National Healthcare Quality and Disparities Report
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Topics
- Access to Care (1)
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- Antibiotics (2)
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- Electronic Health Records (EHRs) (30)
- (-) Emergency Department (76)
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- Falls (4)
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- Risk (6)
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- Screening (2)
- Sepsis (6)
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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 25 of 76 Research Studies DisplayedBui LN, Knox M, Miller-Rosales C
Hospital capabilities associated with behavioral health integration within emergency departments.
The objective of this study was to identify hospital capabilities associated with behavioral health processes in emergency departments. Responses to the National Survey of Healthcare Organizations and Systems were linked American Hospital Association Annual Survey data. Most hospitals reported screening for behavioral health conditions and provided direct referrals to community-based clinicians. Approximately half the hospitals used team approaches to behavioral health. Hospitals that reported more barriers to care delivery innovations also reported less screening and usage of a team approach. The authors concluded that research and interventions which focus on removing barriers or adding processes to disseminate best practices offer a path to accelerate behavioral health integration in emergency departments.
AHRQ-funded; HS024075.
Citation: Bui LN, Knox M, Miller-Rosales C .
Hospital capabilities associated with behavioral health integration within emergency departments.
Med Care 2024 Mar; 62(3):170-74. doi: 10.1097/mlr.0000000000001973.
Keywords: Behavioral Health, Emergency Department, Hospitals, Substance Abuse, Teams, Telehealth, Health Information Technology (HIT)
Salwei ME, Hoonakker P, Carayon P
Usability of a human factors-based clinical decision support in the emergency department: lessons learned for design and implementation.
A human-centered design process was followed to assess the usability and adoption of human factors (HF)-based clinical decision support (CDS) in the emergency department (ED). A CDS was developed to aid in pulmonary embolism (PE) diagnosis, showing high usability in testing. However, despite positive perceptions, actual CDS usage remained low due to integration issues with clinician workflow. The findings highlight the need for ongoing refinement of CDS design to align with clinical workflows and enhance usability.
AHRQ-funded; HS026395; HS024558; HS022086. NIH 142099
Citation: Salwei ME, Hoonakker P, Carayon P .
Usability of a human factors-based clinical decision support in the emergency department: lessons learned for design and implementation.
Hum Factors 2024 Mar; 66(3):647-57. doi: 10.1177/00187208221078625.
Keywords: Clinical Decision Support (CDS), Health Information Technology (HIT), Emergency Department, Implementation
Haimovich AD, Shah MN, Southerland LT
Automating risk stratification for geriatric syndromes in the emergency department.
This study discussed using automated risk stratification to implement screening programs for geriatric syndromes in the emergency department (ED). This method would reduce significant workloads at a time of record-breaking ED patient volumes, staff shortages, and hospital boarding crises. The authors defined the concept of automated risk stratification and screening using existing electronic health record (EHR) data. They discussed progress made in three potential use cases in the ED: falls, cognitive impairment, and end-of-life and palliative care; emphasizing the importance of linking automated screening with systems of healthcare delivery. They found that research progress and operational deployment vary by use case, ranging from deployed solutions in falls screening to algorithmic validation in cognitive impairment and end-of-life care, but should still be considered a potential solution.
AHRQ-funded; HS027735.
Citation: Haimovich AD, Shah MN, Southerland LT .
Automating risk stratification for geriatric syndromes in the emergency department.
J Am Geriatr Soc 2024 Jan; 72(1):258-67. doi: 10.1111/jgs.18594..
Keywords: Elderly, Emergency Department, Risk, Health Information Technology (HIT)
Hekman DJ, Cochran AL, Maru AP
Effectiveness of an emergency department-based machine learning clinical decision support tool to prevent outpatient falls among older adults: protocol for a quasi-experimental study.
This article described a research protocol for evaluating the effectiveness of an automated screening and referral intervention tool for patients receiving falls risk intervention. The study will attempt to quantify the impact of a machine learning (ML) clinical decision support intervention on patient behavior and outcomes. The primary analysis will obtain referral completion rates from different emergency departments. The findings will inform ongoing discussion on the use of ML and artificial intelligence to augment medical decision-making.
