Browsing by Subject "electronic medical record"

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    Systematic Postoperative Nausea Prophylaxis Feedback Improves Clinical Performance in Anesthesiology Residents.
    (J Educ Perioper Med, 2015-07) Greene, Nathaniel H; Norstedt, Peter A; Nair, Bala G; Souter, Karen J
    BACKGROUND: Electronic medical records can generate a wealth of information regarding compliance with perioperative clinical guidelines as well as patient outcomes. Utilizing this information to provide resident physicians with measures of their own clinical performance may positively impact residents' clinical performance. We hypothesize that providing residents with objective measures of their individual adherence to evidence based postoperative nausea and vomiting (PONV) management protocols will improve their compliance with standardized treatment methods. METHODS: We conducted a retrospective baseline analysis of junior anesthesiology residents' compliance with PONV prophylaxis guidelines for high-risk patients. This was followed by a prospective cohort study, before and after an educational intervention, a 15 minute lecture on PONV prophylaxis. The number of pharmacologic prophylactic interventions were tabulated for each operative case and reported back to individual residents in blind and anonymous fashion. The primary outcome was the use of two or more prophylactic interventions for a high-risk patient, while the secondary outcome was the use of three or more prophylactic interventions. A follow up survey was administered to participating residents regarding the use of their individualized clinical performance. RESULTS: After implementation of feedback, patients received a significantly higher amount of PONV prophylactic treatments (p=0.001, means of 1.35 vs. 1.99). Comparison of percentage compliance was 38% vs 73%, respectively (p<0.001). In a follow up survey, residents received the feedback intervention well and had no significant concern in the dissemination of deidentified performance outcomes publically. CONCLUSIONS: Resident compliance with PONV treatment guidelines was improved merely by auditing performance and providing individualized feedback. High-risk patients appear to receive more prophylactic agents after performance feedback and may be more effective than a more commonly used educational intervention to address the same topic. Providing direct performance feedback may be a useful tool for integration into graduate medical education programs.
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    The Button Project: Using Chart Rounds for Teaching Clinical Ophthalmology with an Electronic Medical Record.
    (Advances in medical education and practice, 2019-01) Rosdahl, Jullia A; Zhang, Wenlan; Manjunath, Varsha

    Objective

    Chart rounds have traditionally been used effectively for clinical teaching in ophthalmology. The introduction of the electronic health record has altered practice patterns and some evidence suggests interference with resident education. The purpose of this study was to investigate the use of chart rounds in our ophthalmology department and to see if a simple intervention, an "education button", could positively impact clinical teaching.

    Design

    We used a cross-sectional survey, and pre- and post-intervention surveys to assess the utility of an intervention - an "education button".

    Setting

    Department of Ophthalmology at Duke University, a tertiary care academic ophthalmology practice, in Durham, North Carolina.

    Participants

    Ophthalmology trainees (37), including residents and clinical fellows, and clinical faculty (50) in the department were surveyed anonymously. The overall response rate for the cross-sectional survey was 83% (72/87). The overall response rate for the educational study was 53% for the first time-point and 59% for the second time-point.

    Results

    For the cross-sectional survey, trainees found chart rounds to be useful and would like to increase their frequency. Most faculty reported doing them regularly, although not having enough time was the most common barrier (76% of the faculty). In the pre- and post-assessment of the "education button" (overall response rate 53%), the overall impression was positive with the button easy to use, but the implementation of the button did not appear to change the quality or frequency of chart rounds; nor did it appear to have an effect on covering learning objectives.

    Conclusion

    While the "education button" could help with communication between the faculty and trainees during a busy clinic session to identify cases for discussion, it did not address the most common barrier identified by faculty members, that of not having enough time.
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    Using the Electronic Medical Record to Improve Preoperative Identification of Patients at Risk for Obstructive Sleep Apnea.
    (Journal of perianesthesia nursing : official journal of the American Society of PeriAnesthesia Nurses, 2019-02) Stubberud, Allison B; Moon, Richard E; Morgan, Brett T; Goode, Victoria M
    PURPOSE:Obstructive sleep apnea (OSA) is a breathing disorder found in surgical patients and associated with complications in the postoperative period. The implementation of a preoperative universal screening process using the STOP-BANG questionnaire to identify patients at high risk for OSA provides opportunities for improved management. DESIGN:A pre-post design was used to evaluate screening compliance rates. METHODS:This initiative included staff education, which included the process for evaluating and documenting STOP-BANG scores. The data were collected via a chart review of the electronic medical record (EMR). FINDINGS:The rate of screening for OSA doubled after implementation of this initiative, and compliance with STOP-BANG questionnaire screening was 66.1%. High-risk designation in the EMR was 73.0%. Nearly half of the patients screened were found to be at high risk for OSA. CONCLUSIONS:Implementation of a universal screening initiative for patients and design for the EMR improves compliance with screening and identification of patients at high risk for OSA.