Physician Teamwork Research Articles

Usability barriers and facilitators of a human factors engineering-based clinical decision support technology for diagnosing pulmonary embolism

BackgroundHealth IT, such as clinical decision support (CDS), has the potential to improve patient safety. However, poor usability of health IT continues to be a major concern. Human factors engineering (HFE) approaches are recommended to improve the usability of health IT. Limited evidence exists on the actual impact of HFE methods and principles on the usability of health IT. ObjectiveTo identify and describe the usability barriers and facilitators of an HFE-based CDS prior to implementation in the emergency department (ED). MethodsWe conducted debrief interviews with 32 emergency medicine physicians as a part of a scenario-based simulation study evaluating the usability of the HFE-based CDS. We performed a deductive content analysis of the interviews using the usability criteria of Scapin and Bastien as a framework. ResultsWe identified 271 occurrences of usability barriers (94) and facilitators (177) of the HFE-based CDS. For instance, we found a facilitator relating to the usability criteria prompting as the PE Dx helps the physician order diagnostic tests following the risk assessment. We found the most facilitators relating to the criteria, minimal actions, e.g. as the PE Dx automatically populates vitals signs (e.g., heart rate) from the chart into the CDS. The majority of the usability barriers related to the usability criteria, compatibility (i.e., workflow integration), which was not explicitly considered in the HFE design of the CDS. For example, the CDS did not support resident and attending physician teamwork in the PE diagnostic process. ConclusionThe systematic use of HFE principles in the design of CDS improves the usability of these technologies. In order to further reduce usability barriers, workflow integration should be explicitly considered in the design of health IT.

Improving resident physician interprofessional collaborative practice during bedside interdisciplinary rounds

Significant gaps remain between current interprofessional education (IPE) and true interprofessional collaborative practice (IPCP). This study explores how resident physician teamwork behaviors on bedside interdisciplinary rounds are affected by a team-based pedagogical approach. In the context of interdependent interprofessional workflow and intentional teamwork teaching, we conducted a pre-post comparison study of bedside rounds teamwork behaviors of resident physicians at the beginning and at the end of a four-week rotation between July 2017 and May 2018. All 82 eligible residents during the study period enrolled in the study, making the participation rate 100%. Resident physicians performed 54% of predetermined teamwork behaviors at the beginning and 60% at the end of their rotation (P < 0.001). The most improved behaviors were inviting patient/family cross-check (38%–53%, p < 0.001), avoiding medical jargon (85%–98%, P < 0.001), proposing the plan for the day after other inputs (84%–95%, p < 0.001), and asking permission to enter the room (42%–54%, p = 0.002). Behaviors performed frequently included introducing interdisciplinary staff by name/role and speaking directly to patients. Rarely performed behaviors included introducing self, proposing discharge plans on non-discharge days, and assigning tasks to team members. Our findings suggest that an educational approach based on interdependent work and explicit teamwork feedback can improve resident physician IPCP. This study highlights the importance of intentionally constructing clinical learning environments to achieve effective interprofessional learning.

Patient experience of communication consistency amongst staff is related to nurse-physician teamwork in hospitals.

AimTo investigate whether nurse reported teamwork with physicians was associated with patient perceived consistency in staff‐to‐patient communication.DesignA cross‐sectional survey design was used, drawing on data collected from two surveys in England.MethodsTeamwork was assessed using data from the RN4CAST survey of 2,990 nurses in 31 Trusts in England. Data on patient experience derived from the National Health Services Adult Inpatient Questionnaire, including 12,506 patients in the same Trusts. A cross‐sectional design with multivariate logistic regression was used.ResultsEach 5% increase in the proportion of nurses who agree that there “is a lot of teamwork between nurses and physicians” was associated with 7% lower odds that patients reported inconsistency in communication amongst staff. The results suggest that patients seem to experience the consequences of less teamwork between nurses and physicians through their own perceptions of inconsistency in communication between staff. The findings emphasize good teamwork between doctors and nurses are not only important for the team, but also can have consequences for patients. It provides additional incentive to find mechanisms to breakdown disciplinary barriers and improve the cohesion of clinical teams for the benefit of their patients.

Use of Relational Coordination Scale to Assess Perceptions of Physician Teamwork Skills by Clinical and Administrative Staff

Use of Relational Coordination Scale to Assess Perceptions of Physician Teamwork Skills by Clinical and Administrative Staff

The Effects of Nursing Satisfaction and Turnover Cognitions on Patient Attitudes and Outcomes: A Three-Level Multisource Study.

