The impact of situation-background-assessment-recommendation (SBAR) on safety attitudes in the obstetrics department

The SBAR tool for communication and patient safety in gynaecology and obstetrics: a Tunisian pilot study

BACKGROUND

In healthcare, inadequate communication among providers and insufficient information transmission represent primary contributors to adverse events, particularly in medical specialties such as obstetrics and gynecology. The implementation of SBAR (Situation-Background-Assessment-Recommendation) has been proposed as a standardized communication tool to enhance patient safety. This study aims to evaluate the knowledge, attitudes, and practices related to SBAR communication through a pilot study conducted in a middle-income country.

METHODS

This prospective longitudinal study took place in the gynecology-obstetrics department of a Tunisian university hospital from May to June 2019. All medical and paramedical staff underwent comprehensive theoretical and practical training through a 4-hour SBAR simulation. To gauge participants' knowledge, anonymous multiple-choice questionnaires were administered before the training initiation, with a second assessment conducted at the end of the training to measure satisfaction levels. Two months later, the evaluation utilized questionnaires validated by the French National Authority for Health (HAS).

RESULTS

Among the 62 care staff participants in this study, a majority (89%) demonstrated a low level of knowledge regarding the SBAR tool. The majority (75.8%) expressed enjoyment with the training and indicated their intention to implement changes in their practice by incorporating the SBAR tool in the future (80.7%). Notably, over half of the participants (79%) expressed satisfaction with the training objectives, and 74% reported acquiring new information. Evaluation of the practice revealed positive feedback, particularly in terms of clarity, the relevance of communication, and the time spent on the call.

CONCLUSION

Our pilot study showed that the majority of professionals on the ward had little knowledge of the SBAR tool, a good attitude and a willingness to put it into practice. It is essential that healthcare managers and professionals from all disciplines work together to ensure that good communication practice is developed and maintained. Organisations, including universities and hospitals, need to invest in the education and training of students and health professionals to ensure good quality standardised communication.

Impact of the implementation of Identification-Situation-Background-Assessment-Recommendation (ISBAR) tool to improve quality and safety measure in a lithotripsy and endourological unit

INTRODUCTION

A lack of professional communication and collaboration may be one of the main causes of medication errors. The objective was to evaluate the results of the implementation of ISBAR as a communication and safety tool in a Lithotripsy and Endourologic Unit of a tertiary public hospital.

METHODS

A total of 457 patients were included in a retrospective study from 2014 to 2019. Patients were divided into two groups: group A (357 patients) in which an endourological procedure was performed before march of 2018 (without the implementation of ISBAR tool) and Group B (100 patients) with the implementation of ISBAR tool. The inclusion criteria were patients accepted for surgical intervention by anaesthesiology Department and operated in the period of the study. The variables analysed included number of procedures, global, intraoperative and postoperative complications rate, urinary infection or sepsis, NPR (FMEA), percentage of suspended surgical patients and hospital stay.

RESULTS

The postoperative complications showed no significant differences between groups, but a trend to diminishing was seen in the complication in the group B. The sepsis reduced its incidence and it was close to significant difference. The operative time was shorter in group B 119,11min (114,63-123,59) vs 115,11min (109,63-121,67) p = 0,3. The reduction in the main postoperative complication (sepsis) explained the lower hospital stay for group B. The severe adverse events detected were reduced completely.

CONCLUSIONS

ISBAR tool was an effective patient safety tool improving quality care. To provide safe patient care and improving quality is indispensable an effective communication flow.

Der Übergabeprozess in der zentralen Notaufnahme – Konsentierung von Inhalten im Rahmen eines Delphi-Verfahrens

Hintergrund und Ziel der Arbeit

Für die Übergabe in der Notaufnahme – der Nahtstelle von prähospitaler zu klinischer Versorgung – stellen Merkhilfen („mnemonics“) das „Rückgrat“ für eine strukturierte Übermittlung von relevanten Informationen dar. In Deutschland existiert bis zum heutigen Tag keine Standardisierung bzw. konkrete Vorgabe, welche Merkhilfe zur Übergabe genutzt werden soll. Die vorliegende Untersuchung definiert erstmalig anhand eines strukturierten und mehrstufigen Konsentierungsprozesses (Delphi-Verfahren) von Experten (Mandatsträgern), welche Übergabeinhalte für erforderlich gehalten werden. Ziel dabei ist die Schaffung einer Grundlage zur Entwicklung einer bundeseinheitlichen Merkhilfe.

