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The Role of Clinical Artifacts in Achieving Patient-centered Care Delivery

The Role of Clinical Artifacts in Achieving Patient-centered Care Delivery. Susan E. Piras RN, MSN and The Shared Expectations Early (SEE) Project Team Doctoral Student HFES 2013 International Symposium on Human Factors and Ergonomics in Health Care: Advancing the Cause. Outline. Background

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The Role of Clinical Artifacts in Achieving Patient-centered Care Delivery

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  1. The Role of Clinical Artifacts in Achieving Patient-centered Care Delivery Susan E. Piras RN, MSN and The Shared Expectations Early (SEE) Project Team Doctoral Student HFES 2013 International Symposium on Human Factors and Ergonomics in Health Care: Advancing the Cause

  2. Outline Background Problem • Context • Significance Method Discussion

  3. Background • Observations from Clinical Ethics consultation service: • Families were shocked, surprised, and, at times, in conflict. • Families are not equipped to make critical life decisions on behalf of the patient. • Families and healthcare team often had misaligned expectations about future care.

  4. Context IMAGES Setting: Burn ICU Patient: center of physical care Family: represent the patient Effect of unplanned health events • Nature of burns • Patient population

  5. Problem When trauma occurs: • Patients are unable to direct their care • Advance directives are not in place. • Families as a surrogate to make life decisions • Future course of life, family structure, finances, and routine are affected

  6. Methods

  7. Field Observations: Trajectory of Care Admission  Intubation, Vasopressors CRITICAL Resuscitation Surgical Debridement Off Vasopressors, Extubation  Stabilization RECOVERY Transition to Step-down unit Further surgery Off IV pain medication on po Eating  Preparation for discharge REHABILITATION Discharge

  8. Clinician and Family Interviews Clinician, when speaking about family presence: “…they’re not here the hours that we round…. I think that’s probably the biggest obstacle is finding them without a whole lot of trouble.”Intensivist of BICU Family, when speaking about communication from clinician “…they found a nodule…so they decided to do a CT…to rule out malignancy which is fine but I would have expected a call cause I didn’t even know anything about a nodule, nothing.”Daughter of patient

  9. Clinical Artifacts Discussion: • Data was collected from families but dissemination and purposeful-use was lacking • Artifacts were identified but not readily accessible, inconsistently used, or underutilized. • Artifacts were integrated but not used to their full potential. • Decision to systematically analyze unit artifacts.

  10. Trajectory of Care: Communication Artifacts  Admission CRITICAL -Nurses Admission Assessment Form -Burn Unit Handbook -Shift Rounds -White Board Intubation, Vasopressors Resuscitation Surgical Debridement Off Vasopressors, Extubation Stabilization  RECOVERY -Shift Rounds -White Board Transition to Step-down unit Further surgery Off IV pain medication on po Eating  Preparation for discharge REHABILITATION -Shift Rounds -White Board Discharge

  11. Analysis of Artifacts Systematic analysis of communication artifacts: • What is the purpose of this artifact? • What information does this artifact collect? • Who uses this artifact? • Who benefits from this artifact? • During which phase of care is it most utilized? • What message is the unit/institution conveying with the use of this artifact?

  12. Nursing Admission History Data Form

  13. Burn ICU Patient Handbook “People can go and read it, but, at first it’s just another confusing piece of paper.” Charge RN BICU

  14. Unit Announcement for Multidisciplinary Rounds “I heard on the speaker that they said… “family prepare for rounds”… I didn’t hear that until maybe the second or third one and then we started walking up and…kinda being a part of that conversation physically… rather than just sitting in (the room) and listening.” Family member in BICU

  15. White Board “They have the dry erase board in the room and, they usually have the day written up there and the nurse and another name on there sometimes. And that doesn’t always get changed day to day.” Family member in BICU Name “You know it may be Sunday and the date is still Friday; they don’t change the date.” Family member in BICU

  16. Discussion • Multiple artifacts were identified that capture and relay data in the BICU • Collected data was institution-centered • Interactive aspect of these artifacts has been lost • Improve on present design

  17. HOME Yesterday Major Milestone: Get off breathing machine YOU ARE HERE

  18. See Project Team Members • Anne Miller, Ph.D. • Joe Fanning, Ph.D. • David Schenck, Ph.D. • Paula DeWitt, Ph.D • Lee Parmley, M.D. • Larry Churchill, Ph.D. • Stuart McGrane, M.D. • Cristina Farkas, MS2 • Ricky Shinall, M.D. • Sparrow Smith, M.A. • Susan Piras, M.S.N. • John Burnam, M.T.S. • Tinsley Webster, M.A

  19. Contact Information Susan.E.Piras@Vanderbilt.edu

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