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1.
Front Public Health ; 10: 860536, 2022.
Article in English | MEDLINE | ID: covidwho-1776091

ABSTRACT

Internet of Things (IoT) involves a set of devices that aids in achieving a smart environment. Healthcare systems, which are IoT-oriented, provide monitoring services of patients' data and help take immediate steps in an emergency. Currently, machine learning-based techniques are adopted to ensure security and other non-functional requirements in smart health care systems. However, no attention is given to classifying the non-functional requirements from requirement documents. The manual process of classifying the non-functional requirements from documents is erroneous and laborious. Missing non-functional requirements in the Requirement Engineering (RE) phase results in IoT oriented healthcare system with compromised security and performance. In this research, an experiment is performed where non-functional requirements are classified from the IoT-oriented healthcare system's requirement document. The machine learning algorithms considered for classification are Logistic Regression (LR), Support Vector Machine (SVM), Multinomial Naive Bayes (MNB), K-Nearest Neighbors (KNN), ensemble, Random Forest (RF), and hybrid KNN rule-based machine learning (ML) algorithms. The results show that our novel hybrid KNN rule-based machine learning algorithm outperforms others by showing an average classification accuracy of 75.9% in classifying non-functional requirements from IoT-oriented healthcare requirement documents. This research is not only novel in its concept of using a machine learning approach for classification of non-functional requirements from IoT-oriented healthcare system requirement documents, but it also proposes a novel hybrid KNN-rule based machine learning algorithm for classification with better accuracy. A new dataset is also created for classification purposes, comprising requirements related to IoT-oriented healthcare systems. However, since this dataset is small and consists of only 104 requirements, this might affect the generalizability of the results of this research.


Subject(s)
Documentation/standards , Internet of Things , Bayes Theorem , Delivery of Health Care , Humans , Machine Learning
3.
J Palliat Med ; 25(2): 282-290, 2022 02.
Article in English | MEDLINE | ID: covidwho-1665856

ABSTRACT

Context/Objectives: It is paramount that clinicians assess and document patients' priorities to guide goal-concordant interventions, especially during a public health crisis. Design: Retrospective chart review. Setting: Academic safety-net medical center in central Massachusetts, United States. Methods: We examined electronic medical records (EMRs) to discern goals-of-care (GOC) conversations with COVID-19 patients seen at some point by palliative care during their hospitalization, and all clinicians' use of a structured note template during the peak incidence of COVID-19 from March to May 2020. Patients were grouped based on comorbidities and preadmission living situation. GOC discussions were categorized into three types: code status decisions, other treatment decisions, and no treatment decisions. Results: Nearly all (97%) patients had GOC documentation within 48 hours of admission. Forty-four percent of first GOC conversations incorporated the template. Patients with dementia living in nursing facilities had GOC documentation within hours of hospital admission, whereas healthier patients had their first GOC conversation at one week of hospitalization. Decisions about code status predominated in the first (83%) and second (49%) discussions, followed by a focus on other treatment decisions in subsequent discussions (44%-57%). Many did not require a treatment decision (19%-27%) but focused on quality-of-life definitions. Nearly all survivors were discharged to a facility and only four patients returned home. Many survivors died within three months (case fatality rate: 77%). Conclusions: GOC documentation using a structured template combined with easy EMR retrievability and clinician training holds promise for aligning patients' values with real-time medical decisions, during and after the pandemic.


Subject(s)
COVID-19 , Goals , Documentation , Humans , Patient Care Planning , Retrospective Studies , SARS-CoV-2
4.
PLoS One ; 17(2): e0263278, 2022.
Article in English | MEDLINE | ID: covidwho-1662443

