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Einleitung: Whiteboards können als ein Instrument des Lean Managements zur Steuerung der Verweildauer auf Stationen eingesetzt werden, um aktuelle Patienteninformationen zu bündeln und in regelmäßigen strukturierten sowie interdisziplinären Besprechungen die Patientenversorgung zu steuern, die interdisziplinäre Zusammenarbeit zu optimieren und das Entlassungsmanagement zu verbessern. Das Ziel dieser Studie bestand darin, zu untersuchen, inwiefern die Einführung von Whiteboards in zwei Kliniken mit einer Veränderung der Verweildauer einherging.
Methode: Um die Forschungsfrage zu beantworten, wurden retrospektive Zeitreihen aus den DRG-Routinedaten vor und nach Installation der Whiteboards aus den beiden Kliniken in einem Interrupted Time Series Design genutzt. In der einen Klinik (Chirurgie) lagen 3.734 Fälle für den Zeitraum von Januar 2018 bis Dezember 2019 und in der anderen Klinik (Innere Medizin) 54.049 Fälle für den Zeitraum Juli 2013 bis Dezember 2019 vor.
Ergebnisse: In dem gemittelten Vergleich der Verweildauer (relative Verweildauerabweichung pro DRG von dem jeweiligen Verweildauermittel) konnte in der ersten Klinik kein signifikanter Unterschied zwischen den Werten vor und nach Einführung des Boards festgestellt werden. Am zweiten Klinikum zeigte sich sogar im Vorher-Nachher-Vergleich eine signifikante Verschlechterung der Verweildauer. Eine deskriptive Zeitreihenanalyse vor und nach Einführung zeigte in beiden Kliniken, dass kurz nach der Einführung der Boards sich die Verweildauer verschlechterte, anschließend jedoch verbesserte, d.h. dass die Patienten durchschnittlich früher entlassen wurden. Dieser Unterschied ging jedoch im Zeitverlauf wieder zurück.
Diskussion: Zusammenfassend lässt sich festhalten, dass keine Verbesserung in der Verweildauer im Zuge der Nutzung der Whiteboards durch einen reinen Vorher-Nachher-Vergleich nachweisbar war. In der anschließenden Zeitreihenbetrachtung zeigten sich starke Schwankungen, die zunächst mit einer kurzzeitigen Verschlechterung der Verweildauer nach der Implementierung einhergingen und dann zu einer Verbesserung führten. Im Zeitverlauf verblasste der Unterschied jedoch, sodass die Patienten wieder später entlassen wurden. Methodisch zeigt sich, dass im Gegensatz zu der reinen Vorher-Nachher-Analyse erst eine Zeitreihenbetrachtung einen Einblick in das Geschehen und seine Variabilität lieferte. Für die Praxis ergeben sich folgende Implikationen: Whiteboards können als ein hilfreiches Instrument von Lean Management zur Verweildauersteuerung angesehen werden, wie die zwischenzeitlichen Verbesserungen nahelegen. Dies erfordert jedoch eine kontinuierliche, unter Einbezug der Mitarbeiter durchgeführte Pflege der Informationen und einen erkennbaren Mehrwert. Perspektivisch empfiehlt sich zudem eine Digitalisierung der Boards, um den Nachteilen wie der manuellen Pflege entgegenzuwirken.
Introduction: Handovers are a central process for ensuring information continuity in patient care and, therefore, possess a major influence on patient safety as errors due to poor handovers can lead to life-threatening events. Education to improve handovers and ensure safe patient care can be supported by using critical incident reporting systems (CIRS). The aim of the study is to perform a content analysis of a national CIRS-database with regard to identifying adverse events in handovers situations and to derive competencies for the development of continuing education from these findings.
Methods: A meta model served as a research framework to merge the empirical findings with the London protocol of analysing critical events and the Canadian framework of safety competencies. Relevant cases to be investigated were searched in a freely accessible German CIRS database.
Results: A total of 253 case descriptions were found and analysed. Team factors emerged as the most frequently reported influencing factors following the analysis of the London protocol. Communication errors and missing information as well as a lack of appropriate standards and processes appeared to be the main reasons for critical events to occur. Most of the events happened in units involving surgery and intensive care. A mapping of patient safety competences with the reasons for critical events was conducted in order to determine the practical, concrete and handover related competencies.
Conclusion: Data from a CIRS database and theoretical frameworks can be combined to extract meaningful information about patient safety risks in handover situations. The results are useful for developing curricula to improve handovers based on patient safety competencies.
