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House S, Naim Ali HA, Stucky C. Hospital Unit Type and Professional Roles as a Predictor of Relational Coordination in an Army Medical Center. Qual Manag Health Care 2024; 33:221-230. [PMID: 38654420 DOI: 10.1097/qmh.0000000000000444] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/26/2024]
Abstract
BACKGROUND AND OBJECTIVES High-quality communication and relationships are associated with quality of care. Workflow differences across hospital units can impede communication and relationships among health care professionals. Relational coordination (RC) is a process of communication supported by shared goals, shared knowledge, and mutual respect and is associated with quality of care and better performance outcomes in civilian hospitals. However, RC has not been explored in military hospitals. The objective of our study was to determine whether RC differs between hospital units and professional roles. Specifically, we examined RC differences by unit type for nurses, resident physicians, and physicians working in an Army Medical Center. METHODS We conducted an exploratory analysis of a secondary question from a cross-sectional study using a convenience sample of active-duty and civilian licensed practical nurses (LPNs), registered nurses (RNs), physician residents, and physicians (n = 289). We received institutional review board approval from the study site. Data were collected from January 2020 to March 2020, and participants completed a 47-item survey regarding their experiences of RC in various hospital units. We used t tests and one-way analyses of variance to explore bivariate relationships between RC and other study variables, as well as multiple regression to explore whether RC varied by unit type. We controlled for education and experience by including them in the model because these variables may influence perceptions of nurse-physician RC and their interactions with each other. RESULTS Seventy percent of participants were civilian (n = 203), 75% RNs (n = 217), and 78% female (n = 216). The mean age of respondents was 40 years (SD = 11.7), and the mean experience level was 11.9 years (SD = 9.5). RC was not associated with unit type. Total RC and between-role RC were associated with professional role. Physicians reported higher RC (β = .45, P = .01), and LPNs reported lower RC (β = -.06, P = .01). Education and experience were associated with RC. Participants with less experience reported higher RC (β = -.01, P = .00), and participants with graduate degrees reported lower RC (β = -.62, P = .00). CONCLUSIONS We recommend hospital leaders consider interventions to build interprofessional relationships, including interdisciplinary meetings, huddles, and structured communication tools. Improving RC among health care professionals is a cost-effective and unique way to enhance communication and collaboration among health care professionals across hospital units.
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Affiliation(s)
- Sherita House
- Author Affiliations: University of North Carolina at Greensboro School of Nursing (Dr House); The Heller School for Social Policy and Management, Brandeis University, Waltham, Massachusetts (Dr Naim Ali); and Center for Nursing Science and Clinical Inquiry (CNSCI), Landstuhl Regional Medical Center, Landstuhl, AE, Germany (Dr Stucky)
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Zhang C, Wilson-Sheehan S, Ruch B, Wagler J, Abidali A, Lim ES, Chang YH, Fowler C, Douglas DD, Mathur AK. Safety attitudes culture remain stable in a transplant center: evidence from the coronavirus pandemic. FRONTIERS IN TRANSPLANTATION 2023; 2:1208916. [PMID: 38993852 PMCID: PMC11235290 DOI: 10.3389/frtra.2023.1208916] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Accepted: 09/12/2023] [Indexed: 07/13/2024]
Abstract
Background We sought to understand how safety culture may evolve during disruption, by using the COVID-19 pandemic as an example, to identify vulnerabilities in the system that could impact patient outcomes. Methods A cross-sectional analysis of transplant personnel at a high-volume transplant center was conducted using the Safety Attitudes Questionnaire (SAQ). Survey responses were scaled and evaluated pre- and post-COVID-19 (2019 and 2021). Results Two-hundred and thirty-eight responses were collected (134 pre-pandemic and 104 post-pandemic). Represented organ groups included: kidney (N = 89;38%), heart (N = 18;8%), liver (N = 54;23%), multiple (N = 66;28%), and other (N = 10;4%). Responders primarily included nurses (N = 75;34%), administration (N = 50;23%), and physicians (N = 24;11%). Workers had high safety, job satisfaction, stress recognition, and working conditions satisfaction (score >75) both before and after the pandemic with overlapping responses across both timepoints. Stress recognition, safety, and working conditions improved post-COVID-19, but teamwork, job satisfaction, and perceptions of management were somewhat negatively impacted (all p > 0.05). Conclusions Despite the serious health care disruptions induced by the pandemic, high domain ratings were notable and largely maintained in a high-volume transplant center. The SAQ is a valuable tool for healthcare units and can be used in longitudinal assessments of transplant culture of safety as a component of quality assurance and performance improvement initiatives.
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Affiliation(s)
- Chi Zhang
- Transplant Center, Mayo Clinic, Phoenix, AZ, United States
- Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN, United States
| | | | - Brianna Ruch
- Transplant Center, Mayo Clinic, Phoenix, AZ, United States
| | - Josiah Wagler
- Transplant Center, Mayo Clinic, Phoenix, AZ, United States
| | - Ali Abidali
- Transplant Center, Mayo Clinic, Phoenix, AZ, United States
| | - Elisabeth S. Lim
- Quantitative Health Sciences, Mayo Clinic, Phoenix, AZ, United States
| | - Yu-Hui Chang
- Quantitative Health Sciences, Mayo Clinic, Phoenix, AZ, United States
| | | | | | - Amit K. Mathur
- Transplant Center, Mayo Clinic, Phoenix, AZ, United States
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Patel AA, Schwab JH, Amanatullah DF, Divi SN. AOA Critical Issues Symposium: Shaping the Impact of Artificial Intelligence within Orthopaedic Surgery. J Bone Joint Surg Am 2023; 105:1475-1479. [PMID: 37172106 DOI: 10.2106/jbjs.22.01330] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/14/2023]
Abstract
ABSTRACT Artificial intelligence (AI) is a broad term that is widely used but inconsistently understood. It refers to the ability of any machine to exhibit human-like intelligence by making decisions, solving problems, or learning from experience. With its ability to rapidly process large amounts of information, AI has already transformed many industries such as entertainment, transportation, and communications through consumer-facing products and business-to-business applications. Given its potential, AI is also anticipated to impact the practice of medicine and the delivery of health care. Interest in AI-based techniques has grown rapidly within the orthopaedic community, resulting in an increasing number of publications on this topic. Topics of interest have ranged from the use of AI for imaging interpretation to AI-based techniques for predicting postoperative outcomes.The highly technical and data-driven nature of orthopaedic surgery creates the potential for AI, and its subdisciplines machine learning (ML) and deep learning (DL), to fundamentally transform our understanding of musculoskeletal care. However, AI-based techniques are not well known to most orthopaedic surgeons, nor are they taught with the same level of insight and critical thinking as traditional statistical methodology. With a clear understanding of the science behind AI-based techniques, orthopaedic surgeons will be able to identify the potential pitfalls of the application of AI to musculoskeletal health. Additionally, with increased understanding of AI, surgeons and their patients may have more trust in the results of AI-based analytics, thereby expanding the potential use of AI in clinical care and amplifying the impact it could have in improving quality and value. The purpose of this American Orthopaedic Association (AOA) symposium was to facilitate understanding and development of AI and AI-based techniques within orthopaedic surgery by defining common terminology related to AI, demonstrating the existing clinical utility of AI, and presenting future applications of AI in surgical care.
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Affiliation(s)
- Alpesh A Patel
- Department of Orthopedic Surgery and Neurosurgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Joseph H Schwab
- Department of Orthopedic Surgery, Massachusetts General Hospital, Boston, Massachusetts
| | - Derek F Amanatullah
- Department of Orthopedic Surgery, Stanford University Medical Center, Palo Alto, California
| | - Srikanth N Divi
- Department of Orthopedic Surgery and Neurosurgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois
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Raveendran L, McGuire CS, Gazmin S, Beiko D, Martin LJ. The who, what, and how of teamwork research in medical operating rooms: A scoping review. J Interprof Care 2023; 37:504-514. [PMID: 35543316 DOI: 10.1080/13561820.2022.2058917] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2021] [Revised: 03/14/2022] [Accepted: 03/14/2022] [Indexed: 10/18/2022]
Abstract
Despite the importance of teamwork in the operating room (OR), teamwork can often be conflated with teamwork components (e.g., communication, cooperation). We reviewed the existing literature pertaining to OR teamwork to understand which teamwork components have been assessed. Following PRISMA guidelines for scoping reviews, 4,233 peer-reviewed studies were identified using MEDLINE and Embase. Eighty-seven studies were included for synthesis and analysis. Using the episodic model of teamwork as an organizing framework, studies were grouped into the following teamwork categories: (a) transition processes (e.g., goal specification), (b) action processes (e.g., coordination), (c) interpersonal processes (e.g., conflict management), (d) emergent states (e.g., psychological safety), or (e) omnibus topics (a combination of higher-order teamwork processes). Results demonstrated that action processes were most frequently explored, followed by transition processes, omnibus topics, emergent states, and interpersonal processes. Although all studies were framed as investigations of teamwork, it is important to highlight that most explored only one or a few constructs under the overarching umbrella of teamwork. We advocate for enhanced specificity with descriptions of OR teamwork, reporting practices pertaining to interprofessional demographics and outcomes, and increased diversity in study design and surgery type to advance understanding of teamwork and its implications.
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Affiliation(s)
| | - Cailie S McGuire
- School of Kinesiology and Health Studies, Queen's University, Kingston, ON, Canada
| | - Stefanie Gazmin
- School of Kinesiology and Health Studies, Queen's University, Kingston, ON, Canada
| | - Darren Beiko
- Department of Urology, Queen's University, Kingston, ON, Canada
| | - Luc J Martin
- School of Kinesiology and Health Studies, Queen's University, Kingston, ON, Canada
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Siah RCJ, Xu P, Teh CL, Kow AWC. Evaluation of nursing students' efficacy, attitude, and confidence level in a perioperative setting using virtual-reality simulation. Nurs Forum 2022; 57:1249-1257. [PMID: 35908236 DOI: 10.1111/nuf.12783] [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: 04/09/2022] [Revised: 06/23/2022] [Accepted: 07/14/2022] [Indexed: 12/01/2022]
Abstract
AIMS This study aimed to evaluate the efficacy, attitude, and level of confidence among nursing students as scrub nurses in a perioperative environment via virtual-reality simulation. BACKGROUND The advantages of virtual reality have been demonstrated to provide a safe and effective mechanism to educate and evaluate students' performances, but the use of virtual reality in perioperative nursing remained limited. METHODS Nineteen sessions were conducted in a room equipped with virtual-reality headsets and two touch controllers. The surgical workflow of a scrub nurse was developed based on qualitative perspectives from nursing faculties and hospital clinicians working in operating theaters. A survey on the efficacy, attitude, and level of confidence among the participants was conducted after the virtual-reality simulation. RESULTS Two hundred and seven nursing students due for their clinical posting in operating theaters completed the evaluation. More than 90% of them indicated "neutral" and above in terms of efficacy, attitude, and confidence level with Cronbach's α values exceeding .90. CONCLUSIONS Virtual reality offers promising potential as an alternative clinical experience to physical simulation for nursing students to increase their efficacy, attitude, and level of confidence as scrub nurses in a perioperative environment through a standardized scenario-based digital environment.
