering a
nuanced understanding of health dynamics across demographic segments and highlighting disparities
essential for veteran health system planning.
Findings: Disparities in self-reports of health outcomes, health screenings, vision problems, and
vaccination rates were identified, emphasizing the need for targeted interventions and policy adjustments.
Conclusion: Insights from this study could inform health system planning, using epidemiological data
assessment to suggest enhancements for veteran healthcare delivery. These findings highlight the value of
integrating Generative AI with epidemiological analysis in shaping public health policy and health
planning.
Health Informatics - An International Journal (HIIJ)hiij
Healthcare Informatics: An International Journal is a quarterly open access peer-reviewed journal that Publishes articles which contribute new results in all areas of the health care.
The journal focuses on all of aspect in theory, practices, and applications of Digital Health Records, Knowledge Engineering in Health, E-Health Information, and Information Management in healthcare, Bio-Medical Expert Systems, ICT in health promotion and related topics. Original contributions are solicited on topics covered under the broad areas such as (but not limited to) listed below:
Health Informatics - An International Journal (HIIJ)hiij
Healthcare Informatics: An International Journal is a quarterly open access peer-reviewed journal that Publishes articles which contribute new results in all areas of the health care.
The journal focuses on all of aspect in theory, practices, and applications of Digital Health Records, Knowledge Engineering in Health, E-Health Information, and Information Management in healthcare, Bio-Medical Expert Systems, ICT in health promotion and related topics. Original contributions are solicited on topics covered under the broad areas such as (but not limited to) listed below:
HEALTH DISPARITIES: DIFFERENCES IN VETERAN AND NON-VETERAN POPULATIONS USING ...hiij
Introduction: This study investigated self-reported health status, health screenings, vision problems, and
vaccination rates among veteran and non-veteran groups to uncover health disparities that are critical for
informed health system planning for veteran populations.
Methods: Using public-use data from the National Health Interview Survey (2015-2018), this study adopts
an ecologic cross-sectional approach to conduct an in-depth analysis and visualization of the data assisted
by Generative AI, specifically ChatGPT-4. This integration of advanced AI tools with traditional
epidemiological principles enables systematic data management, analysis, and visualization, offering a
nuanced understanding of health dynamics across demographic segments and highlighting disparities
essential for veteran health system planning.
Findings: Disparities in self-reports of health outcomes, health screenings, vision problems, and
vaccination rates were identified, emphasizing the need for targeted interventions and policy adjustments.
Conclusion: Insights from this study could inform health system planning, using epidemiological data
assessment to suggest enhancements for veteran healthcare delivery. These findings highlight the value of
integrating Generative AI with epidemiological analysis in shaping public health policy and health
planning.
Health Informatics - An International Journal (HIIJ)hiij
Healthcare Informatics: An International Journal is a quarterly open access peer-reviewed journal that Publishes articles which contribute new results in all areas of the health care.
The journal focuses on all of aspect in theory, practices, and applications of Digital Health Records, Knowledge Engineering in Health, E-Health Information, and Information Management in healthcare, Bio-Medical Expert Systems, ICT in health promotion and related topics. Original contributions are solicited on topics covered under the broad areas such as (but not limited to) listed below:
Health Informatics - An International Journal (HIIJ)hiij
Healthcare Informatics: An International Journal is a quarterly open access peer-reviewed journal that Publishes articles which contribute new results in all areas of the health care.
The journal focuses on all of aspect in theory, practices, and applications of Digital Health Records, Knowledge Engineering in Health, E-Health Information, and Information Management in healthcare, Bio-Medical Expert Systems, ICT in health promotion and related topics. Original contributions are solicited on topics covered under the broad areas such as (but not limited to) listed below:
Health Informatics - An International Journal (HIIJ)hiij
Healthcare Informatics: An International Journal is a quarterly open access peer-reviewed journal that Publishes articles which contribute new results in all areas of the health care.
The journal focuses on all of aspect in theory, practices, and applications of Digital Health Records, Knowledge Engineering in Health, E-Health Information, and Information Management in healthcare, Bio-Medical Expert Systems, ICT in health promotion and related topics. Original contributions are solicited on topics covered under the broad areas such as (but not limited to) listed below:
Health Informatics - An International Journal (HIIJ)hiij
Healthcare Informatics: An International Journal is a quarterly open access peer-reviewed journal that Publishes articles which contribute new results in all areas of the health care.
