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Langston DM, Kominsky H, McGreal N, Cartwright C, Murtha M, Posid T, Jenkins LC. Development and Application of a Novel and Efficient Skills Assessment Tool: A Pilot Initiative to Measure Vasectomy Competency on a Smartphone. Urology 2023; 177:12-20. [PMID: 37031843 DOI: 10.1016/j.urology.2023.01.055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2022] [Revised: 01/10/2023] [Accepted: 01/18/2023] [Indexed: 04/11/2023]
Abstract
OBJECTIVE To develop and evaluate a mobile phone-based skills assessment tool that measures procedural competency of urology residents learning to perform a common, non-robotic urology procedure as a means of tracking current skillset and improvement over time. METHODS The assessment tool was a Qualtrics survey accessed via a smartphone link that breaks down a vasectomy into 6 critical steps. Level of competency was measured on a scale of '1-novice' to '5-expert.' Nine residents from Post graduate year (PGY)-1 to PGY-5 were evaluated by one instructor after completing a vasectomy (86 single-side cases recorded over a 6-month period). We compared individual trainees to each other, analyzed performance (improvement) over time, and evaluated competency against cohort and program averages. RESULTS As an example, a single resident ('Resident 2,' N = 11 cases) was compared to cohort (PGY, M = 7.5/resident) and program (all residents, M = 7.4/resident). Results indicate similar skillfulness across Step 1 (puncturing and isolation of vas and hand positioning; P > 0.1), but marginally lower competency on Step 2 (opening of vasal sheath to expose/isolate vas; vs. cohort: P = 0.076, vs. residents: P = 0.082). Significantly lower competency on Steps 3-6 (all P < 0.04) suggests targeted teaching could improve cautery technique, fascial interposition, hemostasis, and positioning of stumps. CONCLUSION Our mobile-based skills assessment is a low cost, novel, and efficient assessment that would support current Accreditation Council for Graduate Medical Education (ACGME) goals to increase competency-based residency training. This tool is easily created and accessed, provides real-time feedback to learners, and can be used for individual and group assessment at a single timepoint or longitudinally.
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Affiliation(s)
| | - Hal Kominsky
- The Ohio State University Department of Urology, Columbus, OH
| | - Noah McGreal
- The Ohio State University College of Medicine, Columbus, OH
| | | | - Matthew Murtha
- The Ohio State University College of Medicine, Columbus, OH
| | - Tasha Posid
- The Ohio State University Department of Urology, Columbus, OH.
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Driesen BE, Baartmans M, Merten H, Otten R, Walker C, Nanayakkara PW, Wagner C. Root Cause Analysis Using the Prevention and Recovery Information System for Monitoring and Analysis Method in Healthcare Facilities: A Systematic Literature Review. J Patient Saf 2022; 18:342-350. [PMID: 34850624 PMCID: PMC9162072 DOI: 10.1097/pts.0000000000000925] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES Unintended events (UEs) are prevalent in healthcare facilities, and learning from them is key to improve patient safety. The Prevention and Recovery Information System for Monitoring and Analysis (PRISMA)-method is a root cause analysis method used in healthcare facilities. The aims of this systematic review are to map the use of the PRISMA-method in healthcare facilities worldwide, to assess the insights that the PRISMA-method offers, and to propose recommendations to increase its usability in healthcare facilities. METHODS PubMed, EMBASE.com, CINAHL, and The Cochrane Library were systematically searched from inception to February 26, 2020. Studies were included if the PRISMA-method for analyzing UEs was applied in healthcare facilities. A quality appraisal was performed, and relevant data based on an appraisal checklist were extracted. RESULTS The search provided 2773 references, of which 25 articles reporting 10,816 UEs met our inclusion criteria. The most frequently identified root causes were human-related, followed by organizational factors. Most studies took place in the Netherlands (n = 20), and the sample size ranged from 1 to 2028 UEs. The study setting and collected data used for PRISMA varied widely. The PRISMA-method performed by multiple persons resulted in more root causes per event. CONCLUSIONS To better understand UEs in healthcare facilities and formulate optimal countermeasures, our recommendations to further improve the PRISMA-method mainly focus on combining information from patient files and reports with interviews, including multiple PRISMA-trained researchers in an analysis, and modify the Eindhoven Classification Model if needed.
