Compliance Is Contagious: Using Informatics Methods to Measure the Spread of a Documentation Standard From a Preoperative Clinic

Hagaman, Daniel H.; Ehrenfeld, Jesse M.; Terekhov, Maxim A.; Kla, Koffi M.; Hamm, Julie; Brumley, Miriam; Wanderer, Jonathan P.

doi:10.1016/j.jopan.2016.08.016

Cited by 4 publications

(8 citation statements)

References 17 publications

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“…The 27 studies of quality dashboards were from Australia (n = 1 85 ), Canada (n = 3 [86][87][88] ), Italy (n = 1 89 ), Malta (n = 1 90 ), the Netherlands (n = 3 [91][92][93] ), Nigeria (n = 1 94 ), the UK (n = 4 27,28,95,96 ) and the USA (n = 13 [97][98][99][100][101][102][103][104][105][106][107][108][109] ). The dashboards were used in the hospital setting, including maternity and outpatient settings (n = 22 27,[85][86][87][88][89][90][91]93,95,[97][98][99][100][101][102][103][104][105][106][107]…”

Section: Study Characteristicsmentioning

confidence: 99%

“…The dashboards incorporated a wide range of metrics, covering topics such as medication (n = 6 95,[97][98][99][100][101] ), nutritional care (n = 1 92 ), care quality for specific conditions (n = 5 89,91,104,107,108 ) or at specific points in the patient pathway (n = 1 105 ), organisation-wide care quality (n = 3 27,85,109 ), organisational performance (e.g. admission and discharge rates) (n = 2 85,90 ) and documentation and data quality (n = 6 85,96,102,103,105,106 ), with some dashboards covering more than one of these areas. A variety of study designs were used, including a cluster RCT (n = 1 105 ), a controlled before-and-after study (n = 1 101 ), before-and-after studies without controls (n = 8 85,89,94,99,100,[102][103][104] ), ITS analyses (n = 2 86,97 ), qualitative studies with data collected through interviews and/or focus groups (n = 6 27,87,88,90,91,106 ) and surveys (n = 5 92,…”

Section: Study Characteristicsmentioning

confidence: 99%

“…admission and discharge rates) (n = 2 85,90 ) and documentation and data quality (n = 6 85,96,102,103,105,106 ), with some dashboards covering more than one of these areas. A variety of study designs were used, including a cluster RCT (n = 1 105 ), a controlled before-and-after study (n = 1 101 ), before-and-after studies without controls (n = 8 85,89,94,99,100,[102][103][104] ), ITS analyses (n = 2 86,97 ), qualitative studies with data collected through interviews and/or focus groups (n = 6 27,87,88,90,91,106 ) and surveys (n = 5 92,96,[107][108][109] ).…”

Section: Study Characteristicsmentioning

confidence: 99%

“…Thirteen studies 85,86,94,95,[97][98][99][100][101][102][103][104][105] provided quantitative data on the impact of quality dashboards, nine 85,94,95,[97][98][99][102][103][104] of which showed positive impacts. The other four studies 86,100,101,105 showed a mixed impact, achieving improvement in some measures but not in others.…”

Section: Effect On Outcomes and Care Processesmentioning

confidence: 99%

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Design and evaluation of an interactive quality dashboard for national clinical audit data: a realist evaluation

Randell

Alvarado

McVey

et al. 2022

Health Soc Care Deliv Res

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Background National audits aim to reduce variations in quality by stimulating quality improvement. However, varying provider engagement with audit data means that this is not being realised. Aim The aim of the study was to develop and evaluate a quality dashboard (i.e. QualDash) to support clinical teams’ and managers’ use of national audit data. Design The study was a realist evaluation and biography of artefacts study. Setting The study involved five NHS acute trusts. Methods and results In phase 1, we developed a theory of national audits through interviews. Data use was supported by data access, audit staff skilled to produce data visualisations, data timeliness and quality, and the importance of perceived metrics. Data were mainly used by clinical teams. Organisational-level staff questioned the legitimacy of national audits. In phase 2, QualDash was co-designed and the QualDash theory was developed. QualDash provides interactive customisable visualisations to enable the exploration of relationships between variables. Locating QualDash on site servers gave users control of data upload frequency. In phase 3, we developed an adoption strategy through focus groups. ‘Champions’, awareness-raising through e-bulletins and demonstrations, and quick reference tools were agreed. In phase 4, we tested the QualDash theory using a mixed-methods evaluation. Constraints on use were metric configurations that did not match users’ expectations, affecting champions’ willingness to promote QualDash, and limited computing resources. Easy customisability supported use. The greatest use was where data use was previously constrained. In these contexts, report preparation time was reduced and efforts to improve data quality were supported, although the interrupted time series analysis did not show improved data quality. Twenty-three questionnaires were returned, revealing positive perceptions of ease of use and usefulness. In phase 5, the feasibility of conducting a cluster randomised controlled trial of QualDash was assessed. Interviews were undertaken to understand how QualDash could be revised to support a region-wide Gold Command. Requirements included multiple real-time data sources and functionality to help to identify priorities. Conclusions Audits seeking to widen engagement may find the following strategies beneficial: involving a range of professional groups in choosing metrics; real-time reporting; presenting ‘headline’ metrics important to organisational-level staff; using routinely collected clinical data to populate data fields; and dashboards that help staff to explore and report audit data. Those designing dashboards may find it beneficial to include the following: ‘at a glance’ visualisation of key metrics; visualisations configured in line with existing visualisations that teams use, with clear labelling; functionality that supports the creation of reports and presentations; the ability to explore relationships between variables and drill down to look at subgroups; and low requirements for computing resources. Organisations introducing a dashboard may find the following strategies beneficial: clinical champion to promote use; testing with real data by audit staff; establishing routines for integrating use into work practices; involving audit staff in adoption activities; and allowing customisation. Limitations The COVID-19 pandemic stopped phase 4 data collection, limiting our ability to further test and refine the QualDash theory. Questionnaire results should be treated with caution because of the small, possibly biased, sample. Control sites for the interrupted time series analysis were not possible because of research and development delays. One intervention site did not submit data. Limited uptake meant that assessing the impact on more measures was not appropriate. Future work The extent to which national audit dashboards are used and the strategies national audits use to encourage uptake, a realist review of the impact of dashboards, and rigorous evaluations of the impact of dashboards and the effectiveness of adoption strategies should be explored. Study registration This study is registered as ISRCTN18289782. Funding This project was funded by the National Institute for Health and Care Research (NIHR) Health and Social Care Delivery Research programme and will be published in full in Health and Social Care Delivery Research; Vol. 10, No. 12. See the NIHR Journals Library website for further project information.