The journal focuses on all of aspect in theory, practices, and applications of Digital Health Records, Knowledge Engineering in Health, E-Health Information, and Information Management in healthcare, Bio-Medical Expert Systems, ICT in health promotion and related topics. Original contributions are solicited on topics covered under the broad areas such as (but not limited to) listed below:
Health Informatics - An International Journal (HIIJ)hiij
Healthcare Informatics: An International Journal is a quarterly open access peer-reviewed journal that Publishes articles which contribute new results in all areas of the health care.
The journal focuses on all of aspect in theory, practices, and applications of Digital Health Records, Knowledge Engineering in Health, E-Health Information, and Information Management in healthcare, Bio-Medical Expert Systems, ICT in health promotion and related topics. Original contributions are solicited on topics covered under the broad areas such as (but not limited to) listed below:
BRIEF COMMENTARY: USING A LOGIC MODEL TO INTEGRATE PUBLIC HEALTH INFORMATICS ...hiij
The COVID-19 pandemic has been a watershed moment in public health surveillance, highlighting the
crucial role of data-driven insights in informing health actions and policies. Revisiting key concepts—
public health, epidemiology in public health practice, public health surveillance, and public health
informatics—lays the foundation for understanding how these elements converge to create a robust public
health surveillance system framework. Especially during the COVID-19 pandemic, this integration was
exemplified by the WHO efforts in data dissemination and the subsequent global response. The role of
public health informatics emerged as instrumental in this context, enhancing data collection, management,
analysis, interpretation, and dissemination processes. A logic model for public health surveillance systems
encapsulates the integration of these concepts. It outlines the inputs and outcomes and emphasizes the
crucial actions and resources for effective system operation, including the imperative of training and
capacity development.
Health Informatics - An International Journal (HIIJ)hiij
Healthcare Informatics: An International Journal is a quarterly open access peer-reviewed journal that Publishes articles which contribute new results in all areas of the health care.
The journal focuses on all of aspect in theory, practices, and applications of Digital Health Records, Knowledge Engineering in Health, E-Health Information, and Information Management in healthcare, Bio-Medical Expert Systems, ICT in health promotion and related topics. Original contributions are solicited on topics covered under the broad areas such as (but not limited to) listed below:
AUTOMATIC AND NON-INVASIVE CONTINUOUS GLUCOSE MONITORING IN PAEDIATRIC PATIENTShiij
Glycated haemoglobin does not allow you to highlight the effects that food choices, physical activity and
medications have on your glycaemic control day by day. The best way to monitor and keep track of the
immediate effects that these have on your blood sugar levels is self-monitoring, therefore the use of a
glucometer. Thanks to this tool you have the possibility to promptly receive information that helps you to
intervene in the most appropriate way, bringing or keeping your blood sugar levels as close as possible to
the reference values indicated by your doctor. Currently, blood glucose meters are used to measure and
control blood glucose. Diabetes is a fairly complex disease and it is important for those who suffer from it
to check their blood sugar (blood sugar) periodically throughout the day to prevent dangerous
complications. Many children newly diagnosed with diabetes and their families may face unique challenges
when dealing with the everyday management of diabetes, including treatments, adapting to dietary
changes, and the routine monitoring of blood glucose. Many questions may also arise when selecting a
blood glucose meter for paediatric patients. With current blood glucose meters, even with multiple daily
self-tests, high and low blood glucose levels may not be detected. Key factors that may be considered when
selecting a meter include accuracy of the meter; size of the meter; small sample size required for testing;
ease of use and easy-to-follow testing procedure; ability for alternate testing sites; quick testing time and
availability of results; ease of portability to allow testing at school and during leisure time; easyto- read
numbers on display; memory options; cost of meter and supplies. In this study we will show a new
automatic portable, non-invasive device and painless for the daily continuous monitoring (24 hours a day)
of blood glucose in paediatric patients.
INTEGRATING MACHINE LEARNING IN CLINICAL DECISION SUPPORT SYSTEMShiij
This review article examines the role of machine learning (ML) in enhancing Clinical Decision Support
Systems (CDSSs) within the modern healthcare landscape. Focusing on the integration of various ML
algorithms, such as regression, random forest, and neural networks, the review aims to showcase their
potential in advancing patient care. A rapid review methodology was utilized, involving a survey of recent
articles from PubMed and Google Scholar on ML applications in healthcare. Key findings include the
demonstration of ML's predictive power in patient outcomes, its ability to augment clinician knowledge,
and the effectiveness of ensemble algorithmic approaches. The review highlights specific applications of
diverse ML models, including moment kernel machines in predicting surgical outcomes, k-means clustering
in simplifying disease phenotypes, and extreme gradient boosting in estimating injury risk. Emphasizing
the potential of ML to tackle current healthcare challenges, the article highlights the critical role of ML in
evolving CDSSs for improved clinical decision-making and patient care. This comprehensive review also
addresses the challenges and limitations of integrating ML into healthcare systems, advocating for a
collaborative approach to refine these systems for safety, efficacy, and equity.
