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Heesters V, van Zanten HA, de Boer LC, Visser R, Heijstek V, Te Pas AB, Witlox RS. Quality improvement initiative: implementing and redefining video review of real-time neonatal procedures using action research. BMJ Open Qual 2024; 13:e002588. [PMID: 38749540 PMCID: PMC11097868 DOI: 10.1136/bmjoq-2023-002588] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Accepted: 04/24/2024] [Indexed: 05/18/2024] Open
Abstract
Video review (VR) of procedures in the medical environment can be used to drive quality improvement. However, first it has to be implemented in a safe and effective way. Our primary objective was to (re)define a guideline for implementing interprofessional VR in a neonatal intensive care unit (NICU). Our secondary objective was to determine the rate of acceptance by providers attending VR. For 9 months, VR sessions were evaluated with a study group, consisting of different stakeholders. A questionnaire was embedded at the end of each session to obtain feedback from providers on the session and on the safe learning environment. In consensus meetings, success factors and preconditions were identified and divided into different factors that influenced the rate of adoption of VR. The number of providers who recorded procedures and attended VR sessions was determined. A total of 18 VR sessions could be organised, with an equal distribution of medical and nursing staff. After the 9-month period, 101/125 (81%) of all providers working on the NICU attended at least 1 session and 80/125 (64%) of all providers recorded their performance of a procedure at least 1 time. In total, 179/297 (61%) providers completed the questionnaire. Almost all providers (99%) reported to have a positive opinion about the review sessions. Preconditions and success factors related to implementation were identified and addressed, including improving the pathway for obtaining consent, preparation of VR, defining the role of the chair during the session and building a safe learning environment. Different strategies were developed to ensure findings from sessions were used for quality improvement. VR was successfully implemented on our NICU and we redefined our guideline with various preconditions and success factors. The adjusted guideline can be helpful for implementation of VR in emergency care settings.
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Affiliation(s)
- Veerle Heesters
- Department of Paediatrics, Leiden University Medical Center, Leiden, The Netherlands
| | | | - Linsey Cc de Boer
- Department of Paediatrics, Leiden University Medical Center, Leiden, The Netherlands
| | - Remco Visser
- Department of Paediatrics, Leiden University Medical Center, Leiden, The Netherlands
| | - Veerle Heijstek
- Department of Paediatrics, Leiden University Medical Center, Leiden, The Netherlands
| | - Arjan B Te Pas
- Department of Paediatrics, Leiden University Medical Center, Leiden, The Netherlands
| | - Ruben Sgm Witlox
- Department of Paediatrics, Leiden University Medical Center, Leiden, The Netherlands
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2
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Garcia-Jorda D, Nikitovic D, Gilfoyle E. Video Review of Simulated Pediatric Cardiac Arrest to Identify Errors/Latent Safety Threats: A Mixed Methods Study. Simul Healthc 2023; 18:232-239. [PMID: 35618263 DOI: 10.1097/sih.0000000000000670] [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: 11/25/2022]
Abstract
INTRODUCTION Outcomes from pediatric in-hospital cardiac arrest depend on the treatment provided as well as resuscitation team performance. Our study aimed to identify errors occurring in this clinical context and develop an analytical framework to classify them. This analytical framework provided a better understanding of team performance, leading to improved patient outcomes. METHODS We analyzed 25 video recordings of pediatric cardiac arrest simulations from the pediatric intensive care unit at the Alberta Children's Hospital. We conducted a qualitative-dominant crossover mixed method analysis to produce a broad understanding of the etiology of errors. Using qualitative framework analysis, we identified and qualitatively described errors and transformed the data coded into quantitative data to determine the frequency of errors. RESULTS We identified 546 errors/error-related actions and behaviors and 25 near misses. The errors were coded into 21 codes that were organized into 5 main themes. Clinical task-related errors accounted for most errors (41.9%), followed by planning, and executing task-related errors (22.3%), distraction-related errors (18.7%), communication-related errors (10.1%), and knowledge/training-related errors (7%). CONCLUSIONS This novel analytical framework can robustly identify, classify, and describe the root causes of errors within this complex clinical context. Future validation of this classification of errors and error-related actions and behaviors on larger samples of resuscitations from various contexts will allow for a better understanding of how errors can be mitigated to improve patient outcomes.
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Affiliation(s)
- Dailys Garcia-Jorda
- From the Departments of Family Medicine (D.G.-J.) and Pediatrics (D.N.), Cumming School of Medicine, University of Calgary, Calgary; and Department of Critical Care Medicine (E.G.), The Hospital for Sick Children, Toronto, Canada
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3
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Yamada NK, Halamek LP. The Evolution of Neonatal Patient Safety. Clin Perinatol 2023; 50:421-434. [PMID: 37201989 DOI: 10.1016/j.clp.2023.01.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/20/2023]
Abstract
Human factors science teaches us that patient safety is achieved not by disciplining individual health care professionals for mistakes, but rather by designing systems that acknowledge human limitations and optimize the work environment for them. Incorporating human factors principles into simulation, debriefing, and quality improvement initiatives will strengthen the quality and resilience of the process improvements and systems changes that are developed. The future of patient safety in neonatology will require continued efforts to engineer and re-engineer systems that support the humans who are at the interface of delivering safe patient care.
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Affiliation(s)
- Nicole K Yamada
- Division of Neonatal and Developmental Medicine, Department of Pediatrics, Stanford University, 453 Quarry Road, MC 5660, Palo Alto, CA 94304, USA.
| | - Louis P Halamek
- Division of Neonatal and Developmental Medicine, Department of Pediatrics, Stanford University, 453 Quarry Road, MC 5660, Palo Alto, CA 94304, USA
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4
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Rosvig LH, Lou S, Hvidman L, Manser T, Uldbjerg N, Kierkegaard O, Brogaard L. Healthcare providers' perceptions and expectations of video-assisted debriefing of real-life obstetrical emergencies: a qualitative study from Denmark. BMJ Open 2023; 13:e062950. [PMID: 36918239 PMCID: PMC10016258 DOI: 10.1136/bmjopen-2022-062950] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/16/2023] Open
Abstract
OBJECTIVES Video-assisted debriefing (VAD) of real-life obstetrical emergencies provides an opportunity to improve quality of care, but is rarely used in clinical practice. A barrier for implementation is the expected mental reservations among healthcare providers. The aim of this study was to explore healthcare providers' perceptions and expectations of VAD of real-life events. SETTING Participants were recruited from two Labour and Delivery Units in Denmark. In both units, VAD of real-life obstetrical emergencies had never been conducted. PARTICIPANTS 22 healthcare providers (10 physicians, 9 midwives and 3 nursing assistants). During the study period (August-October 2021), semi-structured, individual interviews were conducted. Interviews were analysed using thematic analysis. PRIMARY AND SECONDARY OUTCOME MEASURES A qualitative description of healthcare providers' perceptions and expectations of VAD of real-life events. RESULTS Three major themes were identified: (1) Video-assisted debriefing (VAD) as an opportunity for learning: All participants expected VAD to provide an opportunity for learning and improving patient care. All participants expected the video to provide a 'bigger picture', by showing 'what was actually done' instead of 'what we believed was done'. (2) Video-assisted debriefing (VAD) as a cause for concern: The primary concern for all participants was the risk of being exposed as less competent. Participants were concerned that being confronted with every minor detail of their clinical practice would enhance their self-criticalness. (3) Preconditions for video-assisted debriefing (VAD): Participants emphasised the importance of organisational support from management. In addition, creating a safe environment for VAD, for example, by using only expert debriefers was considered an essential precondition for successful implementation. CONCLUSIONS The risk of being exposed as less competent was a barrier towards VAD of real-life events. However, the majority found the educational benefits to outweigh the risk of being exposed.