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Section: Study Characteristicsmentioning

confidence: 99%

Section: Study Characteristicsmentioning

confidence: 99%

Section: Study Characteristicsmentioning

confidence: 99%

Section: Effect On Outcomes and Care Processesmentioning

confidence: 99%

See 2 more Smart Citations

Design and evaluation of an interactive quality dashboard for national clinical audit data: a realist evaluation

Randell

Alvarado

McVey

et al. 2022

Health Soc Care Deliv Res

View full text Add to dashboard Cite

show abstract

“…This preoperative evaluation has been structured to provide a quick summary, as previously described. 19 In addressing our AIC's information need, we developed functionality that extracts the quick, one-sentence summary statement within the "history of present illness" section of the anesthesia preoperative evaluation, and displays it when hovering over the flagged surgical case (►Fig. 3, yellow tooltip).…”

Section: Iterative Design Refinementsmentioning

confidence: 99%

A Perioperative Care Display for Understanding High Acuity Patients

et al. 2021

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Background The data visualization literature asserts that the details of the optimal data display must be tailored to the specific task, the background of the user, and the characteristics of the data. The general organizing principle of a concept-oriented display is known to be useful for many tasks and data types. Objectives In this project, we used general principles of data visualization and a co-design process to produce a clinical display tailored to a specific cognitive task, chosen from the anesthesia domain, but with clear generalizability to other clinical tasks. To support the work of the anesthesia-in-charge (AIC) our task was, for a given day, to depict the acuity level and complexity of each patient in the collection of those that will be operated on the following day. The AIC uses this information to optimally allocate anesthesia staff and providers across operating rooms. Methods We used a co-design process to collaborate with participants who work in the AIC role. We conducted two in-depth interviews with AICs and engaged them in subsequent input on iterative design solutions. Results Through a co-design process, we found (1) the need to carefully match the level of detail in the display to the level required by the clinical task, (2) the impedance caused by irrelevant information on the screen such as icons relevant only to other tasks, and (3) the desire for a specific but optional trajectory of increasingly detailed textual summaries. Conclusion This study reports a real-world clinical informatics development project that engaged users as co-designers. Our process led to the user-preferred design of a single binary flag to identify the subset of patients needing further investigation, and then a trajectory of increasingly detailed, text-based abstractions for each patient that can be displayed when more information is needed.

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An Evidence-based Preoperative Evaluation Documentation Template Improves Perioperative Communication

Piao,

Imdieke,

Sommerness

et al. 2024

Appl Clin Inform

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Objectives The number of surgeries performed in the United States has increased over the past two decades, with a shift to the ambulatory setting. Perioperative complications and mortality pose significant health care burdens. Inadequate preoperative assessment and documentation contribute to communication failure and poor patient outcomes. The aim of this quality improvement project was to design and implement a preoperative evaluation documentation template that not only improved communication during the perioperative pathway but also enhanced the overall user experience. Methods We implemented a revamped evidence-based documentation template in the electronic medical records of a health care organization across three internal medicine clinics on the downtown campus and seven satellite family medicine clinics. A pre- and postintervention design was used to assess the template utilization rate and clinician satisfaction. Results The preoperative template utilization rate increased from 51.2% at baseline to 66.5% after the revamped template “went live” (p < 0.001). Clinician satisfaction with the preoperative documentation template also significantly increased (30.6 vs. 80.0%, p < 0.001). Conclusion Adopting a user-friendly, evidence-based documentation template can enhance the standardization of preoperative evaluation documentation and reduce the documentation burden.

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Compliance Is Contagious: Using Informatics Methods to Measure the Spread of a Documentation Standard From a Preoperative Clinic

Cited by 4 publications

References 17 publications

Design and evaluation of an interactive quality dashboard for national clinical audit data: a realist evaluation

Design and evaluation of an interactive quality dashboard for national clinical audit data: a realist evaluation

A Perioperative Care Display for Understanding High Acuity Patients

An Evidence-based Preoperative Evaluation Documentation Template Improves Perioperative Communication

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