National Healthcare Quality and Disparities Report
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AHRQ Research Studies Date
Topics
- Adverse Events (4)
- Care Coordination (3)
- Caregiving (2)
- Catheter-Associated Urinary Tract Infection (CAUTI) (1)
- Central Line-Associated Bloodstream Infections (CLABSI) (1)
- Children/Adolescents (5)
- Clinician-Patient Communication (5)
- (-) Communication (21)
- COVID-19 (1)
- Electronic Health Records (EHRs) (1)
- Emergency Department (1)
- Emergency Medical Services (EMS) (1)
- Healthcare-Associated Infections (HAIs) (1)
- Healthcare Delivery (3)
- Health Information Technology (HIT) (4)
- Health Services Research (HSR) (1)
- Home Healthcare (1)
- Hospital Discharge (3)
- Hospitalization (3)
- (-) Hospitals (21)
- Implementation (1)
- Inpatient Care (4)
- Intensive Care Unit (ICU) (2)
- Medical Errors (1)
- Mortality (1)
- Nursing (1)
- Nursing Homes (2)
- Organizational Change (2)
- Patient-Centered Healthcare (1)
- Patient-Centered Outcomes Research (1)
- Patient and Family Engagement (3)
- Patient Experience (1)
- Patient Safety (6)
- Prevention (1)
- Provider (1)
- Provider: Nurse (1)
- Provider: Physician (2)
- Quality Improvement (4)
- Quality of Care (3)
- Surgery (1)
- Teams (2)
- Telehealth (2)
- Transitions of Care (3)
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 21 of 21 Research Studies DisplayedKelly MM, Hoonakker PLT, Nacht CL
Parent perspectives on sharing pediatric hospitalization clinical notes.
This qualitative study sought to identify parent perceptions of the benefits and challenges of real-time note access during their child's hospitalization and strategies to optimize note-sharing at the bedside. The study conducted 60-minute interviews with 28 parents who were given access to their child's admission and daily progress notes on a bedside tablet (iPad) and interviewed upon discharge. The parents described 6 benefits of having note access, which: provided a recap and improved their knowledge about their child's care plan, enhanced communication, facilitated empowerment, increased autonomy, and incited positive emotions. Potential challenges described included: causing confusion, hindering communication with the health care team, highlighting problems with note content, and inciting negative emotions. The parents recommended 4 strategies to support sharing: provide preemptive communication about expectations, optimize the note release process, consider parent-friendly note template modifications, and offer informational resources for parents.
AHRQ-funded; HS027214.
Citation: Kelly MM, Hoonakker PLT, Nacht CL .
Parent perspectives on sharing pediatric hospitalization clinical notes.
Pediatrics 2023 Jan; 151(1). doi: 10.1542/peds.2022-057756..
Keywords: Children/Adolescents, Hospitals, Clinician-Patient Communication, Communication, Hospitalization
McAlearney AS, MacEwan SR, Gregory ME
Identifying management practices for promoting infection prevention: perspectives on strategic communication.
The purpose of this study was to better understand the topics and communication strategies used by hospital administrative and clinical leaders to facilitate healthcare-associated infection prevention. Between 2017 and 2019 the researchers interviewed 188 administrative and clinical leaders in 18 U.S. Hospitals and interviewed them about management practices used to promote the prevention of HAI, with a focus on strategic communications. The study found that information sharing regarding infection prevention focused on two main topics: facilitators of success and barriers to success. The researchers also reported that storytelling using examples of real events was useful. The study concluded that the findings provide useful information about how the strategic communication of HAI information can contribute to improvement and advance hospitals’ infection prevention plans and efforts.
AHRQ-funded; HS024958.
Citation: McAlearney AS, MacEwan SR, Gregory ME .
Identifying management practices for promoting infection prevention: perspectives on strategic communication.
Am J Infect Control 2022 Jun;50(6):593-97. doi: 10.1016/j.ajic.2021.11.025..
Keywords: Catheter-Associated Urinary Tract Infection (CAUTI), Central Line-Associated Bloodstream Infections (CLABSI), Healthcare-Associated Infections (HAIs), Hospitals, Prevention, Communication
Lafferty M, Harrod M, Krein S
It's like sending a message in a bottle: a qualitative study of the consequences of one-way communication technologies in hospitals.
Researchers examined how physicians and nurses use available communication technologies and identify the implications for communication and patient care based on the theory of workarounds. They found that one-way communication technologies created an environment where workarounds could flourish. By placing results within the context of the theory of workarounds, they extended what is known about why and how workarounds develop, and they offered strategies to minimize workarounds' adverse effects. They concluded that two-way communication technologies could minimize workarounds and gaps in information exchange and could reduce unnecessary interruptions and the potential for adverse events.
