Browsing by Author "Kashiwagi, Deanne"

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    Closer to or Farther away from an Ideal Model of Care? Lessons Learned from Geographic Cohorting
    (Springer, 2022-09) Kara, Areeba; Kashiwagi, Deanne; Burden, Marisha; Medicine, School of Medicine
    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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    Decision Fatigue in Hospital Settings: A Scoping Review
    (Wiley, 2024-11-11) Perry , Kelsey; Jones , Sarah; Stumpff, Julia C.; Kruer, Rachel; Czosnowski, Lauren; Kashiwagi, Deanne; Kara, Areeba
    BACKGROUND: ‘Decision Fatigue’ (DF) describes the impaired ability to make decisions because of repeated acts of decision-making. We conducted a scoping review to describe DF in inpatient settings. METHODS: To be included, studies should have explored a clinical decision, included a mechanism to account for the order of decision making, published in English in or after the year 2000. Six data bases were searched. Retrieved citations were screened and retained studies were reviewed against inclusion criteria. References of included studies were manually searched, and forward citation searches were conducted to capture relevant sources. RESULTS: The search retrieved 12,781 citations of which 41 were retained following screening. Following review, sixteen studies met inclusion criteria. Half were conference abstracts and no studies examined hospitalists. Emergency medicine and intensive care settings were the most frequently studied clinical environments (n=13, 81%). All studies were observational. The most frequently examined decisions were about resource utilization (n=8, 50%), however only half of these examined downstream clinical outcomes. Decision quality against prespecified standards was examined in four (25%) studies. Work environment and patient attributes were often described but not consistently accounted for in analyses. Clinician attributes were described in four (25%) investigations. Findings were inconsistent: both supporting and refuting DF’s role in the outcome studied. CONCLUSIONS: The role of clinician, patient and work environment attributes in mediating DF is understudied. Similarly, the contexts surrounding the decision under study require further explication and when assessing resource use and decision quality, adjudication should be made against prespecified standards.