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Affiliation(s)
- Rosalind C J Siah
- Alice Lee Centre for Nursing Studies, National University of Singapore, Singapore City, Singapore
| | - Ping Xu
- Nursing Education, National University Hospital, Singapore City, Singapore
| | - Cheang L Teh
- Nursing Education, National University Hospital, Singapore City, Singapore
| | - Alfred W C Kow
- Department of Surgery, National University Hospital, Singapore City, Singapore
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Managing a Team in the Operating Room: The Science of Teamwork and Non-Technical Skills for Surgeons. Curr Probl Surg 2022; 59:101172. [DOI: 10.1016/j.cpsurg.2022.101172] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2022] [Accepted: 05/04/2022] [Indexed: 11/19/2022]
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Joseph A, Chalil Madathil K, Jafarifiroozabadi R, Rogers H, Mihandoust S, Khasawneh A, McNeese N, Holmstedt C, McElligott JT. Communication and Teamwork During Telemedicine-Enabled Stroke Care in an Ambulance. HUMAN FACTORS 2022; 64:21-41. [PMID: 33657904 DOI: 10.1177/0018720821995687] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
OBJECTIVE The purpose of this study is to understand the communication among care teams during telemedicine-enabled stroke consults in an ambulance. BACKGROUND Telemedicine can have a significant impact on acute stroke care by enabling timely intervention in an ambulance before a patient reaches the hospital. However, limited research has been conducted on understanding and supporting team communication during the care delivery process for telemedicine-enabled stroke care in an ambulance. METHOD Video recordings of 13 simulated stroke telemedicine consults conducted in an ambulance were coded to document the tasks, communication events, and flow disruptions during the telemedicine-enabled stroke care delivery process. RESULTS The majority (82%) of all team interactions in telemedicine-enabled stroke care involved verbal interactions among team members. The neurologist, patient, and paramedic were almost equally involved in team interactions during stroke care, though the neurologist initiated 48% of all verbal interactions. Disruptions were observed in 8% of interactions, and communication-related issues contributed to 44%, with interruptions and environmental hazards being other reasons for disruptions in interactions during telemedicine-enabled stroke care. CONCLUSION Successful telemedicine-enabled stroke care involves supporting both verbal and nonverbal communication among all team members using video and audio systems to provide effective coverage of the patient for the clinicians as well as vice versa. APPLICATION This study provides a deeper understanding of team interactions during telemedicine-enabled stroke care that is essential for designing effective systems to support teamwork.
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Affiliation(s)
| | | | | | - Hunter Rogers
- 33319 Air Force Research Lab, Wright Patterson Air Force Base in Dayton, Ohio, USA
| | | | - Amro Khasawneh
- 1466 Johns Hopkins School of Medicine, Baltimore, Maryland, USA
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Mawuena EK, Mannion R. Implications of resource constraints and high workload on speaking up about threats to patient safety: a qualitative study of surgical teams in Ghana. BMJ Qual Saf 2022; 31:662-669. [PMID: 35058330 DOI: 10.1136/bmjqs-2021-014287] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2021] [Accepted: 12/15/2021] [Indexed: 12/16/2022]
Abstract
BackgroundAlthough under-resourcing of healthcare facilities and high workload is known to undermine patient safety, there is a dearth of evidence about how these factors affect employee voice and silence about unsafe care. We address this gap in the literature by exploring how resource constraints and high workload influence the willingness of staff to speak up about threats to patient safety in surgical departments in Ghana.MethodSemistructured interviews with a purposeful sample of 91 multidisciplinary professionals drawn from a range of specialities, ranks and surgical teams in two teaching hospitals in Ghana. Conservation of Resources theory was used as a theoretical frame for the study. Data were processed and analysed thematically with the aid of NVivo 12.ResultsEndemic resource constraints and excessive workload generate stress that undermines employee willingness to speak up about unsafe care. The preoccupation with managing scarce resources predisposes managers in surgical units to ignore or downplay concerns raised and not to instigate appropriate remedial actions. Resource constraints lead to rationing and improvising in order to work around problems with inadequate infrastructure and malfunctioning equipment, which in turn creates unsupportive environments for staff to air legitimate concerns. Faced with high workloads, silence was used as a coping strategy by staff to preserve energy and avoid having to take on the burden of additional work.ConclusionUnder-resourcing and high workload contribute significantly towards undermining employee voice about unsafe care. We highlight the central role that adequate funding and resourcing play in creating safe environments and that supporting ‘hearer’ courage may be as important as supporting speaking up in the first place.
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Liu C, McKenzie A, Sutkin G. Semantically Ambiguous Language in the Teaching Operating Room. JOURNAL OF SURGICAL EDUCATION 2021; 78:1938-1947. [PMID: 33903062 DOI: 10.1016/j.jsurg.2021.03.020] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/05/2021] [Revised: 03/23/2021] [Accepted: 03/28/2021] [Indexed: 06/12/2023]
Abstract
OBJECTIVE Teaching and training surgeons work hard in the OR to understand each other, yet miscommunication is an important cause of preventable adverse events in surgery. Our objective was to perform a formal semantic analysis of language in authentic teaching surgical cases, identify the prevalence and typology of ambiguous or potentially ambiguous language, and describe their potential for miscommunication. DESIGN In this secondary analysis of qualitative data, we collaborated with a semanticist, categorizing linguistic phenomena often associated with miscommunication. We defined an ambiguous phenomenon as a string of language that could be reasonably interpreted in more than one way. We analyzed transcripts of 319 minutes of surgery, coding for 14 linguistic categories. Cohen's kappa was calculated. We determined the prevalence and rate of each linguistic category and chose illustrative examples. PARTICIPANTS AND SETTING Six surgical attendings, four fellows, and six residents, ranging from PGY1 to PGY4, at the University of Pittsburgh Medical Center, a tertiary medical center in Pittsburgh, Pennsylvania. RESULTS We found 3912 examples of potentially ambiguous language, 12.3 per minute. Percentage agreement between two expert raters was 76.3%. The most common phenomena were deixis (3.1 per minute), directional (2.6), anaphora (1.3), implicit instruction (1.3), and degree modifiers (0.7). Restatements/reframing occurred 1.4 times per minute. We identified 131 near misses associated with potentially ambiguous language. Cohen's kappa was 0.70 among expert semanticists. CONCLUSIONS Potentially ambiguous language is common and has the potential to jeopardize safe teaching surgery. We postulate that the high amount of potentially ambiguous language use in the operating room places a burden on the training surgeon to comprehend surgical instruction.
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Affiliation(s)
- Cynthia Liu
- Department of Obstetrics and Gynecology, Female Pelvic Medicine and Reconstructive Surgery, University Missouri Kansas City School of Medicine, Kansas City, Missouri
| | - Andrew McKenzie
- Department of Linguistics, University of Kansas, Kansas City, Missouri
| | - Gary Sutkin
- Department of Obstetrics and Gynecology, Female Pelvic Medicine and Reconstructive Surgery, University Missouri Kansas City School of Medicine, Kansas City, Missouri.
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Amundson AW, Jacob AK, Duncan CM, Tsang AM, Zavaleta KW, Smith HM. Optimizing a Surgical Practice from Start to Finish. Adv Anesth 2021; 39:53-75. [PMID: 34715981 DOI: 10.1016/j.aan.2021.07.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Adam W Amundson
- Department of Anesthesiology, Mayo Clinic, 200 1st Street Southwest, Rochester, MN 55905, USA
| | - Adam K Jacob
- Department of Anesthesiology, Mayo Clinic, 200 1st Street Southwest, Rochester, MN 55905, USA
| | - Chris M Duncan
- Department of Anesthesiology, Mayo Clinic, 200 1st Street Southwest, Rochester, MN 55905, USA
| | - Alvin M Tsang
- Department of Anesthesiology, Mayo Clinic, 200 1st Street Southwest, Rochester, MN 55905, USA
| | - Kathryn W Zavaleta
- Department of Management Engineering and Consulting, Mayo Clinic, 200 1st Street Southwest, Rochester, MN 55905, USA
| | - Hugh M Smith
- Department of Anesthesiology, Mayo Clinic, 200 1st Street Southwest, Rochester, MN 55905, USA.
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Mansour D, Sayeed Z, Padela MT, McCarty S, Tonnos F, Silas D, Mostafa G, Yassir WK. Accountable Operating Room Teams. Orthopedics 2021; 44:e463-e470. [PMID: 34292838 DOI: 10.3928/01477447-20210618-01] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
With Medicare reimbursement diminishing and the aging population consuming more health care, hospitals continue to push for reforms to improve the efficiency of health care delivery, decrease consumption, and elevate the quality of care. Operating rooms command a large share of hospital resources but are also major revenue generators. Surgical care has evolved to become more efficient and accountable. Defining the characteristics of an accountable operating room team has been more elusive and inconsistent. This review defines the characteristics of accountable operating room teams and recommends measures by which to evaluate them. [Orthopedics. 2021;44(4):e463-e470.].
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Lee SH, Khanuja HS, Blanding RJ, Sedgwick J, Pressimone K, Ficke JR, Jones LC. Sustaining Teamwork Behaviors Through Reinforcement of TeamSTEPPS Principles. J Patient Saf 2021; 17:e582-e586. [PMID: 29087977 DOI: 10.1097/pts.0000000000000414] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Teamwork training improves short-term teamwork behaviors. However, improvements are often not sustained. QUESTION/PURPOSE The purpose of this study was to explore the extent to which teamwork reinforcement activities for orthopedic surgery teams lead to sustained teamwork behaviors. METHODS Seven months after 104 staff from an orthopedic surgical unit were trained in Team Strategies and Tools to Enhance Performance and Patient Safety principles, 4 reinforcement activities were implemented regarding leadership and communication: lectures with videos on leadership skills for nursing staff; an online self-paced learning program on communication skills for nursing staff; a 1-page summary on leadership skills e-mailed to surgical staff; and a 1-hour perioperative grand rounds on Team Strategies and Tools to Enhance Performance and Patient Safety principles for anesthesia staff and new staff. Twenty-four orthopedic surgical teams were evaluated on teamwork behaviors during surgery by 2 observers before and after the reinforcement period using the Observational Teamwork Assessment for Surgery tool. RESULTS After reinforcement, leadership (P = 0.022) and communication (P = 0.044) behaviors improved compared with prereinforcement levels. Specifically, nursing staff improved in leadership (P = 0.016) and communication (P = 0.028) behaviors, surgical staff improved in leadership behaviors (P = 0.009), but anesthesia staff did not improve in any teamwork behaviors. CONCLUSIONS Sustained improvement in teamwork behaviors requires reinforcement. LEVEL OF EVIDENCE Level III, prospective pre-post cohort study.
