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Goldhaber NH, Reeves JJ, Puri D, Berumen JA, Tran M, Clay BJ, Longhurst CA, Fergerson B. Surgery and Anesthesia Preoperative "Virtual Huddle": A Pilot Trial to Enhance Communication across the Drape. Appl Clin Inform 2023; 14:772-778. [PMID: 37758227 PMCID: PMC10533219 DOI: 10.1055/s-0043-1772687] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2023] [Accepted: 07/19/2023] [Indexed: 09/30/2023] Open
Abstract
OBJECTIVES Effective communication between surgeons and anesthesiologists is critical for high-quality, safe, and efficient perioperative patient care. Despite widespread implementation of surgical safety checklists and time-outs, ineffective team communication remains a leading cause of patient safety events in the operating room. To promote effective communication, we conducted a pilot trial of a "virtual huddle" between anesthesiologists and surgeons. METHODS Attending anesthesiologists and surgeons at an academic medical center were recruited by email to participate in this feasibility trial. An electronic health record-based smartphone application was utilized to create secure group chats among trial participants the day before a surgery. Text notifications connected a surgeon/anesthesiologist pair in order to introduce colleagues, facilitate a preoperative virtual huddle, and enable open-ended, text message-based communication. A 5-point Likert scale-based survey with a free-text component was used to evaluate the utility of the virtual huddle and usability of the electronic platform. RESULTS A total of 51 unique virtual huddles occurred between 16 surgeons and 12 anesthesiologists over 99 operations. All postintervention survey questions received a positive rating (range: 3.50/5.00-4.53/5.00) and the virtual huddle was considered to be easy to use (4.47/5.00), improve attending-to-attending communication (4.29/5.00), and improve patient care (4.22/5.00). There were no statistically significant differences in the ratings between surgery and anesthesia. In thematic analysis of qualitative survey results, Participants indicated the intervention was particularly useful in interdisciplinary relationship-building and reducing room turnover. The huddle was less useful for simple, routine cases or when participation was one sided. CONCLUSION A preoperative virtual huddle may be a simple and effective intervention to improve communication and teamwork in the operating room. Further study and consideration of broader implementation is warranted.
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Affiliation(s)
- Nicole H. Goldhaber
- Department of Surgery, University of California, San Diego, La Jolla, California, United States
| | - J. Jeffery Reeves
- Department of Surgery, University of California, San Diego, La Jolla, California, United States
| | - Dhruv Puri
- School of Medicine, University of California, San Diego, La Jolla, California, United States
| | - Jennifer A. Berumen
- Department of Surgery, University of California, San Diego, La Jolla, California, United States
| | - Minh Tran
- Department of Anesthesiology, University of California, San Diego, La Jolla, California, United States
| | - Brian J. Clay
- Department of Medicine, Division of Biomedical Informatics, University of California, San Diego, La Jolla, California, United States
| | - Christopher A. Longhurst
- Department of Medicine, Division of Biomedical Informatics, University of California, San Diego, La Jolla, California, United States
| | - Byron Fergerson
- Department of Anesthesiology, University of California, San Diego, La Jolla, California, United States
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Nonoperating room anesthesia: strategies to improve performance. Int Anesthesiol Clin 2021; 59:27-36. [PMID: 34456276 DOI: 10.1097/aia.0000000000000339] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Prospective risk assessments of patient safety events related to drug shortages in hospitals: Three actor-level perspectives. EXPLORATORY RESEARCH IN CLINICAL AND SOCIAL PHARMACY 2021; 3:100055. [PMID: 35480600 PMCID: PMC9031755 DOI: 10.1016/j.rcsop.2021.100055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Revised: 07/06/2021] [Accepted: 08/03/2021] [Indexed: 11/21/2022] Open
Abstract
Background: The increasing number of drug shortages (DSs) worldwide calls for more proactive solutions to prevent the negative impacts of DSs on patient care. Such solutions require in-depth knowledge about potential patient safety risks related to DSs, the processes of recognizing and managing DSs, the contextual setting in which DSs occur, and the actors involved. Objective: The aim of the study is to use prospective risk assessment to identify patient safety risks in hospitals associated with the management of DSs among actors at national, regional and local level in Denmark. Methods: Healthcare Failure Mode and Effect Analysis (HFMEA) was employed in composition with elements from the Systematic Human Error Reduction and Prediction Approach (SHERPA) and the Systems-Theoretic Accident Model and Processes (STAMP). Potential risks related to DS management across three actor levels (national, regional and local) in the Danish healthcare system were described. Each actor level consisted of six participants that were identified using a purposive sampling strategy. Processes and sub-processes related to managing critical DSs were outlined and the actors identified, prioritized and rated potential failure modes, causes and consequences related to the processes. Recommendations to mitigate failures were proposed for high risk failures modes. Results: Overall, a total of 167 failure modes were identified across the three actor levels. At the national level, the process of DS management consisted of 17 sub-processes, from which 71 failure modes were identified. Nine of them were rated as high risk. At regional level, 7 sub-processes and 33 failure modes were identified, of which 9 were rated as high risk. At local level, 14 sub-processes and 63 failure modes were identified, of which 32 were rated as high risk. The high-risk failures were related to a lack of IT support in the medication modules, underestimation of patient safety aspects, and insufficient personnel training and patient information. Conclusion: Exploring DS management failure modes across actor levels provided an overview of interrelated failures. Potential solutions related to high risk failures were developed to ensure that actors ensure patient safety related to DS in healthcare. Healthcare Failure Mode and Effect Analysis (HFMEA) is used to identify patient safety risks in hospitals associated with DS management among actors at national, regional and local level. A total of 167 failure modes were identified across three actor levels Nine high-risk failures were identified at the national and regional level respectively, and 32 high-risk failures were found at the local level. The high-risk failures were related to a lack of IT support in the medication modules, underestimation of patient safety aspects, and insufficient personnel training and patient information. Potential solutions related to high-risk failures were developed to ensure patient safety related to DS in healthcare.
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Jensen MJ, Liao J, Van Gorp B, Sugg SL, Shelton J, Corwin C, Lal G. Incorporating Surgical Ergonomics Education into Surgical Residency Curriculum. JOURNAL OF SURGICAL EDUCATION 2021; 78:1209-1215. [PMID: 33221251 DOI: 10.1016/j.jsurg.2020.11.004] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/13/2020] [Revised: 10/04/2020] [Accepted: 11/06/2020] [Indexed: 06/11/2023]
Abstract
BACKGROUND Education on surgical ergonomics during residency training is lacking. This study aimed to determine the feasibility and impact of incorporating surgical ergonomics lectures into residency curriculum. METHODS A survey was distributed to 42 residents with questions regarding demographics, surgical factors, prevalence of musculoskeletal (MSK) symptoms, and awareness of ergonomic recommendations. The residents then received 2 lectures on ergonomics in surgery. A follow up survey was distributed to evaluate the impact of the lectures. RESULTS Twenty-two residents completed the presession survey. Ninety-one percent reported MSK symptoms attributed to their training. Seventeen residents completed the follow up survey. All reported increased awareness of their own habits while operating and improved understanding of methods to prevent and/or treat work-related injuries. All residents recommended incorporating the lectures as an adjunct to their regular curriculum. CONCLUSIONS The rates of MSK symptoms and/or injury are high among surgeon trainees. Residency is an opportune time to educate on principles of ergonomics and may prevent future injuries.
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Affiliation(s)
- Megan J Jensen
- Departments of Otolaryngology - Head & Neck Surgery, University of Iowa, Iowa City, Iowa
| | - Junlin Liao
- Departments of Surgery, University of Iowa, Iowa City, Iowa
| | - Barbara Van Gorp
- Departments of Physical therapy, University of Iowa, Iowa City, Iowa
| | - Sonia L Sugg
- Departments of Surgery, University of Iowa, Iowa City, Iowa
| | - Julia Shelton
- Departments of Surgery, University of Iowa, Iowa City, Iowa
| | - Claudia Corwin
- Departments of Internal Medicine, University of Iowa, Iowa City, Iowa
| | - Geeta Lal
- Departments of Surgery, University of Iowa, Iowa City, Iowa.
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Whittington KD, Walker J, Hirsch B. Promoting Interdisciplinary Communication as a Vital Function of Effective Teamwork to Positively Impact Patient Outcomes, Satisfaction, and Employee Engagement. J Med Imaging Radiat Sci 2020; 51:S107-S111. [DOI: 10.1016/j.jmir.2020.07.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Revised: 06/26/2020] [Accepted: 07/06/2020] [Indexed: 11/25/2022]
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Hannawa AF, Spitzberg BH, Childress MD, Frankel R, Pham JC, Wu AW. Communication science lessons for patient safety and quality care. JOURNAL OF PATIENT SAFETY AND RISK MANAGEMENT 2020. [DOI: 10.1177/2516043520926424] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
At a time when patient-centered care is a goal and patient safety is a paramount concern across the spectrum of health care, renewed and rigorous attention to interpersonal communication skills makes good sense. In this interdisciplinary article, we share lessons from communication science that can help clinicians communicate more appropriately and effectively with each other and with their patients in healthcare encounters.
