Medical Decisions in the Hospital Setting- M-Safety

Study Overview
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Brief Summary
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This project will introduce and evaluate an intervention designed to improve diagnostic decision making. The intervention will attempt to increase clinician mindfulness and reduce environmental distractions to promote focused thinking. A meta-cognitive intervention using a structured checklist will be evaluated to identify improvement in diagnostic and therapeutic decision-making and examine the role of mindfulness and architectural design in enhancing patient safety.

Detailed Description
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This project will introduce and evaluate an intervention designed to improve diagnostic decision making. The intervention will attempt to increase clinician mindfulness and reduce environmental distractions to promote system 2 thinking. A meta-cognitive intervention using a structured checklist will be evaluated to identify improvement in diagnostic and therapeutic decision-making and examine the role of mindfulness and architectural design in enhancing patient safety. This a pretest-posttest design study that will be conducted with hospitalist physicians working at Michigan Medicine and/or the VA Ann Arbor Healthcare System. The proposed intervention will provide the participants with tools to help promote mindfulness and focus to assist with the diagnostic process. To reduce distraction, headphones to block out surrounding noise and table screens to limit distractions will be offered. To assist with diagnosis, a diagnostic checklist and use of a IPad to use an online diagnosis application will be provided.

Official Title
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Improving Medical-Decision Through Cognition, Technology and Communication, Phase 2

Conditions
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Diagnostic Errors

Intervention / Treatment
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* Behavioral: Mindfulness breathing exercise
* Behavioral: Diagnostic Checklist
* Behavioral: Noise cancelling headphones
* Behavioral: Privacy tablescreen
* Behavioral: Diagnostic assistance application


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Hospital Medicine Physicians Exclusion Criteria: Physicians other than Hopitalists

Ages Eligible for Study
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Minimum Age: 18 Years
Maximum Age: 99 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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Accepts Healthy Volunteers

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Health Services Research
Intervention Model: Single Group Assignment
Interventional Model Description: Pre-posttest study design
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Virtual Pod<br>Mindfulness breathing, privacy screen, noise cancelling headphones, diagnostic checklist, diagnostic support on-line application | Behavioral: Mindfulness breathing exercise<br>* Spire monitor instructed mindfulness breathing<br>Behavioral: Diagnostic Checklist<br>* Checklist reminder for diagnosis<br>Behavioral: Noise cancelling headphones<br>* Noise cancelling headphones<br>Behavioral: Privacy tablescreen<br>* Privacy Tablescreen<br>Behavioral: Diagnostic assistance application<br>* Diagnostic assistance application<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Change in Number of Patient Differential Diagnosis | Differential Diagnosis | 8 months | 
| Change in the Use of Diagnostic Checklist | Diagnostic Checklist | 8 months | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Change in Mindfulness Behaviors Score | This 4 Question Survey Measures Characteristics of Mindfulness, Range- 1=Always, 6=Never | 8 months | 
| Change in Number of Patient Diagnostic Testing | Diagnostic Testing includes Laboratory and Imaging | 8 months | 
| Change in Time Participants are Measured as Calm | Time Measured in Minutes, Using the Spire Monitor | 8 months | 
| Change in Time Participants are Measured as Focused | Time Measured in Minutes, Using the Spire Monitor | 8 months | 
| Change in Time Participants are Measured as Tense | Time Measured in Minutes, Using the Spire Monitor | 8 months | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Diagnostic Errors, Hospital Medicine