1
|
Marsall M, Hornung T, Bäuerle A, Weigl M. Quality of care transition, patient safety incidents, and patients' health status: a structural equation model on the complexity of the discharge process. BMC Health Serv Res 2024; 24:576. [PMID: 38702719 PMCID: PMC11069201 DOI: 10.1186/s12913-024-11047-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2023] [Accepted: 04/25/2024] [Indexed: 05/06/2024] Open
Abstract
BACKGROUND The transition of patients between care contexts poses patient safety risks. Discharges to home from inpatient care can be associated with adverse patient outcomes. Quality in discharge processes is essential in ensuring safe transitions for patients. Current evidence relies on bivariate analyses and neglects contextual factors such as treatment and patient characteristics and the interactions of potential outcomes. This study aimed to investigate the associations between the quality and safety of the discharge process, patient safety incidents, and health-related outcomes after discharge, considering the treatments' and patients' contextual factors in one comprehensive model. METHODS Patients at least 18 years old and discharged home after at least three days of inpatient treatment received a self-report questionnaire. A total of N = 825 patients participated. The assessment contained items to assess the quality and safety of the discharge process from the patient's perspective with the care transitions measure (CTM), a self-report on the incidence of unplanned readmissions and medication complications, health status, and sociodemographic and treatment-related characteristics. Statistical analyses included structural equation modeling (SEM) and additional analyses using logistic regressions. RESULTS Higher quality of care transition was related to a lower incidence of medication complications (B = -0.35, p < 0.01) and better health status (B = 0.74, p < 0.001), but not with lower incidence of readmissions (B = -0.01, p = 0.39). These effects were controlled for the influences of various sociodemographic and treatment-related characteristics in SEM. Additional analyses showed that these associations were only constant when all subscales of the CTM were included. CONCLUSIONS Quality and safety in the discharge process are critical to safe patient transitions to home care. This study contributes to a better understanding of the complex discharge process by applying a model in which various contextual factors and interactions were considered. The findings revealed that high quality discharge processes are associated with a lower likelihood of patient safety incidents and better health status at home even, when sociodemographic and treatment-related characteristics are taken into account. This study supports the call for developing individualized, patient-centered discharge processes to strengthen patient safety in care transitions.
Collapse
Affiliation(s)
- Matthias Marsall
- Institute for Patient Safety (IfPS), University Hospital Bonn, Bonn, Germany.
| | | | - Alexander Bäuerle
- Clinic for Psychosomatic Medicine and Psychotherapy, LVR-University Hospital Essen, University of Duisburg-Essen, Essen, Germany
- Center for Translational Neuro- and Behavioral Sciences (C-TNBS), University of Duisburg-Essen, Essen, Germany
| | - Matthias Weigl
- Institute for Patient Safety (IfPS), University Hospital Bonn, Bonn, Germany
| |
Collapse
|
2
|
Wenderott K, Krups J, Luetkens JA, Weigl M. Radiologists' perspectives on the workflow integration of an artificial intelligence-based computer-aided detection system: A qualitative study. Appl Ergon 2024; 117:104243. [PMID: 38306741 DOI: 10.1016/j.apergo.2024.104243] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Revised: 12/18/2023] [Accepted: 01/23/2024] [Indexed: 02/04/2024]
Abstract
In healthcare, artificial intelligence (AI) is expected to improve work processes, yet most research focuses on the technical features of AI rather than its real-world clinical implementation. To evaluate the implementation process of an AI-based computer-aided detection system (AI-CAD) for prostate MRI readings, we interviewed German radiologists in a pre-post design. We embedded our findings in the Model of Workflow Integration and the Technology Acceptance Model to analyze workflow effects, facilitators, and barriers. The most prominent barriers were: (i) a time delay in the work process, (ii) additional work steps to be taken, and (iii) an unstable performance of the AI-CAD. Most frequently named facilitators were (i) good self-organization, and (ii) good usability of the software. Our results underline the importance of a holistic approach to AI implementation considering the sociotechnical work system and provide valuable insights into key factors of the successful adoption of AI technologies in work systems.
Collapse
Affiliation(s)
- Katharina Wenderott
- Institute for Patient Safety, University Hospital Bonn, Venusberg-Campus 1, 53127, Bonn, Germany.
| | - Jim Krups
- Institute for Patient Safety, University Hospital Bonn, Venusberg-Campus 1, 53127, Bonn, Germany
| | - Julian A Luetkens
- Department of Diagnostic and Interventional Radiology, University Hospital Bonn, Germany; Quantitative Imaging Lab Bonn (QILaB), University Hospital Bonn, Germany
| | - Matthias Weigl
- Institute for Patient Safety, University Hospital Bonn, Venusberg-Campus 1, 53127, Bonn, Germany
| |
Collapse
|
3
|
Marsall M, Weigl M, Schmiedhofer M, Blum K, Rösner H, Strametz R, Gambashidze N. [Discharge management strategies in German general hospitals : A nationwide survey of professionals responsible for clinical risk management]. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 2024:10.1007/s00103-024-03846-0. [PMID: 38429575 DOI: 10.1007/s00103-024-03846-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Accepted: 01/30/2024] [Indexed: 03/03/2024]
Abstract
BACKGROUND Transitions from inpatient care are associated with risks for the safety of patients. In 2017, the framework agreement on discharge management was legally defined. There is currently a lack of empirical data in Germany on the implementation of measures to ensure safe transitions of patients after inpatient care. The aim of this study is to provide an overview of the discharge management strategies implemented by German general hospitals. METHODS Between March and May 2022, specific discharge management strategies as well as structural and organizational characteristics were assessed in a nationwide survey of 401 general hospitals, and descriptive statistics and group comparisons were performed. RESULTS Seven of nine strategies surveyed were implemented in > 95% of all hospitals. The evaluation of discharge planning was only implemented in 61% of the hospitals, and systematic documentation, analysis, and evaluation of readmissions in 54%. Hospitals with a higher number of hospital beds reported significantly less often about "early contact with follow-up care providers" and "organization of a seamless transition to follow-up care." DISCUSSION A large part of the strategies in discharge management from inpatient treatment is implemented in German general hospitals. However, measures for evaluation and the systematic analysis of discharge processes and readmissions of patients have only been partially implemented. However, these are necessary to systematically evaluate and potentially improve the discharge processes.
Collapse
Affiliation(s)
- Matthias Marsall
- Institut für Patientensicherheit (IfPS), Universitätsklinikum Bonn, Venusberg-Campus 1, Gebäude A 02, 53127, Bonn, Deutschland.
