Page
of 10
ZOOM
1
Title of the Paper
Student Name
College of Nursing, Walden University
Course Number, Section, and Title
(Example: NURS 6051 Section 01, Transforming Nursing and Healthcare Through
Technology)
Instructor
Due Date (Month, Day, Year)
2
The Use of Clinical Systems to Improve Outcomes and Efficiencies
This type of assignment is considered an “Annotated Bibliography”.
You should review
the sample Annotated Bibliography from the writing center to help you complete
this
assignment. You do not need a reference page as you will cite each article
before discussing it. If
you cite additional sources in the introduction or conclusion (it is not
necessary to cite additional
sources), you would include a reference page which lists only the additional
sources. In this
assignment, you will review 4 research studies focused on the application of
one type of
clinical system of your choosing.
Listed below are examples of clinical systems:
· Inpatient Electronic
Health Records (EHR)
· Outpatient EHRs
· Computerized Provider
Order Entry (CPOE)
· Specialty Systems:
o Emergency Department Information System
o ICU Information System
o Cardiology Information Systems
o Operating Room Information System
· Ancillary Information
Systems
o Laboratory Information Systems
o Pharmacy Information Systems
o Radiology Information Systems
· Electronic Medication
Administration Record (eMAR)
· Bar Code Medication
Administration (BCMA) Systems,
· Smart Pumps
· Care Planning Systems
· Messaging Systems
· Alerts and Clinical
Decision Support Systems
· Telehealth Systems
· Patient Portals
· Patient Tracking Systems
· Remote Monitoring Systems
· Artificial Intelligence
Systems
· Patient Education Systems
3
After selecting one type of clinical system, you will conduct a search for
recent (within the
last 5 years) research studies that examined the improvement in outcomes and/or
efficiencies.
These studies need to report on the results of a research study and appear in a
scholarly journal,
you should not use studies reported in conference proceedings. The research
studies should
provide evidence to support the use of the clinical system to improve outcomes
and/or
efficiencies, such as “the use of personal health records or portals to support
patients newly
diagnosed with diabetes.” For example, if you selected patient portals as the
clinical system, you
would use the following search terms: patient portals and outcomes. Searching
on outcomes
usually returns results on efficiencies as well.
The articles need to be primary sources, according to the syllabus “A research
report is
primary, and you can tell because it includes materials and methods
demonstrating how the
research was done”. Literature reviews, systematic reviews, narrative reviews
and integrative
reviews are secondary sources and are not appropriate for this assignment.
Quality improvement
projects are not research studies. Studies which examine the predictive
accuracy of tools or
algorithms are also not appropriate as they do not provide evidence of
improvements to
outcomes/efficiencies. Abstracts and conference proceedings are not considered
peer-reviewed
articles. The journal, Studies in Health Technology and Informatics,
republishes papers and
abstracts presented at conferences. Refrain from using the conference
proceedings republished in
this journal. The studies need to provide evidence that the clinical system
improved
outcomes/efficiencies after the clinical system was implemented, which involves
comparing the
outcomes/efficiencies before the clinical system was implemented to the
outcomes/efficiencies
after the clinical system was implemented. The results of the studies need to
demonstrate
4
statistically significant improvements to outcomes/efficiencies after the
clinical system was
implemented.
Here are two links to help you find and identify research articles.
Research Articles
https://academicguides.waldenu.edu/library/evaluating/researcharticles
How to Find Research Articles https://academicanswers.waldenu.edu/faq/73303
The Assignment: (4-5 pages)
In a 4- to 5-page paper, synthesize the peer-reviewed research studies you
reviewed. Be sure to
address the following:
· Identify the 4 peer-reviewed
research articles you reviewed, citing each in APA format.
The articles should appear in alphabetical order in your paper. After the
citation, you
would discuss each article.
· For each study, you will
briefly summarize the study, explain the improvement to
outcomes and/or efficiencies, and discuss lessons learned from the application
of the
clinical system each peer-reviewed article described. Be specific and provide
examples.
Each study should be discussed in approximately one page. In the conclusion you
will
synthesize the studies.
