Deployment of a human-centred clinical decision support system for pulmonary embolism: evaluation of impact on quality of diagnostic decisions.

Unlabelled: Pulmonary embolism (PE) is a serious condition that presents a diagnostic challenge for which diagnostic errors often happen. The literature suggests that a gap remains between PE diagnostic guidelines and adherence in healthcare practice. While system-level decision support tools exist, the clinical impact of a human-centred design (HCD) approach of PE diagnostic tool design is unknown.

Computerised clinical decision support system for the diagnosis of pulmonary thromboembolism: a preclinical pilot study.

Background: Recommendations for the diagnosis of pulmonary embolism are available for healthcare providers. Yet, real practice data show existing gaps in the translation of evidence-based recommendations. This is a study to assess the effect of a computerised decision support system (CDSS) with an enhanced design based on best practices in content and reasoning representation for the diagnosis of pulmonary embolism.

Developing EMR-based algorithms to Identify hospital adverse events for health system performance evaluation and improvement: Study protocol.

Background: Measurement of care quality and safety mainly relies on abstracted administrative data. However, it is well studied that administrative data-based adverse event (AE) detection methods are suboptimal due to lack of clinical information. Electronic medical records (EMR) have been widely implemented and contain detailed and comprehensive information regarding all aspects of patient care, offering a valuable complement to administrative data.

Impact of wait times for treatment on clinical outcomes in patients with obstructive sleep apnoea: protocol for a randomised controlled trial.

Background: Obstructive sleep apnoea (OSA) is a common chronic condition that is associated with significant morbidity and economic cost. Prolonged wait times are increasingly being recognised as a barrier to diagnosis and treatment of many chronic diseases; however, no study to date has prospectively evaluated the impact of wait times on health outcomes in OSA.

Objective: The purpose of this study is to determine whether treatment outcomes for individuals with OSA differ between patients managed using an expedited standard pathway.

Effects of Wait Times on Treatment Adherence and Clinical Outcomes in Patients With Severe Sleep-Disordered Breathing: A Secondary Analysis of a Noninferiority Randomized Clinical Trial.

Importance: Sleep-disordered breathing (SDB) is common and associated with substantial adverse health consequences. Long wait times for SDB care are commonly reported; however, it is unclear whether wait times for care are associated with clinical outcomes.

Objective: To evaluate the association of wait times for care with clinical outcomes for patients with severe SDB.

A Randomized Controlled Trial of an Alternative Care Provider Clinic for Severe Sleep-disordered Breathing.

Lack of timely access to diagnosis and treatment of sleep-disordered breathing (SDB) has sparked interest in using nonphysician providers. Previous studies of these alternative care providers (ACPs) excluded patients with more complicated forms of SDB and did not directly explore the impacts of a model incorporating ACPs on healthcare system performance, such as wait times. To evaluate the use of ACPs in the management of patients with severe SDB from a clinical and system perspective.

A randomised controlled trial assessing the efficacy of an electronic discharge communication tool for preventing death or hospital readmission.

Objective: To assess the efficacy of an electronic discharge communication tool (e-DCT) for preventing death or hospital readmission, as well as reducing patient-reported adverse events after hospital discharge. The e-DCT assessed has already been shown to yield high-quality discharge summaries with high levels of patient and physician satisfaction.

Methods: This two-arm randomised controlled trial was conducted in a Canadian tertiary care centre's internal medicine medical teaching units.

Evaluation of an alternative care provider clinic for severe sleep-disordered breathing: a study protocol for a randomised controlled trial.

Introduction: Despite the high prevalence of sleep-disordered breathing (SDB) and the significant health consequences associated with untreated disease, access to diagnosis and treatment remains a challenge. Even patients with severe SDB (severe obstructive sleep apnoea or hypoventilation), who are at particularly high risk of adverse health effects, are subject to long delays. Previous research has demonstrated that, within a sleep clinic, management by alternative care providers (ACPs) is effective for patients with milder forms of SDB.

Deriving ICD-10 Codes for Patient Safety Indicators for Large-scale Surveillance Using Administrative Hospital Data.

Background: Existing administrative data patient safety indicators (PSIs) have been limited by uncertainty around the timing of onset of included diagnoses.

Objective: We undertook de novo PSI development through a data-driven approach that drew upon "diagnosis timing" information available in some countries' administrative hospital data.

Research Design: Administrative database analysis and modified Delphi rating process.

A framework to assess patient-reported adverse outcomes arising during hospitalization.

Background: The assessment of adverse events from a patient-centered view includes patient-reported adverse outcomes. An adverse outcome refers to any suboptimal outcome experienced by the patient; when adverse outcomes are identified through a patient interview these are called patient-reported adverse outcomes. An adverse event is an adverse outcome that is more likely due to the processes of medical care rather than to the mere progression of disease.

Using Operational Analysis to Improve Access to Pulmonary Function Testing.

Background. Timely pulmonary function testing is crucial to improving diagnosis and treatment of pulmonary diseases. Perceptions of poor access at an academic pulmonary function laboratory prompted analysis of system demand and capacity to identify factors contributing to poor access.

