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Research Studies is a monthly compilation of research articles funded by AHRQ or authored by AHRQ researchers and recently published in journals or newsletters.
Results1 to 25 of 51 Research Studies Displayed
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.
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.
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.
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
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.
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.
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.
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.
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)
Senathirajah Y, Kaufman DR, Cato KD
Characterizing and visualizing display and task fragmentation in the electronic health record: mixed methods design.
The complexity of health care data and workflow presents challenges to the study of usability in electronic health records (EHRs). This study aimed to define and analyze some of the main sources of fragmentation in EHR user interfaces (UIs); discuss relevant theoretical, historical, and practical considerations; and use granular microanalytic methods and visualization techniques to help us understand the nature of fragmentation and opportunities for EHR optimization or redesign.
Citation: Senathirajah Y, Kaufman DR, Cato KD . Characterizing and visualizing display and task fragmentation in the electronic health record: mixed methods design. JMIR Hum Factors 2020 Oct 21;7(4):e18484. doi: 10.2196/18484..
Keywords: Electronic Health Records (EHRs), Health Information Technology (HIT), Workflow, System Design
Gold JA, Becton J, Ash JS
Do you know what your scribe did last spring? The impact of COVID-19 on medical scribe workflow.
This study assessed the impact of COVID-19 on the workflow of medical scribes. This prospective observational study was conducted at an academic medical center in the United States. A total of 74 scribes working in ambulatory practices were recruited, with 57 scribes completing the survey. Overall, 42% of scribes transitioned to remote scribing with 97% serving as remote scribes for telehealth visits. These scribes worked at home and used personal equipment. Of those no longer working as scribes, 46% worked in preclinic support, with a wide range of EHR-related activities reported. The remainder were either redeployed or furloughed.
Citation: Gold JA, Becton J, Ash JS . Do you know what your scribe did last spring? The impact of COVID-19 on medical scribe workflow. Appl Clin Inform 2020 Oct;11(5):807-11. doi: 10.1055/s-0040-1721396..
Keywords: COVID-19, Workflow, Electronic Health Records (EHRs), Telehealth, Health Information Technology (HIT)
Ramly E, Tong M, Bondar S
Workflow barriers and strategies to reduce antibiotic overuse in nursing homes.
Antibiotic overuse is a significant problem in nursing homes (NHs). Strategies to improve antibiotic prescribing practices in NHs are a critical need. In this study, the investigators analyzed antibiotic prescribing workflows to identify strategies for improving antibiotic prescribing in NHs. They found that such strategies included structured information tools, nurse and prescriber education, and organizational improvement.
Citation: Ramly E, Tong M, Bondar S . Workflow barriers and strategies to reduce antibiotic overuse in nursing homes. J Am Geriatr Soc 2020 Oct;68(10):2222-31. doi: 10.1111/jgs.16632..
Keywords: Workflow, Antibiotics, Medication, Nursing Homes, Long-Term Care, Elderly, Antimicrobial Stewardship, Practice Patterns
Daly Guris RJ, Doshi A, Boyer DL
Just-in-time simulation to guide workflow design for coronavirus disease 2019 difficult airway management.
This paper describes the development and enactment of a number of simulation exercises, increasing in complexity for clinicians to practice intubation of critically ill children while wearing personal protective equipment due to coronavirus disease. The simulations ended up aiding in a real-life situation that then occurred less than 12 hours later that validated potential failure points and effectiveness of rapidly generated guidance. From this simulation a COVID-19 airway bundle template was created.
AHRQ-funded; HS026939; HS024511.
Citation: Daly Guris RJ, Doshi A, Boyer DL . Just-in-time simulation to guide workflow design for coronavirus disease 2019 difficult airway management. Pediatr Crit Care Med 2020 Aug;21(8):e485-e90. doi: 10.1097/pcc.0000000000002435..
Keywords: Children/Adolescents, COVID-19, Respiratory Conditions, Workflow, Simulation, Training
Herrick HM, Lorch S, Hsu JY
Impact of flow disruptions in the delivery room.
The goal of this study was to identify the impact of flow disruptions during neonatal resuscitation and to determine their association with key process and outcome measures. Delivery-room resuscitations of neonates less 32 weeks gestational age were video recorded for observation. Results showed that flow disruptions occurred frequently during neonatal resuscitation and recommendations included measuring flow disruptions as a feasible method to assess the impact of human factors in the delivery room and to identify modifiable factors and practices to improve patient care.
