Reshaping ICU Ward Round Practices Using Video-Reflexive Ethnography

Carroll, Katherine; Iedema, Rick; Kerridge, Ross

doi:10.1177/1049732307313430

Cited by 156 publications

(181 citation statements)

References 30 publications

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“…Such reflexivity can contribute to a greater understanding of objectives that are and are not being met and the implications of these practices. 34 In the GIM unit in this study, teaching regarding discharge processes and interprofessional interactions was dependent on initiatives by individual physicians and other healthcare professionals. This finding reflects researchers' calls to include other healthcare professionals in educating residents and providing feedback on their performance, and the need for medical staff training in relation to discharge processes.…”

Section: Discussionmentioning

confidence: 88%

Medical Residents and Interprofessional Interactions in Discharge: An Ethnographic Exploration of Factors That Affect Negotiation

Goldman

Reeves

et al. 2015

J GEN INTERN MED

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BACKGROUND:Interprofessional collaboration is an important aspect of patient discharge from a general internal medicine (GIM) unit. However, there has been minimal empirical or theoretical research that has examined interactions that occur between medical residents and other healthcare professionals in the discharge process. This study provides insight into the social processes that shape and characterize such interactions. OBJECTIVE: To explore factors that shape interactions between medical residents and other healthcare professionals in relation to patient discharge, and to examine the opportunities for negotiations about discharge between these professional groups. DESIGN: A qualitative ethnographic approach using observations, interviews and documentary analysis. PARTICIPANTS AND SETTING: Healthcare professionals working in a GIM unit in Canada. APPROACH: Sixty-five hours of observations were undertaken in a range of settings (e.g. interprofessional rounds, medical and nursing rounds, nursing station) in the unit over a 17-month period. A maximum variation sampling approach was used to identify healthcare professionals working in the unit. Twenty-three interviews were completed, recorded and transcribed verbatim. A directed content approach using theories of medical dominance and negotiated order was used to analyze the data. KEY RESULTS: The organization of clinical work in combination with clinical teaching influenced interprofessional interactions and the quality of discharge in this GIM unit. While organizational activities (orientation and rounds) and individual activities (e.g. role modeling, teaching) supported negotiations between medical residents and other healthcare professionals around discharge, participants had varied perspectives about their effectiveness. CONCLUSIONS: This study illuminates social factors and processes that require attention in order to address challenges with interprofessional collaboration and discharge in GIM. These findings have implications for medical education, workplace learning, patient safety and quality improvement.KEY WORDS: Medical education-practice-based learning; Qualitative research; Quality improvement; Health services research.

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Section: Discussionmentioning

confidence: 88%

Medical Residents and Interprofessional Interactions in Discharge: An Ethnographic Exploration of Factors That Affect Negotiation

Goldman

Reeves

et al. 2015

J GEN INTERN MED

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“…One article 44 is a report of using a video-reflexive ethnography to help staff members develop a greater awareness of practices during medical rounds. Attention was drawn to hierarchies, communication patterns, and problems, eventually leading to change.…”

Section: Decision Making Learning and Cognitionmentioning

confidence: 99%

“…Others 27,31,34,44 tackle the contextual elements that transform cognitive processes. Informatics and new information and communication technologies are notably not addressed in this literature.…”

Section: Decision Making Learning and Cognitionmentioning

confidence: 99%

Delivering Interprofessional Care in Intensive Care: A Scoping Review of Ethnographic Studies

Paradis¹,

Leslie²,

Puntillo³

et al. 2014

American Journal of Critical Care

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BackgroundThe sustained clinical and policy interest in the United States and worldwide in quality and safety activities initiated by the release of To Err Is Human has resulted in some high-profile successes and much disappointment. Despite the energy and good intentions poured into developing new protocols and redesigning technical systems, successes have been few and far between, leading some to argue that more attention should be given to the context of care. Objective To examine the insights provided by qualitative studies of interprofessional care delivery in intensive care. Methods A total of 532 article abstracts were reviewed. Of these, 24 met the inclusion criteria. Results Articles focused on the nurse-physician relationship, patient safety, patients' families and end-of-life care, and learning and cognition. The findings indicated the complexities and nuances of interprofessional life in intensive care and also that much needs to be learned about team processes. Conclusion The fundamental insight that interprofessional interactions in intensive care do not happen in a historical, social, and technological vacuum must be brought to bear on future research in intensive care if patient safety and quality of care are to be improved.

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“…PubMed searches for the terms efficiency, flow, process redesign, and time management bring up many more references for operating rooms than for ICUs or inpatient beds. Some examples of ICU-directed work include videography of an ICU in Australia 27 and human factor analysis in ICU nursing. 5 Time-motion studies have also been conducted on clinical staff, such as physicians.…”

Section: Fieldston Et Al | Bed Utilization In the Picumentioning

confidence: 99%

Direct observation of bed utilization in the pediatric intensive care unit

Fieldston

Terwiesch

et al. 2011

Journal of Hospital Medicine

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BACKGROUND:The pediatric intensive care unit (PICU), with limited number of beds and resource‐intensive services, is a key component of patient flow. Because the PICU is a crossroads for many patients, transfer or discharge delays can negatively impact a patient's clinical status and efficiency.OBJECTIVE:The objective of this study was to describe, using direct observation, PICU bed utilization.METHODS:We conducted a real‐time, prospective observational study in a convenience sample of days in the PICU of an urban, tertiary‐care children's hospital.RESULTS:Among 824 observed hours, 19,887 bed‐hours were recorded, with 82% being for critical care services and 18% for non–critical care services. Fourteen activities accounted for 95% of bed‐hours. Among 200 hours when the PICU was at full capacity, 75% of the time included at least 1 bed that was used for non–critical care services; 37% of the time at least 2 beds. The mean waiting time for a floor bed assignment was 9 hours (median, 5.5 hours) and accounted for 4.62% of all bed‐hours observed.CONCLUSIONS:The PICU delivered critical care services most of the time, but periods of non–critical care services represented a significant amount of time. In particular, periods with no bed available for new patients were associated with at least 1 or more PICU beds being used for non–critical care activities. The method should be reproducible in other settings to learn more about the structure and processes of care and patient flow and to make improvements. Journal of Hospital Medicine 2012; © 2011 Society of Hospital Medicine

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Reshaping ICU Ward Round Practices Using Video-Reflexive Ethnography

Cited by 156 publications

References 30 publications

Medical Residents and Interprofessional Interactions in Discharge: An Ethnographic Exploration of Factors That Affect Negotiation

Medical Residents and Interprofessional Interactions in Discharge: An Ethnographic Exploration of Factors That Affect Negotiation

Delivering Interprofessional Care in Intensive Care: A Scoping Review of Ethnographic Studies

Direct observation of bed utilization in the pediatric intensive care unit

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