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A novel method for assessing interobserver reliability of time and motion studies in health care: Findings from an emergency department pilot study [Meeting Abstract]

Cardell, A; Coplin, M; Demestihas, M; Wu, D; Pitts, S; Kc, D; Haley, L; Hess, J
Background: Time and motion methods have been identified as the gold standard for assessment of health care workflow. Direct observation is a common approach to data collection in such studies. However, a recurrent theme is a lack of consistency in observer training and inter-observer reliability assessment. Inter-observer variability is a potential source of error and bias and reliable methods for assessing observer agreement are needed. Objectives: For this study, primary objectives were to develop a consistent, replicable method for characterizing inter-observer reliability and to apply the method in an emergency department (ED) setting. Methods: Six observers were trained in recognition and electronic data capture of routine tasks in patient care and teaching in an academic medical setting. Training included a 10 page manual, 2 hours of orientation, and a minimum of 3 hours of proctored training. The primary time and motion study involved 700 hours of observation collecting 62000 unique tasks. Inter-observer reliability for both task identification and task duration was assessed using 16 standardized videos. Concordance correlation coefficient (CCC) was chosen as it was the most appropriate measure; for comparison kappa coefficients, intraclass correlation coefficients, and percentage agreement were also reported. The study was approved by the Emory IRB and was funded by the Emory Medical Care Foundation. Results: The analysis revealed a high CCC value across the majority of the primary task categories. For each of the 16 videos, all 6 observers were able to identify the key task of interest. The task categories with the highest CCC (0.98) were communication and direct patient care; with EMR use at 0.97. Lower CCC values (0.81 and 0.79 respectively) were seen when observers were requested to differentiate between time spent on the patient's history and physical and time spent on patient education. Conclusions: We present a novel approach to training and assessing inter-observer reliability in an observational time and motion study. CCC was utilized and found to have a substantial level of agreement (> 0.95) for task categories of communication, direct patient care, and EMR use. Based on these findings, time and motion methods utilizing multiple observers can collect high quality data with a compelling level of consistency in task duration and reliability in task identification between observers
EMBASE:616279960
ISSN: 1553-2712
CID: 2579982

Patterns of Emergency Department High Utilizers at Grady Memorial Hospital [Meeting Abstract]

Taylor, W. J.; Reitz, A. C.; Coplin, M.; Cardell, A.; Kc, D.; Pitts, S.; Wu, D.; Hess, J.
ISI:000445699100078
ISSN: 0196-0644
CID: 5116512

Time-motion Study of Attending Physician Teaching Activities and Interruptions at a Large Academic Emergency Department [Meeting Abstract]

Coplin, Michael A; Cardell, A; Lall, M; Siegelman, J; Demestihas, M; Hess, J
ORIGINAL:0015416
ISSN: 0196-0644
CID: 5116552

Medical Student Core Clinical Ultrasound Milestones: A Consensus Among Directors in the United States

Dinh, Vi Am; Lakoff, Daniel; Hess, Jamie; Bahner, David P; Hoppmann, Richard; Blaivas, Michael; Pellerito, John S; Abuhamad, Alfred; Khandelwal, Sorabh
OBJECTIVES: Many medical schools are implementing point-of-care ultrasound in their curricula to help augment teaching of the physical examination, anatomy, and ultimately clinical management. However, point-of-care ultrasound milestones for medical students remain unknown. The purpose of this study was to formulate a consensus on core medical student clinical point-of-care ultrasound milestones across allopathic and osteopathic medical schools in the United States. Directors who are leading the integration of ultrasound in medical education (USMED) at their respective institutions were surveyed. METHODS: An initial list of 205 potential clinical ultrasound milestones was developed through a literature review. An expert panel consisting of 34 USMED directors across the United States was used to produce consensus on clinical ultrasound milestones through 2 rounds of a modified Delphi technique, an established anonymous process to obtain consensus through multiple rounds of quantitative questionnaires. RESULTS: There was a 100% response rate from the 34 USMED directors in both rounds 1 and 2 of the modified Delphi protocol. After the first round, 2 milestones were revised to improve clarity, and 9 were added on the basis of comments from the USMED directors, resulting in 214 milestones forwarded to round 2. After the second round, only 90 milestones were found to have a high level of agreement and were included in the final medical student core clinical ultrasound milestones. CONCLUSIONS: This study established 90 core clinical milestones that all graduating medical students should obtain before graduation, based on consensus from 34 USMED directors. These core milestones can serve as a guide for curriculum deans who are initiating ultrasound curricula at their institutions. The exact method of implementation and competency assessment needs further investigation.
PMID: 26782162
ISSN: 1550-9613
CID: 2043402

Self-sampling for human papillomavirus in a community setting: feasibility in Hispanic women

De Alba, Israel; Anton-Culver, Hoda; Hubbell, F Allan; Ziogas, Argyrios; Hess, James R; Bracho, America; Arias, Caleb; Manetta, Alberto
BACKGROUND: The aim of the study was (a) to assess sensitivity and specificity of self-sampling in a community setting for identifying high-risk human papillomavirus (HPV) infection and abnormal Papanicolaou (Pap) smears and (b) to assess satisfaction with this collection method among Hispanic women. METHODS: Lay health workers distributed self-collection kits to Hispanic women in the community. Participants collected an unsupervised vaginal sample at home or in the place and time of their preference. RESULTS: A total of 1,213 Hispanics were included and provided a self-sample for HPV testing and were invited for a Pap smear; 662 (55%) of them had a Pap smear and the first 386 of these also had a physician-collected sample for HPV retesting. Using physician collection as the gold standard, unsupervised self-collection had a sensitivity of 90% and specificity of 88% for identifying high-risk HPV. Compared with physician sampling, self-sampling in a community setting had comparable sensitivity for identifying a low-grade lesions or greater in the Pap smear (50% versus 55%; P = 0.45) but lower specificity (94% versus 79%). Overall experience with self-sampling was reported as excellent or very good by 64% and only 2.6% reported a poor or fair experience. CONCLUSIONS: Unsupervised self-collection of vaginal samples for HPV testing in a community setting has a high sensitivity for identifying high-risk HPV and a high satisfaction among Hispanics. This approach may benefit populations with limited access to health care or with cultural barriers to cervical cancer screening.
PMID: 18708409
ISSN: 1055-9965
CID: 161161