AHRQ-funded; HS023538; HS026491; HS026625; HS023806.
Citation: Herrick HM, Lorch S, Hsu JY . Impact of flow disruptions in the delivery room. Resuscitation 2020 May;150:29-35. doi: 10.1016/j.resuscitation.2020.02.037.
Keywords: Workflow, Labor and Delivery, Newborns/Infants, Patient Safety, Healthcare Delivery, Quality Improvement, Quality of Care
Goldberg DG, Soylu TG, Grady VM
Indicators of workplace burnout among physicians, advanced practice clinicians, and staff in small to medium-sized primary care practices.
The goal of this study was to examine whether individual behaviors and attitudes towards major disruptive change has an effect on workplace burnout. Using surveys from healthcare professionals, researchers’ findings showed workplace burnout reported by 31.6% of physicians, 17.2% of advanced practice clinicians, 18.9% of clinical support staff, and 17.5% of administrative staff, with all healthcare professional groups having high levels of anxiety. Providers who experienced higher levels of anxiety and withdrawal were more than three times as likely to report burnout compared to those who experienced low levels in these domains.
Citation: Goldberg DG, Soylu TG, Grady VM . Indicators of workplace burnout among physicians, advanced practice clinicians, and staff in small to medium-sized primary care practices. J Am Board Fam Med 2020 May-Jun;33(3):378-85. doi: 10.3122/jabfm.2020.03.190260..
Keywords: Burnout, Primary Care, Provider, Workflow, Workforce
Craddock Lee SJ, Reimer T, Garcia S
Definition and coordination of roles and responsibilities among cancer center clinic and research personnel.
This survey looked at how cancer center clinic and research personnel define their roles and responsibilities. A survey was developed that incorporated modified components of the Survey of Physician Attitudes Regarding the Care of Cancer Survivors and was administered to clinic nursing staff and research personnel at a National Cancer Institute-designated comprehensive cancer center. Surveys were completed by 105 staff members (50 research staff, 55 clinic staff, 61% response rate). Research staff were more likely to feel that they had the skills to answer questions, convey information, and provide education for patients. Less than one-third of clinic and research staff reported ever receiving communication about responsibilities. There was also substantial variation in the preferred model for delivery to care of patients in clinical trials.
Citation: Craddock Lee SJ, Reimer T, Garcia S . Definition and coordination of roles and responsibilities among cancer center clinic and research personnel. JCO Oncol Pract 2020 Jan;16(1):e64-e74. doi: 10.1200/jop.19.00315..
Keywords: Cancer, Provider, Workflow
Read JM, Weiler DT, Satterly T
Provider preference in exam room layout design and computing.
This study examined the impact of electronic health records (EHRs) on exam room design which would make it easier for providers to promote flexibility, mobility, and body orientation directed towards the patient. Semistructured interviews with 28 providers was conducted and the interviews were audio recorded and transcribed for analysis. Flexibility in sharing the computer screen with patients was an important theme as well as exam room layout, exam room computing and provider workflow.
Citation: Read JM, Weiler DT, Satterly T . Provider preference in exam room layout design and computing. Appl Clin Inform 2019 Oct;10(5):972-80. doi: 10.1055/s-0039-3401813..
Keywords: Electronic Health Records (EHRs), Health Information Technology (HIT), Workflow, Primary Care, Provider
Manojlovich M, Ameling JM, Forman J
Contextual barriers to communication between physicians and nurses about appropriate catheter use.
This study identified contextual barriers to communication between physicians and nurses that contribute to inappropriate use of catheters and increased risk of health care-associated infections. The researchers conducted individual and small-group semistructured interviewed with physicians and nurses in a progressive care unit of an academic hospital. Common barriers included workflow misalignment between clinicians, issues with electronic medical records and pagers, and strained relationships between clinicians.
Citation: Manojlovich M, Ameling JM, Forman J . Contextual barriers to communication between physicians and nurses about appropriate catheter use. Am J Crit Care 2019 Jul;28(4):290-98. doi: 10.4037/ajcc2019372..
Keywords: Catheter-Associated Urinary Tract Infection (CAUTI), Communications, Healthcare-Associated Infections (HAIs), Patient Safety, Provider, Provider: Nurse, Provider: Physician, Urinary Tract Infection (UTI), Workflow
Joseph A, Khoshkenar A, Taaffe KM
Minor flow disruptions, traffic-related factors and their effect on major flow disruptions in the operating room.