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Affiliation(s)
- Annegret F Hannawa
- Center for the Advancement of Healthcare Quality and Patient Safety (CAHQS), Faculty of Communication, Culture and Society, Università della Svizzera italiana (USI), Lugano, Switzerland
| | - Brian H Spitzberg
- School of Communication, San Diego State University, San Diego, CA, USA
| | - Marcia D Childress
- Center for Health Humanities & Ethics, University of Virginia School of Medicine, Charlottesville, VA, USA
| | - Richard Frankel
- School of Medicine, Indiana University, Bloomington, IN, USA
| | - Julius C Pham
- Center for Health Services and Outcomes Research, Johns Hopkins Medicine, Baltimore, MD, USA
| | - Albert W Wu
- Center for Health Services and Outcomes Research, Johns Hopkins Medicine, Baltimore, MD, USA
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Abstract
OBJECTIVES Operating rooms (ORs) and surgical settings are potential sources of sentinel adverse events. To better understand the characteristics of errors in OR processes, we performed prospective risk analysis. METHODS The study was mixed qualitative and quantitative research. We used the Healthcare Failure Mode and Effect Analysis (HFMEA) method to analyze the selected perioperative, operative, and postoperative processes in the OR via a 2-round Delphi technique. We identified the most prominent failure modes according to a Hazard Decision Matrix, analyzed and categorized proposed possible causes, and provided solutions to mitigate hazard scores. RESULTS Ten important processes and 7 subprocesses within the OR were selected and mapped, and 187 failure modes were identified and scored on the basis of severity and probability. A total of 36 potential failure modes were highlighted as high-risk failures and moved to decision trees for further analyses. CONCLUSION Developing policy for the familiarization of new personnel designing a checklist for accurate gases counting; drafting comprehensive presurgical posters; preparing all necessary equipment in difficult intubation; developing instruction for monthly checking of the OR equipment; and developing the evaluation criteria of staff performance are examples of solutions that are proposed to improve the quality of OR processes.
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Koshy K, Syed H, Luckiewicz A, Alsoof D, Koshy G, Harry L. Interventions to improve ergonomics in the operating theatre: A systematic review of ergonomics training and intra-operative microbreaks. Ann Med Surg (Lond) 2020; 55:135-142. [PMID: 32477512 PMCID: PMC7251302 DOI: 10.1016/j.amsu.2020.02.008] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2019] [Revised: 01/31/2020] [Accepted: 02/29/2020] [Indexed: 11/04/2022] Open
Abstract
Musculoskeletal occupational injury is prevalent within the surgical community. This is a multi-factorial issue, but is contributed to by physical posture, environmental hazards and administrative deficiency. There is growing awareness of this issue, with several behavioural, educational and administrative techniques being employed. The literature on this topic is, however, sporadic and difficult to access by healthcare practitioners. The aim of this systematic review was to evaluate the literature on the current interventions used to minimise musculoskeletal occupational injury in surgeons and interventionalists. This review will focus on administrative and human factor interventions, such as intra-operative microbreaks and ergonomics training.
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Affiliation(s)
- Kiron Koshy
- Royal Victoria Infirmary, Newcastle Upon Tyne Hospital Foundation Trust, Newcastle Upon Tyne, UK
| | - Habib Syed
- Brighton and Sussex Medical School, Brighton, East Sussex, UK
| | | | - Daniel Alsoof
- University College London Medical School, London, UK
| | - George Koshy
- Sancheti Institute of Orthopaedics and Rehabilitation, India
| | - Lorraine Harry
- Queen Victoria Hospital NHS Foundation Trust, East Grinstead, UK
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Mortality in Australian Cardiothoracic Surgery: Findings From a National Audit. Ann Thorac Surg 2020; 109:1880-1888. [DOI: 10.1016/j.athoracsur.2019.09.060] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2019] [Revised: 09/12/2019] [Accepted: 09/13/2019] [Indexed: 12/19/2022]
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10
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López-Parra M, Porcar-Andreu L, Arizu-Puigvert M, Pujol-Caballé G. Cohort Study on the Implementation of a Surgical Checklist from the Operating Room to the Postanesthesia Care Unit. J Perianesth Nurs 2020; 35:155-159. [DOI: 10.1016/j.jopan.2019.08.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2019] [Revised: 07/31/2019] [Accepted: 08/25/2019] [Indexed: 11/28/2022]
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Ershadi M, Ershadi M, Niaki S. An integrated HFMEA-DES model for performance improvement of general hospitals. INTERNATIONAL JOURNAL OF QUALITY & RELIABILITY MANAGEMENT 2020. [DOI: 10.1108/ijqrm-08-2019-0277] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PurposeHealthcare failure mode and effect analysis (HFMEA) identifies potential risks and defines preventive actions to reduce the effects of risks. In addition, a discrete event simulation (DES) could evaluate the effects of every improvement scenario. Consequently, a proposed integrated HFMEA-DES model is presented for quality improvement in a general hospital.Design/methodology/approachIn the proposed model, HFMEA is implemented first. As any risk in the hospital is important and that there are many departments and different related risks, all defined risk factors are evaluated using the risk priority number (RPN) for which related corrective actions are defined based on experts' knowledge. Then, a DES model is designed to determine the effects of selected actions before implementation.FindingsResults show that the proposed model not only supports different steps of HFMEA but also is highly in accordance with the determination of real priorities of the risk factors. It predicts the effects of corrective actions before implementation and helps hospital managers to improve performances.Practical implicationsThis research is based on a case study in a well-known general hospital in Iran.Originality/valueThis study takes the advantages of an integrated HFMEA-DES model in supporting the limitation of HFMEA in a general hospital with a large number of beds and patients. The case study proves the effectiveness of the proposed approach for improving the performances of the hospital resources.
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Stephens AL, Bruce CR, Childress A, Malek J. Why Families Get Angry: Practical Strategies for Clinical Ethics Consultants to Rebuild Trust Between Angry Families and Clinicians in the Critical Care Environment. HEC Forum 2020; 31:201-217. [PMID: 30820819 DOI: 10.1007/s10730-019-09370-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Developing a care plan in a critical care context can be challenging when the therapeutic alliance between clinicians and families is compromised by anger. When these cases occur, clinicians often turn to clinical ethics consultants to assist them with repairing this alliance before further damage can occur. This paper describes five different reasons family members may feel and express anger and offers concrete strategies for clinical ethics consultants to use when working with angry families acting as surrogate decision makers for critical care patients. We reviewed records of consults using thematic analysis between January 2015 and June 2016. Each case was coded to identify whether the case involved a negative encounter with an angry family. In our review, we selected 11 cases with at least one of the following concerns or reasons for anger: (1) perceived or actual medical error, (2) concerns about the medical team's competence, (3) miscommunication, (4) perceived conflict of interest or commitment, or (5) loss of control. To successfully implement these strategies, clinical ethics consultants, members of the medical team, and family members should share responsibility for creating a mutually respectful relationship.
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Affiliation(s)
| | - Courtenay R Bruce
- The Methodist Hospital System, System Quality and Patient Safety, Houston, TX, USA
| | - Andrew Childress
- Center for Medical Ethics & Health Policy, Baylor College of Medicine, One Baylor Plaza, Suite 301D, Houston, TX, 77030, USA
| | - Janet Malek
- Center for Medical Ethics & Health Policy, Baylor College of Medicine, One Baylor Plaza, Suite 301D, Houston, TX, 77030, USA.
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Işık I, Gümüşkaya O, Şen S, Arslan Özkan H. The Elephant in the Room: Nurses' Views of Communication Failure and Recommendations for Improvement in Perioperative Care. AORN J 2019; 111:e1-e15. [PMID: 31886544 DOI: 10.1002/aorn.12899] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Perioperative communication failures endanger patient safety and may reduce efficiency. The objective of our phenomenological research study was to determine the reasons for and consequences of perioperative communication failures and to seek recommendations for improvement. Fourteen perioperative nurses participated in this study. We conducted in-depth interviews with a semi-structured questionnaire following Colaizzi's seven-step methodology to extract themes. We organized the themes into categories: causes, consequences, and recommendations for preventing communication failure. Some themes for causes were inadequate time for preoperative preparation, lack of personnel, and disruptive behaviors of physicians. Consequences of communication failure were decreased staff retention, avoidance of colleagues, threats to patient safety, and intra-team violence. Two recommendations included enforcing institutional regulations and creating team spirit. The study revealed that nurses believe that institutional regulations should not only be present but enforced. Further, nurses believe that strengthening employees' interpersonal skills is essential to preventing communication issues.
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Heideveld-Chevalking AJ, Calsbeek H, Hofland J, Meijerink WJHJ, Wolff AP. Prospective methods for identifying perioperative risk-assessment methods for patient safety over 20 years: a systematic review. BJS Open 2019; 4:197-205. [PMID: 32207569 PMCID: PMC7093778 DOI: 10.1002/bjs5.50246] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2019] [Accepted: 11/03/2019] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND Serious preventable surgical events still occur despite considerable efforts to improve patient safety. In addition to learning from retrospective analyses, prospective risk-assessment methods may help to decrease preventable events further by targeting perioperative hazards. The aim of this systematic review was to assess the methods used to identify perioperative patient safety risks prospectively, and to describe the risk areas targeted, the quality characteristics and feasibility of methods. METHODS MEDLINE, Embase, CINAHL and Cochrane databases were searched, adhering to PRISMA guidelines. All studies describing the development and results of prospective methods to identify perioperative patient safety risks were included and assessed on methodological quality. Exclusion criteria were interventional studies, studies targeting one specific issue, studies reporting on structural factors relating to fundamental hospital items, and non-original or case studies. RESULTS The electronic search resulted in 16 708 publications, but only 20 were included for final analysis, describing five prospective risk-assessment methods. Direct observation was used in most studies, often in combination. Direct (16 studies) and indirect (4 studies) observations identified (potential) adverse events (P)AEs, process flow disruptions, poor protocol compliance and poor practice performance. (Modified) Healthcare Failure Mode and Effect Analysis (HFMEA™) (5 studies) targeted potential process flow disruption failures, and direct (P)AE surveillance (3 studies) identified (P)AEs prospectively. Questionnaires (3 studies) identified poor protocol compliance, surgical flow disturbances and patients' willingness to ask questions about their care. Overall, quality characteristics and feasibility of the methods were poorly reported. CONCLUSION The direct (in-person) observation appears to be the primary prospective risk-assessment method that currently may best help to target perioperative hazards. This is a reliable method and covers a broad spectrum of perioperative risk areas.
