Information Technology | Patient Safety | Coordination

Information Technology for Care Coordination

Advance video technology to support operating room coordination.
Peter Hu and his colleagues described an innovative design solution in 2006 issue of Surgical Innovation that maximizes information while ensures patient and staff confidentiality. The staff through the technology (VideoBoard) can obtain real-time OR video at different level of clarity for improved situation awareness. VideoBoard has become an operations necessity as demanded by clinicians. [Sponsored by DoD and NSF]

Supporting multi-disciplinary rounds with information technology
Ayse Gurses and Yan Xiao systematically reviewed the literature on how information tools are used to support care coordination in an 2006 issue of Journal of American Medical Informatics Association. Important functions of information tools to support care coordination were identified as information organization, team communication, and work management, which could be achieved through automatic extraction from clinical information systems, displays and printouts in condensed forms, at-a-glance representations of the care unit, and storing work-process information ephemerally. [Sponsored by NSF].

Automated patient in/out status display supporting OR coordination
Yan Xiao and his colleagues described an algorithm in 2005 issue of Anesthesia & Analgesiato identify remotely whether a patient is in the OR. The algorithm was implemented at a trauma OR (6 room) and a general OR (19 room) and has been used since 2002 in operations to provide real-time, automated, patient in and out time information. The accuracy of the algorithm was shown to be equivalent to human data collection (about 5 minutes). [Sponsored by DoD and NSF]

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What do they use to call a trauma team together?
Yan Xiao and colleagues analyzed a national survey of trauma centers on the use communication technologies in assembling trauma teams in a 2006 issue of Journal of Emergency Medicine. Manual or computerized pagers were number one choice (57% and 37%, respectively). Cellular phones have become a medium of choice between field and hospital care providers. Penetration of newer methods of communications (e.g., text messages and image transfers) was rare. [Sponsored by NSF]

Care coordination system by paper, whiteboards, and computers.
Yan Xiao and Jake Seagull reported their insight of how computers, paper documents, and whiteboards were used in conjunction to support care coordination in an upcoming issue of International Journal of Medical Informatics. When compared with papers and whiteboards, current designs of computerized system are rigid and difficult for care providers to adapt for ever changing communication patterns.

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Patient Safety

Mentors Decrease Compliance with Best Sterile Practices
Jim Guzzo (then a 2nd year surgical resident) analyzed with other researchers video recorded sterile practices during central line placement in an 2006 issue of Surgical Infections. Mentors in the studied cases were found to be a poor role models in complying to sterile practices. Trainees complied more frequently than mentors (88% vs 69%, p<0.01). [Sponsored by AHRQ].

Dynamic delegation medical training.
Yan Xiao with lead author Katherine Klein (professor at Wharton School of Business) interviewed attendings, fellows, and residents in a trauma center to understand leadership in trauma teams, the results of which will be published in the premier journal of Administrative Science Quarterly. Ensuring patient safety while fulfilling academic medicine’s training mission requires attendings and fellows to dynamically delegate leadership from moment to moment. [Sponsored by Army Research Institute]

Ergonomics for tray content design and locations.
Jake Seagull and colleagues analyzed videos of emergency chest tube insertions in a trauma centers to see the impact of chest tray content and locations, published in 2006 issue of Journal of Trauma. Ergonomic analysis revealed risks to the patient and operator by poor instrument-tray positioning and or awkward instrument content. [Sponsored by AHRQ]

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Coordination

Dialogic coordination of trauma teams
Yan Xiao with lead author Samer Faraj (professor at Smith School of Business) reported their major in-depth study of trauma teams in an 2006 issue of Management Science. Facing coordination challenges that were previously poorly studied, trauma teams employ expertise coordination practices of relying on protocols and flexible teaming to counter extreme demands of expertise and resources at times in a busy trauma center. The abilities of trauma teams to cross monitor and adapt protocols were modeled as dialogic coordination: interactive processes among care providers of different disciplines in time-critical responses to novel events and to ensure error-free operation. [Sponsored by NSF]

Who takes care of a trauma patient in the first 15 minutes of admission?
Young-Ju Kim (then a doctoral student from School of Nursing) and collaborators analyzed the availability of trauma specialists in Level I and II trauma centers through a national survey, which will be published in Journal of Trauma. Upon admission only 37% of the trauma centers responded to have trauma surgeons present. For low patient volume centers, early triage, and better notification systems should be considered to better utilize trauma surgeons. [Sponsored by NSF]

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Coordination when operating at capacity, resiliently
Anne Miller (while visiting from Down Under) and Yan Xiao studied how a trauma center responded to fluctuating care demands that will be published in Cognition, Technology, & Work, a journal dedicated to cognitive engineering. Interviews with clinicians with administrative roles were conducted that uncovered multi-level strategies to compensate seasonal variations of care demands. Overlapping shifts were used to tackle daily variations. [Sponsored by NSF]

Negotiation in care coordination
Yan Xiao and colleagues (including collaborators from Carnegie Mellon University) reported their field studies on conflict management in often contentious process of managing operating rooms in an upcoming issue in Cognition, Technology, & Work on large scale collaboration . Coordinators at the “sharp end” are frequently confronted with conflicts. To manage conflicts, they developed ways to induce perceived fairness, often through opportunistic means. Information technology may be difficult for coordinators to manage conflicts because, for example, it can be difficult for them to be tactful in communication. [Sponsored by NSF]

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