While Nursing Informatics competencies seem essential for the daily work of nurses, they are not formally integrated into nursing education in Austria, Germany and Switzerland, nor are there any national educational recommendations. The aim of this paper is to show how such recommendations can be developed, what competency areas are most relevant in the three countries and how the recommendations can be implemented in practice. To this end, a triple iterative procedure was proposed and applied starting with national health informatics recommendations for other professionals, matching and enriching these findings with topics from the international literature and finally validating them in an expert survey with 87 experts and in focus group sessions. Out of the 24 compiled competency areas, the relevance ratings of the following four recommended areas achieved values above 90%: nursing documentation (including terminologies), principles of nursing informatics, data protection and security, and quality assurance and quality management. As there were no significant differences between the three countries, these findings laid the foundation of the DACH Recommendations of Nursing Informatics as joint German (D), Austrian (A), and Swiss (CH) recommendations in Nursing Informatics. The methodology proposed has been utilized internationally, which demonstrates the added value of this study also outside the confines of Austria, Germany, Switzerland.
Background and purpose:
Clinical information logistics is a construct that aims to describe and explain various phenomena of information provision to drive clinical processes. It can be measured by the workflow composite score, an aggregated indicator of the degree of IT support in clinical processes. This study primarily aimed to investigate the yet unknown empirical patterns constituting this construct. The second goal was to derive a data-driven weighting scheme for the constituents of the workflow composite score and to contrast this scheme with a literature based, top-down procedure. This approach should finally test the validity and robustness of the workflow composite score.
Methods:
Based on secondary data from 183 German hospitals, a tiered factor analytic approach (confirmatory and subsequent exploratory factor analysis) was pursued. A weighting scheme, which was based on factor loadings obtained in the analyses, was put into practice.
Results:
We were able to identify five statistically significant factors of clinical information logistics that accounted for 63% of the overall variance. These factors were “flow of data and information”, “mobility”, “clinical decision support and patient safety”, “electronic patient record” and “integration and distribution”. The system of weights derived from the factor loadings resulted in values for the workflow composite score that differed only slightly from the score values that had been previously published based on a top-down approach.
Conclusion:
Our findings give insight into the internal composition of clinical information logistics both in terms of factors and weights. They also allowed us to propose a coherent model of clinical information logistics from a technical perspective that joins empirical findings with theoretical knowledge. Despite the new scheme of weights applied to the calculation of the workflow composite score, the score behaved robustly, which is yet another hint of its validity and therefore its usefulness.
Background:
Large health organizations often struggle to build complex health information technology (HIT) solutions and are faced with ever-growing pressure to continuously innovate their information systems. Limited research has been conducted that explores the relationship between organizations’ innovative capabilities and HIT quality in the sense of achieving high-quality support for patient care processes.
Objective:
The aim of this study is to explain how core constructs of organizational innovation capabilities are linked to HIT quality based on a conceptual sociotechnical model on innovation and quality of HIT, called the IQHIT model, to help determine how better information provision in health organizations can be achieved.
Methods:
We designed a survey to assess various domains of HIT quality, innovation capabilities of health organizations, and context variables and administered it to hospital chief information officers across Austria, Germany, and Switzerland. Data from 232 hospitals were used to empirically fit the model using partial least squares structural equation modeling to reveal associations and mediating and moderating effects.
Results:
The resulting empirical IQHIT model reveals several associations between the analyzed constructs, which can be summarized in 2 main insights. First, it illustrates the linkage between the constructs measuring HIT quality by showing that the professionalism of information management explains the degree of HIT workflow support (R²=0.56), which in turn explains the perceived HIT quality (R²=0.53). Second, the model shows that HIT quality was positively influenced by innovation capabilities related to the top management team, the information technology department, and the organization at large. The assessment of the model’s statistical quality criteria indicated valid model specifications, including sufficient convergent and discriminant validity for measuring the latent constructs that underlie the measures of HIT quality and innovation capabilities.
Conclusions:
The proposed sociotechnical IQHIT model points to the key role of professional information management for HIT workflow support in patient care and perceived HIT quality from the viewpoint of hospital chief information officers. Furthermore, it highlights that organizational innovation capabilities, particularly with respect to the top management team, facilitate HIT quality and suggests that health organizations establish this link by applying professional information management practices. The model may serve to stimulate further scientific work in the field of HIT adoption and diffusion and to provide practical guidance to managers, policy makers, and educators on how to achieve better patient care using HIT.
Background:
While aiming for the same goal of building a national eHealth Infrastructure, Germany and the United States pursued different strategic approaches – particularly regarding the role of promoting the adoption and usage of hospital Electronic Health Records (EHR).
Objective:
To measure and model the diffusion dynamics of EHRs in German hospital care and to contrast the results with the developments in the US.