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Affiliation(s)
| | - H Calsbeek
- IQ healthcare, Radboud Institute for Health Sciences, Radboud University Medical Centre, Nijmegen, the Netherlands
| | - J Hofland
- Department of Anaesthesiology, Radboud University Medical Centre, Nijmegen, the Netherlands
| | - W J H J Meijerink
- Department of Operating Rooms, Radboud University Medical Centre, Nijmegen, the Netherlands
| | - A P Wolff
- Department of Anaesthesiology, University of Groningen Medical Centre, Groningen, the Netherlands
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Randmaa M, Engström M, Mårtensson G, Leo Swenne C, Högberg H. Psychometric properties of an instrument measuring communication within and between the professional groups licensed practical nurses and registered nurses in anaesthetic clinics. BMC Health Serv Res 2019; 19:950. [PMID: 31823775 PMCID: PMC6905046 DOI: 10.1186/s12913-019-4805-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2019] [Accepted: 12/02/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The most common cause of clinical incidents and adverse events in relation to surgery is communication error. There is a shortage of studies on communication between registered nurses and licenced practical nurses as well as of instruments to measure their perception of communication within and between the professional groups. The aim of the present study was to evaluate the psychometric properties of the Swedish version of the adapted ICU Nurse-Physician Questionnaire, designed to also measure communication within and between two professional groups: licensed practical nurses and registered nurses. Specifically, the aim was to examine the instrument's construct validity using confirmatory factor analysis and its internal consistency using Cronbach's Alpha. METHODS A cross-sectional and correlational design was used. The setting was anaesthetic clinics in two Swedish hospitals. A total of 316 questionnaires were delivered during spring 2011, of which 195 were analysed to evaluate the psychometric properties of the questionnaire. Construct validity was assessed using confirmatory factor analysis and internal consistency using Cronbach's Alpha. To assess items with missing values, we conducted a sensitivity analysis of two sets of data, and to assess the assumption of normally distributed data, we used Bayesian estimation. RESULTS The results support the construct validity and internal consistency of the adapted ICU Nurse-Physician Questionnaire. Model fit indices for the confirmative factor analysis were acceptable, and estimated factor loadings were reasonable. There were no large differences between the estimated factor loadings when comparing the two samples, suggesting that items with missing values did not alter the findings. The estimated factor loadings from Bayesian estimation were very similar to the maximum likelihood results. This indicates that confirmative factor analysis using maximum likelihood produced reliable factor loadings. Regarding internal consistency, alpha values ranged from 0.72 to 0.82. CONCLUSIONS The tests of the adapted ICU Nurse-Physician Questionnaire indicate acceptable construct validity and internal consistency, both of which need to be further tested in new settings and samples. TRIAL REGISTRATION Current controlled trials http://www.controlled-trials.com Communication and patient safety in anaesthesia and intensive care. Does implementation of SBAR make any differences? Identifier: ISRCTN37251313, retrospectively registered (assigned 08/11/2012).
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Affiliation(s)
- Maria Randmaa
- Faculty of Health and Occupational Studies, University of Gävle, S-801 76 Gävle, Sweden
| | - Maria Engström
- Faculty of Health and Occupational Studies, University of Gävle, S-801 76 Gävle, Sweden
- Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden
- Nursing Department, Medicine and Health College, Lishui University, Lishui, China
| | - Gunilla Mårtensson
- Faculty of Health and Occupational Studies, University of Gävle, S-801 76 Gävle, Sweden
- Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden
| | - Christine Leo Swenne
- Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden
| | - Hans Högberg
- Faculty of Health and Occupational Studies, University of Gävle, S-801 76 Gävle, Sweden
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Sundberg M, Sexton J, Gruskin K. Pediatric Emergency Medicine Quality of Care: Strategies for Continued Improvement. CLINICAL PEDIATRIC EMERGENCY MEDICINE 2019. [DOI: 10.1016/j.cpem.2019.100712] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Brooke BS, Beckstrom J, Slager SL, Weir CR, Del Fiol G. Discordance in Information Exchange Between Providers During Care Transitions for Surgical Patients. J Surg Res 2019; 244:174-180. [PMID: 31299433 DOI: 10.1016/j.jss.2019.06.049] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2019] [Revised: 04/26/2019] [Accepted: 06/11/2019] [Indexed: 11/28/2022]
Abstract
BACKGROUND The exchange of health information between primary care providers (PCPs) and surgeons is critical during transitions of care for older patients with multiple comorbidities; however, it is unknown to what extent this process occurs. This study was designed to characterize the extent to which factors associated with older patient's recovery, such as functional status, cognitive status, social status, and emotional factors, are shared among PCPs and surgical providers during care transitions. MATERIALS AND METHODS We prospectively identified 15 patients aged over 60 y with ≥3 comorbidities referred for general and vascular surgery procedures at a Veterans Administrative and academic medical center. Semistructured Critical Decision Method interviews were conducted with patients along with their surgical providers and referring PCPs. Thematic content analysis was performed independently by five reviewers on the cognitive processes associated with functional status, cognitive status, social status, and emotional factors. Interrater reliability between providers and patients was assessed using Cohen's kappa. RESULTS Forty-seven Critical Decision Method interviews were conducted, which included 20 paired interviews between a PCP and a surgeon and 16 paired interviews that involved a patient and a provider. The majority of patients reported experiencing poor information exchange between their PCP and surgeon (58%) and feeling they were primarily responsible for communicating their own health information during care transitions (67%). In paired interviews between PCPs and surgeons, there was nearly perfect agreement for the shared knowledge of cognitive (kappa: 0.83) and emotional (kappa 1) factors. In contrast, there was only minimal agreement for shared knowledge of functional status (kappa 0.38) and social status (kappa: 0.34). CONCLUSIONS Information exchange between PCPs and surgical providers is often discordant during transitions of surgical care for medically complex older patients, particularly when it pertains to communicating their functional or social status.
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Affiliation(s)
- Benjamin S Brooke
- Division of Vascular Surgery, Department of Surgery, University of Utah School of Medicine, Salt Lake City, Utah; Department of Biomedical Informatics, University of Utah School of Medicine, Salt Lake City, Utah.
| | - Julie Beckstrom
- Division of Vascular Surgery, Department of Surgery, University of Utah School of Medicine, Salt Lake City, Utah
| | - Stacey L Slager
- Pharmacotherapy Outcomes Research Center, University of Utah School of Pharmacy, Salt Lake City, Utah
| | - Charlene R Weir
- Department of Biomedical Informatics, University of Utah School of Medicine, Salt Lake City, Utah
| | - Guilherme Del Fiol
- Department of Biomedical Informatics, University of Utah School of Medicine, Salt Lake City, Utah
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Shah AC, Herstein AR, Flynn-O'Brien KT, Oh DC, Xue AH, Flanagan MR. Six Sigma Methodology and Postoperative Information Reporting: A Multidisciplinary Quality Improvement Study With Interrupted Time-Series Regression. JOURNAL OF SURGICAL EDUCATION 2019; 76:1048-1067. [PMID: 30954426 DOI: 10.1016/j.jsurg.2018.12.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/01/2018] [Revised: 11/22/2018] [Accepted: 12/26/2018] [Indexed: 06/09/2023]
Abstract
OBJECTIVE The postoperative handover is often compromised by reporting inconsistencies between different specialties. We describe a multidisciplinary quality improvement initiative to improve postoperative information reporting. DESIGN A quality improvement project with interrupted time-series data collection was undertaken in the postanesthesia care unit between January 2015 and August 2015. We utilized Six Sigma methodology to engage multispecialty stakeholders in identifying deficiencies in the existing postoperative handover process in January 2015. A standardized handover process including a checklist and electronic handover note was implemented within a postanesthesia care unit in June 2015. Direct observations of handovers were conducted to determine reporting accuracy, handover duration, and specialty representative attendance. Segmented linear and logistic regression analyses were used for interrupted time-series data. SETTING Single postanesthesia care unit at an academic tertiary referral center. PARTICIPANTS Physician trainees in anesthesia (n = 82) and surgical subspecialties (n = 139), certified registered nurse anesthetists (n = 57), and recovery room registered nurses (n = 139). RESULTS Cumulative handover scores increased by 18.3 points in the postimplementation period (n = 70) when compared to preimplementation handovers (n = 69), a finding which remained statistically significant after adjusting for preintervention time trends (difference 16 points; 95% confidence intervals 3-31; p = 0.021). No statistically significant difference in handover duration was seen between cohorts (6.8 minutes vs 6.1 minutes, difference 0.5 minutes; 95% confidence intervals -2.8 to 3.7; p = 0.78). Three years postimplementation, there was consistent use of a modified electronic handover note and surgical subspecialty attendance during handover. CONCLUSIONS A standardized handover process was associated with improved information reporting among different surgical disciplines without significantly lengthening handover duration.
