Mollie Cummins
University of Utah, College of Nursing, Faculty Member
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Purpose:Community-acquired pressure injuries (CAPIs) are present among approximately 3% of patients admitted to acute-care hospitals. Patients with CAPI are not well represented in the hospital- acquired pressure injury (HAPI) literature... more
Purpose:Community-acquired pressure injuries (CAPIs) are present among approximately 3% of patients admitted to acute-care hospitals. Patients with CAPI are not well represented in the hospital- acquired pressure injury (HAPI) literature because those studies usually exclude patients with CAPI. The purpose of our study was to determine the incidence of HAPI development, and associated risk factors, among critical care patients with CAPI.Design:This was a retrospective cohort study.Subjects and Setting:We used electronic health record data from adult surgical critical care patients admitted to a level-1 trauma center and academic medical center between 2014–2018.Methods:We conducted univariate analysis to compare patients with CAPI who developed HAPI and those who did not, and then used logistic regression analysis to identify independent risk factors for HAPI among patients with CAPI.Results:Among 5,101 patients admitted to the surgical critical care units, 167 (3%) patients were admitted with a CAPI. HAPI were four times more common among patients with CAPI compared to patients without CAPI: Among the 167 patients with CAPI, 47 patients (28%) went on to also develop a HAPI, whereas in the 4,934 patients without CAPI, 352 patients (7%) went on to develop HAPI. Upon multivariate logistic regression analysis (n = 151), decreased serum albumin (OR = 0.47, 95% CI = [0.25, 0.85], p = .02) and excessively dry skin (OR = 2.6, 95% CI = [1.1, 6.22], p = .03) were independent predictors of HAPI development among patients admitted with CAPI.Conclusions:Results from our study show patients with CAPI are at high risk for HAPI, particularly among patients with decreased serum albumin or excessively dry skin.
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Poster Abstract
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The purpose of this pilot study was to describe web reference use patterns of poison control center specialists using time tracking software. We analyzed two weeks of web site use data from Utah poison control center (PCC) computers to... more
The purpose of this pilot study was to describe web reference use patterns of poison control center specialists using time tracking software. We analyzed two weeks of web site use data from Utah poison control center (PCC) computers to describe patterns of reference web site use. We observed frequent use of webPOISONCONTROL and Amazon. Specialists visited additional reference web sites that feature tools such as calculators websites provided the function of age calculation was visited sometime. In the future we plan to conduct a qualitative study to interview Specialists in Poison Information to get the rationales of visiting these webpages. This pilot study demonstrates the utility of time tracking software for better understanding reference utilization in the PCC setting.
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Research Interests: Computer Science and AMIA
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Research Interests: Medicine and Publication
Purpose:Community-acquired pressure injuries (CAPIs) are present among approximately 3% of patients admitted to acute-care hospitals. Patients with CAPI are not well represented in the hospital- acquired pressure injury (HAPI) literature... more
Purpose:Community-acquired pressure injuries (CAPIs) are present among approximately 3% of patients admitted to acute-care hospitals. Patients with CAPI are not well represented in the hospital- acquired pressure injury (HAPI) literature because those studies usually exclude patients with CAPI. The purpose of our study was to determine the incidence of HAPI development, and associated risk factors, among critical care patients with CAPI.Design:This was a retrospective cohort study.Subjects and Setting:We used electronic health record data from adult surgical critical care patients admitted to a level-1 trauma center and academic medical center between 2014–2018.Methods:We conducted univariate analysis to compare patients with CAPI who developed HAPI and those who did not, and then used logistic regression analysis to identify independent risk factors for HAPI among patients with CAPI.Results:Among 5,101 patients admitted to the surgical critical care units, 167 (3%) patients were admitted with a CAPI. HAPI were four times more common among patients with CAPI compared to patients without CAPI: Among the 167 patients with CAPI, 47 patients (28%) went on to also develop a HAPI, whereas in the 4,934 patients without CAPI, 352 patients (7%) went on to develop HAPI. Upon multivariate logistic regression analysis (n = 151), decreased serum albumin (OR = 0.47, 95% CI = [0.25, 0.85], p = .02) and excessively dry skin (OR = 2.6, 95% CI = [1.1, 6.22], p = .03) were independent predictors of HAPI development among patients admitted with CAPI.Conclusions:Results from our study show patients with CAPI are at high risk for HAPI, particularly among patients with decreased serum albumin or excessively dry skin.
