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AHRQ Research Studies Date
Topics
- Ambulatory Care and Surgery (4)
- Children/Adolescents (1)
- Clinical Decision Support (CDS) (1)
- COVID-19 (1)
- Electronic Health Records (EHRs) (5)
- Emergency Department (3)
- Emergency Medical Services (EMS) (1)
- Healthcare Delivery (7)
- Health Information Technology (HIT) (5)
- Implementation (2)
- Lifestyle Changes (1)
- Neurological Disorders (1)
- Nursing (1)
- Patient Experience (2)
- Patient Safety (3)
- Primary Care (5)
- Primary Care: Models of Care (2)
- Provider: Health Personnel (1)
- Quality Improvement (3)
- Quality of Care (3)
- Respiratory Conditions (1)
- Surgery (2)
- Teams (1)
- Tools & Toolkits (1)
- Transitions of Care (1)
- (-) Workflow (16)
AHRQ Research Studies
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Research Studies is a compilation of published research articles funded by AHRQ or authored by AHRQ researchers.
Results
1 to 16 of 16 Research Studies DisplayedBurden A, Potestio C, Pukenas E
Influence of perioperative handoffs on complications and outcomes.
The authors describe the perioperative environment, calling it dynamic and complex, and indicate that there are multiple distractions that can interfere with effective communication and safe patient care. They discuss various aspects involved in handoffs, concluding that an institutional culture that highlights the importance of patient safety and that encourages team collaboration has demonstrated that harm can be decreased and patient safety can be improved.
AHRQ-funded; HS026158.
Citation: Burden A, Potestio C, Pukenas E .
Influence of perioperative handoffs on complications and outcomes.
Adv Anesth 2021 Dec;39:133-48. doi: 10.1016/j.aan.2021.07.008..
Keywords: Patient Safety, Transitions of Care, Workflow
Johnson KD, Schumacher D, Lee RC
Identifying strategies for the management of interruptions for novice triage nurses using an online modified Delphi method.
This study’s purpose was to use the Delphi Method to identify strategies used by triage nurses to effectively manage interrupts that can be taught to novice nurses. A panel of nine triage, education, and operational management experts were selected. The panel participated in three Delphi rounds. Results were synthesized and summaries returned to the participants. A final consensus was reached regarding recommendations for successful strategies to address triage interruptions. Eight strategies to mitigate the impact of interruptions were identified. Six of those strategies were identified as best being taught using simulation.
AHRQ-funded; HS025844.
Citation: Johnson KD, Schumacher D, Lee RC .
Identifying strategies for the management of interruptions for novice triage nurses using an online modified Delphi method.
J Nurs Scholarsh 2021 Nov;53(6):718-26. doi: 10.1111/jnu.12683..
Keywords: Nursing, Workflow
Salwei ME, Carayon P, Hoonakker PLT
Workflow integration analysis of a human factors-based clinical decision support in the emergency department.
Numerous challenges with the implementation, acceptance, and use of health IT are related to poor usability and a lack of integration of the technologies into clinical workflow, and have, therefore, limited the potential of these technologies to improve patient safety. In this paper, the investigators propose a definition and conceptual model of health IT workflow integration. Using interviews of 12 emergency department (ED) physicians, they identified 134 excerpts of barriers and facilitators to workflow integration of a human factors (HF)-based clinical decision support (CDS) implemented in the ED.
AHRQ-funded; HS022086.
Citation: Salwei ME, Carayon P, Hoonakker PLT .
Workflow integration analysis of a human factors-based clinical decision support in the emergency department.
Appl Ergon 2021 Nov;97:103498. doi: 10.1016/j.apergo.2021.103498..
Keywords: Emergency Department, Workflow, Clinical Decision Support (CDS), Health Information Technology (HIT), Implementation
Benneyan JC, White T, Nehls N
Systems analysis of a dedicated ambulatory respiratory unit for seeing and ensuring follow-up of patients with COVID-19 symptoms.
