Transcript A Systematic Study of the Coordination, Communication, and

A Systematic Study of the
Coordination, Communication, and
Information Needs for Patient Care
in an Academic Health Center
James J. Cimino, M.D.
Columbia University
Overall Objective
• To study information flow related to inpatient medication administration
• To identify areas in which information
technology can be used to reduce errors:
– responding to information needs
– communication of information among team
members to support collaboration
Staff
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James J. Cimino, M.D. (15%)
Suzanne Bakken, D.N.Sc. (15%)
Vimla L. Patel, Ph.D. (20%)
Christine Curran, Ph.D. (15%)
Tate Kubose, Ph.D. (70%)
Lawrence McKnight, M.D. (50%)
Peter Stetson, M.D. (50%)
Research Assistant (TBN) (100%)
Budget
Salaries (plus $42,111 cofunding)$166,006
Equipment (computer)
$2,500
Supplies (software, food)
$3,700
Publications
$1,750
Survey subjects
$5,625
Indirect costs
$16,162
Total
$195,743
Time Period
Month 1 2 3 4 5 6 7 8 9 10 11 12
Surveys
D C A
Observational Studies D D D C C A A A A A
Focus Groups
D D D C C A A
Summary Analysis
A A
D - Design
C - Collection
A - Analysis
Significance
• Medical errors abound
• Medication errors (adverse drug events)
• Our study will lead to an improved understanding
of the problem
• Our study will provide a framework for developing
information technology-based solutions
Background
• Studies of information needs
– Inadequate information leads to adverse events
– Underutilization of resources
– Needs are often un-met
• Studies of communication and collaboration
– Communication errors cause adverse events
– Interrupt-driven
– Reliance on face-to-face mode
Preliminary Studies
• Physician surveys (26)
• Nurse surveys (17)
• Physician focus groups (3 groups, 15 participants)
• Nurse focus groups (2 groups, 12 participants)
• Physician observations (2 rounds, 2 individuals)
Preliminary Results:
Surveys and Focus Groups
• Physician: medication lists, links to pharmacy
system, inefficiencies of paging system
• Nurses: drug information needed for patient
education, drug administration policy and
procedures, inefficiencies of paging system
Preliminary Results:
Observations of Information Needs
Don’t Know
Human
Pending
Success
Failure
Chart
Pending
Success
Failure
Resource Pending
Success
Failure
Walking Rounds
Admin
Patient
Domain
3
3
1
2
4
1
2
3
6
12
16
4
1
Teaching Rounds
Admin
Patient
Domain
8
4
7
1
14
8
1
11
19
5
2
10
4
2
10
5
Preliminary Results:
Observations of Coordination Events
Outcome
Don’t Know
Pending Contact
Pending Outcome
Success
Failure
Total
Walking Rounds
Teaching Rounds
Observations
Obs/Hr
Observations
Obs/Hr
7
6
6
9
7
35
0.80
0.69
0.69
1.03
0.80
4.00
5
30
6
3
3
47
0.83
5.00
1.00
0.50
0.50
7.83
Objectives
• Expand on preliminary studies to categorize
and enumerate proximal causes of
medication errors
– Un-met information needs
– Ineffective communication
• Identify specific information technologybased solutions
Tasks
• Surveys
• Observational Studies
• Focus groups
Products: Proximal Causes of Errors
• Unmet information needs related to medications
– Therapeutic decision making
– Administration
– Education of patients
• Ineffective communication
– Order communication
– Coordination of plan
– Feedback on patient response
Products: Publications
• Informatics literature
• Medical literature
Products: Technologic Solutions
• Infobuttons
• Virtual whiteboard
• PalmCIS
AHRQ Proposal
• Three-year plan
• Year 1 Q1-Q4: design technologic solutions
• Year 2 Q1: Testing
• Year 2 Q2 to Year 3 Q1: controlled trial
• Year 3 Q2-4: Analysis
Contributions
• Specific characterizations of proximal causes
of errors
• First step in a clinical trial for error reduction
through information technology