Investigating a Work System Approach to Implement an Emergency Department Surge Management System: Case Study

Jewer, Jennifer

doi:10.2196/37472

Cited by 3 publications

(1 citation statement)

References 25 publications

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“…Surge management and prediction tools and strategies may offer ED administrators solutions to the ongoing causes of ED overcrowding. [38][39][40] At sites across Newfoundland and Labrador researchers are using SurgeCon, 41 a home-grown quality improvement initiative using ED and hospital data to apply real-time protocols to manage surges in ED visits before they occur, reducing ED length of stay. 42,43 At Niagara Health -St. Catherine's Site (Ontario) patient flow simulation exercises were used to help an interdisciplinary team decide where to offload ambulance arrivals and transfer patients needing a bed.…”

Section: Surge Management and Predictionmentioning

confidence: 99%

Interventions Intended to Alleviate Emergency Department Overcrowding

Mason,

Secord,

MacDougall

2023

cjht

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Why Is This an Issue? Emergency department (ED) overcrowding is a known issue in Canada that puts patients’ lives and health at risk when treatment needs within the ED exceed the resources required to address them. The causes and consequences of ED overcrowding are complex, varied, and extend beyond the ED. Left unchecked, ED overcrowding contributes to a deteriorating standard of care as staff become overworked and burned out. What Are the Potential Interventions to Address ED Overcrowding? This roundup of 87 new and emerging interventions intended to alleviated ED overcrowding complements CADTH’s Emergency Department Overcrowding: An Environmental Scan of Contributing Factors and a Summary of Systematic Review Evidence on Interventions. Interventions were included in this report if they are not captured in CADTH’s complimentary report Emergency Department Overcrowding: An Environmental Scan of Contributing Factors and a Summary of Systematic Review Evidence on Interventions because they are either new or are not yet in wide use in EDs and health systems across Canada and could be reasonably be expected to affect ED overcrowding (e.g., by improving patient flow through the ED or reducing the number of people seeking care in the ED). Interventions that could address multiple causal factors (e.g., e-consult services) were also included. What Is the Potential Impact? Decreasing ED overcrowding has the potential to improve the standard of care delivered to those accessing EDs and contribute to decreasing the burden on ED staff, regardless of the intervention or which contributing factor it aims to act upon. Some interventions that can alleviate ED overcrowding also have an impact on primary and community care; bolstering preventive care, increasing access to diagnostic testing for those who need it, and improving access to health care supports can improve health outcomes. What Else Do We Need to Know? The pan-Canadian issue of ED overcrowding calls for real solutions. CADTH is examining the evidence and expert-informed considerations and producing a series of publications about the causes and consequences of, and solutions to, ED overcrowding in health care systems across the country. The interventions identified in this report may be of interest to senior health care decision-makers who are anticipating health system innovation and transformation.

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Section: Surge Management and Predictionmentioning

confidence: 99%

Interventions Intended to Alleviate Emergency Department Overcrowding

Mason,

Secord,

MacDougall

2023

cjht

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Inefficient Processes and Associated Factors in Primary Care Nursing: System Configuration Analysis

