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Developing guidance for patient movement requests
Clear guidelines in policy needed
In hospital medicine, inpatients often request more freedom to move within the hospital complex for a wide range of both benign and potentially concerning reasons, says Sara Stream, MD.
“Hospitalists are often confronted with a dilemma when considering these patient requests: how to promote patient-centered care and autonomy while balancing patient safety, concerns for hospital liability, and the delivery of timely, efficient medical care,” said Dr. Stream, a hospitalist at the VA New York Harbor Healthcare System. Guidance from medical literature and institutional policies on inpatient movement are lacking, so Dr. Stream coauthored an article seeking to develop a framework with which hospitalists can approach patient requests for liberalized movement.
The authors concluded that for a small subset of patients, liberalized movement within the hospital may be clinically feasible: those who are medically, physically, and psychiatrically stable enough to move off their assigned floors without inordinate risk. “For the rest of inpatients, movement outside their monitored inpatient settings may interfere with appropriate medical care and undermine the indications for acute hospitalization,” Dr. Stream said.
Creating institutional policy that identifies relevant clinical, legal and ethical considerations, while incorporating the varied perspectives of physicians, patients, nurses, and hospital administration/risk management will allow requests for increased movement to be evaluated systematically and transparently.
“When patients request liberalized movement, hospitalists should consider the requests systematically: first to identify the intent behind requests, and then to follow a framework to determine whether increased movement would be safe and allow appropriate medical care without creating additional risks,” Dr. Stream said.
Hospitalists should assess and compile individual patient requests for liberalized movement and work with other physicians, nurses, hospital administration, and risk management to devise pertinent policy on this issue that is specific to their institutions. “By eventually creating clear guidelines in policy, health care providers will spend less time managing each individual request to leave the floor because they have a systematic strategy for making consistent decisions about patient movement,” the authors concluded.
Reference
1. Stream S, Alfandre D. “Just Getting a Cup of Coffee” – Considering Best Practices for Patients’ Movement off the Hospital Floor. J Hosp Med. 2019 Nov. doi: 10.12788/jhm.3227.
Clear guidelines in policy needed
Clear guidelines in policy needed
In hospital medicine, inpatients often request more freedom to move within the hospital complex for a wide range of both benign and potentially concerning reasons, says Sara Stream, MD.
“Hospitalists are often confronted with a dilemma when considering these patient requests: how to promote patient-centered care and autonomy while balancing patient safety, concerns for hospital liability, and the delivery of timely, efficient medical care,” said Dr. Stream, a hospitalist at the VA New York Harbor Healthcare System. Guidance from medical literature and institutional policies on inpatient movement are lacking, so Dr. Stream coauthored an article seeking to develop a framework with which hospitalists can approach patient requests for liberalized movement.
The authors concluded that for a small subset of patients, liberalized movement within the hospital may be clinically feasible: those who are medically, physically, and psychiatrically stable enough to move off their assigned floors without inordinate risk. “For the rest of inpatients, movement outside their monitored inpatient settings may interfere with appropriate medical care and undermine the indications for acute hospitalization,” Dr. Stream said.
Creating institutional policy that identifies relevant clinical, legal and ethical considerations, while incorporating the varied perspectives of physicians, patients, nurses, and hospital administration/risk management will allow requests for increased movement to be evaluated systematically and transparently.
“When patients request liberalized movement, hospitalists should consider the requests systematically: first to identify the intent behind requests, and then to follow a framework to determine whether increased movement would be safe and allow appropriate medical care without creating additional risks,” Dr. Stream said.
Hospitalists should assess and compile individual patient requests for liberalized movement and work with other physicians, nurses, hospital administration, and risk management to devise pertinent policy on this issue that is specific to their institutions. “By eventually creating clear guidelines in policy, health care providers will spend less time managing each individual request to leave the floor because they have a systematic strategy for making consistent decisions about patient movement,” the authors concluded.
Reference
1. Stream S, Alfandre D. “Just Getting a Cup of Coffee” – Considering Best Practices for Patients’ Movement off the Hospital Floor. J Hosp Med. 2019 Nov. doi: 10.12788/jhm.3227.
In hospital medicine, inpatients often request more freedom to move within the hospital complex for a wide range of both benign and potentially concerning reasons, says Sara Stream, MD.
“Hospitalists are often confronted with a dilemma when considering these patient requests: how to promote patient-centered care and autonomy while balancing patient safety, concerns for hospital liability, and the delivery of timely, efficient medical care,” said Dr. Stream, a hospitalist at the VA New York Harbor Healthcare System. Guidance from medical literature and institutional policies on inpatient movement are lacking, so Dr. Stream coauthored an article seeking to develop a framework with which hospitalists can approach patient requests for liberalized movement.
The authors concluded that for a small subset of patients, liberalized movement within the hospital may be clinically feasible: those who are medically, physically, and psychiatrically stable enough to move off their assigned floors without inordinate risk. “For the rest of inpatients, movement outside their monitored inpatient settings may interfere with appropriate medical care and undermine the indications for acute hospitalization,” Dr. Stream said.
Creating institutional policy that identifies relevant clinical, legal and ethical considerations, while incorporating the varied perspectives of physicians, patients, nurses, and hospital administration/risk management will allow requests for increased movement to be evaluated systematically and transparently.
“When patients request liberalized movement, hospitalists should consider the requests systematically: first to identify the intent behind requests, and then to follow a framework to determine whether increased movement would be safe and allow appropriate medical care without creating additional risks,” Dr. Stream said.
Hospitalists should assess and compile individual patient requests for liberalized movement and work with other physicians, nurses, hospital administration, and risk management to devise pertinent policy on this issue that is specific to their institutions. “By eventually creating clear guidelines in policy, health care providers will spend less time managing each individual request to leave the floor because they have a systematic strategy for making consistent decisions about patient movement,” the authors concluded.
Reference
1. Stream S, Alfandre D. “Just Getting a Cup of Coffee” – Considering Best Practices for Patients’ Movement off the Hospital Floor. J Hosp Med. 2019 Nov. doi: 10.12788/jhm.3227.
Quick Byte: EHRs and clinician wellness
Concerns abound regarding the workload created by electronic health records (EHRs), but little attention has been paid to the relationship between physicians’ well-being and the volume and sources of in-basket messages they receive.
