Measuring Sensitivity and Precision of Real-Time Location Systems (RTLS): Definition, Protocol and Demonstration for Clinical Relevance.

The ability of a Real Time Location System (RTLS) to provide correct information in a clinical environment is an important consideration in evaluating the effectiveness of the technology. While past efforts describe how well the technology performed in a lab environment, the performance of such technology has not been specifically defined or evaluated in a practice setting involving workflow and movement. Clinical environments pose complexity owing to various layouts and various movements.

Mobile Point-of-Care Medical Photography: Legal Considerations for Health Care Providers.

Medical photographs have been used for decades to document clinical findings. The ease with which medical photographs can be captured and integrated into the electronic health record (EHR) has increased as digital cameras obviated the need for the film development process. Today, cameras integrated into smartphones allow for high-resolution images to be instantly uploaded and integrated into the EHR.

Trauma Activation Responsiveness: An RFID-enabled trauma flowsheet.

Manually documented trauma flow sheets contain critical information regarding trauma resuscitations in the emergency department (ED). The American College of Surgeons (ACS) has enforced certain thresholds on trauma surgeons' arrival time to the trauma bay. Due to the complex and fast-paced ED environment, this information can be easily overlooked or erroneously recorded, affecting compliance with ACS standards.

Unnecessary wait hours: a novel ED system-level metric.

Background: Emergency department (ED) operations leaders are under increasing pressure to make care delivery more efficient. Publicly reported ED efficiency metrics are traditionally patient centred and do not show situational or facility-based improvement opportunities. We propose the consideration of a novel metric, the 'Number of Unnecessary Waits (NUW)' and the corresponding 'Unnecessary Wait Hours (UWH)', to measure space efficiency, and we describe how we used NUW to evaluate operational changes in our ED.

Patients' Experiences and Attitudes of Using a Secure Mobile Phone App for Medical Photography: Qualitative Survey Study.

Background: Point-of-care clinical photography using mobile devices is coming of age as a new standard of care for clinical documentation. High-quality cameras in modern smartphones facilitate faithful reproduction of clinical findings in photographs; however, clinical photographs captured on mobile devices are often taken using the native camera app on the device and transmitted using relatively insecure methods (eg, SMS text message and email) that do not preserve images as part of the electronic medical records. Native camera apps lack robust security features and direct integration with electronic health records (EHRs), which may limit patient acceptability and usefulness to clinicians.

Attitudes and Behavior of Health Care Workers Before, During, and After Implementation of Real-Time Location System Technology.

Objective: To assess how staff attitudes before, during, and after implementation of a real-time location system (RTLS) that uses radio-frequency identification tags on staff and patient identification badges and on equipment affected staff's intention to use and actual use of an RTLS.

Participants And Methods: A series of 3 online surveys were sent to staff at an emergency department with plans to implement an RTLS between June 1, 2015, and November 29, 2016. Each survey corresponded with a different phase of implementation: preimplementation, midimplementation, and postimplementation.

Experiences of Health Care Providers Using a Mobile Medical Photography Application.

Objective: To understand the ways in which providers use a mobile photography application integrated with the electronic health record (EHR) to facilitate clinical care, and the process outcomes that result from the application's use.

Methods: An e-mail survey was sent on November 13, 2017, to 1,463 health care providers at Mayo Clinic who had used an internally developed, EHR-integrated medical photography application.

Results: The survey was completed by 712 (49%) providers.

Patient-Care Team Contact Patterns Impact Treatment Length of Stay in the Emergency Department.

Real-time location systems (RTLS) has found extensive application in the healthcare setting, that is shown to improve safety, save cost, and increase patient satisfaction. More specifically, some studies have shown the efficacy of RTLS leading to an improved workflow in the emergency department. However, due to substantial implementation costs of such technologies, hospital administrators show reluctance in RTLS adoption.

Medical Videography Using a Mobile App: Retrospective Analysis.

Background: As mobile devices and apps grow in popularity, they are increasingly being used by health care providers to aid clinical care. At our institution, we developed and implemented a point-of-care clinical photography app that also permitted the capture of video recordings; however, the clinical findings it was used to capture and the outcomes that resulted following video recording were unclear.

Objective: The study aimed to assess the use of a mobile clinical video recording app at our institution and its impact on clinical care.

Use of an EHR-Integrated Point-of-Care Mobile Medical Photography Application in a Pediatric Emergency Department.

Background: Mobile applications allow health care providers to capture point-of-care medical photographs and transfer them to the electronic health record (EHR). It is unclear how providers use these photographs or how they affect clinical care.