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Affiliation(s)
- Lena Have Rosvig
- Department of Obstetrics and Gynecology, Horsens Regional Hospital, Horsens, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Stina Lou
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
- DEFACTUM - Public Health and Health Services Research, Aarhus, Denmark
- Center for Fetal Diagnostics, Aarhus University Hospital, Aarhus, Denmark
| | - Lone Hvidman
- Department of Obstetrics and Gynecology, Aarhus University Hospital, Aarhus, Denmark
| | - Tanja Manser
- School of Applied Psychology, University of Applied Sciences and Arts Northwestern Switzerland, Olten, Switzerland
| | - Niels Uldbjerg
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
- Department of Obstetrics and Gynecology, Aarhus University Hospital, Aarhus, Denmark
| | - Ole Kierkegaard
- Department of Obstetrics and Gynecology, Horsens Regional Hospital, Horsens, Denmark
| | - Lise Brogaard
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
- Department of Obstetrics and Gynecology, Aarhus University Hospital, Aarhus, Denmark
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5
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Halamek LP, Weiner GM. State-of-the art training in neonatal resuscitation. Semin Perinatol 2022; 46:151628. [PMID: 35717245 DOI: 10.1016/j.semperi.2022.151628] [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: 11/18/2022]
Abstract
Healthcare training has traditionally emphasized acquisition and recall of vast amounts of content knowledge; however, delivering care during resuscitation of neonates requires much more than content knowledge. As the science of resuscitation has progressed, so have the methodologies and technologies used to train healthcare professionals in the cognitive, technical and behavioral skills necessary for effective resuscitation. Simulation of clinical scenarios, debriefing, virtual reality, augmented reality and audiovisual recordings of resuscitations of human neonates are increasingly being used in an effort to improve human and system performance during this life-saving intervention. In the same manner, as evidence has accumulated to support the guidelines for neonatal resuscitation so, too, has affirmation of training methodologies and technologies. This guarantees that training in neonatal resuscitation will continue to evolve to meet the needs of healthcare professionals charged with caring for newborns at one of the most vulnerable times in their lives.
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Affiliation(s)
- Louis P Halamek
- Division of Neonatal and Developmental Medicine, Department of Pediatrics, Center for Academic Medicine, Stanford University, 453 Quarry Road, Palo Alto, CA 94304, USA.
| | - Gary M Weiner
- Department of Pediatrics, Neonatal-Perinatal Medicine, Director, Neonatal-Perinatal Medicine Fellowship Training Program, University of Michigan, C.S. Mott Children's Hospital, 1540 E. Hospital Drive, Room 8621 (C&W), Ann Arbor, MI 48109-4254, USA
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6
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Hill ME, Aliaga SR, Foglia EE. Learning with digital recording and video review of delivery room resuscitation. Semin Fetal Neonatal Med 2022; 27:101396. [PMID: 36457212 DOI: 10.1016/j.siny.2022.101396] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Digital recording and video review of delivery room resuscitations is a proven useful tool to evaluate neonatal resuscitation program (NRP) technical and non-technical skills. It is also valuable for research, quality improvement, and individual and group learning. Digital recording and video review programs are growing in number, and planning and implementation of digital recording requires careful thought. Consideration of technology requirements, policy implementation, and stakeholder involvement is essential to implement a successful digital recording and video review program. Video review can then be applied for individual and team-based learning. An approach to sustainability and on-going quality review of the program are key components critical to success.
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Affiliation(s)
- Morgan E Hill
- Division of Neonatology, Perinatal Institute, Department of Pediatrics, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, OH, USA.
| | - Sofia R Aliaga
- Department of Pediatrics, Division of Neonatal-Perinatal Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Elizabeth E Foglia
- Division of Neonatology, Department of Pediatrics, The Children's Hospital of Philadelphia, University of Pennsylvania School of Medicine, Philadelphia, PA, USA
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7
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Varpula J, Välimäki M, Lantta T, Berg J, Soininen P, Lahti M. Safety hazards in patient seclusion events in psychiatric care: A video observation study. J Psychiatr Ment Health Nurs 2022; 29:359-373. [PMID: 34536315 DOI: 10.1111/jpm.12799] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2020] [Revised: 08/25/2021] [Accepted: 09/07/2021] [Indexed: 02/06/2023]
Abstract
WHAT IS KNOWN ON THE SUBJECT?: Coercive measures such as seclusion are used to maintain the safety of patients and others in psychiatric care. The use of coercive measures can lead to harm among patients and staff. WHAT THE PAPER ADDS TO EXISTING KNOWLEDGE?: This study is the first of its kind to rely on video observation to expose safety hazards in seclusion events that have not been reported previously in the literature. The actions that both patients and staff take during seclusion events can result in various safety hazards. IMPLICATIONS FOR PRACTICE?: Constant monitoring of patients during seclusion is important for identifying safety hazards and intervening to prevent harm. Nursing staff who use seclusion need to be aware of how their actions can contribute to safety hazards and how they can minimize their potential for harm ABSTRACT: Introduction Seclusion is used to maintain safety in psychiatric care. There is still a lack of knowledge on potential safety hazards related to seclusion practices. Aim To identify safety hazards that might jeopardize the safety of patients and staff in seclusion events in psychiatric hospital care. Method A descriptive design with non-participant video observation was used. The data consisted of 36 video recordings, analysed with inductive thematic analysis. Results Safety hazards were related to patient and staff actions. Patient actions included aggressive behaviour, precarious movements, escaping, falling, contamination and preventing visibility. Staff actions included leaving hazardous items in a seclusion room, unsafe administration of medication, unsecured use of restraints and precarious movements and postures. Discussion This is the first observational study to identify safety hazards in seclusion, which may jeopardize the safety of patients and staff. These hazards were related to the actions of patients and staff. Implications for Practice Being better aware of possible safety hazards could help prevent adverse events during patient seclusion events. It is therefore necessary that nursing staff are aware of how their actions might impact their safety and the safety of the patients. Video observation is a useful method for identifying safety hazards. However, its use requires effort to safeguard the privacy and confidentiality of those included in the videos.
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Affiliation(s)
- Jaakko Varpula
- Department of Nursing Science, University of Turku, Turku, Finland
| | - Maritta Välimäki
- Department of Nursing Science, University of Turku, Turku, Finland.,Xiangya School of Nursing, Central South University, Hunan, China
| | - Tella Lantta
- Department of Nursing Science, University of Turku, Turku, Finland
| | - Johanna Berg
- Department of Nursing Science, University of Turku, Turku, Finland.,Turku University of Applied Sciences, Turku, Finland
| | | | - Mari Lahti
- Department of Nursing Science, University of Turku, Turku, Finland.,Turku University of Applied Sciences, Turku, Finland
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8
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Brogaard L, Hvidman L, Esberg G, Finer N, Hjorth-Hansen KR, Manser T, Kierkegaard O, Uldbjerg N, Henriksen TB. Teamwork and Adherence to Guideline on Newborn Resuscitation-Video Review of Neonatal Interdisciplinary Teams. Front Pediatr 2022; 10:828297. [PMID: 35265565 PMCID: PMC8900704 DOI: 10.3389/fped.2022.828297] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2021] [Accepted: 01/12/2022] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND Little is known about the importance of non-technical skills for the adherence to guidelines, when teams of midwives, obstetricians, anesthesiologists, and pediatricians resuscitate and support the transition of newborns. Non-technical skills are competences underpinning successful teamwork in healthcare. These are usually referred to as leadership, situational awareness, communication, teamwork, decision making, and coping with stress and fatigue. OBJECTIVE By review of videos of teams managing newborns with difficult transition, we aimed to investigate whether the level of the teams' non-technical skills was associated with the degree of adherence to guidelines for newborn resuscitation and transitional support at birth. METHODS Four expert raters independently assessed 43 real-life videos of teams managing newborns with transitional difficulties, two assessed the non-technical score and two assessed the clinical performance. Exposure was the non-technical score, obtained by the Global Assessment Of Team Performance checklist (GAOTP). GAOTP was rated on a Likert Scale 1-5 (1 = poor, 3 = average and 5 = excellent). The outcome was the clinical performance score of the team assessed according to adherence of the European Resuscitation Counsel (ERC) guideline for neonatal resuscitation and transitional support. The ERC guideline was adapted into the checklist TeamOBS-Newborn to facilitate a structured and simple performance assessment (low score 0-60, average 60-84, high 85-100). Interrater agreement was analyzed by intraclass correlation (ICC), Bland-Altman analysis, and Cohen's kappa weighted. The risk of high and low clinical performance was analyzed on the logit scale to meet the assumptions of normality and constant standard deviation. RESULTS Teams with an excellent non-technical score had a relative risk 5.5 [95% confidence interval (CI) 2.4-22.5] of high clinical performance score compared to teams with average non-technical score. In addition, we found a dose response like association. The specific non-technical skills associated with the highest degree of adherence to guidelines were leadership and teamwork, coping with stress and fatigue, and communication with parents. Inter-rater agreement was high; raters assessing non-technical skills had an interclass coefficient (ICC) 0.88 (95% CI 0.79-0.94); the neonatologists assessing clinical performance had an ICC of 0.81 (95% CI 0.66-0.89). CONCLUSION Teams with an excellent non-technical score had five times the chance of high clinical performance compared to teams with average non-technical skills. High performance teams were characterized by good leadership and teamwork, coping with stress, and fatigue and communication with parents.
