- Email: [email protected]
Poster 415 Introducing the Siebens Domain Management Model in a Physical Medicine and Rehabilitation Residency Program
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presence of serum anti-Hu antibody. Imaging revealed an enlarged hilar lymph node that was too small to biopsy. Recommended follow-up imaging 3 months later demonstrated a significant increase in the size of the lesion. He was found to have poorly differentiated squamous cell lung carcinoma and subsequently underwent radiation therapy. A follow-up positron emission tomography suggested resolution of the tumor. He is currently able to ambulate well with a walker and is independent with all activities of daily living. Discussion: This is a case of a patient with chronic symptomatic alcoholic neuropathy who presented with acute worsening of neuropathic symptoms secondary to a paraneoplastic syndrome from an occult cancer. A diagnosis of paraneoplastic syndrome facilitated the early treatment of the tumor and resulted in resolution of the paraneoplastic symptoms. Conclusions: This case demonstrates the importance of considering alternate diagnoses when a patient with a preexisting neuropathic condition presents with changes not consistent with the underlying neuropathy.
Poster 413 Human Factors Research to Improve Programming and Variable Drug Dosing for an Intrathecal Drug Delivery System. Sarah Alme, BS (Medtronic Inc, Fridley, MN, United States); , Ajinkya Joglekar, MSBME. Disclosures: S. Alme, none. Objective: The goal was to use Human Factors principles to generate a variable infusion rate (dose) feature while preventing use error for an implanted drug delivery system. Design: Interviews were conducted to identify user needs followed by multiple rounds of usability testing with clinicians. Patients or Programs: Not applicable. Program Description: Not applicable. Setting: Offices (interviews) and simulated clinical environments (usability testing). Participants: Clinicians who implanted and/or managed patients with programmable drug pumps. Interventions: Not applicable. Main Outcome Measures: For critical tasks, the criterion for success was that 100% of the participants must have successfully completed the task after the first attempt. Results: Interviews with 128 clinicians revealed how users think when programming variable infusion rates to manage daily fluctuating therapy needs. Follow-up interviews with 10 clinicians confirmed areas for improvement. During 3 rounds of usability testing with 20 clinicians, the users successfully mapped their infusion plan to a graphic display and established the following capabilities: (1) identify and correct numeric entry errors, (2) proportionally evaluate and visually confirm the infusion pattern, (3) effectively edit individual doses via numeric entry and graphic modification, (4) readily identify the total 24-hour dose for each drug in the reservoir, (5) quickly discern elements of the infusion pattern through color differentiation, and (6) experience greater confidence with the redesigned system. Discussion: Not applicable. Conclusions: Using Human Factors principles, we designed an infusion setup feature that aligns with the way clinicians comprehend and apply varying infusion therapy. Clinicians expressed
PRESENTATIONS
greater confidence in their ability to set up infusion programs, supervise mid level professionals performing infusion setup, and tailor therapy to patients’ variable prescription needs.
Poster 414 The Impact of an Acute Care Hospital’s Active Surveillance Program for Methicillin-resistant Staphylococcus aureus (MRSA) on Clinical Infections With MRSA in an Associated Inpatient Rehabilitation Facility. Aimee Widner, MD (East Carolina University, Greenville, NC, United States); , Clinton E. Faulk, MD, Delores L. Nobles, MT, MPH, Keith M. Ramsey, MD, Paul Vos. Disclosures: A. Widner, none. Objective: To determine how the implementation of a methicillin-resistant Staphylococcus aureus (MRSA) admission screening and decolonization program in an acute care hospital impacted the inpatient rehabilitation facility (IRF) investigated in this study. Design: Retrospective chart review. Setting: Adult IRF located in a tertiary teaching hospital. Participants: Adult patients in the IRF who developed a health care–associated MRSA infection from February 2006 through January 2011. Interventions: In February 2007, the affiliated hospital, Pitt County Memorial Hospital, began screening 100% of admissions for MRSA, with the implementation of decolonization therapy for those who tested positive. Main Outcome Measures: Comparison of monthly MRSA infection rates per 1000 patient days before and after the intervention. Results: The infection rate was lower in the 4 years after the intervention. The mean monthly infection rate before the intervention (February 2006 through January 2007) was 1.2520 per 1000 patient days compared with 0.6772 per 1000 patient days during the years following (February 2007 through January 2011). The decrease in infection rates for health care–associated MRSA after the intervention was statistically significant (P⫽.0255). Conclusions: Based on this study, implementation of an alladmissions MRSA screening and decolonization program of an affiliated hospital resulted in decreased MRSA infection rates in the IRF. Because MRSA infections often have a significantly negative impact on rehabilitation goals, IRFs should not only be cognizant of infection rate trends but also of the affiliated hospital’s scope of policies and practices for infection prevention control.
