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Scientific literature review: hospital management

On this page IHE presents a few key abstracts from the clinical literature about hospital management, selected by our editorial board.

Computerised physician order entry as a new technology for patients’ safety.
Concern about patient safety is a priority in the quality policy of health systems. In the pharmacotherapeutic process, from prescription to administration of drugs, failures that cause unwanted effects in patients may occur. This is especially common in patients with multiple pathologies and polypharmacy, common in medical specialities services. It is essential to analyse and identify the causes that trigger medical errors to prevent their occurrence. In this context, computerised physician order entry is an attractive tool for ensuring patients safety.
Villamañán E, Herrero A, Alvarez-Sala R. Med Clin (Barc). 2010 Apr 29.

Different usage of the same oncology information system in two hospitals in Sydney - lessons go beyond the initial introduction.
The experience of clinicians at two public hospitals in Sydney, Australia, with the introduction and use of an oncology information system (OIS) was examined to extract lessons to guide the introduction of clinical information systems in public hospitals. Semi-structured interviews were conducted with 12 of 15 radiation oncologists employed at the two hospitals. The personnel involved in the decision making process for the introduction of the system were contacted and their decision-making process revisited. The transcribed data were analysed using NVIVO software. Themes emerged included implementation strategies and practices, the radiation oncologists’ current use and satisfaction with the OIS, project management and the impact of the OIS on clinical practice. The hospitals had contrasting experiences in their introduction and use of the OIS. Hospital A used the OIS in all aspects of clinical documentation. Its implementation was associated with strong advocacy by the Head of Department, input by a designated project manager, and use and development of the system by all staff, with timely training and support. With no vision of developing a paperless information system, Hospital B used the OIS only for booking and patient tracking. A departmental policy that data entry for the OIS was centrally undertaken by administrative staff distanced clinicians from the system. All the clinicians considered that the OIS should continuously evolve to meet changing clinical needs and departmental quality improvement initiatives. This case study indicates that critical factors for the successful introduction of clinical information systems into a hospital environment were an initial clear vision to be paperless, strong clinical leadership and management at the departmental level, committed project management, and involvement of all staff, with appropriate training. Clinician engagement is essential for post-adoption evolution of clinical
information systems.
Yu P, Gandhidasan S, Miller AA. Int J Med Inform 2010 Jun;79(6):422-9.

A critical appraisal of physician-hospital integration models.
The economic environment and the current healthcare debate have prompted a critical reevaluation of previous and current physician-hospital integration models. Even though the independent, self-employed, private practice, medical staff remains the most common model, surgical specialists such as vascular surgeons are increasingly being employed and integrated into healthcare delivery systems. The degree of integration varies from minimal to full integration or full employment. This review defines the forces driving these changes and analyses the strengths and weaknesses of each employment model from the physicians’ point of view. Strategies for the successful implementation of a 21st century integrative employment model are discussed.
Satiani B, Vaccaro P. J Vasc Surg. 2010 Apr;51(4): 1046-53.

Implementing an electronic change-of-shift report using transforming care at the bedside processes and methods.
Bedside nurses are well positioned to make changes that positively affect operations and practice. Using Transforming Care at the Bedside processes and methods, the authors describe the clinical nurse-led development, testing and implementation of an electronic template and process for change-of-shift report. Outcomes included a reduction in time spent in change-of-shift reports, reduced end-of-shift overtime and a more standardised process, and staff who perceived improved information quality and were satisfied with the process.
Nelson BA, Massey R. J Nurs Adm. 2010 Apr;40(4):162-8.

Human factors engineering in healthcare systems: the problem of human error and accident management.
This paper discusses some crucial issues associated with the exploitation of data and information about healthcare for the improvement of patient safety. In particular, the issues of human factors and safety management are analysed in relation to exploitation of reports about non-conformity events and field observations. A methodology for integrating field observation and theoretical approaches for safety studies is described. Two sample cases are discussed in detail: the first one makes reference to the use of data collected in the aviation domain and shows how these can be utilised to define hazard and risk; the second one concerns a typical ethnographic study in a large hospital structure for the identification of most relevant areas of intervention. The results show that, if national authorities find a way to harmonise and formalise critical aspects, such as the severity of standard events, it is possible to estimate risk and define auditing needs, well before the occurrence of serious incidents, and to indicate practical ways forward for improving safety standards.
Cacciabue PC, Vella G. Int J Med Inform 2010 Apr;79(4):e1-17.

Effect of point-of-care computer reminders on physician behaviour: a systematic review.
The opportunity to improve care using computer reminders is one of the main incentives for implementing sophisticated clinical information systems. A systematic review was conducted to quantify the expected magnitude of improvements in processes of care from computer reminders delivered to clinicians during their routine activities. The MEDLINE, Embase and CINAHL databases (to July 2008) were searched and the bibliographies of retrieved articles were scanned. Studies were included in the review if they used a randomised or quasi-randomised design to evaluate improvements in processes or outcomes of care from computer reminders delivered to physicians during routine electronic ordering or charting activities. The results were that computer reminders produced much smaller improvements than those generally expected from the implementation of computerised order entry and electronic medical record systems. Further research is required to identify features of reminder systems consistently associated with clinically worthwhile improvements.
Shojania KG et al. CMAJ. 2010 Mar 23;182(5): E216-25.


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