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Affiliation(s)
- Aalap C Shah
- Department of Anesthesiology and Pain Medicine, University of Washington Medical Center, Seattle, Washington; Independent Practice in Los Angeles, California.
| | - Andrew R Herstein
- Department of Anesthesiology and Pain Medicine, University of Washington Medical Center, Seattle, Washington
| | | | - Daniel C Oh
- University of Washington School of Medicine, Seattle, Washington
| | - Anna H Xue
- University of Washington School of Medicine, Seattle, Washington
| | - Meghan R Flanagan
- Department of Surgery, University of Washington Medical Center, Seattle, Washington; Department of Surgery, University of Washington Medical Center, Seattle, Washington
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Muralidharan M, Clapp JT, Pulos BP, Diraviam SP, Baranov DY, Gordon EKB, Lane-Fall MB. How does training in anesthesia residency shape residents' approaches to patient care handoffs? A single-center qualitative interview study. BMC MEDICAL EDUCATION 2018; 18:271. [PMID: 30458779 PMCID: PMC6245869 DOI: 10.1186/s12909-018-1387-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/24/2018] [Accepted: 11/14/2018] [Indexed: 06/09/2023]
Abstract
BACKGROUND Handoffs are a complex procedure whose success relies on mutual discussion rather than simple information transfer. Particularly among trainees, handoffs present major opportunities for medical error. Previous research has explored best practices and pitfalls in general handoff education but has not discussed barriers specific to anesthesiology residents. This study characterizes the experiences of residents in anesthesiology as they learn handoff technique in order to inform strategies for teaching this important component of perioperative care. METHODS In 2016, we conducted a semi-structured interview study of 30 anesthesia residents across all three postgraduate years at a major academic hospital. Interviews were coded by two coders using a grounded theory approach and an iterative process designed to enhance reliability and validity. RESULTS Residents cited lack of consistency as a major impediment to proper handoff education. They found the impact of lectures and written materials to be limited. The level of guidance and direction they received from one-to-one attendings was described as highly variable. Residents' comfort in executing handoffs was heavily dependent on location and situation. They felt that coordination among the parties involved in the handoff was difficult to achieve, causing confusion about the importance of handoffs as well as proper protocol. Finally, residents offered opinions on when handoff education should occur during the residency and had several recommendations for its improving, including standardization of key handoff topics. CONCLUSIONS In a single center study of anesthesiology resident handoff education, residents exhibited confusion related to a perceived disconnect between the stated importance of effective handoffs and a lack of consensus on proper handoff technique. Standardization of curriculum and framing expectations has the potential to enhance resident handoff training in academic anesthesia departments.
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Affiliation(s)
- Madhavi Muralidharan
- Department of Anesthesiology and Critical Care, Perelman School of Medicine, University of Pennsylvania, 423 Guardian Drive, 309 Blockley Hall, Philadelphia, PA 19104 USA
- Penn Center for Perioperative Outcomes Research and Transformation, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA USA
| | - Justin T. Clapp
- Department of Anesthesiology and Critical Care, Perelman School of Medicine, University of Pennsylvania, 423 Guardian Drive, 309 Blockley Hall, Philadelphia, PA 19104 USA
- Penn Center for Perioperative Outcomes Research and Transformation, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA USA
| | - Bridget Perrin Pulos
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, MN USA
| | - Sushmitha P. Diraviam
- Department of Anesthesiology and Critical Care, Perelman School of Medicine, University of Pennsylvania, 423 Guardian Drive, 309 Blockley Hall, Philadelphia, PA 19104 USA
| | - Dimitry Y. Baranov
- Department of Anesthesiology and Critical Care, Perelman School of Medicine, University of Pennsylvania, 423 Guardian Drive, 309 Blockley Hall, Philadelphia, PA 19104 USA
| | - Emily K. B. Gordon
- Department of Anesthesiology and Critical Care, Perelman School of Medicine, University of Pennsylvania, 423 Guardian Drive, 309 Blockley Hall, Philadelphia, PA 19104 USA
| | - Meghan B. Lane-Fall
- Department of Anesthesiology and Critical Care, Perelman School of Medicine, University of Pennsylvania, 423 Guardian Drive, 309 Blockley Hall, Philadelphia, PA 19104 USA
- Penn Center for Perioperative Outcomes Research and Transformation, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA USA
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Pollack TA, Illuri V, Khorzad R, Aleppo G, Johnson Oakes D, Holl JL, Wallia A. Risk assessment of the hospital discharge process of high-risk patients with diabetes. BMJ Open Qual 2018; 7:e000224. [PMID: 29862328 PMCID: PMC5976096 DOI: 10.1136/bmjoq-2017-000224] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2017] [Revised: 03/06/2018] [Accepted: 04/08/2018] [Indexed: 12/15/2022] Open
Abstract
Objectives Describe the application of a risk assessment to identify failures in the hospital discharge process of a high-risk patient group, liver transplant (LT) recipients with diabetes mellitus (DM) and/or hyperglycaemia who require high-risk medications. Design A Failure Modes, Effects and Criticality Analysis (FMECA) of the hospital discharge process of LT recipients with DM and/or hyperglycaemia who required DM education and training before discharge was conducted using information from clinicians, patients and data extraction from the electronic health records (EHR). Failures and their causes were identified and the frequency and characteristics (harm, detectability) of each failure were assigned using a score of low/best (1) to high/worst (10); a Criticality Index (CI=Harm×Frequency) and a Risk Priority Number (RPN=Harm×Frequency×Detection) were also calculated. Setting An academic, tertiary care centre in Chicago, Illinois. Participants Healthcare providers (N=31) including physicians (n= 6), advanced practice providers (n=12), nurses (n=6), pharmacists (n= 4), staff (n=3) and patients (n=6) and caregivers (n=3) participated in the FMECA; EHR data for LT recipients with DM or hyperglycaemia (N=100) were collected. Results Of 78 identified failures, the most critical failures (n=15; RPNs=700, 630, 560; CI=70) were related to variability in delivery of diabetes education and training, care coordination and medication prescribing patterns of providers. Underlying causes included timing of patient education, lack of assessment of patients’ knowledge and industry-level design failures of healthcare products (eg, EHR, insulin pen). Conclusion Most identified critical failures are preventable and suggest the need for the design of interventions, informed by the failures identified by this FMECA, to mitigate safety risks and improve outcomes of high-risk patient populations.
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Affiliation(s)
- Teresa A Pollack
- Division of Endocrinology, Metabolism, and Molecular Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Vidhya Illuri
- Division of Endocrinology, Metabolism, and Molecular Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Rebeca Khorzad
- Center for Health Care Studies, Institute for Public Health and Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Grazia Aleppo
- Division of Endocrinology, Metabolism, and Molecular Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Diana Johnson Oakes
- Division of Endocrinology, Metabolism, and Molecular Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Jane L Holl
- Center for Health Care Studies, Institute for Public Health and Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Amisha Wallia
- Division of Endocrinology, Metabolism, and Molecular Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA.,Center for Health Care Studies, Institute for Public Health and Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
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Merkel MJ, von Dossow V, Zwißler B. [Structured patient handovers in perioperative medicine : Rationale and implementation in clinical practice]. Anaesthesist 2018; 66:396-403. [PMID: 28523364 DOI: 10.1007/s00101-017-0320-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Clear and consistent communication is pivotal for well-functioning teamwork, in operating theatres as well as intensive care units. However, patient handovers significantly vary between specialties and locations. If communication is not well structured, it might increase the risk for mishaps and malpractice. Therefore, implementing structured handover protocols is pivotal. The perioperative setting is a high-risk environment that is prone to communication failures due to operational design (frequent change of shift due to working time restrictions) and a high work load and multitasking (operating room management, short surgery times, concurrent emergencies). Hence teamwork in the operating room and intensive care unit requires clear and consistent communication. In the perioperative setting, the patient is transferred several times: from the ward to operating room, to recovery, intermediate care/intensive care unit and back to normal ward. This necessitates multiple handovers. Since 2005, the World Health Organization (WHO) requests a structured handover concept that processes all relevant information in a predefined order. The SBAR concept (situation, background, assessment, recommendation) is an intuitive communication concept that can improve quality of patient handovers. This underlines the clinical relevance of a structured handover concept that leads to improved outcomes for every patient.In this review, basic measures for a clear and consistent communication are presented. These are pivotal for an effective teamwork and for ensuing patient safety. Furthermore, we will focus on possibilities to implement structured approaches but also on potential barriers of implementation. Communication failure among different health care providers can be identified more easily and hopefully can be eliminated.
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Affiliation(s)
- M J Merkel
- Klinik für Anaesthesiologie, Ludwig-Maximilians-Universität München, München, Deutschland
| | - V von Dossow
- Klinik für Anaesthesiologie, Ludwig-Maximilians-Universität München, München, Deutschland.
| | - B Zwißler
- Klinik für Anaesthesiologie, Ludwig-Maximilians-Universität München, München, Deutschland
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Goch AM, Karia R, Taormina D, Kalet A, Zuckerman J, Egol KA, Phillips D. A Comparison of Assessment Tools: Is Direct Observation an Improvement Over Objective Structured Clinical Examinations for Communications Skills Evaluation? J Grad Med Educ 2018; 10:219-222. [PMID: 29686764 PMCID: PMC5901804 DOI: 10.4300/jgme-d-17-00587.1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2017] [Revised: 10/16/2017] [Accepted: 12/05/2017] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND Evaluation of resident physicians' communications skills is a challenging task and is increasingly accomplished with standardized examinations. There exists a need to identify the effective, efficient methods for assessment of communications skills. OBJECTIVE We compared objective structured clinical examination (OSCE) and direct observation as approaches for assessing resident communications skills. METHODS We conducted a retrospective cohort analysis of orthopaedic surgery resident physicians at a single tertiary care academic institution, using the Institute for Healthcare Communication "4 Es" model for effective communication. Data were collected between 2011 and 2015. A total of 28 residents, each with OSCE and complete direct observation assessment checklists, were included in the analysis. Residents were included if they had 1 OSCE assessment and 2 or more complete direct observation assessments. RESULTS There were 28 of a possible 59 residents (47%) included. A total of 89% (25 of 28) of residents passed the communications skills OSCE; only 54% (15 of 28) of residents passed the direct observation communications assessment. There was a positive, moderate correlation between OSCE and direct observation scores overall (r = 0.415, P = .028). There was no agreement between OSCE and direct observation in categorizing residents into passing and failing scores (κ = 0.205, P = .16), after adjusting for chance agreement. CONCLUSIONS Our results suggest that OSCE and direct observation tools provide different insights into resident communications skills (simulation of rare and challenging situations versus real-life daily encounters), and may provide useful perspectives on resident communications skills in different contexts.
