Qualitative Analysis of Team Communication with a Clinical Texting System at a Midwestern Academic Hospital.

BACKGROUND: Hospitals are increasingly replacing pagers with clinical texting systems that allow users to use smartphones to send messages while maintaining compliance for privacy and security. As more institutions adopt such systems, the need to understand the impact of such transitions on team communication becomes ever more significant. METHODS: We conducted focus groups with hospitalists and individual interviews with nurses at one academic medical center in the Midwest. All interviews and focus groups were audiorecorded, transcribed, and deidentified for analysis. All transcripts and notes were independently read by two members of the research team and coded for themes. RESULTS: Twenty-one hospitalists and eight nurses participated in the study. Although study participants spoke favorably of texting, they identified more dissatisfactions with texting than benefits. There were disagreements regarding appropriate texting practices both within and between the hospitalists and nurses. CONCLUSION: Despite the benefits of texting, there is room for improving team communication and understanding in the realm of clinical texting. A lack of shared understanding regarding when and how to use texting may require long-term solutions that address teamwork and appropriateness.

Innovating Fall Safety: Engaging Patients as Experts.

BACKGROUND: Injury falls are common, with nearly a million hospitalized patients falling annually. Fall risk identification and prevention are largely clinician-centric, lacking patient input. LOCAL PROBLEM: Our fall rates were below the national mean; however, patients who fell and sustained injury were at or above the mean. We lacked processes that engaged patients as safety collaborators. METHODS: This was a quality improvement study examining the effect of a collaborative fall intervention on (1) patient knowledge in action and (2) incidence of falls. INTERVENTION: The patient fall assessment tool was implemented to facilitate collaborative safety conversations. RESULTS: We achieved a statistically significant improvement (P = .0007) in the patient's participation in the development of the safety plan, with a 25% reduction in total falls and a 67% reduction in injury falls. CONCLUSIONS: The patient fall assessment tool may be a successful strategy to engage patients in the development of their safety plan and positively affect safety partnerships.

Inpatient fall prevention from the patient's perspective: A qualitative study.

AIM: The aim of this study was to describe the patient's perspective of fall prevention in an acute care setting to aid in the design of patient centered strategies. BACKGROUND: Falls are one of the most common adverse events in hospitals and can lead to preventable patient harm, increased length of stay, and increased healthcare costs. There is a need to understand fall risk and prevention from the patients' perspectives; however, research in this area is limited. METHODS: To understand the patient perspective, semi-structured interviews were conducted with twelve patients at an academic healthcare center. RESULTS: Qualitative analysis revealed three major themes: (1) how I see myself, (2) how I see the interventions; and (3) how I see us. The theme "How I see myself" describes patients' beliefs of their own fall risk and includes the sub-themes of awareness, acceptance/rejection, implications, emotions, and personal plan. Interventions, such as fall alarms, are illustrated in the theme "How I see the interventions" and includes the subthemes what I see and hear and usefulness of equipment. Finally, "How I see us" describes barriers to participating in the fall prevention plan. CONCLUSIONS: Most fall prevention programs favor clinician-led plan development and implementation. Patient fall assessments needs to shift from being clinician-centric to patient-centric. Nurses must develop relationships with patients to facilitate understanding of their needs. Developing these truly patient-centered programs may reduce the over-reliance on bed alarms and allow for implementation of strategies aimed to mitigate modifiable risk factors leading to falls.