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Affiliation(s)
- Lise Brogaard
- Department of Obstetrics and Gynecology, Aarhus University Hospital, Aarhus, Denmark.,Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Lone Hvidman
- Department of Obstetrics and Gynecology, Aarhus University Hospital, Aarhus, Denmark
| | - Gitte Esberg
- Department of Pediatrics, Aarhus University Hospital, Aarhus, Denmark
| | - Neil Finer
- Department of Neonatology, University of California, San Diego, San Diego, CA, United States
| | | | - Tanja Manser
- School of Applied Psychology, University of Applied Sciences and Arts Northwestern Switzerland, Olten, Switzerland
| | - Ole Kierkegaard
- Department of Obstetrics and Gynecology, Horsens Regional Hospital, Horsens, Denmark
| | - Niels Uldbjerg
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Tine B Henriksen
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark.,Department of Pediatrics, Aarhus University Hospital, Aarhus, Denmark
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9
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Olson L, Bui XA, Mpamize A, Vu H, Nankunda J, Truong TT, Byamugisha J, Dempsey T, Lubulwa C, Winroth A, Helldén D, Nguyen AD, Alfvén T, Pejovic N, Myrnerts Höök S. Neonatal resuscitation monitoring: A low-cost video recording setup for quality improvement in the delivery room at the resuscitation table. Front Pediatr 2022; 10:952489. [PMID: 36405840 PMCID: PMC9666784 DOI: 10.3389/fped.2022.952489] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Accepted: 09/22/2022] [Indexed: 01/25/2023] Open
Abstract
BACKGROUND The quality of neonatal resuscitation after delivery needs to be improved to reach the Sustainable Development Goals 3.2 (reducing neonatal deaths to <12/1,000 live newborns) by the year 2030. Studies have emphasized the importance of correctly performing the basic steps of resuscitation including stimulation, heart rate assessment, ventilation, and thermal control. Recordings with video cameras have previously been shown to be one way to identify performance practices during neonatal resuscitation. METHODS A description of a low-cost delivery room set up for video recording of neonatal resuscitation. The technical setup includes rechargeable high-definition cameras with two-way audio, NeoBeat heart rate monitors, and the NeoTapAS data collection tools for iPad with direct data export of data for statistical analysis. The setup was field tested at Mulago National Referral Hospital, Kampala, Uganda, and Phu San Hanoi Hospital, Hanoi, Vietnam. RESULTS The setup provided highly detailed resuscitation video footage including data on procedures and team performance, heart rate monitoring, and clinical assessment of the neonate. The data were analyzed with the free-of-charge NeoTapAS for iPad, which allowed fast and accurate registration of all resuscitative events. All events were automatically registered and exported to R statistical software for further analysis. CONCLUSIONS Video analysis of neonatal resuscitation is an emerging quality assurance tool with the potential to improve neonatal resuscitation outcomes. Our methodology and technical setup are well adapted for low- and lower-middle-income countries settings where improving neonatal resuscitation outcomes is crucial. This delivery room video recording setup also included two-way audio communication that potentially could be implemented in day-to-day practice or used with remote teleconsultants.
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Affiliation(s)
- Linus Olson
- Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden.,Training and Research Academic Collaboration (TRAC) Sweden - Vietnam, Hanoi, Vietnam.,Neonatal Department, Vietnam National Children's Hospital, Hanoi, Vietnam.,Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
| | - Xuan Anh Bui
- Department of Information Technology, Phu San Hanoi Hospital, Hanoi, Vietnam
| | | | - Hien Vu
- Social Department, Phu San Hanoi, Hanoi Obstetrics and Gynecology Hospital, Hanoi, Vietnam.,Department of International Collaboration, Phu San Hanoi Hospital, Hanoi, Vietnam
| | - Jolly Nankunda
- Mulago Specialized Women and Neonatal Hospital, Kampala, Uganda.,Department of Pediatrics and Child Health, College of Health Sciences, Makerere University, Kampal, Uganda
| | - Tung Thanh Truong
- Social Department, Phu San Hanoi, Hanoi Obstetrics and Gynecology Hospital, Hanoi, Vietnam
| | - Josaphat Byamugisha
- Department of Obstetrics and Gynaecology, College of Health Sciences, Makerere University, Makerere, Uganda
| | - Tina Dempsey
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden.,Astrid Lindgren Children's Hospital, Karolinska University Hospital, Solna, Sweden
| | - Clare Lubulwa
- Mulago Specialized Women and Neonatal Hospital, Kampala, Uganda
| | - Axel Winroth
- Department of Medicine Huddinge, Center for Hematology and Regenerative Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Daniel Helldén
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
| | | | - Anh Duy Nguyen
- Department of Hospital Administration, Phu San Hanoi Hospital, Hanoi, Vietnam
| | - Tobias Alfvén
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden.,Sachs' Children and Youth Hospital, Stockholm, Sweden
| | - Nicolas Pejovic
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden.,Sachs' Children and Youth Hospital, Stockholm, Sweden.,Centre for International Health, University of Bergen, Bergen, Norway
| | - Susanna Myrnerts Höök
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden.,Sachs' Children and Youth Hospital, Stockholm, Sweden.,Centre for International Health, University of Bergen, Bergen, Norway
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10
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Simma B, den Boer M, Nakstad B, Küster H, Herrick HM, Rüdiger M, Aichner H, Kaufmann M. Video recording in the delivery room: current status, implications and implementation. Pediatr Res 2021:10.1038/s41390-021-01865-0. [PMID: 34819653 DOI: 10.1038/s41390-021-01865-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Revised: 11/07/2021] [Accepted: 11/08/2021] [Indexed: 11/09/2022]
Abstract
Many factors determine the performance and success of delivery room management of newborn babies. Improving the quality of care in this challenging surrounding has an important impact on patient safety and on perinatal morbidity and mortality. Video recording (VR) offers the advantage to record and store work as done rather than work as recalled. It provides information about adherence to algorithms and guidelines, and technical, cognitive and behavioural skills. VR is feasible for education and training, improves team performance and results of research led to changes of international guidelines. However, studies thus far have not provided data regarding whether delivery room video recording affects long-term team performance or clinical outcomes. Privacy is a concern because data can be stored and individuals can be identified. We describe the current state of clinical practice in high- and low-resource settings, discuss ethical and medical-legal issues and give recommendations for implementation with the aim of improving the quality of care and outcome of vulnerable babies. IMPACT: VR improves performance by health caregivers providing neonatal resuscitation, teaching and research related to delivery room management, both in high as well low resource settings. VR enables information about adherence to guidelines, technical, behavioural and communication skills within the resuscitation team. VR has ethical and medical-legal implications for healthcare, especially recommendations for implementation of VR in routine clinical care in the delivery room. VR will increase the awareness that short- and long-term outcomes of babies depend on the quality of care in the delivery room.
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Affiliation(s)
- B Simma
- Department of Paediatrics, Academic Teaching Hospital, Landeskrankenhaus Feldkirch, Feldkirch, Austria.
| | - M den Boer
- Division of Neonatology, Leiden University Medical Center, Leiden, The Netherlands
- Department of Medical Ethics and Health Law, Leiden University Medical Center, Leiden, The Netherlands
| | - B Nakstad
- Department of Paediatrics and Adolescent Health, University of Botswana, Gaborone, Botswana
- Division of Paediatrics and Adolescent Medicine, Institute for Clinical Medicine, University of Oslo, Oslo, Norway
| | - H Küster
- Clinic for Paediatric Cardiology, Intensive Care and Neonatology, University Medical Centre Göttingen, Göttingen, Germany
| | - H M Herrick
- Division of Neonatology, Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - M Rüdiger
- Division of Neonatology and Paediatric Intensive Care Medicine, Department of Paediatrics, Faculty of Medicine, Technische Universität Dresden, Dresden, Germany
- Saxony Center for Feto-Neonatal Health, Faculty of Medicine, Technische Universität Dresden, Dresden, Germany
| | - H Aichner
- Department of Paediatrics, Academic Teaching Hospital, Landeskrankenhaus Feldkirch, Feldkirch, Austria
| | - M Kaufmann
- Division of Neonatology and Paediatric Intensive Care Medicine, Department of Paediatrics, Faculty of Medicine, Technische Universität Dresden, Dresden, Germany
- Saxony Center for Feto-Neonatal Health, Faculty of Medicine, Technische Universität Dresden, Dresden, Germany
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11
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Quirion A, Nikouline A, Jung J, Nolan B. Contemporary uses of trauma video review: a scoping review. CAN J EMERG MED 2021; 23:787-796. [PMID: 34453728 DOI: 10.1007/s43678-021-00178-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2020] [Accepted: 07/19/2021] [Indexed: 12/17/2022]
Abstract
OBJECTIVES Trauma resuscitations are sporadic, high-acuity situations and conducting observation in the trauma bay for the purpose of quality improvement is challenging. We aim to review contemporary uses of trauma video review. METHODS Medline and Embase were searched from 1980 to May 2020 for studies involving trauma video review. English studies of adult and paediatric populations were included for study and analysed for uses of trauma video review, outcomes measured and any resulting quality improvement (QI) initiatives. RESULTS A total of 463 publications were identified with 21 studies meeting eligibility for final inclusion. A majority of studies (11) observed technical skills with analysis of critical procedures, including tracheal intubation and thoracotomy. The remaining studies observed team dynamics and communication. Overall, eight studies resulted in new policies being put in place for trauma resuscitations and six studies utilized trauma video review as an educational tool. CONCLUSIONS This study highlights common uses of trauma video review. The greatest benefit for this new technology is in quality improvement and education. The majority of studies focussed on critical procedures and QI initiatives, such as checklists, protocols and continued education. We recommend adoption of video review systems for ongoing improvement of team dynamics and overall trauma and emergency resuscitation.
