Nurse and Physician Perceptions and Decision Making During Interdisciplinary Communication: Factors That Influence Communication Channel Selection.

Errors in decision making and communication play a key role in poor patient outcomes. Safe patient care requires effective decision making during interdisciplinary communication through communication channels. Research on factors that influence nurse and physician decision making during interdisciplinary communication is limited. Understanding influences on nurse and physician decision making during communication channel selection is needed to support effective communication and improved patient outcomes. The purpose of the study was to explore nurse and physician perceptions of and decision-making processes for selecting interruptive or noninterruptive interdisciplinary communication channels in medical-surgical and intermediate acute care settings. Twenty-six participants (10 RNs, 10 resident physicians, and six attending physicians) participated in semistructured interviews in two acute care metropolitan hospitals for this qualitative descriptive study. The Practice Primed Decision Model guided interview question development and early data analysis. Findings include a core category, Development of Trust in the Communication Process, supported by three main themes: (1) Understanding of Patient Status Drives Communication Decision Making; (2) Previous Interdisciplinary Communication Experience Guides Channel Selection; and (3) Perceived Usefulness Influences Communication Channel Selection. Findings from this study provide support for future design and research of communication channels within the EHR and clinical decision support systems.

Public Health Role of Academic Medical Center in Community Outbreak of Hepatitis A, San Diego County, California, USA, 2016-2018.

During 2016-2018, San Diego County, California, USA, experienced one of the largest hepatitis A outbreaks in the United States in 2 decades. In close partnership with local healthcare systems, San Diego County Public Health led a public health response to the outbreak that focused on a 3-pronged strategy to vaccinate, sanitize, and educate. Healthcare systems administered nearly half of the vaccinations delivered in San Diego County. At University of California San Diego Health, the use of informatics tools assisted with the identification of at-risk populations and with vaccine delivery across outpatient and inpatient settings. In addition, acute care facilities helped prevent further disease transmission by delaying the discharge of patients with hepatitis A who were experiencing homelessness. We assessed the public health roles that acute care hospitals can play during a large community outbreak and the critical nature of ongoing collaboration between hospitals and public health systems in controlling such outbreaks.

GABABR-Mediated Paraneoplastic Limbic Encephalitis Due To Thymic Small Cell Carcinoma.

We report the case of a 55-year-old male who presented with several weeks of seizures, agitation, progressive confusion, and receptive aphasia. CSF showed a monocytic pleocytosis and tested positive for GABAB receptor autoantibodies. Pathological examination of an excisional mediastinal lymph node biopsy showed thymic small cell carcinoma, supporting a diagnosis of paraneoplastic limbic encephalitis (PLE). PLE is a subtype of limbic encephalitis and is associated with an array of autoantibodies. Neurologic symptoms related to PLE may precede the detection of the primary cancer. Recognition of the constellation of clinical features of limbic encephalitis should prompt initiation of diagnostic testing for this condition as well as evaluation for an underlying malignancy. A review of the literature reveals that this is the first case report of a patient with thymic small cell cancer presenting with PLE.