Methodik

Durchgeführt wurde ein Delphi-Verfahren, welches sich an den Regularien der Arbeitsgemeinschaft der wissenschaftlichen medizinischen Fachgesellschaften e. V. (AWMF) orientiert.

Ergebnisse

Im Rahmen des durchgeführten Delphi-Verfahrens konnte neben konkreten Inhalten der Merkhilfe auch deren Reihenfolge festgelegt werden. Übergabeinhalte wurden zu den Punkten Crew Resource Management (CRM) und Patientenidentifikation, Beschreibung der Notfallsituation, Notfallpriorität (ABCDE-Schema) und Vitalparameter, durchgeführte Maßnahmen, Anamnese, Zusammenfassung mit der Möglichkeit für Rückfragen durch das übernehmende Team sowie Zeitdauer definiert.

Diskussion

Die Ergebnisse der Arbeit bilden die evidenzbasierte Grundlage für die Entwicklung einer konkreten Merkhilfe („mnemonic“). Weitere Untersuchungen sollten sich nach Entwicklung einer geeigneten Merkhilfe darauf fokussieren, diese im Rahmen einer (prä-)klinischen Anwendungsstudie auf Praxistauglichkeit zu testen. Gleichzeitig sollte ein entsprechendes Schulungskonzept ausgearbeitet werden. Langfristig wird als Ziel eine bundesweit einheitliche Einführung angestrebt.

SBAR Method for Improving Well-Being in the Internal Medicine Unit: Quasi-Experimental Research

SBAR (Situation, Background, Assessment, Recommendation) is a tool for standardizing and improving interprofessional communication. This study aims to explore the impact of SBAR in healthcare professionals' wellbeing, through concepts such as job satisfaction, engagement, resilience, and job performance, in the internal medicine unit of a university hospital in the province of León (Spain). This is an observational, descriptive, longitudinal case study with a pre- and post-intervention approach. Questionnaires were distributed to a group of doctors, nurses, and healthcare assistants before and after the implementation of the SBAR tool in the ward. The use of SBAR was monitored to ensure staff compliance. Data statistical analysis was performed using the SPSS program. Resilience levels increased significantly post-intervention. Job satisfaction and engagement levels remained neutral, slightly decreasing post-intervention. Besides' being a useful tool to improve communication, SBAR was effective in improving resilience among staff. Several aspects related to hospital management may have had an impact on job satisfaction and engagement results.

Nursing staff's instrument for change-of-shift reporting - SBAR (Situation-Background-Assessment-Recommendation): validation and application

OBJECTIVES

to validate and apply a change-of-shift instrument using the SBAR (Situation-Background-Assessment-Recommendation) tool.

METHODS

methodological study for the validation of an instrument. It was validated by ten judges from the area of nursing teaching and care and applied in a surgical gastroenterology ward by 11 nursing technicians in February 2019. The analyses considered descriptive statistics.

RESULTS

the judges analyzed the instrument with a content validity index of 91.7% and made suggestions, which led to the second version of the instrument. The participants reported that the predominant modality of shift handover is oral, in the nursing room, lasting six to ten minutes. Most pay attention during shift change, mention that delays and early departures interfere in the activity and believe that the instrument provides the necessary information and is viable.

CONCLUSIONS

the instrument built was validated, and its application proved relevant, as it was considered necessary and feasible.

Situation-Background-Assessment-Recommendation Technique Improves Nurse-Physician Communication and Patient Satisfaction in Cataract Surgeries

Background

Implementation of the Situation-Background-Assessment-Recommendation (SBAR) communication technique has been shown to increase nurse-physician communication and collaboration. However, data regarding its implementation in ophthalmology settings are limited.

Objective

The purpose of this study was to evaluate the impact of implementing SBAR on nurse-physician communication and on the safety and satisfaction of patients undergoing cataract surgery.

