Development of the Followership Evaluation Instrument for Nurses: A Prospective Longitudinal Survey.

Maintaining a healthy work environment in nursing practice depends not only on the leader's skill but also on the nursing staff's followership. The study purpose is to develop a followership instrument for nurses. We developed a followership evaluation instrument using data from two surveys conducted in 2013 and 2014 and assessed its validity using a questionnaire with nurses in Japan.

Designing and testing clinical simulations of an early warning system for implementation in acute care settings.

Objectives: Conducting simulation testing with end-users is essential for facilitating successful implementation of new health information technologies. This study designed a standardized simulation testing process with a system prototype prior to implementation to help study teams identify the system's interpretability and feasibility from the end-user perspective and to effectively integrate new innovations into real-world clinical settings and workflows.

Materials And Methods: A clinical simulation model was developed to test a new Clinical Decision Support (CDS) system outside of the clinical environment while maintaining high fidelity.

Adverse diagnostic events in hospitalised patients: a single-centre, retrospective cohort study.

Background: Adverse event surveillance approaches underestimate the prevalence of harmful diagnostic errors (DEs) related to hospital care.

Methods: We conducted a single-centre, retrospective cohort study of a stratified sample of patients hospitalised on general medicine using four criteria: transfer to intensive care unit (ICU), death within 90 days, complex clinical events, and none of the aforementioned high-risk criteria. Cases in higher-risk subgroups were over-sampled in predefined percentages.

Intravenous Medication Administration Safety with Smart Infusion Pumps in the Neonatal Intensive Care Unit: An Observational Study.

Introduction: Infants in the neonatal intensive care unit (NICU) are among the most vulnerable patient populations and medication errors are a significant source of risk and harm to neonates. Smart infusion pumps have been implemented to support the safe medication administration process; however, the effect of using smart infusion pumps on medication safety in the NICU is still unclear.

Methods: We conducted an observational study with a prospective point-prevalence approach to investigate intravenous (IV) medication administration errors in the NICU at one academic medical center in the USA.

Developing, pilot testing, and refining requirements for 3 EHR-integrated interventions to improve diagnostic safety in acute care: a user-centered approach.

Objective: To describe a user-centered approach to develop, pilot test, and refine requirements for 3 electronic health record (EHR)-integrated interventions that target key diagnostic process failures in hospitalized patients.

Materials And Methods: Three interventions were prioritized for development: a Diagnostic Safety Column () within an EHR-integrated dashboard to identify at-risk patients; a Diagnostic Time-Out () for clinicians to reassess the working diagnosis; and a Patient Diagnosis Questionnaire () to gather patient concerns about the diagnostic process. Initial requirements were refined from analysis of test cases with elevated risk predicted by logic compared to risk perceived by a clinician working group; testing sessions with clinicians; responses from patients; and focus groups with clinicians and patient advisors using storyboarding to model the integrated interventions.

Providers' and Patients' Perspectives on Diagnostic Errors in the Acute Care Setting.

Background: Diagnostic errors (DEs) have been studied extensively in ambulatory care, but less work has been done in the acute care setting. In this study, the authors examined health care providers' and patients' perspectives about the classification of DEs, the main causes and scope of DEs in acute care, the main gaps in current systems, and the need for innovative solutions.

Methods: A qualitative mixed methods study was conducted, including semistructured interviews with health care providers and focus groups with patient advisors.

Patient Perceptions of Hospital Experiences: Implications for Innovations in Patient Safety.

Objective: The purpose of this study was to qualitatively examine safety experiences of hospitalized patients and families.

Methods: We conducted 5 focus groups at 2 sites with patients and family members of patients who had been hospitalized at least once within the preceding 2 years. Using a semistructured focus group script, participants were asked to describe hospital experiences, including any safety risks or problems, and to discuss trust in the hospital care team or members of the care team.

The Communicating Narrative Concerns Entered by Registered Nurses (CONCERN) Clinical Decision Support Early Warning System: Protocol for a Cluster Randomized Pragmatic Clinical Trial.