Poster 415 Introducing the Siebens Domain Management Model in a Physical Medicine and Rehabilitation Residency Program. Mary G. Bryant, MD (University of Virginia Health System, Charlottesville, VA, United States); , Alan Alfano, MD, Hilary C. Siebens, MD. Disclosures: M. G. Bryant, none. Objective: To conduct a pilot study on introducing the Siebens Domain Management Model (SDMM) in a residency program and including it in documentation templates. Design: Programmatic quality improvement project from 2005 through 2007. The SDMM is a conceptual framework for clinical
PM&R
care that is consistent with the biopsycho-ecological model and the World Health Organization International Classification of Functioning, Disability, and Health. All of a patient’s health-related strengths, problems, and issues are classified into 4 domains: I. Medical/Surgical Issues, II. Mental Status/Emotions/Coping, III. Physical Function, and IV. Living Environment. Physical medicine and rehabilitation residency programs may benefit from introducing it into their curriculum and into patient care documentation. Setting: An academic physical medicine and rehabilitation department affiliated with an inpatient rehabilitation facility. Participants: Department staff and residents. Interventions: The SDMM was taught through lectures and integrated into documentation templates through department meetings and consultation. Brief qualitative surveys were administered to department staff at 6 months (T1) and 2 years (T2) after implementation. Results: At T1 7 residents (86%) rated learning the SDMM as easy; 6 (75%) agreed that the SDMM improves their care of patients; 4 (50%) acknowledged that it took more time. Insufficient resident responses were available at T2. At T1, 4 attending physicians (80%) rated learning the SDMM in documentation as easy and as improving patient care; 3 (60%) thought that it did not take more time. The results were similar at T2. The majority of attending physicians at both T1 and T2 agreed that the SDMM improved their physical medicine and rehabilitation teaching. The majority of department administrator and/or billing personnel (n⫽4) agreed that physician notes were improved and billing coding was easier at T1 and T2. Conclusions: These pilot data provide the first preliminary evidence for ease of implementation of the SDMM and for beneficial results. Study limitations include small number of staff and limited scope of qualitative questionnaires.
Poster 416 Human Factors Research to Develop a New Clinician Programmer. Sarah Alme, BS (Medtronic Inc, Fridley, MN, United States); , Benjamin Somberg, PhD. Disclosures: S. Alme, none. Objective: The aim was to apply human factors principles to generate navigation and final check elements for a new clinician programmer. Design: Interviews were conducted to identify user needs followed by multiple rounds of usability testing with clinicians. Patients or Programs: Not applicable. Program Description: Not applicable. Setting: Offices (interviews) and simulated clinical environments (usability testing). Participants: Clinicians who implanted and/or managed patients with programmable drug pumps. Interventions: Not applicable. Main Outcome Measures: For critical tasks, the criterion for success was that 100% of the participants must have successfully completed the task after the first attempt. Results: Analysis of 140 interviews highlighted inefficiencies and opportunities for improvement with the current system. Based on user-identified needs, an iterative testing strategy was used to develop a clinician programmer with navigation and final check features to enable efficient maneuvering and reduce use error. During
Vol. 3, Iss. 10S1, 2011
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testing, users quickly identified and moved through navigation screens, and understood the screens in their selected workflows. The navigation system provided selectable workflows that were customizable to each clinic’s procedures. Less pertinent information was hidden from view but remained readily accessible. New system alerts were timely to each task and guided the user through steps specific to each workflow. System alerts were nonintrusive, yet stopped user workflow when appropriate. The final check screen reviewed therapy settings, generated alerts when necessary, and specified changes made during the programming session. Discussion: Not applicable. Conclusions: Human Factors Research Principles were applied to develop a new clinician programmer. Navigation and final check features enabled efficient programming and provided a high level of confidence that the drug delivery pump was programmed appropriately.
