Medicine and Health Sciences Commons^™

Nurse-Led Telehealth Visits For Patients With Multiple Sclerosis During The Covid-19 Pandemic And Beyond, Eun Hye Kim

Doctor of Nursing Practice (DNP) Projects

Background: Nearly one million individuals are affected with Multiple Sclerosis (MS) in the United States, and it was estimated the annual economic burden of multiple sclerosis in the U.S. at over $85.4 billion in 2022.

Problem: During the outbreak of COVID-19, the number of nurse-led patient education sessions has decreased due to the conversion of in-person clinic visits to telehealth visits. Despite the widespread use of telehealth for MS patients post-COVID-19 pandemic, limited data is available about the use of nurse-led telehealth visits with a standardized workflow.

Method: A quality improvement project was implemented at the MS clinic in Northern …

The Raci Matrix And Its Use In The Office, Michelle C. Dziurgot Dds

The Journal of the Michigan Dental Association

The RACI Matrix, crucial in office management, delegates tasks efficiently: Responsible individuals, like lead assistants, handle specific duties; Accountable, typically the manager, ensures smooth operations; Consulted, such as patients, provide input; Informed parties, like lab technicians, contribute expertise. By adhering to RACI, dental offices optimize workflow, enhance patient care, and address challenges effectively, ensuring a harmonious and efficient practice.

Implementing A New Clinical Note Template To Reduce Documentation Burden At A Pediatric Organization, Nikki Blaze

Translational Projects (Open Access)

Clinical notes of a patient’s visit to a healthcare provider are necessary for patient care, reimbursement, and regulatory compliance with federal and state laws. Over time, non-standardized processes within the EHR have led to the increasing use of copy-paste to complete clinical notes, leading to irrelevant information being captured in the notes. Sinsky et al. (2020) shared that 49% of physicians' time is spent within the EHR, completing their documentation, placing orders, and reviewing the patient's chart. The documentation requirements for billing and coding created tension as clinicians sought ways to reduce the documentation burden. To reduce the documentation burden …

J Mich Dent Assoc March 2024

The Journal of the Michigan Dental Association

Every month, The Journal of the Michigan Dental Association provides news, information, and features about Michigan dentistry to our state's oral health community and the MDA's 6,200+ members. It stands as the primary publication reaching Michigan dentists.

In the March 2024 issue, the Journal focuses on the landscape of practicing in rural settings. Original content includes:

• A cover story discussing "Market Realities for Rural and Small-Town Practices"

• A feature commentary from a new dentist in the Upper Peninsula on "Why I Chose to Practice in Rural Michigan"

• A feature article highlighting a dental education initiative, "Washington’s RIDE Program: A Model …

  ---

  Go to article

Assessing Workflow In The Postanesthesia Care Unit, Laura Mcgrath, Emma Vierod

Doctor of Nursing Practice (DNP) Student Projects

The postanesthesia care unit (PACU) environment must function smoothly as a critical recovery area for monitoring of immediate postoperative patients. Timely responsiveness to complications is imperative to ensure patient safety. Following postanesthesia observation, a patient is discharged from the PACU to home or is admitted to the hospital. If this transition is delayed by excessive discharge times or poorly managed patient adverse events, it can cause major bottlenecks and issues with throughput for the perioperative setting. This project aims to study the present workflow in the PACU, identify gaps in the workflow and provide recommendations to perioperative leadership. Current PACU …

Clinical And Dosimetric Impact Of 2d Kv Motion Monitoring And Intervention In Liver Stereotactic Body Radiation Therapy., Andrew Santoso, Yevgeniy Vinogradskiy, Tyler Robin, Karyn Goodman, Tracey Schefter, Moyed Miften, Bernard Jones

Department of Radiation Oncology Faculty Papers

PURPOSE: Positional errors resulting from motion are a principal challenge across all disease sites in radiation therapy. This is particularly pertinent when treating lesions in the liver with stereotactic body radiation therapy (SBRT). To achieve dose escalation and margin reduction for liver SBRT, kV real-time imaging interventions may serve as a potential solution. In this study, we report results of a retrospective cohort of liver patients treated using real-time 2D kV-image guidance SBRT with emphasis on the impact of (1) clinical workflow, (2) treatment accuracy, and (3) tumor dose.