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Affiliation(s)
- Andrew Quirion
- Division of Emergency Medicine, Department of Medicine, University of Toronto, S517-112 George Street, Toronto, ON, M5A 2M5, Canada.
| | - Anton Nikouline
- Division of Emergency Medicine, Department of Medicine, University of Toronto, S517-112 George Street, Toronto, ON, M5A 2M5, Canada
| | - James Jung
- Department of Surgery, Massachusetts General Hospital, Boston, MA, USA.,International Centre for Surgical Safety, St. Michael's Hospital, Toronto, ON, Canada
| | - Brodie Nolan
- Division of Emergency Medicine, Department of Medicine, University of Toronto, S517-112 George Street, Toronto, ON, M5A 2M5, Canada.,International Centre for Surgical Safety, St. Michael's Hospital, Toronto, ON, Canada.,Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, ON, Canada.,Department of Emergency Medicine, St. Michael's Hospital, Toronto, ON, Canada
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12
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den Boer MC, Houtlosser M, Foglia EE, Lopriore E, de Vries MC, Engberts DP, Te Pas AB. Deferred consent for delivery room studies: the providers' perspective. Arch Dis Child Fetal Neonatal Ed 2020; 105:310-315. [PMID: 31427459 DOI: 10.1136/archdischild-2019-317280] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2019] [Revised: 07/22/2019] [Accepted: 08/03/2019] [Indexed: 11/04/2022]
Abstract
OBJECTIVE To gain insight into neonatal care providers' perceptions of deferred consent for delivery room (DR) studies in actual scenarios. METHODS We conducted semistructured interviews with 46 neonatal intensive care unit (NICU) staff members of the Leiden University Medical Center (the Netherlands) and the Hospital of the University of Pennsylvania (USA). At the time interviews were conducted, both NICUs conducted the same DR studies, but differed in their consent approaches. Interviews were audio-recorded, transcribed and analysed using the qualitative data analysis software Atlas.ti V.7.0. RESULTS Although providers reported to regard the prospective consent approach as the most preferable consent approach, they acknowledged that a deferred consent approach is needed for high-quality DR management. However, providers reported concerns about parental autonomy, approaching parents for consent and ethical review of study protocols that include a deferred consent approach. Providers furthermore differed in perceived appropriateness of a deferred consent approach for the studies that were being conducted at their NICUs. Providers with first-hand experience with deferred consent reported positive experiences that they attributed to appropriate communication and timing of approaching parents for consent. CONCLUSION Insight into providers' perceptions of deferred consent for DR studies in actual scenarios suggests that a deferred consent approach is considered acceptable, but that actual usage of the approach for DR studies can be improved on.
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Affiliation(s)
- Maria C den Boer
- Division of Neonatology, Leiden University Medical Center, Leiden, Netherlands .,Department of Medical Ethics and Health Law, Leiden University Medical Center, Leiden, Netherlands
| | - Mirjam Houtlosser
- Department of Medical Ethics and Health Law, Leiden University Medical Center, Leiden, Netherlands
| | - Elizabeth E Foglia
- Division of Neonatology, Department of Pediatrics, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania, USA
| | - Enrico Lopriore
- Division of Neonatology, Leiden University Medical Center, Leiden, Netherlands
| | - Martine Charlotte de Vries
- Department of Medical Ethics and Health Law, Leiden University Medical Center, Leiden, Netherlands.,Pediatrics, Leiden University Medical Center, Leiden, The Netherlands
| | - Dirk P Engberts
- Department of Medical Ethics and Health Law, Leiden University Medical Center, Leiden, Netherlands
| | - Arjan B Te Pas
- Division of Neonatology, Leiden University Medical Center, Leiden, Netherlands
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13
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Gabrielli M, Valera L, Barrientos M. Audio and panoramic video recording in the operating room: legal and ethical perspectives. JOURNAL OF MEDICAL ETHICS 2020; 47:medethics-2019-106056. [PMID: 32241807 DOI: 10.1136/medethics-2019-106056] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/30/2019] [Revised: 03/16/2020] [Accepted: 03/20/2020] [Indexed: 06/11/2023]
Abstract
INTRODUCTION The idea of video recording (VR) in the operating room (OR) with panoramic cameras and microphones is a new concept that is changing the approach to medical activities in the OR. However, VR in the OR has brought up many concerns regarding patient privacy and has highlighted legal and ethical issues that were never previously exposed. AIM To review the literature concerning these aspects and provide a better ethical and legal understanding of the new challenges concerning VR in the OR. CONCLUSIONS There is a disparity between the two main legal models concerning VR in the OR, namely the European legal system (General Data Protection Regulation (GDPR)) and the American legal framework (Health Insurance Portability and Accountability Act (HIPAA)). This difference mainly deals with two distinct bioethical paradigms: GDPR places a strong emphasis on protecting patients' privacy to improve the public health system, whereas HIPAA indicates the need to generate protocols to safeguard the risks connected to medical activity and patient privacy. Following from this point, we may argue that, at the ethical and bioethical level, GDPR and HIPAA depend mainly on two different ethical models: a perspective based on moral acquaintances and weak proceduralism, respectively. It is worth noting the importance of developing additional guidelines concerning different world regions to avoid the ethical problems that may emerge when simply applying a foreign paradigm to a very different culture.
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Affiliation(s)
- Mauricio Gabrielli
- Department of Digestive Surgery, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Luca Valera
- Department of Philosophy, Bioethics Centre, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Marcelo Barrientos
- Department of Law, Insurance Research Center, Pontificia Universidad Católica de Chile, Santiago, Chile
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14
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Le Bris A, Mazille-Orfanos N, Simonot P, Luherne M, Flamant C, Gascoin G, ÓLaighin G, Harte R, Pladys P. Parents' and healthcare professionals' perceptions of the use of live video recording in neonatal units: a focus group study. BMC Pediatr 2020; 20:143. [PMID: 32238158 PMCID: PMC7110620 DOI: 10.1186/s12887-020-02041-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2019] [Accepted: 03/20/2020] [Indexed: 01/05/2023] Open
Abstract
Background The emerging use of video in neonatology units raises ethical and practical questions. This study aims to gain a better understanding of the suitability, limitations and constraints concerning the use of live video as a tool in neonatal clinical practice. The perceptions of parents and healthcare professionals in regard to live video were examined. Methods Nine focus groups were conducted in four neonatal units involving 20 healthcare professionals and 19 parents. Data were triangulated using transcripts and field notes and analyzed using inductive and semantic thematic analysis. Results The seven major themes that emerged from the healthcare professionals focus groups were (i) the impact of video recording on healthcare professionals’ behavior; (ii) the impact on parents; (iii) forensic issues;(iv) guarantee of use; (v) benefits for the newborn; (vi) methodology of use; and (vii) technical considerations & feasibility. The five major themes that emerged from parents focus groups were (i) benefits for the newborn and care enhancement; (ii) impact on parents and potential benefits in case of newborn child/parent separation; (iii) informed consent and guarantee of use;(iv) concern about a possible disruptive impact on healthcare professionals; and (v) data protection. Conclusion Both parents and healthcare professionals found video recording useful and acceptable if measures were taken to protect the data and mitigate any negative impacts on healthcare professionals.