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Affiliation(s)
- Soo-Hoon Lee
- From the Old Dominion University, Norfolk, Virginia
| | | | - Renee J Blanding
- Anesthesiology and Critical Care Medicine, The Johns Hopkins University
| | | | - Kathleen Pressimone
- Interprofessional Practice And Patient Safety, The Johns Medical Institutions, Baltimore, Maryland
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Urban D, Burian BK, Patel K, Turley NW, Elam M, MacRobie AG, Merry AF, Kumar M, Hannenberg A, Haynes AB, Brindle ME. Surgical Teams' Attitudes About Surgical Safety and the Surgical Safety Checklist at 10 Years: A Multinational Survey. ANNALS OF SURGERY OPEN 2021; 2:e075. [PMID: 36590849 PMCID: PMC9770110 DOI: 10.1097/as9.0000000000000075] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2020] [Accepted: 05/20/2021] [Indexed: 01/04/2023] Open
Abstract
To assess health care professionals' attitudes on the Surgical Safety Checklist ("the Checklist") in resource-rich health systems and provide insights on strategies for optimizing Checklist use. Background In use for over a decade, the Checklist is a safety instrument aimed at improving operating room communication, teamwork, and evidence-based safety practices. Methods An online survey was sent to surgeons, nurses, and anesthesiologists in 5 high-income countries (Canada, the United States, the United Kingdom, Australia, and New Zealand). Survey results were analyzed using SPSS. Results A total of 2032 health care professionals completed the survey. Of these respondents, 47.6% were nurses, 70.5% were women, 65.1% were from the United States, and 50.0% had 20 years of experience or more in their role. Most respondents felt the Checklist positively impacted patient safety (70.9%), team communication (73.1%), and teamwork (58.9%). Only 50.3% of respondents were satisfied their team's use of the Checklist, and only 47.5% reported team members stopping to fully participate in the process. More nurses lacked confidence regarding their role in the Checklist process than surgeons and anesthesiologists combined (8.9% vs 4.3%). Fewer surgeons and anesthesiologists than nurses felt they received adequate training on the Checklist's use (57.8% vs 76.7%). Conclusions While most respondents perceive the Checklist as enhancing patient safety, not all surgical team members are actively engaging with its use. To enhance buy-in and meaningful use of the Checklist, health systems should provide more training on the Checklist with respect to its purpose and strengthening teamwork.
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Affiliation(s)
- Denisa Urban
- From the Department of Surgery, University of Calgary, Calgary, AB, Canada
| | | | - Kripa Patel
- From the Department of Surgery, University of Calgary, Calgary, AB, Canada
| | - Nathan W. Turley
- From the Department of Surgery, University of Calgary, Calgary, AB, Canada
| | - Meagan Elam
- School of Public Health, Boston University, Boston, MA
| | - Ali G. MacRobie
- From the Department of Surgery, University of Calgary, Calgary, AB, Canada
| | - Alan F. Merry
- Department of Anesthesia, University of Auckland, Auckland, New Zealand
| | - Manoj Kumar
- Department of Surgery, University of Aberdeen, Aberdeen, Scotland
| | - Alexander Hannenberg
- Ariadne Labs, TH Chan Harvard School of Public Health and Brigham and Women’s Hospital, Boston, MA, Harvard
| | | | - Mary E. Brindle
- From the Department of Surgery, University of Calgary, Calgary, AB, Canada
- Ariadne Labs, TH Chan Harvard School of Public Health and Brigham and Women’s Hospital, Boston, MA, Harvard
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Schmidt J, Gambashidze N, Manser T, Güß T, Klatthaar M, Neugebauer F, Hammer A. Does interprofessional team-training affect nurses' and physicians' perceptions of safety culture and communication practices? Results of a pre-post survey study. BMC Health Serv Res 2021; 21:341. [PMID: 33853593 PMCID: PMC8048288 DOI: 10.1186/s12913-021-06137-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2020] [Accepted: 02/01/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Many hospitals seek to increase patient safety through interprofessional team-trainings. Accordingly, these trainings aim to strengthen important key aspects such as safety culture and communication. This study was designed to investigate if an interprofessional team-training, administered to a relatively small group of nurses and physicians would promote a change in healthcare professionals' perceptions on safety culture and communication practices throughout the hospital. We further sought to understand which safety culture aspects foster the transfer of trained communication practices into clinical practice. METHODS We conducted a pre-post survey study using six scales to measure participants' perceptions of safety culture and communication practices. Mean values were compared according to profession and participation in training. Using multiple regression models, the relationship between safety culture and communication practices was determined. RESULTS Before and after the training, we found high mean values for all scales. A significant, positive effect was found for the communication practices of the physicians. Participation in the training sessions played a variably relevant role in the communication practices. In addition, the multiple regression analyses showed that specific safety culture aspects have a cross-professional influence on communication practices in the hospital. CONCLUSIONS This study suggest that interprofessional team-trainings of a small group of professionals can successfully be transferred into clinical practice and indicates the importance of safety culture aspects for such transfer processes. Thus, we recommend the consideration of safety culture aspects before starting a training intervention.
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Affiliation(s)
- Jan Schmidt
- Institute for Patient Safety, University Hospital of Bonn, Venusberg-Campus 1, 53127, Bonn, Germany.
| | - Nikoloz Gambashidze
- Institute for Patient Safety, University Hospital of Bonn, Venusberg-Campus 1, 53127, Bonn, Germany
| | - Tanja Manser
- FHNW School of Applied Psychology, University of Applied Sciences and Arts Northwestern Switzerland, Riggenbachstrasse 16, 4600, Olten, Switzerland
| | - Tim Güß
- UKM Trainingszentrum, University Hospital of Muenster, Malmedyweg 17, 48149, Muenster, Germany
| | - Michael Klatthaar
- UKM Trainingszentrum, University Hospital of Muenster, Malmedyweg 17, 48149, Muenster, Germany
| | - Frank Neugebauer
- QM and clinical risk management, University Hospital of Muenster, Domagkstrasse 20, 48149, Muenster, Germany
| | - Antje Hammer
- Institute for Patient Safety, University Hospital of Bonn, Venusberg-Campus 1, 53127, Bonn, Germany
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Skråmm SH, Smith Jacobsen IL, Hanssen I. Communication as a non-technical skill in the operating room: A qualitative study. Nurs Open 2021; 8:1822-1828. [PMID: 33631059 PMCID: PMC8186708 DOI: 10.1002/nop2.830] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2020] [Revised: 12/11/2020] [Accepted: 01/31/2021] [Indexed: 11/21/2022] Open
Abstract
Aim The aim of this study was to explore how operating room nurses (ORNs) experience operating room (OR) team communication concerning non‐technical skills. Design Based on the Scrub Practitioners List of Intraoperative Non‐Technical Skill (SPLINTS), qualitative individual in‐depth semi‐structured interviews were conducted with 11 ORNs in a Norwegian university hospital. Braun and Clarke's six analytic phases for thematic data analysis were used. Results Surgeons being unprepared or demanding different instruments than the preoperative information indicates, cause stress and frustration. So does noise and brusquely or poor communication. Ensuring good information flow within the entire team is important. When silence is required, the ORNs communicate with gestures, looks and nods. Creating a positive and secure team culture facilitates discussions, questions and information sharing. Conclusion Inappropriate dynamics, inaccurate and/or disrespectful communication and noise may reduce patient safety. Interdisciplinary team training may bring attention to the value of communication as a non‐technical skill.
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Bonaconsa C, Mbamalu O, Mendelson M, Boutall A, Warden C, Rayamajhi S, Pennel T, Hampton M, Joubert I, Tarrant C, Holmes A, Charani E. Visual mapping of team dynamics and communication patterns on surgical ward rounds: an ethnographic study. BMJ Qual Saf 2021; 30:812-824. [PMID: 33563790 DOI: 10.1136/bmjqs-2020-012372] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2020] [Revised: 12/03/2020] [Accepted: 01/19/2021] [Indexed: 12/16/2022]
Abstract
BACKGROUND The effect of team dynamics on infection management and antimicrobial stewardship (AMS) behaviours is not well understood. Using innovative visual mapping, alongside traditional qualitative methods, we studied how surgical team dynamics and communication patterns influence infection-related decision making. MATERIALS/METHODS Between May and November 2019, data were gathered through direct observations of ward rounds and face-to-face interviews with ward round participants in three high infection risk surgical specialties at a tertiary hospital in South Africa. Sociograms, a visual mapping method, mapped content and flow of communication and the social links between participants. Data were analysed using a grounded theory approach. RESULTS Data were gathered from 70 hours of ward round observations, including 1024 individual patient discussions, 60 sociograms and face-to-face interviews with 61 healthcare professionals. AMS and infection-related discussions on ward rounds vary across specialties and are affected by the content and structure of the clinical update provided, consultant leadership styles and competing priorities at the bedside. Registrars and consultants dominate the discussions, limiting the input of other team members with recognised roles in AMS and infection management. Team hierarchies also manifest where staff position themselves, and this influences their contribution to active participation in patient care. Leadership styles affect ward-round dynamics, determining whether nurses and patients are actively engaged in discussions on infection management and antibiotic therapy and whether actions are assigned to identified persons. CONCLUSIONS The surgical bedside ward round remains a medium of communication between registrars and consultants, with little interaction with the patient or other healthcare professionals. A team-focused and inclusive approach could result in more effective decision making about infection management and AMS.
