Institute for the Design of Environments Aligned for Patient Safety (IDEA4PS)

Principal Investigators: Ann Scheck McAlearney, Sc.D., M.S., The Ohio State University, Columbus, OH; formerly Susan Moffatt-Bruce, M.D., Royal College of Physicians and Surgeons of Canada, Ottawa
AHRQ Grant No.: HS024379
Project Period: 09/30/15-09/29/20
Description: The goal of the Institute for the Design of Environments Aligned for Patient Safety (IDEA4PS) was to improve workflows and information transfers in the healthcare environment.

The specific aims were to:

• Explore how cardiac alarms affect healthcare provider decision making.
• Conduct surveillance of healthcare-acquired infections in real time.
• Implement and evaluate secure messaging in electronic health records (EHRs).

The development of the IDEA4PS Lab provided foundational infrastructure to connect stakeholders across Ohio State University and Wexner Medical Center to conduct rigorous research in the context of practice. This focus allowed research to inform operations in a cycle of continuous improvement where clinicians and researchers, including health services experts, analysts, and information technology staff, worked together and improved clinical practice by designing, testing, and exploring the types of information flows resulting in a safer healthcare work environment.

IDEA4PS's work reduced the alarm burden of bedside monitors and the Secondary Alarm Notification System (SANS) that is delivered on nurses' phones. These improvements allowed clinicians to focus on meaningful events over the din of background noise, leading to enhanced safety and quality of patient care. This goal was achieved by^[1-7]:

• Changing policies at five hospitals to reduce false alarms.
• Redesigning audio tones for telemetry alarms.
• Identifying needs of patients and families to improve satisfaction with alarms.
• Assisting in making changes to tones for a new mobile phone platform with SANS and including a new hospital.

The IDEA4PS Lab automated surveillance of hospital-acquired infections to provide results in near real time to stakeholders and tested different visualizations for surveillance results by^[8-10]:

• Creating a simple Clostridium difficile (C. diff) algorithm that correctly identifies all hospital-onset C. diff infections.
• Developing a demonstration C. diff interactive dashboard that uses a map of the hospital as a form of visualization and building data infrastructure that assesses space and time by leveraging geographic information systems to better track infections within the hospital. This dashboard can be applied to other quality and safety outcomes that may benefit from localization within the hospital.

Finally, IDEA4PS explored how hospitalwide use of MyChart Bedside (MCB), an inpatient patient portal, affected the provider work system and processes. After interviews with hospital staff, a health system-level committee was convened to translate findings into operational improvements. These changes included hiring technology navigators to assist with MCB provisioning and training both patients and clinicians on MCB use.^[11-14]

This PSLL’s work has resulted in at least 70 peer-reviewed journal publications, with nearly 600 citations in other publications; nearly 90 presentations at institutions and conferences; and creation of a website (https://u.osu.edu/idea4ps/).

Publications

2021

• MacEwan SR, et al. Identifying the role of inpatient portals to support health literacy: perspectives from patients and care team members. Patient Educ Couns. 2021 Apr;104(4):836-43.

2020

• DePuccio MJ, et al. Patients' perceptions about medical record privacy and security: implications for withholding of information during the COVID-19 pandemic. J Gen Intern Med. 2020;35(10):3122-5.
• Di Tosto G, et al. Metrics for outpatient portal use based on log file analysis: algorithm development. J Med Internet Res. 2020 Jun 12;22(6):e16849. 
• Furniss S, et al. Characteristics of patients using a patient portal via mobile technology. Perspect Health Inf Manag 2020 Winter.
• Hefner JL, et al. Patient and physician perspectives on training to improve communication through secure messaging: Clarifying the rules of engagement. Health Care Manage Rev. 2020 May 5. Online ahead of print.
• McAlearney AS, et al. Care team perspectives about an inpatient portal: benefits and challenges of patients' portal use during hospitalization. Med Care Res Rev. 2020 Jun 17:1077558720925296.
• McAlearney AS, et al. Helping patients be better patients: a qualitative study of perceptions about inpatient portal use. Telemed J E Health. 2020;26(9):1184-7.
• McAlearney AS, et al. Improving acceptance of inpatient portals: patients' and care team members' perspectives. Telemed J E Health. 2020;26(3):310-26.
• McHaney-Lindstrom M, et al. Network analysis of intra-hospital transfers and hospital onset clostridium difficile infection. Health Info Libr J. 2020;37(1):26-34.
• Patterson ES, et al. Enhancing usefulness and usability of a clinical decision support prototype for antibiotic stewardship. Proc Int Symp Hum Factors Ergon Healthc. 2020;9(1):61-5.
• Patterson ES, et al. Scheduling delayed treatment and surgeries post-pandemic: a stakeholder analysis. Proc Int Symp Hum Factors Ergon Healthc. 2020 Sept;9(1):10-4. 
• Valvona SN, et al. Comparative effectiveness of best practice alerts with active and passive presentations: a retrospective study. Proc Int Symp Hum Factors Ergon Healthc. 2020;9(1):105-9. 
• Walker DM, et al. Exploring the digital divide: age and race disparities in use of an inpatient portal. Telemed J E Health. 2020 May;26(5):603-13.