ABSTRACT

BACKGROUND: COVID-19 patients may require emergency medical services for emergent treatment and/or transport to a hospital for further treatment. However, it is common for the patients to experience adverse events during transport, even the shortest transport may cause life-threatening conditions. Most of the studies that have been done on prehospital care of COVID-19 patients were conducted in developed countries. Differences in population demographics and economy may limit the generalizability of available studies. So, this study was aimed at investigating the status of prehospital care delivery for COVID-19 patients in Addis Ababa focusing on adverse events that occurred during transport and associated factors. METHODS: A total of 233 patients consecutively transported to Saint Paul's Hospital Millennium Medical College from November 6 to December 31, 2020, were included in the study. A team of physicians and nurses collected the data using a structured questionnaire. Descriptive statistics were used to summarize data, and ordinal logistic regression was carried out to assess the association between explanatory variables and the outcome variable. Results are presented using frequency, percentage, chi-square, crude and adjusted odds ratios (OR) with 95% confidence intervals. RESULTS: The overall level of adverse events in prehospital setting was 44.2%. Having history of at least one chronic medical illness, [AOR3.2 (95%; CI; 1.11-9.53)]; distance traveled to reach destination facility, [AOR 0.11(95%; CI; 0.02-0.54)]; failure to recognize and administer oxygen to the patient in need of oxygen, [AOR 15.0(95%; CI; 4.0-55.7)]; absent or malfunctioned suctioning device, [AOR 4.0(95%; CI; 1.2-13.0)]; patients handling mishaps, [AOR 12.7(95%; CI; 2.9-56.8)] were the factors associated with adverse events in prehospital transport of COVID-19 patients. CONCLUSIONS: There were a significant proportion of adverse events in prehospital care among COVID-19 patients. Most of the adverse events were preventable. There is an urgent need to strengthen prehospital emergency care in Ethiopia by equipping the ambulances with essential and properly functioning equipment and trained manpower. Awareness creation and training of transport staff in identifying potential hazards, at-risk patients, adequate documentation, and patient handling during transport could help to prevent or minimize adverse events in prehospital care.


Subject(s)
COVID-19/therapy , Transportation of Patients , Adult , Aged , COVID-19/pathology , Cross-Sectional Studies , Documentation , Emergency Medical Services , Ethiopia , Female , Humans , Male , Middle Aged , Surveys and Questionnaires
5.
AORN J ; 114(6): P10-P12, 2021 12.
Article in English | MEDLINE | ID: covidwho-1627382
6.
Palliat Med ; 36(2): 342-347, 2022 02.
Article in English | MEDLINE | ID: covidwho-1582705

ABSTRACT

BACKGROUND: Advance care planning allows patients to share their preferences for medical care with the aim of ensuring goal-concordant care in times of serious illness. The morbidity and mortality of the COVID-19 pandemic has increased the importance and public visibility of advance care planning. However, little is known about the frequency and quality of advance care planning documentation during the pandemic. AIM: This study examined the frequency, quality, and predictors of advance care planning documentation among hospitalized medical patients with and without COVID-19. DESIGN: This retrospective cohort analysis used multivariate logistic regression to identify factors associated with advance care planning documentation. SETTING/PARTICIPANTS: This study included all adult patients tested for COVID-19 and admitted to a tertiary medical center in San Francisco, CA during March 2020. RESULTS: Among 262 patients, 31 (11.8%) tested positive and 231 (88.2%) tested negative for SARS-CoV-2. The rate of advance care planning documentation was 38.7% in patients with COVID-19 and 46.8% in patients without COVID-19 (p = 0.45). Documentation consistently addressed code status (100% and 94.4% for COVID-positive and COVID-negative, respectively), but less often named a surrogate decision maker, discussed prognosis, or elaborated on other wishes for care. Palliative care consultation was associated with increased advance care planning documentation (OR: 6.93, p = 0.004). CONCLUSION: This study found low rates of advance care planning documentation for patients both with and without COVID-19 during an evolving global pandemic. Advance care planning documentation was associated with palliative care consultation, highlighting the importance of such consultation to ensure timely, patient-centered advance care planning.


Subject(s)
Advance Care Planning , COVID-19 , Academic Medical Centers , Adult , Documentation , Humans , Pandemics , Retrospective Studies , SARS-CoV-2
10.
Appl Clin Inform ; 12(5): 1061-1073, 2021 10.
Article in English | MEDLINE | ID: covidwho-1532199

ABSTRACT

BACKGROUND: Substantial strategies to reduce clinical documentation were implemented by health care systems throughout the coronavirus disease-2019 (COVID-19) pandemic at national and local levels. This natural experiment provides an opportunity to study the impact of documentation reduction strategies on documentation burden among clinicians and other health professionals in the United States. OBJECTIVES: The aim of this study was to assess clinicians' and other health care leaders' experiences with and perceptions of COVID-19 documentation reduction strategies and identify which implemented strategies should be prioritized and remain permanent post-pandemic. METHODS: We conducted a national survey of clinicians and health care leaders to understand COVID-19 documentation reduction strategies implemented during the pandemic using snowball sampling through professional networks, listservs, and social media. We developed and validated a 19-item survey leveraging existing post-COVID-19 policy and practice recommendations proposed by Sinsky and Linzer. Participants rated reduction strategies for impact on documentation burden on a scale of 0 to 100. Free-text responses were thematically analyzed. RESULTS: Of the 351 surveys initiated, 193 (55%) were complete. Most participants were informaticians and/or clinicians and worked for a health system or in academia. A majority experienced telehealth expansion (81.9%) during the pandemic, which participants also rated as highly impactful (60.1-61.5) and preferred that it remain (90.5%). Implemented at lower proportions, documenting only pertinent positives to reduce note bloat (66.1 ± 28.3), changing compliance rules and performance metrics to eliminate those without evidence of net benefit (65.7 ± 26.3), and electronic health record (EHR) optimization sprints (64.3 ± 26.9) received the highest impact scores compared with other strategies presented; support for these strategies widely ranged (49.7-63.7%). CONCLUSION: The results of this survey suggest there are many perceived sources of and solutions for documentation burden. Within strategies, we found considerable support for telehealth, documenting pertinent positives, and changing compliance rules. We also found substantial variation in the experience of documentation burden among participants.