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Önler E, Yildiz T, Bahar S. Evaluation of the communication skills of operating room staff. ACTA ACUST UNITED AC 2018. [DOI: 10.1016/j.xjep.2017.11.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Parand A, Faiella G, Franklin BD, Johnston M, Clemente F, Stanton NA, Sevdalis N. A prospective risk assessment of informal carers' medication administration errors within the domiciliary setting. ERGONOMICS 2018; 61:104-121. [PMID: 28498024 DOI: 10.1080/00140139.2017.1330491] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Increasingly, medication is being administered at home by family and friends of the care-recipient. This study aims to identify and analyse risks associated with potential drug administration errors made by informal carers at home. We mapped medication administration at home with a multidisciplinary team that included carers, health care professionals and patients. Evidence-based risk-analysis methodologies were applied: Healthcare Failure Modes and Effect Analysis (HFMEA), Systematic Human Error Reduction and Prediction Analysis (SHERPA) and Systems-Theoretic Accident Model and Processes (STAMP). The process of administration comprises seven sub-processes. Thirty-four possible failure modes were identified and six of these were rated as high risk. These highlighted that medications may be given with a wrong dose, stored incorrectly, not discontinued as instructed, not recorded, or not ordered on time, and often caused by communication and support problems. Combined risk analyses contributed unique information helpful to better understand the medication administration risks and causes within homecare. Practitioner Summary: Increasingly, medication is being administered at home by family and friends of the care-recipient. This study identifies risks associated with potential drug administration errors made by informal carers at home through consensus-based quantitative techniques. The different analyses contribute unique information helpful to better understand the administration risks and causes.
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Affiliation(s)
- Anam Parand
- a Department of Social Psychology , London School of Economics , London , UK
- b The National Institute for Health Research (NIHR) Imperial Patient Safety Translational Research Centre, Imperial College London , London , UK
| | - Giuliana Faiella
- c National Centre of Research, Institute of Bio-structure and Bio-imaging, University of Naples , Rome , Italy
| | - Bryony Dean Franklin
- d Centre for Medication Safety and Service Quality, Pharmacy Department , Imperial College Healthcare NHS Trust/UCL School of Pharmacy , London , UK
| | - Maximilian Johnston
- b The National Institute for Health Research (NIHR) Imperial Patient Safety Translational Research Centre, Imperial College London , London , UK
| | - Fabrizio Clemente
- c National Centre of Research, Institute of Bio-structure and Bio-imaging, University of Naples , Rome , Italy
| | - Neville A Stanton
- e Engineering and the Environment , University of Southampton , Southampton , UK
| | - Nick Sevdalis
- f Centre for Implementation Science , King's College London , London , UK
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Hall M, Robertson J, Merkel M, Aziz M, Hutchens M. A Structured Transfer of Care Process Reduces Perioperative Complications in Cardiac Surgery Patients. Anesth Analg 2017; 125:477-482. [DOI: 10.1213/ane.0000000000002020] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Malley AM, Young GJ. A qualitative study of patient and provider experiences during preoperative care transitions. J Clin Nurs 2017; 26:2016-2024. [PMID: 27706872 PMCID: PMC5495099 DOI: 10.1111/jocn.13610] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/22/2016] [Indexed: 12/15/2022]
Abstract
AIMS AND OBJECTIVES To explore the issues and challenges of care transitions in the preoperative environment. BACKGROUND Ineffective transitions play a role in a majority of serious medical errors. There is a paucity of research related to the preoperative arena and the multiple inherent transitions in care that occur there. DESIGN Qualitative descriptive design was used. METHODS Semistructured interviews were conducted in a 975-bed academic medical centre. RESULTS A total of 30 providers and 10 preoperative patients participated. Themes that arose were as follows: (1) need for clarity of purpose of preoperative care, (2) care coordination, (3) interprofessional boundaries of care and (4) inadequate time and resources. CONCLUSION Effective transitions in the preoperative environment require that providers bridge scope of practice barriers to promote good teamwork. Preoperative care that is a product of well-informed providers and patients can improve the entire perioperative care process and potentially influence postoperative patient outcomes. RELEVANCE TO CLINICAL PRACTICE Nurses are well positioned to bridge the gaps within transitions of care and accordingly affect health outcomes.
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Affiliation(s)
- Ann M Malley
- School of Nursing, New Courtland Center for Transitions and Health, University of Pennsylvania, Philadelphia, PA, USA
- Massachusetts General Hospital, Boston, MA, USA
| | - Gary J Young
- Northeastern University Center for Health Policy and Healthcare Research, Boston, MA, USA
- Strategic Management and Healthcare Systems, Northeastern University, D'Amore-McKim School of Business and Bouve College of Health Sciences, Boston, MA, USA
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Turunen E, Miettinen M, Setälä L, Vehviläinen-Julkunen K. An integrative review of a preoperative nursing care structure. J Clin Nurs 2017; 26:915-930. [DOI: 10.1111/jocn.13448] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/17/2016] [Indexed: 11/27/2022]
Affiliation(s)
- Elina Turunen
- Department of Nursing Science; University of Eastern Finland; Kuopio Finland
| | | | | | - Katri Vehviläinen-Julkunen
- Department of Nursing Science; University of Eastern Finland; Kuopio Finland
- Kuopio University Hospital; Kuopio Finland
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Harl FNR, Saucke MC, Greenberg CC, Ingraham AM. Assessing written communication during interhospital transfers of emergency general surgery patients. J Surg Res 2017. [PMID: 28624064 DOI: 10.1016/j.jss.2017.02.069] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
BACKGROUND Poor communication causes fragmented care. Studies of transitions of care within a hospital and on discharge suggest significant communication deficits. Communication during transfers between hospitals has not been well studied. We assessed the written communication provided during interhospital transfers of emergency general surgery patients. We hypothesized that patients are transferred with incomplete documentation from referring facilities. METHODS We performed a retrospective review of written communication provided during interhospital transfers to our emergency department (ED) from referring EDs for emergency general surgical evaluation between January 1, 2014 and January 1, 2016. Elements of written communication were abstracted from referring facility documents scanned into the medical record using a standardized abstraction protocol. Descriptive statistics summarized the information communicated. RESULTS A total of 129 patients met inclusion criteria. 87.6% (n = 113) of charts contained referring hospital documents. 42.5% (n = 48) were missing history and physicals. Diagnoses were missing in 9.7% (n = 11). Ninety-one computed tomography scans were performed; among 70 with reads, final reads were absent for 70.0% (n = 49). 45 ultrasounds and x-rays were performed; among 27 with reads, final reads were missing for 80.0% (n = 36). Reasons for transfer were missing in 18.6% (n = 21). Referring hospital physicians outside the ED were consulted in 32.7% (n = 37); consultants' notes were absent in 89.2% (n = 33). In 12.4% (n = 14), referring documents arrived after the patient's ED arrival and were not part of the original documentation provided. CONCLUSIONS This study documents that information important to patient care is often missing in the written communication provided during interhospital transfers. This gap affords a foundation for standardizing provider communication during interhospital transfers.
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Affiliation(s)
- Felicity N R Harl
- Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - Megan C Saucke
- Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - Caprice C Greenberg
- Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - Angela M Ingraham
- Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin.
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Magee M, Bardsley JK, Wallia A, Smith KM. Transitioning the Adult with Type 2 Diabetes From the Acute to Chronic Care Setting: Strategies to Support Pragmatic Implementation Success. Curr Diab Rep 2017; 17:6. [PMID: 28138821 DOI: 10.1007/s11892-017-0830-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Scientific evidence is available to guide the how to of medications management when patients with diabetes are hospitalized or present to the Emergency Department. However, few clinical trials in the diabetes field have addressed the execution, coupled with established implementation effectiveness evaluation frameworks to help inform and assess implementation practices to support the transition in care. These deficiencies may be overcome by (1) applying the principles of implementation and delivery systems science; (2) engaging the principles of human factors (HF) throughout the design, development, and evaluation planning activities; and (3) utilizing mixed methods to design the intervention, workflow processes, and evaluate the intervention for sustainability within existing care delivery models. This article provides a discussion of implementation science and human factors science including an overview of commonly used frameworks which can be applied to structure design and implementation of sustainable and generalizable interventions.
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Affiliation(s)
- Michelle Magee
- MedStar Diabetes Institute, 100 Irving St, NW, #4114, Washington, DC, USA.
- MedStar Health Research Institute, 6525 Belcrest Rd., Ste. 700, Hyattsville, MD, 20782, USA.
- Georgetown University School of Medicine and Healthcare Sciences, Washington, DC, USA.
