Rebecca Randell

Effects of computerized decision support systems on nursing performance and patient outcomes: a systematic review

Objective: To examine the effect of computerized decision support systems (CDSSs) on nursing performance and patient outcomes. Method: Fifteen databases, including Medline and CINAHL, were searched up to May 2006 together with reference lists of included studies and relevant reviews. Randomized controlled trials, controlled clinical trials, controlled before and after studies and interrupted time series studies that assessed the effects of CDSS use by nurses in a clinical setting on measurable professional and/or patient outcomes were included. Results: Eight studies, three comparing nurses using CDSS with nurses not using CDSS and five comparing nurses using CDSS with other health professionals not using CDSS, were included. Risk of contamination was a concern in four studies. The effect of CDSS on nursing performance and patient outcomes was inconsistent. Conclusion: The introduction of CDSS may not necessarily lead to a positive outcome; further studies are needed in order to identify contexts in which CDSS use by nurses is most effective. CDSS are complex interventions and should be evaluated as such; future studies should explore the impact of the users and the protocol on which the CDSS is based, reporting details of both. Contamination is a significant issue when evaluating CDSS, so it is important that randomization is at the practitioner or the unit level. Future systematic reviews should focus on particular uses of CDSS.

Building a Context Sensitive Telephone: Some Hopes and Pitfalls for Context Sensitive Computing

Although the idea of making technology more context aware is an alluring one, this seemingly simple move hides a great deal of complexity. Even simple examples such as a context sensitive mobile phone which knows when not to ring, are unlikely to be successful. Any context sensitive technology is likely to make mistakes – like ringing in the middle of a film, or not ringing for an urgent call. Using three examples from fieldwork of alerting systems (two ringing phones and one medical alarm in a hospital), we suggest three guidelines for context systems which could genuinely assist users. First, we argue that context sensitive computing should be used defensively, where incorrect behaviour is tolerable. Second, that technology can provide structures to which people themselves can add context. Third, that technology can communicate context to users, allowing users to make sense of that contextual information themselves. Lastly we argue for an understanding of the long term use of technology use, dwelling with technology, a process which changes how the world is seen and experienced.

Dashboards for improving patient care : review of the literature

AIM This review aimed to provide a comprehensive overview of the current state of evidence for the use of clinical and quality dashboards in health care environments. METHODS A literature search was performed for the dates 1996-2012 on CINAHL, Medline, Embase, Cochrane Library, PsychInfo, Science Direct and ACM Digital Library. A citation search and a hand search of relevant papers were also conducted. RESULTS One hundred and twenty two full text papers were retrieved of which 11 were included in the review. There was considerable heterogeneity in implementation setting, dashboard users and indicators used. There was evidence that in contexts where dashboards were easily accessible to clinicians (such as in the form of a screen saver) their use was associated with improved care processes and patient outcomes. CONCLUSION There is some evidence that implementing clinical and/or quality dashboards that provide immediate access to information for clinicians can improve adherence to quality guidelines and may help improve patient outcomes. However, further high quality detailed research studies need to be conducted to obtain evidence of their efficacy and establish guidelines for their design.

Organisational influences on nurses' use of clinical decision support systems

OBJECTIVE Nurses are increasingly using computerised decision support systems (CDSS) to support their practice. Previous studies have highlighted the importance organisational factors have on the successful implementation of new technologies in healthcare. However, it is unclear how the organisations where nurses work either facilitate or inhibit the successful use of CDSS. The aim of this paper is to explore what nurses and NHS (National Health Service) managers working in NHS organisations in England perceive as the organisational features facilitating the introduction and successful use of CDSS. METHODS A study of four case sites where nurses were using CDSS. Data included 124 observations of nurse/patient consultations, 36 patient interviews, 55 nurse interviews and 18 interviews with clinical unit or NHS managers. The majority of the data were qualitative and analysed using thematic content analysis. FINDINGS There were a number of drivers for the introduction of CDSS, including instigation from individual clinicians and initiatives at policy level. A key element for the successful introduction of technology such as CDSS was clinician engagement. However, also seen as important for successfully implementation of an IT system are other factors such as the need for adequate resources, characteristics of the system itself and adequate training. Other key issues are a supportive environment and the desire to improve continually the quality of patient services. CONCLUSIONS For nurses to use CDSS successfully, engagement by clinicians in the procurement and implementation of systems is useful. However, the data collected in this study suggest this is not necessary for successful implementation; nurses may still successfully introduce and use a CDSS if they perceive it to have benefits to their practice.

