Toward a Medical “Ecology of Attention”

Kissler, Mark J.; Kissler, Katherine; Burden, Marisha

doi:10.1056/nejmp2027190

Cited by 23 publications

(17 citation statements)

References 3 publications

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“…These reports from patients and staff together suggest that improving doctor-patient communication may assist using the NAT: PD-HF more effectively in clinical practice to recognize unmet needs and improve daily life for people living with HF. As attention is linked to higher-quality communication, one way to improve communication would be to adjust the conditions of clinical practice so that patients and their narratives receive sufficient attention for the physician to fully understand their situation or need [ 9 ].…”

Section: Discussionmentioning

confidence: 99%

“…The NAT: PD-HF, more than a questionnaire, is a direct, face-to-face interaction guide aimed to increase the attention dedicated to patients and their narratives in a highly efficient and effective way. Clinical environments that optimize this attention, will not only improve the quality of care and patient and staff satisfaction, but also reduce care costs [ 9 , 10 ]. The implementation of the NAT: PD-HF in the clinical practice could be a fundamental basis for strategies focusing on optimizing attention.…”

Section: Introductionmentioning

confidence: 99%

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Validation of the German version of the needs assessment tool: progressive disease-heart failure

González-Jaramillo

Guyer

Luethi

et al. 2021

Health Qual Life Outcomes

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Background The Needs Assessment Tool: Progressive Disease-Heart Failure (NAT: PD-HF) is a tool created to assess the needs of people living with heart failure and their informal caregivers to assist delivering care in a more comprehensive way that addresses actual needs that are unmet, and to improve quality of life. In this study, we aimed to (1) Translate the tool into German and culturally adapt it. (2) Assess internal consistency, inter-rater reliability, and test–retest reliability of the German NAT: PD-HF. (3) Evaluate whether and how patients and health care personnel understand the tool and its utility. (4) Assess the tool’s face validity, applicability, relevance, and acceptability among health care personnel. Methods Single-center validation study. The tool was translated from English into German using a forward–backward translation. To assess internal consistency, we used Cronbach´s alpha. To assess inter-rater reliability and test–retest reliability, we used Cohen´s kappa, and to assess validity we used face validity. Results The translated tool showed good internal consistency. Raters were in substantial agreement on a majority of the questions, and agreement was almost perfect for all the questions in the test–retest analysis. Face validity was rated high by health care personnel. Conclusion The German NAT: PD-HF is a reliable, valid, and internally consistent tool that is well accepted by both patients and health care personnel. However, it is important to keep in mind that effective use of the tool requires training of health care personnel.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Validation of the German version of the needs assessment tool: progressive disease-heart failure

González-Jaramillo

Guyer

Luethi

et al. 2021

Health Qual Life Outcomes

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“…Although documenting while doctoring has transformed medicine in many advantageous ways (e.g., medication reconciliation, order entry, and access to internet resources), it has also posed significant challenges (44). By splitting attention between the computer and the patient, it has triggered unintended consequences that often lead to "distracted doctoring" (45,46). In addition, taking ecological influences on health into account can be as simple as acknowledging where patients present: in an ambulatory clinic, community hospital emergency department, or academic medical center (47).…”

Section: Ecologicalmentioning

confidence: 99%

Personalizing the BioPsychoSocial Approach: “Add-Ons” and “Add-Ins” in Generalist Practice

Ventres

Frankel

2021

Front. Psychiatry

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Generalist practitioners often find interacting with patients deeply satisfying and joyful; they also experience encounters that are challenging and complex. In both cases, they must be aware of the many issues that affect the processes and outcomes of patient care. Although using the BioPsychoSocial approach is an important, time-tested framework for cultivating one's awareness of patients' presenting concerns, recent developments suggest that additional frames of reference may enhance communication and relationships with patients. In this article, we describe several additions to the BioPsychoSocial approach, considerations we call “add-ons” and “add-ins”. We invite generalist practitioners and, indeed, all health care practitioners, to consider how they can improve their ongoing care of patients by personalizing these and other additions in their day-to-day work with patients.

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“… 13 Fragmented attention can lead to bias and failure to recognize the declining trajectory of a patient. 14 Interruptions, inattention, and their consequences are difficult to measure—with few studies in hospital medicine quantifying their burden and impact. With careful attention to design and implementation, cohorting may be successful in improving communication without increasing unnecessary interruptions—but such refinement requires close monitoring and continuous improvement which are often lacking in strained hospital medicine environments.…”

mentioning

confidence: 99%

“… 8 The evidence also suggests that while cohorting increases shallow availability or “reachability” and the quantity of communication, it may not alone ensure deeper interpersonal communication or improve the quality of communication. 14 , 15 Perversely, this increased reachability and decreased travel time may be used to rationalize increases in daily patient loads for cohorted teams. A focus on increasing productivity in turn may further increase interruptions, decreasing attention and impacting downstream outcomes that are not routinely monitored—such as the quality of communication, cognitive load, cognitive bias, diagnostic errors, and satisfaction with a job well done.…”

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confidence: 99%

Closer to or Farther away from an Ideal Model of Care? Lessons Learned from Geographic Cohorting

2022

Self Cite

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Geographic “cohorting,” “co-location,” “regionalization,” or “localization” refers to the assignation of a hospitalist team to a specific inpatient unit. Its benefits may be related to the formation of a team and the additional interventions like interdisciplinary rounding that the enhanced proximity facilitates. However, cohorting is often adopted in isolation of the bundled approach within which it has proven beneficial. Cohorting may also be associated with unintended consequences such as increased interruptions and increased indirect care time. Institutions may increase patient loads in anticipation of the efficiency gained by cohorting—leading to further increases in interruptions and time away from the bedside. Fragmented attention and increases in indirect care may lead to a perception of increased workload, errors, and burnout. As hospital medicine evolves, there are lessons to be learned by studying cohorting. Institutions and inpatient units should work in synergy to shape the day-to-day work which directly affects patient and clinician outcomes—and ultimately culminates in the success or failure of the parent organization. Such synergy can manifest in workflow design and metric selection. Attention to workloads and adopting the principles of continuous quality improvement are also crucial to developing models of care that deliver excellent care.

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Toward a Medical “Ecology of Attention”

Cited by 23 publications

References 3 publications

Validation of the German version of the needs assessment tool: progressive disease-heart failure

Validation of the German version of the needs assessment tool: progressive disease-heart failure

Personalizing the BioPsychoSocial Approach: “Add-Ons” and “Add-Ins” in Generalist Practice

Closer to or Farther away from an Ideal Model of Care? Lessons Learned from Geographic Cohorting

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