| | - Joan K Bardsley
- MedStar Health Research Institute, 6525 Belcrest Rd., Ste. 700, Hyattsville, MD, 20782, USA
- MedStar Health Corporate Nursing, 6525 Belcrest Rd., Ste. 700, Hyattsville, MD, 20782, USA
| | - Amisha Wallia
- Northwestern University Feinberg School of Medicine, Suite 530 645N, Michigan Avenue, Chicago, IL, 60611, USA
| | - Kelly M Smith
- MedStar Health Research Institute, 6525 Belcrest Rd., Ste. 700, Hyattsville, MD, 20782, USA
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Implementing situation-background-assessment-recommendation in an anaesthetic clinic and subsequent information retention among receivers: A prospective interventional study of postoperative handovers. Eur J Anaesthesiol 2016; 33:172-8. [PMID: 26760400 DOI: 10.1097/eja.0000000000000335] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
BACKGROUND Communication errors cause clinical incidents and adverse events in relation to surgery. To ensure proper postoperative patient care, it is essential that personnel remember and recall information given during the handover from the operating theatre to the postanaesthesia care unit. Formalizing the handover may improve communication and aid memory, but research in this area is lacking. OBJECTIVE The objective of this study was to evaluate whether implementing the communication tool Situation-Background-Assessment-Recommendation (SBAR) affects receivers' information retention after postoperative handover. DESIGN A prospective intervention study with an intervention group and comparison nonintervention group, with assessments before and after the intervention. SETTING The postanaesthesia care units of two hospitals in Sweden during 2011 and 2012. PARTICIPANTS Staff involved in the handover between the operating theatre and the postanaesthesia care units within each hospital. INTERVENTION Implementation of the communication tool SBAR in one hospital. MAIN OUTCOME MEASURES The main outcome was the percentage of recalled information sequences among receivers after the handover. Data were collected using both audio-recordings and observations recorded on a study-specific protocol form. RESULTS Preintervention, 73 handovers were observed (intervention group, n = 40; comparison group, n = 33) involving 72 personnel (intervention group, n = 40; comparison group, n = 32). Postintervention, 91 handovers were observed (intervention group, n = 44; comparison group, n = 47) involving 57 personnel (intervention group, n = 31; comparison group, n = 26). In the intervention group, the percentage of recalled information sequences by the receivers increased from 43.4% preintervention to 52.6% postintervention (P = 0.004) and the SBAR structure improved significantly (P = 0.028). In the comparison group, the corresponding figures were 51.3 and 52.6% (P = 0.725) with no difference in SBAR structure. When a linear regression generalised estimating equation model was used to account for confounding influences, we were unable to show a significant difference in the information recalled between the intervention group and the nonintervention group over time. CONCLUSION Compared with the comparison group with no intervention, when SBAR was implemented in an anaesthetic clinic, we were unable to show any improvement in recalled information among receivers following postoperative handover. TRIAL REGISTRATION Current controlled trials http://www.controlled-trials.com Identifier: ISRCTN37251313.
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Halvorson S, Wheeler B, Willis M, Watters J, Eastman J, O'Donnell R, Merkel M. A multidisciplinary initiative to standardize intensive care to acute care transitions. Int J Qual Health Care 2016; 28:615-625. [PMID: 27535085 DOI: 10.1093/intqhc/mzw076] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2016] [Revised: 06/11/2016] [Accepted: 06/15/2016] [Indexed: 11/12/2022] Open
Abstract
QUALITY ISSUE Transfers from intensive care units to acute care units represent a complex care transition for hospitalized patients. Within our institution, variation in transfer practices resulted in unpredictable processes in which patient safety concerns were raised. INITIAL ASSESSMENT Key stakeholders were engaged across the institution. Patient safety ('incident') reports and a staff survey identified safety concerns. CHOICE OF A SOLUTION Using lean methodology, current transfer processes were mapped for the four adult intensive care units and waste was identified. During a summit of key stakeholders an ideal transfer process was conceived and a structured handoff tool (checklist) was developed. A daily management system (DMS) was implemented to monitor adherence. EVALUATION The primary process outcome was adherence to the standardized workflow. Audits at 4, 8, and 12 months after implementation indicated that the checklist was used for 100% of transfers. Secondary outcomes included the percentage of transfers completed within a pre-specified time window of 120 minutes, provider notification of patient arrival on the acute care unit, and staff survey responses assessing adequacy of transfer communication. LESSONS LEARNED Prior work has shown that structuring handoffs can improve patient safety, but the novelty of this project was addressing the transfer process in its entirety, across silos of care. Factors leading to the success of this project were the involvement of key stakeholders across the entire institution early in the project development phase, employment of lean methodology, and implementation of tools to guide workflow adherence and track causes of deviation from the workflow.
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Affiliation(s)
- Stephanie Halvorson
- Division of Hospital Medicine, Oregon Health & Science University, 3181 SW Sam Jackson Park Road, Portland, OR, USA
| | - Brian Wheeler
- Division of Hospital Medicine, Oregon Health & Science University, 3181 SW Sam Jackson Park Road, Portland, OR, USA
| | - Marge Willis
- Division of Hospital Medicine, Oregon Health & Science University, 3181 SW Sam Jackson Park Road, Portland, OR, USA
| | - Jennifer Watters
- Division of Hospital Medicine, Oregon Health & Science University, 3181 SW Sam Jackson Park Road, Portland, OR, USA.,Department of Surgery at Oregon Health & Science University, 3303 SW Bond Ave, Portland, OR, USA
| | - Jamie Eastman
- Division of Hospital Medicine, Oregon Health & Science University, 3181 SW Sam Jackson Park Road, Portland, OR, USA
| | - Randy O'Donnell
- Division of Hospital Medicine, Oregon Health & Science University, 3181 SW Sam Jackson Park Road, Portland, OR, USA
| | - Matthias Merkel
- Division of Hospital Medicine, Oregon Health & Science University, 3181 SW Sam Jackson Park Road, Portland, OR, USA.,Department of Anesthesiology and Perioperative Medicine at Oregon Health & Science University, 3181 S.W.Sam Jackson Park Road, Portland, OR, USA
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Taleghani YM, Rezaei F, Sheikhbardsiri H. Risk assessment of the emergency processes: Healthcare failure mode and effect analysis. World J Emerg Med 2016; 7:97-105. [PMID: 27313803 DOI: 10.5847/wjem.j.1920-8642.2016.02.003] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Ensuring about the patient's safety is the first vital step in improving the quality of care and the emergency ward is known as a high-risk area in treatment health care. The present study was conducted to evaluate the selected risk processes of emergency surgery department of a treatment-educational Qaem center in Mashhad by using analysis method of the conditions and failure effects in health care. METHODS In this study, in combination (qualitative action research and quantitative cross-sectional), failure modes and effects of 5 high-risk procedures of the emergency surgery department were identified and analyzed according to Healthcare Failure Mode and Effects Analysis (HFMEA). To classify the failure modes from the "nursing errors in clinical management model (NECM)", the classification of the effective causes of error from "Eindhoven model" and determination of the strategies to improve from the "theory of solving problem by an inventive method" were used. To analyze the quantitative data of descriptive statistics (total points) and to analyze the qualitative data, content analysis and agreement of comments of the members were used. RESULTS In 5 selected processes by "voting method using rating", 23 steps, 61 sub-processes and 217 potential failure modes were identified by HFMEA. 25 (11.5%) failure modes as the high risk errors were detected and transferred to the decision tree. The most and the least failure modes were placed in the categories of care errors (54.7%) and knowledge and skill (9.5%), respectively. Also, 29.4% of preventive measures were in the category of human resource management strategy. CONCLUSION "Revision and re-engineering of processes", "continuous monitoring of the works", "preparation and revision of operating procedures and policies", "developing the criteria for evaluating the performance of the personnel", "designing a suitable educational content for needs of employee", "training patients", "reducing the workload and power shortage", "improving team communication" and "preventive management of equipment's" were on the agenda as the guidelines.
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Affiliation(s)
- Yasamin Molavi Taleghani
- Health Management and Economics Research Center, School of Management and Medical Information, Isfahan University of Medical Science, Isfahan, Iran
| | - Fatemeh Rezaei
- Health Management and Economics Research Center, School of Management and Medical Information, Isfahan University of Medical Science, Isfahan, Iran
| | - Hojat Sheikhbardsiri
- Department of Disaster and Emergency Medical Management Center, Kerman University of Medical Science, Kerman, Iran
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Robinson NL. Promoting Patient Safety With Perioperative Hand-off Communication. J Perianesth Nurs 2016; 31:245-53. [DOI: 10.1016/j.jopan.2014.08.144] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2013] [Revised: 07/25/2014] [Accepted: 08/10/2014] [Indexed: 11/25/2022]
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The role of the nurse and the preoperative assessment in patient transitions. AORN J 2016; 102:181.e1-9. [PMID: 26227526 DOI: 10.1016/j.aorn.2015.06.004] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2013] [Revised: 05/15/2014] [Accepted: 06/15/2015] [Indexed: 11/21/2022]
Abstract
Transitions in care in the perioperative environment are numerous and should be considered high-risk endeavors. The preoperative area is the first transition in care for a surgical patient and should be considered a critical dimension of care transition. The purposes of this study were to identify nursing's contributions to transitions in care in the perioperative environment and to identify the role of the preoperative assessment in this transition. Qualitative descriptive design was used. Focus groups were conducted with 24 nurses in a 975-bed medical center. The themes that arose in the focus groups were: (1) understanding patient vulnerabilities, (2) multidimensional communication, (3) managing patients' expectations, and (4) nursing's role in compensating for gaps. We conclude that the nurse's role in the preoperative assessment during the transition of preoperative care is that of advocate who identifies the patient's needs and risk factors that may be affected by the surgical experience. This study suggests that the nursing preoperative assessment can be useful in identifying and defining patients' risk factors not just for surgery, but for the entire perioperative care trajectory.