BRIEF COMMENTARY: USING A LOGIC MODEL TO INTEGRATE PUBLIC HEALTH INFORMATICS ...hiij
The COVID-19 pandemic has been a watershed moment in public health surveillance, highlighting the
crucial role of data-driven insights in informing health actions and policies. Revisiting key concepts—
public health, epidemiology in public health practice, public health surveillance, and public health
informatics—lays the foundation for understanding how these elements converge to create a robust public
health surveillance system framework. Especially during the COVID-19 pandemic, this integration was
exemplified by the WHO efforts in data dissemination and the subsequent global response. The role of
public health informatics emerged as instrumental in this context, enhancing data collection, management,
analysis, interpretation, and dissemination processes. A logic model for public health surveillance systems
encapsulates the integration of these concepts. It outlines the inputs and outcomes and emphasizes the
crucial actions and resources for effective system operation, including the imperative of training and
capacity development.
INTEGRATING MACHINE LEARNING IN CLINICAL DECISION SUPPORT SYSTEMShiij
This review article examines the role of machine learning (ML) in enhancing Clinical Decision Support
Systems (CDSSs) within the modern healthcare landscape. Focusing on the integration of various ML
algorithms, such as regression, random forest, and neural networks, the review aims to showcase their
potential in advancing patient care. A rapid review methodology was utilized, involving a survey of recent
articles from PubMed and Google Scholar on ML applications in healthcare. Key findings include the
demonstration of ML's predictive power in patient outcomes, its ability to augment clinician knowledge,
and the effectiveness of ensemble algorithmic approaches. The review highlights specific applications of
diverse ML models, including moment kernel machines in predicting surgical outcomes, k-means clustering
in simplifying disease phenotypes, and extreme gradient boosting in estimating injury risk. Emphasizing
the potential of ML to tackle current healthcare challenges, the article highlights the critical role of ML in
evolving CDSSs for improved clinical decision-making and patient care. This comprehensive review also
addresses the challenges and limitations of integrating ML into healthcare systems, advocating for a
collaborative approach to refine these systems for safety, efficacy, and equity.
Health Informatics - An International Journal (HIIJ)hiij
Healthcare Informatics: An International Journal is a quarterly open access peer-reviewed journal that Publishes articles which contribute new results in all areas of the health care.
The journal focuses on all of aspect in theory, practices, and applications of Digital Health Records, Knowledge Engineering in Health, E-Health Information, and Information Management in healthcare, Bio-Medical Expert Systems, ICT in health promotion and related topics. Original contributions are solicited on topics covered under the broad areas such as (but not limited to) listed below:
The Proposed Guidelines for Cloud Computing Migration for South African Rural...hiij
It is now overdue for the hospitals in South African rural areas to implement cloud computing technologies in order to access patient data quickly in an emergency. Sometimes medical practitioners take time to attend patients due to the unavailability of kept records, leading to either a loss of time or the reassembling of processes to recapture lost patient files. However, there are few studies that highlight challenges faced by rural hospitals but they do not recommend strategies on how they can migrate to cloud computing. The purpose of this paper was to review recent papers about the critical factors that influence South African hospitals in adopting cloud computing. The contribution of the study is to lay out the importance of cloud computing in the health sectors and to suggest guidelines that South African rural hospitals can follow in order to successfully relocate into cloud computing.The existing literature revealed that Hospitals may enhance their record-keeping procedures and conduct business more effectively with the help of the cloud computing. In conclusion, if hospitals in South African rural areas is to fully benefit from cloud-based records management systems, challenges relating to data storage, privacy, security, and the digital divide must be overcome.
SUPPORTING LARGE-SCALE NUTRITION ANALYSIS BASED ON DIETARY SURVEY DATAhiij
While online survey systems facilitate the collection on copious records on diet, exercise and other healthrelated data, scientists and other public health experts typically must download data from those systems
into external tools for conducting statistical analyses. A more convenient approach would enable
researchers to perform analyses online, without the need to coordinate additional analysis tools. This
paper presents a system illustrating such an approach, using as a testbed the WAVE project, which is a 5-
year childhood obesity prevention initiative being conducted at Oregon State University by health scientists
utilizing a web application called WavePipe. This web application has enabled health scientists to create
studies, enrol subjects, collect physical activity data, and collect nutritional data through online surveys.