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Affiliation(s)
- Candice Bonaconsa
- Division of Infectious Diseases & HIV Medicine, Department of Medicine, Groote Schuur Hospital, University of Cape Town, Rondebosch, Western Cape, South Africa
| | - Oluchi Mbamalu
- Division of Infectious Diseases & HIV Medicine, Department of Medicine, Groote Schuur Hospital, University of Cape Town, Rondebosch, Western Cape, South Africa
| | - Marc Mendelson
- Division of Infectious Diseases & HIV Medicine, Department of Medicine, Groote Schuur Hospital, University of Cape Town, Rondebosch, Western Cape, South Africa
| | - Adam Boutall
- Division of General Surgery, Department of Surgery, Groote Schuur Hospital, University of Cape Town, Cape Town, Western Cape, South Africa
| | - Claire Warden
- Division of General Surgery, Department of Surgery, Groote Schuur Hospital, University of Cape Town, Cape Town, Western Cape, South Africa
| | - Shreya Rayamajhi
- Division of General Surgery, Department of Surgery, Groote Schuur Hospital, University of Cape Town, Cape Town, Western Cape, South Africa
| | - Tim Pennel
- Chris Barnard Division of Cardiothoracic Surgery, University of Cape Town, Cape Town, Western Cape, South Africa
| | - Mark Hampton
- Dr. Matley & Partners Surgical Practice, Cape Town, South Africa
| | - Ivan Joubert
- Division of Critical Care, Department of Anaesthesia and Perioperative Medicine, University of Cape Town, Rondebosch, Western Cape, South Africa
| | - Carolyn Tarrant
- Department of Health Sciences, University of Leicester, Leicester, UK
| | - Alison Holmes
- NIHR Health Protection Research Unit in Healthcare Associated infections and Antimicrobial Resistance, Department of Medicine, Imperial College London, London, UK
| | - Esmita Charani
- NIHR Health Protection Research Unit in Healthcare Associated infections and Antimicrobial Resistance, Department of Medicine, Imperial College London, London, UK
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McHugh SK, Lawton R, O'Hara JK, Sheard L. Does team reflexivity impact teamwork and communication in interprofessional hospital-based healthcare teams? A systematic review and narrative synthesis. BMJ Qual Saf 2020; 29:672-683. [PMID: 31911544 PMCID: PMC7398296 DOI: 10.1136/bmjqs-2019-009921] [Citation(s) in RCA: 36] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2019] [Revised: 12/11/2019] [Accepted: 12/16/2019] [Indexed: 12/21/2022]
Abstract
BACKGROUND Teamwork and communication are recognised as key contributors to safe and high-quality patient care. Interventions targeting process and relational aspects of care may therefore provide patient safety solutions that reflect the complex nature of healthcare. Team reflexivity is one such approach with the potential to support improvements in communication and teamwork, where reflexivity is defined as the ability to pay critical attention to individual and team practices with reference to social and contextual information. OBJECTIVE To systematically review articles that describe the use of team reflexivity in interprofessional hospital-based healthcare teams. METHODS Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, six electronic databases were searched to identify literature investigating the use of team reflexivity in interprofessional hospital-based healthcare teams.The review includes articles investigating the use of team reflexivity to improve teamwork and communication in any naturally occurring hospital-based healthcare teams. Articles' eligibility was validated by two second reviewers (5%). RESULTS Fifteen empirical articles were included in the review. Simulation training and video-reflexive ethnography (VRE) were the most commonly used forms of team reflexivity. Included articles focused on the use of reflexive interventions to improve teamwork and communication within interprofessional healthcare teams. Communication during interprofessional teamworking was the most prominent focus of improvement methods. The nature of this review only allows assessment of team reflexivity as an activity embedded within specific methods. Poorly defined methodological information relating to reflexivity in the reviewed studies made it difficult to draw conclusive evidence about the impact of reflexivity alone. CONCLUSION The reviewed literature suggests that VRE is well placed to provide more locally appropriate solutions to contributory patient safety factors, ranging from individual and social learning to improvements in practices and systems. TRIAL REGISTRATION NUMBER CRD42017055602.
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Affiliation(s)
- Siobhan Kathleen McHugh
- School of Psychology, University of Leeds, Leeds, UK
- Yorkshire Quality and Safety Research Group, Bradford Institute for Health Research, Bradford, UK
| | - Rebecca Lawton
- School of Psychology, University of Leeds, Leeds, UK
- Yorkshire Quality and Safety Research Group, Bradford Institute for Health Research, Bradford, UK
| | - Jane Kathryn O'Hara
- Yorkshire Quality and Safety Research Group, Bradford Institute for Health Research, Bradford, UK
- Leeds Institute of Medical Education, University of Leeds, Leeds, UK
| | - Laura Sheard
- Yorkshire Quality and Safety Research Group, Bradford Institute for Health Research, Bradford, UK
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Whittaker JD, Davison I. A Lack of Communication and Awareness in Nontechnical Skills Training? A Qualitative Analysis of the Perceptions of Trainers and Trainees in Surgical Training. JOURNAL OF SURGICAL EDUCATION 2020; 77:873-888. [PMID: 32037236 DOI: 10.1016/j.jsurg.2020.01.006] [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: 05/11/2019] [Revised: 11/22/2019] [Accepted: 01/19/2020] [Indexed: 06/10/2023]
Abstract
OBJECTIVE To examine the perceptions of surgical trainees and trainers towards nontechnical skills (NTS) as a concept, its role in training, and the challenges of developing these skills. DESIGN A case series of semistructured interviews using an interpretivist grounded theory approach for qualitative analysis. SETTING East Midlands (North) core surgical training programme in the United Kingdom. PARTICIPANTS Ten out of 81 volunteer core surgical trainees and academic educational supervisors (consultant surgeon trainers). RESULTS Understanding of NTS was consistent amongst trainers and trainees but the conceived definition of NTS was much broader than previous definitions. Most viewed NTS as important for surgeons. Trainees believed trainers did not appreciate or were unaware of NTS, likely because of a lack of discussion in practice. Trainers had several reasons for not discussing NTS including insufficient personal relationships with trainees and a lack of robust evidence on which to base discussions. A lack of insight into NTS and surgeon arrogance were suggested as barrier to effective learning. CONCLUSIONS Apparent discordant perceptions may be contributing to a lack of focused NTS feedback for surgeons in training. To implement NTS training changes, more will have to be done to develop a shared understanding.
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Affiliation(s)
- Joshua D Whittaker
- Otolaryngology, Univerisity Hospitals Nottingham, Nottingham, United Kingdom.
| | - Ian Davison
- School of Education, Univeristy of Birmingham, Birmingham, United Kingdom
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19
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Wyatt D. Our Shared Purpose: Teamwork. AORN J 2020; 111:583-584. [DOI: 10.1002/aorn.13060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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20
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Abstract
Traditional surgical training has focused on the acquisition of technical skills and knowledge with minimal focus on teaching nontechnical skills. Patient safety depends on both technical and nontechnical skills, with a higher rate of non-technical skills failure leading to patient harm. Many surgical training and regulatory bodies have incorporated nontechnical skills in the required competencies of a surgeon, but few have introduced formal training in nontechnical skills. Emerging research shows simulation-based education to be a powerful tool to teach nontechnical skills to individual surgeons and surgeons in training, and to interprofessional surgical teams with subsequent improvement of patient safety outcomes.
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Affiliation(s)
- A Lynch
- Department of Paediatric Surgery & Surgical Simulation, Monash Children's Hospital, 246 Clayton Road Clayton, Melbourne, Australia.
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21
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Gupta AK, Stewart SK, Cottell K, McCulloch GAJ, Miller J, Babidge WJ, Maddern GJ. Potentially avoidable issues in urology mortality cases in Australia: identification and improvements. ANZ J Surg 2020; 90:719-724. [PMID: 32106356 DOI: 10.1111/ans.15765] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2019] [Revised: 12/29/2019] [Accepted: 01/29/2020] [Indexed: 12/25/2022]
Abstract
BACKGROUND This study aimed to identify the most common potentially avoidable factors in urology deaths, focusing on the lessons that can be learnt. METHODS This study analysed data from a well-established and comprehensive peer review audit of surgical deaths in Australian hospitals (excluding New South Wales) from 2009 to 2015, focusing on urology cases with identified areas for improvement in patient management. Of all audited deaths, 11% (79/719) had serious clinical management issues with a total of 109 individual clinical management issues identified. These were categorized based on perioperative stage (preoperative, intraoperative or post-operative), followed by thematic analysis within each stage. RESULTS The study found preoperative issues to be the most common (n = 48), followed by post-operative issues (n = 32) with intraoperative issues less common (n = 13). Communication issues were seen at all three stages (n = 16). Overall, the most common theme was at the preoperative stage; inadequate preoperative assessment (n = 27). More specifically, the most common preoperative assessment issues involved a failure to order necessary preoperative investigations, or to administer necessary preoperative treatment (e.g. prophylactic antibiotics). The most common communication issue was between teams and at handover, often involving failure by junior medical staff to communicate issues to the responsible surgical consultant. CONCLUSION Urological surgical cases with potentially avoidable mortality constitute a small, but important subset of deaths. The analysis of these cases can inform various stakeholders to improve the quality and safety of urological surgical care.
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Affiliation(s)
- Aashray K Gupta
- South Australian Audit of Surgical Mortality, Royal Australasian College of Surgeons, Adelaide, South Australia, Australia.,Discipline of Surgery, The University of Adelaide, Adelaide, South Australia, Australia
| | - Sasha K Stewart
- South Australian Audit of Surgical Mortality, Royal Australasian College of Surgeons, Adelaide, South Australia, Australia
| | - Kimberley Cottell
- South Australian Audit of Surgical Mortality, Royal Australasian College of Surgeons, Adelaide, South Australia, Australia
| | - Glenn A J McCulloch
- South Australian Audit of Surgical Mortality, Royal Australasian College of Surgeons, Adelaide, South Australia, Australia
| | - John Miller
- Discipline of Surgery, The University of Adelaide, Adelaide, South Australia, Australia
| | - Wendy J Babidge
- Discipline of Surgery, The University of Adelaide, Adelaide, South Australia, Australia.,Australian and New Zealand Audit of Surgical Mortality, Royal Australasian College of Surgeons, Adelaide, South Australia, Australia
| | - Guy J Maddern
- Discipline of Surgery, The University of Adelaide, Adelaide, South Australia, Australia.,Australian and New Zealand Audit of Surgical Mortality, Royal Australasian College of Surgeons, Adelaide, South Australia, Australia
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Feinman J. Talk About the Echo: The Importance of Effective Communication in the Cardiac Operating Room. J Cardiothorac Vasc Anesth 2020; 34:1990-1992. [PMID: 32199687 DOI: 10.1053/j.jvca.2020.01.050] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2020] [Accepted: 01/26/2020] [Indexed: 11/11/2022]
Affiliation(s)
- Jared Feinman
- Department of Anesthesiology and Critical Care, Hospital of the University of Pennsylvania, Philadelphia, PA
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23
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Kemp MT, Alam HB. Invited Commentary on “The influence of music on the surgical task performance: A systematic review” and prioritizing effective communication first. Int J Surg 2020; 74:39. [DOI: 10.1016/j.ijsu.2019.12.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2019] [Accepted: 12/23/2019] [Indexed: 11/26/2022]
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24
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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: 0.3] [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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25
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Kishiki T, Su B, Johnson B, Lapin B, Kuchta K, Sherman L, Carbray J, Ujiki MB. Simulation training results in improvement of the management of operating room fires—A single-blinded randomized controlled trial. Am J Surg 2019; 218:237-242. [DOI: 10.1016/j.amjsurg.2019.02.035] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2019] [Revised: 02/07/2019] [Accepted: 02/28/2019] [Indexed: 11/30/2022]
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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: 0.8] [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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27
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Chan JCY, Gupta AK, Stewart S, Babidge W, McCulloch G, Worthington MG, Maddern GJ. "Nobody told me": Communication Issues Affecting Australian Cardiothoracic Surgery Patients. Ann Thorac Surg 2019; 108:1801-1806. [PMID: 31254505 DOI: 10.1016/j.athoracsur.2019.04.116] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2018] [Revised: 03/05/2019] [Accepted: 04/29/2019] [Indexed: 10/26/2022]
Abstract
BACKGROUND Failure of communication can have potentially severe results in cardiothoracic surgery. Previous literature regarding patient safety highlighted communication as a common area for improvement. This study utilized a qualitative approach to analyze a national mortality audit data set to identify and describe communication issues that could potentially contribute to patient mortality following cardiothoracic surgery. METHODS We utilized a peer-reviewed audit of surgical deaths after cardiothoracic surgery in Australian hospitals from 2009 to 2015 via the Australian and New Zealand Audit of Surgical Mortality. Cases were identified with clinical management issues then individual analysis of cases highlighting communication issues was undertaken. A total of 91 reports from surgeons and assessors were analysed using a thematic analytic approach. RESULTS A total of 908 cases of potentially avoidable mortality were identified as being associated with clinical management issues, and communication issues were identified in 91 (10%) of these cases, which served as the basis for this analysis. The study found that failure to achieve shared decision making was the most common theme (n = 38, 41.8%), followed by failure to notify patient deterioration (n = 22, 24.1%), misreporting of patient condition (n = 10, 11.0%) and issues related to informed consent (n = 9, 10.0%). The most frequent communication issues occurred between surgeons and the intensive care unit. CONCLUSIONS Poor communication was identified in patients who died after cardiothoracic surgery. Communication is an important modifiable factor in patient mortality. Efforts to address teamwork and communication have the potential to improve safety and quality of care for patients undergoing cardiothoracic surgery.