| | - Matthias Weigl
- Institut für Patientensicherheit (IfPS), Universitätsklinikum Bonn, Venusberg-Campus 1, Gebäude A 02, 53127, Bonn, Deutschland
| | | | - Karl Blum
- Deutsches Krankenhausinstitut, Düsseldorf, Deutschland
| | - Hannah Rösner
- Wiesbaden Business School, Rhein Main University of Applied Sciences, Wiesbaden, Deutschland
| | - Reinhard Strametz
- Wiesbaden Business School, Rhein Main University of Applied Sciences, Wiesbaden, Deutschland
| | - Nikoloz Gambashidze
- Institut für Patientensicherheit (IfPS), Universitätsklinikum Bonn, Venusberg-Campus 1, Gebäude A 02, 53127, Bonn, Deutschland
| |
Collapse
|
4
|
Kaltenegger HC, Marques MD, Becker L, Rohleder N, Nowak D, Wright BJ, Weigl M. Prospective associations of technostress at work, burnout symptoms, hair cortisol, and chronic low-grade inflammation. Brain Behav Immun 2024; 117:320-329. [PMID: 38307447 DOI: 10.1016/j.bbi.2024.01.222] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2023] [Revised: 01/23/2024] [Accepted: 01/25/2024] [Indexed: 02/04/2024] Open
Abstract
BACKGROUND Working conditions in the age of digitalization harbor risks for chronic stress and burnout. However, real-world investigations into biological effects of technostress, that is stress in the context of digital technology use, are sparse. This study prospectively assessed associations between technostress, general work stress, burnout symptoms, hair cortisol, and chronic low-grade inflammation. METHODS Hospital employees (N = 238, 182 females, Mage = 28.5 years) participated in a prospective cohort study with two follow-ups six months apart (T2, T3). Participants answered standardized questionnaires on general job strain (job demand-control ratio), technostressors (work interruptions, multitasking, information overload), burnout symptoms (exhaustion, mental distance), and relevant confounders. Moreover, they provided capillary blood samples for C-reactive protein (CRP) and hair strands for hair cortisol concentration (HCC) analysis. Structural equation modelling was performed. RESULTS The factorial structure of survey measures was confirmed. Burnout symptoms (MT2 = 2.17, MT3 = 2.33) and HCC (MT2 = 4.79, MT3 = 9.56; pg/mg) increased over time, CRP did not (MT2 = 1.15, MT3 = 1.21; mg/L). Adjusted path models showed that technostress was negatively associated with HCC (β = -0.16, p =.003), but not with burnout and CRP. General work stress in contrast, was not significantly associated with burnout, HCC or CRP. Furthermore, there were reciprocal effects of CRP on HCC (β = 0.28, p =.001) and of HCC on CRP (β = -0.10, p ≤.001). Associations were robust in additional analyses including further confounders. CONCLUSION This is the first study on prospective effects of technostress on employees' endocrine and inflammatory systems. Results suggest differential effects of technostress on the hypothalamic-pituitary-adrenocortical axis activity. Given its key role for long-term health, the findings have important implications for occupational health and safety in digitalized work environments.
Collapse
Affiliation(s)
- Helena C Kaltenegger
- Institute and Clinic for Occupational, Social and Environmental Medicine, University Hospital, LMU Munich, Munich, Germany.
| | - Mathew D Marques
- School of Psychology and Public Health, La Trobe University, Melbourne, VIC, Australia
| | - Linda Becker
- Institute of Psychology, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany; Humanwissenschaftliche Fakultät, Vinzenz Pallotti University gGmbH, Vallendar, Germany
| | - Nicolas Rohleder
- Institute of Psychology, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| | - Dennis Nowak
- Institute and Clinic for Occupational, Social and Environmental Medicine, University Hospital, LMU Munich, Munich, Germany
| | - Bradley J Wright
- School of Psychology and Public Health, La Trobe University, Melbourne, VIC, Australia
| | - Matthias Weigl
- Institute and Clinic for Occupational, Social and Environmental Medicine, University Hospital, LMU Munich, Munich, Germany; Institute for Patient Safety, University Hospital Bonn, Bonn, Germany
| |
Collapse
|
5
|
Tlili MA, Aouicha W, Gambashidze N, Ben Cheikh A, Sahli J, Weigl M, Mtiraoui A, Chelbi S, Said Laatiri H, Mallouli M. A retrospective analysis of adverse events reported by Tunisian intensive care units' professionals. BMC Health Serv Res 2024; 24:77. [PMID: 38229159 DOI: 10.1186/s12913-024-10544-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2023] [Accepted: 01/02/2024] [Indexed: 01/18/2024] Open
Abstract
INTRODUCTION Adverse events (AEs) that occur in hospitals remain a challenge worldwide, and especially in intensive care units (ICUs) where they are more likely to occur. Monitoring of AEs can provide insight into the status and advances of patient safety. This study aimed to examine the AEs reported during the 20 months after the implementation of the AE reporting system. METHODS We conducted a retrospective analysis of a voluntary ICU AE reporting system. Incidents were reported by the staff from ten ICUs in the Sahloul University Hospital (Tunisia) between February 2020 and September 2021. RESULTS A total of 265 reports were received, of which 61.9% were deemed preventable. The most frequently reported event was healthcare-associated infection (30.2%, n = 80), followed by pressure ulcers (18.5%, n = 49). At the time of reporting, 25 patients (9.4%) had died as a result of an AE and in 51.3% of cases, the event had resulted in an increased length of stay. Provider-related factors contributed to 64.2% of the events, whilst patient-related factors contributed to 53.6% of the events. As for criticality, 34.3% of the events (n = 91) were unacceptable (c3) and 36.3% of the events (n = 96) were 'acceptable under control' (c2). CONCLUSIONS The reporting system provided rich information on the characteristics of reported AEs that occur in ICUs and their consequences and may be therefore useful for designing effective and evidence-based interventions to reduce the occurrence of AEs.
Collapse
Affiliation(s)
- Mohamed Ayoub Tlili
- University of Sousse, Faculty of Medicine of Sousse, Department of Family and Community Medicine, LR12ES03, 4002, Sousse, Tunisia.
| | - Wiem Aouicha
- University of Sousse, Faculty of Medicine of Sousse, Department of Family and Community Medicine, LR12ES03, 4002, Sousse, Tunisia
| | - Nikoloz Gambashidze
- Institute for Patient Safety, University Hospital Bonn, Venusberg-Campus-1, 53127, Bonn, Germany
| | - Asma Ben Cheikh
- Department of Prevention and Care Safety, Sahloul University Hospital, 4054, Sousse, Tunisia
| | - Jihene Sahli
- University of Sousse, Faculty of Medicine of Sousse, Department of Family and Community Medicine, LR12ES03, 4002, Sousse, Tunisia
| | - Matthias Weigl
- Institute for Patient Safety, University Hospital Bonn, Venusberg-Campus-1, 53127, Bonn, Germany
| | - Ali Mtiraoui
- University of Sousse, Faculty of Medicine of Sousse, Department of Family and Community Medicine, LR12ES03, 4002, Sousse, Tunisia
| | - Souad Chelbi
- University of Sousse, Faculty of Medicine of Sousse, Department of Family and Community Medicine, LR12ES03, 4002, Sousse, Tunisia
| | - Houyem Said Laatiri
- Department of Prevention and Care Safety, Sahloul University Hospital, 4054, Sousse, Tunisia
| | - Manel Mallouli
- University of Sousse, Faculty of Medicine of Sousse, Department of Family and Community Medicine, LR12ES03, 4002, Sousse, Tunisia
| |
Collapse
|
6
|
Wenderott K, Krups J, Luetkens JA, Gambashidze N, Weigl M. Prospective effects of an artificial intelligence-based computer-aided detection system for prostate imaging on routine workflow and radiologists' outcomes. Eur J Radiol 2024; 170:111252. [PMID: 38096741 DOI: 10.1016/j.ejrad.2023.111252] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2023] [Revised: 11/15/2023] [Accepted: 12/04/2023] [Indexed: 01/16/2024]
Abstract
OBJECTIVES Artificial intelligence (AI) is expected to alleviate the negative consequences of rising case numbers for radiologists. Currently, systematic evaluations of the impact of AI solutions in real-world radiological practice are missing. Our study addresses this gap by investigating the impact of the clinical implementation of an AI-based computer-aided detection system (CAD) for prostate MRI reading on clinicians' workflow, workflow throughput times, workload, and stress. MATERIALS AND METHODS CAD was newly implemented into radiology workflow and accompanied by a prospective pre-post study design. We assessed prostate MRI case readings using standardized work observations and questionnaires. The observation period was three months each in a single department. Workflow throughput times, PI-RADS score, CAD usage and radiologists' self-reported workload and stress were recorded. Linear mixed models were employed for effect identification. RESULTS In data analyses, 91 observed case readings (pre: 50, post: 41) were included. Variation of routine workflow was observed following CAD implementation. A non-significant increase in overall workflow throughput time was associated with CAD implementation (mean 16.99 ± 6.21 vs 18.77 ± 9.69 min, p = .51), along with an increase in diagnostic reading time for high suspicion cases (mean 15.73 ± 4.99 vs 23.07 ± 8.75 min, p = .02). Changes in radiologists' self-reported workload or stress were not found. CONCLUSION Implementation of an AI-based detection aid was associated with lower standardization and no effects over time on radiologists' workload or stress. Expectations of AI decreasing the workload of radiologists were not confirmed by our real-world study. PRE-REGISTRATION German register for clinical trials https://drks.de/; DRKS00027391.
