Background: Germ Defence ( www.germdefence.org ) is an evidence-based interactive website that promotes behaviour change for infection control within households.
View Article and Find Full Text PDFObjectives: To evaluate the impact of a new clinic-based rapid sexually transmitted infection testing, diagnosis and treatment service on healthcare delivery and resource needs in an integrated sexual health service.
Design: Controlled interrupted time series study.
Setting: Two integrated sexual health services (SHS) in UK: Unity Sexual Health in Bristol, UK (intervention site) and Croydon Sexual Health in London (control site).
Background In the emergency department physicians are forced to distribute their time to ensure that all admitted patients receive appropriate emergency care. Previous studies have raised concerns about medication discrepancies in patient's drug lists at admission to the emergency department. Thus, it is important to study how emergency department physicians distribute their time, to highlight where workflow redesign can be needed.
View Article and Find Full Text PDFIntroduction: An expected future increase in older adults will demand changes in health care delivery, making development, implementation and evaluation of new health care models essential. The rationale for political decision-making concerning the implementation and application of interventions in health care should include cost estimations, specifically those involving clinical interventions. To provide such data knowledge of time spent on the intervention is imperative.
View Article and Find Full Text PDFInter-observer agreement (IOA) is a key aspect of data quality in time-and-motion studies of clinical work. To date, such studies have used simple and ad hoc approaches for IOA assessment, often with minimal reporting of methodological details. The main methodological issues are how to align time-stamped task intervals that rarely have agreeing start and end times, and how to assess IOA for multiple nominal variables.
View Article and Find Full Text PDFWe present a unique data visualisation approach, called workflow time charts, to illustrate the sequential and multi-dimensional nature of work in emergency departments. Using 40 h of data from direct observations of emergency physicians, we applied the charts to visualise patient-stratified physicians' work as a continuous temporal process, including distinguishing tasks of different types and representing external prompts (similar to interruptions) and multitasking performance. The charts showed frequent changes in the nature of observed activities, with interleaved multitasking a constant feature and external prompts often clustered in time.
View Article and Find Full Text PDFThe incidence and impacts of adverse drug events (ADE) have been extensively studied, but there is an emerging focus on real-time detection systems. These can play an important role, along with systems pharmacology and population-level epidemiology, in a multipronged approach to prevent ADEs and mitigate their harm. Tailoring ADE detection systems to a particular health care setting or ADE type can improve predictive accuracy, but the added complexity reduces its wider applicability.
View Article and Find Full Text PDFThe objective of this observational time and motion study was to increase our understanding of how nurses in home healthcare currently distribute their work time with a focus on the medication management process. The research was conducted in four municipalities in the southern part of Sweden. Participants were nurses working in home healthcare.
View Article and Find Full Text PDFBackground: Interruptions and multitasking have been demonstrated in experimental studies to reduce individuals' task performance. These behaviours are frequently used by clinicians in high-workload, dynamic clinical environments, yet their effects have rarely been studied.
Objective: To assess the relative contributions of interruptions and multitasking by emergency physicians to prescribing errors.
Objective: To examine the impact of an electronic Results Acknowledgement (eRA) system on emergency physicians' test result management work processes and the time taken to acknowledge microbiology and radiology test results for patients discharged from an Emergency Department (ED).
Methods: The impact of the eRA system was assessed in an Australian ED using: a) semi-structured interviews with senior emergency physicians; and b) a time and motion direct observational study of senior emergency physicians completing test acknowledgment pre and post the implementation of the eRA system.
Results: The eRA system led to changes in the way results and actions were collated, stored, documented and communicated.
Multi-tasking is an important skill for clinical work which has received limited research attention. Its impacts on clinical work are poorly understood. In contrast, there is substantial multi-tasking research in cognitive psychology, driver distraction, and human-computer interaction.
View Article and Find Full Text PDFAn observational workflow time study was conducted involving doctors in the emergency department (ED) of a large Australian hospital. During 121.7 h across 58 sessions, we observed interruptive events, conceptualised as prompts, and doctors' strategies to handle those prompts (task-switching, multitasking, acknowledgement, deferral and deflection) to assess the role of multiple work system factors influencing doctors' work in the ED.