Materials and Methods

This cross-sectional study was conducted in the Ophthalmology Department of Zhongshan Hospital, Xiamen University, Xiamen, China, from April 2016 to December 2018. SBAR was implemented through a 1-h course that was repeated every 2 months for 2 years. All nurses and physicians completed the Physician-Nurse Communication Satisfaction Questionnaire before SBAR implementation and 1- and 2-year post-implementation. In addition, all patients who underwent cataract surgery during the defined pre-implementation and 1- and 2-year post-implementation periods were invited to complete a patient satisfaction questionnaire.

Results

In total, 10 nurses and 6 physicians completed all three pre- and post-implementation surveys. In addition, 1215 patients undergoing cataract surgery participated: 358 in the pre-implementation phase, 425 in the 1-year post-implementation, and 432 in the 2-year post-implementation. Physician-nurse communication significantly improved in both 1- and 2-year post-implementation periods compared with the pre-implementation phase (P < 0.01). In addition, there was a significant increase in patient satisfaction scores (P < 0.01) and a decrease in medical complaints and malpractices (P < 0.01) between the pre- and post-implementation phases.

Conclusion

SBAR is a useful tool for enhancing nurse-physician communication and for improving the safety and satisfaction of patients undergoing cataract surgery.

Healthcare professional's perception of patient safety assessed by the hospital survey on patient safety culture in Taiwan: a systematic review

Purpose

Safety activities have been initiated in healthcare organizations in Taiwan, but little is known about the performance and trends of safety culture on a timely basis. This study aims to comprehensively review the articles that have conducted two worldwide patient safety culture instruments (HSPSC and SAQ) in Taiwan to provide the extent of existing knowledge about healthcare professionals' perception related to patient safety.

Design/methodology/approach

The Web of Science, Medline (Pubmed) and Embas were used as the database to search papers related to the patient safety culture in Taiwan from 2008 to June 30, 2019.

Findings

Twenty-four relative articles in total were found and further investigations confirmed that the regular assessment of patient safety culture among hospital staff is essentially important for healthcare organizations to reduce the rates of medical errors and malpractice. Moreover, the elements influencing patient safety culture may vary due to the difference in job positions, age, experience in organization and cultural settings.

Research limitations/implications

The summary of findings enables healthcare administrators and practitioners to understand key components of patient safety culture for continuous improvement in medical quality.

Originality/value

Assessing the safety culture in healthcare organizations is a foundation to achieve excellent medical quality and service. The implications of this study could be useful for hospitals to establish a safer environment for patients.

Instrumento de passagem de plantão da equipe de enfermagem - SBAR (Situation-Background-Assessment-Recommendation): validação e aplicação

RESUMO Objetivos: validar e aplicar instrumento de passagem de plantão utilizando a ferramenta SBAR (Situation-Background-Assessment-Recommendation). Métodos: estudo metodológico para a validação de instrumento. O instrumento foi validado por dez juízes da área de ensino e assistência de enfermagem e aplicado em uma enfermaria de gastroenterologia cirúrgica por 11 técnicos de enfermagem no mês de fevereiro de 2019. As análises consideraram a estatística descritiva. Resultados: os juízes analisaram o instrumento com índice de validade de conteúdo de 91,7%, fizeram sugestões gerando a segunda versão do instrumento. Os participantes referiram que a modalidade de passagem de plantão predominante é oral, na sala de enfermagem, de 6 a 10 minutos. A maioria presta atenção na passagem de plantão, refere que atrasos e saídas antecipadas interferem, acreditam que o instrumento possui informações necessárias e é viável. Conclusões: o instrumento construído foi validado e sua aplicação evidenciou a relevância, pois considera-se o instrumento necessário e viável.

Can SBAR be implemented with high fidelity and does it improve communication between healthcare workers? A systematic review

OBJECTIVE

To characterise the extent to which health professionals perform SBAR (situation, background, assessment, recommendation) as intended (ie, with high fidelity) and the extent to which its use improves communication clarity or other quality measures.

DATA SOURCES

Medline, Healthstar, PsycINFO, Embase and CINAHL to October 2020 and handsearching selected journals.

