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Subject: RE: [ihc] FWD: Why Doctors and Nurses Wont Use IT

Many thanks for this.  This is indeed insightful - and corroborates the work I just did on the patient hand-off sheet.
Another problem is hand-off from like-to-like.  The paper has to bridge this gap too.  Likelyhood is that the SBAR cannot occur in all situations - since the nursing staff skills vary widely.  Then the paper needs to function in another role - carrying the SBAR until more experienced staff need it.  Hence the paper must also allow for critical information to be readily acquired - and typically this is hand written notes.  Computer screen design needs to reflect this - so you would want the patient to wear an RFID - which when scanned instantly brings up that same information.  Perhaps writeable tablet technology is the bridge between paper and computer - or a simple paper hand scanner...?
We could break this down into three sections:
1) Patient basics - condition - vital signs - demographics, etc.
2) Patient treatment history and drug details
3) SBAR information - critical factors to be aware of

-------- Original Message --------
Subject: RE: [ihc] FWD: Why Doctors and Nurses Wont Use IT
From: Fulton Wilcox <fulton.wilcox@coltsnecksolutions.com>
Date: Wed, June 28, 2006 9:32 am
To: "'David RR Webber (XML)'" <david@drrw.info>,

The article in today's Wall Street Journal referenced below is interesting from two perspectives.


First, it highlights "handoffs" as being a critical weak point, where lack of knowledge access/sharing can jeopardize patients. The fact that paper and personal memory/observation "works" for individuals is not the same as saying that those approaches work for the healthcare system.


Second, it describes a hand-off model based on concise checklists which improve the situation although still relying on "oral tradition" and the varying abilities of people to deliver or absorb handoff information.  For system developers, the concise checklist approach perhaps a model to be emulated.



                                                                                                Fulton Wilcox

                                                                                                Colts Neck Solutions LLC





Hospitals Combat Errors at the 'Hand-Off'

New Procedures Aim to Reduce
Miscues as Nurses and Doctors
Transfer Patients to Next Shift
June 28, 2006; Page D1

For hospitals, the "hand-off" has long been the Bermuda Triangle of health care: Dangerous errors and oversights can occur in the gap when a patient is moved to another unit or turned over to a new nurse or doctor during a shift change.


But a few hospitals and health-care quality groups have been ahead of the pack, borrowing communication strategies used in aviation and the military, where hand-off failures can lead to devastating accidents. The non-profit Institute for Healthcare Improvement, for example, is working with hospitals on a communication model known as SBAR -- an acronym for Situation, Background, Assessment and Recommendation -- adapted from a program used to quickly brief nuclear submariners during a change in command.



From: David RR Webber (XML) [mailto:david@drrw.info]
Sent: Friday, June 16, 2006 11:02 AM
To: 'ihc@lists.oasis-open.org'
Subject: [ihc] FWD: Why Doctors and Nurses Wont Use IT



Bob Lewis writes a column on IT, project management and whatever

else peaks his interest.


The following link is to the particular piece.



And there are many good comments and postings to this as well - including why paper is better than screens in a clinical setting. 


Personally I noted the following -> add to that slow operation, poorly conceived functional role, badly designed UI defaulting, no time set-aside for training, and its amazing that any software gets used at all.  Notice the reverse applies to clinical devices – heart monitors, IV pumps, etc – that are much more “soldier proof” and mission critical.  Even there however the amount of “smart intelligence” in those devices (ability to detect if someone has selected a whacko drip rate on the pump for example) – coupled with difficult to read settings (yes average age of a nurse is 46 years – so go figure tiny read outs are useless).
But of course the nursing staff members are not the ones in charge of the budget and selecting the software and tools – so don’t expect this to change any year soon…



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