Clinician Perspectives on Barriers and Enablers to Implementing an Inpatient Oncology Early Warning System: A Mixed-Methods Study

Lyons, Patrick G.; Chen, Vanessa; Sekhar, Tejas C.; McEvoy, Colleen; Kollef, Marin H.; Govindan, Ramaswamy; Westervelt, Peter; Vranas, Kelly C.; Maddox, Thomas M.; Geng, Elvin; Payne, Philip R. O.; Politi, Mary C.

doi:10.1200/cci.22.00104

Cited by 2 publications

(1 citation statement)

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“…Compounding these failures are general and cancer-specific implementation barriers. Lyons et al found that key design and deployment challenges are magnified in the highlyspecialized cancer care setting [138][139][140][141]. Without effective information displays, workflows, and strategies for implementation, predictive information is ignored in an environment where alerts are ubiquitous, untimely, and workflow-misaligned.…”

Section: Time Is Of the Essence: Facilitating Early Recognition And M...mentioning

confidence: 99%

Sepsis and acute respiratory failure in patients with cancer: how can we improve care and outcomes even further?

Lyons,

McEvoy,

Hayes-Lattin

2023

Current Opinion in Critical Care

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Purpose of review Care and outcomes of critically ill patients with cancer have improved over the past decade. This selective review will discuss recent updates in sepsis and acute respiratory failure among patients with cancer, with particular focus on important opportunities to improve outcomes further through attention to phenotyping, predictive analytics, and improved outcome measures. Recent findings The prevalence of cancer diagnoses in intensive care units (ICUs) is nontrivial and increasing. Sepsis and acute respiratory failure remain the most common critical illness syndromes affecting these patients, although other complications are also frequent. Recent research in oncologic sepsis has described outcome variation – including ICU, hospital, and 28-day mortality – across different types of cancer (e.g., solid vs. hematologic malignancies) and different sepsis definitions (e.g., Sepsis-3 vs. prior definitions). Research in acute respiratory failure in oncology patients has highlighted continued uncertainty in the value of diagnostic bronchoscopy for some patients and in the optimal respiratory support strategy. For both of these syndromes, specific challenges include multifactorial heterogeneity (e.g. in etiology and/or underlying cancer), delayed recognition of clinical deterioration, and complex outcomes measurement. Summary Improving outcomes in oncologic critical care requires attention to the heterogeneity of cancer diagnoses, timely recognition and management of critical illness, and defining appropriate ICU outcomes.

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Section: Time Is Of the Essence: Facilitating Early Recognition And M...mentioning

confidence: 99%

Sepsis and acute respiratory failure in patients with cancer: how can we improve care and outcomes even further?

Lyons,

McEvoy,

Hayes-Lattin

2023

Current Opinion in Critical Care

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Redesigning the Hospital Environment to Improve Restfulness

Catley,

Paynter,

Jackson

et al. 2024

JAMA Netw Open

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ImportanceHospital wards are often not conducive to patient sleep, negatively affecting patient health and experience.ObjectivesTo assess determinants of in-hospital restfulness and to design and test rest-promoting interventions on the wards in partnership with clinicians, staff, and patients.Design, Setting, and ParticipantsThis rapid-sequential mixed-methods quality improvement study was performed at a large urban academic hospital in St Louis, Missouri, from May 1, 2021, to December 31, 2022, with follow-up through hospitalization. Mixed-methods activities involved purposively selected hospitalized adults on the wards, nurses, hospitalists, and hospital staff. Interventions included all adult hospitalizations on the study wards.InterventionsSequential stacked bundles of multimodal rest-promoting interventions (general education, focused education on light or noise, safely reducing overnight monitoring or testing, and environmental personalization).Main Outcomes and MeasurementsPre-post comparisons of perceived nighttime quietness (via surveys) and sleep opportunity (coprimary outcomes) as well as clinical interruptions overnight, environmental noise, and adoption and satisfaction.ResultsNine patients (4 female) and 14 staff members (10 female; 3 nurse managers or administrators, 10 nurses, and 1 physician) were interviewed, 38 surveys were collected, and more than 100 hours of observation were performed. Interventions were evaluated for 671 patients (mean [SD] age, 60 [16] years; 336 [50%] female). Determinants of in-hospital rest included infrastructure, staff attitudes, priorities, culture, and patient experiences of anxiety, uncertainty, and loss of control. Informed by these determinants, codesign workshops yielded 39 potential interventions, from which 9 were selected for testing. Related interventions were organized into bundles, which were tested in sequential 2-week sprints. Perceived nighttime quietness improved nonsignificantly during the project (wards “always” quiet at night: 51% preintervention vs 86% postintervention; P = .09), with excessive noise events decreasing from 0.65 (95% CI, 0.53-0.77) to 0 per 100 patient-nights before the intervention (P = .02). Sleep opportunity improved significantly (mean, 4.94 [95% CI, 4.82-5.06] hours per patient-night before the intervention vs 5.10 [95% CI, 5.00-5.20] hours per patient-night after the intervention; P = .01).Conclusions and RelevanceIn this quality improvement study, a set of feasible, acceptable, and beneficial rest-promoting interventions were developed. After implementation of these interventions on the wards, a significant improvement in nighttime quietness and sleep opportunity was observed. These results demonstrate how human-centered design methods can generate practical and effective strategies for improving an important patient-related outcome and a core element of patient experience.

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Clinician Perspectives on Barriers and Enablers to Implementing an Inpatient Oncology Early Warning System: A Mixed-Methods Study

Cited by 2 publications

References 54 publications

Sepsis and acute respiratory failure in patients with cancer: how can we improve care and outcomes even further?

Sepsis and acute respiratory failure in patients with cancer: how can we improve care and outcomes even further?

Redesigning the Hospital Environment to Improve Restfulness

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