METHODS AND MATERIALS: Data from 33 patients treated with 41 courses …

Evaluating Nursing Workflow & Satisfaction Through Patient Sleep Promotion On An Orthopedic Trauma Unit, Samantha Tiede Bsn, Rn

Posters & Presentations

Poster presented at Parkview Nursing Research Symposium, 2023.

Questioned the evidence and necessity around the nursing practice of routine, every four-hour, vital signs during bedtime hours in relation to nursing workflow, satisfaction, and staffing limitations.

Reviewed current staff opinions and personal practices regarding patient rest. Also identified miscellaneous physician orders used to direct patient sleep promotion.

Evaluated opportunities for sleep promotion resulting in the discovery of a “Sleep Bundle” pilot on the acute medical floors.

Adapted pilot to better suit the needs of the orthopedic trauma patient population.

Goal: Balancing nursing tasks and aiding in improved patient outcomes.

The Status Of Digital Pathology And Associated Infrastructure Within Alzheimer's Disease Centers, Rebeca Scalco, Richard J Perrin, Et Al.

2020-Current year OA Pubs

Digital pathology (DP) has transformative potential, especially for Alzheimer disease and related disorders. However, infrastructure barriers may limit adoption. To provide benchmarks and insights into implementation barriers, a survey was conducted in 2019 within National Institutes of Health's Alzheimer's Disease Centers (ADCs). Questions covered infrastructure, funding sources, and data management related to digital pathology. Of the 35 ADCs to which the survey was sent, 33 responded. Most respondents (81%) stated that their ADC had digital slide scanner access, with the most frequent brand being Aperio/Leica (62.9%). Approximately a third of respondents stated there were fees to utilize the scanner. For …

Using Education To Improve Timeliness And Efficiency Of Medication Administration In An Inpatient Hospital Setting: A Quality Improvement Project, Kevin Christopher Lane

Master's Theses and Capstones

Background: Timeliness of medication administration is important for optimal patient care. Technology, interdepartmental communication, and nursing workflow influence on-time delivery of medications. Improving knowledge through PowerPoint™ education and visual aids such as medication alert placards improves interdepartmental communication and positively influences nursing workflow leading to improved medication delivery times.

Local Problem: Nurses spend considerable time looking for and administering medications to patients on the unit. A goal was established to reduce the amount of time nurses spent looking for medications by 5% after implementing PowerPoint™ education to improve workflow.

Methods: This project used the Plan-Do-Study-Act (PDSA) strategy for implementation. …

A Quality Improvement Initiative To Improve Access And Patient Flow In A Non-Emergency Walk-In Care Clinic, Renee J. Broze

DNP Scholarly Projects

Background: A community-based non-emergency walk-in clinic in Southern New Hampshire experienced high volume and inefficient workflows during the pandemic, causing delays in care, long visit times, and low net promoter scores.

Purpose: Institute an evidence-based approach to improve work efficiency through innovative models of care.

Methods: A literature review on best practices for workflow redesign guided the project. The project instituted an on-demand telemedicine service and a clinic fast-track workflow. A mixed methods approach analyzed pre /post cycle times, net promoter scores, and themes from staff interviews. Pre/post cycle times analyzed 12,767 completed appointments.

Results: There was a statistically significant …

Expanding Reach Of Public Health: Lessons From A Pilot Project To Develop Remote Dementia Diagnostic Processes., Chloe Hale, Jennifer Harrison

Georgia Public Health Association Annual Meeting and Conference

Georgia Department of Public Health Injury Prevention Program works to create a healthy Georgia by leveraging resources, addressing systems change, and fortifying a robust person-centered public health response to dementia, including Alzheimer’s disease. The response utilizes Georgia’s established infrastructure, clear priorities, and the dynamic network of partnerships guided by a regularly updated state plan to increase capacity and access to quality care. Systemic change through collaboration and communication can empower people living with dementia, their care partners, professionals, and communities.