Collapse
Affiliation(s)
| | - Jim Krups
- Institute for Patient Safety, University Hospital Bonn, Germany
| | - Julian A Luetkens
- Department of Radiology and Quantitative Imaging Lab Bonn (QILaB), University Hospital Bonn, Germany
| | | | - Matthias Weigl
- Institute for Patient Safety, University Hospital Bonn, Germany
| |
Collapse
|
7
|
Marsall M, Hornung T, Bäuerle A, Weigl M. Measuring transitional patient safety: Adaptation and validation of the German version of the Care Transitions Measure. Z Evid Fortbild Qual Gesundhwes 2023; 182-183:17-25. [PMID: 37951720 DOI: 10.1016/j.zefq.2023.10.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Revised: 09/30/2023] [Accepted: 10/03/2023] [Indexed: 11/14/2023]
Abstract
INTRODUCTION The transition between different care contexts, especially during discharge from inpatient treatment to home, is associated with risks for patient safety. Internationally established, the Care Transitions Measure (CTM) is used to assess the quality and safety of this transition from the patients' perspective. A systematic and standardized assessment of quality and safety in the discharge process from the patients' perspective has not been possible in German-speaking countries due to the lack of a German adaptation and validation of the CTM. This study aims to translate, adapt, and validate the CTM for use in German-speaking countries METHODS: The German version of the CTM was developed based on internationally accepted recommendations for translating and adapting questionnaires. Patients of all departments (except pediatric departments) of a German university hospital who were discharged home after at least three days of inpatient treatment received the questionnaire by mail between May and August 2022. A total of 806 patients participated in the survey. The validity of the CTM was tested by factor analyses. For this purpose, different factor models were compared. In addition, the measurement invariance of the instrument was examined. RESULTS The construct validity of the long version of the CTM (15items) with a two-factorial model structure was confirmed with good model fit indices. The two subscales had excellent internal consistency. In addition, the one short version with four items achieved excellent model fit indices and high internal consistency. For the long version of the CTM, measurement invariance was confirmed for all sociodemographic, care-related, and survey response characteristics examined. The measurement invariance of the short version was only partially confirmed. DISCUSSION The validity and reliability of the German version of the CTM were confirmed. In its long version, the instrument is measurement invariant across various characteristics and thus allows valid interpretation of group differences. The short version is partially measurement invariant and is suitable as a screening instrument for assessing the quality and safety of discharge processes due to its high validity and reliability. CONCLUSIONS With a validated and standardized German version of the CTM, an instrument is now available to assess the quality and safety of the discharge process from the patients' perspective. Thus, this study provides an essential tool for systematically investigating and optimizing patient safety in the discharge process.
Collapse
Affiliation(s)
- Matthias Marsall
- Institute for Patient Safety (IfPS), University Hospital Bonn, Bonn, Germany.
| | | | - Alexander Bäuerle
- Clinic for Psychosomatic Medicine and Psychotherapy, LVR-University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Matthias Weigl
- Institute for Patient Safety (IfPS), University Hospital Bonn, Bonn, Germany
| |
Collapse
|
8
|
Weigl M, Heinrich M, Rivas J, Bergmann F, Kurz M, Silbereisen C, Dieterich HJ, Kleine B, Riek S, Olivieri M, Hoffmann F, Lieftüchter V. Teamwork and mental workload in postsurgical pediatric patient handovers: Prospective effect evaluation of an improvement intervention for OR-PICU patient transitions. Eur J Pediatr 2023; 182:5637-5647. [PMID: 37819421 PMCID: PMC10746584 DOI: 10.1007/s00431-023-05241-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Revised: 09/22/2023] [Accepted: 09/25/2023] [Indexed: 10/13/2023]
Abstract
Postsurgical handover of pediatric patients from operating rooms (OR) to pediatric intensive care units (PICU) is a critical step. This transition is susceptible to errors and inefficiencies particularly if poor multidisciplinary teamwork occurs. Despite wide adoption of standardized handover interventions, comprehensive investigations into joint effects for patient care and provider outcomes are scarce. We aimed to improve OR-PICU handovers quality and sought to evaluate the intervention with particular attention to patient care effects and provider outcomes. A prospective, before-after-study design with an interrupted-series and a multi-source, mixed-methods evaluation approach was established. Drawing upon a participative plan-do-study-act approach, a standardized, checklist-based handover process was designed and implemented. For effect assessments, we observed OR-PICU handovers on site (pre implementation: n = 31, post: n = 30), respectively, with standardized expert observation and provider self-report tools (n = 111, n = 110). Setting was a tertiary Pediatric University Hospital. Supplementary qualitative, semi-structured interviews were conducted, and a general inductive content analysis approach was used to identify key facilitators and barriers on implementation. Improvement efforts focused on stepwise implementation of (1) standardized handover process and (2) a checklist for multi-professional OR-PICU handover communication. We observed significant increases in team and patient setup (pre: 79.3%, post: 98.6%, p < .01), enhanced team engagement (pre: 50%, post: 81.7%, p < .01), and comprehensive information transfer by the anesthesia sub-team (pre: 78.6%, post: 87.3%, p < .01). Expert-rated teamwork outcomes were consistently higher, yet self-reported teamwork did not change over time. Provider perceived stress and disruptions did not change, mental workload tended to decrease over time (pre: M = 3.2, post: 2.9, p = .08). Comprehensiveness of post-operative patient information reported by PICU physician increased significantly: pre: 65.9%, post: 76.2%, p < .05. After implementation, providers acknowledged the importance of standardized handover practices and associated benefits for facilitation of information transfer and comprehensiveness. Among reported barriers were obstacles during implementation as well as insufficient consideration of professionals' individual workflow after surgery. CONCLUSION A multidisciplinary intervention for postsurgical pediatric patient handovers was associated with improved expert-rated teamwork and fewer omissions of key patient information over time. Inconsistent results were obtained for provider-rated mental workload and teamwork outcomes. The findings contribute to a better understanding concerning the interplay of teamwork and provider cognitions in the course of establishing safe patient transitions in pediatric care. WHAT IS KNOWN • Transfer of critically ill children conveys significant challenges for interprofessional communication and teamwork. Prospective research into interventions for safe and efficient handover practices of OR PICU patient transitions is necessary. • Checklists are assumed to facilitate cognitive load among providers in acute clinical environments. WHAT IS NEW • A standardized, checklist-based handover intervention was associated with improvements in team set-up and information transfer. Provider outcomes such as mental workload and stress did not change over time. • The combination of teamwork and provider assessments allows a more nuanced understanding of implementation barriers and sustainable effects in course of OR-PICU handover interventions.
Collapse
Affiliation(s)
- Matthias Weigl
- Institute for Patient Safety, University Hospital, Bonn, 53127, Germany.