Subject(s)
COVID-19 , Delivery of Health Care , Documentation , Humans , Policy , SARS-CoV-2 , United States
11.
Breast Cancer Res Treat ; 191(2): 385-388, 2022 Jan.
Article in English | MEDLINE | ID: covidwho-1530340

ABSTRACT

PURPOSE: Breast cancer survivors take vitamins and supplements to bolster their general health and to decrease the risk of cancer recurrence. Healthcare providers are frequently unaware of their patients non-prescription supplement use. The aim of this study was to study the type and the documentation of patients' dietary supplements and vitamins in the electronic medical record (EMR). METHODS: 50/51 female breast cancer survivors seen over a 7 week period consented to the study. Mean age was 70 and mean years since diagnosis was 13.9. Informed consent and documentation of supplement and vitamin use was obtained by the nurse practitioner the day before the visit. Study data were collected and managed using REDCap electronic data capture tools hosted at Weill Cornell Medicine. RESULTS: Of the 50 study patients, 90% were taking one or more vitamins and/or supplements (mean = 2.4, range = 1-9). The most common were Vitamin D, calcium, and vitamin C. Reasons for vitamin and supplement use included the recommendation by their physician or friend and prevention of bone loss or catching a cold. Five patients mentioned immunity or prevention of COVID-19. The patient reported list was compared with the medication list used by multiple providers in the electronic medical record (EMR). None of the 50 study patients had an accurate list of their vitamins and supplements in the EMR. CONCLUSION: 90% of the breast cancer survivors in our study were taking dietary supplements for a variety of reasons. None had an accurate list in the EMR. We strongly recommend more attention to accurate and easily accessed vitamin and supplement recording by providers.


Subject(s)
Breast Neoplasms , COVID-19 , Cancer Survivors , Aged , Breast Neoplasms/drug therapy , Breast Neoplasms/epidemiology , Dietary Supplements , Documentation , Female , Humans , Neoplasm Recurrence, Local , SARS-CoV-2
12.
BMC Med Educ ; 21(1): 578, 2021 Nov 15.
Article in English | MEDLINE | ID: covidwho-1526629

ABSTRACT

BACKGROUND: Surgical logbooks are a commonly used tool for quality assurance of surgical training. Electronic logbooks are increasingly applied in low-resource settings, but there is limited research on their quality. The aim of this study is to evaluate the quality of an app-based surgical e-logbook system shortly after its implementation in a low-income country and to identify potential areas of improvement for the system. METHODS: Entries in the e-logbook system were cross-checked with hospital records and categorized as matched or overreported. Moreover, the hospital records were checked for underreported procedures. Additionally, semi-structured interviews were conducted with users of the e-logbook system. RESULTS: A total of 278 e-logbook database entries and 379 procedures in the hospital records from 14 users were analyzed. Matches were found in the hospital records for 67.3% of the database entries. Moreover, 32.7% of the database entries were overreported and 50.7% of the procedures in the hospital records were underreported. A previous study of an analog surgical logbook system in the same setting estimated that 73.1% of the entries were matches or close matches. Interviews with 12 e-logbook users found overall satisfaction but also identified potential areas of improvement, including the need for more training in the use of the system, modifications to improve user-friendliness, and better access to the necessary technology. CONCLUSIONS: A reliable documentation system is necessary to evaluate the quality of health workforce training. The early evaluation of a surgical e-logbook system in a low-income country showed that the collected data should be approached with caution. The quantitative analysis suggests that the e-logbook system needs to be improved in terms of accuracy. In interviews, users reported that digitalization of the logbook system was a much-needed innovation but also identified important areas of improvement. Recognition of these aspects at an early stage facilitates guidance and adjustment of further implementation and might improve the accuracy of the system.


