Leveraging the Electronic Health Record to Implement Emergency Department Delirium Screening.
Leveraging the Electronic Health Record to Implement Emergency Department Delirium Screening.
复制标题
利用电子健康记录实施急诊科谵妄筛查。
DOI：
10.1055/a-2073-3736
复制
发表时间：
2023
影响因子：
2.9
通讯作者：
Kennedy,Maura
中科院分区：
文献类型：
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作者：
Chary,AnitaN;Brickhouse,Elise;Torres,Beatrice;Santangelo,Ilianna;Carpenter,ChristopherR;Liu,ShanW;Godwin,KylerM;Naik,AanandD;Singh,Hardeep;Kennedy,Maura
目的了解急诊科如何利用卫生信息技术(HIT)，特别是电子健康记录(EHR)来支持精神分裂症筛查的实施。方法对来自20家急诊科的23名急诊科临床管理人员进行半结构化访谈，了解他们如何利用HIT资源进行精神分裂症筛查。访谈的重点是参与者在实施勃起功能障碍筛查时所经历的挑战，以及他们用来克服这些挑战的基于EHR的策略。我们使用Singh和Sittig社会技术模型中的维度对采访记录进行编码，该模型解决了HIT在复杂的适应性医疗保健系统中的使用问题。随后，我们分析了社会技术模型中常见主题的数据。结果出现了三个主题：(1)工作人员对筛查的坚持性，(2)ED团队成员之间关于阳性筛查的沟通，以及(3)将阳性筛查与精神错乱管理联系起来。与会者描述了几种基于命中的策略，包括视觉轻推、图标、硬停止警报、顺序设置和自动化通信，这些都有助于实施精神错乱筛查。另一个主题是与HIT资源可用性相关的挑战。结论我们的研究结果为计划采用老年筛查的卫生保健机构提供了实用的HIT策略。建立精神错乱筛查工具和提醒，以便在EHR中进行筛查，可能会促使患者坚持筛查。自动化相关的工作流程、团队沟通和对筛查出精神错乱阳性的患者的管理可能有助于节省工作人员的时间。员工教育、参与度和对HIT资源的访问可能会支持成功的筛查实施。
ObjectiveThe aim of this study is to understand how emergency departments (EDs) use health information technology (HIT), and specifically the electronic health record (EHR), to support implementation of delirium screening.MethodsWe conducted semi-structured interviews with 23 ED clinician-administrators, representing 20 EDs, about how they used HIT resources to implement delirium screening. Interviews focused on challenges participants experienced when implementing ED delirium screening and EHR-based strategies they used to overcome them. We coded interview transcripts using dimensions from the Singh and Sittig sociotechnical model, which addresses use of HIT in complex adaptive health care systems. Subsequently, we analyzed data for common themes across dimensions of the sociotechnical model.ResultsThree themes emerged about how the EHR could be used to address challenges in implementation of delirium screening: (1) staff adherence to screening, (2) communication among ED team members about a positive screen, and (3) linking positive screening to delirium management. Participants described several HIT-based strategies including visual nudges, icons, hard stop alerts, order sets, and automated communications that facilitated implementation of delirium screening. An additional theme emerged about challenges related to the availability of HIT resources.ConclusionOur findings provide practical HIT-based strategies for health care institutions planning to adopt geriatric screenings. Building delirium screening tools and reminders to perform screening into the EHR may prompt adherence to screening. Automating related workflows, team communication, and management of patients who screen positive for delirium may help save staff members' time. Staff education, engagement, and access to HIT resources may support successful screening implementation.