J Am Med Inform Assoc 2021 Nov 25;28(12):2601-07. doi: 10.1093/jamia/ocab191.
Citation: Lafferty M, Harrod M, Krein S .
It's like sending a message in a bottle: a qualitative study of the consequences of one-way communication technologies in hospitals.
AHRQ-funded; HS022305..
Keywords: Hospitals, Communication, Health Information Technology (HIT), Provider: Physician
Legler S, Diehl M, Hilliard B
Evaluation of an intrahospital telemedicine program for patients admitted with COVID-19: mixed methods study.
This pilot study’s objective was to evaluate an intrahospital telemedicine program along with its impact on exposure risk and communication for patients admitted with COVID-19. Virtual care was the main primary exposure variable and patient characteristics, PPE use rates, and their association with virtual care were assessed. Out of 137 total patients in their primary analysis, 43 patients used virtual care. There were 82 inpatient days of use, and 401 inpatient days without use. Surveys of 41 patients and clinicians showed high rates of recommendation for further use. A significant reduction in PPE use and physical exam rate was associated with virtual care. However, there are limitations in usability, medical assessment, and empathetic communication.
AHRQ-funded; HS026732.
Citation: Legler S, Diehl M, Hilliard B .
Evaluation of an intrahospital telemedicine program for patients admitted with COVID-19: mixed methods study.
J Med Internet Res 2021 Apr 29;23(4):e25987. doi: 10.2196/25987..
Keywords: Telehealth, Health Information Technology (HIT), Hospitals, Hospitalization, Communication, COVID-19
McAlearney AS, Walker DM, Gaughan A
Helping patients be better patients: a qualitative study of perceptions about inpatient portal use.
This qualitative study looked at perceptions about inpatient portal use and its impact on patient experience and the care process. The authors interviewed 120 patients and 433 care team members across a seven-hospital academic medical center that offers an inpatient portal to hospitalized patients. Care team members felt the inpatient portal helped patients be “better patients” by improving their ability to be informed about their health and enabling them to be more involved in the care process. The care team members suggested portal use could be improved by addressing challenges with tablet administration, use of the patient education feature, and the functionality of the scheduling feature.
AHRQ-funded; HS024379; HS024091.
Citation: McAlearney AS, Walker DM, Gaughan A .
Helping patients be better patients: a qualitative study of perceptions about inpatient portal use.
Telemed J E Health 2020 Sep;26(9):1184-87. doi: 10.1089/tmj.2019.0198..
Keywords: Telehealth, Health Information Technology (HIT), Patient and Family Engagement, Clinician-Patient Communication, Communication, Inpatient Care, Hospitals
Campbell Britton M, Petersen-Pickett J, Hodshon B
Mapping the care transition from hospital to skilled nursing facility.
Researchers used process mapping to illustrate the sequence of events involved with hospital discharge and admission to a skilled nursing facility (SNF). These transitions are often associated with breakdowns in communication that may place patients at risk for adverse events. A quality improvement (QI) team worked with frontline staff at an academic medical center and two local SNFs in the northeastern United States. The final process map included care management, medicine, nursing, admissions and physical therapy service staff. The process map showed numerous activities that need to be coordinated between care teams, and highlighted specific opportunities for improving communication between different teams.
AHRQ-funded; HS023554.
Citation: Campbell Britton M, Petersen-Pickett J, Hodshon B .
Mapping the care transition from hospital to skilled nursing facility.
J Eval Clin Pract 2020 Jun;26(3):786-90. doi: 10.1111/jep.13238..
Keywords: Transitions of Care, Care Coordination, Quality Improvement, Communication, Hospital Discharge, Hospitals, Nursing Homes, Quality of Care
Fisher KA, Gallagher TH, Smith KM
Communicating with patients about breakdowns in care: a national randomised vignette-based survey.
This study examined the impact of an apology when problems occur in patient care breakdowns occur at hospitals. Breakdowns included slow response to call bell, rude aide, and unanswered questions. A national online survey of 1188 adults aged 35 years or older were sampled from an online panel representative of the entire US population, created and maintained by GfK. Twice as many participants receiving an in-depth prompt about care breakdowns would recommend the hospital compared with those receiving no prompt (18.4% vs 8.8%). Almost three times as many participants who received a full apology would probably/definitely recommend the hospital compared with those receiving no apology (34.1% vs 13.6%). The survey also asked whether the respondent would speak up, with feeling upset being a strong determinant of greater intent to speak up.