Subject(s)
Documentation , Hospitals , Data Collection , Electronics , Sierra Leone
13.
BMJ Open ; 11(11): e050268, 2021 11 10.
Article in English | MEDLINE | ID: covidwho-1511474

ABSTRACT

OBJECTIVES: The COVID-19 pandemic pressurised healthcare with increased shortage of care. This resulted in an increase of awareness for code status documentation (ie, whether limitations to specific life-sustaining treatments are in place), both in the medical field and in public media. However, it is unknown whether the increased awareness changed the prevalence and content of code status documentation for COVID-19 patients. We aim to describe differences in code status documentation between infectious patients before the pandemic and COVID-19 patients. SETTING: University Medical Centre of Utrecht, a tertiary care teaching academic hospital in the Netherlands. PARTICIPANTS: A total of 1715 patients were included, 129 in the COVID-19 cohort (a cohort of COVID-19 patients, admitted from March 2020 to June 2020) and 1586 in the pre-COVID-19 cohort (a cohort of patients with (suspected) infections admitted between September 2016 to September 2018). PRIMARY AND SECONDARY OUTCOME MEASURES: We described frequency of code status documentation, frequency of discussion of this code status with patient and/or family, and content of code status. RESULTS: Frequencies of code status documentation (69.8% vs 72.7%, respectively) and discussion (75.6% vs 73.3%, respectively) were similar in both cohorts. More patients in the COVID-19 cohort than in the before COVID-19 cohort had any treatment limitation as opposed to full code (40% vs 25%). Within the treatment limitations, 'no intensive care admission' (81% vs 51%) and 'no intubation' (69% vs 40%) were more frequently documented in the COVID-19 cohort. A smaller difference was seen in 'other limitation' (17% vs 9%), while 'no resuscitation' (96% vs 92%) was comparable between both periods. CONCLUSION: We observed no difference in the frequency of code status documentation or discussion in COVID-19 patients opposed to a pre-COVID-19 cohort. However, treatment limitations were more prevalent in patients with COVID-19, especially 'no intubation' and 'no intensive care admission'.


Subject(s)
COVID-19 , Cohort Studies , Documentation , Humans , Pandemics , SARS-CoV-2
14.
Gesundheitswesen ; 83(S 01): S4-S11, 2021 Nov.
Article in German | MEDLINE | ID: covidwho-1500781

ABSTRACT

AIM OF THE STUDY: To demonstrate the feasibility and exemplarity of an app-based parent registry. METHODS: The app as an elaborated interactive electronic case report form and the underlying data structure of the registry are presented. The initial recruitment efforts are illustrated and the temperature distribution, as well as the distribution of fever events in 2020, are analyzed. RESULTS: The FeverApp successfully collects data into a central registry. Like every study, it also provides information on the current knowledge. The ecological momentary assessment can represent the illness situation at several levels (measurement, fever episode, individual, family, practice, country). Methods for data collection needed to be developed in a flexible manner due to pandemic conditions. The initial recruitment goal of 2400 fever phases in the first two years was met, with nationwide dissemination pending. It is shown that body temperature does not rise indefinitely; fevers reach an average of 39 degrees without antipyretics, although in rare cases temperatures beyond 41 degrees are reached without harm. Furthermore, a comparison with a reference practice shows that fever episodes can be recorded more comprehensively in the app, including infections that do not come to the presentation in a pediatrician's office. Thus, the FeverApp fulfills in a model-like fashion the use of registers in persons basically healthy and maps a multi-level diagnostics. CONCLUSION: The FeverApp could basically establish itself as a supporting tool, the registry can reliably collect data with the method used and maps the current infection situation. In researching the question of how infections develop in the post-Covid period, the app could perform an important task.


Subject(s)
COVID-19 , Documentation , Germany/epidemiology , Humans , Parents , Registries , SARS-CoV-2
17.
BMJ Open Qual ; 10(3)2021 08.
Article in English | MEDLINE | ID: covidwho-1367441

ABSTRACT

Reviewing fluid balance charts is a simple and effective method of assessing and monitoring the hydration status of patients. Several articles report that these charts are often either inaccurately or incompletely filled thereby limiting their usefulness in clinical practice. We had a similar experience in our practice at Kettering General Hospital and conducted a quality improvement project with a goal to increase the number of charts that were completely and accurately filled by a minimum of 50% in a 1-month period and to reassess the sustainability of this improvement after 6 months. Data from baseline measurements showed that only 25% of the charts in the ward had accurate measurements, 20% had correct daily totals and 14% had complete records of all intakes and losses. We collected feedback from nursing staff in the ward on what challenges they faced in using these charts and how best to support them. Corroborated by evidence from the literature, we discovered that inadequate training was a major factor responsible for the poor quality of documentation in these charts. Using simultaneous plan-do-study-act cycles, we designed and delivered personalised teaching on fluid balance chart documentation to the nursing staff. Subsequent data showed remarkable improvements in all the parameters we assessed. For instance, the proportion of charts with accurate measurements increased by 55% and those with complete entries by 122%. Unfortunately, we were unable to demonstrate sustainability of these improvements as our second set of data collection coincided with the SARS-CoV-2 outbreak. In this project, we were able to demonstrate that simple and cost-efficient measures such as adequate training of nursing staff could remarkably improve the quality of fluid balance charts used in our hospitals. We suggest that this training should be included as part of the regular competency assessments for nurses and other healthcare staff.


