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Search All Research Studies
Topics
- Behavioral Health (1)
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- Electronic Health Records (EHRs) (3)
- (-) Emergency Department (11)
- Emergency Medical Services (EMS) (2)
- Healthcare Delivery (2)
- Health Information Technology (HIT) (5)
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- Teams (1)
- Trauma (1)
- (-) Workflow (11)
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 11 of 11 Research Studies DisplayedAghaei P, Bayramzadeh S
Clinicians’ experience with technology within the physical environment of trauma rooms: a focus group study.
This study’s objective was to investigate how trauma team members perceive technological equipment and tools in the trauma room (TR) environment and to identify how the technological equipment could be optimized in relation to the TR’s space. The authors conducted a total of 21 focus group sessions with 69 trauma team members, all of whom worked in Level I TRs from six teaching hospitals in the USA. Findings were analyzed and categorized into three parent themes: imaging equipment, assistive devices, and room features. The results suggest that trauma team members place high importance on the availability and versatility of the technological equipment in the TR environment. CT-scanners were not usually optimized for easy access to the TR. Other suggestions included the implementation of cameras and screens to accommodate situation awareness, and the rapid sharing of data such as imaging results. This study will inform health-care designers with the knowledge they need to make informed decisions when designing TRs. It covers key considerations such as room layout, equipment selection, lighting and controls.
AHRQ-funded; HS027261.
Citation: Aghaei P, Bayramzadeh S .
Clinicians’ experience with technology within the physical environment of trauma rooms: a focus group study.
Facilities 2024 Mar 12. 2024/02/14..
Keywords: Workflow, Teams, Emergency Department, Trauma
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
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
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)
Batt RJ, Kc DS, Stats BR
The effects of discrete work shifts on a nonterminating service system.
The authors showed that in emergency departments (EDs), the patients’ rate of service completion varies over the course of the physician shift. Furthermore, patients that have experienced a physician handoff have a higher rate of service completion than non-handed-off patients. The authors also demonstrated that patients that have been handed off are more likely to revisit the ED within three days, which suggests that patient handoffs lower clinical quality. Finally, the authors used simulation to demonstrate that shift length and new‐patient cutoff rules can be used to reduce handoffs, but at the expense of system throughput.
AHRQ-funded; HS024558.
Citation: Batt RJ, Kc DS, Stats BR .
The effects of discrete work shifts on a nonterminating service system.
Prod Oper Manag 2019 Jun;28(6):1528-44. doi: 10.1111/poms.12999..
Keywords: Emergency Department, Healthcare Delivery, Quality of Care, Workflow
Fong A, Ratwani RM
Understanding emergency medicine physicians multitasking behaviors around interruptions.
Interruptions can adversely impact human performance, particularly in fast-paced and high-risk environments such as the emergency department (ED). In this paper, the investigators present a comprehensive framework for understanding interruptions that is composed of three phases, each with multiple levels: interruption start transition, interruption engagement, and interruption end transition. This three-phase framework is not constrained to discrete task transitions, providing a robust method to categorize multitasking behaviors around interruptions. They apply this framework in categorizing 457 interruption episodes.
AHRQ-funded; HS022362.
Citation: Fong A, Ratwani RM .
Understanding emergency medicine physicians multitasking behaviors around interruptions.
Acad Emerg Med 2018 Oct;25(10):1164-68. doi: 10.1111/acem.13496..
Keywords: Emergency Department, Workflow, Patient Safety, Provider: Physician, Provider
Fong A, Kim TC, Ratwani RM
Task2Heart: exploring heart rate differences with time-motion workflow observations of emergency medicine physicians.
This paper presents Task2Heart, a system developed to integrate near real-time heart rate with in-situ time motion observations. The authors describe and validate the system and discuss its use in the exploration of emergency physician heart rate in-situ.
AHRQ-funded; HS024801.
Citation: Fong A, Kim TC, Ratwani RM .
Task2Heart: exploring heart rate differences with time-motion workflow observations of emergency medicine physicians.
J Med Syst 2018 Aug 7;42(9):170. doi: 10.1007/s10916-018-1024-4..
Keywords: Cardiovascular Conditions, Emergency Department, Workflow, Emergency Medical Services (EMS)
Denton CA, Soni HC, Kannampallil TG
Emergency physicians' perceived influence of EHR use on clinical workflow and performance metrics.
In this article, the authors investigated the perceived effects of electronic health record (EHR) use on clinical workflow and meaningful use (MU) performance metrics. The investigators concluded that physicians' perception of EHRs was likely to influence their practices. They suggested that with negative perceptions of EHR usability problems, positive aspects of EHR use, including the influence on MU performance metrics, may be overridden.
AHRQ-funded; HS022670.
Citation: Denton CA, Soni HC, Kannampallil TG .
Emergency physicians' perceived influence of EHR use on clinical workflow and performance metrics.
Appl Clin Inform 2018 Jul;9(3):725-33. doi: 10.1055/s-0038-1668553..
Keywords: Electronic Health Records (EHRs), Emergency Department, Health Information Technology (HIT), Workflow, Provider: Physician, Provider
Vankipuram A, Traub S, Patel VL
A method for the analysis and visualization of clinical workflow in dynamic environments.
The authors present a cohesive framework that combines a set of analytic techniques that can potentially complement traditional human observations to derive a deeper understanding of clinical workflow. Their framework is divided into three modules: (i) transformation, (ii) analysis, and (iii) visualization. They describe the methods used in each of these modules, and provide a series of visualizations developed using location-tracking data collected at the Mayo Clinic ED.
AHRQ-funded; HS022670.
Citation: Vankipuram A, Traub S, Patel VL .
A method for the analysis and visualization of clinical workflow in dynamic environments.
J Biomed Inform 2018 Mar;79:20-31. doi: 10.1016/j.jbi.2018.01.007.
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Keywords: Emergency Department, Health Information Technology (HIT), Health Information Technology (HIT), Primary Care: Models of Care, 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