Use of a real-time, algorithm-driven, publicly displayed, automated signal to improve insulin prescribing practices.

Aim: The clinical andon board (CAB) is a novel electronic surveillance and communication system, which alerts providers to and prompts treatment of dysglycemia. This investigation was designed to determine the CAB's effectiveness in supporting adherence to standardized evidence-based protocols, as well as improving glycemic control.

Methods: This study was a retrospective pre/post analysis of insulin orders and blood glucose values.

Effectiveness of a multi-component quality improvement intervention on rates of hyperglycaemia.

Purpose: To evaluate the effectiveness of a multifaceted, hospital-wide glycaemic control quality improvement programme.

Methods: The quality improvement intervention comprised three components, derived through root cause analysis: standardising and simplifying care (including evidence-based order sets), increasing visibility (through provider access to clinical data and direct feedback) and educational outreach (directed at the entire institution). Effectiveness was determined at a single urban acute care hospital through time-series analysis with statistical process control charts.

Effect of a Real-Time Electronic Dashboard on a Rapid Response System.

A rapid response system (RRS) may have limited effectiveness when inpatient providers fail to recognize signs of early patient decompensation. We evaluated the impact of an electronic medical record (EMR)-based alerting dashboard on outcomes associated with RRS activation. We used a repeated treatment study in which the dashboard display was successively turned on and off each week for ten 2-week cycles over a 20-week period on the inpatient acute care wards of an academic medical center.

Inbox Messaging: an effective tool for minimizing non-urgent paging related interruptions in hospital medicine provider workflow.

Communication is one of the foundations on which safe, high quality care is built. The nature of hospital medicine requires that nurses and providers be efficient and effective in communicating with multiple disciplines. This need for timely communication must continually be balanced with the need to minimize interruptions in workflow.

Making background work visible: opportunities to address patient information needs in the hospital.

Despite growing use of patient-facing technologies such as patient portals to address information needs for outpatients, we understand little about how patients manage information and use information technologies in an inpatient context. Based on hospital observations and responses to an online questionnaire from previously hospitalized patients and caregivers, we describe information workspace that patients have available to them in the hospital and the information items that patients and caregivers rate as important and difficult to access or manage while hospitalized. We found that patients and caregivers desired information-such as the plan of care and the schedule of activities-that is difficult to access as needed in a hospital setting.

Building an automated problem list based on natural language processing: lessons learned in the early phase of development.

Detailed problem lists that comply with JCAHO requirements are important components of electronic health records. Besides improving continuity of care electronic problem lists could serve as foundation infrastructure for clinical trial recruitment, research, biosurveillance and billing informatics modules. However, physicians rarely maintain problem lists.