Methods Inf Med - An observation tool for studying patient-oriented workflow in hospital emergency departments.

Tópicos

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Resumo

CKGROUND: Studying workflow is a critical step in designing, implementing and evaluating informatics interventions in complex sociotechnical settings, such as hospital emergency departments (EDs). Known approaches to studying workflow in clinical settings attend to the activities of individual clinicians, thus being inadequate to characterize patient care as a cooperative work.OBJECTIVES: The purpose of this paper is twofold. First, we introduce a novel, theory-driven patient-oriented workflow methodology, which better addresses the complex, multiple-provider nature of patient care. Second, we report the development of an observational tool and protocol for use in studies of this type, and the results of an evaluation study.METHODS: We created a tablet computer implementation of an instrument to efficiently capture patient-oriented workflow, and evaluated it through a field study in three EDs. We focused on activities occurring over time during a single patient care episode as well as the roles of the ED staff members who conducted the activities.RESULTS: The evidence generated supports the validity, viability, and reliability of the tool. The coverage of the tool in terms of activities and roles was satisfactory. The tool was able to capture the sequence of activity-role pairs for 108 patient care episodes. The inter-rater reliability assessment yielded a high kappa value (0.79).DISCUSSION: The patient-oriented workflow methodology has the potential to facilitate modeling patient care in EDs by characterizing both roles and activities in sequence. The methodology also provides researchers and practitioners a more realistic and comprehensive workflow perspective that can inform the design, implementation and evaluation of health information technology interventions.

Resumo Limpo

ckground studi workflow critic step design implement evalu informat intervent complex sociotechn set hospit emerg depart ed known approach studi workflow clinic set attend activ individu clinician thus inadequ character patient care cooper workobject purpos paper twofold first introduc novel theorydriven patientori workflow methodolog better address complex multipleprovid natur patient care second report develop observ tool protocol use studi type result evalu studymethod creat tablet comput implement instrument effici captur patientori workflow evalu field studi three ed focus activ occur time singl patient care episod well role ed staff member conduct activitiesresult evid generat support valid viabil reliabl tool coverag tool term activ role satisfactori tool abl captur sequenc activityrol pair patient care episod interrat reliabl assess yield high kappa valu discuss patientori workflow methodolog potenti facilit model patient care ed character role activ sequenc methodolog also provid research practition realist comprehens workflow perspect can inform design implement evalu health inform technolog intervent

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