National Healthcare Quality and Disparities Report
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AHRQ Research Studies Date
Topics
- Adverse Events (1)
- Behavioral Health (1)
- Burnout (1)
- Children/Adolescents (1)
- Clinical Decision Support (CDS) (2)
- Communication (1)
- Diagnostic Safety and Quality (1)
- Education: Continuing Medical Education (1)
- Electronic Health Records (EHRs) (4)
- Emergency Department (2)
- Evidence-Based Practice (2)
- Genetics (1)
- Health Information Technology (HIT) (5)
- Inpatient Care (1)
- Intensive Care Unit (ICU) (1)
- Medication (1)
- Newborns/Infants (1)
- Nursing (2)
- Obesity (1)
- Obesity: Weight Management (1)
- Organizational Change (1)
- Patient Safety (1)
- Primary Care (1)
- Provider (1)
- Quality Improvement (2)
- Quality of Care (2)
- Shared Decision Making (1)
- Stress (1)
- Surgery (2)
- Training (1)
- Transitions of Care (2)
- (-) Workflow (12)
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 12 of 12 Research Studies DisplayedKoch A, Quartucci C, Buchner A
Associations of flow disruptions with patient, staff, and process outcomes: a prospective observational study of robotic-assisted radical prostatectomies.
The purpose of this study was to examine the relationships between intraoperative flow disruptions (FDs) and patient outcomes, staff workload, and surgery duration. Sixty-one robotic-assisted radical prostatectomy procedures were captured (with 61 patients and 243 staff reports). The study found that high rates of FDs were observed; however, there were no significant associations with the rates of patient complications. Equipment- and patient-related FDs were associated with higher staff workload. No relationship was found between greater rates of FDs and duration of procedure.
AHRQ-funded; HS026491.
Citation: Koch A, Quartucci C, Buchner A .
Associations of flow disruptions with patient, staff, and process outcomes: a prospective observational study of robotic-assisted radical prostatectomies.
Surg Endosc 2023 Sep; 37(9):6964-74. doi: 10.1007/s00464-023-10162-2..
Keywords: Surgery, Workflow
Sparling JL, France D, Abraham J
Handoff Effectiveness Research in periOperative environments (HERO) Design Studio: a conference report.
This conference report reviewed the historical background which led to the Handoff Effectiveness Research in periOperative environments (HERO) Design Studio. The objectives of the HERO Design Studio were to examine the existing literature base, create a national research agenda, and build the research infrastructure necessary to address critical evidence gaps in perioperative handoff quality and safety. The authors described how they prepared for the research conference and synthesized the conference’s results. They also recommended future directions regarding perioperative handoff improvement.
AHRQ-funded; HS027769.
Citation: Sparling JL, France D, Abraham J .
Handoff Effectiveness Research in periOperative environments (HERO) Design Studio: a conference report.
Jt Comm J Qual Patient Saf 2023 Aug; 49(8):422-30. doi: 10.1016/j.jcjq.2023.02.004..
Keywords: Health Information Technology (HIT), Workflow, Transitions of Care, Electronic Health Records (EHRs), Evidence-Based Practice
Sparling JL, Hong Mershon B, Abraham J
Perioperative handoff enhancement opportunities through technology and artificial intelligence: a narrative review.
This narrative review synthesized prior research on electronic tools for perioperative handoffs, limitations of current tools and barriers to their implementation, and use of AI and machine learning in perioperative care. Results showed that several efforts have incorporated electronic tools to improve perioperative handoffs, but were limited by imprecision in selecting handoff elements. AI and machine learning use and integration into handoff workflows were not yet being studied. Existing technology such as mobile applications, barcode scanners, and radio-frequency identification tags to advance perioperative safety were similarly not applied to handoffs.
AHRQ-funded; HS027769.
Citation: Sparling JL, Hong Mershon B, Abraham J .
Perioperative handoff enhancement opportunities through technology and artificial intelligence: a narrative review.
Jt Comm J Qual Patient Saf 2023 Aug; 49(8):410-21. doi: 10.1016/j.jcjq.2023.03.009..
Keywords: Health Information Technology (HIT), Workflow, Transitions of Care, Electronic Health Records (EHRs), Evidence-Based Practice
Zamudio J, Kanji FF, Lusk C
Identifying workflow disruptions in robotic-assisted bariatric surgery: elucidating challenges experienced by surgical teams.
The goal of this observational study was to investigate the impact of robotic bariatric surgery (RBS) on the surgical work system via the study of flow disruptions (FDs), or deviations from the natural workflow progression. Twenty-nine RBS procedures were observed at three sites; FDs were recorded in real time and subsequently classified into one of nine work system categories. FDs occurred approximately every 2.4 minutes and happened most frequently during the final patient transfer and robot docking phases of RBS. The coordination challenges that contributed most to these disruptions were associated with waiting for staff/instruments and readjusting equipment.