To explore antecedents and outcomes of nurse self-reported job satisfaction and dissatisfaction-based turnover cognitions, theorizing (using Self-Determination Theory) that leaders can foster work conditions that help fulfill innate needs, thereby fostering satisfaction of nurses and patients, and reducing adverse events. Primary and secondary data were collected within a 4-month period in 2015, from 2,596 nurses in 110 Army treatment facilities (hospitals and clinics) across 35 health care systems. We collected individual nurse responses to the Practice Environment Scale-Nursing Work Index, in addition to aggregated archival data from the same timeframe, including both facility-level patient satisfaction records (the Army Provider Level Satisfaction Survey) and health care system-level adverse events records (provided by the Army Programming, Analysis, and Evaluation office). Five predictors of nurse satisfaction and turnover cognitions emerged-supportive leadership, staffing levels, nurse-physician teamwork, adoption of nursing care practice, and advancement opportunities. Aggregated nurse satisfaction was the most consistent predictor of both patient satisfaction and adverse events. These findings provide evidence of the importance of nurse attitudes in improving perceived and actual performance across facilities and health care systems; in addition to practical steps, managers can take to improve satisfaction and retention.

Association Between Physician Teamwork and Health System Outcomes After Coronary Artery Bypass Grafting.

Patients undergoing coronary artery bypass grafting (CABG) must often see multiple providers dispersed across many care locations. To test whether teamwork (assessed with the bipartite clustering coefficient) among these physicians is a determinant of surgical outcomes, we examined national Medicare data from patients undergoing CABG. Among Medicare beneficiaries who underwent CABG between 2008 and 2011, we mapped relationships between all physicians who treated them during their surgical episodes, including both surgeons and nonsurgeons. After aggregating across CABG episodes in a year to construct the physician social networks serving each health system, we then assessed the level of physician teamwork in these networks with the bipartite clustering coefficient. Finally, we fit a series of multivariable regression models to evaluate associations between a health system's teamwork level and its 60-day surgical outcomes. We observed substantial variation in the level of teamwork between health systems performing CABG (SD for the bipartite clustering coefficient was 0.09). Although health systems with high and low teamwork levels treated beneficiaries with comparable comorbidity scores, these health systems differed over several sociocultural and healthcare capacity factors (eg, physician staff size and surgical caseload). After controlling for these differences, health systems with higher teamwork levels had significantly lower 60-day rates of emergency department visit, readmission, and mortality. Health systems with physicians who tend to work together in tightly-knit groups during CABG episodes realize better surgical outcomes. As such, delivery system reforms focused on building teamwork may have positive effects on surgical care.

An algorithm of dental/dentofacial-based options for managing patients with obstructive sleep apnoea referred to a dentist/dental specialist by a physician.

There are so many documents in the literature discoursing the aetiology, nature, diagnosis and treatment planning of obstructive sleep apnoea (OSA). Almost all of them mention that OSA has to be evaluated and treated through the multidisciplinary teamwork of physicians and dentists. Due to a lack in the literature, this article focuses on dentists' and dental specialists' role in the treatment algorithm of OSA.

Improving nurse-physician teamwork through interprofessional bedside rounding.

BackgroundTeamwork between physicians and nurses has a positive association with patient satisfaction and outcomes, but perceptions of physician–nurse teamwork are often suboptimal.ObjectiveTo improve nurse–physician teamwork in a general medicine inpatient teaching unit by increasing face-to-face communication through interprofessional bedside rounds.InterventionFrom July 2013 through October 2013, physicians (attendings and residents) and nurses from four general medicine teams in a single nursing unit participated in bedside rounding, which involved the inclusion of nurses in morning rounds with the medicine teams at the patients’ bedside. Based on stakeholder analysis and feedback, a checklist for key patient care issues was created and utilized during bedside rounds.AssessmentTo assess the effect of bedside rounding on nurse–physician teamwork, a survey of selected items from the Safety Attitudes Questionnaire (SAQ) was administered to participants before and after the implementation of bedside rounds. The number of pages to the general medicine teams was also measured as a marker of physician–nurse communication.ResultsParticipation rate in bedside rounds across the four medicine teams was 58%. SAQ response rates for attendings, residents, and nurses were 36/36 (100%), 73/73 (100%), and 32/73 (44%) prior to implementation of bedside rounding and 36 attendings (100%), 72 residents (100%), and 14 (19%) nurses after the implementation of bedside rounding, respectively. Prior to bedside rounding, nurses provided lower teamwork ratings (percent agree) than residents and attendings on all SAQ items; but after the intervention, the difference remained significant only on SAQ item 2 (“In this clinical area, it is not difficult to speak up if I perceive a problem with patient care”, 64% for nurses vs 79% for residents vs 94% for attendings, P=0.02). Also, resident responses improved on SAQ item 1 (“Nurse input is well received in this area”, 62% vs 82%, P=0.01).ConclusionIncreasing face-to-face communication through interprofessional bedside rounding can improve the perceptions of nurse–physician teamwork, particularly among residents and nurses.