Poster 417 Current Practice Management Knowledge in a Physical Medicine and Rehabilitation Residency Program. Curtis Hlushak, MBBS (University of Alberta, Edmonton, AB, Canada); , Hernish Acharya, Nigel Ashworth, MB, ChB, MSc, FRCPC. Disclosures: C. Hlushak, none. Objective: (1) To assess current practice management knowledge of physical medicine and rehabilitation residents and staff physicians, (2) to determine if informal learning in practice management occurs during a physical medicine and rehabilitation residency training program, and (3) to identify practice management knowledge deficiencies to guide future curriculum development. Design: A cross-sectional study. Setting: An accredited postgraduate physical medicine and rehabilitation training program. Participants: Residents in postgraduate years 1-5 and clinical and academic staff physicians in a physical medicine and rehabilitation residency training program. Interventions: Completion of a written short answer practice management examination (total score, 162) based on the Canadian Medical Association’s Online Practice Management Curriculum (http://www.cma.ca/index.php/ci_id/49620/la_id/1.htm). Main Outcome Measures: Mean total score on the practice management examination as well as subscores based on specific practice management principles. Results: 15 residents (n⫽11) and staff physicians (n⫽4) completed the examination. Mean scores for staff physicians were significantly higher than those for residents (58.1%⫾10.7% versus 26.6⫾6.2%; P⬍.05). Junior (postgraduate year 1-3) and senior (postgraduate year 4-5) resident mean scores were not significantly different. Staff physicians scored significantly higher (P⬍.05) than residents in financial planning, personal and professional insurance, medical records, physician remuneration, locum, evaluating practice opportunities, marketing a specialist’s practice, and staffing and human resources subcomponents. Conclusions: Practice management knowledge among physical medicine and rehabilitation staff physicians was superior to residents, which suggests that practice management knowledge
presence of serum anti-Hu antibody. Imaging revealed an enlarged hilar lymph node that was too small to biopsy. Recommended follow-up imaging 3 months later demonstrated a significant increase in the size of the lesion. He was found to have poorly differentiated squamous cell lung carcinoma and subsequently underwent radiation therapy. A follow-up positron emission tomography suggested resolution of the tumor. He is currently able to ambulate well with a walker and is independent with all activities of daily living. Discussion: This is a case of a patient with chronic symptomatic alcoholic neuropathy who presented with acute worsening of neuropathic symptoms secondary to a paraneoplastic syndrome from an occult cancer. A diagnosis of paraneoplastic syndrome facilitated the early treatment of the tumor and resulted in resolution of the paraneoplastic symptoms. Conclusions: This case demonstrates the importance of considering alternate diagnoses when a patient with a preexisting neuropathic condition presents with changes not consistent with the underlying neuropathy.
Poster 413 Human Factors Research to Improve Programming and Variable Drug Dosing for an Intrathecal Drug Delivery System. Sarah Alme, BS (Medtronic Inc, Fridley, MN, United States); , Ajinkya Joglekar, MSBME. Disclosures: S. Alme, none. Objective: The goal was to use Human Factors principles to generate a variable infusion rate (dose) feature while preventing use error for an implanted drug delivery system. Design: Interviews were conducted to identify user needs followed by multiple rounds of usability testing with clinicians. Patients or Programs: Not applicable. Program Description: Not applicable. Setting: Offices (interviews) and simulated clinical environments (usability testing). Participants: Clinicians who implanted and/or managed patients with programmable drug pumps. Interventions: Not applicable. Main Outcome Measures: For critical tasks, the criterion for success was that 100% of the participants must have successfully completed the task after the first attempt. Results: Interviews with 128 clinicians revealed how users think when programming variable infusion rates to manage daily fluctuating therapy needs. Follow-up interviews with 10 clinicians confirmed areas for improvement. During 3 rounds of usability testing with 20 clinicians, the users successfully mapped their infusion plan to a graphic display and established the following capabilities: (1) identify and correct numeric entry errors, (2) proportionally evaluate and visually confirm the infusion pattern, (3) effectively edit individual doses via numeric entry and graphic modification, (4) readily identify the total 24-hour dose for each drug in the reservoir, (5) quickly discern elements of the infusion pattern through color differentiation, and (6) experience greater confidence with the redesigned system. Discussion: Not applicable. Conclusions: Using Human Factors principles, we designed an infusion setup feature that aligns with the way clinicians comprehend and apply varying infusion therapy. Clinicians expressed
PRESENTATIONS
greater confidence in their ability to set up infusion programs, supervise mid level professionals performing infusion setup, and tailor therapy to patients’ variable prescription needs.