View Article and Find Full Text PDFAims: Adverse drug reactions (ADRs) have major impacts on patients and the hospital system. Methods identifying ADRs from selected International Classification of Diseases-10th revision (ICD-10) diagnosis and external cause codes can be applied to population-level hospital admissions data, enabling the study of rare, yet serious ADRs. The present study aimed to use ICD10-based methods to identify four types of serious idiosyncratic ADRs in Australia, and to assess changes in incidence and their impact on length of stay (LOS), readmission and in-hospital mortality.
View Article and Find Full Text PDFIntroduction: Interruptions and multitasking are frequent in clinical settings, and have been shown in the cognitive psychology literature to affect performance, increasing the risk of error. However, comparatively less is known about their impact on errors in clinical work. This study will assess the relationship between prescribing errors, interruptions and multitasking in an emergency department (ED) using direct observations and chart review.
View Article and Find Full Text PDFWhen providing care, clinicians are expected to take note of clinical practice guidelines, which offer recommendations based on the available evidence. However, guidelines may not apply to individual patients with comorbidities, as they are typically excluded from clinical trials. Guidelines also tend not to provide relevant evidence on risks, secondary effects and long-term outcomes.
View Article and Find Full Text PDFBackground & Aims: People living with hepatitis C virus (HCV) are at increased risk of all-cause and liver-related mortality, although successful treatment has been shown to reduce this risk. The aim of this study was to provide baseline data on trends in cause-specific mortality and to establish an international surveillance system for evaluating the population level impact of HCV treatments.
Methods: Population level HCV diagnosis databases from Scotland (1997-2010), Australia (New South Wales [NSW]) (1997-2006), and Canada (British Columbia [BC]) (1997-2003) were linked to corresponding death registries using record linkage.
Complete, accurate and timely hospital discharge summaries are important for continuity of care. The aim of this study was to evaluate the effectiveness of an electronic discharge summary system in improving the medication information provided compared to the information in paper discharge summaries. We conducted a retrospective audit of 199 paper and 200 electronic discharge summaries from a 350-bed teaching hospital in Sydney, Australia.
View Article and Find Full Text PDFObjective: To provide a detailed characterisation of clinicians' work management strategies.
Design: 1002.3 h of observational data were derived from three previous studies conducted in a teaching hospital in Sydney, Australia, among emergency department (ED) doctors (n=40), ward doctors (n=57) and ward nurses (n=104).
Objectives: To re-analyse bicycle overtaking data collected by Walker (2007) with a view to assess factors associated with close passing (<1 m), to adjust for other observed factors in a multivariable analysis, and to assess the extent to which the sample size in the original analysis may have contributed to spurious results.
Method: A re-analysis of 2,355 motor vehicle passing events recorded by Walker that includes information on cyclist's distance to the kerb, vehicle size and colour, city of observation, time of day, whether the event occurred while in a bikelane and helmet wearing. Each variable was considered for a final, multivariable model using purposeful selection of variables.
Spat Spatiotemporal Epidemiol
September 2013
Allocating an incomplete address to randomly selected property coordinates within a locality, known as random property allocation, has many advantages over other geoimputation techniques. We compared the performance of random property allocation to four other methods under various conditions using a simulation approach. All methods performed well for large spatial units, but random property allocation was the least prone to bias and error under volatile scenarios with small units and low prevalence.
View Article and Find Full Text PDFBackground: Group A streptococcus (GAS) is an etiological agent for the immune mediated sequela post streptococcal glomerulonephritis (PSGN). In some populations PSGN is recognized as a risk factor for chronic kidney disease (CKD) and end-stage renal disease (ESRD). It was found that a significantly greater proportion of subjects with past history of PSGN than without the history exhibited seroreactions to streptococcal antigens called streptococcal inhibitor of complement (SIC) and to distantly related SIC (DRS).
View Article and Find Full Text PDFBackground: The Downtown Eastside is a robust and densely populated neighbourhood in Vancouver, Canada, that is characterized by low-income housing and drug use and a high prevalence of HIV infection. We evaluated mortality and excess mortality among the broader community of individuals living in this neighbourhood.
Methods: The Community Health and Safety Evaluation is a community-based study of inner-city residents in the Downtown Eastside who were recruited in 2003 and 2004.