STUDY SELECTION AND OUTCOME MEASURES

Eligible studies consisted of controlled trials and time series, including simple before-after design, assessing SBAR implementation fidelity or the effects of SBAR on communication clarity or other quality measures (eg, safety climate, patient outcomes).

DATA EXTRACTION AND SYNTHESIS

Two reviewers independently abstracted data according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses on study features, intervention details and study outcomes. We characterised the magnitude of improvement in outcomes as small (<20% relative increase), moderate (20%-40%) or large (>40%).

RESULTS

Twenty-eight studies (3 randomised controlled trials, 6 controlled before-after studies, and 19 uncontrolled before-after studies) met inclusion criteria. Of the nine studies assessing fidelity of SBAR use, four occurred in classroom settings and three of these studies reported large improvements. The five studies assessing fidelity in clinical settings reported small to moderate effects. Among eight studies measuring communication clarity, only three reported large improvements and two of these occurred in classroom settings. Among the 17 studies reporting impacts on quality measures beyond communication, over half reported moderate to large improvements. These improvements tended to involve measures of teamwork and culture. Improvements in patient outcomes occurred only with intensive multifaceted interventions (eg, early warning scores and rapid response systems).

CONCLUSIONS

High fidelity uptake of SBAR and improvements in communication clarity occurred predominantly in classroom studies. Studies in clinical settings achieving impacts beyond communication typically involved broader, multifaceted interventions. Future efforts to improve communication using SBAR should first confirm high fidelity uptake in clinical settings rather than assuming this has occurred.

PROSPERO REGISTRATION NUMBER

CRD42018111377.

Application of comprehensive u nit-based safety program model in the inter-hospital transfer of patients with critical diseases: a retrospective controlled study

Background

To explore the effect of applying a comprehensive unit-based safety program (CUSP) in the intrahospital transfer of patients with critical diseases.

Methods

A total of 426 critically ill patients in the first affiliated Hospital of Anhui Medical University from August 2018 to February 2019 were divided into two groups according to the time of admission. Overall, 202 patients in the control group were treated with the routine transfer method, and 224 patients in the observational group were treated with the transfer method based on the CUSP model. The safety culture assessment data of medical staff, the occurrence rate of adverse events and related causes, the time of transfer, and the satisfaction of patients’ relatives to the transfer process were compared before and after implementation of the transfer model between the two groups.

Results

Before and after the implementation of the CUSP mode transfer program, there were significant differences in the scores of all dimensions of the safety culture assessment of medical staff (P < 0.05), and the occurrence rate of adverse events and the causes in the observational group were significantly lower than those in the control group (disease-related, staff-related, equipment-related, environment-related) (P < 0.05). The transfer time for Computed Tomography (CT), Magnetic Resonance Imaging (MRI), operating room, and the interventional room was significantly shorter in the observational group than that in the control group (P < 0.05), while the satisfaction of relatives to the transfer process was significantly higher than those in the control group (P < 0.05).

Conclusion

The implementation of CUSP model for the intrahospital transfer of critically ill patients can significantly shorten the in-hospital transfer time, improve the attitude of medical staff towards safety, reduce the occurrence rate of adverse events, and improve the satisfaction of patients’ relatives to the transfer process.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12913-021-06650-7.

[Use of the SBAR tool: Assessment of the value of a short training course on the quality of communication between caregivers in the short and long term]

OBJECTIVES

Communication breakdown is one of the main causes of adverse events in clinical routine. The main objective of this study was to assess whether a short training course on medical communication based on the situation-background-assessment-recommendation (SBAR) tool improved the quality of communication in clinical practice.

METHODS

Interventional study, conducted at the Jeanne de Flandre maternity unit (Lille University Hospital, France) between January 2017 and December 2019. The training sessions lasted 1 hour and consisted of a theoretical part, based on the SBAR tool, and of a practical part (video-stimulated recall and role-play case scenarios). The main outcome measure was the evaluation of the quality of the telephone calls made by a caregiver to the on-call doctor, using a questionnaire completed before (Q1) and remotely from training (Q2).