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There has been little research on using Cognitive load theory (CLT) to guide the design and evaluation mHealth applications. In this presentation, we describe: 1) the historical development of CLT in instructional design, 2) the... more
There has been little research on using Cognitive load theory (CLT) to guide the design and evaluation mHealth applications. In this presentation, we describe: 1) the historical development of CLT in instructional design, 2) the implications of cognitive load (CL) to principles of designing mHealth applications, and 3) a review of cognitive load measurements in educational studies.
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We are developing a new process of health information exchange supported collaboration that leverages the HL7 consolidated CDA standard through four document types (consultation note, history and physical, progress note and discharge... more
We are developing a new process of health information exchange supported collaboration that leverages the HL7 consolidated CDA standard through four document types (consultation note, history and physical, progress note and discharge summary). The focus of the present study is the C-CDA consultation note template that will be submitted from poison control centers (PCC)s to emergency departments (EDs) with treatment recommendations. Specifically, we aimed to (i) create computable mappings between a poison control center database and the C-CDA consultation note template; and (ii) assess the extent and nature of information types that successfully map to discrete data elements in a poison control center database. The resulting template and mappings can be used to implement standards-based health information exchange between PCCs and EDs in the U.S. This is a part of the first formal effort to leverage health information exchange standards to support PCC-ED collaboration.
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BACKGROUND Hospital-acquired pressure injuries are a serious problem among critical care patients. Although most hospital-acquired pressure injuries are stage 2 (partial-thickness skin loss with exposed dermis), no studies have examined... more
BACKGROUND Hospital-acquired pressure injuries are a serious problem among critical care patients. Although most hospital-acquired pressure injuries are stage 2 (partial-thickness skin loss with exposed dermis), no studies have examined outcomes of stage 2 pressure injuries among critical care patients. OBJECTIVES To examine outcomes of stage 2 hospital-acquired pressure injuries among critical care patients and identify factors associated with nonhealing stage 2 hospital-acquired pressure injuries. METHODS Electronic health record data were used to identify surgical critical care patients with stage 2 hospital-acquired pressure injuries at a level I trauma center. Univariate Cox regressions were used to identify factors associated with healed stage 2 hospital-acquired pressure injuries. RESULTS Of 6376 surgical critical care patients, 298 (4.7%) developed stage 2 hospital-acquired pressure injuries; complete data were available for 253 patients. Of these 253 patients, 160 (63%) had unhealed pressure injuries at hospital discharge. Factors inversely related to the presence of a healed hospital-acquired pressure injury were older age (hazard ratio, 0.98; 95% CI, 0.97-0.99; P = .003), elevated serum lactate (hazard ratio, 0.85; 95% CI, 0.75-0.96; P = .01), elevated serum creatinine (hazard ratio, 0.87; 95% CI, 0.77-0.98; P = .02), and lower oxygenation (hazard ratio, 0.64; 95% CI, 0.41-1.00; P = .05). CONCLUSIONS Stage 2 hospital-acquired pressure injuries were not healed at discharge in 63% of the patients in our sample. Nurses should be especially vigilant in treating pressure injury patients who are older, have altered oxygenation or perfusion (elevated serum lactate level or decreased oxygenation), or have evidence of renal compromise.
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Poster Abstract
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The purpose of this pilot study was to describe web reference use patterns of poison control center specialists using time tracking software. We analyzed two weeks of web site use data from Utah poison control center (PCC) computers to... more
The purpose of this pilot study was to describe web reference use patterns of poison control center specialists using time tracking software. We analyzed two weeks of web site use data from Utah poison control center (PCC) computers to describe patterns of reference web site use. We observed frequent use of webPOISONCONTROL and Amazon. Specialists visited additional reference web sites that feature tools such as calculators websites provided the function of age calculation was visited sometime. In the future we plan to conduct a qualitative study to interview Specialists in Poison Information to get the rationales of visiting these webpages. This pilot study demonstrates the utility of time tracking software for better understanding reference utilization in the PCC setting.
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Advances in the field of predictive modeling using artificial intelligence and machine learning have the potential to improve clinical care and outcomes, but only if the results of these models are appropriately presented to clinicians at... more
Advances in the field of predictive modeling using artificial intelligence and machine learning have the potential to improve clinical care and outcomes, but only if the results of these models are appropriately presented to clinicians at the time they make decisions for individual patients. Clinical decision support (CDS) systems could be used to accomplish this. Modern CDS systems are computer-based tools designed to improve clinician decision making for individual patients. However, not all CDS systems are effective. Four principles that have been shown in other medical fields to be important for successful CDS system implementation are (1) integration into clinician workflow, (2) user-centered interface design, (3) evaluation of CDS systems and rules, and (4) standards-based development so the tools can be deployed across health systems.