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Affiliation(s)
- Aude Le Bris
- Department of Neonatology, University Hospital of Rennes, 35000, Rennes, France.
| | | | - Pauline Simonot
- Department of Neonatology, University Hospital of Caen, Caen, France
| | - Maude Luherne
- Research and Innovation Department, Paediatric Department, University Hospital of Rennes and GCS HUGO, Rennes, France
| | - Cyril Flamant
- Department of Neonatology, University Hospital of Nantes, Nantes, France
| | - Geraldine Gascoin
- Department of Neonatology, University Hospital of Angers, Angers, France
| | | | - Richard Harte
- CURAM, Human Movement Laboratory, NUI Galway, Galway, Ireland
| | - Patrick Pladys
- Department of Neonatology, University Hospital of Rennes, 35000, Rennes, France.,Research and Innovation Department, Paediatric Department, University Hospital of Rennes and GCS HUGO, Rennes, France
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15
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Brogaard L, Uldbjerg N. Filming for auditing of real-life emergency teams: a systematic review. BMJ Open Qual 2019; 8:e000588. [PMID: 31909207 PMCID: PMC6937091 DOI: 10.1136/bmjoq-2018-000588] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2018] [Revised: 08/02/2019] [Accepted: 11/12/2019] [Indexed: 12/20/2022] Open
Affiliation(s)
- Lise Brogaard
- Department of Obstetrics and Gynaecology, Regionshospitalet Horsens, Horsens, Denmark
| | - Niels Uldbjerg
- Department of Obstetrics and Gynaecology, Aarhus University Hospital, Aarhus, Denmark
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16
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Abstract
Neonatal resuscitation is an event that can cause high stress among healthcare professionals (HCPs) and is frequently associated with medical errors. Improving patient safety and reducing errors requires a concerted effort with a plan for improvement. Video can be used as a component of the improvement process at several points including standardizing educational information, assessing learner knowledge and skills during simulation, and assessing individual and team performance during actual neonatal resuscitations.
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Affiliation(s)
- Tina A Leone
- Columbia University Vagelos College of Physicians and Surgeons, 622 W. 168th Street, PH 17-302, New York, NY 10032, United States.
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17
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den Boer MC, Houtlosser M, Foglia EE, Tan RNGB, Engberts DP, Te Pas AB. Benefits of recording and reviewing neonatal resuscitation: the providers' perspective. Arch Dis Child Fetal Neonatal Ed 2019; 104:F528-F534. [PMID: 30504441 DOI: 10.1136/archdischild-2018-315648] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2018] [Revised: 10/18/2018] [Accepted: 11/20/2018] [Indexed: 11/03/2022]
Abstract
OBJECTIVE To assess benefits of recording and reviewing neonatal resuscitation as experienced by neonatal care providers. DESIGN A qualitative study using semistructured interviews questioning neonatal care providers about their experiences with recording and reviewing neonatal resuscitation. Data were analysed using the qualitative data analysis software Atlas.ti V.7.0. SETTING Neonatal care providers working at neonatal intensive care units (NICUs) of the Leiden University Medical Center, the Netherlands, and the University of Pennsylvania School of Medicine, USA, participated in this study. RESULTS In total, 48 NICU staff members were interviewed. Reported experiences and attitudes are broadly similar for both NICUs. All interviewed providers reported positive experiences and benefits, with special emphasis on educational benefits. Recording and reviewing neonatal resuscitation is used for various learning activities, such as plenary review meetings and as tool for objective feedback. Providers reported to learn from reviewing their own performance during resuscitation, as well as from reviewing performances of others. Improved time perception, reflection on guideline compliance and acting less invasively during resuscitations were often mentioned as learning outcomes. All providers would recommend other NICUs to implement recording and reviewing neonatal resuscitation, as it is a powerful tool for learning and improving. However, they emphasised preconditions for successful implementation, such as providing information, not being punitive and focusing on the benefits for learning and improving. CONCLUSION Recording and reviewing neonatal resuscitation is considered highly beneficial for learning and improving resuscitation skills and is recommended by providers participating in it.
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Affiliation(s)
- Maria C den Boer
- Division of Neonatology, Leiden University Medical Center, Leiden, The Netherlands.,Department of Medical Ethics and Health Law, Leiden University Medical Center, Leiden, The Netherlands
| | - Mirjam Houtlosser
- Department of Medical Ethics and Health Law, Leiden University Medical Center, Leiden, The Netherlands
| | - Elizabeth E Foglia
- Department of Pediatrics, Division of Neonatology, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania, USA
| | - Ratna N G B Tan
- Division of Neonatology, Leiden University Medical Center, Leiden, The Netherlands
| | - Dirk P Engberts
- Department of Medical Ethics and Health Law, Leiden University Medical Center, Leiden, The Netherlands
| | - Arjan B Te Pas
- Division of Neonatology, Leiden University Medical Center, Leiden, The Netherlands
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18
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Midwives' perceptions of women's mobile phone use and impact on care in birth suite. Midwifery 2019; 76:142-147. [PMID: 31207448 DOI: 10.1016/j.midw.2019.06.002] [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: 04/12/2019] [Revised: 05/23/2019] [Accepted: 06/02/2019] [Indexed: 11/23/2022]
Abstract
BACKGROUND Women's use of mobile phones while in birth suite has been recognised as a common occurrence. However, no evidence has been reported around midwives' perceptions of how women's mobile phone use impacts midwifery care in birth suite. OBJECTIVE To explore midwives' perceptions of women's mobile phone use and impact on care in the labour and birth environment. METHODS A qualitative descriptive study was undertaken. Transcriptions from focus groups were subjected to thematic analysis. FINDINGS Ten focus groups involving 63 Australian midwives were conducted. Four key themes and corresponding subthemes were identified: 'considering consent' which encompassed the subthemes 'establishing boundaries' and 'taken by surprise'; 'competing with the phone' encompassing 'missing the experience' and 'delaying care'; 'being with woman' encompassing 'affecting relationships' and 'not my right to deny'; and finally 'bringing others into the room' with subthemes of 'keeping in touch' and 'seeking a second opinion'. CONCLUSIONS This is the first study to explore midwives perceptions of women's mobile phone use and the impact on a midwife's ability to provide care in birth suite. Findings suggest that women's mobile phone use can influence the relationship between the midwife and the woman and contributes to delays in providing care. Midwives shared how they experienced tensions around their right to grant permission for their image to be recorded. Finally, mobile phones have allowed others not present in the birth suite to access women and influence their decision making. IMPLICATIONS FOR PRACTICE It is widely recognised women are bringing their mobile phones into the labour and birth environment. Therefore, it is important we explore midwives perceptions around the tensions and concerns that exist, so they can be addressed.
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19
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Root L, van Zanten HA, den Boer MC, Foglia EE, Witlox RSGM, Te Pas AB. Improving Guideline Compliance and Documentation Through Auditing Neonatal Resuscitation. Front Pediatr 2019; 7:294. [PMID: 31380327 PMCID: PMC6646726 DOI: 10.3389/fped.2019.00294] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2019] [Accepted: 07/01/2019] [Indexed: 12/17/2022] Open
Abstract
Objective: Evaluate whether weekly audits of neonatal resuscitation using video and physiological parameter recordings improved guideline compliance and documentation in medical records. Study design: Neonatal care providers of the Neonatal Intensive Care Unit (NICU) of Leiden University Medical Center reviewed recordings of neonatal resuscitation during weekly plenary audits since 2014. In an observational pre-post cohort study, we studied a cohort of infants born before and after implementation of weekly audits. Video and physiological parameter recordings of infants needing resuscitation were analyzed. These recordings were compared with the prevailing resuscitation guideline and corresponding documentation in the medical record using a pre-set checklist. Results: A total of 212 infants were included, 42 before and 170 after implementation of weekly audits, with a median (IQR) gestational age of 30 (27-35) weeks vs. 30 (29-33) weeks (p = 0.64) and birth weight of 1368 (998-1780) grams vs. 1420 (1097-1871) grams (p = 0.67). After weekly audits were implemented, providers complied more often to the guideline (63 vs. 77%; p < 0.001). Applying the correct respiratory support based on heart rate and respiration, air conditions (dry vs. humidified air), fraction of inspired oxygen (FiO2), timely start of interventions and evaluation of delivered care improved. Total number of correctly documented items in medical records increased from 39 to 65% (p < 0.001). Greatest improvements were achieved in documentation of present providers, mode of respiratory support and details about transport to the NICU. Conclusion: Regular auditing using video and physiological parameter recordings of infants needing resuscitation at birth improved providers' compliance with resuscitation guideline and documentation in medical records.