This paper is a systems analysis of a dedicated ambulatory respiratory unit for patients with COVID-19 symptoms. Workflow redesigns were necessitated by COVID and included new ambulatory workflows to handle surge volumes, protect patients and staff, and ensure timely reliable care. The workflow innovations observed can possibly be used to benefit routine care. Observations found that more than 85% of follow-ups were completed within 24 hours, and no staff or patient infections were associated with unit operations. Identified issues included role confusion, staffing and gatekeeping bottlenecks, and patient reluctance to visit in person or discuss concerns on the phone.
AHRQ-funded; HS027282.
Citation: Benneyan JC, White T, Nehls N .
Systems analysis of a dedicated ambulatory respiratory unit for seeing and ensuring follow-up of patients with COVID-19 symptoms.
J Ambul Care Manage 2021 Oct-Dec;44(4):293-303. doi: 10.1097/jac.0000000000000390..
Keywords: COVID-19, Ambulatory Care and Surgery, Respiratory Conditions, Workflow, Healthcare Delivery
Joseph A, Neyens D, Mihandoust S
Impact of surgical table orientation on flow disruptions and movement patterns during pediatric outpatient surgeries.
This quantitative observational study observed the impacts of surgical table orientation on flow disruptions (FDs), the number of contacts between team members, and the distance traveled. Findings showed that the orientation of the surgical table significantly influenced staff workflow and movement in the operating room, with an angled surgical table orientation being the least disruptive to surgical work. The anesthesia provider, scrub nurse, and circulating nurse experienced more FDs compared to the surgeon.
AHRQ-funded; HS024380.
Citation: Joseph A, Neyens D, Mihandoust S .
Impact of surgical table orientation on flow disruptions and movement patterns during pediatric outpatient surgeries.
Int J Environ Res Public Health 2021 Jul 31;18(15). doi: 10.3390/ijerph18158114..
Keywords: Children/Adolescents, Ambulatory Care and Surgery, Surgery, Workflow
Hung DY, Mujal G, Jin A
Patient experiences after implementing lean primary care redesigns.
The authors examined the effect of Lean primary care redesigns on patient satisfaction with care and timeliness of care received. After implementation of Lean redesigns, they found that patients reported a 44.8 percent increase in satisfaction with the adequacy of time spent with care providers during office visits. They also reported 71.6 percent higher satisfaction with their care provider's ability to listen to their concerns and a 55.4 percent increase in perceived staff helpfulness at the visit. The amount of time elapsed between a patient request for a routine appointment and the scheduled visit day decreased. On the day of the visit, patient wait times to be seen also decreased gradually.
AHRQ-funded; HS024529.
Citation: Hung DY, Mujal G, Jin A .
Patient experiences after implementing lean primary care redesigns.
Health Serv Res 2021 Jun;56(3):363-70. doi: 10.1111/1475-6773.13605..
Keywords: Patient Experience, Primary Care: Models of Care, Primary Care, Workflow, Quality Improvement, Quality of Care
Freedman S, Golberstein E, Huang TY
Docs with their eyes on the clock? The effect of time pressures on primary care productivity.
J Health Econ 2021 May;77:102442. doi: 10.1016/j.jhealeco.2021.102442.
Investigators examined how time pressure, an important constraint faced by medical care providers, affects productivity in primary care. Data was taken from the electronic health records of a large integrated delivery system. They found that greater time pressure reduced the number of diagnoses recorded during a visit and increased both scheduled and unscheduled follow-up care. Further, they found evidence of increased low-value care, decreased preventive care, and decreased opioid prescribing.
Investigators examined how time pressure, an important constraint faced by medical care providers, affects productivity in primary care. Data was taken from the electronic health records of a large integrated delivery system. They found that greater time pressure reduced the number of diagnoses recorded during a visit and increased both scheduled and unscheduled follow-up care. Further, they found evidence of increased low-value care, decreased preventive care, and decreased opioid prescribing.
AHRQ-funded; HS000036.
Citation: Freedman S, Golberstein E, Huang TY .
Docs with their eyes on the clock? The effect of time pressures on primary care productivity.
J Health Econ 2021 May;77:102442. doi: 10.1016/j.jhealeco.2021.102442..
Keywords: Primary Care, Healthcare Delivery, Workflow
Linke SE, Kallenberg GR, Kronick R
Integrating "Exercise Is Medicine" into primary care workflow: a study protocol.