- Institute and Clinic for Occupational, Social and Environmental Medicine, LMU University Hospital, LMU Munich, Munich, Germany.
| | - Martina Heinrich
- Department of Pediatric Surgery, Dr. von Hauner Children's Hospital, LMU University Hospital, LMU Munich, Munich, Germany
| | - Julia Rivas
- Institute and Clinic for Occupational, Social and Environmental Medicine, LMU University Hospital, LMU Munich, Munich, Germany
| | - Florian Bergmann
- Department of Pediatric Surgery, Dr. von Hauner Children's Hospital, LMU University Hospital, LMU Munich, Munich, Germany
| | - Matthias Kurz
- Department of Anesthesiology, LMU University Hospital Munich, LMU Munich, Munich, Germany
| | - Clemens Silbereisen
- Department of Anesthesiology, LMU University Hospital Munich, LMU Munich, Munich, Germany
| | - Hans-Juergen Dieterich
- Department of Anesthesiology, LMU University Hospital Munich, LMU Munich, Munich, Germany
| | - Beate Kleine
- Department of Pediatrics, Dr. von Hauner Children's Hospital, LMU University Hospital, LMU Munich, Munich, Germany
| | - Susanne Riek
- Department of Pediatrics, Dr. von Hauner Children's Hospital, LMU University Hospital, LMU Munich, Munich, Germany
| | - Martin Olivieri
- Department of Pediatrics, Dr. von Hauner Children's Hospital, LMU University Hospital, LMU Munich, Munich, Germany
| | - Florian Hoffmann
- Department of Pediatrics, Dr. von Hauner Children's Hospital, LMU University Hospital, LMU Munich, Munich, Germany
| | - Victoria Lieftüchter
- Department of Pediatrics, Dr. von Hauner Children's Hospital, LMU University Hospital, LMU Munich, Munich, Germany
| |
Collapse
|
9
|
Becker L, Kaltenegger HC, Nowak D, Weigl M, Rohleder N. Biological stress responses to multitasking and work interruptions: A randomized controlled trial. Psychoneuroendocrinology 2023; 156:106358. [PMID: 37542740 DOI: 10.1016/j.psyneuen.2023.106358] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Revised: 06/13/2023] [Accepted: 08/01/2023] [Indexed: 08/07/2023]
Abstract
In the course of digitalization, new stressors are emerging. In modern working and living environments, two ubiquitous, technology-mediated stressors are multitasking demands and work interruptions. However, biological stress response patterns to multitasking and work interruptions have been sparsely investigated so far. We thus aimed to comprehensively assess biological stress response patterns to both stressors and, additionally, test whether responses differ between digital and partially non-digital settings. A controlled experimental set-up was established and humans' biological markers of the Sympathetic Nervous System (SNS), the hypothalamic-pituitary adrenal (HPA) axis, and the immune system were assessed. N = 186 healthy participants (mean age: 23.2 ± 4.3 years, 74.7% female, body mass-index: 22.3 ± 3.1 kg/m2) took part in this pre-registered study. Each participant was randomly assigned to one of 6 experimental conditions (1 digital single-task, 3 dual-tasks [2 parallel tasks and 1 interruption], 1 multitasking, and 1 passive, control condition). Each one of the dual-tasking as well as the multitasking conditions included a non-digital sub-task, i.e., performing a task in presence of an examiner. All other conditions involved digital tasks only. Salivary alpha-amylase (sAA) levels as a marker for SNS reactivity significantly changed in work interruptions, parallel dual-tasking, and multitasking conditions. No changes were found for control conditions. Furthermore, no significant changes over time and no differences between the conditions were identified for three biological markers: cortisol as marker for HPA axis activity as well as for two immune system markers (secretory Immunoglobulin-A, C-reactive protein). A time course similar to sAA was found for perceived stress: with increases during task execution and decreases afterwards in multitasking and parallel dual-tasking. Yet, it did not change for the work interruption, passive control, and single-tasking condition. Overall, our findings show that dual- and multitasking are perceived as stressful and are associated with an activation of the SNS, but not with responses of HPA axis or immune system. This was consistent for digital as well as partially digital task demands. Our findings will also inform future research into the differential stress effects of digital and non-digital tasks to advance our understanding of biological stress response-patterns to multitasking and work interruptions. Therefore, our findings are highly relevant for understanding the long-term biological health effects of stress in modern (digitalized) environments.
Collapse
Affiliation(s)
- Linda Becker
- Chair of Health Psychology, Department of Psychology, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany.
| | - Helena C Kaltenegger
- Institute and Clinic for Occupational, Social and Environmental Medicine, LMU University Hospital, Munich, Germany
| | - Dennis Nowak
- Institute and Clinic for Occupational, Social and Environmental Medicine, LMU University Hospital, Munich, Germany
| | - Matthias Weigl
- Institute and Clinic for Occupational, Social and Environmental Medicine, LMU University Hospital, Munich, Germany; Institute for Patient Safety, University Hospital Bonn, Bonn, Germany
| | - Nicolas Rohleder
- Chair of Health Psychology, Department of Psychology, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| |
Collapse
|
10
|
Koch A, Quartucci C, Buchner A, Schlenker B, Becker A, Catchpole K, Weigl M. Associations of flow disruptions with patient, staff, and process outcomes: a prospective observational study of robotic-assisted radical prostatectomies. Surg Endosc 2023; 37:6964-6974. [PMID: 37336845 PMCID: PMC10462499 DOI: 10.1007/s00464-023-10162-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Accepted: 05/28/2023] [Indexed: 06/21/2023]
Abstract
BACKGROUND Technological advancements in the operating room (OR) have sparked new challenges for surgical workflow, OR professionals, and patient safety. Disruptive events are frequent across all surgical specialties, but little is known about their effects on patient outcomes and the influence of systemic factors. The aim was to explore the associations of intraoperative flow disruptions (FDs) with patient outcomes, staff workload, and surgery duration. METHODS Prospective, single-center, and multi-source study comprising direct and standardized OR observations of urologic surgical procedures, clinical patient outcomes, and staff- and patient-reported outcome data (PROMs; 3-month follow-up). All data were recorded between 01/2020 and 10/2021. FDs were assessed using standardized procedure observations. Linear and logistic regression analyses including multiple system factors were used to explore the effects of FDs on surgical outcomes. RESULTS 61 robotic-assisted radical prostatectomy procedures were captured (with 61 patients and 243 staff reports). High rates of FDs were observed; however, our analyses did not show significant relationships with patient complication rates. Equipment- and patient-related FDs were associated with increased staff workload. No association was found between higher rates of FDs and procedure duration. CONCLUSIONS FDs were not related to inferior patient outcomes. Our findings may inform future OR investigations that scrutinize the complex interplay of human, team, process, and technological components that mitigate the effects of FDs during surgery.
Collapse
Affiliation(s)
- Amelie Koch
- Institute for Patient Safety, University Hospital, University of Bonn, Venusberg-Campus 1, 53127, Bonn, Germany.
- Institute and Clinic for Occupational, Social and Environmental Medicine, University Hospital, LMU Munich, Munich, Germany.
