Charlotte Tang

An observational study on information flow during nurses' shift change

We present an observational study that was conducted to guide the design and development of technologies to support information flow during nurses shift change in a hospital ward. Our goal is to find out how the complex information sharing processes during nurses brief shift change unfold in a hospital setting. Our study shows the multitude of information media that nurses access during the parallel processes of information assembly and disassembly: digital, paper-based, displayed and verbal media. An initial analysis reveals how the common information spaces, where information media are positioned and accessible by all participants, are actively used and how they interact with the personal information spaces ephemerally constructed by the participants. Several types of information are consistently transposed from the common information spaces to the personal information space including: demographics, historical data, reminders and to-dos, alerts, prompts, scheduling and reporting information. Information types are often enhanced with a variety of visual cues to help nurses carry out their tasks.

Evaluating the deployment of a mobile technology in a hospital ward

Since health care teams are often distributed across time and location, information sharing is crucial for effective patient care. Studying the use of a mobile information technology in a local hospital ward at two months and eleven months after its deployment identifies both short- and long-term phenomena and reveals a mismatch between the intentions behind the deployed mobile technology and the nurses current work practices. We contrast the new mobile technology with the paper artifacts that were previously relied upon in nursing work. Finally, in light of these findings, we suggest design directions for future technology to support the nursing shift work.

Review of Computerized Physician Handoff Tools for Improving the Quality of Patient Care

BACKGROUNDnComputerized physician handoff tools (CHTs) are designed to allow distributed access and synchronous archiving of patient information via Internet protocols. However, their impact on the quality of physician handoff, patient care, and physician work efficiency have not been extensively analyzed.nnnMETHODSnWe searched MEDLINE, PUBMED, EMBASE, CINAHL, the Cochrane database for systematic reviews, and the Cochrane central register for clinical trials, from January 1960 to December 2011. We selected all articles that reported randomized controlled trials, controlled clinical trials, controlled before-after studies, and quasi-experimental studies of the use of CHTs for physician handoff for hospitalized patients. Relevant studies were evaluated independently for their eligibility for inclusion by 2 individuals in a 2-stage process.nnnRESULTSnThe literature search identified 1026 citations of which 6 satisfied the inclusion criteria. One study was a randomized controlled trial, whereas 5 were controlled before-after studies. Two studies showed that using CHTs reduced adverse events and missing patients. Three studies demonstrated improved overall quality of handoff after CHT implementation. One study suggested that CHTs could potentially enhance work efficiency and continuity of care during physician handoff. Conflicting impacts on consistency of handoff were found in 2 studies.nnnCONCLUSIONSnThe evidence that CHTs improve physician handoff and quality of hospitalized patient care is limited. CHT may improve the efficiency of physician work, reduce adverse events, and increase the completeness of physician handoffs. However, further evaluation using rigorous study designs is needed.

A mobile voice communication system in medical setting: love it or hate it?

Hospital work coordination and collaboration often requires mobility for acquiring proper information and resources. In turn, the spatial distribution and the mobility of clinicians can curtail the opportunities for effective communications making collaboration difficult. In this situation, a mobile hands-free voice communication system, Vocera, was introduced to enhance communication. It supports quick and impromptu conversations among coworkers for work coordination and collaboration anytime and anywhere. We study this deployment and present our findings concerning the impact of this communication system on the information flow. Our information flow frameworks communication strategies help contrast the information processes before and after the deployment of Vocera.

Supporting Nurses' Information Flow by Integrating Paper and Digital Charting

Information technology has changed the way health care is delivered. Electronic health records which are prevalently deployed to replace or supplement paper documentations have made distributed information access at various points of care and work activity achievable with the use of mobile information devices. Our particular concern is with nurses information flow, where nurses notes and observations taken at the point of care feed into the electronic record. In these cases, digital technology has not yet entirely replaced paper and pen, because the latter still provide greater ease and flexibility of use when compared to current digital technologies. Even when mobile digital technology is available, clinicians still prefer creating handwritten notes, and then later manually transposing them into the digital medium. Within this context, we created a prototype that integrated digital paper with electronic health charts to retain the benefits of paper and pen, as well as digital medium. A focus group evaluation of this prototype demonstrated promise and potential for its value in a medical environment.

Support for Informal Information Use and its Formalization in Medical Work

This paper reports the findings from two field studies that reveal paper-based artifacts being heavily relied upon in medical shift work despite the deployment of a mobile technology in a local hospital ward. We present the information flow in terms of common and personal information spaces and identify three important functions of these personal artifacts in the actual work practices. Artifacts serve as a bedside information source for patient care delivery, an opportune notepad and an information basis for reporting and handover. We thus recommend a system employing digital pens and paper so that nurses can retain the manual practice of constructing their personal artifacts, flexibly use them in the actual work and easily formalize the informal information recorded therein. We also discuss the benefits and challenges of our proposed technology.

Evaluating new interactions in healthcare: challenges and approaches

New technologies for supporting the provision of healthcare are increasingly pervasive. While healthcare computing previously referred to a desktop computer within the consulting room, we are now seeing an ever broader range of software, hardware and settings. This workshop is concerned with how to conduct evaluations which allow assessment of the overall impact of technology. The workshop will explore challenges and approaches for evaluating new interactions in healthcare. In this paper we outline the goals for this workshop and summarize the issues and questions it intends to explore.

Schedule Change Really Disrupts a Lot of Things!: Never-Ending Physician Scheduling in a Multi-function Multi-setting Practice

We conducted a field study in a nephrology practice that performs multiple functions in a variety of distributed settings. The task of physician scheduling was done manually on paper by a single scheduler. Our study revealed challenges persistently encountered while using a plethora of fragmented, transient paper artifacts. Any changes made to existing schedules often impact other physicians schedules, clinical functions, patients, and the practice operation. Finally, we highlight several issues for consideration in the design of a digital scheduling module for meeting the specific needs of distributed multi-function, multi-setting medical practices. These issues include increasing the level of transparency in the scheduling process, providing light-weight customization of schedules, and actively engaging patients in their health care and management.