Streams is clearly a tool designed to be used for direct patient care, supporting clinicians to provide the right care to patients at risk of developing AKI.
Findings from a health care workflow study undertaken with dieticians in three Australian hospitals which investigated designated workflow categories of direct and indirect care revealed the percentage of time spent on direct and indirect patient support activities was 18.3% and 40.4%, respectively [ 20].
KHCC leadership was reported as being both "goal oriented" (towards the rapid achievement of much higher standards of care, and improvements in organizational functional departments and practices that support direct patient contact) and "participative" (followers were involved, in some cases reported as being "required" to participate in identifying new practices, new improvement process, etc).
All relevant health facility departments were grouped into direct, intermediate, supporting and administration service centres depending on whether they had direct patient contact or facilitated, supported or provided services necessary for a facility to function.
This therefore may reflect that their information needs, related to direct patient care, are better supported.
The information needs of ICU shift leaders concerning direct patient care are well supported with current information management tools, however a significant gap can be found in the information related to resource allocation.
Direct collective involvement may include patient support groups for designing services (a key feature of co-design).
This would allow for both direct patient care by rheumatologists and support of PCPs who can be educated, mentored and given diagnostic and management advice [ 9, 29– 329.
However, most of these stand-alone patient care systems in ICUs are developed to support only direct patient care, and are not integrated with other systems used in the unit or at a hospital level.
The intervention was limited to education and a disease registry and did not include other components of the chronic care model such as delivery system redesign, direct patient education, and self-management support [ 26].
