Key Stakeholder Perceptions of Standard vs. Total Cost of Ownership: A Procurement Analysis for Orthopaedic-Powered Instruments.

This study compares standard procurement methodology (SPM) with total cost of ownership (TCO) methodology for the procurement of orthopaedic-powered instruments. The authors conducted semi-structured standardized interviews with key hospital procurement stakeholders following consolidated criteria for reporting qualitative research. Of the 33 hospital procurement stakeholders interviewed, all (100%) reported that SPM would be easier to use than TCO.

Inventory Optimization in the Perioperative Care Department Using Kotter's Change Model.

Background: Perioperative services have been scrutinized in the context of cost containment in health care, particularly in the procurement and reprocessing of surgical instruments. Although solutions such as surgical instrument inventory optimization (IO) have been proposed, there is a paucity of literature on how to implement this change. The purpose of this project was to describe the implementation of an IO using Kotter's Change Model (KCM).

Improving stroke prevention therapy for patients with atrial fibrillation in primary care: protocol for a pragmatic, cluster-randomized trial.

Background: The prevalence of atrial fibrillation (AF) is growing as the population ages, and at least 15% of ischemic strokes are attributed to AF. However, many high-risk AF patients are not offered guideline-recommended stroke prevention therapy due to a variety of system, provider, and patient-level barriers.

Methods: We will conduct a pragmatic, cluster-randomized controlled trial randomizing primary care clinics to test a "toolkit" of quality improvement interventions in primary care.

Technological aspects of hospital communication challenges: an observational study.

Objective: To gain insights into how technological communication tools impact effective communication among clinicians, which is critical for patient safety.

Design: This multi-site observational study analyzes inter-clinician communication and interaction with information technology, with a focus on the critical process of patient transfer from the Emergency Department to General Internal Medicine.

Setting: Mount Sinai Hospital, Sunnybrook Health Sciences Centre and Toronto General Hospital.

A smartphone-enabled communication system to improve hospital communication: usage and perceptions of medical trainees and nurses on general internal medicine wards.

Background: There is increasing interest in the use of information and communication technologies to improve how clinicians communicate in hospital settings.

Methods: We implemented a communication system with support for physician handover and secure messaging on 2 general internal medicine wards. We measured usage and surveyed physicians and nurses on perceptions of the system's effects on communication.

Effect of a postdischarge virtual ward on readmission or death for high-risk patients: a randomized clinical trial.

Importance: Hospital readmissions are common and costly, and no single intervention or bundle of interventions has reliably reduced readmissions. Virtual wards, which use elements of hospital care in the community, have the potential to reduce readmissions, but have not yet been rigorously evaluated.

Objective: To determine whether a virtual ward-a model of care that uses some of the systems of a hospital ward to provide interprofessional care for community-dwelling patients-can reduce the risk of readmission in patients at high risk of readmission or death when being discharged from hospital.

Put a face to a name: a randomized controlled trial evaluating the impact of providing clinician photographs on inpatients' recall.

Background: Inpatients are visited by many health care providers daily; many cannot remember the name of even one member of their clinical care team. We provided inpatients with photographs of their clinicians and evaluated the impact on patient recall and communication with their health care providers.

Methods: A concealed allocation, randomized controlled trial (ClinicalTrials.

Perceptions of lung cancer and potential impacts on funding and patient care: a qualitative study.

The objective of this study was to explore health-care professionals', health administrators', and not-for-profit cancer organization representatives' perceptions of lung cancer-related stigma and nihilism and the perceived impacts on funding and patient care. This is a qualitative descriptive study using semi-structured interviews, which was conducted in Ontario, Canada. Seventy-four individuals from medical oncology, radiation oncology, thoracic surgery, respirology, pathology, radiology, primary care, palliative care, nursing, pharmacy, social work, genetics, health administration, and not-for-profit cancer organizations participated in this study.

Medical students and personal smartphones in the clinical environment: the impact on confidentiality of personal health information and professionalism.

Background: Smartphones are becoming ubiquitous in health care settings. The increased adoption of mobile technology such as smartphones may be attributed to their use as a point-of-care information source and to perceived improvements in clinical communication and efficiency. However, little is known about medical students' use of personal smartphones for clinical work.

Inpatient and emergent resource use of patients on dialysis at an academic medical center.

Background/aim: End-stage renal disease patients require resources for emergent and inpatient care in addition to ambulatory dialysis. There are two dialysis modalities and settings which patients switch between. Our aim was to characterize the patterns and reasons for switching, as well as the emergent and inpatient utilization of these patients at the University Health Network.

Atrial fibrillation anticoagulation care in a large urban family medicine practice.

Objective: To determine the proportion of patients with atrial fibrillation (AF) in primary care achieving guideline-concordant stroke prevention treatment based on both the previous (2010) and the updated (2012) Canadian guideline recommendations.

Design: Retrospective chart review.

Participants: Primary care patients (N = 204) with AF.

Short message service or disService: issues with text messaging in a complex medical environment.

Background: Hospitals today are experiencing major changes in their clinical communication workflows as conventional numeric paging and face-to-face verbal conversations are being replaced by computer mediated communication systems. In this paper, we highlight the importance of understanding this transition and discuss some of the impacts that may emerge when verbal clinical conversations are replaced by short text messages.

Methods: In-depth interviews (n=108) and non-participatory observation sessions (n=260h) were conducted on the General Internal Medicine wards at five academic teaching hospitals in Toronto, Canada.