This study researched the impact of minor flow disruptions (FDs) on operating room (OR) flow and how it contributes to an increase in serious adverse events. The rate of minor FDs increases the rate of major FDs. More major and minor FDs occur in the anesthesia area than in all other OR areas. They concluded that room design and layout issues contribute to those FDs and that is an important consideration in OR design.
Citation: Joseph A, Khoshkenar A, Taaffe KM . Minor flow disruptions, traffic-related factors and their effect on major flow disruptions in the operating room. BMJ Qual Saf 2019 Apr;28(4):276-83. doi: 10.1136/bmjqs-2018-007957.
Keywords: Adverse Events, Healthcare Delivery, Patient Safety, Surgery, Workflow
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.
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
Hung DY, Harrison MI, Liang SY
AHRQ Author: Harrison MI
Contextual conditions and performance improvement in primary care.
This study examined organizational features of primary care clinics that had gone through Lean redesigns and had experienced the greatest performance improvements. They surveyed 1333 physicians and staff in 43 primary care clinics across a large primary care system. They found that clinics with prior experience with quality improvement had the highest increases in efficiency. Clinics reporting the highest levels of burnout and work stress before the redesign also made efficiency gains. Physician productivity gains was associated with a history of change, staff participation and leadership support. The greatest improvements in patient satisfaction occurred where there was the lowest stress levels with highest levels of teamwork, staff engagement and leadership support.
AHRQ-authored; AHRQ-funded; 2902010000221.
Citation: Hung DY, Harrison MI, Liang SY . Contextual conditions and performance improvement in primary care. Qual Manag Health Care 2019 Apr/Jun;28(2):70-77. doi: 10.1097/qmh.0000000000000198..
Keywords: Organization and Administration, Healthcare Delivery, Primary Care, Provider Performance, Quality Improvement, Quality of Care, Workflow
McGrath SP, Perreard IM, Garland MD
Improving patient safety and clinician workflow in the general care setting with enhanced surveillance monitoring.
This researched analyzed the impact of implementing an improved clinical monitoring system with enhanced surveillance. This enhanced monitoring system was shown to improve patient safety and clinical workflow in inpatient hospital settings. After implementation higher staff satisfaction was shown and reduced average vital signs data collection time by 28%. It improved the availability and accuracy of patient information. However, there was little or no impact on clinical alarms.
Citation: McGrath SP, Perreard IM, Garland MD . Improving patient safety and clinician workflow in the general care setting with enhanced surveillance monitoring. IEEE J Biomed Health Inform 2019 Mar;23(2):857-66. doi: 10.1109/jbhi.2018.2834863..
Keywords: Hospitals, Inpatient Care, Patient Safety, Provider: Clinician, Quality Improvement, Workflow
Hung DY, Gray CP, Truong QA
AHRQ Author: Harrison MI
Sustainment of lean redesigns for primary care teams.
This mixed-methods study examined the sustainment of Lean workflow redesigns for primary care teams several years after being implemented in a large, ambulatory care delivery system. Results showed that staff participation in Lean redesign is a key to facilitating buy-in and adherence to changes. Change ownership and continued availability of time for improvement activities are also critical to the long-term success of Lean implementation in primary care.
AHRQ-authored; AHRQ-funded; 2902010000221.
Citation: Hung DY, Gray CP, Truong QA . Sustainment of lean redesigns for primary care teams. Qual Manag Health Care 2019 Jan/Mar;28(1):15-24. doi: 10.1097/qmh.0000000000000200..
Keywords: Primary Care, Workflow, Teams, Organization and Administration, Quality Improvement, Quality of Care
Fiori K, Patel M, Sanderson D
From policy statement to practice: integrating social needs screening and referral assistance with community health workers in an urban academic health center.
The authors described their experience implementing a novel social needs screening program at an academic pediatric clinic. They found that, on average, 76% of providers had their patients screened on more than half of eligible well-child visits. Their experience suggested that screening for social needs at well-child visits is feasible as part of routine primary care. They recommended that success would best be achieved by leveraging resources, obtaining provider buy-in, and defining program components to sustain activities.
Citation: Fiori K, Patel M, Sanderson D . From policy statement to practice: integrating social needs screening and referral assistance with community health workers in an urban academic health center. J Prim Care Community Health 2019 Jan-Dec;10:2150132719899207. doi: 10.1177/2150132719899207..
Keywords: Children/Adolescents, Community-Based Practice, Healthcare Delivery, Implementation, Screening, Social Determinants of Health, Urban Health, Workflow, Primary Care
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.
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.
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.
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)