Whiteboard Implementation Research Articles

Quality Improvement of Surgical Team Communication of Required Percutaneous Nephrolithotomy Equipment

To evaluate if implementation of a percutaneous nephrolithotomy (PCNL) equipment whiteboard can improve communication accuracy of surgical equipment, streamline operative efficiency, and decrease unnecessary case equipment costs. A real time editable equipment whiteboard was designed and implemented for all PCNL cases between October and December 2021. The relative difference in pre- and post-intervention surgical equipment accuracy as well as overall case costing was compared from 90 days prior to implementation to the period after intervention. Quality assessment surveys were completed prior to whiteboard implementation (N=25) and ost-implementation (n=15). Pre- and post-operative assessment of equipment communication, assessed on a 10-point scale, improved after implementation of the communication whiteboard (Pre-op: 6.7/10 vs. 8.9/10, p<0.001. Post-op: 7.0/10 vs. 9.3/10, p<0.001). On average 64% (3.2/5) of items were accurate on pre-intervention cases. Post-intervention accuracy improved to 88% (4.4/5 items) (p=0.049). There was a significant relative case cost improvement after implementing the PCNL equipment whiteboard with an average of $436.81 USD savings per case (p=0.001) and $488.22 USD per renal moiety (p=0.002). Our baseline quality assessment of surgical team communication regarding PCNL equipment identified an area for improvement. Multidisciplinary feedback resulted in the development of a real time editable PCNL equipment whiteboard which improved team perception of equipment communication, case item accuracy and resulted in a relative average cost savings for PCNL.

Impact of an integrated whiteboard system on physics QA turnaround time

PurposeTo evaluate the impact of a digital whiteboard system integrated with data from the oncology information system (OIS) on the urgency of physics quality assurance (QA) tasks in the radiation oncology department.MethodsQuality check list (QCL) items in the Mosaiq OIS corresponding to eight discrete, sequential steps in the treatment planning process were created. A whiteboard to graphically display active QCLs automatically and in real time was implemented in March 2020 using R shiny. QCL data with completion status were collected in two 12‐month time periods before and after whiteboard implementation: January 2019–December 2019 and July 2020–June 2021. For all plans requiring patient‐specific QA, we recorded when each plan was available for physics QA and which treatments started the following day. We further classified those plans into four categories (urgency levels 1–4 with 4 being the most urgent) depending on how much time was available to perform QA. We compared the proportion of these next‐day QAs in each category between time periods accounting for plan type, day of the week, and time of year.ResultsOverall QA numbers were similar between time periods with 797 and 765 QAs total. The total proportion of next‐day QA decreased by 27% and the proportions of urgency levels 1 and 4 both showed significant decreases after whiteboard implementation of 29.2% and 54.9%, respectively (p<0.05). All plan types had reduced proportions of next‐day QAs, especially nonstereotactic body radiation therapy (non‐SBRT) (30.3% decrease, p<0.05). Fridays and the months of October–December had the highest proportion of next‐day QAs but showed significant reductions of 19.1% and 40.6% in the proportion of next‐day QAs, respectively (p<0.05).ConclusionsThe integrated whiteboard system significantly reduced the proportion of last‐minute physics work, increasing patient safety. Advantages of the integrated whiteboard were low cost, low overhead with automatic interface to the OIS, and concurrent user support.

The Impact of Interactive Whiteboard Use on Teaching Grammar to Grade Seven EFL Learners

This research aims to shed light on the importance of integrating the Interactive Whiteboard in grammar learning. In this line, a qualitative quantitative study was conducted on sixty English as second foreign language seventh-graders over duration of fifteen weeks in grammar lessons. Thirty participants (experimental group) at Saba Zreik School (SZS) benefited from implementing the Interactive Whiteboard in grammar sessions, while thirty students (control group) at Tarbiya Hadith School (THS) did not receive such treatment. The study aims to increase educators' awareness of the efficiency of using the interactive Whiteboard in facilitating the teaching/ learning process and in boosting learners' motivation. For this reason, a grammar pre-test and a grammar post-test were conducted in order to compare and contrast the grammatical proficiency of the control and the experimental groups before and after the treatment period. The results were analyzed by SPSS; hypothesis one correlating Whiteboard usage with students' grammatical recognition level was confirmed; hypothesis two associating the implementation of Whiteboard to better proficiency in grammatical production level was asserted. Furthermore, the questionnaire analysis confirmed the research highlighting the positive role of the Interactive Whiteboard in boosting learners' motivation to learn English. Finally, recommendations for teachers, learners, curriculum designers, and future research have been incorporated.

