Oliwier Dziadkowiec

A systems science approach to fatigue management in research and health care

The purpose of this article was to highlight innovative analytic approaches in symptom science. Complex systems modeling is discussed using fatigue as an example. Fatigue is a common symptom among individuals of any age. It can be acute or chronic, and it can vary across the day and on weekends compared with weekdays. Fatigue can overlap with other symptoms, has many dimensions, and impacts daily function as well as society at large. With the complexities surrounding symptom science, innovative models are needed to advance our understanding of factors within the person, contextual and situational factors, and workplace or health care system factors that impact the symptom experience. Advances in methodologies, such as complex systems modeling, allow for more innovative methods to study the complexities of the symptom experience, design better ways to intervene and manage symptoms, and ultimately improve outcomes related to symptom management, quality of life, and health care utilization.

Determining high touch areas in the operating room with levels of contamination

BACKGROUND The Centers for Disease Control and Prevention put forth the recommendation to clean areas considered high touch more frequently than minimal touch surfaces. The operating room was not included in these recommendations. The purpose of this study was to determine the most frequently touched surfaces in the operating room and their level of contamination. METHODS Phase 1 was a descriptive study to identify high touch areas in the operating room. In phase 2, high touch areas determined in phase 1 were cultured to determine if high touch areas observed were also highly contaminated and if they were more contaminated than a low touch surface. RESULTS The 5 primary high touch surfaces in order were the anesthesia computer mouse, OR bed, nurse computer mouse, OR door, and anesthesia medical cart. Using the OR light as a control, this study demonstrated that a low touch area was less contaminated than the high touch areas with the exception of the OR bed. CONCLUSIONS Based on information and data collected in this study, it is recommended that an enhanced cleaning protocol be established based on the most frequently touched surfaces in the operating room.

Characterizing workflow for pediatric asthma patients in emergency departments using electronic health records

OBJECTIVE The purpose of this study was to describe a workflow analysis approach and apply it in emergency departments (EDs) using data extracted from the electronic health record (EHR) system. MATERIALS AND METHODS We used data that were obtained during 2013 from the ED of a childrens hospital and its four satellite EDs. Workflow-related data were extracted for all patient visits with either a primary or secondary diagnosis on discharge of asthma (ICD-9 code=493). For each patient visit, eight different a priori time-stamped events were identified. Data were also collected on mode of arrival, patient demographics, triage score (i.e. acuity level), and primary/secondary diagnosis. Comparison groups were by acuity levels 2 and 3 with 2 being more acute than 3, arrival mode (ambulance versus walk-in), and site. Data were analyzed using a visualization method and Markov Chains. RESULTS To demonstrate the viability and benefit of the approach, patient care workflows were visually and quantitatively compared. The analysis of the EHR data allowed for exploration of workflow patterns and variation across groups. Results suggest that workflow was different for different arrival modes, settings and acuity levels. DISCUSSION EHRs can be used to explore workflow with statistical and visual analytics techniques novel to the health care setting. The results generated by the proposed approach could be utilized to help institutions identify workflow issues, plan for varied workflows and ultimately improve efficiency in caring for diverse patient groups. CONCLUSION EHR data and novel analytic techniques in health care can expand our understanding of workflow in both large and small ED units.

Utilization of a biomedical device (VeinViewer®) to assist with peripheral intravenous catheter (PIV) insertion for pediatric nurses

PURPOSE Vascular access in pediatric patients can be challenging even with the currently available technological resources. This nurse-driven research study explored time, cost, and resources for intravenous access to determine if a biomedical device, VeinViewer® Vision, would facilitate improvements in pediatric access. In addition, this study looked at nurse perceptions of skills and confidence around intravenous insertion and if the use of the VeinViewer® impacted these perceptions. Literature examining pediatric intravenous access success rates compared with nurse perceived skills and confidence is lacking. DESIGN Nonblinded randomized control trial of pediatric nurses working in an acute care hospital setting. METHODS A preliminary needs assessment solicited feedback from nurses regarding their practice, perceived skills, and confidence with placing peripheral intravenous catheters (PIVs). Due to the results of the preliminary needs assessment, a research study was designed and 40 nurses were recruited to participate. The nurses were randomized into either a VeinViewer® or standard practice group. Nurse participants placed intravenous catheters on hospitalized pediatric patients using established procedures while tracking data for the study. RESULTS Needs assessment showed a majority of nurses felt a biomedical device would be helpful in building their intravenous insertion skills and their confidence. The study results did not demonstrate any clinically significant differences between VeinViewer® use and standard practice for intravenous catheter insertion in pediatric patients for success of placement, number of attempts, or overall cost. In addition, no difference was noted between nurses in either group on perceived skills or confidence with insertion of PIVs. PRACTICE IMPLICATIONS The ongoing need for resources focused on building nurse skills and confidence for PIV insertion was highlighted and organizations should continue to direct efforts toward developing skills and competency for staff that are responsible for pediatric vascular access. This study illustrates the importance of data-driven decision-making for expensive hospital-funded equipment purchases. This nursing led research study highlights how perceptions do not always align with outcomes. The lessons gleaned from this study may aid in decision-making around pediatric intravenous access practice.

A social network analysis of South Central Kansas Workforce Innovations in Regional Economic Development

Purpose – The purpose of this study is to evaluate the composition and strengths/weaknesses and major actors of a coalition of regional economic leaders in the composites participating in the Workforce Innovations in Regional Economic Development (WIRED) project aimed at supporting high-skilled and high-wage careers. Design/methodology/approach – Social network analysis (SNA) was used to assess south-central (SC) Kansas WIRED coalition (n = 81) based on three surveys question: Who do you know? Who do you communicate with? and Who do you collaborate with? All the surveys were administered online in two waves. Findings – SC Kansas WIRED network has a strong core, well-defined periphery and is immune to key actor losses, which suggests that they are well developed and sustainable. The well-defined periphery positions the collaborative to reach out to resources outside of the network and innovation. Practical implications – SC Kansas WIRED Leadership team used the SNA to identify opportunities for further col...