| | - Caroline Quartucci
- Institute and Clinic for Occupational, Social and Environmental Medicine, University Hospital, LMU Munich, Munich, Germany
- Bavarian Health and Food Safety Authority, Institute for Occupational Health and Product Safety, Environmental Health, Munich, Germany
| | - Alexander Buchner
- Department of Urology, University Hospital, LMU Munich, Munich, Germany
| | - Boris Schlenker
- Department of Urology, University Hospital, LMU Munich, Munich, Germany
| | - Armin Becker
- Department of Urology, University Hospital, LMU Munich, Munich, Germany
| | - Ken Catchpole
- Department of Anesthesia and Perioperative Medicine, Medical University of South Carolina, Charleston, USA
| | - Matthias Weigl
- Institute for Patient Safety, University Hospital, University of Bonn, Venusberg-Campus 1, 53127, Bonn, Germany
- Institute and Clinic for Occupational, Social and Environmental Medicine, University Hospital, LMU Munich, Munich, Germany
| |
Collapse
|
11
|
Kaltenegger HC, Becker L, Rohleder N, Nowak D, Quartucci C, Weigl M. Associations of technostressors at work with burnout symptoms and chronic low-grade inflammation: a cross-sectional analysis in hospital employees. Int Arch Occup Environ Health 2023:10.1007/s00420-023-01967-8. [PMID: 37148328 PMCID: PMC10163295 DOI: 10.1007/s00420-023-01967-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Accepted: 02/25/2023] [Indexed: 05/08/2023]
Abstract
OBJECTIVE Despite the increasing scholarly interest in the phenomenon technostress, associated biological effects on employee health are under-researched. Chronic low-grade inflammation is suggested as a central pathway linking stress experience to disease development. The aim of this study was to assess associations of technology-related work stressors (technostressors) with low-grade inflammation and burnout symptoms. METHODS N = 173 (74.6% women, Mage = 31.0 years) university hospital employees participated in a cross-sectional study. Self-report questionnaires were used for the assessment of general psychosocial working conditions (work overload, job control, social climate), a range of different technostressors, burnout symptoms, and relevant confounders. Participants provided capillary blood samples, and high-sensitivity C-reactive protein (hs-CRP) as an inflammatory biomarker was analyzed from dried blood spots. RESULTS Based on a factor analysis, we identified four underlying dimensions of technostressors: techno- and information overload, techno-complexity, interruptions and multitasking as well as usability and technical support. In multivariate linear regressions, techno-/information overload and techno-complexity were associated with core (exhaustion, mental distance) and secondary (psychosomatic complaints) symptoms of burnout. Techno-/information overload was a significant predictor of burnout core symptoms, even when general work overload was controlled for. The technostressors were not associated with hs-CRP. CONCLUSION This is the first study on technology-related stress at work and chronic low-grade inflammation. The results suggest that (information) overload caused by digital technology use is a distinct work stressor with genuine consequences for psychological health. To what extent these effects also manifest on a physiological level needs to be subjected to future studies, ideally with prospective designs.
Collapse
Affiliation(s)
- Helena C Kaltenegger
- Institute and Clinic for Occupational, Social and Environmental Medicine, University Hospital, LMU Munich, Ziemssenstr. 1, 80336, Munich, Germany.
| | - Linda Becker
- Institute of Psychology, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| | - Nicolas Rohleder
- Institute of Psychology, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| | - Dennis Nowak
- Institute and Clinic for Occupational, Social and Environmental Medicine, University Hospital, LMU Munich, Ziemssenstr. 1, 80336, Munich, Germany
| | - Caroline Quartucci
- Institute and Clinic for Occupational, Social and Environmental Medicine, University Hospital, LMU Munich, Ziemssenstr. 1, 80336, Munich, Germany
- Bavarian Health and Food Safety Authority, Institute for Occupational Health and Product Safety, Environmental Health, Munich, Germany
| | - Matthias Weigl
- Institute and Clinic for Occupational, Social and Environmental Medicine, University Hospital, LMU Munich, Ziemssenstr. 1, 80336, Munich, Germany
- Institute for Patient Safety, University Hospital Bonn, Bonn, Germany
| |
Collapse
|
12
|
Marsall M, Bäuerle A, Hasenberg T, Schräpler L, Robitzsch A, Niedergethmann M, Teufel M, Weigl M. Quality of Care Transition During Hospital Discharge, Patient Safety, and Weight Regain After Bariatric Surgery: a Cross-Sectional Study. Obes Surg 2023; 33:1143-1153. [PMID: 36773181 PMCID: PMC10079752 DOI: 10.1007/s11695-023-06486-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Revised: 01/21/2023] [Accepted: 01/27/2023] [Indexed: 02/12/2023]
Abstract
PURPOSE Bariatric surgery is established as the gold standard in the treatment of severe obesity. However, a significant proportion of patients experience a substantial weight regain afterwards. Previous research focused predominantly on patients' personal factors. Yet, critical discharge process factors that contribute to patient's adherence after surgical interventions are rarely examined. This study investigated whether high quality of care transitions in discharge management influences weight regain and the likelihood of experiencing adverse patient safety incidents. MATERIALS AND METHODS A cross-sectional study with 578 patients after bariatric surgery was conducted. Participants answered a standardized assessment on the quality of care transition from hospital to home-, surgery-, and nutrition-related characteristics as well as patient safety incidents. RESULTS Significant weight regain was observed 24 months after surgery. The association between time since surgery and weight regain was weaker in patients with high quality of care transitions (B = 2.27, p < .001). Higher quality of care transition was also significantly related to a lower likelihood of unplanned hospital readmissions (OR = 0.67) and fewer medication complications (OR = 0.48) after surgery. CONCLUSION This study sheds first light on the key influence of high quality of care transitions after bariatric surgery. Improvement efforts into effective discharge processes may establish smoother care transitions and help patients to assume responsibility and compliance with behavioral recommendations after surgery. Moreover, adverse patient safety incidents are less frequent after high quality care transitions indicating both high quality of health services for patients and reducing costs for the health care system.
Collapse
Affiliation(s)
- Matthias Marsall
- Institute for Patient Safety (IfPS), University Hospital Bonn, 53127, Bonn, Germany.
| | - Alexander Bäuerle
- Clinic for Psychosomatic Medicine and Psychotherapy, LVR-University Hospital Essen, University of Duisburg-Essen, 45147, Essen, Germany
| | - Till Hasenberg
- Helios Obesity Center West, Helios St. Elisabeth Hospital Oberhausen, Witten/Herdecke University, Helios University Hospital Wuppertal, 42283, Wuppertal, Germany
| | - Laura Schräpler
- Clinic for Psychosomatic Medicine and Psychotherapy, LVR-University Hospital Essen, University of Duisburg-Essen, 45147, Essen, Germany
| | - Anita Robitzsch
- Clinic for Psychosomatic Medicine and Psychotherapy, LVR-University Hospital Essen, University of Duisburg-Essen, 45147, Essen, Germany
| | - Marco Niedergethmann
- Department of Surgery, Obesity and Metabolic Surgery Center, Alfried Krupp Hospital Essen, 45131, Essen, Germany
| | - Martin Teufel
- Clinic for Psychosomatic Medicine and Psychotherapy, LVR-University Hospital Essen, University of Duisburg-Essen, 45147, Essen, Germany
| | - Matthias Weigl
- Institute for Patient Safety (IfPS), University Hospital Bonn, 53127, Bonn, Germany
| |
Collapse
|
13
|
Stefan P, Pfandler M, Kullmann A, Eck U, Koch A, Mehren C, von der Heide A, Weidert S, Fürmetz J, Euler E, Lazarovici M, Navab N, Weigl M. Computer-assisted simulated workplace-based assessment in surgery: application of the universal framework of intraoperative performance within a mixed-reality simulation. BMJ Surg Interv Health Technol 2023; 5:e000135. [PMID: 36687799 PMCID: PMC9853221 DOI: 10.1136/bmjsit-2022-000135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2022] [Accepted: 08/24/2022] [Indexed: 01/20/2023] Open
Abstract
Objectives Workplace-based assessment (WBA) is a key requirement of competency-based medical education in postgraduate surgical education. Although simulated workplace-based assessment (SWBA) has been proposed to complement WBA, it is insufficiently adopted in surgical education. In particular, approaches to criterion-referenced and automated assessment of intraoperative surgical competency in contextualized SWBA settings are missing.Main objectives were (1) application of the universal framework of intraoperative performance and exemplary adaptation to spine surgery (vertebroplasty); (2) development of computer-assisted assessment based on criterion-referenced metrics; and (3) implementation in contextualized, team-based operating room (OR) simulation, and evaluation of validity. Design Multistage development and assessment study: (1) expert-based definition of performance indicators based on framework's performance domains; (2) development of respective assessment metrics based on preoperative planning and intraoperative performance data; (3) implementation in mixed-reality OR simulation and assessment of surgeons operating in a confederate team. Statistical analyses included internal consistency and interdomain associations, correlations with experience, and technical and non-technical performances. Setting Surgical simulation center. Full surgical team set-up within mixed-reality OR simulation. Participants Eleven surgeons were recruited from two teaching hospitals. Eligibility criteria included surgical specialists in orthopedic, trauma, or neurosurgery with prior VP or kyphoplasty experience. Main outcome measures Computer-assisted assessment of surgeons' intraoperative performance. Results Performance scores were associated with surgeons' experience, observational assessment (Objective Structured Assessment of Technical Skill) scores and overall pass/fail ratings. Results provide strong evidence for validity of our computer-assisted SWBA approach. Diverse indicators of surgeons' technical and non-technical performances could be quantified and captured. Conclusions This study is the first to investigate computer-assisted assessment based on a competency framework in authentic, contextualized team-based OR simulation. Our approach discriminates surgical competency across the domains of intraoperative performance. It advances previous automated assessment based on the use of current surgical simulators in decontextualized settings. Our findings inform future use of computer-assisted multidomain competency assessments of surgeons using SWBA approaches.