AHRQ-funded; HS027735.
Citation: Hekman DJ, Cochran AL, Maru AP .
Effectiveness of an emergency department-based machine learning clinical decision support tool to prevent outpatient falls among older adults: protocol for a quasi-experimental study.
JMIR Res Protoc 2023 Aug 3; 12:e48128. doi: 10.2196/48128..
Keywords: Clinical Decision Support (CDS), Emergency Department, Health Information Technology (HIT), Elderly, Falls
Krishnan JA, Margellos-Anast H, Kumar R
Coordinated Health Care Interventions for Childhood Asthma Gaps in Outcomes (CHICAGO) plan.
The purpose of this clinical trial was to compare an emergency-department- (ED) only intervention and home visits by community health workers for 6 months (ED-plus-home) and enhanced usual care (UC). The study enrolled children aged 5 to 11 years with uncontrolled asthma. The primary outcomes were change over 6 months in the Patient-Reported Outcomes Measurement Information System Asthma Impact Scale score in children and Satisfaction with Participation in Social Roles score in caregivers. The secondary outcomes included guideline-recommended ED discharge care and self-management. The study found that of the 373 children recruited, only 63% completed the 6-month follow-up visit. Differences in Asthma Impact Scores or caregivers' Satisfaction with Participation in Social Roles scores were not significant. However, in the intervention groups guideline-recommended ED discharge care improved significantly versus in the UC group, and self-management behaviors were significantly improved in the ED-plus-home group versus in the ED-only and UC groups.
AHRQ-funded; HS027804.
Citation: Krishnan JA, Margellos-Anast H, Kumar R .
Coordinated Health Care Interventions for Childhood Asthma Gaps in Outcomes (CHICAGO) plan.
J Allergy Clin Immunol Glob 2023 Aug; 2(3). doi: 10.1016/j.jacig.2023.100100..
Keywords: Children/Adolescents, Asthma, Respiratory Conditions, Outcomes, Patient-Centered Outcomes Research, Evidence-Based Practice, Emergency Department, Clinical Decision Support (CDS), Health Information Technology (HIT), Racial and Ethnic Minorities
Moy AJ, Cato KD, Withall J
Using time series clustering to segment and infer emergency department nursing shifts from electronic health record log files.
Clinical shifts are an essential unit of work recognized in clinical settings and may function as a primary unit of analysis in the study of documentation burden. The purpose of this proof- of-concept study was to investigate the feasibility of a new approach utilizing time series clustering to segment and infer clinician shifts from electronic health record (HER) log files. The researchers recorded 33,535,585 events between April-June 2021 and computationally identified 43,911 potential shifts among 2,285 emergency department nurses. On average, shifts were 10.6±3.1 hours in duration. Researchers classified the shifts based on type: day, evening, night; and length: 12-hour, 8-hour, other. The preliminary results of the study found that unsupervised clustering methods may be a feasible approach for quickly identifying clinician shifts.
AHRQ-funded; HS028454.
Citation: Moy AJ, Cato KD, Withall J .
Using time series clustering to segment and infer emergency department nursing shifts from electronic health record log files.
AMIA Annu Symp Proc 2023 Apr 29; 2022:805-14..
Keywords: Electronic Health Records (EHRs), Health Information Technology (HIT), Emergency Department, Workforce
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
Lee AH, McEvoy DS, Stump T
Implementation of an electronic alert to improve timeliness of second dose antibiotics for patients with suspected serious infections in the emergency department: a quasi-randomized controlled trial.
This study analyzed the influence of clinical decision support (CDS) to prevent delays in second doses of broad-spectrum antibiotics in the emergency department (ED). The authors allocated adult patients who received cefepime or piperacillin/tazobactam in 9 EDs within an integrated health care system to an electronic alert that reminded ED clinicians to reorder antibiotics at the appropriate interval vs usual care. Primary outcome was a median delay in antibiotic administration, and secondary outcomes were rates of intensive care unit (ICU) admission, hospital mortality, and hospital length of stay. A total of 1,113 ED patients treated with cefepime or piperacillin/tazobactam were enrolled in the study, of whom 420 remained under ED care when their second dose was due. The electronic alert system was associated with reduced antibiotic delays, but there were no differences in ICU transfers, inpatient mortality, or hospital length of stay.