2019

• Carter R, et al. Assessing mental models from communications: patient, family, and care team messaging within the hospital. Proc Hum Factors Ergon Soc Annu Meet. 2019 Nov 20;63(1).
• Fareed N, et al. Inpatient portal clusters: identifying user groups based on portal features. J Am Med Inform Assoc. 2019;26(1):28-36.
• Hebert C, Root ED. Repurposing geographic information systems for routine hospital infection control. Adv Health Care Manag. 2019 Oct 24;18. 
• Horwood CR, et al. Continuous cardiac monitoring policy implementation: three-year sustained decrease of hospital resource utilization. Adv Health Care Manage. 2019 Oct 24;18:159-71. 
• Huerta T, et al. Patient engagement as measured by inpatient portal use: methodology for log file analysis. J Med Internet Res. 2019;21(3):e10957.
• McAlearney AS, et al. Empowering patients during hospitalization: perspectives on inpatient portal use. Appl Clin Inform. 2019;10(1):103-112.
• McAlearney AS, et al. Patients' perceptions of portal use across care settings: qualitative study. J Med Internet Res. 2019;21(6):e13126.
• McGrath SP, et al. Improving patient safety and clinician workflow in the general care setting with enhanced surveillance monitoring. IEEE J Biomed Health Inform. 2019;23(2):857-66.
• Melsop S, et al. Working across boundaries toward patient safety using design thinking methodologies for transdisciplinary team-of-teams collaboration. Int J Design Manage Prof Pract. 2019;13(3):1-12. 
• Moffatt-Bruce SD, et al. What is the return on investment for implementation of a crew resource management program at an academic medical center? Am J Med Qual. 2019;34(5):502-8.
• Mount-Campbell AF, et al. Value and usage of a workaround artifact: a cognitive work analysis of “brains” use by hospital nurses. J Cogn Eng Decis Mak. 2019;13(2):67-80.
• Patterson ES, et al. Nursing handovers in critical care: a retrospective analysis of information content and function. Proc Int Symp Hum Factors Ergon Healthc. 2019 Sept;8(1):4-8. 
• Patterson ES, et al. Predicting mortality with applied machine learning: can we get there? Proc Int Symp Hum Factors Ergon Healthc. 2019 Sept;8(1):115-9. 
• Rayo MF, et al. Using timbre to improve performance of larger auditory alarm sets. Ergonomics. 2019;62(12):1617-29.
• Reynolds M, et al. Guidance for custom alarm design: you don’t have to “crank it up to 11”. Proc Int Symp Hum Factors Ergon Healthc. 2019;8:142-5.
• Sieck CJ, et al. The patient engagement capacity model: what factors determine a patient’s ability to engage? NEJM Catalyst. 2019 Mar 13. https://www.canaryhealth.com/wp-content/uploads/2019/05/Patient-Engagement-Capacity-Model_-Determining-Patient-Ability-to-Engage-NEJM-catalyst-2019.pdf.
• Vink S, et al. An exploration of the association between inpatient access to tablets and patient satisfaction with hospital care. Perspect Health Inf Manage. 2019 Fall;16(Fall):1i. eCollection 2019 Fall.
• Walker DM, et al. Facilitating organizational change to accommodate an inpatient portal. Appl Clin Inform. 2019 Oct;10(5):898-908. 
• Yu SC, et al. Novel visualization of Clostridium difficile infections in intensive care units. ACI open. 2019 Jul;3(2):e71-e77.