As a major contributor to the burden of most chronic diseases, insufficient physical activity (PA) creates a significant financial burden on the health care system. Exercise Is Medicine (EIM) is a global health initiative committed to the belief that PA is integral to the prevention and treatment of diseases and should be routinely assessed as a vital sign and treated in the health care setting. This paper described an in-progress embedded quality improvement (QI) project that integrated EIM into routine clinical practice.
AHRQ-funded; HS026517.
Citation: Linke SE, Kallenberg GR, Kronick R .
Integrating "Exercise Is Medicine" into primary care workflow: a study protocol.
Transl Behav Med 2021 Apr 26;11(4):921-29. doi: 10.1093/tbm/ibaa088..
Keywords: Primary Care, Lifestyle Changes, Workflow, Healthcare Delivery
Jurewicz KA, Neyens DM, Catchpole K
Observational study of anaesthesia workflow to evaluate physical workspace design and layout.
The objective of this study was to observe the relationship between task switching and physical layout, and then use the data collected to design and assess different anesthesia workspace layouts. Six videos of anesthesia providers from a single medical center in the United States were analyzed. Findings showed that current operating theater layouts do not fit work demands. The authors reported a simple method that facilitates a quick layout design assessment and showed that the anesthesia workspace can be improved to better suit workflow and patient care. They suggested that this arrangement could reduce anesthesia workload while improving task flow efficiency and potentially the safety of care.
AHRQ-funded; HS024380.
Citation: Jurewicz KA, Neyens DM, Catchpole K .
Observational study of anaesthesia workflow to evaluate physical workspace design and layout.
Br J Anaesth 2021 Mar;126(3):633-41. doi: 10.1016/j.bja.2020.08.063..
Keywords: Workflow, Healthcare Delivery, Surgery
Hung DY, Truong QA, Liang SY
Implementing lean quality improvement in primary care: impact on efficiency in performing common clinical tasks.
Investigators examined 3-year impacts of Lean implementation on the amount of time taken for physicians to complete common clinical tasks. They found that Lean redesigns led to improvements in timely completion of 3 out of 4 common clinical tasks, thus supporting the use of Lean techniques to engage teams in routine aspects of patient care. They recommended more research to understand the mechanisms by which Lean promotes quality improvement and effectiveness of care team workflows.
AHRQ-funded; HS024529.
Citation: Hung DY, Truong QA, Liang SY .
Implementing lean quality improvement in primary care: impact on efficiency in performing common clinical tasks.
J Gen Intern Med 2021 Feb;36(2):274-79. doi: 10.1007/s11606-020-06317-9..
Keywords: Primary Care, Quality Improvement, Quality of Care, Primary Care: Models of Care, Primary Care, Implementation, Workflow, Teams, Healthcare Delivery
Patel VL, Denton CA, Soni HC
Physician workflow in two distinctive emergency departments: an observational study.
In this study, the investigators characterized physician workflow in two distinctive emergency departments (ED). Physician practices mediated by electronic health records (EHR) were explored within the context of organizational complexity for the delivery of care. The investigators concluded that 1.) the nature of the clinical practice and EHR-mediated workflow reflected the ED work practices; 2.) physicians in more complex organizations may be less efficient because of the fragmented workflow- however these effects could be mitigated by effort distribution through team communication, which affords inherent safety checks.
AHRQ-funded; HS022670.
Citation: Patel VL, Denton CA, Soni HC .
Physician workflow in two distinctive emergency departments: an observational study.
Appl Clin Inform 2021 Jan;12(1):141-52. doi: 10.1055/s-0040-1722615..
Keywords: Emergency Department, Workflow, Healthcare Delivery, Electronic Health Records (EHRs), Health Information Technology (HIT)
Lowry C, Orr K, Embry B
Primary care scribes: writing a new story for safety net clinics.
The researchers conducted an evaluation of trained volunteer scribes for primary care clinics serving a diverse, low-income population in a US safety net system, which implemented a new EHR between 2011 and 2014. In a safety net primary care system, trained volunteer scribes were associated with improved clinician efficiency and experience and no difference in patient satisfaction.
AHRQ-funded; HS022561; HS023558.