AHRQ-funded; HS027170.
Citation: Lee AH, McEvoy DS, Stump T .
Implementation of an electronic alert to improve timeliness of second dose antibiotics for patients with suspected serious infections in the emergency department: a quasi-randomized controlled trial.
Ann Emerg Med 2023 Apr;81(4):485-91. doi: 10.1016/j.annemergmed.2022.10.022.
Keywords: Antibiotics, Medication, Emergency Department, Clinical Decision Support (CDS), Health Information Technology (HIT)
Roddy MK, Chen P, Jeffery AD
Telemental health in emergency care settings: a qualitative analysis of considerations for sustainability and spread.
The purpose of this study was to explore barriers and facilitators for the spread and sustainability of telemental health video (TMH-V) as precaution policies from the pandemic declined. The researchers conducted a qualitative study using semistructured interviews and observations guided by RE-AIM. Local clinicians, facility leadership, Veterans, and external partners were asked about barriers and facilitators impacting patient willingness to engage in telemental health video (TMH-V) (reach), quality of care (effectiveness), barriers and facilitators impacting provider uptake (adoption), possible adaptations to TMH-V (implementation), and possibilities for long-term use of TMH-V (maintenance). The researchers also observed TMH-V encounters in one emergency department (ED) and one urgent care (UC) to understand how clinicians and Veterans engaged with the technology. The study found that in 10 observations, all interviewees were satisfied with the TMH-V program, and interviewees emphasized greater comfort discussing difficult topics for Veterans (reach). Clinicians indicated that TMH-V provided cross-coverage across sites as well as greater safety and flexibility for clinicians (adoption). Opportunities for improvement include reducing technological responsibilities for on-site staff, electronic health record (EHR) adaptations to correctly depict workload and modality (telehealth vs. in-person), and standardizing protocols to improve efficiency in communication between on-site and remote clinical staff (implementation). Participants supported its dissemination to other sites (maintenance) and indicated there was significant possibility for expanding the service.
AHRQ-funded; HS026395.
Citation: Roddy MK, Chen P, Jeffery AD .
Telemental health in emergency care settings: a qualitative analysis of considerations for sustainability and spread.
Acad Emerg Med 2023 Apr; 30(4):368-78. doi: 10.1111/acem.14682..
Keywords: Emergency Department, Telehealth, Health Information Technology (HIT)
Mohr NM, Okoro U, Harland KK
Outcomes associated with rural emergency department provider-to-provider telehealth for sepsis care: a multicenter cohort study.
The objective of this multicenter cohort study was to test the hypothesis that provider-to-provider tele-emergency department (tele-ED) care is associated with more 28-day hospital-free days and improved Surviving Sepsis Campaign (SSC) guideline adherence in rural emergency departments. Medical records of patients with sepsis were taken from rural hospitals in an established, on-demand, video tele-ED Midwestern network. Findings suggest that tele-ED cases did not have more 28-day hospital-free days or 28-day in-hospital mortality. A subgroup of patients treated by advanced practice providers suggest that mortality was lower in the cohort with tele-ED use in spite of no significant difference in complete SSC adherence. The researchers concluded that rural emergency department patients treated with provider-to-provider tele-ED care in a developed network showed similar clinical outcomes to those treated without.
AHRQ-funded; HS025753.
Citation: Mohr NM, Okoro U, Harland KK .
Outcomes associated with rural emergency department provider-to-provider telehealth for sepsis care: a multicenter cohort study.
Ann Emerg Med 2023 Jan;81(1):1-13. doi: 10.1016/j.annemergmed.2022.07.024..
Keywords: Rural Health, Emergency Department, Telehealth, Health Information Technology (HIT), Sepsis, Outcomes
Shah W, Villaflores CW, Chuong LH
Association between in-person vs telehealth follow-up and rates of repeated hospital visits among patients seen in the emergency department.