According to a recent paper in Health Affairs, “in a survey, 36 percent of the physicians reported burnout symptoms, and 29 percent intended to reduce their clinical work time in the upcoming year. Receiving more than the average number of system-generated in-basket messages was associated with 40 percent higher probability of burnout and 38 percent higher probability of intending to reduce clinical work time.”
Reference
1. Tai-Seale M, Dillon EC, Yang Y, et al. Physicians’ Well-Being Linked To In-Basket Messages Generated By Algorithms In Electronic Health Records. Health Aff. 2019 Jul. doi: 10.1377/hlthaff.2018.05509.
Concerns abound regarding the workload created by electronic health records (EHRs), but little attention has been paid to the relationship between physicians’ well-being and the volume and sources of in-basket messages they receive.
According to a recent paper in Health Affairs, “in a survey, 36 percent of the physicians reported burnout symptoms, and 29 percent intended to reduce their clinical work time in the upcoming year. Receiving more than the average number of system-generated in-basket messages was associated with 40 percent higher probability of burnout and 38 percent higher probability of intending to reduce clinical work time.”
Reference
1. Tai-Seale M, Dillon EC, Yang Y, et al. Physicians’ Well-Being Linked To In-Basket Messages Generated By Algorithms In Electronic Health Records. Health Aff. 2019 Jul. doi: 10.1377/hlthaff.2018.05509.
Concerns abound regarding the workload created by electronic health records (EHRs), but little attention has been paid to the relationship between physicians’ well-being and the volume and sources of in-basket messages they receive.
According to a recent paper in Health Affairs, “in a survey, 36 percent of the physicians reported burnout symptoms, and 29 percent intended to reduce their clinical work time in the upcoming year. Receiving more than the average number of system-generated in-basket messages was associated with 40 percent higher probability of burnout and 38 percent higher probability of intending to reduce clinical work time.”
Reference
1. Tai-Seale M, Dillon EC, Yang Y, et al. Physicians’ Well-Being Linked To In-Basket Messages Generated By Algorithms In Electronic Health Records. Health Aff. 2019 Jul. doi: 10.1377/hlthaff.2018.05509.
Improving health care with simulation
QI is for clinicians too
Simulation is commonly used in the education and training of health care professionals, but more recently it’s entering the quality improvement world.
“Instead of just thinking about training individuals and teams, people are starting to use simulation to look at the physical layout of resuscitation bays, to map work flows of a patient journey through hospitals, to identify latent safety threats,” said Victoria Brazil, MD, MBA, lead author of a study on the subject in BMJ Quality & Safety. “These are great things to do, but many of the people doing it didn’t have quality improvement skills or knowledge – that’s why we wrote this article.”
Dr. Brazil, a specialist in health care simulation at Gold Coast (Australia) Hospital and Health Service, explained that, “in terms of the top takeaways, for quality improvement teams – and I’m including everyday clinicians in this: Think about simulation as one of the tools that can be utilized when looking at the questions of how we make our performance better, whether that’s a team performance, environmental, investigational impacts, or one of my key interests, whether that’s about exploring and shaping culture in hospitals, which we’ve done a lot of work on using simulation.”
Quality improvement has become a very specialized field, she added, so hospitalists may think it’s outside their purview. “As clinicians, we don’t think about ourselves as being engaged in quality improvement. I think that’s a shame, because many of the things that we can do bit by bit to make our patient outcomes better, we need to be thinking about finding better ways to do those things. I suggest simulation is one way, and that doesn’t need to be a massive simulation center. It can be simulating the kind of things that are important to you, your teams, and your patients and using those to both explore improved performance.”
Dr. Brazil said that Gold Coast Hospital has used simulation as a way of getting people from different departments and different professions together to shape culture through understanding shared knowledge and goals around patient journeys.
“That’s been pretty successful for us, and I think it’s really important that quality improvement has that understanding of context and culture as well as the idea of having specific interventions – maybe like a simulation – to try and improve an outcome,” she said.
Reference
1. Brazil V et al.. Connecting simulation and quality improvement: How can healthcare simulation really improve patient care? BMJ Qual Saf. 2019 Jul 18. doi: 10.1136/bmjqs-2019-009767.
QI is for clinicians too
QI is for clinicians too
Simulation is commonly used in the education and training of health care professionals, but more recently it’s entering the quality improvement world.
“Instead of just thinking about training individuals and teams, people are starting to use simulation to look at the physical layout of resuscitation bays, to map work flows of a patient journey through hospitals, to identify latent safety threats,” said Victoria Brazil, MD, MBA, lead author of a study on the subject in BMJ Quality & Safety. “These are great things to do, but many of the people doing it didn’t have quality improvement skills or knowledge – that’s why we wrote this article.”
Dr. Brazil, a specialist in health care simulation at Gold Coast (Australia) Hospital and Health Service, explained that, “in terms of the top takeaways, for quality improvement teams – and I’m including everyday clinicians in this: Think about simulation as one of the tools that can be utilized when looking at the questions of how we make our performance better, whether that’s a team performance, environmental, investigational impacts, or one of my key interests, whether that’s about exploring and shaping culture in hospitals, which we’ve done a lot of work on using simulation.”
Quality improvement has become a very specialized field, she added, so hospitalists may think it’s outside their purview. “As clinicians, we don’t think about ourselves as being engaged in quality improvement. I think that’s a shame, because many of the things that we can do bit by bit to make our patient outcomes better, we need to be thinking about finding better ways to do those things. I suggest simulation is one way, and that doesn’t need to be a massive simulation center. It can be simulating the kind of things that are important to you, your teams, and your patients and using those to both explore improved performance.”
Dr. Brazil said that Gold Coast Hospital has used simulation as a way of getting people from different departments and different professions together to shape culture through understanding shared knowledge and goals around patient journeys.
“That’s been pretty successful for us, and I think it’s really important that quality improvement has that understanding of context and culture as well as the idea of having specific interventions – maybe like a simulation – to try and improve an outcome,” she said.