Subject(s)
COVID-19 , Quality Improvement , Documentation , Humans , SARS-CoV-2 , Water-Electrolyte Balance
18.
Bull World Health Organ ; 99(8): 546-547, 2021 Aug 01.
Article in English | MEDLINE | ID: covidwho-1344236

ABSTRACT

Governments worldwide are pressing ahead with COVID-19 passes, despite significant technical, ethical and social obstacles to implementation. Gary Humphreys reports.


Subject(s)
COVID-19 Vaccines/administration & dosage , COVID-19/prevention & control , Documentation/standards , Humans , SARS-CoV-2 , Zimbabwe
19.
Appl Clin Inform ; 12(3): 629-636, 2021 05.
Article in English | MEDLINE | ID: covidwho-1309479

ABSTRACT

OBJECTIVES: Accurate metrics of provider activity within the electronic health record (EHR) are critical to understand workflow efficiency and target optimization initiatives. We utilized newly described, log-based core metrics at a tertiary cancer center during rapid escalation of telemedicine secondary to initial coronavirus disease-2019 (COVID-19) peak onset of social distancing restrictions at our medical center (COVID-19 peak). These metrics evaluate the impact on total EHR time, work outside of work, time on documentation, time on prescriptions, inbox time, teamwork for orders, and undivided attention patients receive during an encounter. Our study aims were to evaluate feasibility of implementing these metrics as an efficient tool to optimize provider workflow and to track impact on workflow to various provider groups, including physicians, advanced practice providers (APPs), and different medical divisions, during times of significant policy change in the treatment landscape. METHODS: Data compilation and analysis was retrospectively performed in Tableau utilizing user and schedule data obtained from Cerner Millennium PowerChart and our internal scheduling software. We analyzed three distinct time periods: the 3 months prior to the initial COVID-19 peak, the 3 months during peak, and 3 months immediately post-peak. RESULTS: Application of early COVID-19 restrictions led to a significant increase of telemedicine encounters from baseline <1% up to 29.2% of all patient encounters. During initial peak period, there was a significant increase in total EHR time, work outside of work, time on documentation, and inbox time for providers. Overall APPs spent significantly more time in the EHR compared with physicians. All of the metrics returned to near baseline after the initial COVID-19 peak in our area. CONCLUSION: Our analysis showed that implementation of these core metrics is both feasible and can provide an accurate representation of provider EHR workflow adjustments during periods of change, while providing a basis for cross-vendor and cross-institutional analysis.


Subject(s)
COVID-19/epidemiology , Cancer Care Facilities/statistics & numerical data , Electronic Health Records , Neoplasms/therapy , SARS-CoV-2 , Telemedicine/methods , Telemedicine/statistics & numerical data , Algorithms , Data Collection , Documentation , Health Policy , Humans , Pattern Recognition, Automated , Retrospective Studies , Software , User-Computer Interface , Workflow
20.
J Correct Health Care ; 27(2): 89-102, 2021 06.
Article in English | MEDLINE | ID: covidwho-1262061

ABSTRACT

During a pandemic, basic public health precautions must be taken across settings and populations. However, confinement conditions change what can be done in correctional settings. Correctional nursing (CN) care, like all nursing care, needs to be named and encoded to be recognized and used to generate data that will advance the discipline and maintain standards of care. The Omaha System is a standardized interprofessional terminology that has been used since 1992 to guide and document care. In 2019, a collaboration between the newly formed American Correctional Nurses Association and the Omaha System Community of Practice began a joint effort with other stakeholders aimed at encoding evidence-based pandemic response interventions used in CN. The resulting guidelines are included and illustrated with examples from CN practice.


Subject(s)
COVID-19/nursing , Correctional Facilities/standards , Documentation/standards , Nurses/standards , COVID-19/epidemiology , Humans , Nurses/organization & administration , Nursing Care/standards , Practice Guidelines as Topic , SARS-CoV-2 , United States/epidemiology
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