Strabismus surgical time-out: an illustrated whiteboard modification

Errors in strabismus surgery-including wrong eye, wrong muscle, and wrong procedure-can occur when there is confusion about the surgical plan among members of the surgical team, including surgeons, anesthesia staff, nurses, and technicians. The purpose of this study was to assess whether implementation of a strabismus-specific whiteboard combined with oral statement of the surgical plan using nonophthalmological terminology could improve communication among the team before commencement of surgery. A strabismus-specific whiteboard with labeled diagram of the eyes and extraocular muscles was designed. Patient identifiers, diagnosis, deviation, and procedure name were included. This whiteboard was completed preoperatively and referenced during time-out. The surgeonsand operating room staff were trained in its use, and surveys were completed before and 6months after implementation of the whiteboard time-out. The pre-implementation survey was completed by 19 operating room staff members, of whom 15 completed the post-implementation survey. The strabismus specific whiteboard increased staff member understanding of procedure laterality (74% to 93%), muscle(s) to be operated (37% to 93%), and specific procedure(s) planned (37% to 87%). Surgeon surveysalso showed increased confidence in staff member understanding of each parameter with whiteboard use. A standardized time-out combined with an illustrated strabismus surgery whiteboard improvescommunication between team members and has the potential to reduce surgical errors.

Electronic whiteboard implementation as a quality management tool optimizes IVF laboratory standardization and improves clinical outcomes.

To test whether an electronic whiteboard in the IVF laboratory increases the likelihood that critical evaluation procedures are performed within optimum pre-set time ranges. A retrospective cohort study of oocyte retrievals in our IVF clinic between 06/01/2012 and 05/31/2018 was included. The electronic whiteboard was introduced on 04/06/2014. Prior to implementation, embryologists strived to adhere to the set evaluation times without a formal guide. The primary outcomes were the proportion of embryologist evaluations performed in optimum time ranges and the proportion of usable embryos per patient. A total of 4645 retrievals met inclusion criteria. Implementation of the whiteboard was associated with (1) an increase in the proportion of fertilization checks performed within the optimum time range for ICSI cycles (+ 5.1%, RR = 1.06, CI = 1.02-1.10); (2) an increase in the proportion of day 3 evaluations performed within the optimum time range, whether assisted hatching was performed (+ 23.6%, RR = 1.48, CI = 1.36-1.60) or not (+ 13.8%, RR = 1.23, CI = 1.12-1.35); and (3) an increase in the proportion of day 5 evaluations within the optimum time range (+ 15.5%, RR = 1.23, CI = 1.12-1.35). Additionally, the mean number of usable embryos per patient increased from 2.8 to 4.5 after the whiteboard was implemented (RR = 1.25, CI = 1.19-1.31). The use of an electronic whiteboard that posts optimum times for performing critical procedures significantly increases the proportion of evaluations that occur within these ranges. Such improved standardization led to positive downstream effects on the number of usable embryos per patient. We suggest that electronic whiteboard implementation driven by real-time data collection should be considered in all IVF laboratories.

Longitudinal Review of the White Board Implementation Shows Improved Efficiency in Radiation Therapy Planning