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Affiliation(s)
- Justin C Y Chan
- Department of Cardiothoracic Surgery, Royal Adelaide Hospital, Adelaide, Australia; Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, Australia.
| | - Aashray K Gupta
- Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, Australia
| | - Sasha Stewart
- Australian and New Zealand Audit of Surgical Mortality, Royal Australasian College of Surgeons, Adelaide, Australia
| | - Wendy Babidge
- Australian and New Zealand Audit of Surgical Mortality, Royal Australasian College of Surgeons, Adelaide, Australia
| | - Glenn McCulloch
- Australian and New Zealand Audit of Surgical Mortality, Royal Australasian College of Surgeons, Adelaide, Australia
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Nordström A, Wihlborg M. A Phenomenographic Study of Swedish Nurse Anesthetists' and OR Nurses' Work Experiences. AORN J 2019; 109:217-226. [PMID: 30694551 DOI: 10.1002/aorn.12582] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
In the complex OR environment, perioperative team members need to practice communication and teamwork to ensure safe, high-quality care. A lack of collaboration among professionals in the OR during surgery results in inefficiency, increased tension, and suboptimal patient care. The purpose of this study was to determine how nurse anesthetists and OR nurses experienced their work in the OR. We used a qualitative design with a phenomenographic approach and conducted 12 interviews in two surgical departments in the southern part of Sweden. We identified four categories of description: team member approach, professional awareness, lifelong learning approach, and safety and the patient's interest. We found that the nurses' work experiences in the OR were multifaceted and correlated with concepts of teamwork, safety, and communication.
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29
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Differing perceptions of preoperative communication among surgical team members. Am J Surg 2019; 217:1-6. [DOI: 10.1016/j.amjsurg.2018.06.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2017] [Revised: 05/25/2018] [Accepted: 06/01/2018] [Indexed: 11/19/2022]
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30
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Varpio L, Bader KS, Meyer HS, Durning SJ, Artino AR, Hamwey MK. Interprofessional Healthcare Teams in the Military: A Scoping Literature Review. Mil Med 2018; 183:e448-e454. [PMID: 29741728 DOI: 10.1093/milmed/usy087] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2017] [Accepted: 04/10/2018] [Indexed: 01/31/2025] Open
Abstract
Introduction Research into healthcare delivered via interprofessional healthcare teams (IHTs) has uncovered that IHTs can improve patient satisfaction, enhance collaborative behaviors, reduce clinical error rates, and streamline management of care delivery. Importantly, these achievements are attained by IHTs that have been trained via interprofessional education (IPE). Research indicates that IHT training must be contextualized to suit the demands of each care context. However, research into the unique demands required of military IHTs has yet to be explored. For any form of IPE to be successfully implemented in the military, we need a clear understanding of how IHT competencies must be tailored to suit military care contexts. Specifically, we must know: (1) What evidence is currently available regarding IHTs in the military?; and (2) What gaps in the evidence need to be addressed for IPE to be customized to meet the needs of military healthcare delivery? Method A scoping review of the literature was conducted to identify the breadth of knowledge currently available regarding military interprofessional healthcare teams (MIHTs). A search of PubMed, EMBASE, PsycInfo, ERIC, DTIC.mil, and NYAM Gray Literature databases was conducted without date restrictions. The search terms were: (interprofessional* OR inter-professional*) AND (military OR Army OR Navy OR Naval OR Marines OR “Air Force” OR “Public Health Service”) AND (health OR medicine). Of the 675 articles identified via the initial search, only 21 articles met inclusion criteria (i.e., involved military personnel, included teams that were medically focused, comprised at least two professional disciplines, and had at least two people). Results The manuscripts included: seven original research studies, six commentaries, five reviews, one letter, one annual report, and one innovation report. Analyses identified three themes (i.e., effective communication, supportive team environments, shared role understanding, and equity among team members) related to successful MIHT collaborations and five related to unsuccessful MIHT collaborations (i.e., inability to develop team cohesion, lack of trust, ineffective communication and communication breakdowns, unaddressed or unresolved conflicts, and rank conflicts). These manuscripts highlighted contextual factors that shape MIHTs. For example, MIHTs often work and live together for extended periods of time when deployed. Also, military rank can facilitate collaboration by establishing clear lines of reporting but can problematize collaboration when inexperienced care providers (e.g., early career physicians) outrank other team members (e.g., medics) who have more experience providing care in deployment contexts. Discussion Given that the experiences of military personnel can be perilous and unpredictable, the military has an obligation to study the unique contexts of care where MIHTs are employed. In doing so, educational interventions can be tailored to better aid our service men and women, as well as their families.
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Affiliation(s)
- Lara Varpio
- Department of Medicine, Uniformed Services University of the Health Sciences, 4301 Jones Bridge Road, Bethesda, MD
| | - Karlen S Bader
- Department of Medicine, The Henry M Jackson Foundation for the Advancement of Military Medicine and The Uniformed Services University of the Health Sciences, 4301 Jones Bridge Road, Bethesda, MD
| | - Holly S Meyer
- Department of Medicine, The Henry M Jackson Foundation for the Advancement of Military Medicine and The Uniformed Services University of the Health Sciences, 4301 Jones Bridge Road, Bethesda, MD
| | - Steven J Durning
- Department of Medicine, Uniformed Services University of the Health Sciences, 4301 Jones Bridge Road, Bethesda, MD
| | - Anthony R Artino
- Department of Medicine, Uniformed Services University of the Health Sciences, 4301 Jones Bridge Road, Bethesda, MD
| | - Meghan K Hamwey
- Department of Medicine, The Henry M Jackson Foundation for the Advancement of Military Medicine and The Uniformed Services University of the Health Sciences, 4301 Jones Bridge Road, Bethesda, MD
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Neuhaus C, Huck M, Hofmann G, St. Pierre M, Weigand MA, Lichtenstern C. Applying the human factors analysis and classification system to critical incident reports in anaesthesiology. Acta Anaesthesiol Scand 2018; 62:1403-1411. [PMID: 29974938 DOI: 10.1111/aas.13213] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2018] [Accepted: 06/11/2018] [Indexed: 11/30/2022]
Abstract
BACKGROUND The Human Factors Analysis and Classification System (HFACS) was developed as a practical taxonomy to investigate and analyse the human contribution to accidents and incidents. Based on Reason's "Swiss Cheese Model", it considers individual, environmental, leadership and organizational contributing factors in four hierarchical levels. The aim of this study was to assess the applicability of a modified HFACS taxonomy to incident reports from a large, anonymous critical incident database with the goal of gaining valuable insight into underlying, more systemic conditions and recurring schemes that might add important information for future incident avoidance. METHODS We analysed 50 reports from an anonymous, anaesthesiologic, single-centre Critical Incident Reporting System using a modified HFACS-CIRS taxonomy. The 19 HFACS categories were further subdivided into a total of 117 nanocodes representing specific behaviours or preconditions for incident development. RESULTS On an individual level, the most frequent contributions were decision errors, attributed to inadequate risk assessment or critical-thinking failure. Communication and Coordination, mostly due to inadequate or ineffective communication, was contributory in two-thirds of reports. Half of the reports showed contributory complex interactions in a sociotechnical environment. Ratability scores were noticeably lower for categories evaluating leadership and organizational influences, necessitating careful interpretation. CONCLUSIONS We applied the HFACS taxonomy to the analysis of CIRS reports in anaesthesiology. This constitutes a structured approach that, especially when applied to a large data set, might help guide future mitigation and intervention strategies to reduce critical incidents and improve patient safety. Improved, more structured reporting templates could further optimize systematic analysis.
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Affiliation(s)
- Christopher Neuhaus
- Department of Anaesthesiology Heidelberg University Hospital Heidelberg Germany
| | - Matthias Huck
- Department of Anaesthesiology Heidelberg University Hospital Heidelberg Germany
| | - Götz Hofmann
- Department of Anaesthesiology Heidelberg University Hospital Heidelberg Germany
| | - Michael St. Pierre
- Department of Anaesthesiology Erlangen University Hospital Erlangen Germany
| | - Markus A. Weigand
- Department of Anaesthesiology Heidelberg University Hospital Heidelberg Germany
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Rydenfält C, Borell J, Erlingsdottir G. What do doctors mean when they talk about teamwork? Possible implications for interprofessional care. J Interprof Care 2018; 33:714-723. [PMID: 30362854 DOI: 10.1080/13561820.2018.1538943] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
The concept of teamwork has been associated with improved patient safety, more effective care and a better work environment. However, the academic literature on teamwork is pluralistic, and there are reports on discrepancies between theory and practice. Furthermore, healthcare professionals' direct conceptualizations of teamwork are sometimes missing in the research. In this study, we examine doctors' conceptualizations of teamwork. We also investigate what doctors think is important in order to achieve good teamwork, and how the empirical findings relate to theory. Finally, we discuss the methodological implications for future studies. The research design was explorative. The main data consisted of semi-structured interviews with twenty clinically active doctors, analyzed with conventional content analysis. Additional data sources included field observations and interviews with management staff. There was large variation in the doctors' conceptualizations of teamwork. The only characteristic they shared in common was that team members should have specific roles. This could have consequences for practice, because the rationale behind different behaviors depends on how teamwork is conceptualized. Several of the teamwork-enabling factors identified concerned non-technical skills. Future studies should put more emphasis on the practitioners' perspective in the research design, to create a more grounded foundation for both research and practice.
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Affiliation(s)
- Christofer Rydenfält
- Department of Design Sciences, Faculty of Engineering, Lund University, Lund, Sweden
| | - Jonas Borell
- Department of Design Sciences, Faculty of Engineering, Lund University, Lund, Sweden
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Abstract
Communication failures can lead to sentinel events in the operating room. Knowledge of basic surgical steps is important for all team members to ensure work flow efficiency. Surgeons and non-surgeons were surveyed to determine perceived and actual quality of communication between team members, using knowledge of surgical steps as a marker of communication quality. Participants agreed that communication was important, but non-surgeons were unable to name the four key steps of a laparoscopic cholecystectomy (p = 5.0E-07), indicating poor communication between surgeons and non-surgeons.