Materials and methods:
All acute care hospitals that were members of the German statutory health system were surveyed during the period 2007–2017 for EHR adoption. Bass models were computed based on the German data and the corresponding data of the American Hospital Association (AHA) from non-federal hospitals in order to model and explain the diffusion of innovation.
Results:
While the diffusion dynamics observed in the US resembled the typical s-shaped curve with high imitation effects (q = 0.583) but with a relatively low innovation effect (p = 0.025), EHR diffusion in Germany stagnated with adoption rates of approx. 50% (imitation effect q = -0.544) despite a higher innovation effect (p = 0.303).
Discussion:
These findings correlate with different governmental strategies in the US and Germany of financially supporting EHR adoption. Imitation only seems to work if there are financial incentives, e.g. those of the HITECH Act in the US. They are lacking in Germany, where the government left health IT adoption strategies solely to the free market and the consensus among all of the stakeholders.
Conclusion:
Bass diffusion models proved to be useful for distinguishing the diffusion dynamics in German and US non-federal hospitals. When applying the Bass model, the imitation parameter needs a broader interpretation beyond the network effects, including driving forces such as incentives and regulations, as was demonstrated by this study.
Die Gesundheitstelematik unterstützt die Versorgungskontinuität und fördert damit die Patientensicherheit. In Anlehnung an den eArztbrief wurde an der FH Osnabrück der elektronische Pflegebericht entwickelt. Mit dem ePflegebe-richt leistet die Pflege einen ersten wichtigen Beitrag zur Gestaltung eigener gesundheitstelematischer Anwendungen.
Introduction: Establishing continuity of care in handovers at changes of shift is a challenging endeavor that is jeopardized by time pressure and errors typically occurring during synchronous communication. Only if the outgoing and incoming persons manage to collaboratively build a common ground for the next steps of care is it possible to ensure a proper continuation. Electronic systems, in particular electronic patient record systems, are powerful providers of information but their actual use might threaten achieving a common understanding of the patient if they force clinicians to work asynchronously. In order to gain a deeper understanding of communication failures and how to overcome them, we performed a systematic review of the literature, aiming to answer the following four research questions: (1a) What are typical errors and (1b) their consequences in handovers? (2) How can they be overcome by conventional strategies and instruments? (3) electronic systems? (4) Are there any instruments to support collaborative grounding?
Methods: We searched the databases MEDLINE, CINAHL, and COCHRANE for articles on handovers in general and in combination with the terms electronic record systems and grounding that covered the time period of January 2000 to May 2012.
Results: The search led to 519 articles of which 60 were then finally included into the review. We found a sharp increase in the number of relevant studies starting with 2008. As could be documented by 20 studies that addressed communication errors, omission of detailed patient information including anticipatory guidance during handovers was the greatest problem. This deficiency could be partly overcome by structuring and systematizing the information, e.g. according to Situation, Background, Assessment and Recommendation schema (SBAR), and by employing electronic tools integrated in electronic records systems as 23 studies on conventional and 22 articles on electronic systems showed. Despite the increase in quantity and quality of the information achieved, it also became clear that there was still the unsolved problem of anticipatory guidance and presenting “the full story” of the patient. Only a small number of studies actually addressed how to establish common ground with the help of electronic tools.
Discussion: The increase in studies manifests the rise of great interest in the handover scenario. Electronic patient record systems proved to be excellent information feeders to handover tools, but their role in collaborative grounding is unclear. Concepts of how to move to joint information processing and IT-enabled social interaction have to be implemented and tested.
Background: Clinical handovers at changes of shifts are typical scenarios of time restricted and information intensive communication, which are highly cognitively demanding. The currently available applications supporting handovers typically present complex information in a textual checklist-like manner. This presentation style has been criticised for not meeting the specific user requirements.
Objectives: We, therefore, aimed at developing a concept for visualising the overview of a clinical case that serves as an alternative way to checklist-like presentations in clinical handovers. We also aimed at implementing this concept in a handoverEHR in order to support the pre-handover phase, the actual handover, and the post-handover phase as well as at evaluating its usability and attractiveness.
Results: We developed and implemented a concept that draws on Tolman's pioneering work on cognitive maps that we designed in accordance with Gestalt principles. These maps provide a pictorial overview of a clinical case. The application to build, manipulate, and store the cognitive maps was integrated into an openEHR based handover record that extends conventional records with handover specific information. Usability (n = 28) and attractiveness (n = 26) testing with experienced clinicians resulted in good ratings for suitability for the task as well as for attractiveness and pragmatism.
Conclusion: We propose cognitive maps to represent and visualise the clinical case in situations where there is limited time to present complex information.