AHRQ-funded; HS024596; HS022757.
Citation: Fisher KA, Gallagher TH, Smith KM .
Communicating with patients about breakdowns in care: a national randomised vignette-based survey.
BMJ Qual Saf 2020 Apr;29(4):313-19. doi: 10.1136/bmjqs-2019-009712..
Keywords: Clinician-Patient Communication, Communication, Patient Experience, Patient and Family Engagement, Quality Improvement, Quality of Care, Hospitals
Manojlovich M, Harrod M, Hofer TP
Using qualitative methods to explore communication practices in the context of patient care rounds on general care units.
This study examined communication practices between nurses and physicians in general care units at 4 Midwestern hospitals. A total of 163 physicians, registered nurses, and nurse practitioners participated. The researchers observed and shadowed clinicians during rounds and other times during a 2 week period as well as conducting interviews and holding focus groups. Workflow differences affected rounds and subsequently communication practices. Good rapport between physicians and nurses contributed to nurse participation during rounds. Lower rapport made some nurses feel uncomfortable accompanying physicians during rounds unless invited.
AHRQ-funded; HS022305.
Citation: Manojlovich M, Harrod M, Hofer TP .
Using qualitative methods to explore communication practices in the context of patient care rounds on general care units.
J Gen Intern Med 2020 Mar;35(3):839-45. doi: 10.1007/s11606-019-05580-9..
Keywords: Communication, Provider: Physician, Provider: Nurse, Provider, Hospitals, Teams, Inpatient Care, Healthcare Delivery
Anandaiah AM, Stevens JP, Sullivan AM
Implementation of a bundled consent process in the ICU: a single-center experience.
This study examined perceptions of internal medicine residents in the ICU of an urban academic medical center about using a bundled consent process with patients and their families. The bundled consent provides consent for all commonly performed procedures on a single form. It has been advocated as an efficient method, but there is little published literature about its use. Out of 164 internal residents surveyed, 102 completed the survey. The majority (78%) felt it scared or stressed families, and only 26% felt confident that they would obtain valid informed consent.
AHRQ-funded; HS024288.
Citation: Anandaiah AM, Stevens JP, Sullivan AM .
Implementation of a bundled consent process in the ICU: a single-center experience.
Crit Care Med 2019 Oct;47(10):1332-36. doi: 10.1097/ccm.0000000000003905..
Keywords: Implementation, Intensive Care Unit (ICU), Hospitals, Clinician-Patient Communication, Communication
Timbie JW, Kranz AM, Mahmud A
Federally qualified health center strategies for integrating care with hospitals and their association with measures of communication.
Federally qualified health centers have aligned clinical services and systems with local hospitals, but little is known about the specific care integration strategies health centers use or their impact on care. In this study, a research team examined the use of strategies by health centers to integrate care with hospitals and emergency departments (EDs) and their association with performance on measures of health center-hospital communication.
AHRQ-funded; HS024067.
Citation: Timbie JW, Kranz AM, Mahmud A .
Federally qualified health center strategies for integrating care with hospitals and their association with measures of communication.
Jt Comm J Qual Patient Saf 2019 Sep;45(9):620-28. doi: 10.1016/j.jcjq.2019.06.004..
Keywords: Patient-Centered Healthcare, Patient-Centered Outcomes Research, Hospitals, Communication, Emergency Department, Care Coordination, Healthcare Delivery
Campbell Britton M, Hodshon B, Chaudhry SI
Implementing a warm handoff between hospital and skilled nursing facility clinicians.
This study focused on increasing better communication during transfers from hospitals and skilled nursing facilities (SNFs). Warm handoffs between hospital and SNF physicians was implemented. Participation in warm handoffs gradually increased – starting at 15.78% in stage 1 and increasing to 46.89% in stage 3. A total of 2417 patient discharges were included in this study.
AHRQ-funded; HS023554.
Citation: Campbell Britton M, Hodshon B, Chaudhry SI .
Implementing a warm handoff between hospital and skilled nursing facility clinicians.
J Patient Saf 2019 Sep;15(3):198-204. doi: 10.1097/pts.0000000000000529..
Keywords: Communication, Patient Safety, Hospital Discharge, Transitions of Care, Care Coordination, Hospitals, Nursing Homes
Asan O, Scanlan MC, Crotty B
Parental perceptions of displayed patient data in a PICU: an example of unintentional empowerment.