The pilot remote dementia diagnostic process and procedure engages long-term plans for increasing annual wellness visits, dementia risk reduction, early …

Ten Simple Rules And A Template For Creating Workflows-As-Applications, Michael J. Roach, N. Tessa Pierce-Ward, Radoslaw Suchecki, Vijini Mallawaarachchi, Bhavya Papudeshi, Scott A. Handley, C. Titus Brown, Nathan S. Watson-Haigh, Robert A. Edwards

2020-Current year OA Pubs

No abstract provided.

Ontology-Based Feature Engineering In Machine Learning Workflows For Heterogeneous Epilepsy Patient Records, Satya S Sahoo, Katja Kobow, Jianzhe Zhang, Jeffrey Buchhalter, Mojtaba Dayyani, Dipak P Upadhyaya, Katrina Prantzalos, Meenakshi Bhattacharjee, Ingmar Blumcke, Samuel Wiebe, Samden D Lhatoo

Journal Articles

Biomedical ontologies are widely used to harmonize heterogeneous data and integrate large volumes of clinical data from multiple sources. This study analyzed the utility of ontologies beyond their traditional roles, that is, in addressing a challenging and currently underserved field of feature engineering in machine learning workflows. Machine learning workflows are being increasingly used to analyze medical records with heterogeneous phenotypic, genotypic, and related medical terms to improve patient care. We performed a retrospective study using neuropathology reports from the German Neuropathology Reference Center for Epilepsy Surgery at Erlangen, Germany. This cohort included 312 patients who underwent epilepsy surgery and …

Real-Time Analysis And Display Of Quantitative Measures To Track And Improve Clinical Workflow, Reshma Munbodh, Toni M Roth, Kara L Leonard, Robert C Court, Utkarsh Shukla, Sarah Andrea, Marissa Gray, Gregg Leichtman, Eric E Klein

2020-Current year OA Pubs

PURPOSE: Radiotherapy treatment planning is a complex process with multiple, dependent steps involving an interdisciplinary patient care team. Effective communication and real-time tracking of resources and care path activities are key for clinical efficiency and patient safety.

MATERIALS AND METHODS: We designed and implemented a secure, interactive web-based dashboard for patient care path, clinical workflow, and resource utilization management. The dashboard enables visualization of resource utilization and tracks progress in a patient's care path from the time of acquisition of the planning CT to the time of treatment in real-time. It integrates with the departmental electronic medical records (EMR) system …

A Simple Standard For Sharing Ontological Mappings (Sssom)., Nicolas Matentzoglu, James P Balhoff, Susan M. Bello, Chris Bizon, Matthew Brush, Tiffany J Callahan, Christopher G Chute, William D Duncan, Chris T Evelo, Davera Gabriel, John Graybeal, Alasdair Gray, Benjamin M Gyori, Melissa Haendel, Henriette Harmse, Nomi L Harris, Ian Harrow, Harshad B Hegde, Amelia L Hoyt, Charles T Hoyt, Dazhi Jiao, Ernesto Jiménez-Ruiz, Simon Jupp, Hyeongsik Kim, Sebastian Koehler, Thomas Liener, Qinqin Long, James Malone, James A Mclaughlin, Julie A Mcmurry, Sierra Moxon, Monica C Munoz-Torres, David Osumi-Sutherland, James A Overton, Bjoern Peters, Tim Putman, Núria Queralt-Rosinach, Kent Shefchek, Harold Solbrig, Anne Thessen, Tania Tudorache, Nicole Vasilevsky, Alex H Wagner, Christopher J Mungall

Faculty Research 2022

Despite progress in the development of standards for describing and exchanging scientific information, the lack of easy-to-use standards for mapping between different representations of the same or similar objects in different databases poses a major impediment to data integration and interoperability. Mappings often lack the metadata needed to be correctly interpreted and applied. For example, are two terms equivalent or merely related? Are they narrow or broad matches? Or are they associated in some other way? Such relationships between the mapped terms are often not documented, which leads to incorrect assumptions and makes them hard to use in scenarios that …

Evaluation Of A Pharmacist-Led Health Literacy Workflow In The Ambulatory Clinic, Alexis Mann Pharmd, Mba

Parkview Pharmacy Department

Presented at the 36th Great Lakes Pharmacy Residency Conference.

