Ethical Issues in Implementation Science: A Qualitative Interview Study of Participating Clinicians.

Background: Implementation science presents ethical issues not well addressed by traditional research ethics frameworks. There is little empirical work examining how clinicians whose work is affected by implementation studies view these issues. Accordingly, we interviewed clinicians working at sites participating in an implementation study seeking to improve patient handoffs to the intensive care unit (ICU).

Perioperative Environment Safety Culture: A Scoping Review Addressing Safety Culture, Climate, Enacting Behaviors, and Enabling Factors.

While there is an increasing interest in patient safety and in transforming safety culture in the perioperative environment, it is not clear what methods are being used to understand, assess, and influence safety culture and climate. This article seeks to uncover what instruments and measures are used to assess safety culture and investigates how these measures are applied in baseline assessments and interventions in the perioperative environment to enhance/support safety culture. Study investigators are encouraged to collect and analyze data about engaging in behaviors that prevent, respond to, or resolve safety issues, and related factors that support understanding their effects.

Systematic Approach for Comparing Team-based Care Processes.

Team-based care process modeling techniques have focused on understanding and designing solutions for a single site. Less is known about tailoring an effective team-based care process from one site to another, which is necessary for multi-site implementation efforts. We propose an approach for analyzing and comparing a team-based care process performed at two sites to inform redesign opportunities.

Family, nurse, and physician beliefs on family-centered rounds: A 21-site study.

Background: Variation exists in family-centered rounds (FCR).

Objective: We sought to understand patient/family and clinician FCR beliefs/attitudes and practices to support implementation efforts.

Designs, Settings And Participants: Patients/families and clinicians at 21 geographically diverse US community/academic pediatric teaching hospitals participated in a prospective cohort dissemination and implementation study.

Intervention, individual, and contextual determinants to high adherence to structured family-centered rounds: a national multi-site mixed methods study.

Background: Effective communication in transitions between healthcare team members is associated with improved patient safety and experience through a clinically meaningful reduction in serious safety events. Family-centered rounds (FCR) can serve a critical role in interprofessional and patient-family communication. Despite widespread support, FCRs are not utilized consistently in many institutions.

Association of Patient and Family Reports of Hospital Safety Climate With Language Proficiency in the US.

Importance: Patients with language barriers have a higher risk of experiencing hospital safety events. This study hypothesized that language barriers would be associated with poorer perceptions of hospital safety climate relating to communication openness.

Objective: To examine disparities in reported hospital safety climate by language proficiency in a cohort of hospitalized children and their families.

Planning the Episode: Home Care Admission Nurse Decision-Making Regarding the Patient Visit Pattern.

During home health care (HHC) admissions, nurses provide input into decisions regarding the skilled nursing visit frequency and episode duration. This important clinical decision can impact patient outcomes including hospitalization. Episode duration has recently gained greater importance due to the Centers for Medicare and Medicaid Services (CMS) decrease in reimbursable episode length from 60 to 30 days.

Implementing Family-Centered Rounds in Hospital Pediatric Settings: A Scoping Review.

Context: The American Academy of Pediatrics and Institute for Patient and Family-Centered Care issued a joint policy statement in 2012 recommending family and nurse participation in rounds as a standard practice.

Objective: To synthesize available evidence on the state of the implementation of family-centered rounds (FCRs), including identified barriers to stakeholder acceptance and participation in FCRs in pediatric inpatient settings and implementation strategies to increase adherence and related outcomes.

Data Sources: PubMed and Medline and the Cochrane Database of Systematic Reviews.

Handoffs and transitions in critical care-understanding scalability: study protocol for a multicenter stepped wedge type 2 hybrid effectiveness-implementation trial.

Background: The implementation of evidence-based practices in critical care faces specific challenges, including intense time pressure and patient acuity. These challenges result in evidence-to-practice gaps that diminish the impact of proven-effective interventions for patients requiring intensive care unit support. Research is needed to understand and address implementation determinants in critical care settings.

A Cross University-Led COVID-19 Rapid-Response Effort: Design, Build, and Distribute Drexel AJFlex Face Shields.

The purpose of this article is to demonstrate how a new cross-community leadership team came together, collaborated, coordinated across academic units with external community partners, and executed a joint mission to address the unmet clinical need for medical face shields during these unprecedented times. Key aspects of this success include the ability to forge and leverage new opportunities, overcome challenges, adapt to changing constraints, and serve the significant need across the Philadelphia region and healthcare systems. We teamed to design-build durable face shields (AJFlex Shields).

Incorporating home healthcare nurses' admission information needs to inform data standards.