This study investigated whether the rates of emergency department (ED) return visits and hospitalization differ between patients who obtain in-person versus telehealth encounters for post-ED follow-up care. This retrospective cohort study included adult patients who came to either of 2 in-system EDs of a single urban integrated academic system from April 2020 to September 2021, were discharged home, and obtained a follow-up appointment with a primary care physician within 14 days of their index ED visit. Overall, the study recorded 12,848 patients with 16,987 ED encounters (mean age 53 years; 57% women, 12% Black or African American; 22% Hispanic or Latinx; and 58% White) included. Overall, 17% of initial ED encounters led to returns to the ED, and 4% subsequent hospitalizations. Telehealth vs in-person follow-up visits were associated with increased rates of ED returns (28.3 more ED returns per 1000 encounters) and hospitalizations (10.6 more hospitalizations per 1000 encounters).
AHRQ-funded; HS026372.
Citation: Shah W, Villaflores CW, Chuong LH .
Association between in-person vs telehealth follow-up and rates of repeated hospital visits among patients seen in the emergency department.
JAMA Netw Open 2022 Oct;5(10):e2237783. doi: 10.1001/jamanetworkopen.2022.37783..
Keywords: Telehealth, Health Information Technology (HIT), Emergency Department, Healthcare Utilization, Hospitals
Dutta S, McEvoy DS, Rubins DM
Clinical decision support improves blood culture collection before intravenous antibiotic administration in the emergency department.
This paper discusses the outcomes of using a clinical decision support (CDS) tool that was implemented in emergency departments (EDs) for sepsis patients to remind healthcare staff to take blood cultures before administration of intravenous (IV) antibiotics. The study compared timely blood culture collection outcomes prior to IV antibiotics for 54,538 adult ED patients 1 year before and after a CDS intervention implementation in the electronic health record. The baseline phase found that 46.1% had blood cultures prior to IV antibiotics, compared to 58.8% after the intervention. The CDS improved blood culture collection rates without increasing overutilization.
AHRQ-funded; HS02717.
Citation: Dutta S, McEvoy DS, Rubins DM .
Clinical decision support improves blood culture collection before intravenous antibiotic administration in the emergency department.
J Am Med Inform Assoc 2022 Sep 12;29(10):1705-14. doi: 10.1093/jamia/ocac115..
Keywords: Clinical Decision Support (CDS), Health Information Technology (HIT), Antibiotics, Emergency Department, Medication, Sepsis
Hinson JS, Klein E, Smith A
Multisite implementation of a workflow-integrated machine learning system to optimize COVID-19 hospital admission decisions.
This study’s objective was to develop, implement, and evaluate an electronic health record (EHR) embedded clinical decision support (CDS) system that leveraged machine learning (ML) to estimate short-term risk for clinical deterioration in patients with or under investigation for COVID-19. The system translates model-generated risk for critical care needs within 24 hours and inpatient care needs within 72 hours into rapidly interpretable COVID-19 Deterioration Risk Levels made viewable within ED clinician workflow. A retrospective cohort of 21,452 ED patients who visited one of five ED study sites was used to derive ML models and were prospectively validated in 15,670 ED visits that occurred before (n = 4322) or after (n = 11,348) CDS implementation. Model performance and numerous patient-oriented outcomes including in-hospital mortality were measured across study periods. ML model performance was excellent under all conditions. AUC ranged from 0.85 to 0.91 for prediction of critical care needs and 0.80-0.90 for inpatient care needs. Total mortality was unchanged across study periods but was reduced among high-risk patients after the implementation.
AHRQ-funded; HS026640.
Citation: Hinson JS, Klein E, Smith A .
Multisite implementation of a workflow-integrated machine learning system to optimize COVID-19 hospital admission decisions.
NPJ Digit Med 2022 Jul 16;5(1):94. doi: 10.1038/s41746-022-00646-1..