Using patient flow simulation to improve access at a multidisciplinary sleep centre.

The lack of timely access to diagnosis and treatment for sleep disorders is well described, but little attention has been paid to understanding how multiple system constraints contribute to long waiting times. The objectives of this study were to identify system constraints leading to long waiting times at a multidisciplinary sleep centre, and to use patient flow simulation modelling to test solutions that could improve access. Discrete-event simulation models of patient flow were constructed using historical data from 150 patients referred to the sleep centre, and used to both examine reasons for access delays and to test alternative system configurations that were predicted by administrators to reduce waiting times.

The costs of developing, implementing, and operating a safety learning system in community practice.

Background: The cost of implementing safety systems in primary care has not been examined. One type of safety system is a safety learning system (SLS). An SLS has 2 components: a reporting that monitors patient safety incidents and a learning component that facilitated the development and implementation of improvement strategies.

Validity of AHRQ patient safety indicators derived from ICD-10 hospital discharge abstract data (chart review study).

Objective: To assess if the Agency for Healthcare Research and Quality  patient safety indictors (PSIs) could be used for case findings in the International Classification of Disease 10th revision (ICD-10) hospital discharge abstract data.

Design: We identified and randomly selected 490 patients with a foreign body left during a procedure (PSI 5-foreign body), selected infections (IV site) due to medical care (PSI 7-infection), postoperative pulmonary embolism (PE) or deep vein thrombosis (DVT; PSI 12-PE/DVT), postoperative sepsis (PSI 13-sepsis)and accidental puncture or laceration (PSI 15-laceration) among patients discharged from three adult acute care hospitals in Calgary, Canada in 2007 and 2008. Their charts were reviewed for determining the presence of PSIs and used as the reference standard, positive predictive value (PPV) statistics were calculated to determine the proportion of positives in the administrative data representing 'true positives'.

The seamless transfer of care: a pilot study assessing the usability of an electronic transfer of care communication tool.

The purpose of this pilot study was to explore the feasibility of implementing a new electronic transfer of care (TOC) tool. The study was conducted in a Canadian tertiary care center. Brief survey instruments were completed by acute care physicians, community-based physicians, and patients to assess providers' perspectives on the usability of the novel electronic tool.

The effect of continuous pressure monitoring on strategic shifting of medical inpatients at risk for PUs.

Objective: To assess the impact of continuous pressure imaging technology on strategic turning of patients by health professionals.

Method: This pilot study of a newly-developed continuous pressure imaging technology (XSENSOR ForeSite PatientTurn System) involved two phases of videotaped observation of medical inpatients, with each patient serving as his/her own control: a control phase in which continuous pressure imaging was not available to health-care providers and an intervention phase where it was. The primary outcome was to determine whether access to the technology influenced the rate of patient turns/shifts by nursing staff.

The Seamless Transfer-of-Care Protocol: a randomized controlled trial assessing the efficacy of an electronic transfer-of-care communication tool.

Background: The transition between acute care and community care represents a vulnerable period in health care delivery. The vulnerability of this period has been attributed to changes to patients' medication regimens during hospitalization, failure to reconcile discrepancies between admission and discharge and the burdening of patients/families to take over care responsibilities at discharge and to relay important information to the primary care physician. Electronic communication platforms can provide an immediate link between acute care and community care physicians (and other community providers), designed to ensure consistent information transfer.

Reporting, learning and the culture of safety.

Systems that provide healthcare workers with the opportunity ot report hazards, hazardous situations errors, close calls and adverse events make it possible for an organization that receives such reports tu use these opportunities to learn and /or hold people accountable for their actions. When organizational learning is the primary goal, reporting should be confidential, voluntary and easy to perform and should lead to risk mitigation strategies following appropriate analysis; conversely, when the goal is accountability, reporting is more likely to be made mandatory. reporting systems do not necessarily equate to safer patient care and have been criticized for capturing too many mundane events but only a small minority of important events.

Building a safety and quality culture in healthcare: where it starts.

Healthcare in Canada underachieves stakeholders' expectations for safe, high-quality care. The authors maintain that a common understanding of, and vision for, what is required to achieve improved outcomes for patients is missing. Educating tomorrow's healthcare professionals is paramount to address this critical shortfall.

What is the value and impact of quality and safety teams? A scoping review.

Background: The purpose of this study was to conduct a scoping review of the literature about the establishment and impact of quality and safety team initiatives in acute care.

Methods: Studies were identified through electronic searches of Medline, Embase, CINAHL, PsycINFO, ABI Inform, Cochrane databases. Grey literature and bibliographies were also searched.

Excessive daytime sleepiness is associated with increased health care utilization among patients referred for assessment of OSA.

Study Objectives: Excessive daytime sleepiness is an important public health concern associated with increased morbidity and mortality. However, in the absence of sleep diagnostic testing, it is difficult to separate the independent effects of sleepiness from those of intrinsic sleep disorders such as obstructive sleep apnea (OSA). The objective of this study was to determine if excessive daytime sleepiness was independently associated with increased health care utilization among patients referred for assessment of OSA.