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Affiliation(s)
- Laura Root
- Division of Neonatology, Department of Pediatrics, Leiden University Medical Center, Leiden, Netherlands
| | - Henriette A van Zanten
- Division of Neonatology, Department of Pediatrics, Leiden University Medical Center, Leiden, Netherlands
| | - Maria C den Boer
- Division of Neonatology, Department of Pediatrics, Leiden University Medical Center, Leiden, Netherlands
| | - Elizabeth E Foglia
- Division of Neonatology, Department of Pediatrics, University of Pennsylvania School of Medicine, Philadelphia, PA, United States
| | - Ruben S G M Witlox
- Division of Neonatology, Department of Pediatrics, Leiden University Medical Center, Leiden, Netherlands
| | - Arjan B Te Pas
- Division of Neonatology, Department of Pediatrics, Leiden University Medical Center, Leiden, Netherlands
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20
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Bergström H, Larsson LG, Stenberg E. Audio-video recording during laparoscopic surgery reduces irrelevant conversation between surgeons: a cohort study. BMC Surg 2018; 18:92. [PMID: 30400860 PMCID: PMC6219023 DOI: 10.1186/s12893-018-0428-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2018] [Accepted: 10/22/2018] [Indexed: 11/10/2022] Open
Abstract
Background The prevalence of perioperative surgical complications is a worldwide issue: In many cases, these events are preventable. Audio-video recording during laparoscopic surgery provides useful information for the purposes of education and event analyses, and may have an impact on the focus of the surgeons operating. The aim of the present study was to investigate how audio-video recording in the operating room during laparoscopic surgery affects the focus of the surgeon and his/her assistant. Methods A group of laparoscopic procedures where video recording only was performed was compared to a group where both audio and video recordings were made. All laparoscopic procedures were performed at Lindesberg Hospital, Sweden, during the period August to September 2017. The primary outcome was conversation not relevant to the ongoing procedure. Secondary outcomes were intra- and postoperative adverse events or complications, operation time and number of times the assistant was corrected by the surgeon. Results The study included 41 procedures, 20 in the video only group and 21 in the audio-video group. The material comprised laparoscopic cholecystectomies, totally extraperitoneal inguinal hernia repairs and bariatric surgical procedures. Irrelevant conversation time fell from 4.2% of surgical time to 1.4% when both audio and video recordings were made (p = 0.002). No differences in perioperative adverse event or complication rates were seen. Conclusion Audio-video recording during laparoscopic abdominal surgery reduces irrelevant conversation time and may improve intraoperative safety and surgical outcome. Trial registration Available at FOU Sweden (ID: 232771) and retrospectively at Clinical trials.gov (ID: NCT03425175; date of registration 7/2 2018).
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Affiliation(s)
- Hannah Bergström
- Department of Surgery, Faculty of Medicine and Health, Örebro University, SE-70185, Örebro, Sweden
| | - Lars-Göran Larsson
- Department of Surgery, Faculty of Medicine and Health, Örebro University, SE-70185, Örebro, Sweden
| | - Erik Stenberg
- Department of Surgery, Faculty of Medicine and Health, Örebro University, SE-70185, Örebro, Sweden.
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21
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den Boer MC, Houtlosser M, van Zanten HA, Foglia EE, Engberts DP, Te Pas AB. Ethical dilemmas of recording and reviewing neonatal resuscitation. Arch Dis Child Fetal Neonatal Ed 2018; 103:F280-F284. [PMID: 29353257 DOI: 10.1136/archdischild-2017-314191] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2017] [Revised: 12/28/2017] [Accepted: 12/29/2017] [Indexed: 01/26/2023]
Abstract
Neonatal resuscitation is provided to approximately 3% of neonates. Adequate ventilation is often the key to successful resuscitation, but this can be difficult to provide. There is increasing evidence that inappropriate respiratory support can have severe consequences. Several neonatal intensive care units have recorded and reviewed neonatal resuscitation procedures for quality assessment, education and research; however, ethical dilemmas sometimes make it difficult to implement this review process. We reviewed the literature on the development of recording and reviewing neonatal resuscitation and have summarised the ethical concerns involved. Recording and reviewing vital physiological parameters and video imaging of neonatal resuscitation in the delivery room is a valuable tool for quality assurance, education and research. Furthermore, it can improve the quality of neonatal resuscitation provided. We observed that ethical dilemmas arise as the review process is operating in several domains of healthcare that all have their specific moral framework with requirements and conditions on issues such as consent, privacy and data storage. These moral requirements and conditions vary due to local circumstances. Further research on the ethical aspects of recording and reviewing is desirable before wider implementation of this technique can be recommended.
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Affiliation(s)
- Maria C den Boer
- Division of Neonatology, Leiden University Medical Center, Leiden, The Netherlands.,Department of Medical Ethics and Health Law, Leiden University Medical Center, Leiden, The Netherlands
| | - Mirjam Houtlosser
- Department of Medical Ethics and Health Law, Leiden University Medical Center, Leiden, The Netherlands
| | | | - Elizabeth E Foglia
- Division of Neonatology, Department of Pediatrics, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania, USA
| | - Dirk P Engberts
- Department of Medical Ethics and Health Law, Leiden University Medical Center, Leiden, The Netherlands
| | - Arjan B Te Pas
- Division of Neonatology, Leiden University Medical Center, Leiden, The Netherlands
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22
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Pino M, Parry R, Feathers L, Faull C. Is it acceptable to video-record palliative care consultations for research and training purposes? A qualitative interview study exploring the views of hospice patients, carers and clinical staff. Palliat Med 2017; 31:707-715. [PMID: 28590153 PMCID: PMC5557161 DOI: 10.1177/0269216317696419] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Research using video recordings can advance understanding of healthcare communication and improve care, but making and using video recordings carries risks. AIM To explore views of hospice patients, carers and clinical staff about whether videoing patient-doctor consultations is acceptable for research and training purposes. DESIGN We used semi-structured group and individual interviews to gather hospice patients, carers and clinical staff views. We used Braun and Clark's thematic analysis. SETTING/PARTICIPANTS Interviews were conducted at one English hospice to inform the development of a larger video-based study. We invited patients with capacity to consent and whom the care team judged were neither acutely unwell nor severely distressed (11), carers of current or past patients (5), palliative medicine doctors (7), senior nurses (4) and communication skills educators (5). RESULTS Participants viewed video-based research on communication as valuable because of its potential to improve communication, care and staff training. Video-based research raised concerns including its potential to affect the nature and content of the consultation and threats to confidentiality; however, these were not seen as sufficient grounds for rejecting video-based research. Video-based research was seen as acceptable and useful providing that measures are taken to reduce possible risks across the recruitment, recording and dissemination phases of the research process. CONCLUSION Video-based research is an acceptable and worthwhile way of investigating communication in palliative medicine. Situated judgements should be made about when it is appropriate to involve individual patients and carers in video-based research on the basis of their level of vulnerability and ability to freely consent.
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Affiliation(s)
- Marco Pino
- 1 Department of Social Sciences, Loughborough University, Loughborough, UK
| | - Ruth Parry
- 2 School of Health Sciences, The University of Nottingham, Nottingham, UK
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23
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Lloyd A, Lowe DJ, Edgar S, Caesar D, Dewar A, Clegg GR. Video recording in the emergency department: a pathway to success. Emerg Med J 2017; 34:628-630. [PMID: 28659303 DOI: 10.1136/emermed-2017-206731] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2017] [Revised: 04/26/2017] [Accepted: 05/26/2017] [Indexed: 11/03/2022]
Affiliation(s)
- Adam Lloyd
- University of Edinburgh, Nursing Studies, Edinburgh, Scotland, UK.,Department of Emergency Medicine, NHS Lothian, Edinburgh, Scotland, UK.,University of Edinburgh, Resuscitation Research Group, Edinburgh, Scotland
| | - David John Lowe
- University of Glasgow, MVLS, Glasgow Royal Infirmary, Glasgow, Scotland, UK.,Emergency Department, Queen Elizabeth University Hospital, Glasgow, Scotland, UK
| | - Simon Edgar
- Department of Anaesthesia, NHS Lothian, Edinburgh, Scotland, UK.,University of Edinburgh, Edinburgh, Scotland, UK
| | - Dave Caesar
- Department of Emergency Medicine, NHS Lothian, Edinburgh, Scotland, UK.,Office of the Chief Medical Officer, Scottish Government, Edinburgh, Scotland, UK
| | - Alistair Dewar
- Department of Emergency Medicine, NHS Lothian, Edinburgh, Scotland, UK.,University of Edinburgh, Resuscitation Research Group, Edinburgh, Scotland
| | - Gareth R Clegg
- Department of Emergency Medicine, NHS Lothian, Edinburgh, Scotland, UK.,University of Edinburgh, Resuscitation Research Group, Edinburgh, Scotland
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24
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Shivananda S, Twiss J, el-Gouhary E, el-Helou S, Williams C, Murthy P, Suresh G. Video recording of neonatal resuscitation: A feasibility study to inform widespread adoption. World J Clin Pediatr 2017; 6:69-80. [PMID: 28224098 PMCID: PMC5296632 DOI: 10.5409/wjcp.v6.i1.69] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2016] [Revised: 10/12/2016] [Accepted: 11/17/2016] [Indexed: 02/06/2023] Open
Abstract
AIM To determine the feasibility of introducing video recording (VR) of neonatal resuscitation (NR) in a perinatal centre.
