Information system’s impact on shift leaders’ indoor movement in emergency departments

Rising incidents of emergency department (ED) shift leader’s manual operation workflow is an increasing concern in ED operational information management. Shift leaders have a challenging task in running EDs. Currently, EDs are overcrowded, congested and patients are becoming more diverse. Staff have less and less time to carry out clinical monitoring and decision-making. In addition, there is increasing pressure to receive and repatriate patients. New information systems can help to cope with the increasing workload in busy ED operations management. (Lundgrén-Laine et al. 2013; Peltonen 2019)

The purpose of the study was to explore the movement of shift leaders before and after the implementation of the Columna Clinical Logistics (CCL) information system in the ED. A Bluetooth-based indoor positioning system was used in the study and 752 beacon records were collected between 2015-2016.

The results showed that there were differences in the stay time and the number of visits between the control units. In the intervention unit, the results of descriptive analysis of ED shift leaders' movement showed that the number of visits and the stay time were different between before and after implemented the CCL system. A statistical difference was seen in the nurse shift leaders’ movement during on-call hours (p=0.0193) before and after system implementation. 

The use of the CCL system can reduce the room visits and stay time by ED shift leader to collect relevant information, save leaders' time and energy, and improve the management efficiency of ED daily operation. Compared with normal office hours, the movement change of nurse shift leader during on-call hour is more significant. The use of the CCL system has not been able to significantly reduce the room visits and stay time for physician shift leader to collect relevant information. However, these findings must be interpreted with caution due to the limitations. More research is needed to validate these findings. 

Keywords: Emergency department; information system; shift leader; operations management

Author information 

Zhuqing Ren

RN, MNSc

Department of Nursing Science

University of Turku

Zhuqing.z.ren(at)utu.fi

 

References

Lundgrén-Laine, Heljä, Maria Kalafati, Elina Kontio, Tommi Kauko, and Sanna Salanterä. 2013. “Crucial Information Needs of ICU Charge Nurses in Finland and Greece.” Nursing in Critical Care 18(3):142–53.

Peltonen, Laura-Maria. 2019. Lectio Praecursoria, Information Needs in the Day-to-Day Operations Management of Hospital Units. Vol. 11.

It’s a runaway train – the upsurge of health and well-being apps

The upsurge of health and well-being apps has been prevalent over the years. Not to mention its recent boost in abundance that obviously doubled tenfold during the COVID-19 era, as almost everything are being done in various digital ways whenever possible or if our technology allows for it. These health and well-being apps can be used for health data collection, care delivery, monitoring purposes as well as health promotion and care engagement. Whilst they offer vast opportunities to augment care for various health-related goals, they also have the potential to disrupt proper care when what it can offer is not done right or otherwise lack the right information for the right user. As a healthcare professional, this thought reminds me of the five rights in medication administration – the right patient, the right drug, the right time, the right dose and the right route (high-five nurses!).

The issues of quality and safety are two important things that should be addressed with all health-related apps as it is set to become a significant source of health information and guidance. Apps that fall under the medical device category are bound by regulations and policies within the European Union such as the Conformité Européenne or widely known as the CE marking and acts, directives as well as policies for regulating medical devices. On the other hand, there are health apps that fall under the non-medical device category, like apps for health promotion that are commonly used to supplement the education of children on health behaviors and risk preventions or apps that promote mindfulness, relaxations or simply offer health information. Non-medical device apps are those that are not used in any way to diagnose, prevent, monitor, treat nor alleviate a disease, injury or handicap as defined by the European Commission (2017).

If we look at some literature, some say it’s like the “Wild West” for health apps under the non-medical device category. Imagine the cowboys, outlaws and who knows what else were out there way back then in a desert-ish town, where everyone just do what they want as they please.  Speaking of metaphors, let’s update it in another way and make it somehow closer to our digital age – it’s a runaway train! Although, we have regulations on data protection and privacy for everything digital when it comes to use of personal information, regardless of whether it’s a medical or non-medical device app, it is not just enough when we are talking about a person’s health and well-being. Big things came from small things so a wise man once said, imagine what a little misinformation or misuse that apparently does not have an immediate or direct effect to our human physiology can lead to in the long run. Uncontrolled, unregulated and unchecked health apps like a runaway train, poses as a looming predicament.

 

The Qvalidi Tool project led by the Qvalidi Consortium and the University of Turku’s Department of Nursing Science recognize the need to address the degree of quality and validity of health and well-being apps under the non-medical device category. To recognize these shortcomings is definitely a good start to devise solutions to bridge the gap. The project developed a comprehensive checklist in 2019 based on research and up-to-date guidelines to support the development, evaluation and reporting of health and well-being apps. Currently, the on-going study designed a practical and easy-to-use evaluation scale and will be tested to establish its psychometric properties.