Advancing Ubiquitous Collaboration For Telehealth - A Framework To Evaluate Technology-Mediated Collaborative Workflow For Telehealth, Hypertension Exam Workflow Study, Christopher Bondy Ph.D., Linlin Chen Ph.D, Pamela Grover Md, Pengcheng Shi Ph.D

Articles

Healthcare systems are under siege globally regarding technology adoption; the recent pandemic has only magnified the issues. Providers and patients alike look to new enabling technologies to establish real-time connectivity and capability for a growing range of remote telehealth solutions. The migration to new technology is not as seamless as clinicians and patients would like since the new workflows pose new responsibilities and barriers to adoption across the telehealth ecosystem. Technology-mediated workflows (integrated software and personal medical devices) are increasingly important in patient-centered healthcare; software-intense systems will become integral in prescribed treatment plans [1]. My research explored the path to …

Optimizing Secure Patient Messaging Workflow In A Vermont Primary Care Clinic, Kimberly S. Oleary

College of Nursing and Health Sciences Doctor of Nursing Practice (DNP) Project Publications

Optimizing Secure Patient Messaging Workflow in a Vermont Primary Care Clinic

Kim O’Leary, DNPc, RN

DNP Advisor: Margaret Aitken, DNP, AGNP, ANP-BC

Site Mentor: James Williamson, MHA, Site Supervisor, Adult Primary Care

Background: Secure patient messaging is a popular tool designed for non-urgent questions, yet patients sometimes use it to relay urgent concerns. As office workflows tend to prioritize responses to other methods of communication, this presents a potentially unsafe situation in which clinical staff may not respond to these urgent messages in a timely manner.

Purpose: To develop a methodology to improve the timeliness, effectiveness, and safety of secure …

Evaluating Technology-Mediated Collaborative Workflows For Telehealth, Christopher Bondy Ph.D., Pengcheng Shi, Pamela Grover Md, Vicki Hanson, Linlin Chen, Rui Li

Articles

Goals: This paper discusses the need for a predictable method to evaluate gains and gaps of collaborative technology-mediated workflows and introduces an evaluation framework to address this need. Methods: The Collaborative Space Analysis Framework (CS-AF), introduced in this research, is a cross-disciplinary evaluation method designed to evaluate technology-mediated collaborative workflows. The 5-step CS-AF approach includes: (1) current-state workflow definition, (2) current-state (baseline) workflow assessment, (3) technology-mediated workflow development and deployment, (4) technology-mediated workflow assessment, (5) analysis, and conclusions. For this research, a comprehensive, empirical study of hypertension exam workflow for telehealth was conducted using the CS-AF approach. Results: The CS-AF …

Implementing An Application Programming Interface For Promis Measures At Three Medical Centers, Michael Bass, Christian Oncken, Allison W. Mcintyre, Chris Dasilva, Joshua Spuhl, Nan E. Rothrock

2020-Current year OA Pubs

BACKGROUND: There is an increasing body of literature advocating for the collection of patient-reported outcomes (PROs) in clinical care. Unfortunately, there are many barriers to integrating PRO measures, particularly computer adaptive tests (CATs), within electronic health records (EHRs), thereby limiting access to advances in PRO measures in clinical care settings.

OBJECTIVE: To address this obstacle, we created and evaluated a software integration of an Application Programming Interface (API) service for administering and scoring Patient-Reported Outcomes Measurement Information System (PROMIS) measures with the EHR system.