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Affiliation(s)
- Babiche E.J.M. Driesen
- From the Department of Emergency Medicine, Amsterdam Public Health Research Institute, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam
| | - Mees Baartmans
- Netherlands Institute for Health Services Research (NIVEL), Utrecht
| | - Hanneke Merten
- Department of Public and Occupational Health, Amsterdam Public Health Research Institute, Amsterdam UMC, Vrije Universiteit Amsterdam
| | - René Otten
- Medical Library, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Camilla Walker
- Faculty of Biology, Medicine and Health, University of Manchester, Manchester, United Kingdom
| | - Prabath W.B. Nanayakkara
- Section of General and Acute Internal Medicine, Department of Internal Medicine, Amsterdam Public Health Research Institute, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Cordula Wagner
- Netherlands Institute for Health Services Research (NIVEL), Utrecht
- Department of Public and Occupational Health, Amsterdam Public Health Research Institute, Amsterdam UMC, Vrije Universiteit Amsterdam
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Risk factors affecting maternal health outcomes in Rivers State of Nigeria: Towards the PRISMA model. Soc Sci Med 2020; 265:113520. [PMID: 33250317 DOI: 10.1016/j.socscimed.2020.113520] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Revised: 10/14/2020] [Accepted: 11/10/2020] [Indexed: 12/29/2022]
Abstract
Existing research suggests that Nigeria accounts for about 23% of the world's maternal mortality ratio, with negative impacts on women's wellbeing and the country's socio-economic development. The underlying risk factors can be categorized into political influences, poor access to healthcare, inadequate utilization of health facilities, poor family planning support and complex pregnancy-related illness. Yet, the complex interrelations amongst the factors makes it difficult to ascertain the riskiest ones that affect women's reproduction and child death, with the existing intervening strategies failing to address the problem. This study identifies maternal health risk factors and prioritizes their management in Rivers State of Nigeria, using the Prevention and Recovery Information System for Monitoring and Analysis (PRISMA) model. Taking a quantitative turn, we applied exploratory factor analysis to analyze 174 returned questionnaires from healthcare professionals working in Rivers State and used the results to establish relationships between maternal health risk factors, prioritizing the riskiest factors. The outcomes indicate that the PRISMA model provides an effective framework for identifying and managing maternal mortality risks that can enable healthcare experts and managers to address the avoidable risk factors and mitigate the unavoidable patient-related risk factors in Nigeria. The implications for theory, practice and policy are discussed.
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Bialek L, Poletajew S, Magusiak PM, Ostrach M, Szpernalowski J, Dybowski B, Radziszewski P. Bimanual palpation for staging of bladder cancer-clinical use and its predictors. Turk J Urol 2019; 45:22-26. [PMID: 30468424 DOI: 10.5152/tud.2018.27243] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2018] [Accepted: 07/03/2018] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To analyze the frequency of performing bimanual palpation (BP) during transurethral resection of the bladder tumor (TURBT) and to identify its predictors. MATERIAL AND METHODS This retrospective analysis enrolled 568 consecutive patients, who underwent TURBT due to primary bladder cancer. There were thirty surgeons involved in the analysis, each performed a mean of 18.9 TURBTs (range 1-43). Univariate and multivariate logistic regression analyses were performed to identify factors predicting the BP use. RESULTS Two hundred and sixty-five patients (46.7%) underwent BP. BP was performed in 36.1% of Ta tumors, 49.1% of T1 tumors and 76.6% of ≥T2 tumors (p<0.001); in 60.2% of tumors >3 cm and in 33.3% of tumors <3 cm (p<0.001). Female, and male doctors performed BP in 38.3%, and 48.8% of the cases, respectively (p=0.01). Senior residents performed BP more often than junior residents and certified junior and senior urologists (64.6% vs. 39.2% vs. 48.2% vs. 31.1%, respectively; p=0.03). In multivariate logistic regression analysis higher tumor stage, larger tumor size, as well as senior residents and male surgeons performing TURBT were independent predictors of BP. CONCLUSION Though BP is recommended for each patient at the time of TURBT, it is performed only in the minority of patients undergoing TURBT, mainly those with advanced or larger tumors, operated by senior residents and male surgeons.