Objective: Patient transitions into home health care (HHC) often occur without the transfer of information needed for critical clinical decisions and the plan of care. Owing to a lack of universally implemented standards, there is wide variation in information transfer. We sought to characterize missing information at HHC admission.

There's a Problem With the Problem List: Incongruence of Patient Problem Information Across the Home Care Admission.

Objectives: Illustrate patterns of patient problem information received and documented across the home health care (HHC) admission process and offer practice, policy, and health information technology recommendations to improve information transfer.

Design: Observational field study.

Setting And Participants: Three diverse HHC agencies using different commercial point-of-care electronic health records (EHRs).

Getting to Complete and Accurate Medication Lists During the Transition to Home Health Care.

Objectives: Characterize the work that home health care (HHC) admission nurses complete as part of the medication reconciliation tasks, explore the impact of shared electronic medication data (interoperability) from the referral source on medication reconciliation, and highlight opportunities to enhance medication reconciliation with respect to transition in care to HHC agencies.

Design: Observational field study.

Settings And Participants: Three diverse Pennsylvania HHC agencies; each used different electronic health record systems with different interoperability characteristics.

Identification of temporal condition patterns associated with pediatric obesity incidence using sequence mining and big data.

Background: Electronic health records (EHRs) are potentially important components in addressing pediatric obesity in clinical settings and at the population level. This work aims to identify temporal condition patterns surrounding obesity incidence in a large pediatric population that may inform clinical care and childhood obesity policy and prevention efforts.

Methods: EHR data from healthcare visits with an initial record of obesity incidence (index visit) from 2009 through 2016 at the Children's Hospital of Philadelphia, and visits immediately before (pre-index) and after (post-index), were compared with a matched control population of patients with a healthy weight to characterize the prevalence of common diagnoses and condition trajectories.

Temporal condition pattern mining in large, sparse electronic health record data: A case study in characterizing pediatric asthma.

Objective: This study introduces a temporal condition pattern mining methodology to address the sparse nature of coded condition concept utilization in electronic health record data. As a validation study, we applied this method to reveal condition patterns surrounding an initial diagnosis of pediatric asthma.

Materials And Methods: The SPADE (Sequential PAttern Discovery using Equivalence classes) algorithm was used to identify common temporal condition patterns surrounding the initial diagnosis of pediatric asthma in a study population of 71 824 patients from the Children's Hospital of Philadelphia.

Incongruence of Patient Problem Information Across Three Phases of Home Care Admission: There's a Problem with the Problem List.

In home health care, the patient problem list is an important component of the admission and care planning processes and determines the subsequent care received. We examined the information received from the referring facilities and its relationship with the final patient problem list generated at home health care admission. Researchers observed 12 admissions and collected available documents related to the admission and care planning process.

Availability and Quality of Information Used by Nurses While Admitting Patients to a Rural Home Health Care Agency.

Home health care admission nurses need high quality patient information but that information is not uniformly available. Despite this challenge, these nurses must make four critical decisions at patient admission to construct the plan of care: (1) patient problems to address in the home health care episode; (2) patient medication management; (3) services in addition to skilled nursing; and (4) skilled nursing visit pattern. We observed 12 in-home admissions at a rural home health care agency and interviewed nurses before and after about these decisions.

Knowledge Elicitation of Homecare Admission Decision Making Processes via Focus Group, Member Checking and Data Visualization.

Researchers elicit knowledge related to expert decision-making processes to inform information technology design and related interventions. However, in healthcare, many subject matter experts have limited time for such endeavors. In addition, researchers need to analyze voluminous amounts of qualitative data.

Impact of Home Care Admission Nurses' Goals on Electronic Health Record Documentation Strategies at the Point of Care.

Home care nurses have multiple goals at the patient admission visit. Electronic health records support some of these goals, including high-quality documentation, but nurses may not complete the electronic documentation at the point of care. To characterize admission nurses' practices at the point of care and lay the foundation for design recommendations, this study investigates admission nurses' documentation strategies with respect to entering electronic data and how nursing goals affect them.

Home Care Admission Information: What Nurses Need and What Nurses Have. A Mixed Methods Study.

Effective communication between clinicians across care settings is fundamental for continuity of care and decreased risk of errors. The home care admission often starts without important information needed for formulation of the plan of care. We conducted a mixed methods analysis to investigate home care admission information from two perspectives: qualitative information regarding information nurses reported they needed during an admission, and quantitative information regarding information actually available.

Data Visualization of Home Care Admission Nurses' Decision-Making.

The hospital to home care admission process is when nurses make important decisions about the post-transition episode, including medication reconciliation, plan of care, future visit patterns, and the inclusion of other disciplines. It is not clear how nurses get and use information to support decision-making. We conducted a focus group case study with six admitting home health nurses at a rural agency in Pennsylvania.