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Research Interests: Computer Science and AMIA
Background: Studies of graduate online education indicate a need for increased interaction among students and faculty. However, it can be challenging to foster a high level of scholarly interaction and engagement in fully online courses.... more
Background: Studies of graduate online education indicate a need for increased interaction among students and faculty. However, it can be challenging to foster a high level of scholarly interaction and engagement in fully online courses. The objective of this study was to evaluate student perceptions and participation patterns related to online, asynchronous video discussion in a graduate health sciences course. Method: An asynchronous video discussion was piloted in a 2014 interprofessional informatics course and students were subsequently surveyed to determine their perceptions of this approach. Participation patterns were analyzed using descriptive statistics and social network analysis. Results: The results indicate broad and inclusive interaction among students and faculty, with discussion characteristics perceived as equivalent to, or better than, traditional classroom discussion. The quality of student participation was high, and students spent additional time researching and preparing their contributions. Conclusion: This format for a seminar-style discussion holds good potential for effective teaching and learning in online graduate-level health courses and supports the development of students' critical thinking and scholarly communication skills. [ J Nurs Educ . 2016;55(12):706–710.]
Research Interests: Program Evaluation, Psychology, Nursing, Communication, Perception, and 15 moreMedical Education, Medicine, Humans, Descriptive Statistics, Nursing Education, Asynchronous Communication, Computer Assisted Instruction, Female, Male, Curriculum and Pedagogy, Clinical Competence, Pilot Projects, Internet, Video Recording, and interprofessional relations
Research Interests: Medicine and Publication
There has been little research on using Cognitive load theory (CLT) to guide the design and evaluation mHealth applications. In this presentation, we describe: 1) the historical development of CLT in instructional design, 2) the... more
There has been little research on using Cognitive load theory (CLT) to guide the design and evaluation mHealth applications. In this presentation, we describe: 1) the historical development of CLT in instructional design, 2) the implications of cognitive load (CL) to principles of designing mHealth applications, and 3) a review of cognitive load measurements in educational studies.
Research Interests:
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We are developing a new process of health information exchange supported collaboration that leverages the HL7 consolidated CDA standard through four document types (consultation note, history and physical, progress note and discharge... more
We are developing a new process of health information exchange supported collaboration that leverages the HL7 consolidated CDA standard through four document types (consultation note, history and physical, progress note and discharge summary). The focus of the present study is the C-CDA consultation note template that will be submitted from poison control centers (PCC)s to emergency departments (EDs) with treatment recommendations. Specifically, we aimed to (i) create computable mappings between a poison control center database and the C-CDA consultation note template; and (ii) assess the extent and nature of information types that successfully map to discrete data elements in a poison control center database. The resulting template and mappings can be used to implement standards-based health information exchange between PCCs and EDs in the U.S. This is a part of the first formal effort to leverage health information exchange standards to support PCC-ED collaboration.
Research Interests:
BACKGROUND Hospital-acquired pressure injuries are a serious problem among critical care patients. Although most hospital-acquired pressure injuries are stage 2 (partial-thickness skin loss with exposed dermis), no studies have examined... more
BACKGROUND Hospital-acquired pressure injuries are a serious problem among critical care patients. Although most hospital-acquired pressure injuries are stage 2 (partial-thickness skin loss with exposed dermis), no studies have examined outcomes of stage 2 pressure injuries among critical care patients. OBJECTIVES To examine outcomes of stage 2 hospital-acquired pressure injuries among critical care patients and identify factors associated with nonhealing stage 2 hospital-acquired pressure injuries. METHODS Electronic health record data were used to identify surgical critical care patients with stage 2 hospital-acquired pressure injuries at a level I trauma center. Univariate Cox regressions were used to identify factors associated with healed stage 2 hospital-acquired pressure injuries. RESULTS Of 6376 surgical critical care patients, 298 (4.7%) developed stage 2 hospital-acquired pressure injuries; complete data were available for 253 patients. Of these 253 patients, 160 (63%) had unhealed pressure injuries at hospital discharge. Factors inversely related to the presence of a healed hospital-acquired pressure injury were older age (hazard ratio, 0.98; 95% CI, 0.97-0.99; P = .003), elevated serum lactate (hazard ratio, 0.85; 95% CI, 0.75-0.96; P = .01), elevated serum creatinine (hazard ratio, 0.87; 95% CI, 0.77-0.98; P = .02), and lower oxygenation (hazard ratio, 0.64; 95% CI, 0.41-1.00; P = .05). CONCLUSIONS Stage 2 hospital-acquired pressure injuries were not healed at discharge in 63% of the patients in our sample. Nurses should be especially vigilant in treating pressure injury patients who are older, have altered oxygenation or perfusion (elevated serum lactate level or decreased oxygenation), or have evidence of renal compromise.
