key: cord-0883845-0sz014nq
authors: Qureshi, Fahad; Provance, Jeremy; Ramprasad, Aarya
title: Analysis of the Effect of Introducing Stress onto Medical Practitioners in Modern American Healthcare
date: 2020-10-31
journal: Journal of the National Medical Association
DOI: 10.1016/j.jnma.2020.09.076
sha: 96a525ace177df939400e9908faabff84eff3241
doc_id: 883845
cord_uid: 0sz014nq

nan

Uju Momah, BA, Dirk Stanley, MD. The University of Connecticut School of Medicine, Farmington, CT Introduction: Electronic medical records (EMRs) are designed to improve patient care and clinical efficiency. Instead, they can make workflow arduous and stressful. Therefore, it is imperative to evaluate EMR performance. This study investigates provider satisfaction with the UConn Health EMR. Our goal was to identify how Epic contributes to clinical workflow and provider satisfaction. We hypothesized that provider age and readiness training would impact the aforementioned factors and correlate with provider burnout. Methods: We developed and distributed a survey tool to providers across UConn Health. It was designed around three pillars: service quality, information and provider satisfaction. We assessed ease of EMR operability and comprehension through questions of clinical documentation, Epic training, InBasket, and technology support. These components were measured against a provider's response to a series of affirmative and negative questions in order to create a quantitative happiness scale. From this scale, we identified patterns that impacted provider satisfaction. Results: Our survey generated over 50 responses. We found that over 65% providers selfidentified as advanced EMR users, with 5 + years of experience. Additionally, almost 75% of providers agreed that use of the EMR supported their ability to provide optimal patient care. These findings were noted in the context of providers who, on average, graduated from medical school over 20 years ago. While this was the case, nearly 40% of providers were frustrated by the EMR, 50% cited excess paperwork and 30% cited that use detracted from their responsibilities outside of patient care. Conclusions: EMR use is a critical component of clinical workflow. It continues to enhance the ability of provider's to give patient care. However, from our study, we found that several factors, including continued education, are required for adept adoption of these systems to best support clinical practice and address issues of provider burnout. Introduction: On each occasion that an epidemic affects medical practitioners across the United States, physicians are required to perform action that they had not before or act in new ways. This range of new actions can lead to an unsafe work environment as providers may be pressured into working in circumstances they do not feel comfortable with. On numerous occasions, this has been documented to lead to preventable mistakes. We intend to use the novel coronavirus as a sample of how provider roles may switch to understand if mistakes happen for this reason. Research question: Do preventable mistakes occur as a result of pressure on physicians during epidemics? Methodology: We used a system of surveys delivered to orthopedic and neurologic surgeons across the United States. Individuals were picked from a public registry using a random number generator so that each practitioner was equally likely to be selected. We asked a simple yes or no question-"has the shortage of physicians due to the novel coronavirus caused hospital administration mandated work that you do not feel comfortable with due to a lack of practice, experience, and/or skill." Of those contacted, our response rate was 88.9% from 180 total contacted. Data: Conclusion: It is critical that orthopedic and neurologic surgeons, are not pressured to take place in tasks they do not feel qualified to take. Though a shortage of physicians may manifest itself in placing a need, only qualified individuals should be allowed to participate in any given activity. Furthermore, it is imperative for hospitals to determine plans in advance of an epidemic, as an unorganized response was the primary complaint of orthopedic and neurologic surgeons.

Introduction: In this age of desiring better health care with lower costs, reducing unnecessary laboratory testing can be beneficial to help accomplish both. Unnecessary labs are a substantial contributor to the estimated $910 billion/year in health care waste. Not only is cost an issue but ordering repetitive labs have consequences of further invasive testing that can lead to increased health risks and medical errors for patients. At our facility, the cash pay prices for the following lab tests are: BMP $169, CBC $150, BNP $299, Lipase $94, Amylase $115, CRP $68, and ESR $54. Methods: Our goal was to reduce unnecessary laboratory test ordering from physicians at our facility by increasing awareness of excessive lab ordering with reduction of total lab frequency and lab frequency per patient by 10%. The American College of Physicians (ACP) Choosing Wisely guidelines show that routinely ordering labs daily (BMP, CBC, and BNP) is not helpful, unless you need them to change management. These guidelines also show that lipase and CRP are more sensitive markers for pancreatitis and inflammation, respectively. Our plan for these goals was to increase awareness to physicians about being conscious and reducing repetitive daily labs. We placed posters throughout the hospital and discuss this plan with physicians at their monthly meeting. Results: The benefits of reducing unnecessary inpatient labs are improved patient outcome and satisfaction due to fewer needle sticks and decreased phlebotomy, reduction in medical errors due to abnormal labs, and reduction in costs for patients and the hospital. The potential cost savings from this project within two months was $88,879 from a mere $5 for printing and laminating costs for the posters. Conclusion: Overall, lab ordering frequency was reduced by 20% and there will be continued education to more health care providers. We plan to incorporate and hopefully reduce other labs (ex: magnesium, troponin, procalcitonin, etc) that are potentially being ordered excessively. In summary, the key learnings are lab testing is expensive, costs can be reduced by ordering daily labs only if necessary, patient safety and satisfaction can be increased, and medical errors can be reduced. 

Methicillin-resistant Staphylococcus aureus: vascular surgeons should fight back

Surgeons and the opioid epidemic: Treatment and education strategies for the practicing surgeon

Ergonomics principles associated with laparoscopic surgeon injury/illness

Patients benefit while surgeons suffer: an impending epidemic

Orthopedic surgeons' attitudes and practices concerning treatment of patients with HIV infection

Identification of a new human coronavirus

Reducing Unnecessary Inpatient Labs in a Teaching Hospital