Amit Tej Singh

All Publications

• Resident and nurse perspectives on the use of secure text messaging systems. Journal of hospital medicine Aziz, S., Barber, J., Singh, A., Alayari, A., Rassbach, C. E. 2022

  Abstract

  BACKGROUND: As hospitals shift away from pagers and towardssecure text messaging systems (STMS), limited research exists on the drawbacks of such systems. Preliminary data show that introduction of STMS can lead to a dramatic increase in interruptions, which may contribute to medical errors.OBJECTIVE: This study aimed to investigate residents' and nurses' experiences with STMS at a quaternary care children's hospital.DESIGN: This was a qualitative study with focus groups.SETTING AND PARTICIPANTS: Participants were pediatric residents and nurses at Lucile Packard Children's Hospital.INTERVENTION: Focus groups were audio recorded, transcribed verbatim, and coded by 2 independent coders. Codes were discussed until consensus was reached.MAIN OUTCOME AND MEASURES: Data was analyzed through a thematic, descriptive content analysis approach. Themes were developed alongside a framework of teamwork, patient safety, and clinician well-being.RESULTS: Three resident focus groups (n=14) and three nurse focus groups (n=21) were held. Six themes were identified: (1) STMS can facilitate teamwork through multiple communication modalities and technological features. (2) STMS can negatively impact teamwork by decreasing face-to-face communication and frontline decision-making. (3) STMS can promote patient safety through closed-loop communication and ready access to team members. (4) STMS can negatively impact patient safety through alarm fatigue, interruptions, and miscommunication. (5) STMS can positively impact clinician well-being through satisfaction and relationship building. (6) STMS can negatively impact clinician well-being through increased stress related to communication volume.CONCLUSION: Use of STMS in the hospital setting has many advantages as well as drawbacks. With appropriate guidelines and training designed to mitigate the drawbacks, STMS have the potential to be valuable means of communication for healthcare team members.

  View details for DOI 10.1002/jhm.12953

  View details for PubMedID 36036216

• Improving Efficiency on a Pediatric Hospital Medicine Service With Schedule-Based Family-Centered Rounds. Hospital pediatrics Wang, M. E., Hutauruk, R. M., Perales, S., Chang, J., Kim, J., Singh, A. T. 2022

  Abstract

  BACKGROUND AND OBJECTIVES: Inconsistencies in the timing and process of family-centered rounds can contribute to inefficiencies in patient care, inconsistent nursing participation, and variable end times. Through the implementation of schedule-based rounds, our aims were to (1) start 90% of rounds encounters within 30 minutes of the scheduled time, (2) increase nursing presence from 79% to >90%, and (3) increase the percentage of rounds completed by 11:20 am from 0% to 80% within 1 year.METHODS: We used quality improvement methods to implement and evaluate a scheduled rounds process on a pediatric hospital medicine service at a university-affiliated children's hospital. Interventions included customization of an electronic health record-linked scheduling tool, daily schedule management by the senior resident, real-time rounds notification to nurses, improved education on rounding expectations, streamlined rounding workflow, and family notification of rounding time. Data were collected daily and run charts were used to track metrics.RESULTS: One year after implementation, a median of 96% of rounds encounters occurred within 30 minutes of scheduled rounding time, nursing presence increased from a median of 79% to 94%, and the percentage of rounds completed by 11:20 am increased from a median of 0% to 86%. Rounds end times were later with a higher patient census.CONCLUSIONS: We improved the efficiency of our rounding workflow and bedside nursing presence through a scheduled rounds process facilitated by an electronic health record-linked scheduling tool.

  View details for DOI 10.1542/hpeds.2021-006379

  View details for PubMedID 35434735

• Impact of a relationship-centered care communication curriculum on pediatric residents' practice, perspectives, and opportunities to evelop expertise. Patient education and counseling Selling, S. K., Kirkey, D., Goyal, T., Singh, A., Gold, C. A., Hilgenberg, S. L., Weimer-Elder, B., Kuo, K. W., Rassbach, C. E. 2021

  Abstract

  OBJECTIVES: To investigate the impacts of a Relationship-Centered Care (RCC) communication curriculum with coaching on pediatric residents 1) self-reported use of RCC strategies and perspectives, and 2) opportunities to develop adaptive expertise.METHODS: Residents (n=77) completed a 4h RCC training and shared resultant RCC goals with Coaches (n=15). Data included resident surveys and reflections immediately post-training, and resident and coach surveys 6-months later. Reported use of RCC strategies were compared over time with paired t-tests. Qualitative data were analyzed using open coding guided by sensitizing principles from the RCC framework and adaptive expertise.RESULTS: Pediatric residents reported significant increases (p<0.001) in use of 4/9 RCC strategies after 6 months: eliciting all concerns, chunking information, checking for understanding, and teach-back. Resident reflections highlighted shifts in perspective around RCC. Training combined with coaching provided opportunities for residents to develop adaptive expertise through adapting and innovating across settings and contexts.CONCLUSION: Residents had significant increases in reported use of key RCC strategies after a training combined with coaching and demonstrated opportunities to develop adaptive expertise.PRACTICE IMPLICATIONS: Residency programs should include RCC training with an emphasis on the new and challenging strategies and provide opportunities to practice and receive coaching.

