Electronic Health Record (EHR) is an essential program maintained by healthcare providers which contain patients’ information. EHR plays a vital role in determining the value of care provided in the emergency department (ED). The information contained in EHR includes patients’ medical history and progress note. On the other hand, the quality of care services offered by the emergency room (ER) nurses and physicians is of critical significance. The quality of the service in the ER is best measured through its ability to meet patients’ expectations. The consensus of quality care is referred to as “The care ER nurses, and physicians would desire to receive in case they are admitted” (Welch, 2010). ER’s quality measure involves information that describes an element of medical care that has significance to one or more patients. Some patients’ conditions require priority and urgency. Various stakeholders in the ED describe quality care, depending on their role in the department.
Following the existing gaps in studies on the emergency department, a study was conducted in 10 healthcare organizations’ ED across the state of Alaska. The research was based on qualitative measures to assess EHR and the quality of care in the emergency room for nurses and ER (emergency room physicians). The question was presented to the participants of the study who were comprised of ER nurses and ER physicians, and patients who had been previously admitted to the emergency department. Qualitative methods were employed in the study to examine the function of EHR in the ED. These methods were essential in developing a critical understanding of ER nurses and physicians and the use of EHR in the ED. Data was collected through observations, in-depth interview, and focus group interviews.
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Participants
Across all the healthcare organizations where the research was conducted, 8-10 participants were randomly selected from healthcare providers in the ER and patients who had at one time admitted in the ER, and recruited for the study. During the selection of participants, the probability of any person from the group to be included in the study was equal. The age of the participants ranged from 18 to 50 years. This age group was predicted to have sufficient knowledge of the activities that took place in the emergency department. People below the age of 18 were eliminated from the study on two reasons. The researchers assumed that this age group had inadequate knowledge about EHR and the ED. To recruit this person under the age of 18 also required the researchers to seek consent from the formers’ parents or guardians. In each group of participants, there was at least two-thirds gender equality, but the male gender dominated in most groups. All the respondents were selected within 10 miles radius around each of the 10 healthcare organizations where the research was conducted (Christensen, Johnson, Turner & Christensen, 2011). This aspect was considered to ensure that all participants had adequate information about the ED of healthcare organizations around their locality. Also, it was because of the social-economic conditions surrounding the area of study in addition to marching with time frames and resources present for the study. The randomly selected participants were sufficiently educated about the purpose, processes, and experiments of the study. Their consent was then sought through a questionnaire to ensure that they all understood and agreed on their roles in the study. Expert information about EHR and quality of care for the ER nurses and ER physicians were also provided before the study.
Incentives were provided to participants as a form of compensation for their time and an appreciation for voluntarily participating in the research. The number of incentives given to each participant was critically examined to ensure that it did not override the principle of freely provided and fully informed consent. A particular concern was raised during the selection of the probability of the incentives to exert influence on potential participants (Smoyer, Blankenship & Belt, 2009). Therefore, potential participants from the financially disadvantaged population were considered to be vulnerable to this coercion and hence were excluded from the study.
Inclusion criteria involved all emergency departments which used EHR within the state of Alaska. All ER nurses and physicians, patients with an experience of ED who were 18-50 years of age and people from the financially stable population were considered eligible for the study. Previewed articles on quality care on EHR and quality care in the ED, focusing on patient experience were also eligible (Christensen et al., 2011). On the other hand, all patients who had been admitted in the ER within the previous 6 months before the study, primary care nurses and physicians, and members of the financially disadvantaged population were all excluded from the study.
Procedures
Qualitative procedures commonly used in medical research were employed to examine EHR and quality of care for ER nurses and ER physicians in the selected healthcare organizations. These procedures were essential in providing a critical understanding of ER nurses and physicians’ activities and use of EHR in the ED. Interviews and focus groups were the main methods used for data collection. The research employed structured and semi-structured interviews. Structured interviews were essentially verbally administered questionnaires, where a set of predetermined questions were asked to the respondents. The questions were designed with little or no variation and had no scope for follow-up questions to responses that required further elaborations. The interviewers effectively elaborated questions that seemed to be difficult for respondents to answer due to literacy or numeracy challenges. Semi-structured interviews were designed to carry most of the vital questions in the areas explored by the research to pursue much-required details from the respondents. The interviews were also tailored to provide participants with guidance on what to talk about during the interviews (Taylor et al., 2015). Open-ended questions were asked to give the respondent the opportunity to expound their views. They were also arranged in order of sensitivity where simpler questions began followed by more sensitive ones. All interviews were tape recorded. Each interview session lasted between 20 to 50 minutes.
