Resident Workflow and Psychiatric Emergency Consultation: Identifying Factors for Quality Improvement in a Training Environment

Blair, Thomas R.; Wiener, Zev; Seroussi, Ariel; Tang, Lingqi; O’Hora, Jennifer; Cheung, E.

doi:10.1007/s40596-016-0646-4

Cited by 58 publications

(3 citation statements)

References 8 publications

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“…Collaborative relationships across medical and surgical specialties are also important. At one institution, the quality leader served on the steering committee of the medical-surgical hospital committee that developed and implemented universal screening for suicide risk and developed workflows for more efficient psychiatric consultation in the emergency department [ 18 ]. Additional functions of the quality leaders include facilitating morbidity and mortality conferences and identifying root causes to suboptimal outcomes such as serious safety events, death by suicide soon after discharge, unwarranted falls, infection outbreaks, and poor transitions of care.…”

Section: Five Key Skills For Academic Medical Center Leaders Developimentioning

confidence: 99%

Building Psychiatric Quality Programs and Defining Quality Leadership Roles at Four Academic Medical Centers

Black

Cheung

et al. 2020

Acad Psychiatry

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Section: Five Key Skills For Academic Medical Center Leaders Developimentioning

confidence: 99%

Building Psychiatric Quality Programs and Defining Quality Leadership Roles at Four Academic Medical Centers

Black

Cheung

et al. 2020

Acad Psychiatry

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“…Indeed, the psychiatry training literature provides ample evidence that psychiatry trainees suffer stress, burnout, depression at higher rates than their peers in other medical specialties ( 19 ), and that organizational factors and training demands have been identified as risk factors that likely contribute to the development of those negative training outcomes ( 19–22 ). Training experiences that are more integrated into trainees’ regular routines are less likely to be disruptive to trainee workflow and are therefore less likely to contribute to the development of burnout ( 23 , 24 ).…”

Section: Introductionmentioning

confidence: 99%

Implementing a workflow-integrated motivational interviewing training program for psychiatry trainees on an inpatient consultation-liaison rotation: lessons learned

2023

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BackgroundEffective consultation-liaison psychiatry (CLP) is proactive, collaborative, and requires providers to have proficiency with therapeutic skills beyond nosology and medication management. Motivational interviewing (MI) is an evidenced-based intervention that should be considered essential for CLP trainees to learn. Given that the demands of training and patient care are already experienced as stressful for many psychiatry trainees, the authors endeavored to create a MI training program that was integrated into trainees’ normal CLP workflow.MethodTwenty-two trainees on an inpatient CLP rotation participated in a six-week MI training program that was incorporated into their regular workflow. The program included didactic sessions with role-playing, as well as on-demand between-session coaching via an expert in MI. Trainee participation and perceptions of MI were measured via a questionnaire that was administered prior to each training session.ResultsTrainee participation in the didactic sessions was inconsistent. Questionnaire data revealed positive baseline perceptions of motivational interviewing and its usefulness in inpatient medical settings. Additionally, as trainees participated in the program, perceived knowledge of motivational interviewing as well as awareness of motivational issues among their patients increased. Finally, participation in program was not perceived as disruptive to daily workflow for the participants.DiscussionThis the first documented attempt at implementing a MI training program for CLP trainees that was integrated into their regular workflow. Preliminary data identified some encouraging trends, but also unexpected challenges. These lessons could inform how these types of training programs are implemented moving forward.

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“…5,6 Several studies have investigated the impact of an EHR on residents in specialties including otolaryngology, emergency medicine, internal medicine, pediatrics, psychiatry, orthopaedics, and general surgery. [7][8][9][10][11][12][13] Many of these studies focused their attention on how residents and fellows spent their time caring for patients in an inpatient setting, while some focused on the effect of implementation of a note template within the EHR. 14,15 There are few studies investigating ophthalmology trainee workflow as it relates to an EHR, but these focus on how the presence of an ophthalmology trainee affects overall clinic flow in which an EHR is present or on the implementation of a template within the EHR.…”

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confidence: 99%

Impact of Electronic Health Record Implementation on Ophthalmology Trainee Time Expenditures

et al. 2019

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Objective Electronic health records (EHRs) are widely adopted, but the time demands of EHR use on ophthalmology trainees are not well understood. This study evaluated ophthalmology trainee time spent on clinical activities in an outpatient clinic undergoing EHR implementation. Design Prospective, manual time-motion observations of ophthalmology trainees in 2018. Participants Eleven ophthalmology residents and fellows observed during 156 patient encounters. Methods Prospective time-motion study of ophthalmology trainees 2 weeks before and 6 weeks after EHR implementation in an academic ophthalmology department. Manual time-motion observations were conducted for 11 ophthalmology trainees in 6 subspecialty clinics during 156 patient encounters. Time spent documenting, examining, and talking with patients were recorded. Factors influencing time requirements were evaluated using linear mixed effects models. Main Outcome Measures Total time spent by ophthalmology residents and fellows per patient, time spent on documentation, examination, and talking with patients. Results Seven ophthalmology residents and four ophthalmology fellows with mean (standard deviation) postgraduate year of 3.7 (1.2) were observed during 156 patient encounters. Using paper charts, mean total time spent on each patient was 11.6 (6.5) minutes, with 5.4 (3.5) minutes spent documenting (48%). After EHR implementation, mean total time spent on each patient was 11.8 (6.9) minutes, with 6.8 (4.7) minutes spent documenting (57%). Total time expenditure per patient did not significantly change after EHR implementation (+0.17 minutes, 95% confidence interval [CI] for difference in means: –2.78, 2.45; p = 0.90). Documentation time did not change significantly after EHR implementation in absolute terms (+1.42 minutes, 95% CI: –3.13, 0.29; p = 0.10), but was significantly greater as a proportion of total time (48% on paper to 57% on EHR; +9%, 95% CI: 2.17, 15.83; p = 0.011). Conclusion Total time spent per patient and absolute time spent on documentation was not significantly different whether ophthalmology trainees used paper charts or the recently implemented EHR. Percentage of total time spent on documentation increased significantly with early EHR use. Evaluating EHR impact on ophthalmology trainees may improve understanding of how trainees learn to use the EHR and may shed light on strategies to address trainee burnout.

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Resident Workflow and Psychiatric Emergency Consultation: Identifying Factors for Quality Improvement in a Training Environment

Abstract: Implications for resident education are discussed.

Cited by 58 publications

References 8 publications

Building Psychiatric Quality Programs and Defining Quality Leadership Roles at Four Academic Medical Centers

Building Psychiatric Quality Programs and Defining Quality Leadership Roles at Four Academic Medical Centers

Implementing a workflow-integrated motivational interviewing training program for psychiatry trainees on an inpatient consultation-liaison rotation: lessons learned

Impact of Electronic Health Record Implementation on Ophthalmology Trainee Time Expenditures

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