AMIA ... Annual Symposium proceedings / AMIA Symposium. AMIA Symposium
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AMIA Annu Symp Proc · Jan 2014
Identification and management of information problems by emergency department staff.
Patient-care teams frequently encounter information problems during their daily activities. These information problems include wrong, outdated, conflicting, incomplete, or missing information. Information problems can negatively impact the patient-care workflow, lead to misunderstandings about patient information, and potentially lead to medical errors. ⋯ However, there is limited research on how patient-care teams currently identify and manage information problems that they encounter during their work. Through qualitative observations and interviews in an emergency department (ED), we identified the types of information problems encountered by ED staff, and examined how they identified and managed the information problems. We also discuss the impact that these information problems can have on the patient-care teams, including the cascading effects of information problems on workflow and the ambiguous accountability for fixing information problems within collaborative teams.
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The Tele Intensive Care Unit (tele-ICU) supports a high volume, high acuity population of patients. There is a high-volume of incoming and outgoing calls, especially during the evening and night hours, through the tele-ICU hubs. The tele-ICU clinicians must be able to communicate effectively to team members in order to support the care of complex and critically ill patients while supporting and maintaining a standard to improve time to intervention. ⋯ The software provides a multi-relational database of message instances to mine information for evaluation and quality improvement for all entities that touch the tele-ICU. The software design incorporates years of critical care and software design experience combined with new skills acquired in an applied Health Informatics program. This software tool will function in the tele-ICU environment and perform as a front-end application that gathers, routes, and displays internal communication messages for intervention by priority and provider.
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AMIA Annu Symp Proc · Jan 2013
Comparative StudyMobile app versus Web app: a comparison using 2008-2012 "PubMed for Handhelds" server data.
Recent surveys show that mobile apps are more popular than Web apps. Apple's iTunes Store, now has about 800,000 apps and reported to have about 40 billion downloads. Android apps, although fewer, is available to the most number of smartphones today. ⋯ Month-by-month comparison showed a 3 to 5-fold increase in queries. The six-month total accesses comparison increased 280% from the previous four-year average. A review of 500 randomly selected queries revealed that the majority of queries were clinical questions ((97.8%) and 61% of these queries are searches related to therapy.
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AMIA Annu Symp Proc · Jan 2013
A modified real AdaBoost algorithm to discover intensive care unit subgroups with a poor outcome.
The Intensive Care Unit (ICU) population is heterogeneous. At individual ICUs, the quality of care may vary within subgroups. We investigate whether poor outcomes of an ICU can be traced back to excess deaths in specific patient subgroups, by discovering candidate subgroups, with a modified adaptive decision tree boosting algorithm applied to 80 Dutch ICUs. ⋯ Variables Glasgow Coma Scale and age were used most. There were 29 ICUs with overall poor outcomes, and for 22 our algorithm found all excess deaths. A new method based on adaptive decision tree boosting discovered many subgroups of ICU patients for which there is potentially room for outcomes improvement.
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AMIA Annu Symp Proc · Jan 2013
Use of simulated physician handoffs to study cross-cover chart biopsy in the electronic medical record.
Clinical handoffs involve the rapid transfer of patient information from one provider or team to another, through activities which may introduce errors and affect care delivery. "Cross-coverage" requires quickly familiarizing oneself with unfamiliar patients whose management plans were established by another provider or team. Through this work, we describe physicians' information seeking approaches within an electronic medical record (EMR) during physician handoff and chart biopsy at a major academic medical center. ⋯ We found highly variable navigation of the EMR but greater similarity in physicians' EMR navigation behavior when the chart review was prompted by simulated interruptions. Understanding how physicians seek and assimilate patient data can inform handoff tool design and suggest strategies for explicitly supporting EMR chart biopsies.