Reference
1. Brazil V et al.. Connecting simulation and quality improvement: How can healthcare simulation really improve patient care? BMJ Qual Saf. 2019 Jul 18. doi: 10.1136/bmjqs-2019-009767.
Simulation is commonly used in the education and training of health care professionals, but more recently it’s entering the quality improvement world.
“Instead of just thinking about training individuals and teams, people are starting to use simulation to look at the physical layout of resuscitation bays, to map work flows of a patient journey through hospitals, to identify latent safety threats,” said Victoria Brazil, MD, MBA, lead author of a study on the subject in BMJ Quality & Safety. “These are great things to do, but many of the people doing it didn’t have quality improvement skills or knowledge – that’s why we wrote this article.”
Dr. Brazil, a specialist in health care simulation at Gold Coast (Australia) Hospital and Health Service, explained that, “in terms of the top takeaways, for quality improvement teams – and I’m including everyday clinicians in this: Think about simulation as one of the tools that can be utilized when looking at the questions of how we make our performance better, whether that’s a team performance, environmental, investigational impacts, or one of my key interests, whether that’s about exploring and shaping culture in hospitals, which we’ve done a lot of work on using simulation.”
Quality improvement has become a very specialized field, she added, so hospitalists may think it’s outside their purview. “As clinicians, we don’t think about ourselves as being engaged in quality improvement. I think that’s a shame, because many of the things that we can do bit by bit to make our patient outcomes better, we need to be thinking about finding better ways to do those things. I suggest simulation is one way, and that doesn’t need to be a massive simulation center. It can be simulating the kind of things that are important to you, your teams, and your patients and using those to both explore improved performance.”
Dr. Brazil said that Gold Coast Hospital has used simulation as a way of getting people from different departments and different professions together to shape culture through understanding shared knowledge and goals around patient journeys.
“That’s been pretty successful for us, and I think it’s really important that quality improvement has that understanding of context and culture as well as the idea of having specific interventions – maybe like a simulation – to try and improve an outcome,” she said.
Reference
1. Brazil V et al.. Connecting simulation and quality improvement: How can healthcare simulation really improve patient care? BMJ Qual Saf. 2019 Jul 18. doi: 10.1136/bmjqs-2019-009767.
Creating best practices for APPs
A holistic approach to integration
Hospital medicine groups (HMGs) nationally are confronted with a host of challenging issues: increased patient volume/complexities, resident duty-hour restrictions, and a rise in provider burnout. Many are turning to advanced practice providers (APPs) to help lighten these burdens.
But no practical guidelines exist around how to successfully incorporate APPs in a way that meets the needs of the patients, the providers, the HMG, and the health system, according to Kasey Bowden, MSN, FNP, AG-ACNP, lead author of a HM19 abstract on that subject.
“Much of the recent literature around APP utilization involves descriptive anecdotes on how individual HMGs have utilized APPs, and what metrics this helped them to achieve,” she said. “While these stories are often compelling, they provide no tangible value to HMGs looking to incorporate APPs into practice, as they do not address unique elements that limit successful APP integration, including diverse educational backgrounds of APPs and exceedingly high turnover rates (12.6% nationally).”
Ms. Bowden and coauthors created a conceptual framework, which recognizes that, without taking a holistic approach, many HMGs will fail to successfully integrate APPs. “Our hope is that by utilizing this framework to define APP-physician best practices, we will be able to create a useful tool for all HMGs that will promote successful APP-physician collaborative practice models.”
She thinks that hospitalists could also use this framework to examine their current practice models and to see where there may be opportunity for improvement. For example, a group may look at their own APP turnover rate. “If turnover rate is high in the first year, it may suggest inadequate onboarding/training, if it is high after 3 years, this may suggest minimal opportunities for professional growth and advancement,” Ms. Bowden said. “I would love to see a consensus group form within SHM of physician and APP leaders to utilize this framework to establish ‘APP-Physician best practices,’ and create a guideline available to all HMGs so that they can successfully incorporate APPs into their practice,” she said.
Reference
1. Bowden K et al. Creation of APP-physician best practices: A necessary tool for the growing APP workforce. Hospital Medicine 2019, Abstract 436.
A holistic approach to integration
A holistic approach to integration
Hospital medicine groups (HMGs) nationally are confronted with a host of challenging issues: increased patient volume/complexities, resident duty-hour restrictions, and a rise in provider burnout. Many are turning to advanced practice providers (APPs) to help lighten these burdens.
But no practical guidelines exist around how to successfully incorporate APPs in a way that meets the needs of the patients, the providers, the HMG, and the health system, according to Kasey Bowden, MSN, FNP, AG-ACNP, lead author of a HM19 abstract on that subject.
“Much of the recent literature around APP utilization involves descriptive anecdotes on how individual HMGs have utilized APPs, and what metrics this helped them to achieve,” she said. “While these stories are often compelling, they provide no tangible value to HMGs looking to incorporate APPs into practice, as they do not address unique elements that limit successful APP integration, including diverse educational backgrounds of APPs and exceedingly high turnover rates (12.6% nationally).”
Ms. Bowden and coauthors created a conceptual framework, which recognizes that, without taking a holistic approach, many HMGs will fail to successfully integrate APPs. “Our hope is that by utilizing this framework to define APP-physician best practices, we will be able to create a useful tool for all HMGs that will promote successful APP-physician collaborative practice models.”
She thinks that hospitalists could also use this framework to examine their current practice models and to see where there may be opportunity for improvement. For example, a group may look at their own APP turnover rate. “If turnover rate is high in the first year, it may suggest inadequate onboarding/training, if it is high after 3 years, this may suggest minimal opportunities for professional growth and advancement,” Ms. Bowden said. “I would love to see a consensus group form within SHM of physician and APP leaders to utilize this framework to establish ‘APP-Physician best practices,’ and create a guideline available to all HMGs so that they can successfully incorporate APPs into their practice,” she said.
Reference
1. Bowden K et al. Creation of APP-physician best practices: A necessary tool for the growing APP workforce. Hospital Medicine 2019, Abstract 436.
Hospital medicine groups (HMGs) nationally are confronted with a host of challenging issues: increased patient volume/complexities, resident duty-hour restrictions, and a rise in provider burnout. Many are turning to advanced practice providers (APPs) to help lighten these burdens.