Citation: Lowry C, Orr K, Embry B .
Primary care scribes: writing a new story for safety net clinics.
BMJ Open Qual 2017 Oct 25;6(2):e000124. doi: 10.1136/bmjoq-2017-000124.
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Keywords: Electronic Health Records (EHRs), Patient Experience, Primary Care, Health Information Technology (HIT), Workflow
Benda NC, Fairbanks RJ, Fairbanks RJ
Are you paying attention? Related guidance on how concepts of attention may inform effective time sharing of tasks in emergency medicine.
The authors respond to an earlier article providing a thoughtful introduction to the importance of teaching effective task switching in emergency medicine. Their letter introduces the concept of attention, provides examples of tasks that can be most safely and effectively time shared, and notes that these principles must be considered in designing tools for the time sharing and rapid switching of tasks necessary in the ED environment.
AHRQ-funded; HS022542.
Citation: Benda NC, Fairbanks RJ, Fairbanks RJ .
Are you paying attention? Related guidance on how concepts of attention may inform effective time sharing of tasks in emergency medicine.
Ann Emerg Med 2017 May;69(5):669-70. doi: 10.1016/j.annemergmed.2017.01.027.
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Keywords: Workflow, Emergency Medical Services (EMS), Emergency Department, Patient Safety
Calvitti A, Hochheiser H, Ashfaq S
Physician activity during outpatient visits and subjective workload.
The researchers describe methods for capturing and analyzing EHR use and clinical workflow of physicians during outpatient encounters and relating activity to physicians' self-reported workload. They found that visit activity was highly variable across individual physicians, and the observed activity metrics ranged widely as correlates to subjective workload.
AHRQ-funded; HS021290.
Citation: Calvitti A, Hochheiser H, Ashfaq S .
Physician activity during outpatient visits and subjective workload.
J Biomed Inform 2017 May;69:135-49. doi: 10.1016/j.jbi.2017.03.011.
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Keywords: Healthcare Delivery, Electronic Health Records (EHRs), Health Information Technology (HIT), Workflow, Ambulatory Care and Surgery
Hanauer DA, Branford GL, Greenberg G
Two-year longitudinal assessment of physicians' perceptions after replacement of a longstanding homegrown electronic health record: does a J-curve of satisfaction really exist?
This report describes a 2-year prospective, longitudinal survey of attending physicians in 3 clinical areas (family medicine, general pediatrics, internal medicine) who experienced a transition from a homegrown electronic health record (EHR) to a vendor EHR. The primary goal was to determine if perceptions followed a J-curve pattern in which they initially dropped but eventually surpassed baseline measures. A J-curve was not found for any measures, including workflow, safety, communication, and satisfaction.
AHRQ-funded; HS023613.
Citation: Hanauer DA, Branford GL, Greenberg G .
Two-year longitudinal assessment of physicians' perceptions after replacement of a longstanding homegrown electronic health record: does a J-curve of satisfaction really exist?
J Am Med Inform Assoc 2017 Apr 1;24(e1):e157-e65. doi: 10.1093/jamia/ocw077.
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Keywords: Electronic Health Records (EHRs), Provider: Health Personnel, Ambulatory Care and Surgery, Patient Safety, Workflow
Narayanan J, Dobrin S, Choi J
Structured clinical documentation in the electronic medical record to improve quality and to support practice-based research in epilepsy.
The researchers describe a stepwise process for building structured clinical documentation support tools in the electronic medical record (EMR) that define best practices in epilepsy, and describe how they incorporated these toolkits into their clinical workflow. These tools write notes and capture hundreds of fields of data including several score tests. They also summarize brain imaging, blood laboratory, and electroencephalography results, and document neuromodulation treatments.
AHRQ-funded; HS024057.
Citation: Narayanan J, Dobrin S, Choi J .
Structured clinical documentation in the electronic medical record to improve quality and to support practice-based research in epilepsy.
Epilepsia 2017 Jan;58(1):68-76. doi: 10.1111/epi.13607.
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Keywords: Electronic Health Records (EHRs), Health Information Technology (HIT), Neurological Disorders, Quality of Care, Quality Improvement, Tools & Toolkits, Workflow