Poster 414 The Impact of an Acute Care Hospital’s Active Surveillance Program for Methicillin-resistant Staphylococcus aureus (MRSA) on Clinical Infections With MRSA in an Associated Inpatient Rehabilitation Facility. Aimee Widner, MD (East Carolina University, Greenville, NC, United States); , Clinton E. Faulk, MD, Delores L. Nobles, MT, MPH, Keith M. Ramsey, MD, Paul Vos. Disclosures: A. Widner, none. Objective: To determine how the implementation of a methicillin-resistant Staphylococcus aureus (MRSA) admission screening and decolonization program in an acute care hospital impacted the inpatient rehabilitation facility (IRF) investigated in this study. Design: Retrospective chart review. Setting: Adult IRF located in a tertiary teaching hospital. Participants: Adult patients in the IRF who developed a health care–associated MRSA infection from February 2006 through January 2011. Interventions: In February 2007, the affiliated hospital, Pitt County Memorial Hospital, began screening 100% of admissions for MRSA, with the implementation of decolonization therapy for those who tested positive. Main Outcome Measures: Comparison of monthly MRSA infection rates per 1000 patient days before and after the intervention. Results: The infection rate was lower in the 4 years after the intervention. The mean monthly infection rate before the intervention (February 2006 through January 2007) was 1.2520 per 1000 patient days compared with 0.6772 per 1000 patient days during the years following (February 2007 through January 2011). The decrease in infection rates for health care–associated MRSA after the intervention was statistically significant (P⫽.0255). Conclusions: Based on this study, implementation of an alladmissions MRSA screening and decolonization program of an affiliated hospital resulted in decreased MRSA infection rates in the IRF. Because MRSA infections often have a significantly negative impact on rehabilitation goals, IRFs should not only be cognizant of infection rate trends but also of the affiliated hospital’s scope of policies and practices for infection prevention control.
Poster 415 Introducing the Siebens Domain Management Model in a Physical Medicine and Rehabilitation Residency Program. Mary G. Bryant, MD (University of Virginia Health System, Charlottesville, VA, United States); , Alan Alfano, MD, Hilary C. Siebens, MD. Disclosures: M. G. Bryant, none. Objective: To conduct a pilot study on introducing the Siebens Domain Management Model (SDMM) in a residency program and including it in documentation templates. Design: Programmatic quality improvement project from 2005 through 2007. The SDMM is a conceptual framework for clinical
PM&R
care that is consistent with the biopsycho-ecological model and the World Health Organization International Classification of Functioning, Disability, and Health. All of a patient’s health-related strengths, problems, and issues are classified into 4 domains: I. Medical/Surgical Issues, II. Mental Status/Emotions/Coping, III. Physical Function, and IV. Living Environment. Physical medicine and rehabilitation residency programs may benefit from introducing it into their curriculum and into patient care documentation. Setting: An academic physical medicine and rehabilitation department affiliated with an inpatient rehabilitation facility. Participants: Department staff and residents. Interventions: The SDMM was taught through lectures and integrated into documentation templates through department meetings and consultation. Brief qualitative surveys were administered to department staff at 6 months (T1) and 2 years (T2) after implementation. Results: At T1 7 residents (86%) rated learning the SDMM as easy; 6 (75%) agreed that the SDMM improves their care of patients; 4 (50%) acknowledged that it took more time. Insufficient resident responses were available at T2. At T1, 4 attending physicians (80%) rated learning the SDMM in documentation as easy and as improving patient care; 3 (60%) thought that it did not take more time. The results were similar at T2. The majority of attending physicians at both T1 and T2 agreed that the SDMM improved their physical medicine and rehabilitation teaching. The majority of department administrator and/or billing personnel (n⫽4) agreed that physician notes were improved and billing coding was easier at T1 and T2. Conclusions: These pilot data provide the first preliminary evidence for ease of implementation of the SDMM and for beneficial results. Study limitations include small number of staff and limited scope of qualitative questionnaires.