AHRQ-funded; HS026491.
Citation: Zamudio J, Kanji FF, Lusk C .
Identifying workflow disruptions in robotic-assisted bariatric surgery: elucidating challenges experienced by surgical teams.
Obes Surg 2023 Jul; 33(7):2083-89. doi: 10.1007/s11695-023-06620-4..
Keywords: Obesity: Weight Management, Surgery, Workflow, Obesity
Huff NR, Chimowitz H, DelPico MA
The consequences of emotionally evocative patient behaviors on emergency nurses' patient assessments and handoffs: an experimental study using simulated patient cases.
The purpose of this experimental vignette research study was to explore the impact of emotionally evocative patient behavior and mental illness on 130 emergency nurses' emotions, patient assessments, testing advocacy, and written handoffs. The researchers asked the nurses to complete four multimedia computer-simulated patient encounters in which patient behavior (irritable vs. calm) and mental illness (present vs. absent) were purposely varied. The nurses recorded their emotions and clinical evaluations, recommended diagnostic tests, and provided written handoffs. The study found that the nurses experienced greater negative emotions (anger, unease) and reported decreased engagement when evaluating patients demonstrating irritable (vs. calm) behavior. Nurses also considered patients with irritable (vs. calm) behavior as more likely to exaggerate their pain and as poorer historians, and as less likely to cooperate, return to work, and recover. Nurses' handoffs were more likely to include negative descriptions of patients with irritable (vs. calm) behavior and exclude specific clinical information. The existence of mental illness increased unease and sadness and lead to nurses being less likely to recommend a needed test for a correct diagnosis.
AHRQ-funded; HS025752.
Citation: Huff NR, Chimowitz H, DelPico MA .
The consequences of emotionally evocative patient behaviors on emergency nurses' patient assessments and handoffs: an experimental study using simulated patient cases.
Int J Nurs Stud 2023 Jul; 143:104507. doi: 10.1016/j.ijnurstu.2023.104507..
Keywords: Emergency Department, Behavioral Health, Nursing, Workflow
Moy AJ, Hobensack M, Marshall K
Understanding the perceived role of electronic health records and workflow fragmentation on clinician documentation burden in emergency departments.
This study’s goal was to understand the perceived role of electronic health records (EHR) and workflow fragmentation on clinician documentation burden in the emergency department (ED). The authors conducted semistructured interviews with a national sample of US prescribing providers and registered nurses who actively practice in the adult ED setting and use Epic Systems' EHR. They recruited 12 prescribing providers and 12 registered nurses. Six themes were found related to EHR factors perceived to contribute to documentation burden including lack of advanced EHR capabilities, absence of EHR optimization for clinicians, poor user interface design, hindered communication, increased manual work, and added workflow blockages, and five themes associated with cognitive load. The relationship between workflow fragmentation and EHR documentation burden brought up two themes: underlying sources and adverse consequences.
AHRQ-funded; HS028454.
Citation: Moy AJ, Hobensack M, Marshall K .
Understanding the perceived role of electronic health records and workflow fragmentation on clinician documentation burden in emergency departments.
J Am Med Inform Assoc 2023 Apr 19; 30(5):797-808. doi: 10.1093/jamia/ocad038..
Keywords: Electronic Health Records (EHRs), Workflow, Health Information Technology (HIT), Emergency Department
Gephart SM, Tolentino DA, Quinn MC
Neonatal intensive care workflow analysis informing NEC-Zero clinical decision support design.
The aim of this qualitative descriptive study was to explore the current clinical workflow and sociotechnical processes of clinicians for necrotizing enterocolitis risk awareness, timely discovery of symptoms, and treatment to guide decision support design. The researchers conducted 11 focus groups in two neonatal ICUs. The study found that workflow processes were different for nurses (who observe the signs of necrotizing enterocolitis and inform providers to order diagnostic tests and treatments) and providers (who receive notification of necrotizing enterocolitis concern and then decide what actions to take). The researchers reported that clinicians wanted a necrotizing enterocolitis-relevant dashboard with: 1) nutrition tracking and recognition of necrotizing enterocolitis; 2) features to support decision-making; 3) breast milk tracking and feeding clinical decision support; 4) tools for necrotizing enterocolitis surveillance and quality reporting; and 5) general electronic health records improvements to enhance user experience.
AHRQ-funded; HS022908.
Citation: Gephart SM, Tolentino DA, Quinn MC .
Neonatal intensive care workflow analysis informing NEC-Zero clinical decision support design.
