Elina Kontio

Managing daily intensive care activities: An observational study concerning ad hoc decision making of charge nurses and intensivists

IntroductionManagement of daily activities in ICUs is challenging. ICU shift leaders, charge nurses and intensivists have to make several immediate ad hoc decisions to enable the fluent flow of ICU activities. Even though the management of ICU activities is quite well delineated by international consensus guidelines, we know only a little about the content of the real clinical decision making of ICU shift leaders.MethodsWe conducted an observational study with the think-aloud technique to describe the ad hoc decision making of ICU shift leaders. The study was performed in two university-affiliated hospital ICUs. Twelve charge nurses and eight intensivists were recruited. Observations were recorded and transcribed for qualitative content analysis using the protocol analysis method. The software program NVivo 7 was used to manage the data. The interrater agreement was assessed with percentages and by Cohens κ.ResultsWe identified 463 ad hoc decisions made by the charge nurses and 444 made by the intensivists. During our data collection time, this breaks down to over 230 immediately made decisions per day (24 hours). We divided the ad hoc decision making of ICU shift leaders into two types: process-focused and situation-focused. Process-focused decision making included more permanent information, such as human resources, know-how and material resources, whereas situation-focused decision making included decisions about single events, such as patient admission. We named eight different categories for ICU ad hoc decision making: (1) adverse events, (2) diagnostics, (3) human resources and know-how, (4) material resources, (5) patient admission, (6) patient discharge, (7) patient information and vital signs and (8) special treatments.ConclusionsICU shift leaders make a great number of complex ad hoc decisions throughout the day. Often this decision making involves both intensivists and charge nurses. It forms a bundle that requires versatile, immediate information for a successful outcome. In the future, we need to investigate which information is crucial for ad hoc decision making. These challenges should also be emphasised when information technology programs for ICU care management are developed.

National survey focusing on the crucial information needs of intensive care charge nurses and intensivists: same goal, different demands

BackgroundAlthough information technology adequately supports clinical care in many intensive care units (ICUs), it provides much poorer support for the managerial information needed to coordinate multi-professional care. To gain a general view of the most crucial multi-professional information needs of ICU shift leaders a national survey was conducted, focusing on the information needs of charge nurses and intensivists.MethodsBased on our previous observation study an online survey was developed, containing 122 information need statements related to the decision-making of ICU shift leaders. Information need statements were divided into six dimensions: patient admission, organisation and management of work, allocation of staff and material resources, special treatments, and patient discharge. This survey involved all ICU shift leaders (n = 738) who worked in any of the 17 highest level ICUs for adults in university hospitals in Finland during the autumn of 2009. Both charge nurses’ and intensivists’ crucial information needs for care coordination were evaluated.ResultsTwo hundred and fifty-seven (50%) charge nurses and 96 (43%) intensivists responded to the survey. The consistency of the survey was found to be good (Cronbach’s α scores between .87–.97, with a total explanatory power of 64.53%). Altogether, 57 crucial information needs for care coordination were found; 22 of which were shared between shift leaders. The most crucial of these information needs were related to organisation and management, patient admission, and allocation of staff resources. The associations between working experience, or shift leader acting frequencies, and crucial information needs were not statistically significant. However, a statistically significant difference was found between the number of ICU beds and the ICU experience of charge nurses with information needs, under the dimension of organisation and management of work. The information needs of charge nurses and intensivists differed. Charge nurses’ information needs related to care coordination, were more varied, and concerned issues at a unit level, whereas intensivists focused on direct patient care.ConclusionsThe reliability and validity of our survey was found to be good. Our study findings show that care coordination at an ICU is a collaborative process among ICU shift leaders with multiprofessional information needs related to organisation and management, patient admission, and allocation of staff resources. Study findings can be used to identify the most crucial information needs of ICU shift leaders when new information technology is developed to support managerial decision-making during care coordination.

Information utilization in tactical decision making of middle management health managers.

Healthcare is an information-intensive field, as information is needed to make strategic, tactical, and operational decisions. The purpose of this study was to identify the tactical decisions that middle management healthcare managers make, the information that is available, and the necessary information that is missing using the cardiac care process as an example. Data were collected through focused interviews of nurses and physicians who work in middle management in a secondary healthcare field. The interviews were coded and analyzed using the thematic content analysis method. We identified two main categories of tactical decisions: those concerning the process of care and those concerning the resources for the care. We termed the categories “process decisions” and “resource decisions.” The availability of information varied. Much of the necessary information was created and processed manually. Our results show that the collection, mining, and systematic use of information are difficult because of the existence of many types of information systems and their varying abilities to produce and report information. Finally, much of the important information is missing. In conclusion, the information management process in healthcare settings needs to be improved, and a new generation of information system is needed to support tactical decision making in middle management.

Critical incidents and important information in the care processes of patients with cardiac symptoms

AIM To describe important information in the care processes of patients with cardiac symptoms. BACKGROUND Process-based work-flow models are increasingly being used in healthcare. At the same time, developments in information systems offer the possibility of supporting improvements in process and information management in healthcare. To better utilize these possibilities we need to understand more about important information content and flow during treatment processes. METHOD A qualitative approach involving the critical incident technique was used. Critical incidents were collected using a semi-structured questionnaire (50 respondents) and interviews (n=10). RESULTS Three incident categories of important information were identified: (1) process-related incidents, (2) managerial incidents and (3) clinical incidents. Process-related incidents focused on agreed-care practices and the importance of the care environment. Managerial incidents focused on human and material resources. Clinical incidents focused on medical and nursing care and the importance of patient education. CONCLUSIONS Information content, information flow and the timing of such information should be modelled further in order to improve the management of care processes. IMPLICATIONS FOR NURSING MANAGEMENT Increasing knowledge about essential points of information as part of nursing management is important.

Experiences on Telemedicine Solutions for Diabetes Care – Case eMedic Project

Diabetes is one of the most common diseases in the world. The optimisation of diabetes treatment would mean remarkable savings in health care budgets. eHealth technology can provide new tools to increase healthcare access, improve care delivery systems, and support individuals in engaging in the treatment of their disease as well as provide new solutions for health care professionals. The aim of this paper is to describe the usability of self-management technological solutions in the eMedic project. A qualitative explorative study approach was applied. During the eMedic pilots on self-management, the usability of the devices and applications was assessed by using the System Usability Scale (SUS) questionnaire. The eMedic project shows that eHealth solutions in self-management can have a successful role in healthcare, but focus and effort must be put on the usability of the applications and technical solutions.