 

Author’s Information:

Kaile Kubota

MHSc, MSN, RN, Doctoral Candidate (DPNurs)

Department of Nursing Science, University of Turku

kakubo(at)utu.fi

References:

Albrecht, U., Von Jan, U., & Pramann, O. (2013). Standard reporting for medical apps. Studies in Health Technology and Informatics, 190, 201–203. https://doi.org/10.3233/978-1-61499-276-9-201

European Commission. (2017). Regulation (EU) 2017/745 of the European Parliament and of the Council of 5 April 2017 on medical devices, amending Directive 2001/83/EC, Regulation (EC) No 178/2002 and Regulation (EC) No 1223/2009 and repealing Council Directives 90/385/EEC and93/42/EEC (Text with EEA relevance.) https://eur-lex.europa.eu/legal-content/ EN/ALL/?uri=CELEX:32017R0745

Hamari L, Parisod H, Pakarinen A, Skogberg M, Aromaa M, Leppänen V, Salantera S. (2020) Digitaalisten terveys- ja hyvinvointisovellusten kehittäminen, arviointi ja raportointi: Qvalidi 2019- tarkistuslistan kehittäminen ja sisältö. Hoitotiede 2020, 32 (1), 52-66.

Tomlinson, M., Rotheram-Borus, M., Swartz, L., & Tsai, A. (2013). Scaling Up mHealth: Where Is the Evidence? PLoS Medicine, 10(2), e1001382–e1001382. https://doi.org/10.1371/journal.pmed.1001382

Wisniewski, H., Liu, G., Henson, P., Vaidyam, A., Hajratalli, N. K., Onnela, J.-P., & Torous, J. (2019). Understanding the quality, effectiveness and attributes of top-rated smartphone health apps. Evidence-Based Mental Health, 22(1), 4–9. https://doi.org/10.1136/ebmental-2018-300069

PhD mobility and Maintaining my own Wellness: Reflections from a Canadian nurse researcher living in the Netherlands, studying in Finland

I am a Canadian, after studying and practicing nursing for almost a decade on the southwest coast of Canada I decided to begin graduate studies in nursing science abroad. I have been living in Europe for two years, and what I know now I could never have achieved without mobility in studies.

I need to back-up and describe a concept to guide this reflection of my experiences so far with mobility during PhD studies. Aaron Antonovsky, was a sociologist and he developed the concept of a Sense of Coherence (SOC) (Schnyder et al., 2000). The concept helps describe the location someone is on the continuum between ‘ease’ and ‘dis-ease’, and focuses on factors related to maintenance of health and wellbeing. This concept incorporates three attributes; Comprehensibility, Manageability, and Meaningfulness. As graduate students we fit somewhere on this continuum because of institutional, social, physical, and other personal factors. I would like to describe what it means for me to be on this continuum as a PhD student from the perspective of mobility in graduate studies. Using ‘Comprehensibility’ and ‘Meaningfulness’ as guiding concepts I will ask two important questions for a reflection of my experience.

Comprehensibility, do I understand and have confidence in what is happening during my PhD study?

My PhD study’s central focus has been on international collaboration. Therefore, I answer the question by asking specifically, do I understand my international collaborations? At the beginning of my study I did not have a good understanding of all components of my international collaborations. My PhD plan was revolving around a collaboration in a country other than that of my University enrollment (The University of Turku) and although I understood the collaboration from a practical sense I had not asked myself critical questions about the nature of this collaboration. For example, could I have confidence that the contribution I made to this collaboration would benefit my academic and scholarly development. I decided to ask this question a little later than I think I should have, however once I did ask this question I pinpointed a source of my discomfort and feelings of helplessness within this collaboration. As a result I developed a new collaboration plan and I started out by asking if my contribution to this collaboration makes sense for my personal and professional goals. I can now answer yes to this question and I am moving forward in my PhD study with comprehensibility. I feel more confident as a leader and as a novice researcher.

Meaningfulness: Is my goal of completing a PhD worth my efforts and commitment?

Essentially, what comes to mind when I answer this question is; do I have any stakes in the international collaborations. I don’t find it easy to separate meanings in my life and the meaning that I have made in my research work. My research work is something I do because I love developing myself and seeing the world around me develop. Working in Health Science means for me that I get to see an intersectionality between my own capacity for wellness and the discoveries made by research teams for the betterment of wellness for individuals, communities, populations and nations. At various times in my short research career I have felt a spark of personal meaning when working on a research problem with a group of passionate and thoughtful colleagues. I know now that I will be the most committed to a project when I get that spark, and after re-organizing my research plan for my PhD and re-structuring the international collaborations this spark is popping up all over the place.

Tips for others based on this short reflection of my experience:

•  Listen to your feelings of uncertainty in any study experience and after reflection of the uncertainty and your current circumstance take action.
• Listen to those that see you most often and know your circumstances truly, they will give you the right advice even if it is hard to hear, take the advice and reflect on it. (Family, partners, and/or mentors)
• Remember that you have the power to ask and receive answers and support for reaching your personal and professional goals.
• Chase the sparks that motivate you and give you a sense of meaning from your work.

Finally, I recommend international collaboration and mobility in graduate studies. If these elements are added to any study plan there is potential for building confidence and meaning which are elements for arriving at the ‘ease’ end of Aaron Antonovsky’s continuum.

Writer:

Jenny Auxier 

PhD Candidate

University of Turku

Department of Nursing Science

Reference:
Schnyder, U., Büchi, S., Sensky, T., & Klaghofer, R. (2000). Antonovsky’s Sense of Coherence: Trait or State? Psychotherapy and Psychosomatics, 69(6), 296–302. https://doi.org/10.1159/000012411