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Affiliation(s)
- Dahlia Kenawy
- Albert Einstein College of Medicine, 1300 Morris Park Ave, Bronx, NY, USA 10461
| | - Daniel Schwartz
- Albert Einstein College of Medicine, 1300 Morris Park Ave, Bronx, NY, USA 10461
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Knox BJ, Jøsok Ø, Helkala K, Khooshabeh P, Ødegaard T, Lugo RG, Sütterlin S. Socio-technical communication: The hybrid space and the OLB model for science-based cyber education. MILITARY PSYCHOLOGY 2018. [DOI: 10.1080/08995605.2018.1478546] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
- Benjamin J. Knox
- Norwegian Defence Cyber Academy, Defence University College, Lillehammer, Norway
| | - Øyvind Jøsok
- Norwegian Defence Cyber Academy, Defence University College, Lillehammer, Norway
- Child and Youth Participation and Development Research Program, Inland University of Applied Science, Lillehammer, Norway
| | - Kirsi Helkala
- Norwegian Defence Cyber Academy, Defence University College, Lillehammer, Norway
| | - Peter Khooshabeh
- US Army Research Laboratory, Human Research and Engineering Directorate, Los Angeles, California
| | - Terje Ødegaard
- Department of Psychology, Inland University of Applied Science, Lillehammer, Norway
| | - Ricardo G. Lugo
- Department of Psychology, Inland University of Applied Science, Lillehammer, Norway
| | - Stefan Sütterlin
- CHTD Research Group, Oslo University Hospital, Oslo, Norway
- Faculty for Health and Welfare Sciences, Østfold University College, Fredrikstad, Norway
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Stomski N, Gluyas H, Andrus P, Williams A, Hopkins M, Walters J, Sandy M, Morrison P. The influence of situation awareness training on nurses' confidence about patient safety skills: A prospective cohort study. NURSE EDUCATION TODAY 2018; 63:24-28. [PMID: 29407256 DOI: 10.1016/j.nedt.2018.01.019] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/28/2017] [Revised: 12/04/2017] [Accepted: 01/22/2018] [Indexed: 06/07/2023]
Abstract
BACKGROUND Several studies report that patient safety skills, especially non-technical skills, receive scant attention in nursing curricula. Hence, there is a compelling reason to incorporate material that enhances non-technical skills, such as situation awareness, in nursing curricula in order to assist in the reduction of healthcare related adverse events. OBJECTIVES The objectives of this study were to: 1) understand final year nursing students' confidence in their patient safety skills; and 2) examine the impact of situation awareness training on final year nursing students' confidence in their patient safety skills. METHODS Participants were enrolled from a convenience sample comprising final year nursing students at a Western Australia university. Self-reported confidence in patient safety skills was assessed with the Health Professional in Patient Safety Survey before and after the delivery of a situation awareness educational intervention. Pre/post educational intervention differences were examined by repeated measures ANOVA. RESULTS No significant differences in confidence about patient safety skills were identified within settings (class/clinical). However, confidence in patient safety skills significantly decreased between settings i.e. nursing students lost confidence after clinical placements. CONCLUSION The educational intervention delivered in this study did not seem to improve confidence in patient safety skills, but substantial ceiling effects may have confounded the identification of such improvement. Further studies are required to establish whether the findings of this study can be generalised to other university nursing cohorts.
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Affiliation(s)
- Norman Stomski
- School of Health Professions, Murdoch University, 90 South St, Murdoch, 6150, WA, Australia.
| | - Heather Gluyas
- School of Health Professions, Murdoch University, 90 South St, Murdoch, 6150, WA, Australia
| | - Prue Andrus
- School of Health Professions, Murdoch University, 90 South St, Murdoch, 6150, WA, Australia
| | - Anne Williams
- School of Health Professions, Murdoch University, 90 South St, Murdoch, 6150, WA, Australia
| | - Martin Hopkins
- School of Health Professions, Murdoch University, 90 South St, Murdoch, 6150, WA, Australia
| | - Jennifer Walters
- School of Health Professions, Murdoch University, 90 South St, Murdoch, 6150, WA, Australia
| | - Martinique Sandy
- School of Health Professions, Murdoch University, 90 South St, Murdoch, 6150, WA, Australia
| | - Paul Morrison
- School of Health Professions, Murdoch University, 90 South St, Murdoch, 6150, WA, Australia
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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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Costa C, Lusk P. Perceptions of Interdisciplinary Communication Among Correctional Health Care Providers. JOURNAL OF CORRECTIONAL HEALTH CARE 2018; 23:122-130. [PMID: 28100138 DOI: 10.1177/1078345816686064] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Collaborative practice is a health care standard that improves patient outcomes through maximizing the use of resources and mutual work of all health care providers. Since collaborative practice depends on interdisciplinary communication, effective communication training for health care participants is imperative for success. This article presents the results of research that studied perceptions of interdisciplinary communication and collaborative practice among 24 health care personnel in three correctional facilities in Orange County, California. The research explored different approaches in terms of team structure, mutual support, situation monitoring, leadership, and communication practices. The study used questionnaires to examine the perceptions of teamwork and interdisciplinary communication and how they can be impacted by one educational session. The study results are discussed in terms of modern approaches to health care, including evidence-based practice, along with nationwide initiatives for improving the health of inmates with psychiatric issues.
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Affiliation(s)
- Christine Costa
- 1 School of Nursing, College of Health and Human Services, California State University, Long Beach, CA, USA
| | - Pamela Lusk
- 2 Brandman University Nursing, Irvine, CA, USA
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Li N, Marshall D, Sykes M, McCulloch P, Shalhoub J, Maruthappu M. Systematic review of methods for quantifying teamwork in the operating theatre. BJS Open 2018; 2:42-51. [PMID: 29951628 PMCID: PMC5952378 DOI: 10.1002/bjs5.40] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2017] [Accepted: 11/28/2017] [Indexed: 12/22/2022] Open
Abstract
Background Teamwork in the operating theatre is becoming increasingly recognized as a major factor in clinical outcomes. Many tools have been developed to measure teamwork. Most fall into two categories: self‐assessment by theatre staff and assessment by observers. A critical and comparative analysis of the validity and reliability of these tools is lacking. Methods MEDLINE and Embase databases were searched following PRISMA guidelines. Content validity was assessed using measurements of inter‐rater agreement, predictive validity and multisite reliability, and interobserver reliability using statistical measures of inter‐rater agreement and reliability. Quantitative meta‐analysis was deemed unsuitable. Results Forty‐eight articles were selected for final inclusion; self‐assessment tools were used in 18 and observational tools in 28, and there were two qualitative studies. Self‐assessment of teamwork by profession varied with the profession of the assessor. The most robust self‐assessment tool was the Safety Attitudes Questionnaire (SAQ), although this failed to demonstrate multisite reliability. The most robust observational tool was the Non‐Technical Skills (NOTECHS) system, which demonstrated both test–retest reliability (P > 0·09) and interobserver reliability (Rwg = 0·96). Conclusion Self‐assessment of teamwork by the theatre team was influenced by professional differences. Observational tools, when used by trained observers, circumvented this.
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Affiliation(s)
- N Li
- Department of General Surgery Wexham Park Hospital Slough UK
| | - D Marshall
- Department of Medicine Imperial College London London UK
| | - M Sykes
- Department of Medicine Imperial College London London UK
| | - P McCulloch
- Nuffield Department of Surgery University of Oxford Oxford UK
| | - J Shalhoub
- Department of Surgery and Cancer Imperial College London London UK
| | - M Maruthappu
- Department of Medicine Imperial College London London UK
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Jones C, Durbridge M. Culture, silence and voice: The implications for patient safety in the operating theatre. J Perioper Pract 2018; 26:281-284. [PMID: 29328767 DOI: 10.1177/175045891602601204] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2016] [Accepted: 09/16/2016] [Indexed: 11/17/2022]
Abstract
Team culture is an important antecedent to safety behaviours such as speaking up. A positive safety culture in the operating theatre has been linked to fewer adverse events. Psychological safety, a component of safety culture, is the belief that the team is safe to take risks such as raising concerns. Power dynamics can influence active speaking up behaviour or 'voice'. When theatre team members chose to remain silent rather than voice concerns this can be a protective or defensive strategy rather than passive inactivity.
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Affiliation(s)
- Ceri Jones
- University Hospitals Leicester and University of Cardiff, UK
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Blumenthal DM, Olenski AR, Tsugawa Y, Jena AB. Association Between Treatment by Locum Tenens Internal Medicine Physicians and 30-Day Mortality Among Hospitalized Medicare Beneficiaries. JAMA 2017; 318:2119-2129. [PMID: 29209722 PMCID: PMC5820716 DOI: 10.1001/jama.2017.17925] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
IMPORTANCE Use of locum tenens physicians has increased in the United States, but information about their quality and costs of care is lacking. OBJECTIVE To evaluate quality and costs of care among hospitalized Medicare beneficiaries treated by locum tenens vs non-locum tenens physicians. DESIGN, SETTING, AND PARTICIPANTS A random sample of Medicare fee-for-service beneficiaries hospitalized during 2009-2014 was used to compare quality and costs of hospital care delivered by locum tenens and non-locum tenens internal medicine physicians. EXPOSURES Treatment by locum tenens general internal medicine physicians. MAIN OUTCOMES AND MEASURES The primary outcome was 30-day mortality. Secondary outcomes included inpatient Medicare Part B spending, length of stay, and 30-day readmissions. Differences between locum tenens and non-locum tenens physicians were estimated using multivariable logistic regression models adjusted for beneficiary clinical and demographic characteristics and hospital fixed effects, which enabled comparisons of clinical outcomes between physicians practicing within the same hospital. In prespecified subgroup analyses, outcomes were reevaluated among hospitals with different levels of intensity of locum tenens physician use. RESULTS Of 1 818 873 Medicare admissions treated by general internists, 38 475 (2.1%) received care from a locum tenens physician; 9.3% (4123/44 520) of general internists were temporarily covered by a locum tenens physician at some point. Differences in patient characteristics, demographics, comorbidities, and reason for admission between locum tenens and non-locum tenens physicians were not clinically relevant. Treatment by locum tenens physicians, compared with treatment by non-locum tenens physicians (n = 44 520 physicians), was not associated with a significant difference in 30-day mortality (8.83% vs 8.70%; adjusted difference, 0.14%; 95% CI, -0.18% to 0.45%). Patients treated by locum tenens physicians had significantly higher Part B spending ($1836 vs $1712; adjusted difference, $124; 95% CI, $93 to $154), significantly longer mean length of stay (5.64 days vs 5.21 days; adjusted difference, 0.43 days; 95% CI, 0.34 to 0.52), and significantly lower 30-day readmissions (22.80% vs 23.83%; adjusted difference, -1.00%; 95% CI -1.57% to -0.54%). CONCLUSIONS AND RELEVANCE Among hospitalized Medicare beneficiaries treated by a general internist, there were no significant differences in overall 30-day mortality rates among patients treated by locum tenens compared with non-locum tenens physicians. Additional research may help determine hospital-level factors associated with the quality and costs of care related to locum tenens physicians.