This paper presents a new sub-system that enables health scientists to analyse and visualize nutritional
profiles based on large quantities of 24-hour dietary recall records for sub-groups of study subjects over
any desired period of time. In addition, the sub-system enables scientists to enter new food information
from food composition databases to build a comprehensive food profile. Interview feedback from novice
health science researchers using the new functionality indicated that it provided a usable interface and
generated high receptiveness to using the system in practice.
AN EHEALTH ADOPTION FRAMEWORK FOR DEVELOPING COUNTRIES: A SYSTEMATIC REVIEWhiij
The document summarizes a systematic literature review on factors influencing adoption of eHealth technologies in developing countries. The review analyzed 29 papers published between 2009-2021. Key findings included:
- Widely used frameworks for eHealth adoption in developing countries were TAM, UTAUT, and TOE, but these did not fully capture all relevant factors.
- Additional factors identified included socio-demographic, technological, information, socio-cultural, organizational, governance, ethical/legal, and financial dimensions.
- The review proposed a novel, context-specific eHealth adoption framework for developing countries with eight dimensions addressing the above factors.
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Local Advanced Lung Cancer: Artificial Intelligence, Synergetics, Complex Sys...Oleg Kshivets
Overall life span (LS) was 1671.7±1721.6 days and cumulative 5YS reached 62.4%, 10 years – 50.4%, 20 years – 44.6%. 94 LCP lived more than 5 years without cancer (LS=2958.6±1723.6 days), 22 – more than 10 years (LS=5571±1841.8 days). 67 LCP died because of LC (LS=471.9±344 days). AT significantly improved 5YS (68% vs. 53.7%) (P=0.028 by log-rank test). Cox modeling displayed that 5YS of LCP significantly depended on: N0-N12, T3-4, blood cell circuit, cell ratio factors (ratio between cancer cells-CC and blood cells subpopulations), LC cell dynamics, recalcification time, heparin tolerance, prothrombin index, protein, AT, procedure type (P=0.000-0.031). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and N0-12 (rank=1), thrombocytes/CC (rank=2), segmented neutrophils/CC (3), eosinophils/CC (4), erythrocytes/CC (5), healthy cells/CC (6), lymphocytes/CC (7), stick neutrophils/CC (8), leucocytes/CC (9), monocytes/CC (10). Correct prediction of 5YS was 100% by neural networks computing (error=0.000; area under ROC curve=1.0).
Integrating Ayurveda into Parkinson’s Management: A Holistic ApproachAyurveda ForAll
Explore the benefits of combining Ayurveda with conventional Parkinson's treatments. Learn how a holistic approach can manage symptoms, enhance well-being, and balance body energies. Discover the steps to safely integrate Ayurvedic practices into your Parkinson’s care plan, including expert guidance on diet, herbal remedies, and lifestyle modifications.
IMPACT OF HEALTH INFORMATICS TECHNOLOGY ON THE IMPLEMENTATION OF A MODIFIED EARLY WARNING SCORE (MEWS)
1. Health Informatics - An International Journal (HIIJ) Vol.4, No.3/4, November 2015
DOI: 10.5121/hiij.2015.4403 27
IMPACT OF HEALTH INFORMATICS TECHNOLOGY
ON THE IMPLEMENTATION OF A MODIFIED EARLY
WARNING SCORE (MEWS)
Sajeesh Kumar
Department of Health Informatics & Information Management, University of Tennessee
Health Science Center, Memphis, TN, USA
ABSTRACT
The Modified Early Warning System (MEWS) is based on a patient score that helps the medical team
monitor patients to identify a patient that may be experiencing a sudden decline in care. This study consists
of a detailed review of clinical data and patient outcomes to assess impact of technology and patient care.
There are a total of thirteen hospitals included in this review. These facilities have implemented vitals
capture and the MEWS scoring system.
KEYWORDS
Modified Early Warning System, electronic health record, Meaningful Use
1. INTRODUCTION
The adoption of Electronic Health Records has increased in recent years. As a result discrete data
elements are more widely available which can be leveraged for secondary use. Clinical decision
support and alert notification to clinicians are examples of such uses. The implementation of early
warning systems can assist in identifying patients that may be at risk for decomposition or decline
in clinical condition. Specifically, clarifications of availability in near real-time to facilitate the
calculation of the Modified Early Warning Score (MEWS).
The Modified Early Warning System is based on a patient score that helps the medical team
monitor patients to identify a patient that may be experiencing a sudden decline in care. Based on
literature review the data elements and threshold vary slightly be essentially include the
following: Respiratory Rate, Heart Rate, Systolic Blood Pressure, Consciousness/Alertness Level,
Temperature and Urine Output.