RESULTS

One hundred and twenty health professionals were trained (n=120). Following the trainings, there was an improvement in communication in the short term, whether in terms of relevance (64.9 vs. 52.6, P<0.001) or conciseness of the message (36.9 vs. 32.2, P<0.001), but also in terms of long-term in a real clinical situation (Q2: 3.9 vs. Q1: 3.0, P<0.001). Finally, 81% of participants were satisfied with the training.

CONCLUSIONS

Short training sessions on communication based on the SBAR tool appeared to improve participants' knowledge and skills in the short-term, but also in the longer term in a real clinical situation.

Current Practices in Pediatric Emergency Medicine Fellowship Trauma Training

OBJECTIVE

The management of injured children is a required element of pediatric emergency medicine (PEM) fellowship training. Given the relatively infrequent exposure of trainees to major trauma, it is important to understand how programs train fellows and assess their competency in pediatric trauma.

METHODS

An online survey was sent to 84 PEM fellowship program directors (PDs). Program directors were asked to describe their program's characteristics, the degree of fellow independence, educational techniques used to train fellows in trauma, and their expectation of fellows' competency in 14 core trauma-related skills upon graduation. Program directors were classified as having high expectations if they anticipated that graduating fellows could perform 12 trauma skills or more independently.

RESULTS

Fifty-nine programs (70%) responded. Although most programs (55, 93%) identified as pediatric trauma centers, fellows at the majority of programs (41, 69%) spent some or all of their trauma experience at an outside hospital. Only a minority of programs (17, 29%) allowed fellows to lead pediatric trauma resuscitations as independent attendings without precepting. Programs used over a dozen different educational methods to varying degrees. Less than half of programs (28, 47%) used a formal trauma curriculum. Whereas 33 PDs (56%) had high expectations, only 9 (15%) expected fellows to be able to perform all 14 skills.

CONCLUSIONS

There is considerable variability in how PEM fellows are trained to care for injured children. Most PDs do not realistically expect fellows to be able to perform all recommended trauma skills after graduation. Our findings highlight the need for further research and efforts to standardize the training of PEM fellows in pediatric trauma.

Evaluation of the Situation, Background, Assessment, and Recommendation Handover Tool in Improving Communication and Satisfaction Among Jordanian Nurses Working in Intensive Care Units

BACKGROUND

The SBAR (situation, background, assessment, and recommendation) is a standardized handover tool that has been utilized in health care settings. It has positive impacts on staff communication and patient quality of care. In Jordan, few reports are available about handover tools' impacts.

PURPOSE

To evaluate the implementation of the SBAR among nurses in intensive care units (ICUs) in Jordan.

METHODS

A pretest-posttest quasi-experimental design was used. A convenience sample of 71 ICU nurses participated. The 43-item ICU physician-nurse questionnaire was used to measure SBAR effectiveness as measured by the following subscales: general relationship and communication, teamwork and leadership, and job satisfaction.

RESULTS

There was a significant improvement in posttest knowledge scores and in "general relationships and communication" and "satisfaction" scores. There was a significant improvement in both "general relationships and communication" and "satisfaction" posttest scores compared with their pretest scores (t = 16.709, 2.656; P < .001, P < .01) consecutively.

CONCLUSIONS

This study revealed a strong indicator to encourage the SBAR utilization among nurses in health care settings. The SBAR has a positive impact on enhancing communication between nurses and increasing their job satisfaction. Thus, the utilization of such a standardized tool that maintains and assures good communication relationships shall increase level of satisfaction. Future studies are recommended to provide further evidence on its feasibility and efficacy as compared with traditional handover tools and among different health care contexts.

Training in the use of intrapartum electronic fetal monitoring with cardiotocography: systematic review and meta‐analysis

Background

Sub‐optimal classification, interpretation and response to intrapartum electronic fetal monitoring using cardiotocography are known problems. Training is often recommended as a solution, but there is lack of clarity about the effects of training and which type of training works best.

Objectives

Systematic review of the effects of training healthcare professionals in intrapartum cardiotocography (PROSPERO protocol: CRD42017064525).

Search strategy

CENTRAL, Cochrane Library, MEDLINE, EMBASE, PsycINFO, British Nursing Database, CINAHL, ERIC, Scopus, Web of Science, ProQuest, grey literature and ongoing clinical trials were searched.