But no practical guidelines exist around how to successfully incorporate APPs in a way that meets the needs of the patients, the providers, the HMG, and the health system, according to Kasey Bowden, MSN, FNP, AG-ACNP, lead author of a HM19 abstract on that subject.
“Much of the recent literature around APP utilization involves descriptive anecdotes on how individual HMGs have utilized APPs, and what metrics this helped them to achieve,” she said. “While these stories are often compelling, they provide no tangible value to HMGs looking to incorporate APPs into practice, as they do not address unique elements that limit successful APP integration, including diverse educational backgrounds of APPs and exceedingly high turnover rates (12.6% nationally).”
Ms. Bowden and coauthors created a conceptual framework, which recognizes that, without taking a holistic approach, many HMGs will fail to successfully integrate APPs. “Our hope is that by utilizing this framework to define APP-physician best practices, we will be able to create a useful tool for all HMGs that will promote successful APP-physician collaborative practice models.”
She thinks that hospitalists could also use this framework to examine their current practice models and to see where there may be opportunity for improvement. For example, a group may look at their own APP turnover rate. “If turnover rate is high in the first year, it may suggest inadequate onboarding/training, if it is high after 3 years, this may suggest minimal opportunities for professional growth and advancement,” Ms. Bowden said. “I would love to see a consensus group form within SHM of physician and APP leaders to utilize this framework to establish ‘APP-Physician best practices,’ and create a guideline available to all HMGs so that they can successfully incorporate APPs into their practice,” she said.
Reference
1. Bowden K et al. Creation of APP-physician best practices: A necessary tool for the growing APP workforce. Hospital Medicine 2019, Abstract 436.
Reducing alarm fatigue in the hospital
Noise increases patient anxiety
Researchers are exploring ways to make alarms and monitors less irritating and more informative.
“Hospitals today can be sonic hellscapes, which studies have shown regularly exceed levels set by the World Health Organization: droning IV pumps, ding-donging nurse call buttons, voices crackling on loudspeakers, ringing telephones, beeping elevators, buzzing ID scanners, clattering carts, coughing, screaming, vomiting,” according to a recent article in the New York Times.
And that’s not to mention all the alarms that blare regularly, day and night. “A single patient might trigger hundreds each day, challenging caregivers to figure out which machine is beeping, and what is wrong with the patient, if anything,” according to the article.
All this noise contributes to patient anxiety and delirium and to staff burnout too. Alarm fatigue is a serious problem, related to the high rate of false alarms, the lack of alarm standardization, and the number of medical devices that emit an alarm. Its effect is to make caregivers less responsive.
A group of researchers is developing new sounds that could replace current alarms. These new signals might mimic electronic dance music or the sounds of a heartbeat; they may combine audible alarms with visual cues such as interactive screens; they will certainly be quieter. Testing remains to be done around how quickly clinicians will be able to learn the sounds and how loud they need to be. The researchers say a new standard is likely to go into effect in 2020.
Reference
1. Rueb ES. To Reduce Hospital Noise, Researchers Create Alarms That Whistle and Sing. New York Times. July 9, 2019.
Noise increases patient anxiety
Noise increases patient anxiety
Researchers are exploring ways to make alarms and monitors less irritating and more informative.
“Hospitals today can be sonic hellscapes, which studies have shown regularly exceed levels set by the World Health Organization: droning IV pumps, ding-donging nurse call buttons, voices crackling on loudspeakers, ringing telephones, beeping elevators, buzzing ID scanners, clattering carts, coughing, screaming, vomiting,” according to a recent article in the New York Times.
And that’s not to mention all the alarms that blare regularly, day and night. “A single patient might trigger hundreds each day, challenging caregivers to figure out which machine is beeping, and what is wrong with the patient, if anything,” according to the article.
All this noise contributes to patient anxiety and delirium and to staff burnout too. Alarm fatigue is a serious problem, related to the high rate of false alarms, the lack of alarm standardization, and the number of medical devices that emit an alarm. Its effect is to make caregivers less responsive.
A group of researchers is developing new sounds that could replace current alarms. These new signals might mimic electronic dance music or the sounds of a heartbeat; they may combine audible alarms with visual cues such as interactive screens; they will certainly be quieter. Testing remains to be done around how quickly clinicians will be able to learn the sounds and how loud they need to be. The researchers say a new standard is likely to go into effect in 2020.
Reference
1. Rueb ES. To Reduce Hospital Noise, Researchers Create Alarms That Whistle and Sing. New York Times. July 9, 2019.
Researchers are exploring ways to make alarms and monitors less irritating and more informative.
“Hospitals today can be sonic hellscapes, which studies have shown regularly exceed levels set by the World Health Organization: droning IV pumps, ding-donging nurse call buttons, voices crackling on loudspeakers, ringing telephones, beeping elevators, buzzing ID scanners, clattering carts, coughing, screaming, vomiting,” according to a recent article in the New York Times.
And that’s not to mention all the alarms that blare regularly, day and night. “A single patient might trigger hundreds each day, challenging caregivers to figure out which machine is beeping, and what is wrong with the patient, if anything,” according to the article.
All this noise contributes to patient anxiety and delirium and to staff burnout too. Alarm fatigue is a serious problem, related to the high rate of false alarms, the lack of alarm standardization, and the number of medical devices that emit an alarm. Its effect is to make caregivers less responsive.
A group of researchers is developing new sounds that could replace current alarms. These new signals might mimic electronic dance music or the sounds of a heartbeat; they may combine audible alarms with visual cues such as interactive screens; they will certainly be quieter. Testing remains to be done around how quickly clinicians will be able to learn the sounds and how loud they need to be. The researchers say a new standard is likely to go into effect in 2020.
Reference
1. Rueb ES. To Reduce Hospital Noise, Researchers Create Alarms That Whistle and Sing. New York Times. July 9, 2019.
Treating pain with virtual reality
Pilot studies are underway
Physicians may soon have another tool to help patients deal with pain: virtual reality (VR) therapy. A New York Times article earlier this year described this new treatment option and the way immersive VR experiences seem to crowd pain sensations out of the brain.