Keywords: COVID-19, Clinical Decision Support (CDS), Health Information Technology (HIT), Implementation, Electronic Health Records (EHRs), Emergency Department, Shared Decision Making
Ward MJ, Shuster JL, Mohr NM
Implementation of telehealth for psychiatric care in VA emergency departments and urgent care clinics.
The purpose of this AHRQ-funded, mixed-methods study was to evaluate an emergency telehealth intervention in emergency department (ED) and urgent care clinic (UCC) settings within the Veterans Health Administration (VHA) in March 2020. The Reach, Effectiveness, Adoption, Implementation, Maintenance (RE-AIM) framework was utilized to compare the 3 months preimplementation of the telehealth intervention (December 1, 2019 through February 29, 2020) with the 3 months postimplementation of the telehealth intervention (April 1, 2020 through June 30, 2020), and then assess sustainability through January 31, 2021. Qualitative data from surveys and semistructured interviews were conducted and analyze. The telemental health intervention was used in 83% (319) of unscheduled mental health consultations in the postimplementation phase, with no adverse trends in length of stay, 7-day revisits, or 30-day mortality. In the sustainability phase, use of the intervention was high with 82% (n = 1,010) of all unscheduled mental health consultations performed by telemental health. The study concluded that the use of unscheduled telemental health intervention was highly acceptable and sustainable in ED and UCC settings and did not impact the safety and efficacy of mental health consultations.
AHRQ-funded; HS025753.
Citation: Ward MJ, Shuster JL, Mohr NM .
Implementation of telehealth for psychiatric care in VA emergency departments and urgent care clinics.
Telemed J E Health 2022 Jul;28(7):985-93. doi: 10.1089/tmj.2021.0263..
Keywords: COVID-19, Telehealth, Health Information Technology (HIT), Behavioral Health, Emergency Department
Jacobsohn GC, Leaf M, Liao F
Collaborative design and implementation of a clinical decision support system for automated fall-risk identification and referrals in emergency departments.
The authors used a collaborative and iterative approach to design and implement an automated clinical decision support system (CDS) for Emergency Department (ED) providers to identify and refer older adult ED patients at high risk of future falls. The system was developed using collaborative input from an interdisciplinary design team and integrated seamlessly into existing ED workflows. A key feature of development was the unique combination of patient experience strategies, human-centered design, and implementation science, which allowed for the CDS tool and intervention implementation strategies to be designed simultaneously. Challenges included: usability problems, data inaccessibility, time constraints, low appointment availability, high volume of patients, and others. The study concluded that using the collaborative, iterative approach was successful in achieving all project goals, and could be applied to other cases.
AHRQ-funded; HS024558.
Citation: Jacobsohn GC, Leaf M, Liao F .
Collaborative design and implementation of a clinical decision support system for automated fall-risk identification and referrals in emergency departments.
Healthc 2022 Mar;10(1):100598. doi: 10.1016/j.hjdsi.2021.100598..
Keywords: Elderly, Clinical Decision Support (CDS), Shared Decision Making, Falls, Risk, Emergency Department, Health Information Technology (HIT)
Yadgir SR, Engstrom C, Jacobsohn GC
Machine learning-assisted screening for cognitive impairment in the emergency department.
Researchers developed and evaluated an automated screening tool to identify a subset of patients at high risk for cognitive impairment (CI). Using the Blessed Orientation Memory Concentration (BOMC) test, administered in the emergency department, they found that an algorithm based on electronic health record data can define a subset of patients at higher risk for CI. They recommended that incorporating such an algorithm into a screening workflow could allow screening efforts and resources to be focused where they have the most impact.
AHRQ-funded; HS024558.
Citation: Yadgir SR, Engstrom C, Jacobsohn GC .
Machine learning-assisted screening for cognitive impairment in the emergency department.
J Am Geriatr Soc 2022 Mar;70(3):831-37. doi: 10.1111/jgs.17491..
Keywords: Neurological Disorders, Screening, Emergency Department, Electronic Health Records (EHRs), Health Information Technology (HIT), Elderly
Pruitt ZM, Howe JL, Hettinger AZ
Emergency physician perceptions of electronic health record usability and safety.
