Express check-in: developing a personal health record for patients admitted to hospital with medical emergencies: a mixed-method feasibility study

Abstract

Background Patient participation is increasingly recognized as a key component in the redesign of health care processes and is advocated as a means to improve patient safety. We explored the usage of participatory engagement in patient-created and co-designed medical records for emergency admission to hospital. Methods Design: Prospective iterative development and feasibility testing of personal health records. Setting: An Acute Medical Unit in a University affiliated hospital. Participants: Patients admitted to hospital for medical emergencies. Interventions: We used a design-led development of personal health record prototypes and feasibility testing of records completed by patients during the process of emergency admission. ‘Express-check-in’ records contained items of social history, screening questions for sepsis and acute kidney injury, in addition to the patients’ ideas, concerns and expectations. Main outcomes measures: The outcome metrics focused on feasibility and a selection of quality-domains: Effectiveness of recording relevant history, time-efficiency of documentation process, patient centredness of resulting records, staff and patient feedback. The incidence of sepsis and acute kidney injury were used as surrogate measures for assessing the safety impact. Results The medical record prototypes were developed in an iterative fashion and tested with 100 patients in which 39 patients were 70 or older, and 25 patients were classified as clinically frail. 96% of the data items were completed by patients with no or minimal help from healthcare professionals. The completeness of these patient records was superior to that of the corresponding medical records in that they contained deeply held beliefs and fears, whereas concerns and expectations recorded by patients were only mirrored in a small proportion of the formal clinical records. The sepsis self-screening tool identified 68% of patients requiring treatment with antibiotics. The intervention was feasible independent of the level of formal education and effective in frail and elderly patients with support from family and staff. The prototyped records were well received and felt to be practical by patients and staff. The staff indicated that reading the patients’ documentation led to significant changes in their clinical management. Conclusions Medical record accessibility to patients during hospital care contributes to the co-management of personal health care and might add critical information over and above the records compiled by healthcare professionals.

Co-design of interventions to improve acute care in hospital: A rapid review of the literature and application of the BASE methodology, a novel system for the design of patient centered service prototypes

“…Co-design resulted in new pathways in a small proportion of the studies. Design methods used for co-design were modifications of Plan-Do-Study-Act 44,46 cycles and Experienced Based Co-design 47,48 as well as a range of other less standardised methods.…”

“…An 'Express-Check-in' for patients admitted to hospital that allows patients to document their history and clinical priorities in hospital records has been tested in over 100 patients. 55 Well over 80% of patients approached filled the documentation.…”

The Impact of Pandemic-Driven Care Redesign on Hospital Efficiency

“…58 Subbe et al explored the usage of participatory engagement in patient-created and co-designed medical records for emergency admission to the British hospital. 59 Bhayana et al created an electronic list of computed tomography (CT) requests that radiology residents would monitor to optimize after-hours workflow of CT orders. 60 Brooks et al assessed a novel payor-focused strategy to efficiently navigate the prior authorization process while eliminating physician burden and reducing inappropriate denials.…”