Radiation therapy has a planning process that begins when a patient decides to undergo radiation therapy and spans to the time when the patient starts his/her treatments. This process can be lengthy due to the complex work flow that takes place between CT simulation and treatment delivery. The process also requires detailed communication between physicians, physicists, planners and other support staff. Any delays or mistakes in the work flow can cause safety concerns, patient anxiety and/or decrease the efficiency of the center. Our growing department uses a system of Smarter Radiation Oncology tools, which, among other things, includes the use of our home grown electronic tracking system called “Treatment Planning White Board” to streamline the process of radiation therapy treatment planning. In this study we evaluate the longitudinal efficiency of the Treatment Planning White Board. From 2016 – 2018, we tracked 5860 patient treatments’ (2016:391; 2017: 2494; 2018: 2975) using the Treatment Planning White Board. There are 9 steps that are tracked between CT simulation (CT SIM) to virtual simulation (VSIM) prior to treatment. Each step is assigned a predetermined time limit and personnel responsible for each of the steps are sent reminders throughout the process. We calculated the work hours (WHrs) (excluding nights, weekends and holidays) for each step of the process. We report the overall and prostate cancer external beam planning specific WHrs averages with the standard error of mean. With the implementation of the White Board, there was a significant improvement in WHrs of the treatment planning process (from CT SIM to VSIM): 2016, 155 +/- 8.5 WHrs; 2017, 113 +/- 2.3 WHrs; 2018, 86 +/- 1.2 WHrs. In 2018, there was a 45% and 25% improvement in overall treatment planning WHrs compared to 2016 and 2017, respectively. The most significant changes occurred in the physics and planning parts of the process, including plan generation after contour review and QA aspects. There were no differences in the physician aspects of the process: contour time, MD plan review or MD sign off. When we further evaluated the WHrs for prostate cancer external beam planning, these differences persisted. CT SIM to VSIM WHrs were: 2016, 160 +/- 15.5 WHrs; 2017,127 +/- 6.3 WHrs; 2018, 104.3 +/- 4 WHrs. In 2018, there was a 35% and 18% improvement in prostate cancer treatment planning WHrs compared to 2016 and 2017, respectively. Similar to the overall trends, the improvement were seen in the physics and planning aspects of the process. Treatment Planning White Board implementation has led to longitudinal improvement in efficiency in radiation therapy planning at our busy academic center mainly by improving the physics and planning aspects of the treatment. We hope to use this data to refine planning time and alleviate patient anxiety, by providing them with better estimates and transparency of the planning process.

Whiteboard patient tracking system improves radiation oncology treatment planning workflow

As care delivery becomes ever more complex, and physicians and health care systems face increasing demands, improved efficiency within radiation oncology departments is essential. The workflow required for quality radiation treatment delivery necessitates detailed communication between multiple specialized team members and emerging technologies, sometimes at different locations. In this study, we compare the time required for completion of several components of this process, before and after whiteboard implementation, hypothesizing that whiteboard usage would decrease the time required to complete the designated task, thereby improving workflow. We retrospectively reviewed dosimetric workflow data from 578 patients treated between January 2015 and January 2017 (320 pre- and 258 post-whiteboard). The whiteboard system cataloged various patient clinical factors as well as workflow metrics. Departmental workflow was then examined and time from simulation date to contour approval, plan approval, and start date of the prescribed therapy were compared. Statistical analyses were performed using Mann-Whitney tests or paired t tests. There was a 17% reduction in the time from simulation to contour approval, 3.0 to 2.5 days, respectively (p = 0.007). There was also a 24% reduction in the time from simulation to plan approval, 6.3 to 4.8 days (p < 0.001). On subset analysis by individual disease site, head and neck cancer as well as lung cancer cases showed statistical improvement in the time from simulation to plan approval. Two of the three physicians evaluated demonstrated a statistical improvement in the time from simulation to plan approval. Physician 1 improved from 6.9 to 5.5 days (p = 0.001) and physician 3 from 8.7 to 8.3 days (p = 0.002). Whiteboard implementation resulted in a significant decrease in time from CT simulation date to contour approval and plan approval. When used effectively, an automated whiteboard system facilitates improved workflow.

Whiteboard Use in Labor and Delivery: A Tool to Improve Patient Knowledge of the Name of the Delivery Provider and Satisfaction with Care.

Introduction The impact of whiteboard use in labor rooms has not previously been studied. This quality improvement study aimed to evaluate patient knowledge of their delivering physician's name and the change in patient satisfaction after the implementation of a whiteboard in labor rooms. Methods A multidisciplinary team designed a dry-erase whiteboard prompting care providers to record their names, roles and patient care information. A questionnaire was administered to patients before and after the whiteboard implementation. Patients who had a planned cesarean or vaginal birth within 1h of admission were excluded. Categorical variables were compared using Chi square and Fisher's exact tests. A multivariable logistic regression was performed to control for confounders. Results 191 patients completed the questionnaires. Although patients were not randomized, the pre-and post-intervention groups were similar. Post-intervention, we found a significant increase in recalling the delivery resident's name [21/101 (20.8%) vs. 33/90 (36.7%), p = 0.016] and a non-significant increase in recalling the name of the attending and nurse [19/101 (18.8%) vs. 23/90 (25.6%), p = 0.296; 46/101 (45.5%) vs. 53/90 (58.9%), p = 0.082]. Post-intervention, patient satisfaction with care was significantly higher [83/101 (82.2%) vs. 83/89 (93.3%), p = 0.028]. Knowledge of the delivery resident's name was associated with higher patient satisfaction [115/137 (84%) vs. 51/53 (96%), p = 0.03] and attendance of the postpartum care visit [50.4% (69/137) vs. 64.8% (35/54), p = 0.049]. Discussion The use of a well-designed whiteboard increases laboring patients' knowledge of their delivery physician's name and may improve patient satisfaction with care on Labor and Delivery.

