Background

Inpatient medication-tracking tools, when designed to meet patients' needs, can play an important role in fostering patient participation in their own care and patient-provider communication during a hospital stay.

SummaryObjective: To investigate patients' experience using an inpatient personal health record (PHR) on a tablet computer to increase engagement in their hospital care. Methods: We performed observations and conducted semi-structured interviews with 14 post-operative cardiac surgical patients and their family members who received an inpatient PHR. Themes were identified using an inductive coding scheme. Results: All participants responded favorably to having access to view their clinical information. A majority (85.7%) of participants used the application following an initial training session. Patients reported high satisfaction with being able to view their hospital medications and access educational materials related to their medical conditions. Patients reported a desire to view daily progress reports about their hospital stay and have access to educational information about their postacute recovery. In addition, patients expressed a common desire to view their diagnoses, laboratory test results, radiology reports, and procedure notes in language that is patient-friendly. Conclusion:Patients have unmet information needs in the hospital setting. Our findings suggest that for some inpatients and their family members, providing personalized health information through a tablet computer may improve satisfaction, decrease anxiety, increase understanding of their health conditions, and improve safety and quality of care. BackgroundBeing a patient in the hospital is an anxiety-inducing experience. Poor communication and lack of access to information can have detrimental effects on a patient's psychological wellbeing and coping abilities [1][2][3][4][5]. Policymakers [6, 7] and patient advocates [8,9] are increasingly focusing on this problem. This study investigates how an inpatient personal health record (PHR) may help address the information needs of patients and improve their engagement and experience in the hospital.Provision of medical information and education about care can allay a patient's uncertainty and stress [10][11][12][13][14][15]. Further, sharing information has been shown to reduce patient requests for clinicians' time, foster a sense of control and empowerment while promoting self-efficacy and ownership of illness [16][17][18], and lead to increased participation as an informed partner in making health decisions [19][20][21][22]. Previous research suggests that patients want to use PHRs and believe that they will be valuable [23]. Moreover, patients believe that their adherence to treatment regimens will improve if they have the opportunity to read and understand their health information [24,25]. However, patients are not typically given the opportunity to review their health information in the hospital. For example, in a survey of hospitalized patients conducted by Cumbler and colleagues, 90% of respondents said they wanted to review their hospital medication list for accuracy, but only 28% said they were given the opportunity to do so [26]. Without access to a documented care plan, patients ar...

Objectives: The Emergency Medicine Milestone Project, a framework for assessing competencies, has been used as a method of providing focused resident feedback. However, the emergency medicine milestones do not include specific objective data about resident clinical efficiency and productivity, and studies have shown that milestone-based feedback does not improve resident satisfaction with the feedback process. We examined whether providing performance metric reports to resident physicians improves their satisfaction with the feedback process and their clinical performance. Methods:We conducted a three-phase stepped-wedge randomized pilot study of emergency medicine residents at a single, urban academic site. In phase 1, all residents received traditional feedback; in phase 2, residents were randomized to receive traditional feedback (control group) or traditional feedback with performance metric reports (intervention group); and in phase 3, all residents received monthly performance metric reports and traditional feedback. To assess resident satisfaction with the feedback process, surveys using 6-point Likert scales were administered at each study phase and analyzed using two-sample t-tests. Analysis of variance in repeated measures was performed to compare impact of feedback on resident clinical performance, specifically patient treatment time (PTT) and patient visits per hour.Results: Forty-one residents participated in the trial of which 21 were randomized to the intervention group and 20 in the control group. Ninety percent of residents liked receiving the report and 74% believed that it better prepared them for expectations of becoming an attending physician. Additionally, residents randomized to the intervention group reported higher satisfaction (p = 0.01) with the quality of the feedback compared to residents in the control group. However, receiving performance metric reports, regardless of study phase or postgraduate year status, did not affect clinical performance, specifically PTT (183 minutes vs. 177 minutes, p = 0.34) or patients visits per hour (0.99 vs. 1.04, p = 0.46). Conclusions:While feedback with performance metric reports did not improve resident clinical performance, resident physicians were more satisfied with the feedback process, and a majority of residents expressed liking the reports and felt that it better prepared them to become attending physicians. Residency training programs could consider augmenting feedback with performance metric reports to aide in the transition from resident to attending physician.

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