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Affiliation(s)
- Lukasz Bialek
- Department of General, Oncological and Functional Urology, Medical University of Warsaw, Warsaw, Poland
| | - Slawomir Poletajew
- Department of General, Oncological and Functional Urology, Medical University of Warsaw, Warsaw, Poland
| | - Piotr Maciej Magusiak
- Department of General, Oncological and Functional Urology, Medical University of Warsaw, Warsaw, Poland
| | - Mikolaj Ostrach
- Department of General, Oncological and Functional Urology, Medical University of Warsaw, Warsaw, Poland
| | - Jakub Szpernalowski
- Department of General, Oncological and Functional Urology, Medical University of Warsaw, Warsaw, Poland
| | - Bartosz Dybowski
- Department of General, Oncological and Functional Urology, Medical University of Warsaw, Warsaw, Poland
| | - Piotr Radziszewski
- Department of General, Oncological and Functional Urology, Medical University of Warsaw, Warsaw, Poland
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Van KA, Nogueira L, Gustafson D, Tieu W, Averch TD, Kim FJ. The Culture of Patient Safety Practice: Systematic Review. UROLOGY PRACTICE 2017; 4:296-301. [PMID: 37592640 DOI: 10.1016/j.urpr.2016.08.003] [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: 11/26/2022]
Abstract
INTRODUCTION Regulations and guidelines are essential components of maintaining safety in multiple industries. In health care these processes exist to help distinguish weaknesses in patient care and identify adverse events. We review the processes that have been established in health care to promote the culture of patient safety. METHODS Sources were acquired through the NCBI (National Center for Biotechnology Information) database using the keywords "safety," "World Health Organization" and "Joint Commission on Accreditation of Healthcare Organizations." Other sources were obtained through research into specific safety processing topics of industrial and nonindustrial institutions. RESULTS The organizational properties of patient care expand beyond the number of incidents an institution experiences and include standardized safety values for specific patient care procedures. Tools such as SBAR (Situation, Background, Assessment, Recommendation), Reason's Swiss cheese model and the general guidelines established by the WHO have been used to detect and reduce the likelihood of errors in patient practice. These tools also demonstrate the importance of adopting regulated checklists and protocols that are essential at every stage of patient care. CONCLUSIONS While various systems have been implemented throughout the health care industry to overcome processing weaknesses, a continued display of effectiveness and improvement of current subspecialty specific guidelines are necessary for the assurance of safety in contemporary patient care.
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Affiliation(s)
- Kevin A Van
- Denver Health Medical Center, University of Colorado at Denver, Denver, Colorado
| | - Leticia Nogueira
- Denver Health Medical Center, University of Colorado at Denver, Denver, Colorado
| | - Diedra Gustafson
- Denver Health Medical Center, University of Colorado at Denver, Denver, Colorado
| | - Wenda Tieu
- Denver Health Medical Center, University of Colorado at Denver, Denver, Colorado
| | - Timothy D Averch
- Department of Urology, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Fernando J Kim
- Denver Health Medical Center, University of Colorado at Denver, Denver, Colorado
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de Vries AH, Schout BMA, van Merriënboer JJG, Pelger RCM, Koldewijn EL, Muijtjens AMM, Wagner C. High educational impact of a national simulation-based urological curriculum including technical and non-technical skills. Surg Endosc 2016; 31:928-936. [PMID: 27387182 DOI: 10.1007/s00464-016-5060-1] [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] [Received: 10/14/2015] [Accepted: 06/16/2016] [Indexed: 11/28/2022]
Abstract
BACKGROUND Although simulation training is increasingly used to meet modern technology and patient safety demands, its successful integration within surgical curricula is still rare. The Dutch Urological Practical Skills (D-UPS) curriculum provides modular simulation-based training of technical and non-technical basic urological skills in the local hospital setting. This study aims to assess the educational impact of implementing the D-UPS curriculum in the Netherlands and to provide focus points for improvement of the D-UPS curriculum according to the participants. METHODS Educational impact was assessed by means of qualitative individual module-specific feedback and a quantitative cross-sectional survey among residents and supervisors. Twenty out of 26 Dutch teaching hospitals participated. The survey focussed on practical aspects, the D-UPS curriculum in general, and the impact of the D-UPS curriculum on the development of technical and non-technical skills. RESULTS A considerable survey response of 95 % for residents and 76 % for supervisors was obtained. Modules were attended by junior and senior residents, supervised by a urologist, and peer teaching was used. Ninety percent of supervisors versus 67 % of residents judged the D-UPS curriculum as an important addition to current residency training (p = 0.007). Participants' aggregated general judgement of the modules showed a substantial percentage favorable score (M ± SE: 57 ± 4 %). The impact of training on, e.g., knowledge of materials/equipment and ability to anticipate on complications was high, especially for junior residents (77 ± 5 and 71 ± 7 %, respectively). Focus points for improvement of the D-UPS curriculum according to the participants include adaptation of the training level to residents' level of experience and focus on logistics. CONCLUSION The simulation-based D-UPS curriculum has a high educational impact. Residents and supervisors consider the curriculum to be an important addition to current residency training. Focus points for improvement of the D-UPS curriculum according to the participants include increased attention to logistics and integration of a spiral learning approach.
