The Role of Clinical Artifacts in Achieving Patient-centered Care Delivery
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Transcript of The Role of Clinical Artifacts in Achieving Patient-centered Care Delivery
The Role of Clinical Artifacts in Achieving Patient-centered Care
Delivery
Susan E. Piras RN, MSN and The Shared Expectations Early (SEE) Project Team
Doctoral Student
HFES 2013 International Symposium on Human Factors and Ergonomics in Health Care: Advancing the Cause
Outline
BackgroundProblem
– Context– Significance
MethodDiscussion
Background
• Observations from Clinical Ethics consultation service: – Families were shocked, surprised, and, at
times, in conflict.– Families are not equipped to make critical life
decisions on behalf of the patient. – Families and healthcare team often had
misaligned expectations about future care.
ContextSetting: Burn ICU Patient: center of physical careFamily: represent the patientEffect of unplanned health events
– Nature of burns– Patient population
IMAGES
Problem
When trauma occurs:• Patients are unable to direct their care• Advance directives are not in place.• Families as a surrogate to make life decisions• Future course of life, family structure, finances, and routine are affected
Methods
Field Observations: Trajectory of Care
Admission
Resuscitation
Surgical Debridement
Intubation, Vasopressors
Off Vasopressors, Extubation
Stabilization
Transition to Step-down unit
Further surgery
Discharge
Off IV pain medication on po
EatingPreparation for discharge
RECOVERY
CRITICAL
REHABILITATION
Clinician and Family Interviews
Clinician, when speaking about family presence:“…they’re not here the hours that we round…. I think that’s probably the biggest obstacle is finding them without a whole lot of trouble.”
Intensivist of BICU
Family, when speaking about communication from clinician“…they found a nodule…so they decided to do a CT…to rule out malignancy which is fine but I would have expected a call cause I didn’t
even know anything about a nodule, nothing.” Daughter of patient
Clinical Artifacts
Discussion:• Data was collected from families but
dissemination and purposeful-use was lacking• Artifacts were identified but not readily
accessible, inconsistently used, or underutilized.• Artifacts were integrated but not used to their full
potential.• Decision to systematically analyze unit artifacts.
Trajectory of Care: Communication Artifacts
Admission
Resuscitation
Surgical Debridement
Intubation, Vasopressors
Off Vasopressors, Extubation
Stabilization
Transition to Step-down unit
Further surgery
Discharge
Off IV pain medication on po
EatingPreparation for discharge
RECOVERY-Shift Rounds-White Board
CRITICAL-Nurses Admission Assessment Form-Burn Unit Handbook-Shift Rounds-White Board
REHABILITATION-Shift Rounds-White Board
Analysis of Artifacts
Systematic analysis of communication artifacts:– What is the purpose of this artifact?– What information does this artifact collect?– Who uses this artifact?– Who benefits from this artifact?– During which phase of care is it most utilized?– What message is the unit/institution conveying
with the use of this artifact?
Nursing Admission History
Data Form
Burn ICU Patient
Handbook
“People can go and read it, but, at first it’s just another confusing piece of paper.”
Charge RN BICU
Unit Announcement for
Multidisciplinary Rounds
“I heard on the speaker that they said… “family prepare for rounds”… I didn’t hear that until maybe the second or third one and then we started walking up and…kinda being a part of that conversation physically… rather than just sitting in (the room) and listening.”
Family member in BICU
White Board
“You know it may be Sunday and the date is still Friday; they don’t change the date.”
Family member in BICU
“They have the dry erase board in the room and, they usually have the day written up there and the nurse and another name on there sometimes. And that doesn’t always get changed day to day.”
Family member in BICU
Name
Discussion
• Multiple artifacts were identified that capture and relay data in the BICU
• Collected data was institution-centered• Interactive aspect of these artifacts has been
lost• Improve on present design
Critical Recovery Rehabilitation HOME
Major Milestone: Get off breathing machine
YOU ARE HERE
STAFF NOTES PATIENT & FAMILY NOTES
Surgeon: Critical Care Attending Physician: Tim Jones Nurse Practitioner: Bedside Nurse: Susan Smith RN
Date: November 2, 2012
KEY UPCOMING EVENTS: Surgery scheduled 11/3 at 9:00 a.m. Transfer to stepdown unit later this week
TODAY’S KEY GOALS: Decrease ventilator Increase nutrition intake
Patient’s Primary Contact Person: Betty Hopkins Contact Info:
Alternate Contact Person: Bob Hopkins Contact info:
If you cannot attend rounds for a daily update, please call 615.000.0000 for a daily update.
Date: 11/2/2012 Please share questions/concern/observations: -How many more surgeries will he have? --He needs haircut
Yesterday
See Project Team Members
• Anne Miller, Ph.D.• Joe Fanning, Ph.D.• David Schenck, Ph.D.• Paula DeWitt, Ph.D• Lee Parmley, M.D.• Larry Churchill, Ph.D.• Stuart McGrane, M.D.
• Cristina Farkas, MS2• Ricky Shinall, M.D. • Sparrow Smith, M.A.• Susan Piras, M.S.N. • John Burnam, M.T.S.• Tinsley Webster, M.A
Contact Information