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AHRQ Research Studies Date
Topics
- Ambulatory Care and Surgery (2)
- Burnout (1)
- Cancer (1)
- Cardiovascular Conditions (1)
- Children/Adolescents (1)
- Clinical Decision Support (CDS) (1)
- COVID-19 (1)
- Critical Care (1)
- Electronic Health Records (EHRs) (2)
- Emergency Department (6)
- Emergency Medical Services (EMS) (1)
- Healthcare Delivery (6)
- Health Information Exchange (HIE) (1)
- Health Information Technology (HIT) (6)
- Hospitals (1)
- Implementation (2)
- Lifestyle Changes (1)
- Nursing (4)
- Organizational Change (1)
- Patient Experience (1)
- Patient Safety (5)
- Prevention (1)
- Primary Care (5)
- Primary Care: Models of Care (3)
- Provider (4)
- Provider: Nurse (3)
- Provider: Physician (3)
- Quality Improvement (2)
- Quality of Care (2)
- Respiratory Conditions (1)
- Screening (1)
- Surgery (3)
- Teams (2)
- Transitions of Care (1)
- (-) Workflow (22)
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 22 of 22 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)
Rosen MA, Dietz AS, Lee N
Sensor-based measurement of critical care nursing workload: Unobtrusive measures of nursing activity complement traditional task and patient level indicators of workload to predict perceived exertion.
The purpose of this study was to establish the validity of sensor-based measures of work processes for predicting perceived mental and physical exertion of critical care nurses. Environmental sensors worn by staff in a surgical intensive care unit captured work process data. Nurses rated their mental and physical exertion for each four-hour block, and recorded patient and staffing-level workload factors. Analysis of this data yielded highly predictive models of critical care nursing workload to generate insights into workflow and work design. The researchers conclude that sensor-based measures are a viable complement to traditional task demand measures of workload.
AHRQ-funded; HS023553.
Citation: Rosen MA, Dietz AS, Lee N .
Sensor-based measurement of critical care nursing workload: Unobtrusive measures of nursing activity complement traditional task and patient level indicators of workload to predict perceived exertion.
PLoS One 2018 Oct 12;13(10):e0204819. doi: 10.1371/journal.pone.0204819..
Keywords: Critical Care, Nursing, Provider: Nurse, Patient Safety, 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
Cummins MR, Ranade-Kharkar P, Johansen C
Simple workflow changes enable effective patient identity matching in poison control.
In this study, to increase the documentation of patient identifiers by the Utah Poison Control Center (PCC), the authors (1) adapted documentation practices to enable more complete and consistent documentation, and (2) implemented staff training to improve collection of identifiers. The investigators found that compared with the same time period in 2016, the Utah PCC showed an increase of 27% (p < 0.001) in collection of birth date for cases referred to a health care facility, while improvements in the collection of other identifiers ranged from 0 to 8%.
AHRQ-funded; HS021472.
Citation: Cummins MR, Ranade-Kharkar P, Johansen C .
Simple workflow changes enable effective patient identity matching in poison control.
Appl Clin Inform 2018 Jul;9(3):553-57. doi: 10.1055/s-0038-1667000..
Keywords: Workflow, Health Information Exchange (HIE)
Bayramzadeh S, Joseph A, San D
The impact of operating room layout on circulating nurse's work patterns and flow disruptions: a behavioral mapping study.
The purpose of this study was to assess how the adjacencies of functionally different areas within operating rooms (ORs) can influence the circulating nurse's (CN) workflow patterns and disruptions. The investigators video recorded and thematically coded a convenience sample of 25 surgeries for CN's activities, locations, and flow disruptions. The investigators suggest that optimum adjacencies should be considered while designing ORs such that they are more efficient and safer.
AHRQ-funded; HS024380.
Citation: Bayramzadeh S, Joseph A, San D .
The impact of operating room layout on circulating nurse's work patterns and flow disruptions: a behavioral mapping study.
HERD 2018 Jul;11(3):124-38. doi: 10.1177/1937586717751124..
Keywords: Surgery, Workflow, Hospitals, Nursing, Provider: Nurse, Provider, Patient Safety
Hung DY, Harrison MI , Truong Q
AHRQ Author: Harrison MI
Experiences of primary care physicians and staff following lean workflow redesign.
The researchers examined the work experiences of primary care physicians and staff after implementing Lean-based workflow redesigns. They found that both physicians and nonphysician staff reported higher levels of engagement and teamwork after implementing redesigns. However, the subjects also experienced higher levels of burnout and perceptions of the workplace as stressful.
AHRQ-authored; AHRQ-funded; 290201000022I.
Citation: Hung DY, Harrison MI , Truong Q .
Experiences of primary care physicians and staff following lean workflow redesign.
BMC Health Serv Res 2018 Apr 10;18(1):274. doi: 10.1186/s12913-018-3062-5.
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Keywords: Primary Care, Workflow, Burnout, Organizational Change, Provider: Physician, Teams
Blaz JW, Doig AK, Cloyes KG
The symbolic functions of nurses' cognitive artifacts on a medical oncology unit.
Acute care nurses continue to rely on personally created paper-based tools-their "paper brains"-to support work during a shift, although standardized handoff tools are recommended. This interpretive descriptive study examines the functions these paper brains serve beyond handoff in the medical oncology unit at a cancer specialty hospital.
AHRQ-funded; HS022183.
Citation: Blaz JW, Doig AK, Cloyes KG .
The symbolic functions of nurses' cognitive artifacts on a medical oncology unit.
West J Nurs Res 2018 Apr;40(4):520-36. doi: 10.1177/0193945916683683.
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Keywords: Nursing, Provider: Nurse, Provider, Workflow
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
Borycki E, Senathirajah Y, Kushniruk AW
The future of mobile usability, workflow and safety testing.
In this paper, the authors outline a vision for the future of mobile usability, workflow and safety testing. The authors argue for the use of glasses that can audio and video record usability, workflow and safety data.
AHRQ-funded; HS023708.
Citation: Borycki E, Senathirajah Y, Kushniruk AW .
The future of mobile usability, workflow and safety testing.
Stud Health Technol Inform 2017;245:15-19..
Keywords: Health Information Technology (HIT), Patient Safety, Workflow
Zai AH, Kim S, Kamis A
Applying operations research to optimize a novel population management system for cancer screening.
The objective of this paper is to optimize a new visit-independent, population-based cancer screening system (TopCare) by using operations research techniques to simulate changes in patient outreach staffing levels (delegates, navigators), modifications to user workflow within the information technology (IT) system, and changes in cancer screening recommendations. Results showed that simulating the impact of changes in staffing, system parameters, and clinical inputs on the effectiveness and efficiency of care can inform the allocation of limited resources in population management.
AHRQ-funded; HS018161.
Citation: Zai AH, Kim S, Kamis A .
Applying operations research to optimize a novel population management system for cancer screening.
J Am Med Inform Assoc 2014 Feb;21(e1):e129-35. doi: 10.1136/amiajnl-2013-001681.
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Keywords: Cancer, Health Information Technology (HIT), Prevention, Screening, Workflow