Collapse
Affiliation(s)
- Philipp Stefan
- Chair for Computer Aided Medical Procedures and Augmented Reality, Department of Informatics, Technical University of Munich, München, Germany
| | - Michael Pfandler
- Institute and Outpatient Clinic for Occupational, Social, and Environmental Medicine, University Hospital, Ludwig Maximilians University Munich, München, Germany
| | - Aljoscha Kullmann
- Chair for Computer Aided Medical Procedures and Augmented Reality, Department of Informatics, Technical University of Munich, München, Germany
| | - Ulrich Eck
- Chair for Computer Aided Medical Procedures and Augmented Reality, Department of Informatics, Technical University of Munich, München, Germany
| | - Amelie Koch
- Institute and Outpatient Clinic for Occupational, Social, and Environmental Medicine, University Hospital, Ludwig Maximilians University Munich, München, Germany
| | - Christoph Mehren
- Spine Center, Schön Klinik München Harlaching, München, Germany,Academic Teaching Hospital and Spine Research Institute, Paracelsus Medical University, Salzburg, Austria
| | - Anna von der Heide
- Department of General, Trauma and Reconstructive Surgery, University Hospital, Campus Grosshadern, Ludwig Maximilians University Munich, München, Germany
| | - Simon Weidert
- Department of General, Trauma and Reconstructive Surgery, University Hospital, Campus Grosshadern, Ludwig Maximilians University Munich, München, Germany
| | - Julian Fürmetz
- Department of General, Trauma and Reconstructive Surgery, University Hospital, Campus Innenstadt, Ludwig Maximilians University Munich, München, Germany
| | - Ekkehard Euler
- Department of General, Trauma and Reconstructive Surgery, University Hospital, Campus Innenstadt, Ludwig Maximilians University Munich, München, Germany
| | - Marc Lazarovici
- Institute for Emergency Medicine and Management in Medicine (INM), University Hospital, Ludwig Maximilians University Munich, München, Germany
| | - Nassir Navab
- Chair for Computer Aided Medical Procedures and Augmented Reality, Department of Informatics, Technical University of Munich, München, Germany
| | - Matthias Weigl
- Institute and Outpatient Clinic for Occupational, Social, and Environmental Medicine, University Hospital, Ludwig Maximilians University Munich, München, Germany,Institute for Patient Safety, University of Bonn, Bonn, Germany
| |
Collapse
|
14
|
Koch A, Schlenker B, Becker A, Weigl M. Operating room team strategies to reduce flow disruptions in high-risk task episodes: resilience in robot-assisted surgery. Ergonomics 2022:1-14. [PMID: 36285451 DOI: 10.1080/00140139.2022.2136406] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Accepted: 10/10/2022] [Indexed: 06/16/2023]
Abstract
In healthcare work settings, flow disruptions (FDs) pose a potential threat to patient safety. Resilience research suggests that adaptive behavioural strategies contribute to preventing cognitive overload through FDs at crucial moments. We aimed to explore the nature and efficacy of operating room (OR) team strategies to prevent FDs in robot-assisted surgery. Within a mixed-methods design, we first asked surgical professionals, which strategies they apply, and secondly, identified behavioural strategies through direct observations. Findings were analysed using content analysis. Additionally, FDs were assessed through live observations in the OR. The sample included four interviewed experts and 15 observed surgical cases. Sixty originally received strategies were synthesised into 17 final OR team strategies. Overall, 658 FDs were observed with external FDs being the most frequent. During high-risk episodes, FDs were significantly reduced (p < 0.0001). The identified strategies reveal how OR teams deliberatively and dynamically manage and mitigate FDs during critical tasks. Our findings contribute to a nuanced understanding of adaptive strategies to safeguard performance in robot surgery services. Practitioner Summary: Flow disruptions (FDs) in surgical work may become a severe safety threat during high-risk situations. With interviews and observations, we explored team strategies applied to prevent FDs in critical moments. We obtained a comprehensive list of behavioural strategies and found that FDs were significantly reduced during a specific high-risk surgical task. Our findings emphasise the role of providers' and teams' adaptive capabilities to manage workflow in high-technology care environments.
Collapse
Affiliation(s)
- Amelie Koch
- Institute and Clinic for Occupational, Social and Environmental Medicine, University Hospital, LMU, Munich, Germany
- Institute for Patient Safety, University Hospital, University of Bonn, Bonn, Germany
| | - Boris Schlenker
- Department of Urology, University Hospital, LMU, Munich, Germany
| | - Armin Becker
- Department of Urology, University Hospital, LMU, Munich, Germany
| | - Matthias Weigl
- Institute and Clinic for Occupational, Social and Environmental Medicine, University Hospital, LMU, Munich, Germany
- Institute for Patient Safety, University Hospital, University of Bonn, Bonn, Germany
| |
Collapse
|
15
|
Ecker S, Weigl M, Gaiswinkler S. Good health information for people with a migration background. Eur J Public Health 2022. [DOI: 10.1093/eurpub/ckac131.503] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
Studies show that people with a migration background are often uncertain concerning the kinds of health services that are offered and where to turn to with which health concerns. Some factors, like fears or obstacles (e.g. deductibles), lead to the health system not being used (on time). This is particularly true for those who are socioeconomically or socially disadvantaged. The aim of the project was to get an insight into the information needs of this population group as a basis for producing and disseminating good health information in the future.
Methods
In this qualitative study co-researchers conducted guided focus groups (separated by sex) or interviews in their first languages. In total, more than 100 people from 16 different countries of origin were involved in the survey.
Results
In general, a substantial need for multilingual health information prepared in easy-to-understand language was expressed. Some health topics (e.g. the Austrian health system, mental health and available support) were mentioned by many participants. Other issues were relevant for few groups only (e.g. TCM). Gender differences can be seen in some groups but not in all. Besides acquaintances/relatives, general practitioners were named as main source of information. Indications can be derived on how health information should be prepared, designed and distributed. Besides multilingual health information, translation services are needed during appointments but also for the medical reports.
Conclusions
When searching for health information, but also when trying to understand it, language barriers are a major obstacle. Multilingual and culture-sensitive explainer videos on selected topics are an appropriate medium for reaching a broad group of people. Low-threshold multilingual regional contact points could provide an important contribution to health equity, as a guide in the health system, providing information and translation services, and setting health promotion offers.
Key messages
• Language barriers represent a major obstacle for vulnerable population groups with migration background in all stages of the health care process.
• There is a substantial need for adequately prepared multilingual health information.