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Gupta AK, Stewart SK, Cottell K, McCulloch GAJ, Babidge W, Maddern GJ. Potentially avoidable issues in neurosurgical mortality cases in Australia: identification and improvements. ANZ J Surg 2016; 87:86-91. [DOI: 10.1111/ans.13542] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2015] [Revised: 02/14/2016] [Accepted: 02/22/2016] [Indexed: 11/29/2022]
Affiliation(s)
- Aashray K. Gupta
- South Australian Audit of Perioperative Mortality (SAAPM); Royal Australasian College of Surgeons; Adelaide South Australia Australia
| | - Sasha K. Stewart
- South Australian Audit of Perioperative Mortality (SAAPM); Royal Australasian College of Surgeons; Adelaide South Australia Australia
| | - Kimberley Cottell
- South Australian Audit of Perioperative Mortality (SAAPM); Royal Australasian College of Surgeons; Adelaide South Australia Australia
| | - Glenn A. J. McCulloch
- South Australian Audit of Perioperative Mortality (SAAPM); Royal Australasian College of Surgeons; Adelaide South Australia Australia
| | - Wendy Babidge
- University of Adelaide Discipline of Surgery; The Queen Elizabeth Hospital; Adelaide South Australia Australia
- Australian and New Zealand Audit of Surgical Mortality (ANZASM); Royal Australasian College of Surgeons; Adelaide South Australia Australia
| | - Guy J. Maddern
- University of Adelaide Discipline of Surgery; The Queen Elizabeth Hospital; Adelaide South Australia Australia
- Australian and New Zealand Audit of Surgical Mortality (ANZASM); Royal Australasian College of Surgeons; Adelaide South Australia Australia
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Surgical Team Stability and Risk of Sharps-Related Blood and Body Fluid Exposures During Surgical Procedures. Infect Control Hosp Epidemiol 2016; 37:512-8. [DOI: 10.1017/ice.2016.12] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVETo explore whether surgical teams with greater stability among their members (ie, members have worked together more in the past) experience lower rates of sharps-related percutaneous blood and body fluid exposures (BBFE) during surgical procedures.DESIGNA 10-year retrospective cohort study.SETTINGA single large academic teaching hospital.PARTICIPANTSSurgical teams participating in surgical procedures (n=333,073) performed during 2001–2010 and 2,113 reported percutaneous BBFE were analyzed.METHODSA social network measure (referred to as the team stability index) was used to quantify the extent to which surgical team members worked together in the previous 6 months. Poisson regression was used to examine the effect of team stability on the risk of BBFE while controlling for procedure characteristics and accounting for procedure duration. Separate regression models were generated for percutaneous BBFE involving suture needles and those involving other surgical devices.RESULTSThe team stability index was associated with the risk of percutaneous BBFE (adjusted rate ratio, 0.93 [95% CI, 0.88–0.97]). However, the association was stronger for percutaneous BBFE involving devices other than suture needles (adjusted rate ratio, 0.92 [95% CI, 0.85–0.99]) than for exposures involving suture needles (0.96 [0.88–1.04]).CONCLUSIONSGreater team stability may reduce the risk of percutaneous BBFE during surgical procedures, particularly for exposures involving devices other than suture needles. Additional research should be conducted on the basis of primary data gathered specifically to measure qualities of relationships among surgical team personnel.Infect Control Hosp Epidemiol 2016;37:512–518
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Chopra S, Hachach-Haram N, Baird DLH, Elliott K, Lykostratis H, Renton S, Shalhoub J. Integrated Patient Coordination System (IntPaCS): a bespoke tool for surgical patient management. Postgrad Med J 2016; 92:208-16. [DOI: 10.1136/postgradmedj-2015-133713] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2015] [Accepted: 12/07/2015] [Indexed: 11/03/2022]
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Ahmed K, Anderson O, Jawad M, Tierney T, Darzi A, Athanasiou T, Hanna GB. Design and validation of the surgical ward round assessment tool: a quantitative observational study. Am J Surg 2015; 209:682-688.e2. [DOI: 10.1016/j.amjsurg.2014.08.017] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2014] [Revised: 07/22/2014] [Accepted: 08/04/2014] [Indexed: 10/23/2022]
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Towards the next frontier for simulation-based training: full-hospital simulation across the entire patient pathway. Ann Surg 2015; 260:252-8. [PMID: 24263325 DOI: 10.1097/sla.0000000000000305] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To evaluate the efficacy of an entire hospital simulation in imparting skills to expert healthcare providers, encompassing both retention and transfer to clinical practice. BACKGROUND Studies demonstrating the effectiveness of simulation do not concentrate upon expert multidisciplinary teams. Moreover, their focus is confined to a single clinical setting, thereby not considering the complex interactions across multiple hospital departments. METHODS A total of 288 participants (Attending surgeons, anesthesiologists, physicians, and nurses) completed this largest simulation study to date, set in the UK Defence Medical Services' Hospital Simulator and the conflict zone in Afghanistan. The simulator termed "Hospital Exercise" (HOSPEX) is a fully immersive live-in simulation experience that covers the entire environment of a military hospital with all departments. Participants undertook a 3-day training program within HOSPEX before deployment to war zones. Primary outcome measures were assessed with IMPAcT (the Imperial Military Personnel Assessment Tool). IMPAcT measures crisis management, trauma care, hospital environment, operational readiness, and transfer of skills to civilian practice. Reliability, skills learning, and retention in the conflict zone were assessed statistically. RESULTS Reliability in skills assessment was excellent (Cronbach α: nontechnical skills = 0.87-0.94; environment/patient skills = 0.83-0.95). Pre/post-HOSPEX comparisons revealed significant improvements in decision making (M = 4.98, SD = 1.20 to M = 5.39, SD = 0.91; P = 0.03), situational awareness (M = 5.44, SD = 1.04 to M = 5.74, SD = 0.92; P = 0.01), trauma care (M = 5.53, SD = 1.23 to M = 5.85, SD = 1.09; P = 0.05), and knowledge of hospital environment (M = 5.19, SD = 1.17 to M = 5.42, SD = 0.97; P = 0.04). No skills decayed over time when assessed several months later in the real conflict zone. All skills transferred to civilian clinical practice. CONCLUSIONS This is the first study to describe the value of a full-hospital simulation across the entire patient pathway. Such macrosimulations may be the way forward for integrating the complex training needs of expert clinicians and testing organizational "fitness for purpose" of entire hospitals.
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Petrovic MA, Aboumatar H, Scholl AT, Gill RS, Krenzischek DA, Camp MS, Senger CM, Deng Y, Chang TY, Xie Y, Jurdi ZR, Martinez EA. The perioperative handoff protocol: evaluating impacts on handoff defects and provider satisfaction in adult perianesthesia care units. J Clin Anesth 2014; 27:111-9. [PMID: 25541368 DOI: 10.1016/j.jclinane.2014.09.007] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2013] [Revised: 08/24/2014] [Accepted: 09/03/2014] [Indexed: 11/30/2022]
Abstract
STUDY OBJECTIVE To evaluate a new perioperative handoff protocol in the adult perianesthesia care units (PACUs). DESIGN Prospective, unblinded cross-sectional study. SETTING Perianesthesia care unit in a tertiary care facility serving 55,000 patients annually. PATIENTS One hundred three surgery patients. INTERVENTIONS During a 4-week preintervention phase, 53 perioperative handoffs were observed, and data were collected daily by a trained observer. Educational sessions were conducted to train perioperative practitioners on the new protocol. Two weeks after implementation, 50 consecutive handoffs were observed, and practitioners were surveyed with the same methodology as in the preintervention phase. MEASUREMENTS Type of information shared, type and duration of procedure, total duration of handoff, number and type of providers at the bedside, number of report interruptions, environmental distractions, and any other disruptive events. Observers also tracked technical/equipment problems to include malfunctioning or compromised operation of medical equipment, such as the cardiac monitor, transducer, oxygen tank, and pulse oximeter. MAIN RESULTS A total of 103 handoffs were observed (53 preintervention and 50 postintervention). The mean number of defects per handoff decreased from 9.92 to 3.68 (P < .01). The mean number of missed information items from the surgery report decreased from 7.57 to 1.2 items per handoff and from 2.02 to 0.94 (P < .01) for the anesthesia report. Technical defects reported by unit nurses decreased from 0.34 to 0.10 (P = .04). Verbal reports delivered by surgeons increased from 21.2% to 83.3%. Although the mean duration of handoffs increased by 2 minutes (P = .01), the average time from patient arrival at PACU to handoff start was reduced by 1.5 minutes (P = .01). Satisfaction with the handoff improved significantly among PACU nurses. CONCLUSIONS The perioperative handoff protocol implementation was associated with improved information sharing and reduced handoff defects.
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Affiliation(s)
- Michelle A Petrovic
- Department of Anesthesiology and Critical Care Medicine, The Johns Hopkins University School of Medicine, Baltimore, MD, USA.
| | - Hanan Aboumatar
- Department of Medicine, Education and Research Associate, Armstrong Institute for Safety and Quality, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | | | - Randeep S Gill
- The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | | | - Melissa S Camp
- Department of Surgery, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Carolyn M Senger
- The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Yi Deng
- The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | | | - Yanjun Xie
- The Johns Hopkins University, Baltimore, MD, USA
| | | | - Elizabeth A Martinez
- Department of Anesthesiology and Critical Care Medicine, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
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Pukenas EW, Dodson G, Deal ER, Gratz I, Allen E, Burden AR. Simulation-based education with deliberate practice may improve intraoperative handoff skills: a pilot study. J Clin Anesth 2014; 26:530-8. [DOI: 10.1016/j.jclinane.2014.03.015] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2012] [Revised: 03/10/2014] [Accepted: 03/11/2014] [Indexed: 01/22/2023]
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Tibbs SM, Moss J. Promoting teamwork and surgical optimization: combining TeamSTEPPS with a specialty team protocol. AORN J 2014; 100:477-88. [PMID: 25443118 DOI: 10.1016/j.aorn.2014.01.028] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2013] [Revised: 11/21/2013] [Accepted: 01/01/2014] [Indexed: 10/24/2022]
Abstract
This quality improvement project was a 300-day descriptive preintervention and postintervention comparison consisting of a convenience sample of 18 gynecology surgical team members. We administered the Team Strategies & Tools to Enhance Performance and Patient Safety (TeamSTEPPS®) Teamwork Perception Questionnaire to measure the perception of teamwork. In addition, we collected data regarding rates of compliance (ie, huddle, time out) and measurable surgical procedure times. Results showed a statistically significant increase in the number of team members present for each procedure, 2.34 μ before compared with 2.61 μ after (P = .038), and in the final time-out (FTO) compliance as a result of a clarification of the definition of FTO, 1.05 μ before compared with 1.18 μ after (P = .004). Additionally, there was improvement in staff members' perception of teamwork. The implementation of team training, protocols, and algorithms can enhance surgical optimization, communication, and work relationships.
