Computerized clinical pathways (Care Plans): Piloting a strategy to enhance quality patient care
Clinical Nurse Specialists, Cone Health, Greensboro, North Carolina 27401, USA. Clinical nurse specialist CNS
(Impact Factor: 0.99).
09/2012; 26(5):277-82. DOI: 10.1097/NUR.0b013e31825aebc1
Having paper and electronic documentation can interfere with staff communication and workflow. In this 950-bed multicampus acute healthcare network in the southeastern United States, paper pathways did not clearly demonstrate multidisciplinary documentation and involvement in the plan of care. The majority of documentation was computerized, but clinical pathways remained in the paper chart. Limited literature findings, incomplete pathway documentation, and nurse dissatisfaction with cumbersome documentation processes created the impetus for this practice change. DESCRIPTION OF THE PROJECT/INNOVATION: To provide a sound basis for transitioning the pathways into the electronic medical record, a pilot was conducted on 1 medical-surgical department using 1 computerized pathway. Outcomes were measured utilizing pathway documentation audits and staff perception surveys. PROJECT OUTCOMES: Pilot results revealed improvements in pathway documentation and staff satisfaction with use of the computerized pathway. There was a 69% increase in the documentation of barriers to patient progression/utilization of the problem list, 10% increase in documentation of patient medication teaching, and 31% increase in documentation by ancillary staff using the computerized pathway. According to the survey results, staff perceived that the computerized pathway was a more useful tool in (1) prompting them to educate the patient (36% increase compared with paper); (2) communicating pertinent patient information during shift report (34% increase compared with paper); and (3) documenting barriers to patient progression (30% increase in comparison to paper). Based on these results, approval was obtained from health network administrators to move forward with system-wide implementation.
In order for clinical pathways to be effective, patient-centered communication tools, they must be easily accessible, be utilized by all health team members, and complement day-to-day workflow. Piloting innovative practice changes helps to garnish buy-in and support from all levels of the healthcare team.
Automation provides a first step to easier accessibility and linkage of pathways to other pertinent information and multidisciplinary patient care processes. Computerized pathways may be an impetus for healthcare providers to view automation as a key step to improving multidisciplinary care delivery and patient care quality.
Available from: Hyo Suk Nam
- "The effect of this system was also demonstrated in a multicenter study with various hospital settings.40 A computerized in-hospital alert system may be the impetus for healthcare providers to improve multidisciplinary care delivery and patient care quality.41 "
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ABSTRACT: Information technology and mobile devices may be beneficial and useful in many aspects of stroke management, including recognition of stroke, transport and triage of patients, emergent stroke evaluation at the hospital, and rehabilitation. In this review, we address the contributions of information technology and mobile health to stroke management.
Rapid detection and triage are essential for effective thrombolytic treatment. Awareness of stroke warning signs and responses to stroke could be enhanced by using mobile applications. Furthermore, prehospital assessment and notification could be streamlined for use in telemedicine and teleradiology. A mobile telemedicine system for assessing the National Institutes of Health Stroke Scale scores has shown higher correlation and fast assessment comparing with face-to-face method. Because the benefits of thrombolytic treatment are time-dependent, treatment should be initiated as quickly as possible. In-hospital communication between multidisciplinary team members can be enhanced using information technology. A computerized in-hospital alert system using computerized physician-order entry was shown to be effective in reducing the time intervals from hospital arrival to medical evaluations and thrombolytic treatment. Mobile devices can also be used as supplementary tools for neurologic examination and clinical decision-making. In post-stroke rehabilitation, virtual reality and telerehabilitation are helpful. Mobile applications might be useful for public awareness, lifestyle modification, and education/training of healthcare professionals.
Information technology and mobile health are useful tools for management of stroke patients from the acute period to rehabilitation. Further improvement of technology will change and enhance stroke prevention and treatment.
09/2013; 15(3):135-143. DOI:10.5853/jos.2013.15.3.135
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ABSTRACT: This paper proposes a temporal data mining method to construct and maintain a clinical pathway used for schedule management of clinical care. The method consists of the following four steps: first, histories of nursing orders are extracted from hospital information system. Second, orders are classified into several groups by using clustering and multidimensional scaling method. Third, by using the information on groups, feature selection is applied to the data and important features for classification are extracted. Finally, original temporal data are split into several groups and the first step will be repeated. After the grouping results are stable, a new pathway is constructed based on the induced results. The method was applied to a dataset whose patients had an operation of cataracts. The results show that the reuse of stored data will give a powerful tool for maintenance of clinical pathway, which can be viewed as data-oriented management of nursing schedule.
Proceedings of the 2nd international workshop on Managing interoperability and compleXity in health systems; 10/2012
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ABSTRACT: This paper presents data mining results in which the temporal behavior of global hospital activities is visualized. The results show that the reuse of stored data will provide a powerful tool for hospital management and lead to improvement of hospital services.
Future Generation Computer Systems 01/2013; 33. DOI:10.1016/j.future.2013.10.014 · 2.79 Impact Factor
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