The aim of this assignment is to find 4 research studies that are primary
sources (original studies)
that provide evidence that a clinical system improved outcomes/efficiencies. A
good example of
evidence from a research study that demonstrated improvements was the Dykes et
al. (2017)
study that is a required reading in Module 4.
Dykes, P. C., Rozenblum, R., Dalal, A., Massaro, A., Chang, F., Clements, M.,
Collins, S.
…Bates, D. W. (2017). Prospective evaluation of a multifaceted intervention
to improve
outcomes in intensive care: The Promoting Respect and Ongoing Safety Through
Patient
5
Engagement Communication and Technology Study Download Prospective evaluation
of a
multifaceted intervention to improve outcomes in intensive care: The Promoting
Respect and
Ongoing Safety Through Patient Engagement Communication and Technology Study.
Critical
Care Medicine, 45(8), e806–e813. doi:10.1097/CCM.0000000000002449
They identified, “The primary outcome was the aggregate rate per 1,000
patient days of selected
AEs, defined as failed processes of care and/or unintended consequences of
medical care that can
lead to patient harm (2, 17). To avoid outcomes ascertainment bias, we included
only those AEs
that are routinely reported within established organizational surveillance
processes (and there-
fore captured and vetted independently of the study team):
falls, pressure ulcers, catheter-associated urinary tract infections, central
catheter-associated
bloodstream infections, and ventilator-associated events. Secondary outcomes
were patient and
care partner satisfaction, care plan concordance (e.g.,
agreement on the care plan) between the patient and providers,
and healthcare utilization”.
They looked at the primary and secondary outcome measures before and after the
intervention and found that “There was a 29% relative reduction in the
aggregate rate of
AEs, from 59.0 per 1,000 patient days (95% CI, 51.8–67.2) to 41.9 per 1,000
patient days (95%
CI, 36.3–48.3), p value of less than 0.001 (Table 3) and pre-post, p value
equals to 0.049 for
the interrupted time series. This translates into a reduction of 17.1 AEs per
1,000 patient days.
Also, results were very similar using weighted estimating equations to account
for missing
data. The percent of patients who reported a top box score (9 or 10 on the 0–10
HCAHPS
question [19]) for their overall hospital rating significantly improved from
71.8 (95% CI, 61.1–
82.6) to 93.3 (95% CI, 88.2–98.4), p value of less than 0.001. Care partner
satisfaction with the
6
ICU experience also improved significantly from 84.3 (95% CI, 81.3–87.3) to
90.0 (95% CI,
88.1–91.9), p value of less than 0.001. Care team concordance with patient’s
care plan and
resource utilization was unchanged”. This is a great example of a study
that found improvements
in outcomes. They looked at the differences in the outcome measures before and
after the
intervention (which included a web-based tool kit) and found the above
improvements.
Lessons learned are based on the knowledge gained from conducting the study.
They
generally highlight the strengths and weaknesses of the study that impacted the
process of
conducting the study to share knowledge of what had a positive and negative
impact on the
study. They can also include directions for future research based on the
findings of the study.
In summary, you need to select one type of clinical system and find 4 current
research
articles, published in scholarly journals, that examined outcomes and/or
efficiencies related to
the clinical system you chose. On the next page is the beginning of the shell
of the paper. I
purposely chose four articles on CPOE that were not current.
7
The Use of Clinical Systems to Improve Outcomes and Efficiencies
Include an introductory paragraph designed to inform the reader of what you
will cover in
the paper. Include a purpose statement with all the topics you will address.
The purpose of this
paper is…
Annotated Bibliography
Fortescue, E. B., Kaushal, R., Landrigan, C. P., McKenna, K. J., Clapp, M. D.,
Federico, F.,
Goldmann, D. A. & Bates, D. W. (2003). Prioritizing strategies for
preventing medication
errors and adverse drug events in pediatric inpatients. Pediatrics, 111(4),
722-729.
In the first paragraph you will summarize the study. Briefly describe the aim
of the study,
the sample and setting, and the methods.