Whiteboard Patient Tracking System Improves Radiation Oncology Treatment Planning Workflow

The workflow between CT simulation and treatment delivery requires detailed communication between multiple team members and computer software systems. With increasing clinical demands and multiple facilities, resultant delays may adversely impact patient care. Our goal was to evaluate the clinical impact of a new Whiteboard system to accomplish tasks between CT simulation and treatment delivery. The Whiteboard system allows daily tracking of key steps within the treatment planning workflow, with scheduled periodic automated email reminders for incomplete tasks. We compared the time required for completion of several components of this process, before and after Whiteboard implementation, hypothesizing that Whiteboard usage would decrease the time required to complete the designated task, thereby improving workflow. As a historic control, from 2014 and 2016, our dosimetrists tracked completion dates of key components of the radiation oncology workflow. Pending or incomplete patient contours and plan approval requests were sent to physicians via email by the dosimetrist. Three attending physicians were selected who regularly use and update Whiteboard data for their patients and for whom historic data was available. The Whiteboard was implemented in 2016 and tracked patient data in a customizable database. Daily automated email reminders were sent to the physicians regarding incomplete contours or plans awaiting review. Dosimetrists were notified when patients were simulated, contours were complete, and plans were approved. There were 248 patients in the pre-Whiteboard and 292 in the post-Whiteboard groups, for a total of 540 patients analyzed. The following data were collected for analysis: number of days from CT simulation date to contours approval, simulation date to plan approval, and completed contours to plan approval. Patients with incomplete documentation were excluded. T-tests were used to assess statistical significance. Days from CT simulation to contours approval, simulation to plan approval, and contours to plan approval were assessed. Mean and median intervals are demonstrated in the accompanying table below. In each case, p-values were <0.0001 in favor of Whiteboard implementation.Abstract 3309Mean (SD)MedianSimulation to Contour Approval (d)Before WB3.5 (2.5)3.0After WB2.1 (2.1)1.0CT Simulation to Plan Approval (d)Before WB6.1 (3.4)6.0After WB4.4 (2.8)5.0Contour Approval to Plan Approval (d)Before WB2.7 (3.1)1.0After WB1.6 (1.9)1.0 Open table in a new tab Whiteboard implementation resulted in a significant decrease in time from CT simulation date to contours approval, simulation date to plan approval, and contours to plan approval. When used effectively, an automated Whiteboard system facilitates improved workflow.

Managing and Communicating Operational Workflow: Designing and Implementing an Electronic Outpatient Whiteboard.

Healthcare team members in emergency department contexts have used electronic whiteboard solutions to help manage operational workflow for many years. Ambulatory clinic settings have highly complex operational workflow, but are still limited in electronic assistance to communicate and coordinate work activities. To describe and discuss the design, implementation, use, and ongoing evolution of a coordination and collaboration tool supporting ambulatory clinic operational workflow at Vanderbilt University Medical Center (VUMC). The outpatient whiteboard tool was initially designed to support healthcare work related to an electronic chemotherapy order-entry application. After a highly successful initial implementation in an oncology context, a high demand emerged across the organization for the outpatient whiteboard implementation. Over the past 10 years, developers have followed an iterative user-centered design process to evolve the tool. The electronic outpatient whiteboard system supports 194 separate whiteboards and is accessed by over 2800 distinct users on a typical day. Clinics can configure their whiteboards to support unique workflow elements. Since initial release, features such as immunization clinical decision support have been integrated into the system, based on requests from end users. The success of the electronic outpatient whiteboard demonstrates the usefulness of an operational workflow tool within the ambulatory clinic setting. Operational workflow tools can play a significant role in supporting coordination, collaboration, and teamwork in ambulatory healthcare settings.