Jeffrey I. Gold, PhD, director of the Children’s Outcomes, Research, and Evaluation program at Children’s Hospital Los Angeles, told the newspaper that VR was “like an endogenous narcotic providing a physiological and chemical burst that causes you to feel good.”
So far, VR has been most successfully used in cases of acute pain. “But it can also enhance the effectiveness of established techniques like physical therapy, hypnosis and cognitive behavioral therapy to treat debilitating chronic pain,” the New York Times reported.
“Using VR as an adjunct, we can teach coping skills, techniques patients can use on their own that will help diminish chronic pain,” said Hunter Hoffman, PhD, principal investigator at the Human Photonics Laboratory of the University of Washington, Seattle. “Learning changes the brain and gives patients something that continues to work when they take the helmet off. When patients realize their pain isn’t inevitable, they’re more receptive to doing physical therapy exercises and more likely to move on their own.”
Others with experience in VR say the technique can foster mindfulness, which teaches the mind how to quiet the body and nervous system through breathing.
Pilot studies of VR and pain management are underway, and software companies are developing programs that create therapeutic VR environments.
Reference
1. “Virtual Reality as Therapy for Pain.” Jane E. Brody, New York Times. 2019 Apr 29. https://www.nytimes.com/2019/04/29/well/live/virtual-reality-as-therapy-for-pain.html.
Pilot studies are underway
Pilot studies are underway
Physicians may soon have another tool to help patients deal with pain: virtual reality (VR) therapy. A New York Times article earlier this year described this new treatment option and the way immersive VR experiences seem to crowd pain sensations out of the brain.
Jeffrey I. Gold, PhD, director of the Children’s Outcomes, Research, and Evaluation program at Children’s Hospital Los Angeles, told the newspaper that VR was “like an endogenous narcotic providing a physiological and chemical burst that causes you to feel good.”
So far, VR has been most successfully used in cases of acute pain. “But it can also enhance the effectiveness of established techniques like physical therapy, hypnosis and cognitive behavioral therapy to treat debilitating chronic pain,” the New York Times reported.
“Using VR as an adjunct, we can teach coping skills, techniques patients can use on their own that will help diminish chronic pain,” said Hunter Hoffman, PhD, principal investigator at the Human Photonics Laboratory of the University of Washington, Seattle. “Learning changes the brain and gives patients something that continues to work when they take the helmet off. When patients realize their pain isn’t inevitable, they’re more receptive to doing physical therapy exercises and more likely to move on their own.”
Others with experience in VR say the technique can foster mindfulness, which teaches the mind how to quiet the body and nervous system through breathing.
Pilot studies of VR and pain management are underway, and software companies are developing programs that create therapeutic VR environments.
Reference
1. “Virtual Reality as Therapy for Pain.” Jane E. Brody, New York Times. 2019 Apr 29. https://www.nytimes.com/2019/04/29/well/live/virtual-reality-as-therapy-for-pain.html.
Physicians may soon have another tool to help patients deal with pain: virtual reality (VR) therapy. A New York Times article earlier this year described this new treatment option and the way immersive VR experiences seem to crowd pain sensations out of the brain.
Jeffrey I. Gold, PhD, director of the Children’s Outcomes, Research, and Evaluation program at Children’s Hospital Los Angeles, told the newspaper that VR was “like an endogenous narcotic providing a physiological and chemical burst that causes you to feel good.”
So far, VR has been most successfully used in cases of acute pain. “But it can also enhance the effectiveness of established techniques like physical therapy, hypnosis and cognitive behavioral therapy to treat debilitating chronic pain,” the New York Times reported.
“Using VR as an adjunct, we can teach coping skills, techniques patients can use on their own that will help diminish chronic pain,” said Hunter Hoffman, PhD, principal investigator at the Human Photonics Laboratory of the University of Washington, Seattle. “Learning changes the brain and gives patients something that continues to work when they take the helmet off. When patients realize their pain isn’t inevitable, they’re more receptive to doing physical therapy exercises and more likely to move on their own.”
Others with experience in VR say the technique can foster mindfulness, which teaches the mind how to quiet the body and nervous system through breathing.
Pilot studies of VR and pain management are underway, and software companies are developing programs that create therapeutic VR environments.
Reference
1. “Virtual Reality as Therapy for Pain.” Jane E. Brody, New York Times. 2019 Apr 29. https://www.nytimes.com/2019/04/29/well/live/virtual-reality-as-therapy-for-pain.html.
Cultivating patient activation through technology
Tech alone is not enough
Patient activation refers to an individual’s knowledge, skill, and confidence in managing their health and health care, according to a recent BMJ editorial. It’s recognized as a critical aspect of high-quality, patient-centered health care – patient activation has the potential to improve patient outcomes while reducing costs.
Total knee replacement offers a great opportunity to study patient activation, said editorial lead author Jesse I. Wolfstadt, MD, MS, FRCSC, of the University of Toronto. “It may help address the one in five patients who are unsatisfied with their knee replacement despite an otherwise technically sound procedure.”
The authors considered some patient activation studies that have shown positive results for cultivating activation through technology. In one, patients engaging with a bedside multimedia intervention on a tablet after undergoing knee replacement reported better pain scores, length of stay, knee function, and satisfaction with care. Another study showed patients who received automated text messages after joint replacement improved time spent on home exercises, decreased their use of narcotics, and had fewer calls to the surgeon’s office.
But “negative mobile app studies seem to suggest that when technologies are used as a passive educational intervention, patient activation may suffer,” according to the editorial. “One possible key ingredient to successful patient activation is the engagement of the health care team that is facilitated through mobile technology. ... Mobile apps and other technological interventions also must have clear goals if they are to be used successfully; and these goals are likely to differ for different patient populations and disease processes.”
Technology alone is not enough to affect patient activation, Dr. Wolfstadt said. “The key to success will likely involve tailoring interventions to individual patients and facilitating increased engagement with the health care team. You can’t just give a patient an app or other form of technology and expect it to replace the function of patient-clinician communication/interaction.”
Reference
1. Wolfstadt JI et ak. Improving patient outcomes following total joint arthroplasty: Is there an app for that? BMJ Qual Saf. 2019 May 2019. doi: 10.1136/bmjqs-2019-009571.