METHODS: We created a RESTful API and evaluated the technical feasibility and impact on clinical workflow …

Commonalities Across Computational Workflows For Uncovering Explanatory Variants In Undiagnosed Cases, Shilpa Nadimpalli Kobren, Dustin Baldridge, Daniel J Wegner, Alexander J Paul, Et Al.

2020-Current year OA Pubs

PURPOSE: Genomic sequencing has become an increasingly powerful and relevant tool to be leveraged for the discovery of genetic aberrations underlying rare, Mendelian conditions. Although the computational tools incorporated into diagnostic workflows for this task are continually evolving and improving, we nevertheless sought to investigate commonalities across sequencing processing workflows to reveal consensus and standard practice tools and highlight exploratory analyses where technical and theoretical method improvements would be most impactful.

METHODS: We collected details regarding the computational approaches used by a genetic testing laboratory and 11 clinical research sites in the United States participating in the Undiagnosed Diseases Network …

Novel Autosegmentation Spatial Similarity Metrics Capture The Time Required To Correct Segmentations Better Than Traditional Metrics In A Thoracic Cavity Segmentation Workflow, Kendall J Kiser, Arko Barman, Sonja Stieb, Clifton D Fuller, Luca Giancardo

2020-Current year OA Pubs

Automated segmentation templates can save clinicians time compared to de novo segmentation but may still take substantial time to review and correct. It has not been thoroughly investigated which automated segmentation-corrected segmentation similarity metrics best predict clinician correction time. Bilateral thoracic cavity volumes in 329 CT scans were segmented by a UNet-inspired deep learning segmentation tool and subsequently corrected by a fourth-year medical student. Eight spatial similarity metrics were calculated between the automated and corrected segmentations and associated with correction times using Spearman's rank correlation coefficients. Nine clinical variables were also associated with metrics and correction times using Spearman's rank …

Electronic Clinical Decision Support For Children With Minor Head Trauma And Intracranial Injuries: A Sociotechnical Analysis, Jacob K Greenberg, Ayodamola Otun, Azzah Nasraddin, Ross C Brownson, Nathan Kuppermann, David D Limbrick, Po-Yin Yen, Randi E Foraker

2020-Current year OA Pubs

BACKGROUND: Current management of children with minor head trauma (MHT) and intracranial injuries is not evidence-based and may place some children at risk of harm. Evidence-based electronic clinical decision support (CDS) for management of these children may improve patient safety and decrease resource use. To guide these efforts, we evaluated the sociotechnical environment impacting the implementation of electronic CDS, including workflow and communication, institutional culture, and hardware and software infrastructure, among other factors.

METHODS: Between March and May, 2020 semi-structured qualitative focus group interviews were conducted to identify sociotechnical influences on CDS implementation. Physicians from neurosurgery, emergency medicine, critical care, …

Multifaceted Management Of Covid In The Medical Student Population Of Sidney Kimmel Medical College, Wayne Bond Lau, Kristin Desimone, Leonard Levine, Kathryn Trayes, Charlie Pohl

Department of Emergency Medicine Posters

COVID has created hardships in the lives of many persons. In a time of chaos, it was clear our institution needed an efficient workflow to track all students requiring quarantine, so that academic progress and student wellness would not be casualties.

This presentation reviews that workflow in detail, for the purpose of sharing strengths of the process for the greater GSA/OSR network’s benefit.

Increasing Comfort Of Mychart Patient Messaging In An Outpatient Oncology Clinic, Katherine Herdzik

Master of Science in Nursing Scholarly Project

Increasing Comfort of MyChart Patient Messaging in an Outpatient Oncology Clinic

Katherine Herdzik, BSN, RN

Abstract

Electronic patient portals have provided increased access to the electronic health record and patient information. A feature within the portal is a messaging system, creating a secure method of communication between and patient/family member and their care team. Scholarly literature has suggested that this method of communication helps to increase trust between the patient and providers, enhancing the healthcare experience. This study focuses on educational review to increase comfort with the MyChart messaging portal for care managers and nurse practitioners in an outpatient pediatric …

Creation Of A Covid-19 Community Testing Team For Home Health And Hospice, Lilah Raja

