scholarly journals Innovation in hemodialysis: Using the Biodesign process to identify unmet needs

2020 ◽  
pp. 112972982091369
Author(s):  
Dimitri A Augustin ◽  
Glenn M Chertow ◽  
Dan E Azagury
Keyword(s):  
Patient Care ◽  
Unmet Needs ◽  
Innovation Process ◽  
Health Technology ◽  
Initial Part ◽  
Public And Private ◽  
Clinical Observations ◽  
Hemodialysis Unit ◽  
Novel Devices ◽  
Case Based

There is renewed demand to accelerate innovation in nephrology; public and private sectors are creating programs to support its growth. The Stanford Biodesign innovation process, first developed in 2000, provides a roadmap for health technology and device innovation. There is insufficient published guidance on the application of the Biodesign process in the generation of novel devices to address nephrology- and/or dialysis-related clinical unmet needs. We present “needs finding,” the initial part of the identify phase in the Biodesign innovation process and how it may be utilized for nephrology- and/or dialysis-related innovation. We describe here how to apply the Biodesign process to identify unmet dialysis-related needs, with the use of specific case-based examples based on observations within a hemodialysis unit. We then explore how to develop these needs using background research, direct clinical observations, interviews, documentation of observations and interview findings, and development of multiple needs statements. We conclude that there is an opportunity for nephrology innovators to use this methodology broadly in order to identify areas for innovation and initiated the development on novel solutions to be introduced into patient care.

scholarly journals Physician Workflow in Two Distinctive Emergency Departments: An Observational Study

2021 ◽  
Vol 12 (01) ◽  
pp. 141-152
Author(s):  
Vimla L. Patel ◽  
Courtney A. Denton ◽  
Hiral C. Soni ◽  
Thomas G. Kannampallil ◽  
Stephen J. Traub ◽  
...  
Keyword(s):  
Patient Care ◽  
Emergency Departments ◽  
Direct Patient Care ◽  
Team Communication ◽  
Delivery Of Care ◽  
Physician Practices ◽  
Clinical Observations ◽  
Workflow Pattern ◽  
Open Coding ◽  
Temporal Events

Abstract Objectives We characterize physician workflow in two distinctive emergency departments (ED). Physician practices mediated by electronic health records (EHR) are explored within the context of organizational complexity for the delivery of care. Methods Two urban clinical sites, including an academic teaching ED, were selected. Fourteen physicians were recruited. Overall, 62 hours of direct clinical observations were conducted characterizing clinical activities (EHR use, team communication, and patient care). Data were analyzed using qualitative open-coding techniques and descriptive statistics. Timeline belts were used to represent temporal events. Results At site 1, physicians, engaged in more team communication, followed by direct patient care. Although physicians spent 61% of their clinical time at workstations, only 25% was spent on the EHR, primarily for clinical documentation and review. Site 2 physicians engaged primarily in direct patient care spending 52% of their time at a workstation, and 31% dedicated to EHRs, focused on chart review. At site 1, physicians showed nonlinear complex workflow patterns with a greater frequency of multitasking and interruptions, resulting in workflow fragmentation. In comparison, at site 2, a less complex environment with a unique patient assignment system, resulting in a more linear workflow pattern. Conclusion The nature of the clinical practice and EHR-mediated workflow reflects the ED work practices. Physicians in more complex organizations may be less efficient because of the fragmented workflow. However, these effects can be mitigated by effort distribution through team communication, which affords inherent safety checks.

scholarly journals P2.15-17 Patient Care in Advanced Lung Cancer: Unmet Needs

2018 ◽  
Vol 13 (10) ◽  
pp. S824
Author(s):  
J. Morere ◽  
F. Eisinger ◽  
H. Naman ◽  
R. Sellami ◽  
C. Lhomel ◽  
...  
Keyword(s):  
Lung Cancer ◽  
Patient Care ◽  
Unmet Needs ◽  
Advanced Lung Cancer

Digital Professionalism in Patient Care: A Case Based Survey of Patients

2021 ◽  
Author(s):  
Andrea Boyd Tressler ◽  
Robert Naples ◽  
Paola A. Barrios ◽  
Xue Jia ◽  
Judith C. French ◽  
...  
Keyword(s):  
Patient Care ◽  
Case Based

P035: Development of a province-wide audit program for return visits to the emergency department

CJEM ◽  
2017 ◽  
Vol 19 (S1) ◽  
pp. S89-S90
Author(s):  
L.B. Chartier ◽  
O. Ostrow ◽  
I. Yuen ◽  
S. Kutty ◽  
B. Davis ◽  
...  
Keyword(s):  
Emergency Department ◽  
Patient Care ◽  
Quality Care ◽  
Improve Patient Care ◽  
Lessons Learned ◽  
Quality And Safety ◽  
Term Care ◽  
Clinical Observations ◽  
Quality Program ◽  
Physician Leaders