The use of technology to aid in patient care and nursing workflow has evolved significantly over
the last several years. In addition to the implementation of electronic health records,
organizations are implementing electronic vital capture devices (capsules). This equipment is
used to electronically transmit data from a device to the electronic health record (EHR). The
patients’ vitals are used in real-time to facilitate the calculation of the MEWS scores. The goal of
this research is to evaluate the use of the medical devices in facility and assess the availability of
data elements to calculate the MEWS score. This current work seeks to further explore the impact
vitals capture and MEWS implementation on patient outcomes such as cardiac arrest, length of
stay (LOS) and mortality.
2. Health Informatics - An International Journal (HIIJ) Vol.4, No.3/4, November 2015
28
This study consists of a detailed review of clinical data and patient outcomes to assess impact of
technology and patient care. There are a total of thirteen hospitals included in this review. These
facilities have implemented vitals capture and the MEWS scoring system. This population may be
biased if they are considered early adopters of technology. Any conclusions would need to be
interpreted with understanding of this study limitation.
2. LITERATURE
This literature search was conducted using electronic databases MEDLINE, PubMed, and
Up To Date. The search terms included but not limited to: modified warning systems,
modified early warning system, MEWS, MEWS Score, pediatric warning systems, PEWS,
PEWS Score, PEWS and Sepsis. The advanced search filters were also used to limit those
articles published from the year 1990 through the current year 2014. These techniques
resulted in almost 800 possibly relevant articles. After manual review, 66 articles appeared
relevant to thesis topic. A more detailed review of each abstract was conducted this resulted
in 5 articles that provided additional background and 6 articles with original research.
FIGURE 1: Literature Search Flow Diagram
Modified Early Warning Systems (MEWS) attempt to identify deteriorating patients early so timely
interventions can occur thus reducing serious adverse events (Hammond et al, 2012).
The studies were split based on patient age. One group consisted of two articles focused on the
pediatric population and the Pediatric Early Warning System (PEWS) score. The other group
consisted of three articles which were focused on the adult patient population and the MEWS score.
The populations studied were in the following countries: United States, United Kingdom and
Australia.
Survey Methods and Variables
The study methods varied across all articles that were reviewed. However, they all included a
retrospective review. It is important to indicate that the scoring tools in both of the pediatric studies
were generally similar. The tool from the Duncan 2012, article had a few additional evaluation
criteria in each of the areas. Additionally, this tool included a color coding system.
3. Health Informatics - An International Journal (HIIJ) Vol.4, No.3/4, November 2015
29
In the Sensitivity of the Pediatric Early Warning Score article, the researchers highlighted two prior
studies that addressed the Pediatric Early Warning Score (PEWS) to unplanned transfers to a higher
level of care. Additionally, the authors identified that this study “added” to the collective research.
The team had a hypothesis that at least 80% of patients had a critical PEWS score preceding the
event (code call/rapid response team notification). The study was conducted through a retrospective
chart review of 186 cases/unique patients that had a rapid response team and/or code blue event.
Based on the records identified, a nurse that specialized in critical care determined the PEWS for
each patient at various intervals in the 24 hours prior to the event. Additional data was also collected
to further aid the research. The study concluded that sensitivity of the PEWS was 85.5%, defined as
the patient having a critical score within 24 prior to the event. The team determined that the median
time for the first critical PEWS event was 696 minutes (11 hours and 36 minutes). In the other
article that addressed the pediatric population the authors focused on the experience of Stony Brook
University Medical Center (SBUMC) and their journey with implementing an early warning
system. The center started with the implementation of the Pediatric Early Warning Score (PEWS) in
2007. They provided detailed descriptions that presented an overview of the workflow and
processes that should be taken based on the patient’s score. They implemented a status board at
each nursing station providing a quick view of the unit’s general acuity level. The program has been
4. Health Informatics - An International Journal (HIIJ) Vol.4, No.3/4, November 2015
30
expanded to the adult population and SBUMC has implemented the modified early warning system
(MEWS). These tools continued to be refined and have been incorporated into the electronic health
record. However, the facility has identified limitations with bedside documentation. As a result,
there could be delays in the scoring and alerting of the patient’s condition. Even with some of the
limitations, the utilization of the warning system is another tool that staff can use to help patients
that may be at risk for a decompensating condition (Duncan, et al 2012).
