In general, well-designed EMR tools can significantly decrease the cognitive energy required to navigate the vast array of information with which physicians constantly contend, and can absorb much of the information that would otherwise consume the physician’s working memory. To the extent the EMR tool was responsible for these changes in handoff practices, one can posit potential mechanisms for the change. Given the importance of illness severity assessment for forming and communicating a concise shared mental model of a patient’s clinical status, this is a key finding. One exception may be illness severity assessment, as given the very low rate of inclusion preimplementation we may have defined this parameter overly narrowly still, the very high rate of inclusion postimplementation suggests that the template was likely successful in prompting users to include it. The same was true for laboratory tests and vitals. Our method of scoring for inclusion likely underestimates true changes in completeness, as preimplementation medications included only a subset of those administered for a given patient whereas all medications ordered were pulled into the handoff postimplementation. To our knowledge, we are among the first to show that implementation of an EMR-embedded tool can be associated with objective increases in written handoff completeness. Statistical analyses were performed using MedCalc (MedCalc Software, Ostend, Belgium, ). The proportion complete for a given element was compared by Χ 2 test between all preintervention handoff samples and all postintervention handoff samples, as well as between general medicine and specialty service completeness for each element. There was no difference in completeness for any content element between general medicine and specialty service patients in either study period (online supplementary appendix I). A total of 166 written handoffs were assessed during the postimplementation study period in August and September 2016, representing 144 distinct patients. The intervention was implemented in June 2015. Sixty-one per cent of these written handoffs corresponded to general medicine service patients, with the remaining 39% corresponding to patients being cared for by haematology, oncology, or cardiology services. The computer-based template before and after completion is pictured in figures 1 and 2, respectively the printed handoff is pictured in figure 3.Ī total of 288 written handoff documents were assessed during the preimplementation study period in April and May 2015, representing 241 unique patients. When printed, the tool automatically pulled in information on updated patient medications, allergies, vital signs and basic laboratory test results without any action on the part of the user in addition to demographic information already included on the earlier version (which included updated code status, as above). The new template was developed through focus groups with Internal Medicine and Surgery residents as well as a multidisciplinary group that included hospitalist and nursing leadership. The template replaced the free-text handoff note described above and included separate free-text boxes for a patient summary, to-do list, and contingency planning as well as a radio button drop-down menu prompting the inclusion of an illness severity evaluation. Studying for Step 3? Here's the most useful resources.The study intervention was the implementation of an Epic-based handoff template based on I-PASS handoff elements. UCSD Practical guide to clinical medicine Links for help with getting through residency: No links or images linking to the NP or PA subs posted for targeted harassment. No targeted harassment against individuals or organizations.Ĩ. No personal agendas, spam, or links to websites for brigading.ħ. B) If you message the moderators about a removed post you must link the post in your message or will be ignoredĦ. A) New and anonymous accounts are welcome but posts and comments may be delayed as they must be approved manually.ĥ. No protected health information or personal information.ĥ. No questions about applying to residency or medical school. No questions pertaining to medical school. No "What are my chances?" or similar threads. If you have any suggestions to make the sub better, please message the moderator.Ģ. Welcome to the Residency subreddit, a community of interns and residents who are just trying to make it through! This is a sub dedicated to resident physicians in training.
0 Comments
Leave a Reply. |
AuthorWrite something about yourself. No need to be fancy, just an overview. ArchivesCategories |