Master's Projects and Capstones

The novel SARS-CoV-2 strain (COVID-19) was identified in Wuhan, China in December 2019 (Eddy et. al, 2020). The resulting US outbreak has affected the Kaiser Permanente (KP) Oakland health care system. With the threat of COVID-19 highest among immunosuppressed and elderly clients, KP Oakland home health and hospice (HH/HO) department is rapidly mobilizing to provide community and in-home testing for eligible clients. A project was created to build a COVID-19 testing team workflow to provide diagnostic and preventative testing. This project focuses on team-based interventions that will change the pre-existing practice of requiring HH/HO clients to travel to remote testing …

Technology And Workflow Recommendations To Improve Use Of Guideline Directed Medical Therapy For Heart Failure With Reduced Ejection Fraction., Roy Robertson Md, Ryan Ahmed, Tammy Toscos Phd, Victor P. Cornet Ms, Shauna Wagner, Sarah Colletta, Carly Daley, Michael Mirro Md

Health Services and Informatics Research

BACKGROUND: Optimal use of Guideline Directed Medical Therapy (GDMT) is the cornerstone of reducing mortality and morbidity in heart failure patients with reduced ejection fraction (HFrEF). Interventions targeted at increasing GDMT use are necessary to improve outcomes. Integration of a pharmacist in specialty clinics may improve GDMT use; However, the potential benefit may be underrealized due to constraints in technology use and workflow.

PROJECT INTENT: To understand existing processes and explore workflow optimization opportunities to enhance use of GDMT prescription for patients with HFrEF.

METHODOLOGY: Teams of 2 researchers performed contextual inquiry4 during in-situ, 2-hour observations with 5 physicians, 3 …

Lean Daily Management: Keeping Quality And Safety At The Forefront During The Covid-19 Pandemic, Suneela Nayak, Ruth Hanselman, Natalia Johnson, Sydney Green

Operations Transformation

This storyboard describes how our Operational Excellence Platform pivoted to keep quality at the forefront of the Covid-19 response. Applying the Framework for Safe Effective and Reliable Care, we implemented the following innovations:

• Daily quality huddles became virtual, with 70-100 frontline leaders sharing alerts, announcements and celebrations
• Traditional Gemba Walks transformed into daily Executive Gemba Rounds visiting all care teams and focusing on patient and workforce safety.
• Patient and Workforce safety concerns were resolved real time and those requiring coordinated response were triaged to the Hospital Incident Command System (HICS) for accelerated action.

Innovative communication strategies were adopted to clarify …

Development And Implementation Of A Covid-19 Specific Peri-Operative Workflow For Anesthesia Providers, Alexander Olson, David Maguire, David Gratch, Dietrich Gravenstein, Michael Mahla, Anna Rabinowitz

Health Equity and Quality Improvement (HEQI) Summit

What's the Problem?

• Needed to develop and clarify the use of PPE in the COVID-19 era
• New considerations for infection control in OR
• Unique airway equipment and filter placement considerations
• Potential shortages of equipment and medications, need for conservation
• Need to incorporate human factors principles into protocol release and procedural compliance

We realized that there was no standard protocol for these functions existing in a visually compelling graphic form for wide distribution throughout anesthesia care areas, and sought to create one.

On Privacy-Aware Escience Workflows, Khalid Belhajjame, Noura Faci, Zakaria Maamar, Vanilson Burégio, Edvan Soares, Mahmoud Barhamgi

All Works

© 2020, Springer-Verlag GmbH Austria, part of Springer Nature. Computing-intensive experiments in modern sciences have become increasingly data-driven illustrating perfectly the Big-Data era. These experiments are usually specified and enacted in the form of workflows that would need to manage (i.e., read, write, store, and retrieve) highly-sensitive data like persons’ medical records. We assume for this work that the operations that constitute a workflow are 1-to-1 operations, in the sense that for each input data record they produce a single data record. While there is an active research body on how to protect sensitive data by, for instance, anonymizing datasets, …