The other two articles focused on the adult population. In the third article by Gardner-Thorpe, J. et
al (2006), the study included 334 elective and emergent surgical patients that were selected over a
five month period. The team conducted prospective data collection on various elements (age,
gender, American Society of Anesthesiologists (ASA) Physical Status Classification System
surgical operation, length of stay) as the MEWS was calculated for each patient daily. In the data
analysis the team selected a threshold of a MEWS greater than four or more. Of these patients, 75%
had triggered the early warning system and went to critical care. They also completed detailed
sensitivity and specificity testing to demonstrate how the MEWS could be leveraged as a predictor
of admission to a critical care unit. In another, there was a review of the frequency of vital signs
before and after the implementation of MEWS charting and staff education. The study evaluated 69
patients pre-implementation and 70 patients post-implementation. For the purpose of the study a full
set of patient vitals included blood pressure, heart rate, temperature, oxygen saturation, respiratory
rate and urine output. This study has very specific findings that indicated a 210% increase in overall
frequency of vital sign documentation. This study was limited to the ICU population and was done
within three months of the implementation of the MEWS (Hammond et al, 2012).
Modified Early Warning Score (MEWS) transforms this physiological data, and using weighted
criteria, determines an aggregate score that may be used to categorize clinical deterioration and
direct care. The score can be determined electronically or manually based on the processes of the
individual facilities. The table below illustrates the scoring system. In 2001, Subbe et al. validated
a Modified Early Warning Score (MEWS) that demonstrated a significant relationship between
the score and transfers to the ICU or death. Additionally the study indicates that a clinical
pathway or alerting system could be implemented to have clinical staff respond to those patients
with high scores to respond with medical intervention. In this study, there is a bedside evaluation
of the patient and calculation of the MEWS score with a screening tool to assist in the
identification of patients that might be at risk. The score is comprised of five measures:
1. Blood pressure
2. Heart Rate
3. Temperature
4. Level of Consciousness or (AVPU)
5. Respiratory Rate
Table 2: MEWS Scoring System
Components 3 2 1 0 1 2 3
Systolic Blood
Pressure (mmHg)
<70 71-
80
81-
100
101-
199
≥200
Pulse Rate (HR)
(bpm)
<40 41-
50
51-100 101-110 111-129 ≥130
Respiratory rate
(bpm)
<9 9-14 15-20 21-29 ≥30
Temperature (C) <35 35-38.4 ≥38.5
AVPU score Alert Reacting Reacting Unresponsive
5. Health Informatics - An International Journal (HIIJ) Vol.4, No.3/4, November 2015
31
to Voice to Pain
This study concluded that the MEWS was a simple bedside tool that was administered by nursing
staff. This tool helped to identify those patients that were at risk of deterioration and needed more
acute clinical intervention.
All of the above studies independently concluded value in the implementation of MEWS and/or
PEWS score. In general they found that there is a strong indicator of its potential to alert the care
providers of the patient’s clinical deterioration. Even with some of the limitations of the various
studies, the researchers determined that the utilization of the warning system is another tool that
staff can use to help patients that may be at risk for a decompensating condition. The authors
concluded that the MEWS is an important part of a risk management strategy that is simple to
implement, (Gardner-Thorpe J. et al 2006).
3. METHOD
This current study includes thirteen acute care facilities that have implemented the Vital Now
technology and actively implemented the MEWS scoring system. This is a review patient level
summary data and includes the evaluation of the availability of the key data elements to calculate
the MEWS score. Additionally, the study also includes a review of a review of key outcome
indicators. This includes the number of cardiac arrests, length of stay and mortality rate.
This data analysis is a retrospective data review from data collected in the calendar year 2013. The
data has been extracted from the Enterprise Data Warehouse and specifically the clinical domain of
vitals and internal outcomes reporting system. The facilities to be included in the evaluation would
include the following, implementation of MEWS score, implementation of vitals capture and on the
latest version of the HIS system. This would ensure that all required data elements had the potential
to be present.
A select group of thirteen facilities have been selected for study. This will be referred to as the study
cohort. Given the confidential and proprietary nature of the information, all patient identifiers have
been removed and the facilities have been blinded for external review purposes.
4. RESULTS
The summary of the study results are described in the section below. Frist is the analysis of all
facilities and their vital capture rates. The vitals capture metric includes several elements. The
electronic vitals are defined as the total number of vitals obtained electronically and submitted
through the neuron to the hospital information system (HIS). The manual vitals are defined as
the total number of vitals entered manually into the HIS. The electronic vitals capture rate is a
percentage as follows, (electronic/(manual + electronic))x 100.