Background: Every year, hundreds of thousands of inpatients die from cardiac arrest and sepsis, which could be avoided if those patients' risk for deterioration were detected and timely interventions were initiated. Thus, a system is needed to convert real-time, raw patient data into consumable information that clinicians can utilize to identify patients at risk of deterioration and thus prevent mortality and improve patient health outcomes. The overarching goal of the COmmunicating Narrative Concerns Entered by Registered Nurses (CONCERN) study is to implement and evaluate an early warning score system that provides clinical decision support (CDS) in electronic health record systems.

Analyzing diagnostic errors in the acute setting: a process-driven approach.

Objectives: We describe an approach for analyzing failures in diagnostic processes in a small, enriched cohort of general medicine patients who expired during hospitalization and experienced medical error. Our objective was to delineate a systematic strategy for identifying frequent and significant failures in the diagnostic process to inform strategies for preventing adverse events due to diagnostic error.

Methods: Two clinicians independently reviewed detailed records of purposively sampled cases identified from established institutional case review forums and assessed the likelihood of diagnostic error using the Safer Dx instrument.

Identifying nursing documentation patterns associated with patient deterioration and recovery from deterioration in critical and acute care settings.

Objectives: Nursing documentation behavior within electronic health records may reflect a nurse's concern about a patient and can be used to predict patient deterioration. Our study objectives were to quantify variations in nursing documentation patterns, confirm those patterns and variations with clinicians, and identify which patterns indicate patient deterioration and recovery from clinical deterioration events in the critical and acute care settings.

Methods: We collected patient data from electronic health records and conducted a regression analysis to identify different nursing documentation patterns associated with patient outcomes resulting from clinical deterioration events in the intensive care unit (ICU) and acute care unit (ACU).

Nursing Documentation Variation Across Different Medical Facilities Within an Integrated Healthcare System.

The purpose of this study was to demonstrate nursing documentation variation based on electronic health record design and its relationship with different levels of care by reviewing how various flowsheet measures, within the same electronic health record across an integrated healthcare system, are documented in different types of medical facilities. Flowsheet data with information on patients who were admitted to academic medical centers, community hospitals, and rehabilitation centers were used to calculate the frequency of flowsheet entries documented. We then compared the distinct flowsheet measures documented in five flowsheet templates across the different facilities.

Engaging Patients in the Use of Real-Time Electronic Clinical Data to Improve the Safety and Reliability of Their Own Care.

Objectives: There is considerable evidence that providing patients with access to their health information is beneficial, but there is limited evidence regarding the effect of providing real-time patient safety-related information on health outcomes. The aim of this study was to evaluate the association between use of an electronic patient safety dashboard (Safety Advisor) and health outcomes.

Methods: The Safety Advisor was implemented in 6 adult medicine units at one hospital in the United States.

Healthcare Process Modeling to Phenotype Clinician Behaviors for Exploiting the Signal Gain of Clinical Expertise (HPM-ExpertSignals): Development and evaluation of a conceptual framework.

Objective: There are signals of clinicians' expert and knowledge-driven behaviors within clinical information systems (CIS) that can be exploited to support clinical prediction. Describe development of the Healthcare Process Modeling Framework to Phenotype Clinician Behaviors for Exploiting the Signal Gain of Clinical Expertise (HPM-ExpertSignals).

Materials And Methods: We employed an iterative framework development approach that combined data-driven modeling and simulation testing to define and refine a process for phenotyping clinician behaviors.

Information Needs and the Use of Documentation to Support Collaborative Decision-Making: Implications for the Reduction of Central Line-Associated Blood Stream Infections.

It is clear that interdisciplinary communication and collaboration have the potential to mitigate healthcare-associated harm, yet there is limited research on how communication through documentation in the patient record can support collaborative decision making. Understanding what information is needed to support collaborative decision making is necessary to design electronic health information systems that facilitate effective communication and, ultimately, safe care. To explore this issue, we focused on information needs related to central venous catheter management and the prevention of central line-associated blood stream infections.