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Affiliation(s)
- Anna H de Vries
- Department of Urology, Catharina Hospital, Michelangelolaan 2, 5623 EJ, Eindhoven, The Netherlands.
| | - Barbara M A Schout
- Department of Urology, Alrijne Hospital, Leiden, The Netherlands.,Netherlands Institute for Health Services Research (NIVEL), Utrecht, The Netherlands
| | | | - Rob C M Pelger
- Department of Urology, University Medical Center Leiden, Leiden, The Netherlands
| | - Evert L Koldewijn
- Department of Urology, Catharina Hospital, Michelangelolaan 2, 5623 EJ, Eindhoven, The Netherlands.,School of Health Professions Education, Maastricht University, Maastricht, The Netherlands
| | - Arno M M Muijtjens
- Department of Educational Development and Research, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands
| | - Cordula Wagner
- Netherlands Institute for Health Services Research (NIVEL), Utrecht, The Netherlands.,Department of Public and Occupational Health, EMGO Institute for Health and Care Research, Amsterdam, The Netherlands
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de Vries AH, Lesterhuis E, Verweij LM, Schout BMA, van der Horst HJR, Leppink J, Koldewijn EL, Wagner C. High level of patient satisfaction and comfort during diagnostic urological procedures performed by urologists and residents. Scand J Urol 2015; 50:206-11. [PMID: 26635064 DOI: 10.3109/21681805.2015.1116109] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE The aim of this study was to investigate how patients experience diagnostic urological procedures performed by urologists, junior residents and senior residents, and to assess the influence of procedure-related factors on patient experiences. METHODS Data were collected during 222 procedures: 84 transrectal ultrasound-guided prostate biopsies (TRUSP; urologists n = 39, residents n = 45) and 138 urethrocystoscopies (UCS; urologists n = 44, residents n = 94) in six hospitals. Patient experiences were assessed using a questionnaire focusing on pain, comfort and satisfaction (visual analogue scale, 0-10) and communication aspects on a four-point Likert scale. Clinical observations were made to identify influencing factors. RESULTS Median values for patient experiences across procedures were 10 (range 5-10) for patient satisfaction, 2 (0-9) for pain and 8 (0-10) for comfort. Generalized estimating equations revealed no significant differences between urologists, senior residents and junior residents in terms of experienced patient comfort, satisfaction or pain. Procedural time was longer for residents, but this did not correlate significantly with patient-experienced comfort (p = 0.3). In UCS, patient comfort and satisfaction were higher in the supine position for male and female patients, respectively (p < 0.01). In TRUSP, local anaesthesia resulted in a significant decrease in pain (p = 0.002) and an increase in comfort (p = 0.03). Finally, older patients experienced less pain and gave higher comfort and satisfaction responses than younger patients. CONCLUSIONS Patients expressed high levels of satisfaction and comfort during diagnostic urological procedures. Experiences were not affected by the level of training, suggesting highly developed interpersonal and communication skills for residents in an early stage of residency training. Patients demonstrated significant preferences for local anaesthesia in TRUSP and performance of UCS in the supine position over the lithotomy position.
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Affiliation(s)
- A H de Vries
- a Department of Urology , Catharina Hospital , Eindhoven , The Netherlands
| | - E Lesterhuis
- b Department of Urology , Westfriesgasthuis , Hoorn , The Netherlands
| | - L M Verweij
- c Netherlands Institute for Health Services Research (NIVEL) , Utrecht , The Netherlands
| | - B M A Schout
- c Netherlands Institute for Health Services Research (NIVEL) , Utrecht , The Netherlands ;,d Department of Urology , Alrijne Hospital , Leiden , The Netherlands
| | | | - J Leppink
- f Department of Educational Development and Research , School of Health Professions Education, Maastricht University , Maastricht , The Netherlands
| | - E L Koldewijn
- a Department of Urology , Catharina Hospital , Eindhoven , The Netherlands ;,g Faculty of Health, Medicine and Life Sciences, Maastricht University , Maastricht , The Netherlands
| | - C Wagner
- c Netherlands Institute for Health Services Research (NIVEL) , Utrecht , The Netherlands ;,h Department of Public and Occupational Health , EMGO Institute for Health and Care Research , Amsterdam , The Netherlands
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