Tech alone is not enough
Tech alone is not enough
Patient activation refers to an individual’s knowledge, skill, and confidence in managing their health and health care, according to a recent BMJ editorial. It’s recognized as a critical aspect of high-quality, patient-centered health care – patient activation has the potential to improve patient outcomes while reducing costs.
Total knee replacement offers a great opportunity to study patient activation, said editorial lead author Jesse I. Wolfstadt, MD, MS, FRCSC, of the University of Toronto. “It may help address the one in five patients who are unsatisfied with their knee replacement despite an otherwise technically sound procedure.”
The authors considered some patient activation studies that have shown positive results for cultivating activation through technology. In one, patients engaging with a bedside multimedia intervention on a tablet after undergoing knee replacement reported better pain scores, length of stay, knee function, and satisfaction with care. Another study showed patients who received automated text messages after joint replacement improved time spent on home exercises, decreased their use of narcotics, and had fewer calls to the surgeon’s office.
But “negative mobile app studies seem to suggest that when technologies are used as a passive educational intervention, patient activation may suffer,” according to the editorial. “One possible key ingredient to successful patient activation is the engagement of the health care team that is facilitated through mobile technology. ... Mobile apps and other technological interventions also must have clear goals if they are to be used successfully; and these goals are likely to differ for different patient populations and disease processes.”
Technology alone is not enough to affect patient activation, Dr. Wolfstadt said. “The key to success will likely involve tailoring interventions to individual patients and facilitating increased engagement with the health care team. You can’t just give a patient an app or other form of technology and expect it to replace the function of patient-clinician communication/interaction.”
Reference
1. Wolfstadt JI et ak. Improving patient outcomes following total joint arthroplasty: Is there an app for that? BMJ Qual Saf. 2019 May 2019. doi: 10.1136/bmjqs-2019-009571.
Patient activation refers to an individual’s knowledge, skill, and confidence in managing their health and health care, according to a recent BMJ editorial. It’s recognized as a critical aspect of high-quality, patient-centered health care – patient activation has the potential to improve patient outcomes while reducing costs.
Total knee replacement offers a great opportunity to study patient activation, said editorial lead author Jesse I. Wolfstadt, MD, MS, FRCSC, of the University of Toronto. “It may help address the one in five patients who are unsatisfied with their knee replacement despite an otherwise technically sound procedure.”
The authors considered some patient activation studies that have shown positive results for cultivating activation through technology. In one, patients engaging with a bedside multimedia intervention on a tablet after undergoing knee replacement reported better pain scores, length of stay, knee function, and satisfaction with care. Another study showed patients who received automated text messages after joint replacement improved time spent on home exercises, decreased their use of narcotics, and had fewer calls to the surgeon’s office.
But “negative mobile app studies seem to suggest that when technologies are used as a passive educational intervention, patient activation may suffer,” according to the editorial. “One possible key ingredient to successful patient activation is the engagement of the health care team that is facilitated through mobile technology. ... Mobile apps and other technological interventions also must have clear goals if they are to be used successfully; and these goals are likely to differ for different patient populations and disease processes.”
Technology alone is not enough to affect patient activation, Dr. Wolfstadt said. “The key to success will likely involve tailoring interventions to individual patients and facilitating increased engagement with the health care team. You can’t just give a patient an app or other form of technology and expect it to replace the function of patient-clinician communication/interaction.”
Reference
1. Wolfstadt JI et ak. Improving patient outcomes following total joint arthroplasty: Is there an app for that? BMJ Qual Saf. 2019 May 2019. doi: 10.1136/bmjqs-2019-009571.
Aligning scheduling and satisfaction
Research reveals counterintuitive results
Hospitalist work schedules have been the subject of much reporting – and recent research. Studies have shown that control over work hours and schedule flexibility are predictors of clinicians’ career satisfaction and burnout, factors linked to quality of patient care and retention.
Starting in January 2017, an academic hospital medicine group at the University of Colorado at Denver, Aurora, undertook a scheduling redesign using improvement methodology, combined with purchased scheduling software. Tyler Anstett, DO, a hospitalist and assistant professor at the university, and colleagues presented the results in an abstract published during the SHM 2019 annual conference last March.
“We wrote this abstract as a report of the work that we did over several years in our hospital medicine group to improve hospitalist satisfaction with their schedules,” said Dr. Anstett. “We identified that, despite not following the traditional seven-on, seven-off model and 100% fulfillment of individual schedule requests, the majority of clinicians were dissatisfied with the scheduling process and their overall clinical schedules. Further, building these complex, individualized schedules resulted in a heavy administrative burden. We strove to provide better alignment of schedule satisfaction and the administrative burden of incorporating individualized schedule requests.”
Prior to January 2017, service stretches had ranged from 5 to 9 days, and there were few limits on time-off requests.
“Through sequential interventions, we standardized service stretches to 7 days (Tuesday-Monday), introduced a limited number of guaranteed 7-day time-off requests (Tuesday-Monday), and added a limited number of nonguaranteed 3-day flexible time-off requests,” according to the authors. “This simplification improved the automation of the scheduling software, which increased the schedule release lead time to an average of 16 weeks. Further, despite standardizing service stretches to 7 days and limiting time-off requests, physicians surveyed reported improved satisfaction with both their scheduling process (34% of participants ‘satisfied’ in 2017 to 67% in 2018) and their overall clinical schedules (50% of participants ‘satisfied’ in 2017 to 75% in 2018).”So counterintuitively, creating individualized schedules may not result in improved satisfaction and likely results in heavy administrative burden, Dr. Anstett said. “Standardization of schedule creation with allowance of a ‘free-market’ system, allowing clinicians to self-individualize their schedules may also result in less administrative burden and improved satisfaction.”
Reference
1. Anstett T et al. K.I.S.S. (Keep It Simple … Schedules): How Standardization and Simplification Can Improve Scheduling and Physician Satisfaction. SHM 2019, Abstract 112. Accessed June 4, 2019.
Research reveals counterintuitive results
Research reveals counterintuitive results
Hospitalist work schedules have been the subject of much reporting – and recent research. Studies have shown that control over work hours and schedule flexibility are predictors of clinicians’ career satisfaction and burnout, factors linked to quality of patient care and retention.