In the second paragraph you will identify the outcomes and/or efficiencies
examined in the study and explain the results related to improvements in the
outcomes
and/or efficiencies.
In the third paragraph, you will discuss lessons learned from the findings of
the
study and relate the lessons learned to the application of the clinical system.
Potts, A. L., Barr, F. E., Gregory, D. F., Wright, L., & Patel, N. R.
(2004). Computerized
physician order entry and medication errors in a pediatric critical care
unit. Pediatrics, 113(1), 59-63.
In the first paragraph you will summarize the study. Briefly describe the aim
of the study,
the sample and setting, and the methods.
In the second paragraph you will identify the outcomes and/or efficiencies
examined in the study and explain the results related to improvements in the
outcomes
and/or efficiencies.
8
In the third paragraph, you will discuss lessons learned from the findings of
the
study and relate the lessons learned to the application of the clinical system.
Upperman, J. S., Staley, P., Friend, K., Neches, W., Kazimer, D., Benes, J.,
& Wiener, E. S.
(2005). The impact of hospitalwide computerized physician order entry on
medical errors
in a pediatric hospital. Journal of Pediatric Surgery, 40(1), 57-59.
In the first paragraph you will summarize the study. Briefly describe the aim
of the
study, the sample and setting, and the methods.
In the second paragraph you will identify the outcomes and/or efficiencies
examined in the study and explain the results related to improvements in the
outcomes
and/or efficiencies.
In the third paragraph, you will discuss lessons learned from the findings of
the
study and relate the lessons learned to the application of the clinical system.
Walsh, K. E., Landrigan, C. P., Adams, W. G., Vinci, R. J., Chessare, J. B.,
Cooper, M. R.,
Hebert, P. M, Schainker, E. G., McLaughlin, T. J., & Bauchner, H. (2008).
Effect of
computer order entry on prevention of serious medication errors in hospitalized
children. Pediatrics, 121(3), e421-e427.
In the first paragraph you will summarize the study. Briefly describe the aim
of the
study, the sample and setting, and the methods.
In the second paragraph you will identify the outcomes and/or efficiencies
examined in the study and explain the results related to improvements in the
outcomes
and/or efficiencies.
In the third paragraph, you will discuss lessons learned from the findings of
the
study and relate the lessons learned to the application of the clinical system.
9
Criteria in the Rubric: Summarizing the 4 Research Studies
1. Summarize each study, explaining the improvements to outcomes, efficiencies,
and
lessons learned from the application of the clinical system each peer-reviewed
article
described. Be specific and provide examples.
To earn an excellent rating the rubric requires:
· The response accurately
and thoroughly summarizes in detail each study
reviewed, explaining in detail the improvement to outcomes, efficiencies, and
lessons learned from the application of the clinical system each peer-reviewed
article described.
· Specific, accurate, and
detailed examples are provided which fully support the
response.
Conclusion
The conclusion should synthesize the major results of all four research
studies,
comparing and contrasting the findings of all studies and highlighting
similarities and differences
in the studies. Here are links to Walden’s Writing Center on Synthesis:
https://academicguides.waldenu.edu/writingcenter/evidence/synthesis
https://academicanswers.waldenu.edu/faq/358645
Although the use of systematic reviews are not appropriate for this assignment;
the
results, discussion, and/or conclusion section(s) of systematic reviews are
good example
synthesizing the studies’ findings. Here is an example of systematic review
with a great synthesis
of the results: Han, H.R., Gleason, K.T., Sun, C.A., Miller, H.N., Kang, S.J.,
Chow, S.,
Anderson, R., Nagy, P. & Bauer, T. (2019). Using patient portals to improve
patient outcomes:
systematic review. JMIR Human Factors, 6(4), e15038.
http://doi.org.10.2196/15038.
10
Criteria in the Rubric: A Conclusion with a Synthesis of the 4 Studies
1. Synthesize the findings from the 4 peer-reviewed research articles in a
cohesive
conclusion.
To earn an excellent rating the rubric requires:
· Response includes a
synthesis of the findings in an exceptionally well-written
conclusion