Objectives: We aimed to understand the content, purpose, and outcomes of point-of-care medical photography performed in the pediatric emergency department (ED) at large academic medical center.

Impact of scribes on throughput metrics and billing during an electronic medical record transition.

Objective: Evaluate an established scribe program on throughput and revenue capture in an Emergency Department (ED) undergoing an EMR transition.

Methods: A prospective cohort design comparing patients managed with and without scribes in an academic ED. Throughput metrics (medians, min) and relative value units (RVUs, means) were collected.

Characterization of emergency department abandonment using a real-time location system.

Background: Patients who present to emergency departments (EDs) for evaluation but are noted to have left without being seen (LWBS) are potentially at great risk. Governmental agencies, such as the Centers for Medicare and Medicaid, as well as hospitals and health organizations, are examining the factors which drive LWBS, including accurately quantifying patient tolerance to wait times and targeting interventions to improve patient tolerance to waiting.

Objective: Compare traditional methods of estimating time to LWBS with an objective method using a real-time location tracking system (RTLS); examine temporal factors associated with greater LWBS rates.

Anti-factor Xa Monitoring and Activated Charcoal for a Pediatric Patient With Rivaroxaban Overdose.

Rivaroxaban, an oral anticoagulant, directly inhibits factor Xa (FXa). A 35-month-old boy was brought to the emergency department 15 minutes after ingesting 200 mg of rivaroxaban (16 mg/kg). Activated charcoal (AC) was administered; the patient was observed with monitoring of plasma anti-FXa levels and discharged the following day after an uneventful hospital observation.

Physician, Interrupted: Workflow Interruptions and Patient Care in the Emergency Department.

Background: It is unclear how workflow interruptions impact emergency physicians at the point of care.

Objectives: Our study aimed to evaluate interruption characteristics experienced by academic emergency physicians.

Methods: This prospective, observational study collected interruptions during attending physician shifts.

Contact tracing with a real-time location system: A case study of increasing relative effectiveness in an emergency department.

Background: Contact tracing is the systematic method of identifying individuals potentially exposed to infectious diseases. Electronic medical record (EMR) use for contact tracing is time-consuming and may miss exposed individuals. Real-time location systems (RTLSs) may improve contact identification.

PhotoExam: adoption of an iOS-based clinical image capture application at Mayo Clinic.

Background: Mayo Clinic developed an internal iOS-based, point-of-care clinical image capture application for clinicians. We aimed to assess the adoption and utilization of the application at Mayo Clinic.

Methods: Metadata of 22,784 photos of 6417 patients taken by 606 users over 8040 clinical encounters between 3/1/2015 and 10/31/2015 were analyzed.

Pediatric Sepsis Secondary to an Occult Dental Abscess: A Case Report.

Background: In general, hematogenous spread of bacteria in children is uncommon. Bacteremia, however, is a known complication of dental procedures and severe caries, but is infrequently associated with primary, asymptomatic, non-procedural-related, dentoalveolar infection.

Case Report: The patient is a 7-year-old previously healthy boy who presented to the Emergency Department (ED) with "fever, mottling, and shaking chills.

Pilot Study of Kano "Attractive Quality" Techniques to Identify Change in Emergency Department Patient Experience.

Study Objective: We describe the use of the Kano Attractive Quality analytic tool to improve an identified patient experience gap in perceived compassion by emergency department (ED) providers.

Methods: In phase 1, point-of-service surveying assessed baseline patient perception of ED provider compassion. Phase 2 deployed Kano surveys to predict the effect of 4 proposed interventions on patient perception.

Intelligent Emergency Department: Validation of Sociometers to Study Workload.

Sociometers are wearable sensors that continuously measure body movements, interactions, and speech. The purpose of this study is to test sociometers in a smart environment in a live clinical setting, to assess their reliability in capturing and quantifying data. The long-term goal of this work is to create an intelligent emergency department that captures real-time human interactions using sociometers to sense current system dynamics, predict future state, and continuously learn to enable the highest levels of emergency care delivery.

Implementation and impact of a rapid response team in a children's hospital.

Like the previous two studies of RRS implementation in a children's hospital, this study--the first to use an RRT model--showed a decrease in the incidence of arrests (although not at a significant level). Low mortality rates and infrequent arrests in children's hospitals make changes in these measures insensitive indicators of the positive impact of RRT implementation. RRTs provide an immediate response for children whose clinical condition is worrisome and whose attending physicians are not immediately present.