Starting in January 2017, an academic hospital medicine group at the University of Colorado at Denver, Aurora, undertook a scheduling redesign using improvement methodology, combined with purchased scheduling software. Tyler Anstett, DO, a hospitalist and assistant professor at the university, and colleagues presented the results in an abstract published during the SHM 2019 annual conference last March.
“We wrote this abstract as a report of the work that we did over several years in our hospital medicine group to improve hospitalist satisfaction with their schedules,” said Dr. Anstett. “We identified that, despite not following the traditional seven-on, seven-off model and 100% fulfillment of individual schedule requests, the majority of clinicians were dissatisfied with the scheduling process and their overall clinical schedules. Further, building these complex, individualized schedules resulted in a heavy administrative burden. We strove to provide better alignment of schedule satisfaction and the administrative burden of incorporating individualized schedule requests.”
Prior to January 2017, service stretches had ranged from 5 to 9 days, and there were few limits on time-off requests.
“Through sequential interventions, we standardized service stretches to 7 days (Tuesday-Monday), introduced a limited number of guaranteed 7-day time-off requests (Tuesday-Monday), and added a limited number of nonguaranteed 3-day flexible time-off requests,” according to the authors. “This simplification improved the automation of the scheduling software, which increased the schedule release lead time to an average of 16 weeks. Further, despite standardizing service stretches to 7 days and limiting time-off requests, physicians surveyed reported improved satisfaction with both their scheduling process (34% of participants ‘satisfied’ in 2017 to 67% in 2018) and their overall clinical schedules (50% of participants ‘satisfied’ in 2017 to 75% in 2018).”So counterintuitively, creating individualized schedules may not result in improved satisfaction and likely results in heavy administrative burden, Dr. Anstett said. “Standardization of schedule creation with allowance of a ‘free-market’ system, allowing clinicians to self-individualize their schedules may also result in less administrative burden and improved satisfaction.”
Reference
1. Anstett T et al. K.I.S.S. (Keep It Simple … Schedules): How Standardization and Simplification Can Improve Scheduling and Physician Satisfaction. SHM 2019, Abstract 112. Accessed June 4, 2019.
Hospitalist work schedules have been the subject of much reporting – and recent research. Studies have shown that control over work hours and schedule flexibility are predictors of clinicians’ career satisfaction and burnout, factors linked to quality of patient care and retention.
Starting in January 2017, an academic hospital medicine group at the University of Colorado at Denver, Aurora, undertook a scheduling redesign using improvement methodology, combined with purchased scheduling software. Tyler Anstett, DO, a hospitalist and assistant professor at the university, and colleagues presented the results in an abstract published during the SHM 2019 annual conference last March.
“We wrote this abstract as a report of the work that we did over several years in our hospital medicine group to improve hospitalist satisfaction with their schedules,” said Dr. Anstett. “We identified that, despite not following the traditional seven-on, seven-off model and 100% fulfillment of individual schedule requests, the majority of clinicians were dissatisfied with the scheduling process and their overall clinical schedules. Further, building these complex, individualized schedules resulted in a heavy administrative burden. We strove to provide better alignment of schedule satisfaction and the administrative burden of incorporating individualized schedule requests.”
Prior to January 2017, service stretches had ranged from 5 to 9 days, and there were few limits on time-off requests.
“Through sequential interventions, we standardized service stretches to 7 days (Tuesday-Monday), introduced a limited number of guaranteed 7-day time-off requests (Tuesday-Monday), and added a limited number of nonguaranteed 3-day flexible time-off requests,” according to the authors. “This simplification improved the automation of the scheduling software, which increased the schedule release lead time to an average of 16 weeks. Further, despite standardizing service stretches to 7 days and limiting time-off requests, physicians surveyed reported improved satisfaction with both their scheduling process (34% of participants ‘satisfied’ in 2017 to 67% in 2018) and their overall clinical schedules (50% of participants ‘satisfied’ in 2017 to 75% in 2018).”So counterintuitively, creating individualized schedules may not result in improved satisfaction and likely results in heavy administrative burden, Dr. Anstett said. “Standardization of schedule creation with allowance of a ‘free-market’ system, allowing clinicians to self-individualize their schedules may also result in less administrative burden and improved satisfaction.”
Reference
1. Anstett T et al. K.I.S.S. (Keep It Simple … Schedules): How Standardization and Simplification Can Improve Scheduling and Physician Satisfaction. SHM 2019, Abstract 112. Accessed June 4, 2019.
Quick Byte: Act locally
To solve our most pressing national health issues, we must start locally, according to a Health Affairs blog post.
“For example, in [Mecklenburg County] North Carolina, African Americans face rates of cardiovascular disease 22% higher than their white counterparts do. To fight this, an organization called Village HeartBEAT joined forces with more than 60 faith-based groups to reach more than 20,000 people – connecting them with health resources to reduce their cardiovascular risk. As a direct result, rates of smoking decreased from 17.4% to 13.9%, and obesity rates fell from 70% to 64.7%.”
Mecklenburg County is a winner of the Healthiest Cities & Counties Challenge, a collaboration between the Aetna Foundation, the American Public Health Association, and the National Association of Counties, which has awarded more than $1.5 million in grants and prizes over the last 2 years.
Reference
1. Graham G, Benjamin G. “Winning Local Solutions to Our Most Pressing Public Health Needs.” Health Affairs. https://www.healthaffairs.org/do/10.1377/hblog20190423.202497/full/. Published April 25, 2019.
To solve our most pressing national health issues, we must start locally, according to a Health Affairs blog post.
“For example, in [Mecklenburg County] North Carolina, African Americans face rates of cardiovascular disease 22% higher than their white counterparts do. To fight this, an organization called Village HeartBEAT joined forces with more than 60 faith-based groups to reach more than 20,000 people – connecting them with health resources to reduce their cardiovascular risk. As a direct result, rates of smoking decreased from 17.4% to 13.9%, and obesity rates fell from 70% to 64.7%.”
Mecklenburg County is a winner of the Healthiest Cities & Counties Challenge, a collaboration between the Aetna Foundation, the American Public Health Association, and the National Association of Counties, which has awarded more than $1.5 million in grants and prizes over the last 2 years.