Selection criteria

Primary studies that reported impact of training healthcare professionals in intrapartum cardiotocography. Title/abstract, full‐text screening and quality assessment were conducted in duplicate.

Data collection and analysis

Data were synthesised both narratively and using meta‐analysis. Risk of bias and overall quality were assessed with the Mixed Methods Appraisal Tool and GRADE.

Main results

Sixty‐four studies were included. Overall, training and reporting were heterogeneous, the outcomes evaluated varied widely and study quality was low. Five randomised controlled trials reported that training improved knowledge of maternity professionals compared with no training, but evidence was of low quality. Evidence for the impact of cardiotocography training on neonatal and maternal outcomes was limited, showed inconsistent effects, and was of low overall quality. Evidence for the optimal content and method of delivery of training was very limited.

Conclusions

Given the scale of harm and litigation claims associated with electronic fetal monitoring, the evidence‐base for training requires improvement. It should address intervention design, evaluation of clinical outcomes and system‐wide contexts of sub‐optimal practice.

Tweetable abstract

Training in fetal monitoring: systematic review finds little evidence of impact on neonatal outcomes.

Training in fetal monitoring: systematic review finds little evidence of impact on neonatal outcomes.

CONSTRUCTION OF THE INSTRUMENT FOR CARE TRANSITION IN PEDIATRIC UNITS

ABSTRACT Objective: to build and semantically validate a safe communication tool to systematize care transition in pediatric clinical and emergency units. Method: a methodological study, based on the Classic Theory of Psychometric Tests and on the Instrument Development Model, proposed by Pasquali, which included seven professionals, five nurses and two physicians, experts in pediatrics and/or patient safety, who followed specific criteria for inclusion. Data collection was carried out between November and December 2016 and took place with the application of a form made available to the experts via the Google Drive/Microsoft® tool in two validation rounds, conducted by the Delphi Technique, being organized into two domains with 19 items. Data analysis was performed by calculating the Content Validity Index. Results: in order to validate the content, it was necessary to reach a Content Validity Index ≥ 0.80; thus, in the first round, five items underwent changes and were adjusted according to the experts' recommendations. These were validated in the second round, maintaining two domains and nineteen items. Conclusion: the construction and content validation of the instrument can enhance and qualify the clinical practice and contribute to minimize failures in pediatric patient safety associated with effective communication.

A systematic review on the structured handover interventions between nurses in improving patient safety outcomes

AIM

This review aimed to elucidate the effectiveness of structured handovers in improving patient outcomes in the wards.

BACKGROUND

Studies have reported that the lack of quality handovers is one of the main causes of adverse effects.

EVALUATION

A search over six electronic databases: MEDLINE; CINAHL; Web of Science; EMBASE; Scopus; and CENTRAL via Ovid concluded nine studies and synthesized by two independent reviewers based on the Cochrane Handbook for Systematic Reviews of Interventions. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement was used to guide the undertaking of this review and meta-analysis. All studies published up to February 2019 were considered in this review.

KEY ISSUES

This review has demonstrated that structured handovers reduced the incidences of patient complications, medication errors and general adverse events. However, the results were not statistically significant.

CONCLUSION

Current structured handover formats were effective in reducing problematic handovers such as omission of information, inaccurate information and documentation errors.

IMPLICATIONS FOR NURSING MANAGEMENT

Although there is limited high-quality and rigorous research conducted to gain a clearer understanding of the impacts on patient-related outcomes in nursing care, structured handovers remained effective in reducing the number of mistakes in information transfer.

Interventions to improve team effectiveness within health care: a systematic review of the past decade

BACKGROUND

A high variety of team interventions aims to improve team performance outcomes. In 2008, we conducted a systematic review to provide an overview of the scientific studies focused on these interventions. However, over the past decade, the literature on team interventions has rapidly evolved. An updated overview is therefore required, and it will focus on all possible team interventions without restrictions to a type of intervention, setting, or research design.

OBJECTIVES

To review the literature from the past decade on interventions with the goal of improving team effectiveness within healthcare organizations and identify the "evidence base" levels of the research.