Table 3: Vitals Capture
6. Health Informatics - An International Journal (HIIJ) Vol.4, No.3/4, November 2015
32
Facility Electronic Manual Percentage Electronic Manual Percentage Electronic Manual Percentage
A 151689 16065 90 40925 2792 94 11074 624 95
B 160886 56412 74 78239 28655 73 6737 2000 77
C 63963 31466 67 34931 17215 67 2976 1258 70
D 143938 20666 87 84304 10949 89 6814 761 90
E 123497 27834 82 64964 15175 81 4990 1181 81
F 123289 27317 82 68923 11807 85 4985 550 90
G 91692 18365 83 48256 8348 85 3520 756 82
H 76286 12820 86 38200 6581 85 3335 587 85
I 44829 9631 82 26211 5485 83 2240 332 87
J 76442 8881 90 41530 4996 89 3655 387 90
K 77434 10252 88 40617 5818 87 2739 362 88
L 49362 3187 94 24697 1617 94 2240 106 95
M 113355 22831 83 62625 9545 87 5041 485 91
Last Month6 Months 3 Months
7. Health Informatics - An International Journal (HIIJ) Vol.4, No.3/4, November 2015
33
In reviewing the data, Facility C has the lowest electronic capture rate with just 70% in the last
month. Facilities A and L have the highest electronic capture rate. In the last month they both
achieved 95%. Upon review of the trend over the last six month, seven of the thirteen facilities
improved their performance of the capture of vitals through the neuron to the HIS. This is a
positive trend and would allow timely calculation of the MEWS score.
The next analysis is on the MEWS score calculation. The MEWS score metric includes
several elements. The MEWS vitals are defined as the total number of vitals obtained
electronically where the five elements are all present. This includes systolic blood pressure,
heart rate, respiratory rate, body temperature and level of consciousness as measure by
AVPU. Any vitals that are entered manually into the HIS are excluded from the numerator.
The all vitals calculation is defined as the total number of vitals including both manual and
electronic capture.
Table 4: MEWS Score Calculation
Facility MEWS Vitals All Vitals Percentage MEWS Vitals All Vitals Percentage MEWS Vitals All Vitals Percentage
A 80930 105092 77 29782 37937 79 29782 37937 79
B 77494 117448 66 33932 51868 65 15207 23729 64
C 31145 48555 64 13511 21945 62 5870 9705 60
D 90074 118001 76 43510 56989 76 18908 24632 77
E 76568 91855 83 35541 42765 83 14537 17514 83
F 69377 87191 80 29306 38882 75 12375 16171 77
G 46784 75284 62 22846 34005 67 10819 14755 73
H 37008 53298 69 14914 21823 68 5865 8960 65
I 31854 37818 84 15059 18010 84 6429 7901 81
J 51996 63390 82 23944 29141 82 10124 12350 82
K 38725 55141 70 15232 22318 68 6504 9777 67
L 32850 38043 86 15271 17441 88 6753 7845 86
M 71597 80438 89 32499 36552 89 13527 15121 89
6 Months 3 Months Last Month
FIGURE 3: MEWS Score Calculation Diagram
A B C D E F G H I J K L M
6 month 77 66 64 76 83 80 62 69 84 82 70 86 89
3 month 79 65 62 76 83 75 67 68 84 82 68 88 89
Past Month 79 64 60 77 83 77 73 65 81 82 67 86 89
0
10
20
30
40
50
60
70
80
90
100
Percentage
MEWS Scores
8. Health Informatics - An International Journal (HIIJ) Vol.4, No.3/4, November 2015
34
In reviewing the data, Facility C has the lowest MEWS Score calculation with just 60% in the
last month. Facility A that had one of the highest electronic vital capture rate is only at 79% of
the MEWS Score calculation. Facility M has the highest calculation with 89% over the last six
months. It appears that more detailed analysis of the data would be important to understand
which elements of MEWS score are not being captured electronically. This would be important
to help improve the MEWS score calculation.
The next analysis of data is focused on outcomes in several categories. The first of which is looking
at the incidence of cardiac arrest in the facility as defined by ICD-9-CM diagnosis code in either the
primary or other diagnosis categories. This metric was defined as the total number of cardiac arrests
divided by the total number of discharges x 100 to calculate a percentage.
FIGURE 4: Percentage of Cardiac Arrests Diagram
A B C D E F G H I J K L M
6 months 0.43 0.50 0.36 0.36 0.29 0.37 0.20 0.16 0.19 0.39 0.35 0.50 0.45
3 month 0.41 0.54 0.32 0.35 0.32 0.39 0.17 0.22 0.18 0.39 0.40 0.55 0.45
Past Month 0.47 0.34 0.39 0.30 0.38 0.47 0.23 0.05 0.25 0.38 0.20 0.53 0.37
0.00%
0.10%
0.20%
0.30%
0.40%
0.50%
0.60%
Percentage
% of Cardiac Arrest
Upon review of the data all of the facilities had less than a 1% cardiac arrest rate. The percentages
ranged from .05% to .55%. Facility H has the lowest overall cardiac arrest rate. In general their
vitals capture was about 85% and their MEWS Score Calculation was 65-69%.