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LeBlanc J, Donnon T, Hutchison C, Duffy P. Development of an orthopedic surgery trauma patient handover checklist. Can J Surg 2014; 57:8-14. [PMID: 24461220 DOI: 10.1503/cjs.025912] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
BACKGROUND In surgery, preoperative handover of surgical trauma patients is a process that must be made as safe as possible. We sought to determine vital clinical information to be transferred between patient care teams and to develop a standardized handover checklist. METHODS We conducted standardized small-group interviews about trauma patient handover. Based on this information, we created a questionnaire to gather perspectives from all Canadian Orthopaedic Association (COA) members about which topics they felt would be most important on a handover checklist. We analyzed the responses to develop a standardized handover checklist. RESULTS Of the 1106 COA members, 247 responded to the questionnaire. The top 7 topics felt to be most important for achieving patient safety in the handover were comorbidities, diagnosis, readiness for the operating room, stability, associated injuries, history/mechanism of injury and outstanding issues. The expert recommendations were to have handover completed the same way every day, all appropriate radiographs available, adequate time, all appropriate laboratory work and more time to spend with patients with more severe illness. CONCLUSION Our main recommendations for safe handover are to use standardized checklists specific to the patient and site needs. We provide an example of a standardized checklist that should be used for preoperative handovers. To our knowledge, this is the first checklist for handover developed by a group of experts in orthopedic surgery, which is both manageable in length and simple to use.
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Affiliation(s)
- Justin LeBlanc
- The Department of Orthopaedic Surgery, Faculty of Medicine, University of Calgary, Calgary, Alta
| | - Tyrone Donnon
- The Medical Education and Research Unit and Department of Community Health Sciences, Faculty of Medicine, University of Calgary, Calgary, Alta
| | - Carol Hutchison
- The Department of Surgery, Faculty of Medicine, University of Calgary, Calgary, Alta
| | - Paul Duffy
- The Department of Surgery, Faculty of Medicine, University of Calgary, Calgary, Alta
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Montero Ruiz E, López Álvarez J. [Patient handoffs: Problems and solutions]. REVISTA DE CALIDAD ASISTENCIAL : ORGANO DE LA SOCIEDAD ESPANOLA DE CALIDAD ASISTENCIAL 2014; 29:116-117. [PMID: 24582534 DOI: 10.1016/j.cali.2013.09.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/27/2013] [Accepted: 09/09/2013] [Indexed: 06/03/2023]
Affiliation(s)
- E Montero Ruiz
- Servicio de Medicina Interna, Hospital Universitario Príncipe de Asturias, Alcalá de Henares,Madrid, España.
| | - J López Álvarez
- Servicio de Medicina Interna, Hospital Universitario Príncipe de Asturias, Alcalá de Henares,Madrid, España
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García-Sánchez MJ, Fernández-Guerrero C, López-Toribio P, Bueno-Cavanillas A, Prieto-Cuéllar M, Guzmán-Malpica EM, Cuevas-Valenzuela P, Moreno-Abril E, Lara-Ramos P. [Quality of the anesthesiologist written record during the transfer of postoperative patients: Influence of implementing a structured communication tool]. ACTA ACUST UNITED AC 2013; 61:6-14. [PMID: 24290786 DOI: 10.1016/j.redar.2013.09.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2013] [Revised: 08/31/2013] [Accepted: 09/20/2013] [Indexed: 10/26/2022]
Abstract
OBJECTIVE The lack of communication is a major cause of health care errors, especially during patient transfer between practitioners and/or healthcare units, when standardization of communication is a recommended practice. In our study we wanted to assess whether the application of the structured communication SBAR tool could influence the quality of the information written on the progress sheet by the anesthesiologist involved in the transfer of the patient after surgery. MATERIAL AND METHODS This is an observational, retrospective, randomized, quality review of the written record made by the anesthesiologist during the transfer of patients from the surgical area to the postoperative recovery unit, by applying a validated list. We evaluated three observation periods: a control period of two months in 2011 (preSBAR) and a second period of two months in 2012 (postSBAR); in the latter two groups of patients were transferred (postSBAR +) or without SBAR (postSBAR-). RESULTS The strength of agreement between raters obtained an intraclass correlation coefficient of 0.8459 (p <0.001). There were significant differences in the study group, with highest average score in the group with SBAR (postSBAR + group: mean ± SD 7.56 ± 1.20 versus postSBAR-group: 5.41 ± 2.98, p <0.001) and depending on the anesthesiologist responsible for the intervention participated in the study (mean ± SD: 7.00 ± 1.99, compared to 4.81 ± 3.24 in the non-participants, p <0.001). CONCLUSIONS There was an improvement in the quality of written records made in 2012 during the implementation of the SBAR, without the actual application of this instrument appearing to influence it. The anesthesiologists that were involved in new forms of patient safety were also those who made written records of highest quality.
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Affiliation(s)
- M J García-Sánchez
- Servicio Anestesiología, Reanimación y Terapia del Dolor, Complejo Hospitalario de Granada, Granada, España.
| | - C Fernández-Guerrero
- Servicio Anestesiología, Reanimación y Terapia del Dolor, Complejo Hospitalario de Granada, Granada, España
| | - P López-Toribio
- Servicio Anestesiología, Reanimación y Terapia del Dolor, Complejo Hospitalario de Granada, Granada, España
| | - A Bueno-Cavanillas
- Medicina Preventiva y Salud Pública, Facultad de Medicina, Universidad de Granada, Granada, España
| | - M Prieto-Cuéllar
- Servicio Anestesiología, Reanimación y Terapia del Dolor, Complejo Hospitalario de Granada, Granada, España
| | - E M Guzmán-Malpica
- Servicio Anestesiología, Reanimación y Terapia del Dolor, Complejo Hospitalario de Granada, Granada, España
| | - P Cuevas-Valenzuela
- Servicio Anestesiología, Reanimación y Terapia del Dolor, AGS Sur de Granada, Granada, España
| | - E Moreno-Abril
- Servicio Anestesiología, Reanimación y Terapia del Dolor, Complejo Hospitalario de Granada, Granada, España
| | - P Lara-Ramos
- Unidad de Reanimación, Servicio Anestesiología, Reanimación y Terapia del Dolor, Complejo Hospitalario de Granada, Granada, España
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Wahr JA, Prager RL, Abernathy JH, Martinez EA, Salas E, Seifert PC, Groom RC, Spiess BD, Searles BE, Sundt TM, Sanchez JA, Shappell SA, Culig MH, Lazzara EH, Fitzgerald DC, Thourani VH, Eghtesady P, Ikonomidis JS, England MR, Sellke FW, Nussmeier NA. Patient safety in the cardiac operating room: human factors and teamwork: a scientific statement from the American Heart Association. Circulation 2013; 128:1139-69. [PMID: 23918255 DOI: 10.1161/cir.0b013e3182a38efa] [Citation(s) in RCA: 167] [Impact Index Per Article: 15.2] [Reference Citation Analysis] [Key Words] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
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Lin YC, Chan TF, Lai CS, Chin CC, Chou FH, Lin HJ. The impact of an interprofessional problem-based learning curriculum of clinical ethics on medical and nursing students' attitudes and ability of interprofessional collaboration: a pilot study. Kaohsiung J Med Sci 2013; 29:505-11. [PMID: 24018155 DOI: 10.1016/j.kjms.2013.05.006] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2011] [Accepted: 02/04/2013] [Indexed: 11/16/2022] Open
Abstract
Clinical ethic situations in modern multiprofessional healthcare systems may involve different healthcare professions who work together for patient care. The undergraduate interprofessional education of clinical ethics would help to incubate healthcare students' ability of interprofessional collaboration in solving ethical problems. However, the impact from an interprofessional educational model on student's attitudes and confidence of interprofessional collaboration should be carefully evaluated during the process of curricular development. This study aimed to conduct a pilot interprofessional PBL curriculum of clinical ethics and evaluate the curricular impact on interprofessional students' attitude and confidence of collaborative teamwork. Thirty-six medical and nursing students volunteered to participate in this study and were divided into three groups (medical group, nursing group, and mixed group). Tutors were recruited from the Medical School and the College of Nursing. The pilot curriculum included one lecture of clinical ethics, one PBL case study with two tutorial sessions, and one session of group discussion and feedback. A narrative story with multiple story lines and a multiperspective problem analysis tool were used in the PBL tutorials. The students' self-evaluation of learning questionnaire was used to evaluate students' learning of clinical ethics and interprofessional collaborative skills and attitude. The internal consistency of the questionnaire was measured by Cronbach α, and the criterion-related validity of the questionnaire was evaluated through associations between the dimension scores with the student group by one-way analysis of variance test (ANOVA) test and Tukey-Kramer honestly significant difference (HSD) comparison. There was significant difference among different groups in students' ability and attitudes about "interprofessional communication and collaboration" (p = 0.0184). The scores in the mixed group (37.58 ± 3.26) were higher than the medical group (32.10 ± 4.98). In conclusion, our model for the interprofessional PBL curriculum of clinical ethics is practicable and will produce positive impacts on students' attitudes and confidence of interprofessional collaboration.
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Affiliation(s)
- Yu-Chih Lin
- Division of General Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
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Ahmed K, Khan N, Khan MS, Dasgupta P. Development and content validation of a surgical safety checklist for operating theatres that use robotic technology. BJU Int 2013; 111:1161-74. [DOI: 10.1111/bju.12010] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- Kamran Ahmed
- MRC Centre for Transplantation; King's College London; King's Health Partners; Department of Urology; Guy's Hospital; London UK
| | - Nuzhath Khan
- MRC Centre for Transplantation; King's College London; King's Health Partners; Department of Urology; Guy's Hospital; London UK
| | - Mohammed Shamim Khan
- MRC Centre for Transplantation; King's College London; King's Health Partners; Department of Urology; Guy's Hospital; London UK
| | - Prokar Dasgupta
- MRC Centre for Transplantation; King's College London; King's Health Partners; Department of Urology; Guy's Hospital; London UK
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