Loosely formed patient care teams

Lee, So-Young; Tang, Choon Yik; Park, Sun Young; Chen, Yunan

doi:10.1145/2145204.2145334

Cited by 33 publications

(5 citation statements)

References 32 publications

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“…38% of respondents use switchboard commonly or frequently, suggesting that the identification of correct person to, or modality for, contact may be difficult. These findings would be consistent with the challenges identifying correct personnel described in Emergency Departments and supports the concept of Role-based Communications (27).…”

Section: Discussionsupporting

confidence: 84%

Technology Based Challenges of Informal Clinical Communication in an Australian tertiary referral hospital – A mixed methods assessment of The Need for Change

Hart,

Hosking,

Todd

et al. 2024

Preprint

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BackgroundEffective communication is critical for safe, efficient clinical practice. Communication failures result in errors, misdiagnosis, inappropriate treatment and poor care. Communication errors also contribute to sentinel events and are an underlying factor in healthcare system complaints.Formal Clinical Communication (FCC) tools, such as ISBAR, improve patient outcomes. Governance of FCC is increasingly based around Electronic Medical Record (EMR), however much Informal clinical communication (ICC) occurs outside of the EMR.ICC involves disparate platforms including pagers, Short Message Service (SMS) texts, encrypted messaging apps, phones and local radio networks (eg Vocera). Documentation of ICC in the clinical record is low quality and not easily or routinely audited. ICC based on personal identities relies on accurate rosters, switchboard staff or secondary lists. Significant inefficiency and potential clinical risk can occur if the correct role to communicate with cannot be contacted quickly and easily.Local ProblemIn 2019, Austin Health performed a clinical governance assessment of ICC processes against National Standards for FCC. Further investigation and process mapping of ICC occurred in 2020. This indicated a paucity of relevant policy and procedures to govern ICC practices, with highly variable and overly complex processes.AimsTo document the technology used in informal communication between clinical and / or administrative staff.To document the self-perceived impact on staff of current communications methods.To document the self-perceived potential efficiency and safety impact of current communications methods.To identify key factors for consideration in organisational informal communication improvement.MethodMulti-disciplinary on-line staff cross-sectional survey using Microsoft Forms. The survey sought to confirm the range of informal communication methods in use and identify respondents’ perceptions of current multimodal communication technology issues and their inherent risks.Results115 self-selected clinical and administrative staff completed the survey. Multiple communication channels are used. Respondents noted high levels of frustration, delay, interruption and inefficiency. Desired communication improvements and use considerations were identified. Survey findings validated a prior clinical governance assessment of the existing ICC framework, and the need for technology reform.ConclusionsThere are gaps in governance standards for ICC, both locally and at a broader level. Sequential additions to technology platforms have created a high-risk communications environment. Staff perceptions of inefficiency, delay, frustration and a high level of patient safety risk were consistent across professions. This work informed the subsequent development of an enterprise platform dedicated to informal clinical communication.Key Message Summary BoxWhat is already known on this topic– Poor Communication practice contributes to preventable errors or adverse events in patient care. Use of structured handover tools such as ISBAR provide a framework to improve Formal Clinical Communication. Current multi-modal, communication technologies for Informal Clinical Communication are interruptive, inefficient, compound staff frustration and create potential for patient harm.What this study adds– We describe staff impressions of frustration, time wasting and potential for patient harm with existing multi-modal communications technologies together with a framework for informal communication policy enhancement.How this study might affect research, practice or policy– These findings provide a call for governance standards for informal clinical communication. We highlight the need for rationalisation of multi-modal communications technologies to reduce communication complexity and identify some key functional requirements for new technologies.

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Section: Discussionsupporting

confidence: 84%

Technology Based Challenges of Informal Clinical Communication in an Australian tertiary referral hospital – A mixed methods assessment of The Need for Change

Hart,

Hosking,

Todd

et al. 2024

Preprint

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“…The patterns of coordination among the operators in our study are similar to those reported earlier in co-located teams, e.g. in (Faraj and Xiao 2006;Lee et al 2012). The EC and SP operators are engaged in expertise coordination practices through the use of formalized tools and routines-e.g.…”

Section: Support For Leading Care Networksupporting

confidence: 83%

From Episodes to Continuity of Care: a Study of a Call Center for Supporting Independent Living

Farshchian

Vilarinho

Mikalsen

2017

Comput Supported Coop Work

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Call centers are a central coordination hub for remote health services and telemedicine. Recently, also telecare providers use call centers to support the remote care of seniors living independently. Although we know that the quality of the interaction between caregiver and senior care recipient is important, there is a gap in our knowledge as to how ICT solutions can support this interaction through a call center model. In this paper, we describe a case study of a modern call center designed to provide services for independent living, primarily for seniors. The case study gives us new insight into how service providers envision ICT support for independent living in the future. We discuss our findings from interviews, observations and design workshops in light of relevant literature about independent living and call centers. We conclude with a set of directions for future ICT for call centers to support independent living of seniors. These tools should: 1) support continuity of care instead of episodes of care, 2) support caregiving activities in addition to medical triage activities, 3) support "technical caregiving" i.e. remote use, testing and maintenance of technology at home, and 4) support call center operators in leading ad hoc and emergent coordination in distributed teams.

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“…Patient care is often delivered by multiple care providers that coordinate across time and space [6,21]; however, coordination between care team members remains challenging [2]. Prior work studied coordination in time-and safety-critical settings, such as surgical ward [6,7,92], trauma resuscitation room [90], emergency department [63], and intensive care [50]. Researchers highlighted the role of artifacts and common information spaces [21,45], such as paper schedules, electronic records, whiteboards and interactive displays, in facilitating coordination and collaborative sensemaking [8,14,77,80,101,112].…”

Section: Coordination In Clinical Settingsmentioning

confidence: 99%

Investigating Why Clinicians Deviate from Standards of Care: Liberating Patients from Mechanical Ventilation in the ICU

Yildirim,

Zlotnikov,

Venkat

et al. 2024

Proceedings of the CHI Conference on Human Factors in Computing Systems

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Clinical practice guidelines, care pathways, and protocols are designed to support evidence-based practices for clinicians; however, their adoption remains a challenge. We set out to investigate why clinicians deviate from the "Wake Up and Breathe" protocol, an evidence-based guideline for liberating patients from mechanical ventilation in the intensive care unit (ICU). We conducted over 40 hours of direct observations of live clinical workflows, 17 interviews with frontline care providers, and 4 co-design workshops at three different medical intensive care units. Our findings indicate that unlike prior literature suggests, disagreement with the protocol is not a substantial barrier to adoption. Instead, the uncertainty surrounding the application of the protocol for individual patients leads clinicians to deprioritize adoption in favor of tasks where they have high certainty. Reflecting on these insights, we identify opportunities for technical systems to help clinicians in effectively executing the protocol and discuss future directions for HCI research to support the integration of protocols into clinical practice in complex, team-based healthcare settings.

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Loosely formed patient care teams

Cited by 33 publications

References 32 publications

Technology Based Challenges of Informal Clinical Communication in an Australian tertiary referral hospital – A mixed methods assessment of The Need for Change

Technology Based Challenges of Informal Clinical Communication in an Australian tertiary referral hospital – A mixed methods assessment of The Need for Change

From Episodes to Continuity of Care: a Study of a Call Center for Supporting Independent Living

Investigating Why Clinicians Deviate from Standards of Care: Liberating Patients from Mechanical Ventilation in the ICU

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