Focus groups sessions were moderated and recorded by an appointed facilitator during the sessions, which lasted between 2 to 3 hours each. The main purpose of these groups was to generate participants experience and beliefs about the research question. At the beginning of the sessions, the moderator informed participants of the presence of recording equipment and also assured them of their information confidentiality. All questions were arranged from general to more specific (Taylor et al., 2015). While the moderator observed the interactions within the groups, a research team member observed and recorded the participants’ responses to the questions. For audibility, a multi-directional external microphone was used. Videotaping was also employed to capture both verbal and nonverbal aspects of the groups’ proceedings. All recordings were transcribed immediately after the sessions.
Interviews in this research were employed for their efficiency in exploring views, experiences, motivations, and beliefs of participants about EHR and quality of care in ED – how they rated the use of EHR in contributing to quality care in ER. Qualitative methods, such as interviews were believed to provide a comprehensive understanding of the social phenomena in the ED better than quantitative procedures. Interviews were also perceived as critical for research in ED where detailed insights were required from individual participants. They were also essential for exploring sensitive issues such as patients’ experience in ER that would be inappropriate to discuss in a group setting. Additionally, interviews were flexible, and the questions would be tailored for easier understanding by the respondents (Taylor et al., 2015). Focus groups, on the other hand, were used for their ability to gather collective views and their meaning. They were also essential in clarifying data collected through other methods. It was also prescribed that participants in these groups would be able to generate shared experience about the quality of care in the ER.
The procedures used in data collection addressed the research question in various ways. Use of open-ended questions in the interviews allowed ER nurses and physicians to share their information with EHR in the ED, and how the program helped them improve care service for patients in the ER. Most of the structured questions asked helped the researcher understand the significance of EHR in the ED. Focus groups addressed the research question from a collective perspective (Taylor et al., 2015). The issue of EHR easing workflow in ER was addressed through probing questions where different participants; patients, ER nurses, and physicians, and residents expressed their perceptions about the program used in ED.
Data collection
A qualitative approach with data analysis informed by the grounded theory was used in collecting data. The data used in this research was imported and transferred from the National Ambulatory Medical Care Survey Emergency Department Data. This source is a section of the National Healthcare Emergency Department Research Body Representative of all states in the US. The interviewers in this research were both young and elderly to represent the entire US population. The data from this source was tested for its reliability in this research. Various issues concerning the imported data were qualitatively evaluated. For instance, the time in which the data was collected was viewed as relevant to the current study (Brailsford et al., 2009). The suitability of the imported data was evaluated against the procedures and participants used in the current study. In this context, the research team analyzed various terms and units used initially during collecting data from the primary source. The data was said to be suitable for use in the current research. The differences found between the secondary data were insignificant to hinder the use of data in the current study.
Data Analysis
After data collection, the research team embarked on analyzing the imported data to compare them with issues in the current study. Recorded data from the secondary source were transcribed and compared with the current study issues. Atlas.ti software was then used in the analysis to help the research team to deal in the most involving part of the analysis. The software was essential in dealing with a large amount of data systematically (Houghton et al., 2015). The software was also significant in organizing and reorganizing data and identifying the less significant data from the secondary source. Likewise it helped to assign demographic features to the study participants. Data were then read and re-read to identify themes and categories. In analytical categories, common responses and behavior expressed by a group of respondents and participants were identified and categorized accordingly. In this context, all data identified in every category were examined through constant comparison (Houghton et al., 2015). After categorization of data, grounded theory was employed in analysis to explain the meaning behind certain phenomena observed in the secondary data. The phenomena were best explained by comparing the data from similar cases experienced in various settings. The research team used the grounded approach to tailor differing explanation to fit in the current study.
References
Brailsford, S. C., Harper, P. R., Patel, B., & Pitt, M. (2009). An analysis of the academic literature on simulation and modeling in health care. Journal of Simulation, 3(3), 130-140.
Christensen, L. B., Johnson, B., Turner, L. A., & Christensen, L. B. (2011). Research methods, design, and analysis.
Houghton, C., Murphy, K., Shaw, D., & Casey, D. (2015). Qualitative case study data analysis: An example from practice. Nurse Researcher , 22 (5).
Jorgensen, D. L. (2015). Participant observation. Emerging trends in the social and behavioral sciences: An interdisciplinary, searchable, and linkable resource, 1-15.
Smoyer, A. B., Blankenship, K. M., & Belt, B. (2009). Compensation for incarcerated research participants: diverse state policies suggest a new research agenda. American journal of public health, 99(10), 1746-1752.
Taylor, S. J., Bogdan, R., & DeVault, M. (2015). Introduction to qualitative research methods: A guidebook and resource. John Wiley & Sons.
Welch, S. J. (2010). Twenty years of patient satisfaction research applied to the emergency department: a qualitative review. American Journal of Medical Quality, 25(1), 64-72.