  View details for DOI 10.1016/j.pec.2021.08.014

  View details for PubMedID 34538683

• Role of Texting as a Source of Cognitive Burden in a Pediatric Cardiovascular ICU. Hospital pediatrics Han, B., Gal, D. B., Mafla, M., Sacks, L. D., Singh, A. T., Shin, A. Y. 2021

  Abstract

  OBJECTIVES: To characterize frontline provider perception of clinical text messaging and quantify clinical texting data in a pediatric cardiovascular ICU (CICU).METHODS: This is a mixed-methods, retrospective single center study. A survey of frontline CICU providers (pediatric fellows, nurse practitioners, and physician assistants) was conducted to assess attitudes characterizing text messaging on cognitive burden. Text messaging data were abstracted and quantified between January 29, 2020, and April 18, 2020, and the patterns of text messages were analyzed per shift and by provider.RESULTS: The survey was completed by 33 of 39 providers (85%). Out of responders, 78% indicated that clinical text messaging frequently or very frequently disrupts critical thinking and workflow. They also felt that the burden of messages was worse during the night shift. Through abstraction, 31926 text messages were identified. A median of 15 (interquartile range: 12-19) messages per hour were received. A median of 5 messages were received per hour per provider during the day shift and 6 during the night shift. From the entire study period, there were total 2 hours of high-frequency texting (≥15 texts per hour) during the day shift and 68 hours during the night shift.CONCLUSION: In our study, providers in the CICU received a large number of texts with a disproportionate burden during the night shift. Text messages are a potential source of cognitive overload for providers. Optimization of text messaging may be needed to mitigate cognitive burden for frontline providers.

  View details for DOI 10.1542/hpeds.2021-005869

  View details for PubMedID 34497133

• Automatic detection of hand hygiene using computer vision technology. Journal of the American Medical Informatics Association : JAMIA Singh, A. n., Haque, A. n., Alahi, A. n., Yeung, S. n., Guo, M. n., Glassman, J. R., Beninati, W. n., Platchek, T. n., Fei-Fei, L. n., Milstein, A. n. 2020

  Abstract

  Hand hygiene is essential for preventing hospital-acquired infections but is difficult to accurately track. The gold-standard (human auditors) is insufficient for assessing true overall compliance. Computer vision technology has the ability to perform more accurate appraisals. Our primary objective was to evaluate if a computer vision algorithm could accurately observe hand hygiene dispenser use in images captured by depth sensors.Sixteen depth sensors were installed on one hospital unit. Images were collected continuously from March to August 2017. Utilizing a convolutional neural network, a machine learning algorithm was trained to detect hand hygiene dispenser use in the images. The algorithm's accuracy was then compared with simultaneous in-person observations of hand hygiene dispenser usage. Concordance rate between human observation and algorithm's assessment was calculated. Ground truth was established by blinded annotation of the entire image set. Sensitivity and specificity were calculated for both human and machine-level observation.A concordance rate of 96.8% was observed between human and algorithm (kappa = 0.85). Concordance among the 3 independent auditors to establish ground truth was 95.4% (Fleiss's kappa = 0.87). Sensitivity and specificity of the machine learning algorithm were 92.1% and 98.3%, respectively. Human observations showed sensitivity and specificity of 85.2% and 99.4%, respectively.A computer vision algorithm was equivalent to human observation in detecting hand hygiene dispenser use. Computer vision monitoring has the potential to provide a more complete appraisal of hand hygiene activity in hospitals than the current gold-standard given its ability for continuous coverage of a unit in space and time.