Beyond handover: supporting awareness for continuous coverage

Hospitals are required to operate as a continuous system because patient care cannot be temporarily suspended and handover is seen as a key method for enabling this. This paper reports a study of handover in a medical admissions unit. We draw on the notion of awareness as conceptualised within the Computer-Supported Cooperative Work literature to explore the role played by a variety of cognitive artifacts in supporting continuous coverage. While such awareness is typically characterised as being ‘effortless’, our study reveals that maintaining awareness in a context such as the medical admissions unit is effortful due to invisible work. We suggest that the notion of awareness is beneficial for exploring the practices of continuous coverage because it moves attention away from the moment of handover, instead encouraging consideration of the variety of practices through which clinicians display their work to, and monitor the work of, colleagues on different shifts. We argue that efforts to support continuous coverage should focus on improving awareness by increasing the visibility of information.

The Diagnostic Concordance of Whole Slide Imaging and Light Microscopy: A Systematic Review

CONTEXT -Light microscopy (LM) is considered the reference standard for diagnosis in pathology. Whole slide imaging (WSI) generates digital images of cellular and tissue samples and offers multiple advantages compared with LM. Currently, WSI is not widely used for primary diagnosis. The lack of evidence regarding concordance between diagnoses rendered by WSI and LM is a significant barrier to both regulatory approval and uptake. OBJECTIVE -To examine the published literature on the concordance of pathologic diagnoses rendered by WSI compared with those rendered by LM. DATA SOURCES -We conducted a systematic review of studies assessing the concordance of pathologic diagnoses rendered by WSI and LM. Studies were identified following a systematic search of Medline (Medline Industries, Mundelein, Illinois), Medline in progress (Medline Industries), EMBASE (Elsevier, Amsterdam, the Netherlands), and the Cochrane Library (Wiley, London, England), between 1999 and March 2015. CONCLUSIONS -Thirty-eight studies were included in the review. The mean diagnostic concordance of WSI and LM, weighted by the number of cases per study, was 92.4%. The weighted mean κ coefficient between WSI and LM was 0.75, signifying substantial agreement. Of the 30 studies quoting percentage concordance, 18 (60%) showed a concordance of 90% or greater, of which 10 (33%) showed a concordance of 95% or greater. This review found evidence to support a high level of diagnostic concordance. However, there were few studies, many were small, and they varied in quality, suggesting that further validation studies are still needed.

Virtual reality microscope versus conventional microscope regarding time to diagnosis: an experimental study

Aims:  To create and evaluate a virtual reality (VR) microscope that is as efficient as the conventional microscope, seeking to support the introduction of digital slides into routine practice.

The importance of the verbal shift handover report: a multi-site case study.

OBJECTIVE Shift handover is seen as a key tool in ensuring continuity of care yet a number of studies have highlighted the role of shift handovers in adverse events. This, combined with the increased frequency of shift handovers, has led to interest in providing technological support for handover to enhance safety. The aim of this paper is to describe current practices for the conduct of shift handovers and to use this as a basis for considering the role that technology could play in supporting handover. METHODS A multi-site case study of handover was conducted. Data included observations of 15 medical shift handovers and 33 nursing shift handovers across three case sites. FINDINGS The findings highlight the way in which the verbal shift handover report is practically focused, displaying the healthcare professionals ability to know what information is required and where further explanation is needed. As well as supporting teaching and team cohesion, shift handover can provide an opportunity to reflect on the previous shift and for discussion with patients and their families. CONCLUSIONS The benefits provided by a face to face handover suggest that technology should focus on supporting rather than replacing the verbal shift handover report, providing a flexible solution that allows handover participants to gather more information as it is required.

Supporting nurse decision making in primary care: exploring use of and attitude to decision tools

Nurses are increasingly working more autonomously in extended roles, yet we know little about the nature of the decisions they make. Decisions vary in terms of complexity, ambiguity and presentation, and the nature of the decision task impacts on the process of decision making, such as the likelihood of using a decision tool. Thus, knowledge about the nature of nursing decisions is essential for development of effective decision tools. This article presents an analysis of 410 nurse—patient consultations and interviews with 76 primary care nurses, and explores the nature of the decisions that primary care nurses make and the impact of that on their use of and attitudes towards decision tools.

User customisation of medical devices: the reality and the possibilities

While studies of office environments have treated the customisation of technology by users as a positive response to the situated nature of work, customisation of devices in the medical domain, and other safety-critical domains, when acknowledged, has been treated understandably as a violation and a threat to safety. This paper looks at the customisation of medical devices by nursing staff, based on an observational study carried out in three Scottish intensive care units. Drawing on the insights of ethnomethodology, this paper proposes an alternative approach to the study of user customisation and its organisation. An attempt has been made to go beyond the simple categorisation of types of customisation to explicate the detail of how customisation is carried out. Drawing on concerns in human-computer interaction and arguments in medicine surrounding the use of protocols, the potential for supporting customisation in the medical domain is discussed.