Investigators sought to identify emergency physicians' perceived electronic health record (EHR) usability and safety strengths and shortcomings across major EHR vendor products. They found that the 3 most commonly discussed usability topics were Workflow Support (shortcoming), Visual Display (strength), and Data Entry. Fourteen cross-hospital/cross-vendor themes, 6 vendor-specific themes, and 4 hospital-specific themes emerged as well.
AHRQ-funded; HS025136.
Citation: Pruitt ZM, Howe JL, Hettinger AZ .
Emergency physician perceptions of electronic health record usability and safety.
J Patient Saf 2021 Dec 1;17(8):e983-e87. doi: 10.1097/pts.0000000000000849..
Keywords: Emergency Department, Electronic Health Records (EHRs), Health Information Technology (HIT), Patient Safety
Hayden EM, Davis C, Clark S
Telehealth in emergency medicine: a consensus conference to map the intersection of telehealth and emergency medicine.
Through the 2020 Society for Academic Emergency Medicine's annual consensus conference, experts in emergency medicine (EM) and telehealth created a research agenda to explore how EM should intersect with telehealth. The multiyear process resulted in consensus with a final set of 24 important research questions. The primary finding from the process was the breadth of gaps in the evidence for telehealth in EM and telehealth in general. The consensus process identified priority research questions for the use of and evaluation of telehealth in EM to fill the current knowledge gaps.
AHRQ-funded; HS027528.
Citation: Hayden EM, Davis C, Clark S .
Telehealth in emergency medicine: a consensus conference to map the intersection of telehealth and emergency medicine.
Acad Emerg Med 2021 Dec;28(12):1452-74. doi: 10.1111/acem.14330..
Keywords: Telehealth, Health Information Technology (HIT), Emergency Department, COVID-19
Chartash D, Sharifi M, Emerson B
Documentation of shared decisionmaking in the emergency department.
Patient-centered communication and shared decision making is a vital element of clinical practice, but little is known about its impact or value in the emergency department (ED) setting. The researchers of this study developed a natural language processing tool using regular expressions to identify shared decision making, patient-centered communications, and to describe visit-, site-, and temporal-level patterns within a large health system. The study took place in two parts: part 1 was the development and validation of the natural language processing tool, and part 2 was a retrospective analysis of shared decision making and patient discussion using the processing tool to assess ED physician and advanced practitioner documentation from 2013 to 2020. Compared to chart review of 600 ED notes, the accuracy rates of the natural language processing tool were 96.7% and 88.9% respectively. Between 2013 to 2020 the researchers observed greater likelihood of shared decision-making documentation among physicians vs advanced practice providers, higher likelihood among female vs male patients, and lower likelihood of shared decision-making in Black patients compared with White patients. The researchers also found that patient discussion and shared decision-making were associated with higher levels of commercial insurance status and level of triage. The study concluded that a natural language processing tool was developed, validated, and utilized to identify incidences of shared decision making from ED documentation, with the researchers finding multiple possible factors which contribute to variation in shared decision making.
AHRQ-funded; HS025701.
Citation: Chartash D, Sharifi M, Emerson B .
Documentation of shared decisionmaking in the emergency department.
Ann Emerg Med 2021 Nov;78(5):637-49. doi: 10.1016/j.annemergmed.2021.04.038..
Keywords: Shared Decision Making, Emergency Department, Patient-Centered Healthcare, Electronic Health Records (EHRs), Health Information Technology (HIT)
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
Mohr NM, Campbell KD, Swanson MB
Provider-to-provider telemedicine improves adherence to sepsis bundle care in community emergency departments.
Sepsis is a life-threatening emergency. Together, early recognition and intervention decreases mortality. Protocol-based resuscitation in the emergency department (ED) has improved survival in sepsis patients, but guideline-adherent care is less common in low-volume EDs. This study examined the association between provider-to-provider telemedicine and adherence with sepsis bundle components in rural community hospitals. The investigators found that telemedicine patients were more likely to receive initial blood lactate measurement, timely broad-spectrum antibiotics, and adequate fluid resuscitation.
AHRQ-funded; HS025753.