METHODS This was a prospective cohort quality improvement study on preterm infants and their caregivers. Based on evidence and experience of other centers using VR intervention, a contextually relevant implementation and evaluation strategy was designed in the planning phase. The components of intervention were pre-resuscitation team huddle, VR of NR and video debriefing (VD), all occurring on the same day. Various domains of feasibility and sustainability as well as feasibility criteria were predefined. Data for analysis was collected using quantitative and qualitative methods.
RESULTS Seventy-one caregivers participated in VD of 14 NRs facilitated by six trained instructors. Ninety-one percent of caregivers perceived enhanced learning and patient safety and, 48 issues were identified related to policy, caregiver roles, and latent safety threats. Ninety percent of caregivers expressed their willingness to participate in VD activity and supported the idea of integrating it into a resuscitation team routine. Eighty-three percent and 50% of instructors expressed satisfaction with video review software and quality of audio VR. No issues about maintenance of infant or caregivers’ confidentiality and erasure of videos were reported. Criteria for feasibility were met (refusal rate of < 10%, VR performed on > 50% of occasions, and < 20% caregivers’ perceiving a negative impact on team performance). Necessary adaptations to enhance sustainability were identified.
CONCLUSION VR of NR as a standard of care quality assurance activity to enhance caregivers’ learning and create opportunities that improve patient safety is feasible. Despite its complexity with inherent challenges in implementation, the intervention was acceptable, implementable, and potentially sustainable with adaptations.
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25
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Lowe DJ, Dewar A, Lloyd A, Edgar S, Clegg GR. Optimising clinical performance during resuscitation using video evaluation. Postgrad Med J 2016; 93:449-453. [PMID: 27986970 DOI: 10.1136/postgradmedj-2016-134357] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2016] [Revised: 11/02/2016] [Accepted: 11/23/2016] [Indexed: 11/04/2022]
Abstract
Video evaluation of resuscitation is becoming increasingly integrated into practice in a number of clinical settings. The purpose of this review article is to examine how video may enhance clinical care during resuscitation. As healthcare and available therapeutic interventions evolve, re-evaluation of accepted paradigms requires data to describe current practice and support change. Analysis of video recordings affords creation of a framework to evaluate individual and team performance and develop unique and tailored strategies to optimise care delivery. While video has been used in a number of non-clinical settings, there has been a recent increase of video systems in the prehospital and other clinical areas. This paper reviews the key opportunities in the emergency department-based resuscitation setting to enhance ergonomics, technical and non-technical skills-at both team and individual level-through video-assisted care performance analysis and feedback.
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Affiliation(s)
- David J Lowe
- Resuscitation Research Group, Royal Infirmary Edinburgh, Edinburgh, UK.,Department of Anaesthesia, Critical Care & Pain, University of Glasgow, Glasgow, UK.,Emergency Department, Glasgow Royal Infirmary, Glasgow, UK
| | - Alistair Dewar
- Resuscitation Research Group, Royal Infirmary Edinburgh, Edinburgh, UK.,Department of Emergency Medicine, Royal Infirmary of Edinburgh, Edinburgh, UK
| | - Adam Lloyd
- Resuscitation Research Group, Royal Infirmary Edinburgh, Edinburgh, UK.,Nursing Studies, University of Edinburgh, Edinburgh, UK
| | - Simon Edgar
- Resuscitation Research Group, Royal Infirmary Edinburgh, Edinburgh, UK.,Directorate of Medical Education and Department of Anaesthesia, University of Edinburgh, Edinburgh, UK
| | - Gareth R Clegg
- Resuscitation Research Group, Royal Infirmary Edinburgh, Edinburgh, UK.,Department of Emergency Medicine, Royal Infirmary of Edinburgh, Edinburgh, UK
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Skåre C, Boldingh AM, Nakstad B, Calisch TE, Niles DE, Nadkarni VM, Kramer-Johansen J, Olasveengen TM. Ventilation fraction during the first 30s of neonatal resuscitation. Resuscitation 2016; 107:25-30. [PMID: 27496260 DOI: 10.1016/j.resuscitation.2016.07.231] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2016] [Revised: 07/06/2016] [Accepted: 07/17/2016] [Indexed: 11/30/2022]
Abstract
AIM Approximately 5% of newborns receive positive pressure ventilation (PPV) for successful transition. Guidelines urge providers to ensure effective PPV for 30-60s before considering chest compressions and intravenous therapy. Pauses in this initial PPV may delay recovery of spontaneous respiration. The aim was to find the ventilation fraction during the first 30s of PPV in non-breathing babies. METHODS Prospective observational study in two hospitals in Norway. All newborns receiving PPV immediately after delivery were included. Cameras with motion detectors were installed at every resuscitation bay capturing both expected and unexpected compromised newborns. We determined the cumulative number of seconds with PPV efforts excluding pauses in infants without spontaneous breathing and reported ventilation fraction during the first minute. Data are presented as median (IQR). RESULTS 110 of 3508 (3%) newborns received PPV and were filmed in the resuscitation bays. PPV started 42 (18-78)s after arrival at the resuscitation bay and median duration was 100 (35-225)s. Forty-eight infants (44%) were ventilated continuously, or with minimal pause (ventilation fraction >90%) during the first 30s of PPV. For the remaining 62 infants ventilation fraction was 60% (39-75). PPV was interrupted due to adjustments, checking heart rate, stimulation, administration of CPAP and suctioning. CONCLUSION In 56% of the neonatal resuscitations interruptions in ventilation are frequent with 60% ventilation fraction during the first 30s of PPV. Eliminating disruption for improved quality of PPV delivery should be emphasized when training newborn resuscitation providers.
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Affiliation(s)
- Christiane Skåre
- Norwegian National Advisory Unit for Prehospital Emergency Care (NAKOS) and Department of Anaesthesiology, Oslo University Hospital and University of Oslo, Oslo, Norway.
| | - Anne-Marthe Boldingh
- Department of Paediatric and Adolescent Medicine, Akershus University Hospital, Lørenskog, Norway; Institute of Clinical Medicine Campus Ahus, University of Oslo, Lørenskog, Norway
| | - Britt Nakstad
- Department of Paediatric and Adolescent Medicine, Akershus University Hospital, Lørenskog, Norway; Institute of Clinical Medicine Campus Ahus, University of Oslo, Lørenskog, Norway
| | - Tor Einar Calisch
- Neonatal Intensive Care Unit, Oslo University Hospital, Oslo, Norway
| | - Dana E Niles
- Center for Simulation, Advanced Education and Innovation, The Children's Hospital in Philadelphia, Philadelphia, USA
| | - Vinay M Nadkarni
- Department of Anesthesia, Critical Care and Pediatrics, University of Pennsylvania Perelman School of Medicine, The Children's Hospital of Philadelphia, Philadelphia, USA
| | - Jo Kramer-Johansen
- Norwegian National Advisory Unit for Prehospital Emergency Care (NAKOS) and Department of Anaesthesiology, Oslo University Hospital and University of Oslo, Oslo, Norway
| | - Theresa M Olasveengen
- Norwegian National Advisory Unit for Prehospital Emergency Care (NAKOS) and Department of Anaesthesiology, Oslo University Hospital and University of Oslo, Oslo, Norway
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Parry R, Pino M, Faull C, Feathers L. Acceptability and design of video-based research on healthcare communication: Evidence and recommendations. PATIENT EDUCATION AND COUNSELING 2016; 99:1271-1284. [PMID: 27066862 DOI: 10.1016/j.pec.2016.03.013] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/09/2015] [Revised: 02/27/2016] [Accepted: 03/15/2016] [Indexed: 06/05/2023]
Abstract
OBJECTIVES To contribute to understandings about acceptability and risks entailed in video-based research on healthcare communication. To generate recommendations for non-covert video-based research on healthcare communication - with a focus on maximising its acceptability to participants, and managing and reducing its risks. METHODS A literature review and synthesis of (a) empirical research on participant acceptability and risks of video recording; (b) regulations of professional and governmental bodies; (c) reviews and commentaries; (d) guidance and recommendations. These were gathered across several academic and professional fields (including medical, educational, and social scientific). RESULTS 36 publications were included in the review and synthesis (7 regulatory documents, 7 empirical, 4 reviews/commentaries, 18 guidance/recommendations). In the context of research aiming in some way to improve healthcare communication: CONCLUSION AND PRACTICE IMPLICATIONS The recommendations are designed to support deliberations and decisions about individual studies and to support ethical scrutiny of proposed research studies. Whilst preliminary, it is nevertheless the most comprehensive and detailed currently available.
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Affiliation(s)
- Ruth Parry
- Health Sciences, University of Nottingham, Nottingham, UK
| | - Marco Pino
- Health Sciences, University of Nottingham, Nottingham, UK
| | - Christina Faull
- LOROS Hospice Care for Leicestershire and Rutland, and Medicine University Hospitals Leicester, UK
| | - Luke Feathers
- LOROS Hospice Care for Leicestershire and Rutland, and Medicine University Hospitals Leicester, UK.