Comput Inform Nurs 2023 Feb; 41(2):94-101. doi: 10.1097/cin.0000000000000929..
Keywords: Newborns/Infants, Clinical Decision Support (CDS), Intensive Care Unit (ICU), Workflow, Health Information Technology (HIT)
Starmer AJ, Destino L, Yoon CS
Intern and resident workflow patterns on pediatric inpatient units: a multicenter time-motion study.
The researchers sought to quantify the proportion of time spent by residents in direct care, indirect care activities, and education across 9 pediatric institutions. They found that across all sites and levels of training, trainees spent more time in interprofessional communication (34.7 percent), and at the computer (20.5 percent), and less time in contact with patients and families (12.0 percent) and in educational activities (4.7 percent).
AHRQ-funded; HS019456.
Citation: Starmer AJ, Destino L, Yoon CS .
Intern and resident workflow patterns on pediatric inpatient units: a multicenter time-motion study.
JAMA Pediatr 2015 Dec;169(12):1175-7. doi: 10.1001/jamapediatrics.2015.2471..
Keywords: Children/Adolescents, Education: Continuing Medical Education, Inpatient Care, Provider, Training, Workflow
Cutting EM, Overby CL, Banchero M
Using workflow modeling to identify areas to improve genetic test processes in the University of Maryland Translational Pharmacogenomics Project.
The researchers used information gained from focus groups in order to illustrate the current process of delivering genetic test results to clinicians. They proposed a business process model and notation (BPMN) representation of this process for a Translational Pharmacogenomics Project being implemented at the University of Maryland Medical Center. They found that the current process could be improved to reduce input errors, better inform and notify clinicians about the implications of certain genetic tests, and make results more easily understood. They demonstrated theiruse of BPMN to improve this important clinical process for CYP2C19 genetic testing.
AHRQ-funded; HS023390.
Citation: Cutting EM, Overby CL, Banchero M .
Using workflow modeling to identify areas to improve genetic test processes in the University of Maryland Translational Pharmacogenomics Project.
AMIA Annu Symp Proc 2015 Nov 5;2015:466-74.
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Keywords: Genetics, Diagnostic Safety and Quality, Medication, Workflow, Quality Improvement, Quality of Care, Organizational Change
Gephart S, Carrington JM, Finley B
A systematic review of nurses' experiences with unintended consequences when using the electronic health record.
The purpose of this article is to present the state of the science on nurses' experiences with unintended consequences of electronic health records (EHRs). Findings demonstrate that nurses experience changes to workflow, must continually adapt to meet patient's needs in the context of imperfect EHR systems, and have difficulty accessing the information they need to make patient care decisions. Implications for nurse administrators include the need for continual engagement with nurses along the continuum of EHR design, as well as the need to encourage nurses to speak up and acknowledge workflow changes that threaten patient safety or do not support work efficiency.
AHRQ-funded; HS021074.
Citation: Gephart S, Carrington JM, Finley B .
A systematic review of nurses' experiences with unintended consequences when using the electronic health record.
Nurs Adm Q 2015 Oct-Dec;39(4):345-56. doi: 10.1097/naq.0000000000000119.
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Keywords: Adverse Events, Clinical Decision Support (CDS), Electronic Health Records (EHRs), Nursing, Workflow
Linzer M, Poplau S, Grossman E
A cluster randomized trial of interventions to improve work conditions and clinician burnout in primary care: results from the Healthy Work Place (HWP) Study.
This study aimed to assess if improvements in work conditions reduce clinician stress and burnout. It found that burnout was more likely to improve with workflow interventions and with targeted QI projects than in controls. Also, interventions in communication or workflow led to greater improvements in clinician satisfaction.
AHRQ-funded; HS018160.
Citation: Linzer M, Poplau S, Grossman E .
A cluster randomized trial of interventions to improve work conditions and clinician burnout in primary care: results from the Healthy Work Place (HWP) Study.
J Gen Intern Med 2015 Aug;30(8):1105-11. doi: 10.1007/s11606-015-3235-4..
Keywords: Burnout, Stress, Primary Care, Workflow, Quality Improvement, Quality of Care, Communication
Butler KA, Mercer E, Bahrami A
Model checking for verification of interactive health IT systems.
The authors proposed to formalize the relationship between HIT and the conceptual work that increasingly typifies modern care. They demonstrated the method on a patient contact system to show that model checking is effective for interactive systems and that much of it can be automated.
AHRQ-funded; HS021233.
Citation: Butler KA, Mercer E, Bahrami A .
Model checking for verification of interactive health IT systems.
AMIA Annu Symp Proc 2015;2015:349-58.
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Keywords: Shared Decision Making, Health Information Technology (HIT), Health Information Technology (HIT), Patient Safety, Workflow