Introduction: Routine auditing of charts of patients with an emergency department (ED) return visit (RV) resulting in hospital admission can uncover quality and safety gaps in care. This feedback can be helpful to clinicians, administrators, and leaders working to improve clinical outcomes, increase patient satisfaction, and promote high-value care. Health Quality Ontario (HQO) has been tasked by Ontario’s Ministry of Health and Long-Term Care (MOHLTC) to manage the newly created ED RV Quality Program (RVQP), which mandates EDs participating in the Pay-for-Results (P4R) program to audit a minimum of 25-50 RVs/year. The goal of the first-ever ED-specific province-wide Quality Improvement (QI) initiative of this kind is to promote a culture of QI that will lead to improved patient care. Methods: Participating hospitals receive quarterly confidential reports from Access to Care (ATC) that show their and other hospitals’ rates of RVs, as well as identifying information for patients meeting RV inclusion criteria at their ED (within 72 hrs of index visit, or within 7 days with specific diagnoses). HQO has partnered with QI experts and ED physician-leaders to develop various guidance materials. These materials have been disseminated through various media. Hospitals are conducting audits to identify underlying quality issues, take steps to address the underlying causes, and submit reports to HQO. A taskforce will then analyze clinical observations, summarize key findings and lessons learned, and share improvements at a provincial level through an annual report. Results: Since its launch in April 2016, 73 P4R and 16 voluntarily enrolled non-P4R hospitals (which collectively receive approximately 90% of ED visits in the province) are participating in the RVQP. ED leaders have engaged their hospital’s leadership to leverage interest and resources to improve patient care in the ED. To date, hospitals have conducted thousands of audits and have identified quality and safety gaps to address, which will be analyzed in February 2017 for reporting shortly thereafter. These will inform QI endeavours locally and provincially, and be the largest source of such data ever created in Ontario. Conclusion: The ED RVQP aims to create a culture of continuous QI in the Ontario health care system, which provides care to over 13.8 million people. Other jurisdictions can replicate this model to promote high-quality care.

The development of a data-matching algorithm to define the ‘case patient’

2013 ◽  
Vol 37 (1) ◽  
pp. 54 ◽  
Author(s):  
Shelley Cox ◽  
Rohan Martin ◽  
Piyali Somaia ◽  
Karen Smith
Keyword(s):  
Patient Care ◽  
Emergency Services ◽  
Accurate Method ◽  
Patient Specific ◽  
Patient Records ◽  
Case Patient ◽  
Matching Algorithm ◽  
Patient Level ◽  
Electronic Data Capture System ◽  
Case Based

Objectives. To describe a model that matches electronic patient care records within a given case to one or more patients within that case. Method. This retrospective study included data from all metropolitan Ambulance Victoria electronic patient care records (n = 445 576) for the time period 1 January 2009–31 May 2010. Data were captured via VACIS (Ambulance Victoria, Melbourne, Vic., Australia), an in-field electronic data capture system linked to an integrated data warehouse database. The case patient algorithm included ‘Jaro–Winkler’, ‘Soundex’ and ‘weight matching’ conditions. Results. The case patient matching algorithm has a sensitivity of 99.98%, a specificity of 99.91% and an overall accuracy of 99.98%. Conclusions. The case patient algorithm provides Ambulance Victoria with a sophisticated, efficient and highly accurate method of matching patient records within a given case. This method has applicability to other emergency services where unique identifiers are case based rather than patient based. What is known about the topic? Accurate pre-hospital data that can be linked to patient outcomes is widely accepted as critical to support pre-hospital patient care and system performance. What does this paper add? There is a paucity of literature describing electronic matching of patient care records at the patient level rather than the case level. Ambulance Victoria has developed a complex yet efficient and highly accurate method for electronically matching patient records, in the absence of a patient-specific unique identifier. Linkage of patient information from multiple patient care records to determine if the records are for the same individual defines the ‘case patient’. What are the implications for practitioners? This paper describes a model of record linkage where patients are matched within a given case at the patient level as opposed to the case level. This methodology is applicable to other emergency services where unique identifiers are case based.

Spinal Neurosurgery

2018 ◽  
Keyword(s):  
Patient Care ◽  
Management Strategies ◽  
Oral Examination ◽  
Diagnosis And Treatment ◽  
High Yield ◽  
Complication Management ◽  
Treatment Plans ◽  
Spine Surgeon ◽  
Case Based

Neurosurgery by Example: Key Cases and Fundamental Principles provides case-based, high yield content for the spine surgeon and neurosurgeons preparing for the American Board of Neurological Surgeons oral examination. It covers a wide array of spinal pathologies with their presentation, diagnosis, and treatment plans. Postoperative and complication management strategies are offered as well in order to prepare surgeons who can then provide comprehensive patient care for complex spine conditions.