The objective of this study was to explore the perceptions of parents of pediatric patients in a PICU regarding real-time open electronic health record data displayed in patient rooms. The investigators suggest that a new health information technology system providing continuous access to open electronic health record data may be an effective way to empower and engage parents in the PICU, but also note potential drawbacks.
AHRQ-funded; HS023626.
Citation: Asan O, Scanlan MC, Crotty B .
Parental perceptions of displayed patient data in a PICU: an example of unintentional empowerment.
Pediatr Crit Care Med 2019 May;20(5):435-41. doi: 10.1097/pcc.0000000000001895..
Keywords: Caregiving, Children/Adolescents, Communication, Electronic Health Records (EHRs), Health Information Technology (HIT), Hospitals, Intensive Care Unit (ICU), Patient and Family Engagement
Jones CD, Jones J, Bowles KH
Quality of hospital communication and patient preparation for home health care: results from a statewide survey of home health care nurses and staff.
The purpose of this study was to evaluate the quality of communication between hospitals and home health care (HHC) clinicians and patient preparedness to receive HHC in a statewide sample of HHC nurses and staff. The authors concluded that communication between hospitals and HHC was suboptimal, and patients were often not prepared to receive HHC. They suggest that providing EHR access for HHC clinicians is a promising solution to improve the quality of communication.
AHRQ-funded; HS024569.
Citation: Jones CD, Jones J, Bowles KH .
Quality of hospital communication and patient preparation for home health care: results from a statewide survey of home health care nurses and staff.
J Am Med Dir Assoc 2019 Apr;20(4):487-91. doi: 10.1016/j.jamda.2019.01.004..
Keywords: Transitions of Care, Home Healthcare, Hospital Discharge, Hospitals, Communication
Manojlovich M, Frankel RM, Harrod M
Formative evaluation of the video reflexive ethnography method, as applied to the physician-nurse dyad.
Poor communication between physicians and nurses continues to contributor to adverse events in the hospital setting. This article evaluates the use of video reflexive ethnography (VRE) as a means of improving communication and improving patient safety, and concludes that video-record communication between physicians and nurses during patient care rounds is feasible and acceptable.
AHRQ-funded; HS024760.
Citation: Manojlovich M, Frankel RM, Harrod M .
Formative evaluation of the video reflexive ethnography method, as applied to the physician-nurse dyad.
BMJ Qual Saf 2019 Feb;28(2):160-66. doi: 10.1136/bmjqs-2017-007728..
Keywords: Adverse Events, Communication, Hospitals, Nursing, Patient Safety
Smith ME, Wells EE, Friese CR
Interpersonal and organizational dynamics are key drivers of failure to rescue.
This qualitative study of providers from hospitals with high and low rescue rates identified key factors that providers believe influence the successful rescue of surgical patients. These factors are: teamwork, action taking, psychological safety, recognition of complications, and communication. Providers surveyed agreed on two targets for improvement: delayed recognition of developing complications, and poor interprofessional communication and inability to express clinical concerns. The authors conclude that, to improve perioperative outcomes, hospitals and payers should shift their attention to improving early detection and increasing communication effectiveness when major complications occur.
AHRQ-funded; HS023621; HS024403.
Citation: Smith ME, Wells EE, Friese CR .
Interpersonal and organizational dynamics are key drivers of failure to rescue.
Health Aff 2018 Nov;37(11):1870-76. doi: 10.1377/hlthaff.2018.0704..
Keywords: Adverse Events, Communication, Hospitals, Mortality, Organizational Change, Patient Safety, Surgery
Parker MW, Carroll M, Bolser B
Implementation of a communication bundle for high-risk patients.
This study occurs in a large pediatric hospital with a history of success in decreasing unrecognized deterioration, in which patients at higher risk of deterioration are termed "watchers." Because communication errors often contribute to unrecognized deterioration, clear and timely communication of watcher status to all team members and contingency planning was desired. The researchers sought to increase the percentage of eligible watchers with a complete communication, teamwork, and planning bundle within 2 hours of identification from 28% to 80%.
AHRQ-funded; HS023827.
Citation: Parker MW, Carroll M, Bolser B .
Implementation of a communication bundle for high-risk patients.
Hosp Pediatr 2017 Sep;7(9):523-29. doi: 10.1542/hpeds.2016-0170..
Keywords: Children/Adolescents, Communication, Healthcare Delivery, Hospitals, Inpatient Care
Khan A, Furtak SL, Melvin P
Parent-provider miscommunications in hospitalized children.