Use of an interdisciplinary, participatory design approach to develop a usable patient self-assessment tool in atrial fibrillation.

After identifying that significant care gaps exist within the management of atrial fibrillation (AF), a patient-focused tool was developed to help patients better assess and manage their AF. This tool aims to provide education and awareness regarding the management of symptoms and stroke risk associated with AF, while engaging patients to identify if their condition is optimally managed and to become involved in their own care. An interdisciplinary group of health care providers and designers worked together in a participatory design approach to develop the tool with input from patients.

Use of imaging in the emergency department: physicians have limited effect on variation.

Purpose: To quantify interphysician variation in imaging use during emergency department (ED) visits and examine the contribution of factors to this variation at the patient, visit, and physician level.

Materials And Methods: This study was HIPAA compliant and approved by the institutional review board of Partners Healthcare System (Boston, Mass), with waiver of informed consent. In this retrospective study of 88 851 consecutive ED visits during 2011 at a large urban teaching hospital, a hierarchical logistic regression model was used to identify multiple predictors for the probability that low- or high-cost imaging would be ordered during a given visit.

Educational impact of using smartphones for clinical communication on general medicine: more global, less local.

Background: Medical trainees increasingly use smartphones in their clinical work. Similar to other information technology implementations, smartphone use can result in unintended consequences. This study aimed to examine the impact of smartphone use for clinical communication on medical trainees' educational experiences.

The intended and unintended consequences of communication systems on general internal medicine inpatient care delivery: a prospective observational case study of five teaching hospitals.

Background: Effective clinical communication is critical to providing high-quality patient care. Hospitals have used different types of interventions to improve communication between care teams, but there have been few studies of their effectiveness.

Objectives: To describe the effects of different communication interventions and their problems.

It's not about pager replacement: an in-depth look at the interprofessional nature of communication in healthcare.

Background: Institutions have tried to replace the use of numeric pagers for clinical communication by implementing health information technology (HIT) solutions. However, failing to account for the sociotechnical aspects of HIT or the interplay of technology with existing clinical workflow, culture, and social interactions may create other unintended consequences.

Objective: To evaluate a Web-based messaging system that allows asynchronous communication between health providers and identify the unintended consequences associated with implementing such technology.

Our patients expect more (and so do we): it's time to rethink patient satisfaction.

A current focus of healthcare organizations and legislation requires hospitals to place more importance on patient experience and satisfaction than ever before. Institutional patient satisfaction survey tools yield data that represent approximately 5% of patients and may not represent the typical patient experience. Moreover, our research demonstrates that only 1% of surveyed providers rely on these data as their primary source of patient satisfaction feedback.

The relative influence of available resources during the residency match: a national survey of canadian medical students.

Background: Many medical students find choosing a residency challenging. There are several steps involved, including determining one's own priorities, arranging electives, choosing a training program and site, and preparing an in-depth application and a rank order list. Many resources are available to assist students, including the Canadian Resident Matching Service website, program websites, career counselors, career information sessions, mentors, peers, family/friends, and the Canadian Medical Residency Guide.

Computerised provider order entry and residency education in an academic medical centre.

Context: Many academic medical centres (AMCs) have introduced institutional policies, changed processes of care and implemented new technologies to improve health care quality. The impact of such changes on medical education has received little attention. We examine the impact of computerised provider order entry (CPOE) on the educational experiences of medical trainees who work and train in AMCs.

Effects of clinical communication interventions in hospitals: a systematic review of information and communication technology adoptions for improved communication between clinicians.

Objective: To conduct a systematic review of the literature to identify, describe and assess interventions of information and communication technology on the processes of communication and associated patient outcomes within hospital settings.

Materials And Methods: Studies published from the years 1996 to 2010 were considered and were selected if they described an evaluation of information and communication technology interventions to improve clinical communication within hospitals. Two authors abstracted data from full text articles, and the quality of individual articles were appraised.

Vaccine-critical videos on YouTube and their impact on medical students' attitudes about seasonal influenza immunization: a pre and post study.

YouTube is a video-sharing platform that is increasingly utilized to share and disseminate health-related information about immunization. Using a pre-post survey methodology, we compared the impact of two of the most popular YouTube videos discussing seasonal influenza vaccine, both vaccine-critical, on the attitudes towards immunizing of first year medical students attending a Canadian medical school. Forty-one medical students were randomized to view either a scientifically styled, seemingly "evidence-based", vaccine-critical video or a video using anecdotal stories of harms and highly sensationalized imagery.

The use of smartphones in general and internal medicine units: a boon or a bane to the promotion of interprofessional collaboration?

Effective communication and coordination are critical components for improving collaborative care delivery among different healthcare providers who work in mobile and time-pressured environments. Increasingly, healthcare providers are exploring alternative communication technologies to help bridge the temporal and spatial issues that are often inherent in the clinical communication conundrum. Our study examined perceptions of General Internal Medicine (GIM) staff on the usage of Smartphone devices and a Webpaging system, which were implemented on the inpatient GIM units at two teaching hospitals in North America.

A review of the cost of atrial fibrillation.

Objectives: To systematically review and synthesize the literature on the costs of atrial fibrillation (AF) with attention to study design and costing methods, geography, and intervention approaches.

Methods: A systematic search for previously published studies reporting the costs for AF patients was conducted. Data were analyzed in three steps: first by evaluating overall system costs; second by evaluating the relative contribution of specific cost components; and third by examining variations across study designs, across primary treatment approach, and by geography.