Reference
1. Graham G, Benjamin G. “Winning Local Solutions to Our Most Pressing Public Health Needs.” Health Affairs. https://www.healthaffairs.org/do/10.1377/hblog20190423.202497/full/. Published April 25, 2019.
To solve our most pressing national health issues, we must start locally, according to a Health Affairs blog post.
“For example, in [Mecklenburg County] North Carolina, African Americans face rates of cardiovascular disease 22% higher than their white counterparts do. To fight this, an organization called Village HeartBEAT joined forces with more than 60 faith-based groups to reach more than 20,000 people – connecting them with health resources to reduce their cardiovascular risk. As a direct result, rates of smoking decreased from 17.4% to 13.9%, and obesity rates fell from 70% to 64.7%.”
Mecklenburg County is a winner of the Healthiest Cities & Counties Challenge, a collaboration between the Aetna Foundation, the American Public Health Association, and the National Association of Counties, which has awarded more than $1.5 million in grants and prizes over the last 2 years.
Reference
1. Graham G, Benjamin G. “Winning Local Solutions to Our Most Pressing Public Health Needs.” Health Affairs. https://www.healthaffairs.org/do/10.1377/hblog20190423.202497/full/. Published April 25, 2019.
Improving sepsis-related outcomes
Early diagnosis a key goal
Sepsis is a leading cause of death and disease among patients in hospitals, and it’s the subject of a recent quality improvement study in the Journal for Healthcare Quality.
“The number of cases per year has been increasing in the U.S., and it is the most expensive condition treated in U.S. hospitals,” said lead author M. Courtney Hughes, PhD, of Northern Illinois University in DeKalb.
But early identification of symptoms can be complex and difficult for clinicians, meaning there’s a continuing need for research studies examining sepsis identification and prevention. “The purpose of this study was to examine a quality improvement project that consisted of clinical alerts, audit and feedback, and staff education at an integrated health care system in the Midwest,” she said.
In a retrospective analysis, the researchers examined data from three health systems to determine the impact of a 10-month sepsis quality improvement program that consisted of clinical alerts, audit and feedback, and staff education. The results showed that, compared with the control group, the intervention group significantly decreased length of stay and costs per stay.
“One way to improve sepsis health outcomes and decrease costs may be for hospitals to implement a sepsis quality improvement program,” Dr. Hughes said. “Also, providing sepsis performance data and education to hospital providers and administrators can arm staff with the knowledge and tools necessary for improving processes and performance related to sepsis.”
Dr. Hughes said that she hopes this work will encourage hospitalists to seek sepsis-related performance data and training. “By doing so, they may help achieve earlier diagnosis of sepsis cases and initiation of the Surviving Sepsis Campaign bundle.”
Reference
Hughes MC et al. A quality improvement project to improve sepsis-related outcomes at an integrated healthcare system. J Healthc Qual. Published online 2019 Mar 14. doi: 10.1097/JHQ.0000000000000193.
Early diagnosis a key goal
Early diagnosis a key goal
Sepsis is a leading cause of death and disease among patients in hospitals, and it’s the subject of a recent quality improvement study in the Journal for Healthcare Quality.
“The number of cases per year has been increasing in the U.S., and it is the most expensive condition treated in U.S. hospitals,” said lead author M. Courtney Hughes, PhD, of Northern Illinois University in DeKalb.
But early identification of symptoms can be complex and difficult for clinicians, meaning there’s a continuing need for research studies examining sepsis identification and prevention. “The purpose of this study was to examine a quality improvement project that consisted of clinical alerts, audit and feedback, and staff education at an integrated health care system in the Midwest,” she said.
In a retrospective analysis, the researchers examined data from three health systems to determine the impact of a 10-month sepsis quality improvement program that consisted of clinical alerts, audit and feedback, and staff education. The results showed that, compared with the control group, the intervention group significantly decreased length of stay and costs per stay.
“One way to improve sepsis health outcomes and decrease costs may be for hospitals to implement a sepsis quality improvement program,” Dr. Hughes said. “Also, providing sepsis performance data and education to hospital providers and administrators can arm staff with the knowledge and tools necessary for improving processes and performance related to sepsis.”
Dr. Hughes said that she hopes this work will encourage hospitalists to seek sepsis-related performance data and training. “By doing so, they may help achieve earlier diagnosis of sepsis cases and initiation of the Surviving Sepsis Campaign bundle.”
Reference
Hughes MC et al. A quality improvement project to improve sepsis-related outcomes at an integrated healthcare system. J Healthc Qual. Published online 2019 Mar 14. doi: 10.1097/JHQ.0000000000000193.
Sepsis is a leading cause of death and disease among patients in hospitals, and it’s the subject of a recent quality improvement study in the Journal for Healthcare Quality.
“The number of cases per year has been increasing in the U.S., and it is the most expensive condition treated in U.S. hospitals,” said lead author M. Courtney Hughes, PhD, of Northern Illinois University in DeKalb.
But early identification of symptoms can be complex and difficult for clinicians, meaning there’s a continuing need for research studies examining sepsis identification and prevention. “The purpose of this study was to examine a quality improvement project that consisted of clinical alerts, audit and feedback, and staff education at an integrated health care system in the Midwest,” she said.
In a retrospective analysis, the researchers examined data from three health systems to determine the impact of a 10-month sepsis quality improvement program that consisted of clinical alerts, audit and feedback, and staff education. The results showed that, compared with the control group, the intervention group significantly decreased length of stay and costs per stay.
“One way to improve sepsis health outcomes and decrease costs may be for hospitals to implement a sepsis quality improvement program,” Dr. Hughes said. “Also, providing sepsis performance data and education to hospital providers and administrators can arm staff with the knowledge and tools necessary for improving processes and performance related to sepsis.”
Dr. Hughes said that she hopes this work will encourage hospitalists to seek sepsis-related performance data and training. “By doing so, they may help achieve earlier diagnosis of sepsis cases and initiation of the Surviving Sepsis Campaign bundle.”
Reference
Hughes MC et al. A quality improvement project to improve sepsis-related outcomes at an integrated healthcare system. J Healthc Qual. Published online 2019 Mar 14. doi: 10.1097/JHQ.0000000000000193.