Sources of Disagreement Among Public and Private Agency Paramedics

1995 ◽  
Vol 10 (2) ◽  
pp. 92-95
Author(s):  
Carol S. Federiuk ◽  
Kerth O'Brien
Keyword(s):  
Patient Care ◽  
Interpersonal Relationships ◽  
Cohort Analysis ◽  
Patient Treatment ◽  
Public And Private ◽  
Public Agency ◽  
Patient Transport ◽  
Private Agency ◽  
Wide Range ◽  
Different Types

AbstractIntroduction:The purpose of the study was to document the occurrence and causes of disagreements between paramedics in a tiered-response emergency medical services (EMS) system.Methods:This cohort analysis of disagreements between paramedics sampled 63 male public agency, 90 male private agency, and 41 female private agency paramedics. Paramedics responded to Likert-type items and one open-ended item concerning the occurrence of conflict between paramedics.Results:On-scene conflict between EMS personnel from public and private agencies was reported by 70% of the respondents. Conflicts that interfered with patient care were reported to occur more frequently between paramedics from different types of agencies. The most commonly mentioned subject of disagreement was patient treatment, followed by patient transport, interpersonal and interagency conflicts, and patient assessment.Conclusion:A majority of paramedics have experienced on-scene disagreements with other paramedics. Disagreements occur more frequently between paramedics from different agencies and encompass a wide range of issues concerning patient care and interpersonal relationships.

scholarly journals Government Innovation of Kulon Progo “Bela-Beli” Programme

2018 ◽  
Vol 73 ◽  
pp. 09019
Author(s):  
Yuwono Teguh ◽  
Warsito ◽  
Ghulam Manar Dzunuwanus
Keyword(s):  
Local Government ◽  
Innovation Process ◽  
Public And Private ◽  
Private Participation ◽  
Special Area ◽  
Government Innovation

Innovation can be found in many local government of Indonesia. However, innovation based on ideology only found in Kulon Progo Regency of Yogyakarta Special Area. Under administration of Hasto Wardoyo, the regent, innovation goes to many areas and brings many benefits for both people and government. It ignited economics development, public and private participation, as well as government transformation. It is important to understand the innovation process since it comes from ideological aspect that is different from any innovation ever.

scholarly journals Health technology assessment in Brazil: what do healthcare system players think about it?

2011 ◽  
Vol 129 (4) ◽  
pp. 198-205 ◽  
Author(s):  
Marcos Bosi Ferraz ◽  
Patricia Coelho de Soárez ◽  
Paola Zucchi
Keyword(s):  
Health Economics ◽  
Health Technology Assessment ◽  
Healthcare System ◽  
Technology Assessment ◽  
International Health ◽  
Health Technology ◽  
Cross Sectional Study ◽  
Cross Sectional ◽  
Public And Private ◽  
The Government

CONTEXT AND OBJECTIVES: The health technology assessment (HTA) process has been developed locally. The aim of this study was to describe, analyze and compare the opinions of participants in international health economics symposia about the HTA process used in Brazil. DESIGN AND SETTING: Observational cross-sectional study at the 2006 and 2008 International Health Economics Symposia, in São Paulo. METHODS: A structured questionnaire was applied. For the statistical analysis, the percentage distribution for each category was calculated, and variables were compared using tests for two-sample proportion hypotheses. RESULTS: Totals of 153 and 74 participants answered the 2006 and 2008 surveys, respectively. The response rate was better for the 2006 survey (67.1%) than for the 2008 survey (31.8%). Most interviewees were between the ages of 30 and 49 years and were managers in the healthcare system. Most of them considered that the current HTA process was incomplete and unable to meet the needs of the healthcare system. They mentioned the government, academia and experts as the three main groups of people who should be involved in the process, and selected efficiency/effectiveness, safety and disease relevance as the three main criteria to be considered in the HTA process. There is a trend towards developing decentralized regionalized HTA processes, with separate assessment and decision-making for the public and private systems. CONCLUSIONS: The HTA concept is well known. Healthcare system players feel that the process has methodological limitations. Additional surveys are needed to track the HTA process and its application in Brazil.

Health Technologies for the Developing World: Addressing the Unmet Needs

1992 ◽  
Vol 8 (4) ◽  
pp. 623-634 ◽  
Author(s):  
Michael J. Free
Keyword(s):  
Public Sector ◽  
Unmet Needs ◽  
Developing World ◽  
Appropriate Technology ◽  
Public And Private ◽  
The Public ◽  
Health Technologies ◽  
Private Sector Organizations ◽  
Public And Private Sector

AbstractThis paper provides a critical overview of several strategies and mechanisms that have been employed by the Program for Appropriate Technology in Health over the past decade to address the unmet needs for health technologies in the developing world. Partnerships between public and private-sector organizations are emphasized in order to share risks, encourage efficiency, and ensure the availability of priority products for health care in resource-poor settings. Incentives for the involvement of the commercial sector, the means to protect the interest of the public sector, and the role of bridging organizations are discussed in the light of the shifting goals of the public sector.

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