The Role of Palliative Care in Patient’s Recovering

Palliative care is the study of specialized medical care for patients with serious illnesses. It is the study of approaches that provide relief from mental stress, pain, physical stress and serious illness, eventually improving the quality of life for both the patients and their family. Palliative care is a teamwork of physicians, nurses, and other health professionals which provides an extra layer of support. Palliative care can be provided in hospitals, or at patient's home and as community palliative care programs.

Determination of the UV solar risk in Argentina with high-resolution maps calculated using TOMS ozone climatology

The connection between ultraviolet (UV) radiation and various skin diseases is well known. In this work, we present the computer program “UVARG”, developed in order to prevent the risk of getting sunburn for persons exposed to solar UV radiation in Argentina, a country that extends from low (tropical) to high southern hemisphere latitudes. The software calculates the so-called “erythemal irradiance”, i.e., the spectral irradiance weighted by the McKinlay and Diffey action spectrum for erythema and integrated in wavelength. The erythemal irradiance depends mainly on the following geophysical parameters: solar elevation, total ozone column, surface altitude, surface albedo, total aerosol optical depth and Sun–Earth distance. Minor corrections are due to the variability in the vertical ozone, aerosol, pressure, humidity and temperature profiles and the extraterrestrial spectral solar UV irradiance. Key parameter in the software is a total ozone column climatology incorporating monthly averages, standard deviations and tendencies for the particular geographical situation of Argentina that was obtained from TOMS/NASA satellite data from 1978 to 2000. Different skin types are considered in order to determine the sunburn risk at any time of the day and any day of the year, with and without sunscreen protection. We present examples of the software for three different regions: the high altitude tropical Puna of Atacama desert in the North–West, Tierra del Fuego in the South when the ozone hole event overpasses and low summertime ozone conditions over Buenos Aires, the largest populated city in the country. In particular, we analyzed the maximum time for persons having different skin types during representative days of the year (southern hemisphere equinoxes and solstices). This work was made possible by the collaboration between the Argentine Skin Cancer Foundation, the Institute of Physics Rosario (CONICET-National University of Rosario, Argentina) and the Institute of Medical Physics, University of Innsbruck, Austria. With the teamwork of physicians and physicists, a scientifically reliable and easy-to-handle tool was developed to predict the risk of solar exposure in Argentina. It can be used by dermatologists as well as health authorities and educators in order to prevent health problems induced by solar UV radiation.

A Study of Prospective Ophthalmology Residents’ Career Perceptions

Objectives: The purpose of this study was to identify differences in ophthalmology resident candidates and practicing ophthalmologists’ career perceptions. A secondary aim was to evaluate specific demographic factors (e.g., gender, ethnicity, career interests, etc.) among residency candidates regarding their career perceptions.Methods: A survey instrument (Critical factors in Career Perceptions) was sent by e-mail to prospective residents (n= 122). Group differences were calculated using a one sample t-test analysis.Results: Compared to practicing ophthalmologists (n = 56), residency candidates were more likely (p < 0.05) to expect greater professional job satisfaction from a number of career factors (e.g., time with patients, physician teamwork, etc.); family-personal factors (e.g., diversity of job skills, sole professional responsibility, etc.); and financial factors (i.e., income and security) than those in practice. Gender differences between candidates revealed that women were more interested in spending time with patients and in computer technology applications.Conclusions: These results suggest that medical school and residency program leaders to consider specific factors ophthalmologists encounter in their profession so that residency candidates have a more realistic view of their chosen profession. Several recommendations for resident recruitment and curriculum development are provided.

ULCERATIVE COLITIS: PHYSICIAN TEAMWORK IN THE TREATMENT.

ULCERATIVE COLITIS: PHYSICIAN TEAMWORK IN THE TREATMENT.