Research Interests:
Advances in the field of predictive modeling using artificial intelligence and machine learning have the potential to improve clinical care and outcomes, but only if the results of these models are appropriately presented to clinicians at... more
Advances in the field of predictive modeling using artificial intelligence and machine learning have the potential to improve clinical care and outcomes, but only if the results of these models are appropriately presented to clinicians at the time they make decisions for individual patients. Clinical decision support (CDS) systems could be used to accomplish this. Modern CDS systems are computer-based tools designed to improve clinician decision making for individual patients. However, not all CDS systems are effective. Four principles that have been shown in other medical fields to be important for successful CDS system implementation are (1) integration into clinician workflow, (2) user-centered interface design, (3) evaluation of CDS systems and rules, and (4) standards-based development so the tools can be deployed across health systems.
Research Interests:
Background: Studies of graduate online education indicate a need for increased interaction among students and faculty. However, it can be challenging to foster a high level of scholarly interaction and engagement in fully online courses.... more
Background: Studies of graduate online education indicate a need for increased interaction among students and faculty. However, it can be challenging to foster a high level of scholarly interaction and engagement in fully online courses. The objective of this study was to evaluate student perceptions and participation patterns related to online, asynchronous video discussion in a graduate health sciences course. Method: An asynchronous video discussion was piloted in a 2014 interprofessional informatics course and students were subsequently surveyed to determine their perceptions of this approach. Participation patterns were analyzed using descriptive statistics and social network analysis. Results: The results indicate broad and inclusive interaction among students and faculty, with discussion characteristics perceived as equivalent to, or better than, traditional classroom discussion. The quality of student participation was high, and students spent additional time researching and preparing their contributions. Conclusion: This format for a seminar-style discussion holds good potential for effective teaching and learning in online graduate-level health courses and supports the development of students' critical thinking and scholarly communication skills. [ J Nurs Educ . 2016;55(12):706–710.]
Research Interests: Program Evaluation, Psychology, Nursing, Communication, Perception, and 15 moreMedical Education, Medicine, Humans, Descriptive Statistics, Nursing Education, Asynchronous Communication, Computer Assisted Instruction, Female, Male, Curriculum and Pedagogy, Clinical Competence, Pilot Projects, Internet, Video Recording, and interprofessional relations
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The US emergency departments and poison control centers use telephone communication to exchange information about poison exposed patients. Electronically exchanged patient information could better support care for poisoned patients by... more
The US emergency departments and poison control centers use telephone communication to exchange information about poison exposed patients. Electronically exchanged patient information could better support care for poisoned patients by improving information availability for decision making and by decreasing unnecessary emergency department telephone interruptions. As federal initiatives push to increase clinical health information exchange (HIE), it is essential to assess the readiness of US poison control centers. We conducted a nationwide Delphi study to determine consensus on legal, operational, and clinical considerations that are important for electronic information exchange between emergency departments and poison control centers. A national panel of US experts (n = 71) in emergency medicine and poison control participated in a Delphi study, September-December 2010. Panelists rated statements describing concepts related to implementation, adoption, or potential outcomes of electronic information exchange between emergency departments and poison control centers. The statements reflected panelist responses to initial open-ended questions and literature-based concepts. A total of 71 panelists agreed to participate. The response rate for each round ranged from 0.73 to 0.77. Most (114/121) statements reached consensus. Seven statements failed to reach consensus. Panelists indicated that user involvement in the design of systems and tools is important. Workflow integration, safety, evidence of benefit, and outcomes are high-importance issues. Future research and development related to electronic information exchange should address high-importance issues: safety, patient outcomes, workflow integration, and evidence of benefit. It should also address key barriers: initial and ongoing costs associated with electronic information exchange, the absence of software and tools to facilitate exchange, and the need for training. Users should be involved in the design of an electronic information exchange process, and the process should support, not replace, verbal communication.