Computer use in an urban university hospital: technology ahead of literacy.

The linkage of patient safety and care quality to the implementation of computerized information systems assumes that clinical staff are skilled with computers. Nurses and nursing support staff increasingly require computers to carry out their work. Minimum computer competencies for nurses have been identified. The determination of whether the current nursing workforce has acquired these competencies remains uncertain. We administered a self-assessment survey to nurses and nursing support staff to determine proficiency with computer skills they might perform at work. Respondents reported inadequacies in basic and work-related computer skills. More than 28% scored themselves as having fair or poor proficiency on all skills, and more than 50% as fair or poor on five of 11 skills. Respondents over age 50 and those graduating before 1984 tended to score proficiency lower. Our study suggests that many nurses and nursing support staff may not have the minimum computer competencies to effectively and efficiently perform their work.

Building a results review system: a critical first step in transitioning from paper medical records.

Electronic health records (EHRs) are valuable tools for efficiently delivering safe and effective care, yet the majority of providers continue to rely on paper based systems. Cost is a significant barrier to adoption. Providers unable to afford a comprehensive EHR may still be capable of taking a less costly first step toward improving quality and safety with less aggressive yet effective clinical information system strategies. We identified a single, clearly definable, clinical information need: Improving the delivery of results and reports. We built a results review system to improve the efficiency and reliability of access to clinical information for providers working in the New Orleans safety net for the under/uninsured. We measured provider satisfaction with clinical information delivery systems before and after implementation and analyzed the rate of adoption and ongoing system utilization. Providers expressed increased satisfaction, and showed rapid adoption and an ongoing high rate of utilization over time.

The use of telemedicine in the management of diabetes-related foot ulceration: a pilot study.

OBJECTIVE: To determine if the management of forefoot ulcerations through telemedicine is medically equivalent to ulcer care at a diabetes foot program. DESIGN: Nonrandomized comparison of forefoot ulcer healing rates. SETTING: The Louisiana State University Health Sciences Center Diabetes Foot Program, Baton Rouge, LA, and Lallie Kemp Medical Center, Independence, LA. PARTICIPANTS: Twenty consecutive patients with diabetes were treated for neuropathic forefoot ulcerations via telemedicine consultation and 120 consecutive patients with diabetes were treated face-to-face at a diabetes foot program. INTERVENTIONS: Management of forefoot ulcers by a certified wound care nurse trained in the use of a staged management approach algorithm and alternative off-loading methods, supported by real-time interactive telemedicine consultation. MAIN OUTCOME VARIABLES: Forefoot ulcer healing time in days, percentage of wounds healed in 12 weeks, and healing time ratio (adjusted for age, gender, ulcer duration, location, size, crossover, and grade). RESULTS: No differences were found between the telemedicine and diabetes foot program groups in the average forefoot ulcer healing time (43.2 + 29.3 vs. and 45.5 + 43.4 days, P =.828), the percent of forefoot ulcers healed in 12 weeks (75 % vs. 81%, P =.546) and the adjusted healing time ratio (1.40 vs 1.00, P =.104). CONCLUSION: These data appear to support the effectiveness of real-time interactive telemedicine consultation in the management of diabetes-related forefoot ulceration.