China
Africa
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Implementation systems that support resilient performance
Published in Frances Rapport, Robyn Clay-Williams, Jeffrey Braithwaite, Implementation Science, 2022
However, implementing the changes more widely met with reluctance due to conflicting views across the implementation system on how best to solve the problems that were discovered. Fragmentation across different parts of the hospital and the implementation system impeded change. Fragmentation led one group to push for simplification of alerts and sounds and a reluctance to change from the current alarm sounds. Another group pushed for uniformity and compliance with a new set of monitoring policies for the entire organization (Fitzgerald 2019). Both ignored the science on how to improve anticipation and resilience in cognitive work systems. Instead, these groups relied on their previous model of how they thought nurses use alarms to monitor rather than the empirical results from the studies on how nurses actually monitor patients, given weaknesses in the alerts. These types of misunderstandings reveal how the gap between Work-as-Imagined and Work-as-Done can be common in implementation systems (see essay 58; Sklar and Aarons, “Scaling-Out” Evidence-based Practices).
Top Informatics Trends for the Next Decade
Published in Connie White Delaney, Charlotte A. Weaver, Joyce Sensmeier, Lisiane Pruinelli, Patrick Weber, Nursing and Informatics for the 21st Century – Embracing a Digital World, 3rd Edition, Book 3, 2022
The Taskforce on Telehealth Policy was formed to assess early findings under the flexibilities granted by Congress and the Centers for Medicare and Medicaid Services (CMS) during the public health emergency (National Committee for Quality Assurance, 2020). These findings show a positive impact on patient safety from telehealth by preventing care delays, reducing exposure to pathogens and minimizing travel needed for in-person care. Early evidence identified by the Taskforce suggests that the expansion of telehealth has driven a reduction in missed appointments, and the availability of telehealth has not resulted in excess cost or utilization increases, except for behavioral health. To prevent telehealth from adding to the fragmentation and data silos in our healthcare ecosystem, rules and protocols for data sharing and care coordination between telehealth and other care sites should be developed. Safeguards are also needed to prevent fraud, maintain quality and ensure that the shift to virtual care does not leave behind individuals with limited access to technology (Levey, 2021).
The Diseased Body
Published in Roger Cooter, John Pickstone, Medicine in the Twentieth Century, 2020
Other aspects of hospital medicine also generated concerns about fragmentation. Surgeons, to many of their critics, seemed increasingly willing to regard the body in mechanistic terms, each part substitutable if it went wrong. Hearts, lungs, kidneys and other internal organs all became replaceable, while microsurgical techniques in the 1980s allowed severed fingers, arms and other appendages to be rejoined to the body. Some of the replacement body parts came from the recently dead, but others came from living donors. In the age immediately following decolonization, the purchase by the West of human body parts from the Third World highlighted the problematic connections with former colonies. It also raised two other questions of connection. The use of artificial body parts — hips in the 1960s, hearts in the 1980s — prompted debates about the boundaries between human and machine. So too, the use of animal parts in replacement surgery generated questions about the boundaries between humans and animals, and the transfer of animal diseases to humans.
Healthcare professionals’ experiences and perspectives of team-based interdisciplinary pain rehabilitation with immigrants requiring an interpreter. A qualitative study
Published in Disability and Rehabilitation, 2023
Karin Uhlin, Elisabeth Persson, Britt-Marie Stålnacke, Monika Löfgren
There were also several organisational obstacles, outside the IPRI programme, which hampered the patients. Although the patients had severe needs, they were not prioritised, and the lack of coordinated care was an obstacle. Zander et al. made similar findings in Swedish primary care [21]. The needs of female patients from the Middle East were too complex for healthcare professionals to handle on their own; they entailed a need to develop multi-professional collaboration with other authorities. Coordinated care is supposed to counterbalance fragmentation in healthcare. The development and implementation of coordinated care has been on the agenda in Sweden for many years [30]. However, for patients with chronic pain, so far, few examples have been found where care has been coordinated. A Swedish national report from 2016 [31] concluded that the care for patients with pain has a lack of structure on all levels and that there is no organised collaboration between different levels of care. In the present study, the lack of continued support for patients after the IPRI programme made the informants question the long-term value of the patients’ achievements.
Sleep apnea and atrial fibrillation: challenges in clinical and translational research
Published in Expert Review of Cardiovascular Therapy, 2022
Benedikt Linz, Julie Norup Hertel, Jeroen Hendriks, Arnela Saljic, Dobromir Dobrev, Mathias Baumert, Thomas Jespersen, Dominik Linz
Although technologies for simple sleep apnea testing are available, hurdles, including lack of infrastructures and inflexible reimbursement models, currently prevent the implementation in AF clinics. The limited access to sleep apnea testing devices complicates the implementation of sleep apnea testing and management in AF outpatient clinics. A recent joint survey by the European Heart Rhythm Association (EHRA) and the Association of Cardiovascular Nurses and Allied Professions (ACNAP) showed a clear underutilization of OSA management in AF patients [59]. Only 10.8% of cardiology departments reported having a structured OSA assessment pathway implemented at the cardiology department. Furthermore, only 6.7% of the respondents indicated that they test >70% of their AF patients for OSA as a component of rhythm control therapy. Additionally, this survey identified various structural barriers currently preventing optimal implementation, including the absence of established collaboration between cardiology and sleep clinics (35.6%), as well as the lack of financial (23.6%), and workforce-related resources (21.3%). All these factors limit structured testing facilities of OSA, which currently only occurs in a minority of AF patients. The implementation of SDB testing and SDB management in AF clinics requires close interdisciplinary collaboration between the electrophysiologist/cardiologist and sleep specialists. This is best organized within an integrated care model to improve comprehensive care delivery and prevent fragmentation.
Integrated care for adults with dementia and other cognitive disorders
Published in International Review of Psychiatry, 2018
Brian Draper, Lee-Fay Low, Henry Brodaty
However, there is no unifying definition or common conceptual understanding of integrated care (WHO, 2016); it might be better recognized for what it is not, that is, episodic, reactive, and fragmented care. For people with dementia and other cognitive disorders there are numerous ways in which care might become episodic or fragmented with likely suboptimal outcomes. Some examples include fragmentation of the diagnostic process when multiple diagnostic pathways involving different types of specialists occur simultaneously (Draper et al., 2016): lack of integration of primary and specialist care; lack of integration of hospital and community care; and poor coordination between health and social care. These can be accentuated by policy and jurisdictional issues in which elements of care administered by different organizations might result in gaps and barriers for people with dementia and their carers.