Tarver,

Savoy,

Patel

et al. 2024

JMIR Hum Factors

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Background: Industrywide, primary care nurses' work is increasing in complexity and team orientation. Mobile health information technologies (HIT) designed to aid nurses with indirect care tasks, including charting, have had mixed success. Failed introductions of HIT may be explained by insufficient integration into nurses' work processes, owing to an incomplete or incorrect understanding of the underlying work systems. Despite this need for context, published evidence has focused more on inpatient settings than on primary care.Objective: Characterize nurses' and health technicians' perceptions of process inefficiencies in the primary care setting, and identify related work system factors.Methods: Guided by the Systems Engineering for Patient Safety (SEIPS) 2.0 model, we conducted an exploratory work system analysis with a convenience sample of primary care nurses and health technicians. Semi-structured contextual interviews were conducted in two sets of primary care clinics in the Midwestern United States, one in an urban tertiary care center, and the other in a rural community-based outpatient facility. Using directed qualitative content analysis of transcripts, we identified tasks participants perceived as frequent, redundant, or difficult, related processes, and recommendations for improvement. Additionally, we conducted configuration analyses to identify associations between process inefficiencies and work system factors. Results:We interviewed a convenience sample of 20 primary care nurses and 2 health technicians, averaging approximately 12 years of experience in their current role. Across sites, participants perceived two processes, managing patient calls and clinic walk-in visits, as inefficient. Among work system factors, participants described organizational and technological factors associated with inefficiencies. For example, new organization policies to decrease patient waiting invoked frequent, repetitive, and difficult tasks, including chart review and check-in using tablet computers. Participants reported that issues with policy implementation and technology usability contributed to process inefficiencies. Organizational and technological factors were also perceived among participants as the most adaptable. Suggested technology changes included new tools for walk-in triage and patient self-reporting of symptoms. Conclusions:In response to changes to organizational policy and technology, without compensative changes elsewhere in their primary care work system, participants reported process adaptations. These adaptations indicate inefficient work processes. Understanding how the implementation of organizational policies affects other factors in the primary care work system may improve the quality of such implementations and, in turn, increase the effectiveness and efficiency of primary care nurse processes. Moreover, the design and implementation of HIT interventions should consider influential work system factors and

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Inefficient Processes and Associated Factors in Primary Care Nursing: System Configuration Analysis (Preprint)

Tarver¹,

Savoy²,

Patel³

et al. 2023

Preprint

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BACKGROUND Better understanding the work system for primary care nurses is vital to understanding their needs and informing the design, development, and successful implementation of interventions to support their work. However, published evidence is sparse on primary care nurses’ work systems which takes into account multiple factors such as persons, tasks, tools and technologies, organization, and environment, and how they interact with each other. This has implications for mobile health information technologies (HIT) (e.g., laptops, tablets, and smartphones) designed to aid nurses in completing tasks at the point of care and away from their desk. These mobile HITs are not always available, or may not adequately meet their needs, because they are not well integrated into nurses’ work which may be due to a lack of understanding of the primary care nurses’ work system factors that may lead to process inefficiencies. OBJECTIVE The objective of this study is to characterize nurses’ perceptions of process inefficiencies in the primary care setting. METHODS Guided by the Systems Engineering for Patient Safety (SEIPS) 2.0 model, we conducted a work system analysis with primary care nurses and health technicians. Semi-structured interviews and observations were conducted in two sets of primary care clinics in the Midwestern United States, one set in an urban tertiary care center, and the other in a rural community-based outpatient facility. Participants were asked to identify frequent, redundant, or difficult tasks, related processes, and make recommendations for improvement. We applied SEIPS to analyze the relationships between work system factors that influenced process inefficiencies. RESULTS We interviewed a convenience sample of 20 nurses and two health technicians, averaging approximately 12 years of experience in their current primary care role. Across sites, the processes of managing patient calls and walk-ins were consistently perceived by participants as inefficient, in part due to policies affecting patient flow management. These processes included managing electronic notifications, chart review, and documentation, which were identified as frequent, repetitive, and difficult tasks. During interviews, participants identified potential mobile HIT solutions, including a digital triage system and a mobile application to record patient symptoms. CONCLUSIONS Using SEIPS 2.0, we show that when technology does not properly align with tasks, policies, and other work system factors, care processes and outcomes can be adversely affected. Understanding how the implementation of organizational policies impacts other factors in the work system is required to promote the effectiveness and efficiency of primary care nurse processes Moreover, the design and implementation of mobile HIT interventions should consider influential work system factors and their effects on primary care.

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Investigating a Work System Approach to Implement an Emergency Department Surge Management System: Case Study

Cited by 3 publications

References 25 publications

Interventions Intended to Alleviate Emergency Department Overcrowding

Interventions Intended to Alleviate Emergency Department Overcrowding

Inefficient Processes and Associated Factors in Primary Care Nursing: System Configuration Analysis

Inefficient Processes and Associated Factors in Primary Care Nursing: System Configuration Analysis (Preprint)

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