  View details for DOI 10.1093/jamia/ocaa115

  View details for PubMedID 32712656

• Secure Text Messaging in Healthcare: Latent Threats and Opportunities to Improve Patient Safety. Journal of hospital medicine Hagedorn, P. A., Singh, A., Luo, B., Bonafide, C. P., Simmons, J. M. 2019; 14: E1-E3

  View details for DOI 10.12788/jhm.3305

  View details for PubMedID 31532741

• Current Practices and Perspectives on Peer Observation and Feedback: A National Survey. Academic pediatrics McDaniel, C. E., Singh, A. T., Beck, J. B., Birnie, K., Fromme, H. B., Ginwalla, C. F., Griego, E., King, M., Maniscalco, J., Nazif, J., Patra, K. P., Seelbach, E., Walker, J. M., Bhansali, P. 2019

  Abstract

  OBJECTIVE: Peer observation and feedback (POF) is the direct observation of an activity performed by a colleague followed by feedback with the goal of improved performance and professional development. Although well described in the education literature, the use of POF as a tool for development beyond teaching skills has not been explored. We aimed to characterize the practice of POF among pediatric hospitalists, to explore the perceived benefits and barriers, and to identify preferences regarding POF.METHODS: We developed a 14-item cross-sectional survey regarding divisional expectations, personal practice, perceived benefits and barriers, and preferences related to POF. We refined the survey based on expert feedback, cognitive interviews, and pilot testing, distributing the final survey to pediatric hospitalists at twelve institutions across the United States.RESULTS: Of 357 eligible participants, 198 (56%) responded with 115 (58%) practicing in a freestanding children's hospital. While 61% had participated in POF, less than half (42%) reported divisional POF expectation. The most common perceived benefits of POF were identifying areas for improvement (94%) and learning about colleagues' teaching and clinical styles (94%). The greatest perceived barriers were time (51%) and discomfort with receiving feedback from peers (38%), although participation within a POF program reduced perceived barriers. Most (76%) desired formal POF programs focused on improving teaching skills (85%), clinical management (83%), and family-centered rounds (82%).CONCLUSION: Though the majority of faculty desired POF, developing a supportive environment and feasible program is challenging. This study provides considerations for improving and designing POF programs.

  View details for PubMedID 30910598

• Working to Make the Hospital Smarter. Hospital pediatrics Singh, A. T. 2017; 7 (2): 122-124

  View details for DOI 10.1542/hpeds.2016-0092

  View details for PubMedID 28049133

• Who's My Doctor? Using an Electronic Tool to Improve Team Member Identification on an Inpatient Pediatrics Team. Hospital pediatrics Singh, A., Rhee, K. E., Brennan, J. J., Kuelbs, C., El-Kareh, R., Fisher, E. S. 2016; 6 (3): 157-165

  Abstract

  Increase parent/caregiver ability to correctly identify the attending in charge and define terminology of treatment team members (TTMs). We hypothesized that correct TTM identification would increase with use of an electronic communication tool. Secondary aims included assessing subjects' satisfaction with and trust of TTM and interest in computer activities during hospitalization.Two similar groups of parents/legal guardians/primary caregivers of children admitted to the Pediatric Hospital Medicine teaching service with an unplanned first admission were surveyed before (Phase 1) and after (Phase 2) implementation of a novel electronic medical record (EMR)-based tool with names, photos, and definitions of TTMs. Physicians were also surveyed only during Phase 1. Surveys assessed TTM identification, satisfaction, trust, and computer use.More subjects in Phase 2 correctly identified attending physicians by name (71% vs. 28%, P < .001) and correctly defined terms intern, resident, and attending (P ≤ .03) compared with Phase 1. Almost all subjects (>79%) and TTMs (>87%) reported that subjects' ability to identify TTMs moderately or strongly impacted satisfaction and trust. The majority of subjects expressed interest in using computers to understand TTMs in each phase.Subjects' ability to correctly identify attending physicians and define TTMs was significantly greater for those who used our tool. In our study, subjects reported that TTM identification impacted aspects of the TTM relationship, yet few could correctly identify TTMs before tool use. This pilot study showed early success in engaging subjects with the EMR in the hospital and suggests that families would engage in computer-based activities in this setting.

  View details for DOI 10.1542/hpeds.2015-0164

  View details for PubMedID 26920366

• Mom, I’m going to be an INPATIENT doctor…” (A Graduating PHM Fellow’s Musings on the Past, Present, and Future) Hospital Pediatrics Singh, A. T. 2013; 3: 2

  View details for DOI 10.1542/hpeds.2013-0030

• Painful Arthritis and Extremity Rash in an 8-Year-Old Boy CLINICAL INFECTIOUS DISEASES Islam, S., Cooney, T., Singh, A., Petru, A. M., LaBeaud, A. D. 2012; 54 (10): 1473-?

  View details for DOI 10.1093/cid/cir1007

  View details for Web of Science ID 000304049300019

  View details for PubMedID 22527963