2018

• Duchemin AM, et al. Utilizing mindfulness with health-care professionals to improve burnout, self-compassion, and patient quality and safety measures: a comparison of cardiac units. Glob Adv Health Med. 2018;7:139-40. doi: 10.1177/2164956118773837.
• Edworthy J, et al. Getting better hospital alarm sounds into a global standard. Ergon Des. 2018;26(4):4-13. 
• Hefner JL, et al. Training to optimize collaborative use of an inpatient portal. Appl Clin Inform. 2018;9(3):558-64.
• Horwood CR, et al. A qualitative analysis of clinical decompensation in the surgical patient: perceptions of nurses and physicians. Surgery. 2018;164(6):1311-5.
• Horwood CR, et al. Gaps between alarm capabilities and decision-making needs: an observational study of detecting patient decompensation. Proc Int Symp Hum Factors Ergon Healthc. 2018;7(1):112-6.
• Knupp AM, et al. Associations among nurse fatigue, individual nurse factors, and aspects of the nursing practice environment. J Nurs Adm. 2018;48(12):642-8.
• Moffatt-Bruce S, et al. IDEA4PS: the development of a research-oriented learning healthcare system. Am J Med Qual. 2018;33(4):420-5.
• Patterson ES. Workarounds to intended use of health information technology: a narrative review of the human factors engineering literature. Hum Factors. 2018;60(3):281-92.
• Patterson ES, et al. A mixed methods approach to tailoring evidence-based guidance for antibiotic stewardship to one medical system. Proc Int Symp Hum Factors Ergon Healthc. 2018;7(1):224-31.
• Patterson ES, et al. Use preferences for continuous cardiac and respiratory monitoring systems in hospitals: a survey of patients and family caregivers. Proc Int Symp Hum Factors Ergon Healthc. 2018;7(1):123-8.
• Rayo MF, et al. Participatory bullseye toolkit interview: identifying physicians' relative prioritization of decision factors when ordering radiologic imaging in a hospital setting. Proc Int Symp Hum Factors Ergon Healthc. 2018;7(1):1-7.
• Sarkhel R, et al. How nurses identify hospitalized patients on their personal notes: findings from analyzing "brains" headers with multiple raters. Proc Int Symp Hum Factors Ergon Healthc. 2018;7(1):205-9.
• Schmidt CR, et al. Development and prospective validation of a model estimating risk of readmission in cancer patients. J Surg Oncol. 2018;117(6):1113-8.
• Sheffer J, et al. A roundtable discussion: improving the "alarm problem" will require much more than just reducing the number of alarms. Biomed Instrum Technol. 2018 Nov/Dec;52(6):454-61. 
• Sieck CJ, et al. Improving the patient experience through patient portals: Insights from experienced portal users. Patient Exp J. 2018;5(3):Article 8.
• Sieck CJ, et al. Understanding secure messaging in the inpatient environment: a new avenue for communication and patient engagement. Appl Clin Inform. 2018;9(4):860-8.
• Walker DM, et al. Framework for evaluating and implementing inpatient portals: a multi-stakeholder perspective. J Med Syst. 2018;42(9):158.
• Walker DM, et al. Optimizing the user experience: identifying opportunities to improve use of an inpatient portal. Appl Clin Inform. 2018;9(1):105-13.
• Yen PY, et al. Usability evaluation of a commercial inpatient portal. Int J Med Inform. 2018;110:10-8.

2017

• Hefner JL, et al. Cultural transformation after implementation of crew resource management: is it really possible? Am J Med Qual. 2017;32(4):384-90.
• Hefner JL, et al. Navigating a ship with a broken compass: evaluating standard algorithms to measure patient safety. J Am Med Inform Assoc. 2017;24(2):310-5.
• Hefner JL, et al. System-wide inpatient portal implementation: survey of health care team perceptions. JMIR Med Inform. 2017;5(3):e31.
• Moffatt-Bruce SD, et al. ERAS: safety checklists, antibiotics, and VTE prophylaxis. J Surg Oncol. 2017;116(5):601-7.
• Patterson ES, et al. Clustering and prioritizing patient safety issues during EHR implementation and upgrades in hospital settings. Proc Int Symp Hum Factors Ergon Healthc. 2017;6(1):125-31.
• Patterson ES, et al. Safe practice recommendations for the use of copy-forward with nursing flow sheets in hospital settings. Jt Comm J Qual Patient Saf. 2017;43(8):375-85.
• Sieck CJ, et al. The rules of engagement: perspectives on secure messaging from experienced ambulatory patient portal users. JMIR Med Inform. 2017;5(3):e13.
• Walker DM, et al. Information technology to support patient engagement: where do we stand and where can we go? J Am Med Inform Assoc. 2017;24(6):1088-94.
• Yen PY, et al. Health information technology (HIT)  adaptation: refocusing on the journey to successful HIT implementation. JMIR Med Inform. 2017;5(3):e28.