METHODS

Seven major databases were systematically searched for relevant articles published between 2008 and July 2018. Of the original search yield of 6025 studies, 297 studies met the inclusion criteria according to three independent authors and were subsequently included for analysis. The Grading of Recommendations, Assessment, Development, and Evaluation Scale was used to assess the level of empirical evidence.

RESULTS

Three types of interventions were distinguished: (1) Training, which is sub-divided into training that is based on predefined principles (i.e. CRM: crew resource management and TeamSTEPPS: Team Strategies and Tools to Enhance Performance and Patient Safety), on a specific method (i.e. simulation), or on general team training. (2) Tools covers tools that structure (i.e. SBAR: Situation, Background, Assessment, and Recommendation, (de)briefing checklists, and rounds), facilitate (through communication technology), or trigger (through monitoring and feedback) teamwork. (3) Organizational (re)design is about (re)designing structures to stimulate team processes and team functioning. (4) A programme is a combination of the previous types. The majority of studies evaluated a training focused on the (acute) hospital care setting. Most of the evaluated interventions focused on improving non-technical skills and provided evidence of improvements.

CONCLUSION

Over the last decade, the number of studies on team interventions has increased exponentially. At the same time, research tends to focus on certain interventions, settings, and/or outcomes. Principle-based training (i.e. CRM and TeamSTEPPS) and simulation-based training seem to provide the greatest opportunities for reaching the improvement goals in team functioning.

Assessment of safety culture in a public hospital in the Federal District, Brazil

OBJECTIVE

to assess the perception of health professionals regarding safety culture of a high complexity public hospital of the Federal District, Brazil.

METHOD

cross-sectional and descriptive study. The Safety Attitudes Questionnaire was used in electronic format. Descriptive and inferential analyses were carried out.

RESULTS

358 professionals participated, with 242 (67.6%) being female. Of these, 224 (62.6%) worked directly or indirectly with patients in assistance activities; 79 (22.1%) in administrative activities; 14 (3.9%) in management; and 41 (11.5%) in others. The total score was 57.1. Job satisfaction factors and stress perception had the most expressive results, 76.2 and 68.8, respectively. The category "working conditions" presented the lowest result, 40.7.

CONCLUSION

the results are below the score of 75, value recommended as indicative of a positive safety atmosphere. We suggest the implementation of actions for the promotion of safety culture and new studies with representative samples of all segments of workers.

Management and outcomes of patients presenting with sepsis and septic shock to the emergency department during nursing handover: a retrospective cohort study

Background

Clinical handover is an important process for the transition of patient-care responsibility to the next healthcare provider, but it may divert the attention of the team away from active patients. This is challenging in the Emergency Department (ED) because of highly dynamic patient conditions and is likely relevant in conditions that requires time-sensitive therapies, such as sepsis. We aimed to examine the management and outcomes of patients presenting with sepsis and septic shock to the ED during nursing handover.

Methods

This retrospective cohort study was conducted at a 115-bed ED and more than 200,000 annual ED visits, within a 900-bed academic tertiary care center. Data on Surviving Sepsis Campaign (SSC) bundle elements and hospital mortality were collected for all ≥14-year-old patients who presented to the ED with a diagnosis of sepsis and septic shock between January 1, 2011 and October 30, 2013. Our primary outcome was time to antibiotics, were other SSC bundle elements and mortality counted as secondary outcomes. Patients were divided into two groups: 1) handover time group, comprising patients who presented an hour before or after the start of handover time (6–8 AM/PM), and 2) non-handover time group, comprising patients who presented over the remaining 20 h.

Results

During the study period, 1330 patients presented with sepsis or septic shock (228, handover time group; 1102, non-handover time group). No significant differences were found between the handover time and non-handover time groups, respectively, in median time to antibiotic administration (100 [interquartile range (IQR) 57–172] vs. 95 [IQR 50–190] minutes; P = 0.07), median time to serum lactate result (162 [IQR 108–246] vs. 156 [IQR 180–246] minutes; P = 0.33) and median time to obtain blood culture (54 [IQR 36–119] vs. 52 [IQR 28–103] minutes; P = 0.52), and hospital mortality rate (29.4% vs. 28.9%; P = 0.89).

Conclusion

No significant differences were found in median time of SSC bundle elements or hospital mortality between patients who presented during the handover and non-handover times.