Development and Validation of WeCares, a Survey Instrument to Assess Hospitalized Patients' and Family Members' "Willingness to Engage in Your Care and Safety".

Background: Patient engagement is recognized as a method to improve care quality and safety. A research team developed WeCares (Willingness to Engage in Your Care and Safety), a survey instrument assessing patients' and families' engagement in the safety of their care during their hospital stay. The objective of this study is to establish the preliminary construct validity and internal consistency of WeCares.

Leveraging Clinical Expertise as a Feature - not an Outcome - of Predictive Models: Evaluation of an Early Warning System Use Case.

Identifying patients at risk of deterioration in the hospital and intervening more quickly to prevent adverse events is a top patient safety priority. Early warning scores (EWS) identify at risk patients, but there is much opportunity for improvement particularly related to increasing lead time - the time from an alert trigger to adverse event (e.g.

Development and validation of early warning score system: A systematic literature review.

Objectives: This review aims to: 1) evaluate the quality of model reporting, 2) provide an overview of methodology for developing and validating Early Warning Score Systems (EWSs) for adult patients in acute care settings, and 3) highlight the strengths and limitations of the methodologies, as well as identify future directions for EWS derivation and validation studies.

Methodology: A systematic search was conducted in PubMed, Cochrane Library, and CINAHL. Only peer reviewed articles and clinical guidelines regarding developing and validating EWSs for adult patients in acute care settings were included.

Unique Patient-Reported Hospital Safety Concerns With Online Tool: MySafeCare.

Background: Hospitalized patients and their care partners have valuable and unique perspectives of the medical care they receive. Direct and real-time reporting of patients' safety concerns, though limited in the acute care setting, could provide opportunities to improve patient care.

Methods: We implemented the MySafeCare (MSC) application on six acute care units for 18 months as part of a patient-centered health information technology intervention to promote engagement and safety in the acute care setting.

Use, Perceived Usability, and Barriers to Implementation of a Patient Safety Dashboard Integrated within a Vendor EHR.

Background: Preventable adverse events continue to be a threat to hospitalized patients. Clinical decision support in the form of dashboards may improve compliance with evidence-based safety practices. However, limited research describes providers' experiences with dashboards integrated into vendor electronic health record (EHR) systems.

Mining clinical phrases from nursing notes to discover risk factors of patient deterioration.

Objective: Early identification and treatment of patient deterioration is crucial to improving clinical outcomes. To act, hospital rapid response (RR) teams often rely on nurses' clinical judgement typically documented narratively in the electronic health record (EHR). We developed a data-driven, unsupervised method to discover potential risk factors of RR events from nursing notes.

Unsupervised Machine Learning of Topics Documented by Nurses about Hospitalized Patients Prior to a Rapid-Response Event.

Background: In the hospital setting, it is crucial to identify patients at risk for deterioration before it fully develops, so providers can respond rapidly to reverse the deterioration. Rapid response (RR) activation criteria include a subjective component ("worried about the patient") that is often documented in nurses' notes and is hard to capture and quantify, hindering active screening for deteriorating patients.

Objectives: We used unsupervised machine learning to automatically discover RR event risk/protective factors from unstructured nursing notes.

Lessons learned implementing a complex and innovative patient safety learning laboratory project in a large academic medical center.

Objective: The objective of this paper is to share challenges, recommendations, and lessons learned regarding the development and implementation of a Patient Safety Learning Laboratory (PSLL) project, an innovative and complex intervention comprised of a suite of Health Information Technology (HIT) tools integrated with a newly implemented Electronic Health Record (EHR) vendor system in the acute care setting at a large academic center.

Materials And Methods: The PSLL Administrative Core engaged stakeholders and study personnel throughout all phases of the project: problem analysis, design, development, implementation, and evaluation. Implementation challenges and recommendations were derived from direct observations and the collective experience of PSLL study personnel.

Design of a safety dashboard for patients.

Background: Nearly one third of hospitalized patients suffer harm from medical errors in U.S. hospitals each year.