The objectives of this study were to: (1) examine characteristics of parent-provider miscommunications about hospitalized children; (2) describe associations among parent-provider miscommunications, parent-reported errors, and hospital experience; and (3) compare parent and attending physician reports of parent-provider miscommunications. The investigators found that parent-provider miscommunications were associated with parent-reported errors and suboptimal hospital experience. Parents reported parent-provider miscommunications more often than attending physicians did.
AHRQ-funded; HS022986; HS000063.
Citation: Khan A, Furtak SL, Melvin P .
Parent-provider miscommunications in hospitalized children.
Hosp Pediatr 2017 Sep;7(9):505-15. doi: 10.1542/hpeds.2016-0190..
Keywords: Adverse Events, Caregiving, Children/Adolescents, Clinician-Patient Communication, Communication, Hospitalization, Hospitals, Medical Errors, Patient Safety
Luxenberg A, Chan B, Khanna R
Efficiency and interpretability of text paging communication for medical inpatients: a mixed-methods analysis.
The purpose of this analysis was to investigate text page message content and structure, focusing on efficiency and safety. The authors analyzed the messages generated at an academic tertiary care hospital sent or received by hospital staff via an internal service, including those relating to the care of specific patients. While most messages were nonurgent, those that were lacked consistent language to indicate urgency. The authors conclude that text paging has significant limitations for real-time communication in acute-care settings, and their data should be a basis to inform the development of guidelines on the effective, efficient use of text paging.
AHRQ-funded; HS023558.
Citation: Luxenberg A, Chan B, Khanna R .
Efficiency and interpretability of text paging communication for medical inpatients: a mixed-methods analysis.
JAMA Intern Med 2017 Aug;177(8):1218-20. doi: 10.1001/jamainternmed.2017.2133..
Keywords: Communication, Inpatient Care, Hospitals, Patient Safety
Mueller SK, Schnipper JL, Giannelli K
Impact of regionalized care on concordance of plan and preventable adverse events on general medicine services.
This study regionalized 3 inpatient general medical teams to nursing units and examined the association with communication and preventable adverse events (AEs). It found that regionalization of care teams improved recognition of care team members, discussion of daily care plan, and agreement on estimated discharge date, but did not significantly improve nurse and physician concordance of the care plan or reduce the odds of preventable AEs.
AHRQ-funded; HS023331.
Citation: Mueller SK, Schnipper JL, Giannelli K .
Impact of regionalized care on concordance of plan and preventable adverse events on general medicine services.
J Hosp Med 2016 Sep;11(9):620-7. doi: 10.1002/jhm.2566.
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Keywords: Adverse Events, Communication, Hospitals, Patient Safety, Teams
Nembhard IM, Labao I, Savage S
Breaking the silence: determinants of voice for quality improvement in hospitals.
The researchers examined the drivers of “voice” for health professionals in hospitals. “Voice” is understood as the discretionary communication of ideas, suggestions, concerns, or opinions about work-related issues with the intent to improve organizational or unit functioning. They found that factors related to individuals (e.g., tenure), work (e.g., work configuration), organizational context (e.g., culture), data (e.g., benchmarking), and the external environment (e.g., attention) influenced health professionals’ voice.
AHRQ-funded; HS018987.
Citation: Nembhard IM, Labao I, Savage S .
Breaking the silence: determinants of voice for quality improvement in hospitals.
Health Care Manage Rev 2015 Jul-Sep;40(3):225-36. doi: 10.1097/hmr.0000000000000028..
Keywords: Hospitals, Quality Improvement, Quality of Care, Communication, Organizational Change, Health Services Research (HSR)
Brady PW, Zix J, Brilli R
Developing and evaluating the success of a family activated medical emergency team: a quality improvement report.
The researchers aimed to develop a reliable process for family-activated medical emergency teams (METs) and to evaluate its effect on MET call rate and subsequent transfer to the intensive care unit (ICU). They found that children with family-activated METs were transferred to the ICU less commonly than those with clinician MET calls. Families, like clinicians, most commonly called MET for concerns of clinical deterioration; however, families also identified lack of response from clinicians and a dismissive interaction between team and family.
AHRQ-funded; HS021114.
Citation: Brady PW, Zix J, Brilli R .
Developing and evaluating the success of a family activated medical emergency team: a quality improvement report.
BMJ Qual Saf 2015 Mar;24(3):203-11. doi: 10.1136/bmjqs-2014-003001.
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Keywords: Communication, Emergency Medical Services (EMS), Hospitals, Children/Adolescents, Quality Improvement