2016

• Carballo NJ, et al. Perceived effectiveness, self-efficacy, and social support for oral appliance therapy among older veterans with obstructive sleep apnea. Clin Ther. 2016;38(11):2407-15.
• Elsharydah A, et al. Retained surgical items after abdominal and pelvic surgery: incidence, trend and predictors- observational study. Ann Med Surg (Lond). 2016;12:60-4.
• Fairbanks RJ. Usability in health IT: beyond compliance to meaningful design and assessment. Proc Hum Factors Ergon Soc Annu Meet. 2016 Sep;60(1):643-6.
• Ford EW, et al. Assessing the relationship between patient safety culture and EHR strategy. Int J Health Care Qual Assur. 2016;29(6):614-27.
• Moffatt-Bruce S, Huerta T. From ideas to institute for the design of environments aligned for patient safety (IDEA4PS): the reality of research and the keys to making it work. Int J Acad Med. 2016;2(3):2-5.
• Nguyen MC, et al. Evidence-based cardiac monitoring in surgical patients: reducing alarm fatigue and improving resource allocation. J Am Coll Surg. 2016;223(4):e168.
• Rayo MF, et al. Implementing an institution-wide quality improvement policy to ensure appropriate use of continuous cardiac monitoring: a mixed-methods retrospective data analysis and direct observation study. BMJ Qual Saf. 2016;25(10):796-802.
• Rayo MF, Moffatt-Bruce SD. Diagnosing and treating "alarm fatigue": pragmatic and evidence-based approaches needed. Jt Comm J Qual Patient Saf. 2016 Jul;42(7):291-2.
• Reale C, et al. Promoting patient safety with human factors methods: practical approaches to current medication management issues. Proc Hum Factors Ergon Soc Annu Meet. 2016;60:647-51.

References

1. Rayo MF, et al. Implementing an institution-wide quality improvement policy to ensure appropriate use of continuous cardiac monitoring: a mixed-methods retrospective data analysis and direct observation study. BMJ Qual Saf. 2016;25(10):796-802.
2. Rayo MF, Moffatt-Bruce SD. Diagnosing and treating "alarm fatigue": pragmatic and evidence-based approaches needed. Jt Comm J Qual Patient Saf. 2016 Jul;42(7):291-2.
3. Rayo MF, et al. Using timbre to improve performance of larger auditory alarm sets. Ergonomics. 2019;62(12):1617-29.
4. Sarkhel R, et al. How nurses identify hospitalized patients on their personal notes: findings from analyzing "brains" headers with multiple raters. Proc Int Symp Hum Factors Ergon Healthc. 2018;7(1):205-9.
5. Edworthy J, et al. Getting Alarm Sounds Into a Global Standard: A Case Study With Reflections. Undated online manuscript.
6. Nguyen MC, et al. Evidence-based cardiac monitoring in surgical patients: reducing alarm fatigue and improving resource allocation. J Am Coll Surg. 2016;223(4):e168.
7. Reynolds M, et al. Guidance for custom alarm design: you don’t have to “crank it up to 11”. Proc Int Symp Hum Factors Ergon Healthc. 2019;8:142-5.
8. McHaney-Lindstrom M, et al. Network analysis of intra-hospital transfers and hospital onset clostridium difficile infection. Health Info Libr J. 2020;37(1):26-34.
9. Yu SC, et al. Novel visualization of Clostridium difficile infections in intensive care units. ACI open. 2019 Jul;3(2):e71-e77.
10. McAlearney AS, et al. Searching for management approaches to reduce HAI transmission (SMART): a study protocol. Implement Sci. 2017;12(1):82.
11. McAlearney AS, et al. Improving acceptance of inpatient portals: patients' and care team members' perspectives. Telemed J E Health. 2020;26(3):310-26.
12. McAlearney, AS, et al. Care team perspectives about an inpatient portal: benefits and challenges of patients' portal use during hospitalization. Med Care Res Rev. 2020:1077558720925296.
13. Walker DM, et al. Exploring the digital divide: age and race disparities in use of an inpatient portal. Telemed J E Health. 2020 May;26(5):603-13.
14. MacEwan SR, et al. Identifying the role of inpatient portals to support health literacy: perspectives from patients and care team members. Patient Educ Couns. 2021 Apr;104(4):836-43.