In recent literature researcher has identified that there is the potential to leverage the MEWS score
an early indication of patients that may be at risk for Sepsis. However, there does not appear any
definitive correlation. Zavatti, L. et al (2010) concluded that there was a low sensitivity in the
identification of patients with severe septic shock. However, the study was limited to the review of
51 patients in the study. The next data analysis was focused on patient outcomes (LOS and
Mortality) for sepsis patients in the thirteen facilities. For both the length of stay and mortality there
is a year over year comparison with 2013 as the current year and 2012 as the prior year. The first
metric is length of stay. This is defined as the number of days during the patients stay.
9. Health Informatics - An International Journal (HIIJ) Vol.4, No.3/4, November 2015
35
FIGURE 5: Sepsis Length of Stay Diagram
A B C D E F G H I J K L M
Sepsis - LOS CY - 13 12.410.78.7614.213.28.2610.36.119.277.968.086.4311.3
Sepsis - LOS PY - 12 9.729.798.8218.613.39.358.6911.18.8411.211.9 6.4 10.6
0
2
4
6
8
10
12
14
16
18
20Days
Sepsis Length of Stay
As noted in Figure 5, Sepsis Length of Stay Diagram, Facility D has the highest LOS in 2012 with
18.6. Facility D also had the highest LOS in 2013 with 14.2 days. However, this is a positive change
of 4.4 days. Facility H had the lowest LOS in 2013 with just 6.11 days. This is a reduction of 5 days
from the prior year. This is the same facility that had the lowest number of cardiac arrests.
The last analysis was the mortality rate. This metric is defined as the total number of patients in the
reporting period and the total number of deaths. This analysis is also limited to just those patients
with a diagnosis of sepsis.
FIGURE 6: Sepsis Mortality Rate Diagram
As noted in Figure 6, Sepsis Mortality Rate Diagram, 10 of the 13 Facility had a decrease
in the Sepsis Mortality Rate from prior year. However, Facility C has the highest mortality
10. Health Informatics - An International Journal (HIIJ) Vol.4, No.3/4, November 2015
36
rate in 2013 with .29%. Facility L has the lowest mortality rate with .04%. Facility D which
had the highest LOS in 2013 with 14.2 days has the second lowest mortality rate with
.06%.
6. CONCLUSIONS
In general there is data available electronically that can be leveraged for secondary use. Moreover,
this data can be leveraged in near real-time to impact the care that is delivered to patients. The
facilities in this study appear to have adopted the collection of vitals in an electronic method and
compliance ranged from 95% - 67% in the last six months. Additionally, the MEWS calculation
when all five elements were present also appeared in 89% - 60% of the cases. This provides an
opportunity for improvement if the MEWS score were to be leveraged for alerting and monitoring.
There may be an opportunity for more detailed analysis on each of the five components to
determine if there is an educational opportunity or barrier to collecting all of the data required for
the MEWS score calculation.
For the outcome measures there appeared to be a strong relationship in one facility where the low
cardiac arrest rate also resulted in a low LOS for sepsis patients. There was also a notable finding in
the facility with a higher length of stay and a lower mortality rate for 2013.
For future research, a recommendation would be to evaluate the patient outcomes prior to the
implementation of MEWS at the facility. This might provide a more accurate impact analysis of
MEWS and outcomes. Additionally study would be warranted to determine if MEWS could be an
early predictor of sepsis.
ACKNOWLEDGEMENTS
The authors would like to thank the faculty at Department of Health Informatics and Information
Management, University of Tennessee.
REFERENCES
[1] Akre, M., Finkelstein, M., Erickson, M., Liu, M., Vanderbilt, L., & Billman, G. (2010). Sensitivity of
the Pediatric Early Warning Score to identify patient deterioration. Pediatrics, 125(4), e763-e769.
[2] Duncan, K. D., McMullan, C., & Mills, B. M. (2012). Early warning systems: The next level of rapid
response. Nursing 2012, 42(2), 38-44.
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AUTHOR
Sajeesh Kumar, PhD., is Executive Director- Institute for Health Outcomes and Policy ,
Chair-Health Outcomes and Policy Research PhD program and Associate Professor,
Department of Health Informatics & Information Management, University of
Tennessee-Memphis. Dr. Kumar’s research focuses on design and development of
public health informatics, telemedicine technology, health education technologies and
health informatics technology evaluation. Dr. Kumar holds an impressive record of
competitive research funding and research awards.