Citation: Mohr NM, Campbell KD, Swanson MB .
Provider-to-provider telemedicine improves adherence to sepsis bundle care in community emergency departments.
J Telemed Telecare 2021 Sep;27(8):518-26. doi: 10.1177/1357633x19896667..
Keywords: Telehealth, Health Information Technology (HIT), Emergency Department, Sepsis
Soares WE, Knee A, Gemme SR
SC, et al. A prospective evaluation of Clinical HEART score agreement, accuracy, and adherence in emergency department chest pain patients.
The HEART score is a risk stratification aid that may safely reduce chest pain admissions for emergency department patients. However, differences in interpretation of subjective components potentially alters the performance of the score. In this study, the investigators compared agreement between HEART scores determined during clinical practice with research-generated scores and estimated their accuracy in predicting 30-day major adverse cardiac events.
AHRQ-funded; HS024815.
Citation: Soares WE, Knee A, Gemme SR .
SC, et al. A prospective evaluation of Clinical HEART score agreement, accuracy, and adherence in emergency department chest pain patients.
Ann Emerg Med 2021 Aug;78(2):231-41. doi: 10.1016/j.annemergmed.2021.03.024..
Keywords: Heart Disease and Health, Cardiovascular Conditions, Emergency Department, Diagnostic Safety and Quality, Clinical Decision Support (CDS), Health Information Technology (HIT)
Swanson MB, Miller AC, Ward MM MM
Emergency department telemedicine consults decrease time to interpret computed tomography of the head in a multi-network cohort.
Telemedicine can improve access to emergency stroke care in rural areas, but the benefit of telemedicine across different types and models of telemedicine networks is unknown. The objectives of this study were to (1) identify the impact of telemedicine on ED stroke care, (2) identify if telemedicine impact varied by network, and (3) describe the variation in process outcomes by telemedicine across EDs.
AHRQ-funded; HS025753.
Citation: Swanson MB, Miller AC, Ward MM MM .
Emergency department telemedicine consults decrease time to interpret computed tomography of the head in a multi-network cohort.
J Telemed Telecare 2021 Jul;27(6):343-52. doi: 10.1177/1357633x19877746..
Keywords: Emergency Department, Telehealth, Health Information Technology (HIT), Imaging, Stroke, Cardiovascular Conditions
Wang X, Blumenthal HJ, Hoffman D
Modeling patient-related workload in the emergency department using electronic health record data.
Understanding and managing clinician workload is important for clinician (nurses, physicians and advanced practice providers) occupational health as well as patient safety. Efforts have been made to develop strategies for managing clinician workload by improving patient assignment. The goal of the current study was to use electronic health record (EHR) data to predict the amount of work that individual patients contributed to clinician workload (patient-related workload).
AHRQ-funded; HS022542.
Citation: Wang X, Blumenthal HJ, Hoffman D .
Modeling patient-related workload in the emergency department using electronic health record data.
Int J Med Inform 2021 Jun;150:104451. doi: 10.1016/j.ijmedinf.2021.104451..
Keywords: Emergency Department, Electronic Health Records (EHRs), Health Information Technology (HIT), Provider: Physician
Enayati M, Sir M, Zhang X
Monitoring diagnostic safety risks in emergency departments: protocol for a machine learning study.
This study’s objective will be to identify variables associated with diagnostic errors in emergency departments using large-scale EHR data and machine learning techniques. It will use trigger algorithms with electronic health record (EHR) data repositories to generate a large data set of records that are labeled trigger-positive or trigger-negative, depending on if they meet certain criteria. This study will be conducted by 2 academic medical centers with affiliated community hospitals.
AHRQ-funded; HS027363; HS026622.
Citation: Enayati M, Sir M, Zhang X .
Monitoring diagnostic safety risks in emergency departments: protocol for a machine learning study.
JMIR Res Protoc 2021 Jun 14;10(6):e24642. doi: 10.2196/24642..
Keywords: Emergency Department, Diagnostic Safety and Quality, Patient Safety, Risk, Electronic Health Records (EHRs), Health Information Technology (HIT)