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Affiliation(s)
- Daniel M. Blumenthal
- Cardiology Division, Massachusetts General Hospital, Boston
- Harvard Medical School, Boston, Massachusetts
| | | | - Yusuke Tsugawa
- Department of Medicine, University of California, Los Angeles
| | - Anupam B. Jena
- Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts
- Department of Medicine, Massachusetts General Hospital, Boston
- National Bureau of Economic Research, Cambridge, Massachusetts
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Bell E, Leger P, Sankar T, Racine E. Deep Brain Stimulation as Clinical Innovation: An Ethical and Organizational Framework to Sustain Deliberations About Psychiatric Deep Brain Stimulation. Neurosurgery 2017; 79:3-10. [PMID: 26909704 DOI: 10.1227/neu.0000000000001207] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
UNLABELLED Deep brain stimulation (DBS) for psychiatric disorders needs to be investigated in proper research trials. However, there are rare circumstances in which DBS could be offered to psychiatric patients as a form of surgical innovation, therefore potentially blurring the lines between these research trials and health care. In this article, we discuss the conditions under which surgical innovation may be accepted as a practice falling at the frontiers of standard clinical care and research per se. However, recognizing this distinction does not settle all ethical issues. Our article offers ethical guideposts to allow clinicians, surgical teams, institutions, and institutional review boards to deliberate about some of the fundamental issues that should be considered before surgical innovation with psychiatric DBS is undertaken. We provide key guiding questions to sustain this deliberation. Then we review the normative and empirical literature that exists to guide reflection about the ethics of surgical innovation and psychiatric DBS with respect to general ethical questions pertinent to psychiatric DBS, multidisciplinary team perspectives in psychiatric DBS, mechanisms for oversight in psychiatric DBS, and capacity and consent in psychiatric DBS. The considerations presented here are to recognize the very specific nature of surgical innovation and to ensure that surgical innovation in the context of psychiatric DBS remains a limited, special category of activity that does not replace appropriate surgical research or become the standard of care based on limited evidence. ABBREVIATIONS DBS, deep brain stimulationIRB, institutional review boardOCD, obsessive-compulsive disorder.
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Affiliation(s)
- Emily Bell
- *Neuroethics Research Unit, Institut de recherches cliniques de Montréal (IRCM), Montréal, Quebec, Canada; ‡Division of Neurosurgery, University of Alberta, Edmonton, Alberta, Canada; §Department of Medicine and Department of Social and Preventive Medicine, Université de Montréal, Montréal, Quebec, Canada; ¶Departments of Neurology and Neurosurgery, Experimental Medicine & Biomedical Ethics Unit, McGill University, Montréal, Quebec, Canada
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Lam P, Lopez Filici A, Middleton C, McGillicuddy P. Exploring healthcare professionals' perceptions of the anesthesia assistant role and its impact on patients and interprofessional collaboration. J Interprof Care 2017; 32:24-32. [PMID: 29083250 DOI: 10.1080/13561820.2017.1379960] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
To practice interprofessional collaboration (IPC), understanding the roles of each profession in the team is key. Anesthesia assistants (AAs) are a relatively new addition to the Canadian healthcare system. As a result, its role in the delivery of anesthesia care can be misunderstood by other healthcare professionals. Using an exploratory multiple case study design, this article explores healthcare professionals' perceptions of the AA role and its impact on patients and IPC. Sixteen semi-structured, in-depth interviews were conducted with a purposive sample of nine healthcare professions from inside and outside the peri-operative care unit in two urban, acute care, university-affiliated teaching research hospitals in Ontario. A thematic analysis of the interview transcripts identified five overarching themes: limited understanding of the AA role, improved patient-centred care, improve IPC and interprofessional education, ongoing challenges, and the future direction for professional growth. Results indicated that despite regular clinical practice collaboration, participants have a limited understanding of AAs in terms of their educational prerequisites, scope of practice, and roles. One reason for this lack of understanding is that there is a high variability of titles and clinical duties for non-physician anesthesia providers. The diverse range of anesthesia services provided by AAs can also become a barrier to the full understanding of their scope of practice and roles. The limited understanding of the AA role was reported as one of AAs' ongoing challenges. It prevents AAs from realising their full scope of practice. Participants suggested that AAs' professional growth should focus on promoting and expanding their role. Understanding other healthcare professionals' perceptions of AAs will assist them to become better ambassadors for their role, and to more effectively promote and practice IPC. Ultimately, this will result in improved interprofessional teamwork to deliver effective and efficient patient care.
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Affiliation(s)
- Phoebe Lam
- a Department of Anesthesia and Pain Management , University Health Network , Toronto , Canada
| | - Ana Lopez Filici
- b Anesthesia Clinical Services, Department of Anesthesia and Pain Management , University Health Network , Toronto , Canada
| | - Claire Middleton
- c Department of Anesthesia and Pain Management , University Health Network and The Michener Institute of Education at UHN , Toronto , Canada
| | - Patricia McGillicuddy
- d Collaborative Academic Practice , University Health Network , Toronto , Canada.,e Department of Social Work , University of Toronto , Toronto , Canada
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Sullivan JL, Rivard PE, Shin MH, Rosen AK. Applying the High Reliability Health Care Maturity Model to Assess Hospital Performance: A VA Case Study. Jt Comm J Qual Patient Saf 2017; 42:389-411. [PMID: 27535456 DOI: 10.1016/s1553-7250(16)42080-5] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
BACKGROUND The lack of a tool for categorizing and differentiating hospitals according to their high reliability organization (HRO)-related characteristics has hindered progress toward implementing and sustaining evidence-based HRO practices. Hospitals would benefit both from an understanding of the organizational characteristics that support HRO practices and from knowledge about the steps necessary to achieve HRO status to reduce the risk of harm and improve outcomes. The High Reliability Health Care Maturity (HRHCM) model, a model for health care organizations' achievement of high reliability with zero patient harm, incorporates three major domains critical for promoting HROs-Leadership, Safety Culture, and Robust Process Improvement ®. A study was conducted to examine the content validity of the HRHCM model and evaluate whether it can differentiate hospitals' maturity levels for each of the model's components. METHODS Staff perceptions of patient safety at six US Department of Veterans Affairs (VA) hospitals were examined to determine whether all 14 HRHCM components were present and to characterize each hospital's level of organizational maturity. RESULTS Twelve of the 14 components from the HRHCM model were detected; two additional characteristics emerged that are present in the HRO literature but not represented in the model-teamwork culture and system-focused tools for learning and improvement. Each hospital's level of organizational maturity could be characterized for 9 of the 14 components. DISCUSSION The findings suggest the HRHCM model has good content validity and that there is differentiation between hospitals on model components. Additional research is needed to understand how these components can be used to build the infrastructure necessary for reaching high reliability.
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Affiliation(s)
- Jennifer L Sullivan
- Center for Healthcare Organization and Implementation Research (CHOIR), VA Boston Healthcare System, USA
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Varban OA, Niemann A, Stricklen A, Ross R, Ghaferi AA, Finks JF, Dimick JB. Far from Standardized: Using Surgical Videos to Identify Variation in Technique for Laparoscopic Sleeve Gastrectomy. J Laparoendosc Adv Surg Tech A 2017; 27:761-767. [PMID: 28686537 DOI: 10.1089/lap.2017.0184] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Video assessment is an emerging tool for understanding variation in surgical technique. METHODS Representative videos of laparoscopic sleeve gastrectomy (LSG) were voluntarily submitted by 20 surgeons who participated in a statewide quality improvement collaborative. The amount of time required to complete the salient steps of the operation was measured and variations in the tasks performed during each step were captured. RESULTS Twenty-two videos of LSG were submitted and 11 videos included concurrent hiatal hernia repair. Data obtained from video analysis identified variation in time to complete each step of the procedure: prestapling dissection of stomach (5-25 minutes), gastric stapling (8-20 minutes), and management of the staple line (1-25 minutes). Time required to perform a hiatal hernia repair also varied (1-26 minutes), as did the type of repair: 55% were performed with a posterior cruropexy, 27% were performed with an anterior cruropexy, and 18% were performed with both. Ten different permutations of staple heights and buttressing material were used during division of the stomach with a gastric stapler. Management of the staple line included use of buttressing (64%), fibrin sealant (36%), oversewing (9%), surgical clips (18%), imbrication of the staple line (36%), and omentoplasty (55%). CONCLUSIONS LSG technique is not uniform. Video analysis identified variation in (1) time to complete each step of the procedure, (2) hiatal hernia repair technique, (3) stapling technique, and (4) post-transection staple line management. Future efforts linking video analysis with clinical outcomes can provide objective evidence to support best practices.
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Affiliation(s)
- Oliver A Varban
- 1 Department of Surgery, University of Michigan Health Systems , Ann Arbor, Michigan
| | - Adam Niemann
- 2 Department of Surgery, University of Michigan Medical School , Ann Arbor, Michigan
| | - Amanda Stricklen
- 3 Department of Surgery, Center for Healthcare Outcomes and Policy, University of Michigan , Ann Arbor, Michigan
| | - Rachel Ross
- 3 Department of Surgery, Center for Healthcare Outcomes and Policy, University of Michigan , Ann Arbor, Michigan
| | - Amir A Ghaferi
- 3 Department of Surgery, Center for Healthcare Outcomes and Policy, University of Michigan , Ann Arbor, Michigan
| | - Jonathan F Finks
- 1 Department of Surgery, University of Michigan Health Systems , Ann Arbor, Michigan
| | - Justin B Dimick
- 1 Department of Surgery, University of Michigan Health Systems , Ann Arbor, Michigan.,3 Department of Surgery, Center for Healthcare Outcomes and Policy, University of Michigan , Ann Arbor, Michigan
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Abstract
BACKGROUND Briefing of the trauma team before patient arrival is unstructured in many centers. We surveyed trauma teams regarding agreement on patient care priorities and evaluated the impact of a structured, physician-led briefing on concordance during simulated resuscitations. METHODS Trauma nurses at our Level II center were surveyed, and they participated in four resuscitation scenarios, randomized to "briefed" or "nonbriefed." For nonbriefed scenarios, nurses independently reviewed triage sheets with written information. Briefed scenarios had a structured 4-minute physician-led briefing reviewing triage sheets identical to nonbriefed scenarios. Teams included three to four nurses (subjects) and two to four confederates (physicians, respiratory therapists). Each team served as their own control group. Confederates were blinded to nurses' briefed or nonbriefed status. Immediately before, and at the midpoint of each scenario, nurses estimated patients' morbidity and mortality and ranked the top 3 of 16 designated immediate care priorities. Briefed and nonbriefed groups' responses were compared for (1) agreement using intraclass correlation coefficient, (2) concordance with physicians' responses using the Fisher exact test, (3) teamwork via T-NOTECHS ratings by nurses and physicians using t-test, and (4) time to complete clinical tasks using t test. RESULTS Thirty-eight nurses participated. Ninety-seven percent "agreed/strongly agreed" briefing is important, but only 46% agreed briefing was done well. Comparing briefed versus nonbriefed scenarios, nurses' estimation of morbidity and mortality in the briefed scenarios showed significantly greater agreement with each other and with physicians' answers (p < 0.01). Rank lists also better agreed with each other (intraclass correlation coefficient, 0.64 vs 0.59) and with physicians' answers in the briefed scenarios. T-NOTECHS Leadership ratings were significantly higher in the briefed scenarios (3.70 vs 3.39; p < 0.01). Time to completion of key clinical tasks was significantly faster for one of the briefed scenarios. CONCLUSIONS Discordant perceptions of patient care goals was frequently observed. Structured physician-led briefing seemed to improve interprofessional team concordance, leadership, and task completion in simulated trauma resuscitations.