Collapse
Affiliation(s)
- S Ecker
- Health, Society and Equity, Austrian National Public Health Institute , Vienna, Austria
| | - M Weigl
- Health, Society and Equity, Austrian National Public Health Institute , Vienna, Austria
| | - S Gaiswinkler
- Health, Society and Equity, Austrian National Public Health Institute , Vienna, Austria
| |
Collapse
|
16
|
Kaltenegger HC, Weigl M, Becker L, Rohleder N, Nowak D, Quartucci C. Psychosocial working conditions and chronic low-grade inflammation in geriatric care professionals: A cross-sectional study. PLoS One 2022; 17:e0274202. [PMID: 36107874 PMCID: PMC9477283 DOI: 10.1371/journal.pone.0274202] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2022] [Accepted: 08/23/2022] [Indexed: 11/18/2022] Open
Abstract
Background
Chronic low-grade inflammation has been suggested as a key factor in the association between stress exposure and long-term health. Care work is recognized as a profession with a high degree of job stress and health risks. However, for care professionals, the study base on inflammatory activity due to adverse working conditions is limited.
Objective
The aim of this study was to explore associations between self-reported psychosocial working conditions and care professionals’ biomarkers of systemic low-grade inflammation.
Methods
N = 140 geriatric care professionals (79.3% females, mean age = 44.1 years) of six care facilities were enrolled in a cross-sectional study consisting of standardized medical examinations and employee surveys. Standardized questionnaires were used for evaluation of psychosocial work characteristics (work overload, job autonomy, social support) based on Karasek’s job strain model. Blood samples were drawn for two biomarkers of inflammatory activity: C-reactive protein (CRP) and leukocyte count. Analyses comprised uni- and multivariate logistic and linear regression analyses.
Results
We determined a proportion of 5.4% of care professionals with increased low-grade inflammation. We further observed a relationship between job autonomy and CRP, such that reports of high job autonomy were associated with increased levels of CRP (adjusted OR = 4.10, 95% CI [1.10, 15.26], p = .035), which was robust in additional analyses on further potential confounders. No significant associations with participants’ leukocyte numbers were found.
Conclusions
This exploratory study contributes to the research base on links between workplace stress and ensuing illness in care professionals. Our findings may help to identify risk and protective factors of the work environment for chronic low-grade inflammation. The results require further scrutiny, and future prospective studies on associations of psychosocial working conditions, low-grade inflammation and long-term health outcomes in care professionals are needed.
Collapse
Affiliation(s)
- Helena C. Kaltenegger
- Institute and Clinic for Occupational, Social and Environmental Medicine, University Hospital, LMU Munich, Munich, Germany
- * E-mail:
| | - Matthias Weigl
- Institute and Clinic for Occupational, Social and Environmental Medicine, University Hospital, LMU Munich, Munich, Germany
- Institute for Patient Safety, University Hospital Bonn, Bonn, Germany
| | - Linda Becker
- Chair of Health Psychology, Institute of Psychology, Friedrich-Alexander University Erlangen-Nürnberg, Erlangen, Germany
| | - Nicolas Rohleder
- Chair of Health Psychology, Institute of Psychology, Friedrich-Alexander University Erlangen-Nürnberg, Erlangen, Germany
| | - Dennis Nowak
- Institute and Clinic for Occupational, Social and Environmental Medicine, University Hospital, LMU Munich, Munich, Germany
| | - Caroline Quartucci
- Institute and Clinic for Occupational, Social and Environmental Medicine, University Hospital, LMU Munich, Munich, Germany
- Bavarian Health and Food Safety Authority, Institute for Occupational Health and Product Safety, Environmental Health, Munich, Germany
| |
Collapse
|
17
|
Affiliation(s)
- Matthias Weigl
- Institute for Patient Safety, University Hospital, Bonn University, Bonn, Germany
| |
Collapse
|
18
|
Wenderott K, Gambashidze N, Weigl M. Integration of artificial intelligence into sociotechnical work systems — Effects of artificial intelligence solutions in medical imaging on clinical efficiency: Protocol for a systematic literature review (Preprint). JMIR Res Protoc 2022; 11:e40485. [DOI: 10.2196/40485] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2022] [Revised: 09/16/2022] [Accepted: 10/20/2022] [Indexed: 11/07/2022] Open
|
19
|
Weigl M, Bartl C, Suttner S, Rauh M, Seelbach-Göbel B, Köninger A. Monozentrische Evaluation der Frühgeburtenrate im ersten Lockdown der SARS-CoV-2-Pandemie. Geburtshilfe Frauenheilkd 2022. [DOI: 10.1055/s-0042-1749050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
|
20
|
Weigl M, Kögel F, Seelbach-Göbel B, Köninger A. Geburtshilfliches Outcome des zweiten Zwillings bei di- versus monochorialen Schwangerschaften bei intendierter vaginaler Geburt. Geburtshilfe Frauenheilkd 2022. [DOI: 10.1055/s-0042-1749051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
|
21
|
Becker L, Kaltenegger HC, Nowak D, Rohleder N, Weigl M. Differences in stress system (re-)activity between single and dual- or multitasking in healthy adults: A systematic review and meta-analysis. Health Psychol Rev 2022; 17:78-103. [PMID: 35477383 DOI: 10.1080/17437199.2022.2071323] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
AbstractIn the age of digitization, multitasking requirements are ubiquitous, especially in the workplace. Multitasking (MT) describes the activity of performing multiple (at least two) tasks at the same time. Dual tasking (DT) refers to the sequential switching between two tasks. The aim of our systematic review and meta-analysis was first to investigate whether physiological stress systems become activated in response to or during MT/DT and, secondly, whether this (re-)activity is higher compared to single tasking. We focused on the Sympathetic Nervous System (SNS), the Parasympathetic Nervous System (PNS), the hypothalamic-pituitary adrenal (HPA) axis, and the immune system. The systematic review has been pre-registered with PROSPERO (CRD42020181415). A total of twenty-five articles were identified as eligible, in which n = 26 studies were reported, with N = 1,142 participants. Our main findings are that SNS activity is significantly higher and PNS activity is significantly lower during MT/DT than during single tasking. Only two studies were found, in which HPA axis (re-)activity was surveyed. No eligible study was identified in which immune system (re-)activity was investigated. This is the first systematic synthesis of the literature base showing that stress system activity is increased during MT/DT in comparison to single-tasking.
Collapse
Affiliation(s)
- Linda Becker
- Department of Psychology, Chair of Health Psychology, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| | - Helena C Kaltenegger
- Institute and Clinic for Occupational, Social and Environmental Medicine, LMU University Hospital Munich, Germany
| | - Dennis Nowak
- Institute and Clinic for Occupational, Social and Environmental Medicine, LMU University Hospital Munich, Germany
| | - Nicolas Rohleder
- Department of Psychology, Chair of Health Psychology, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| | - Matthias Weigl
- Institute and Clinic for Occupational, Social and Environmental Medicine, LMU University Hospital Munich, Germany.,Institute for Patient Safety, University Hospital, Bonn, Germany
| |
Collapse
|
22
|
Becker L, Kaltenegger HC, Nowak D, Weigl M, Rohleder N. Physiological stress in response to multitasking and work interruptions: Study protocol. PLoS One 2022; 17:e0263785. [PMID: 35134093 PMCID: PMC8824354 DOI: 10.1371/journal.pone.0263785] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2021] [Accepted: 01/26/2022] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND The biopsychological response patterns to digital stress have been sparsely investigated so far. Important potential stressors in modern working environments due to increased digitalization are multitasking and work interruptions. In this study protocol, we present a protocol for a laboratory experiment, in which we will investigate the biopsychological stress response patterns to multitasking and work interruptions. METHODS In total, N = 192 healthy, adult participants will be assigned to six experimental conditions in a randomized order (one single-task, three dual-task (two in parallel and one as interruption), one multitasking, and one passive control condition). Salivary alpha-amylase as well as heart rate as markers for Sympathetic Nervous System Activity, heart rate variability as measure for Parasympathetic Nervous System (PNS) activity, and cortisol as measure for activity of the hypothalamic-pituitary adrenal (HPA) axis will be assessed at six time points throughout the experimental session. Furthermore, inflammatory markers (i.e., IL-6, C-reactive protein (CRP), and secretory immunoglobulin-A) will be assessed before and after the task as well as 24 hours after it (IL-6 and CRP only). Main outcomes will be the time course of these physiological stress markers. Reactivity of these measures will be compared between the experimental conditions (dual-tasking, work interruptions, and multitasking) with the control conditions (single-tasking and passive control). DISCUSSION With this study protocol, we present a comprehensive experiment, which will enable an extensive investigation of physiological stress-responses to multitasking and work interruptions. Our planned study will contribute to a better understanding of physiological response patterns to modern (digital) stressors. Potential risks and limitations are discussed. The findings will have important implications, especially in the context of digital health in modern working and living environments.
