Primary Subject area Hospital Paediatrics Background Family-centered rounds (FCR) are the cornerstone of pediatric hospital care and have many proven benefits including improved patient outcomes, satisfaction, communication and safety. Traditionally, FCR take place in the patient’s room; however, due the COVID-19 pandemic, entering patient rooms was no longer advisable in order to maintain physical distancing and preserve personal protective equipment (PPE). Therefore, it became clear early in our pandemic response that a new process was required to ensure the benefits of FCR were maintained given their paramount importance to safe and quality patient care. Objectives The objective of this study was to virtualize the in-person FCR process used by our pediatric inpatient medicine teams to improve safety and reduce PPE costs during the COVID-19 pandemic. Design/Methods We quickly identified available hardware (laptops, tablets) and video conferencing software, assembled a multidisciplinary project team and secured administrative and quality improvement support. Quality improvement methodology and participatory design were used to develop and refine our virtual family-centered rounds (vFCR) standard work, and on April 6, 2020 we launched our first vFCR. Over the next 3 months we engaged in a series of plan-do-study-act (PDSA) cycles to iteratively improve our process: nurse auditors attended vFCR daily then met with our project team to review data and observations, and real-time feedback was sought from patients and caregivers. Results Data collected on 1792 vFCR between April 6 and July 31, 2020 revealed 74% of nurses, physicians and trainees were satisfied or very satisfied with vFCR and 88% felt they had a good understanding of the patient care plan after vFCR. 79% of patients and caregivers were satisfied or very satisfied with vFCR and 88% of caregivers felt like a valued member of their child’s care team. We met our target of 10 minutes per patient in 74% of vFCR with an average transition time of <3 minutes between patients. Patients and caregivers felt vFCR were collaborative, more private and less intimidating than in-person FCR, and some even preferred the virtual approach. Conclusion During this pilot, we achieved a standardized vFCR workflow that is safe, feasible, efficient and confidential, with high levels of stakeholder satisfaction and support. vFCR was highly valued by families and yielded unanticipated benefits. Based on current usage, vFCR are saving ~$36,000 monthly in PPE. The importance of this work during the COVID-19 pandemic is clear, but also has benefits in non-pandemic times, including allowing caregivers to participate in FCR when they cannot be at the bedside, enhancing FCR confidentiality, and improving communication and care for isolated patients. Furthermore, the vFCR process is easily adaptable to other inpatient workflows such as consults and multi-disciplinary meetings. We believe this virtual care model is both highly relevant and transferable to a variety of health care settings across Canada and beyond.
The Institute of Medicine (2005) identified Human Factors (HF) engineering as an approach to promote better healthcare system design. The use of HF in healthcare has evidently delivered improvement in safety, quality, and productivity. Although existing literature shows the application of HF in practice, there is limited discussion of the integration of HF into healthcare operations, and the science of HF and its mechanism to deliver improved outcomes. This gap makes it difficult for healthcare professionals and management to see how HF can benefit their organization. Even if the potential benefits of integrating HF into healthcare organizations are understood, there is a lack of guidance on how to best deploy full-time HF practitioners. Despite the vast number of hospitals and healthcare systems around the world, only a few have actively and successfully engaged HF practitioners as part of their internal operations. This panel invites four healthcare HF practitioners, with diverse backgrounds and sub-specialties (Micro-, Physical-, and Macro-Ergonomics) to share their roles and contributions to their organization, and discuss their pathway to becoming integrated into their healthcare organization. This panel will provide guidance on how healthcare organizations can deploy and achieve the full benefit of their full-time HF practitioner (e.g., which unit/functional department to position HF and proper expectations of HF). Additionally, the panel will discuss insights for educators and budding HF practitioners on what it takes to advance their career in this challenging, yet literally life-saving industry.
Many factors contribute to the successful implementation and adoption of electronic medical records (EMRs). Easy access to the EMR, where and when required by clinicians, is a key component of adoption and end-user satisfaction with the system. A pediatric hospital implementing an integrated EMR used multiple methods within an iterative human-centered design (HCD) framework to develop hardware and access solutions supporting future EMR workflows in Inpatient and Emergency Departments. Context of use analysis, participatory design methods, preliminary analysis of evaluative simulations and tacit knowledge of the project team led to the development of guiding principles for hardware implementation and solutions supporting just-in-time documentation within the constraints of existing facility design.
Human factors (HF) has multiple domains that integrate various disciplines; and its principles and methods can be diversely applied within an organization. Healthcare organizations have started to deploy HF Practitioner (HFP) to assist in enhancing patient safety. However, the path for HFP integration into a hospital is still immature, clinical staff may be unclear of how to effectively collaborate with their HFP, and what benefits could HFP provide. This panel brings in 5 panelists from different organizations, who will share their experience in collaborating with their clinical advocate. Most importantly, audiences will hear their clinician advocates’ perceptions of the collaborations and benefits that their HFP has delivered, which encouraged them to drink our HFP ‘Kool-Aid.’
Improving healthcare using phased, iterative and participatory methods requires time and resources to do comprehensively. The reality, particularly for practitioners, is that constraints related to human resources, cost and time may impact the rigor of data collection and analysis. Under such conditions, project teams may rely on tacit knowledge and expertise to fill in potential gaps in understanding and validate design decisions. But what kind of insights might emerge if we were freed from such constraints, and given the time to study a context in more detail? Our research group explored this question by using Computer Assisted Qualitative Data Analysis Software (NVivo) and qualitative research coding methods to analyze a sample of video data collected from a series of electronic medical record (EMR) workflow simulations that were originally used to support EMR implementation in a pediatric hospital. The results from the NVivo video analysis revealed some details not previously captured by initial data analysis methods, but at significant resource cost. A comparison of video analysis methods, findings and respective costs are compared and discussed in the context of design development and implementation.
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