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28
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Silas MR, Grassia P, Langerman A. Video recording of the operating room—is anonymity possible? J Surg Res 2015; 197:272-6. [DOI: 10.1016/j.jss.2015.03.097] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2015] [Revised: 03/11/2015] [Accepted: 03/27/2015] [Indexed: 10/23/2022]
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Debriefing in the Emergency Department After Clinical Events: A Practical Guide. Ann Emerg Med 2015; 65:690-8. [DOI: 10.1016/j.annemergmed.2014.10.019] [Citation(s) in RCA: 110] [Impact Index Per Article: 12.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2014] [Revised: 10/07/2014] [Accepted: 10/10/2014] [Indexed: 12/13/2022]
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Pezaro S, Lilley L. Digital voice recorders - A conceptual intervention to facilitate contemporaneous record keeping in midwifery practice. Women Birth 2015; 28:e171-6. [PMID: 25997729 DOI: 10.1016/j.wombi.2015.04.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2015] [Revised: 04/29/2015] [Accepted: 04/30/2015] [Indexed: 11/26/2022]
Abstract
BACKGROUND The first responder, faced with any obstetric incident, frequently finds themselves within a dichotomy of multi-tasking activities. One challenge for the midwife, is to keep accurate and contemporaneous medical records, whilst simultaneously providing immediate clinical care. AIM This paper aims to propose an innovative conceptualisation and a practical solution for maternity services, which strive to uphold best practice in creating contemporaneous and accurate medical records. The feasibility of introducing the use of voice recorders within maternity services will be explored, and offered as a mechanism to facilitate record keeping and simultaneous clinical care. METHODS A synthesised narrative review of the literature is conducted. This review academically tests the conceptual hypothesis that the implementation of voice recorders within maternity services may augment the midwife's ability to generate contemporaneous medical records. A background literature review will also explore the key drivers for this particular innovation, and the challenges facing healthcare leaders in service improvement. FINDINGS This paper builds upon previous suggestions that digital voice recorders may be an effective solution to enhance overall obstetric outcomes, and focuses upon conceptual processes for implementation. CONCLUSIONS This paper offers the principal conclusion that the integration of voice recorders into midwifery practice for the purpose of supporting contemporaneous record keeping may be feasible within the current healthcare climate.
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Affiliation(s)
- Sally Pezaro
- Coventry University, Centre for Technology Enabled Health Research, UK.
| | - Linda Lilley
- School of Health, University of Northampton, Park Campus, Boughton Green Road, Northampton NN2 7AL, UK
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Abstract
BACKGROUND AND OBJECTIVES Pharmacogenetics (PGx) promises to optimize patient response to therapy. However, the public's acceptance of PGx is not well known, notably when this applies to children. Our objective was to explore perceptions of PGx testing among individuals, who differ from each other by either parental status or educational exposure to PGx, and to explore parents' views between PGx testing for oneself and PGx testing for their children. METHODS An exploratory survey was conducted among parents and other adults. Surveys P and C were completed by parents, survey NP by middle-aged nonparents, and survey MS by medical students. RESULTS Proper explanation before PGx testing appeared to be the most important issue to the respondents (eg, P = 1.55 × 10(-38) for survey NP). Respondents who were more knowledgeable about PGx were also more comfortable with PGx testing (eg, P = 2.53 × 10(-7) in case of mild disease). When PGx testing was for one's child, parents valued their own understanding more than their child's assent (P = 1.57 × 10(-17)). CONCLUSIONS The acceptability of PGx testing, either for oneself or for one's child, seemed to depend on baseline PGx knowledge, but not on parenthood.
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Affiliation(s)
| | - Carleton Bruce
- Department of Pediatrics, University of British Columbia, Vancouver, British Columbia, Canada
| | - Michael Hayden
- Department of Pediatrics, University of British Columbia, Vancouver, British Columbia, Canada
| | - Michael J Rieder
- Schulich School of Medicine and Dentistry, and Departments of Pediatrics, Physiology and Pharmacology, and Medicine, and University of Western Ontario, London, Ontario, Canada; and
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Kasangaki A, Macnab A, Cannon W. Videotaped interviews as a medium to enhance cross-cultural programme evaluation. Health Promot Int 2012; 27:74-81. [DOI: 10.1093/heapro/dar098] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Abstract
OBJECTIVE The authors had previously found flaws in resuscitation after severe neonatal asphyxia in cases selected on the grounds of suspected malpractice and financial compensation claims. The aim of the present study was to evaluate neonatal resuscitation in the general obstetric population in a setting with skilled attendance at birth. DESIGN Observational study. SETTING AND PATIENTS All infants born in the Stockholm County during 2004-2006 with a gestational age of ≥33 weeks, planned as vaginal delivery, with a normal cardiotocographic recording on admission to hospital and with an Apgar score of <7 at 5 min were included. MAIN OUTCOME MEASURES Adherence to guidelines for neonatal resuscitation. RESULTS Documentation was unsatisfactory in 142 (45%) infants. Other important shortcomings identified were delayed initiation of extensive resuscitation due to late paging or late arrival of attending paediatrician/neonatologist (n=48), and unsatisfactory ventilation related to late intubation and late securing of free airway (n=15). CONCLUSIONS Substandard care in neonatal resuscitation is not limited to cases of severe asphyxia related to claims for medical malpractice. The overall documentation of neonatal resuscitation needs to be much better to enable accurate and reliable evaluation. Obvious actions to improve standards of care include the paging of skilled personnel at an earlier stage in cases of complicated deliveries and team and skills training in neonatal ventilation.
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Affiliation(s)
- Sophie Berglund
- Department of Clinical Sciences, Karolinska Institutet, Danderyd Hospital, Stockholm, Sweden.
| | - Mikael Norman
- Department for Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden
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Gambadauro P, Magos A. Surgical Videos for Accident Analysis, Performance Improvement, and Complication Prevention. Surg Innov 2011; 19:76-80. [DOI: 10.1177/1553350611415424] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Conventional audit of surgical records through review of surgical results provides useful knowledge but hardly helps identify the technical reasons lying behind specific outcomes or complications. Surgical teams not only need to know that a complication might happen but also how and when it is most likely to happen. Functional awareness is therefore needed to prevent complications, know how to deal with them, and improve overall surgical performance. The authors wish to argue that the systematic recording and reviewing of surgical videos, a “surgical black box,” might improve surgical care, help prevent complications, and allow accident analysis. A possible strategy to test this hypothesis is presented and discussed. Recording and reviewing surgical interventions, apart from helping us achieve functional awareness and increasing the safety profile of our performance, allows us also to effectively share our experience with colleagues. The authors believe that those potential implications make this hypothesis worth testing.
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Affiliation(s)
- Pietro Gambadauro
- Centre for Reproduction, Uppsala University Hospital, Uppsala, Sweden
| | - Adam Magos
- University Department of Obstetrics and Gynaecology, Royal Free Hospital, London, UK
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Gelbart B, Hiscock R, Barfield C. Assessment of neonatal resuscitation performance using video recording in a perinatal centre. J Paediatr Child Health 2010; 46:378-83. [PMID: 20546105 DOI: 10.1111/j.1440-1754.2010.01747.x] [Citation(s) in RCA: 52] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
AIM To assess the quality of neonatal resuscitation using video recordings in a perinatal centre. METHODS Video recording was performed during high-risk deliveries between August 2007 and January 2008. Video recordings of neonatal resuscitations were assessed using a scoring tool previously used to assess resuscitation performance. Qualitative assessments and observations of team function and technical aspects of management were also recorded. Apgar scores documented in the Medical History and those derived from the video record were compared. RESULTS Twenty video recordings of neonatal resuscitations were assessed. Of the assessed domains; invasive ventilation and administration of surfactant were performed best with median scores of 100%. Performed least well were preparation and initial steps as well as the assessment and communication of heart rate (HR); 69% and 75%, respectively. Apgar scores were overestimated by a median value of 2 points at both 1 and 5 min (P < 0.001). Errors during resuscitation included inadequate oropharyngeal suction, aggressive stimulation, poor communication of heart rate and inadequate non-invasive ventilation. Failure to detect deterioration was also observed. CONCLUSION Video recording identified strengths and weaknesses in the performance of neonatal resuscitation and can facilitate targeted education and quality assurance programmes.
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Affiliation(s)
- Ben Gelbart
- Mercy Hospital for Women, 163 Studley Road Heidelberg 3084, Victoria, Australia.
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Editorial. Prax Kinderpsychol Kinderpsychiatr 2010; 59:171-3. [DOI: 10.13109/prkk.2010.59.3.171] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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