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Schiff L, Tsafrir Z, Aoun J, Taylor A, Theoharis E, Eisenstein D. Quality of Communication in Robotic Surgery and Surgical Outcomes. JSLS 2017; 20:JSLS.2016.00026. [PMID: 27493469 PMCID: PMC4949353 DOI: 10.4293/jsls.2016.00026] [Citation(s) in RCA: 44] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
Background and Objectives: Robotic surgery has introduced unique challenges to surgical workflow. The association between quality of communication in robotic-assisted laparoscopic surgery and surgical outcomes was evaluated. Methods: After each gynecologic robotic surgery, the team members involved in the surgery completed a survey regarding the quality of communication. A composite quality-of-communication score was developed using principal component analysis. A higher composite quality-of-communication score signified poor communication. Objective parameters, such as operative time and estimated blood loss (EBL), were gathered from the patient's medical record and correlated with the composite quality-of-communication scores. Results: Forty robotic cases from March through May 2013 were included. Thirty-two participants including surgeons, circulating nurses, and surgical technicians participated in the study. A higher composite quality-of-communication score was associated with greater EBL (P = .010) and longer operative time (P = .045), after adjustment for body mass index, prior major abdominal surgery, and uterine weight. Specifically, for every 1-SD increase in the perceived lack of communication, there was an additional 51 mL EBL and a 31-min increase in operative time. The most common reasons reported for poor communication in the operating room were noise level (28/36, 78%) and console-to-bedside communication problems (23/36, 64%). Conclusion: Our study demonstrates a significant association between poor intraoperative team communication and worse surgical outcomes in robotic gynecologic surgery. Employing strategies to decrease extraneous room noise, improve console-to-bedside communication and team training may have a positive impact on communication and related surgical outcomes.
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Affiliation(s)
- Lauren Schiff
- Division of Advanced Laparoscopy and Pelvic Pain, Department of Obstetrics and Gynecology. University of North Carolina, Chapel Hill, North Carolina, USA
| | - Ziv Tsafrir
- Division of Minimally Invasive Gynecology, Women's Health Services, Henry Ford Hospital, West Bloomfield, Michigan, USA
| | - Joelle Aoun
- Division of Minimally Invasive Gynecology, Women's Health Services, Henry Ford Hospital, West Bloomfield, Michigan, USA
| | - Andrew Taylor
- Division of Biostatistics, Public Health Sciences, Henry Ford Health System, Detroit, Michigan, USA
| | - Evan Theoharis
- Division of Minimally Invasive Gynecology, Women's Health Services, Henry Ford Hospital, West Bloomfield, Michigan, USA
| | - David Eisenstein
- Division of Minimally Invasive Gynecology, Women's Health Services, Henry Ford Hospital, West Bloomfield, Michigan, USA
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André B, Nøst TH, Frigstad SA, Sjøvold E. Differences in communication within the nursing group and with members of other professions at a hospital unit. J Clin Nurs 2017; 26:956-963. [PMID: 27240269 DOI: 10.1111/jocn.13410] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/14/2016] [Indexed: 11/28/2022]
Abstract
AIMS AND OBJECTIVES To investigate what differences exist in nurses' communications with each other as opposed to their communications with members of other healthcare professions. BACKGROUND Difficulties have been reported related to the introduction of interdisciplinary collaboration in hospitals even when their efficacy has been demonstrated. DESIGN This paper is a report of a project that was a cross-sectional survey design. METHOD Nurses and assistant nurses received questionnaires that examined two different components of interdisciplinary collaboration. Using the psychometric method known as Systematizing Person-Group Relations to gather data and for analysis, the method aims to investigate the dominant aspects of the particular work environment by identifying key characteristics of interdisciplinary collaboration. RESULTS The respondents reported significant differences in six of the 12 factors; high scores on caring, acceptance, engagement and empathy characterised communication with members of their own professional group as low scores on the same factors characterised communication with other healthcare professions. CONCLUSION Findings in this study suggests that nurses behave in a more loyal, accepting and critical manner when communicating with each other than they do when communicating with members of other healthcare professions. Nurses are more influenced by behaviours characterised by assertiveness and resignation in their communication with members of other healthcare professions. The findings indicate that nurse's experience mixed emotions and behaviours that influence their communications with healthcare personnel from other professions. RELEVANCE TO CLINICAL PRACTICE Nurses often hold key positions on interdisciplinary collaboration; therefore, they must develop the communicative skills required in this position to be able to improve the quality of patient care in hospitals, related to nurses' experiences and skills.
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Affiliation(s)
- Beate André
- Department of Public Health and Nursing, Norwegian University of Science and Technology (NTNU), Trondheim, Norway.,NTNU Center for Health Promotion Research, Trondheim, Norway
| | - Torunn H Nøst
- Department of Public Health and Nursing, Norwegian University of Science and Technology (NTNU), Trondheim, Norway.,NTNU Center for Health Promotion Research, Trondheim, Norway
| | - Sigrun A Frigstad
- Department of Nursing Science, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
| | - Endre Sjøvold
- Department of Industrial Economics and Technology Management, Faculty of Social Sciences and Technology Management, NTNU, Trondheim, Norway
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Creutzfeldt J, Hedman L, Felländer-Tsai L. Cardiopulmonary Resuscitation Training by Avatars: A Qualitative Study of Medical Students' Experiences Using a Multiplayer Virtual World. JMIR Serious Games 2016; 4:e22. [PMID: 27986645 PMCID: PMC5203677 DOI: 10.2196/games.6448] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2016] [Revised: 11/15/2016] [Accepted: 11/23/2016] [Indexed: 11/13/2022] Open
Abstract
Background Emergency medical practices are often team efforts. Training for various tasks and collaborations may be carried out in virtual environments. Although promising results exist from studies of serious games, little is known about the subjective reactions of learners when using multiplayer virtual world (MVW) training in medicine. Objective The objective of this study was to reach a better understanding of the learners’ reactions and experiences when using an MVW for team training of cardiopulmonary resuscitation (CPR). Methods Twelve Swedish medical students participated in semistructured focus group discussions after CPR training in an MVW with partially preset options. The students’ perceptions and feelings related to use of this educational tool were investigated. Using qualitative methodology, discussions were analyzed by a phenomenological data-driven approach. Quality measures included negotiations, back-and-forth reading, triangulation, and validation with the informants. Results Four categories characterizing the students’ experiences could be defined: (1) Focused Mental Training, (2) Interface Diverting Focus From Training, (3) Benefits of Practicing in a Group, and (4) Easy Loss of Focus When Passive. We interpreted the results, compared them to findings of others, and propose advantages and risks of using virtual worlds for learning. Conclusions Beneficial aspects of learning CPR in a virtual world were confirmed. To achieve high participant engagement and create good conditions for training, well-established procedures should be practiced. Furthermore, students should be kept in an active mode and frequent feedback should be utilized. It cannot be completely ruled out that the use of virtual training may contribute to erroneous self-beliefs that can affect later clinical performance.
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Affiliation(s)
- Johan Creutzfeldt
- Department of Clinical Science, Intervention and Technology (CLINTEC), Karolinska Institutet, Stockholm, Sweden.,Center for Advanced Medical Simulation and Training, Karolinska University Hospital, Stockholm, Sweden
| | - Leif Hedman
- Department of Clinical Science, Intervention and Technology (CLINTEC), Karolinska Institutet, Stockholm, Sweden.,Department of Psychology, Umeå University, Umeå, Sweden
| | - Li Felländer-Tsai
- Department of Clinical Science, Intervention and Technology (CLINTEC), Karolinska Institutet, Stockholm, Sweden.,Center for Advanced Medical Simulation and Training, Karolinska University Hospital, Stockholm, Sweden
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Scalea TM. Repainting the ceiling: Do patient safety and satisfaction initiatives make things safer or more satisfying? J Trauma Acute Care Surg 2016; 81:997-1002. [PMID: 27192465 DOI: 10.1097/ta.0000000000001111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
- Thomas M Scalea
- Published online: May 18, 2016. From the R Adams Cowley Shock Trauma Center, University of Maryland, Baltimore, Maryland
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Movement Along the Spine Induced by Transcranial Electrical Stimulation Related Electrode Positioning. Spine (Phila Pa 1976) 2016; 41:1128-1132. [PMID: 26890949 DOI: 10.1097/brs.0000000000001495] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN A prospective, nonrandomized cohort study. OBJECTIVE To describe a technique quantifying movement induced by transcranial electrical stimulation (TES) induced movement in relation to the positioning of electrodes during spinal deformity surgery. SUMMARY OF BACKGROUND DATA TES induced movement may cause injuries and delay surgical procedures. When TES movements are evoked, muscles other than those being monitored any adjustments in stimulation protocols and electrode positioning may be expected to minimize movement whereas preserving quality of monitoring. In this study, seismic evoked responses (SER) induced through TES were studied at different electrode positions. METHODS Intraoperative TES-motor evoked potentials were carried out in 12 patients undergoing corrective spine surgery. Accelerometer transducers recorded SER in two directions at four different locations of the spine for TES-electrode montage groups Cz-Fz and C3-C4. A paired t test was used to compare the means of SER and the relationship between movement and TES electrode positioning. RESULTS SERs were strongest in the upper body. All mean SERs values for the Cz-Fz group were up to five times larger when compared with the C3-C4 group. However, there were no differences between the C3-C4 and Cz-Fz groups in the lower body locations. Both electrode montage groups showed a gradual stepwise reduction in all mean SER values along the spine from the cranial to caudal region. For the upper body locations, there were no significant associations between SER and both montages; in contrast, a significant association SER was demonstrated in the lumbar region. CONCLUSION At supramaximum levels, movements resulting from multipulse TES are likely caused by relatively strong contractions from muscles in the neck resulting from direct extracranial stimulation. When interchanging electrode montages in individual cases, the movement in the neck may become reduced. At lumbar levels transcranial evoked muscle contractions dominate movement in the surgically exposed areas. LEVEL OF EVIDENCE 4.
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