Poster 416 Human Factors Research to Develop a New Clinician Programmer. Sarah Alme, BS (Medtronic Inc, Fridley, MN, United States); , Benjamin Somberg, PhD. Disclosures: S. Alme, none. Objective: The aim was to apply human factors principles to generate navigation and final check elements for a new clinician programmer. Design: Interviews were conducted to identify user needs followed by multiple rounds of usability testing with clinicians. Patients or Programs: Not applicable. Program Description: Not applicable. Setting: Offices (interviews) and simulated clinical environments (usability testing). Participants: Clinicians who implanted and/or managed patients with programmable drug pumps. Interventions: Not applicable. Main Outcome Measures: For critical tasks, the criterion for success was that 100% of the participants must have successfully completed the task after the first attempt. Results: Analysis of 140 interviews highlighted inefficiencies and opportunities for improvement with the current system. Based on user-identified needs, an iterative testing strategy was used to develop a clinician programmer with navigation and final check features to enable efficient maneuvering and reduce use error. During
Vol. 3, Iss. 10S1, 2011
S319
testing, users quickly identified and moved through navigation screens, and understood the screens in their selected workflows. The navigation system provided selectable workflows that were customizable to each clinic’s procedures. Less pertinent information was hidden from view but remained readily accessible. New system alerts were timely to each task and guided the user through steps specific to each workflow. System alerts were nonintrusive, yet stopped user workflow when appropriate. The final check screen reviewed therapy settings, generated alerts when necessary, and specified changes made during the programming session. Discussion: Not applicable. Conclusions: Human Factors Research Principles were applied to develop a new clinician programmer. Navigation and final check features enabled efficient programming and provided a high level of confidence that the drug delivery pump was programmed appropriately.
Poster 417 Current Practice Management Knowledge in a Physical Medicine and Rehabilitation Residency Program. Curtis Hlushak, MBBS (University of Alberta, Edmonton, AB, Canada); , Hernish Acharya, Nigel Ashworth, MB, ChB, MSc, FRCPC. Disclosures: C. Hlushak, none. Objective: (1) To assess current practice management knowledge of physical medicine and rehabilitation residents and staff physicians, (2) to determine if informal learning in practice management occurs during a physical medicine and rehabilitation residency training program, and (3) to identify practice management knowledge deficiencies to guide future curriculum development. Design: A cross-sectional study. Setting: An accredited postgraduate physical medicine and rehabilitation training program. Participants: Residents in postgraduate years 1-5 and clinical and academic staff physicians in a physical medicine and rehabilitation residency training program. Interventions: Completion of a written short answer practice management examination (total score, 162) based on the Canadian Medical Association’s Online Practice Management Curriculum (http://www.cma.ca/index.php/ci_id/49620/la_id/1.htm). Main Outcome Measures: Mean total score on the practice management examination as well as subscores based on specific practice management principles. Results: 15 residents (n⫽11) and staff physicians (n⫽4) completed the examination. Mean scores for staff physicians were significantly higher than those for residents (58.1%⫾10.7% versus 26.6⫾6.2%; P⬍.05). Junior (postgraduate year 1-3) and senior (postgraduate year 4-5) resident mean scores were not significantly different. Staff physicians scored significantly higher (P⬍.05) than residents in financial planning, personal and professional insurance, medical records, physician remuneration, locum, evaluating practice opportunities, marketing a specialist’s practice, and staffing and human resources subcomponents. Conclusions: Practice management knowledge among physical medicine and rehabilitation staff physicians was superior to residents, which suggests that practice management knowledge