Collapse
Affiliation(s)
- Linda Becker
- Department of Psychology, Chair of Health Psychology, Friedrich-Alexander University Erlangen-Nürnberg, Erlangen, Germany
| | - Helena C. Kaltenegger
- Institute and Clinic for Occupational, Social and Environmental Medicine, LMU University Hospital Munich, Munich, Germany
| | - Dennis Nowak
- Institute and Clinic for Occupational, Social and Environmental Medicine, LMU University Hospital Munich, Munich, Germany
| | - Matthias Weigl
- Institute and Clinic for Occupational, Social and Environmental Medicine, LMU University Hospital Munich, Munich, Germany
- Institute for Patient Safety, University Hospital, Bonn, Germany
| | - Nicolas Rohleder
- Department of Psychology, Chair of Health Psychology, Friedrich-Alexander University Erlangen-Nürnberg, Erlangen, Germany
| |
Collapse
|
23
|
Kaltenegger HC, Becker L, Rohleder N, Nowak D, Weigl M. Associations of working conditions and chronic low-grade inflammation among employees: a systematic review and meta-analysis. Scand J Work Environ Health 2021; 47:565-581. [PMID: 34523689 PMCID: PMC9058622 DOI: 10.5271/sjweh.3982] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
Objectives: Chronic low-grade inflammation has been identified as a key pathway linking stress experience to human health. However, systematic evaluations on the relationship of work stress and immune function are scarce and predominantly based on cross-sectional studies. We performed a systematic review and meta-analysis of prospective studies on associations of working conditions and inflammatory biomarkers. Methods: In line with our previously established study protocol and the PRISMA-guidelines, we systematically searched electronic databases for prospective studies on working conditions as well as workplace interventions and inflammatory markers in employees. We classified studies (by design, type of exposure/intervention, outcome) and performed rigorous risk-of-bias assessments. Studies were summarized qualitatively, and a meta-analysis was conducted. Results: We identified 23 eligible studies (N=16 432) with a broad scope of working conditions and inflammatory markers. For interventional designs, we differentiated between individual-directed/behavioral (including physical and mental) and organization-directed/structural interventions. Workplace physical exercise interventions were associated with a decrease in C-reactive protein (k=5; d=-0.61; P<0.001). For other workplace interventions, ie, mental and organizational/structural, results were inconclusive. Concerning observational studies, dimensions of the job demand–control(–support) model were most frequently investigated, and results showed weak – if any – associations with inflammatory markers. Conclusions: The research base was heterogeneous and high-level evidence was limited. More prospective studies are needed with broader consideration of work stressors and inflammatory markers. For practical occupational health management, exercise interventions are effective measures to reduce chronic low-grade inflammation.
Collapse
Affiliation(s)
- Helena C Kaltenegger
- Institute and Clinic for Occupational, Social and Environmental Medicine, University Hospital, LMU Munich, Ziemssenstraße 1, 80336, München, Germany.
| | | | | | | | | |
Collapse
|
24
|
Antony G, Antosik J, Weigl M, Marbler C, Laschkolnig A. HIA on lockdown and social distancing to contain the COVID-19 pandemic in Austria – results and lessons learned. Eur J Public Health 2021. [DOI: 10.1093/eurpub/ckab164.129] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
The COVID-19 pandemic and the measures taken created opportunities in various areas of life, but also created new challenges or increased existing ones, which can also have a (direct or indirect) impact on health and well-being of the population or certain population groups. This health impact assessment (HIA) was commissioned to provide an overview of these effects. The foundation of gathering information for the impact assessment was a national literature research and analysis combined with an online survey. In addition, a search of international literature was conducted by the European Observatory on Health Systems and Policies. The impact assessment and an initial collection of recommendations for action were carried out together with relevant stakeholders in the context of several thematically merged online assessment workshops. Positive and negative - direct as well as indirect - impacts on health in different areas of life could be identified, with the negative impacts predominating in proportion. In addition to identifying the impacts, the HIA also identified groups that were particularly affected by the pandemic. In the course of this HIA, it became clear that the direct in indirect health impacts in many areas of life are interrelated (e. g., job loss, family climate, social inclusion, and psychological well-being) and that a separate discussion often fell short. This HIA provides an overview of various impacts and allows first impressions on actions for future measures in regard to the pandemic in various areas of life, according to the HiAP approach.
Collapse
Affiliation(s)
- G Antony
- Austrian National Public Health Institute, Vienna, Austria
| | - J Antosik
- Austrian National Public Health Institute, Vienna, Austria
| | - M Weigl
- Austrian National Public Health Institute, Vienna, Austria
| | - C Marbler
- Austrian National Public Health Institute, Vienna, Austria
| | - A Laschkolnig
- Austrian National Public Health Institute, Vienna, Austria
| |
Collapse
|
25
|
Catchpole K, Lusk C, Weigl M, Anger J, Cohen T. Addressing misconceptions of flow disruption studies in "Is non-stop always better? Examining assumptions behind the concept of flow disruptions in studies of robot-assisted surgery". J Robot Surg 2021; 16:989-990. [PMID: 34626319 DOI: 10.1007/s11701-021-01318-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2021] [Accepted: 10/03/2021] [Indexed: 10/20/2022]
Abstract
This letter to the editor provides a response to "Is non-stop always better? Examining assumptions behind the concept of flow disruptions in studies of robot-assisted surgery." The authors provide much needed clarification on misconceptions of flow disruption studies. The evolving methodology is not aimed at creating a "non-stop" flow, or optimizing efficiency, but understanding the clinical process from a systems perspective.
Collapse
Affiliation(s)
- Ken Catchpole
- Department of Anesthesia and Perioperative Medicine, Medical University of South Carolina, 167 Ashley Ave., Suite 301, MSC 912, Charleston, SC, 29425, USA
| | - Connor Lusk
- Department of Anesthesia and Perioperative Medicine, Medical University of South Carolina, 167 Ashley Ave., Suite 301, MSC 912, Charleston, SC, 29425, USA.
| | - Matthias Weigl
- Institute for Patient Safety, Bonn University Hospital, Bonn, Germany
| | - Jennifer Anger
- Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Tara Cohen
- Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| |
Collapse
|
26
|
Abstract
Employee health and ability to perform is essential to a functioning health care system. Even before the coronavirus disease 2019 (COVID-19) pandemic, a substantial proportion of employees reported impaired mental health at work. This paper outlines the state of knowledge and evidence on interventions to promote mental health in the workplace, with particular focus on the organization of work and activities. In addition to an initial review of approaches, the factors facilitating successful and effective approaches are addressed.
Collapse
Affiliation(s)
- Matthias Weigl
- Institut für Patientensicherheit, Medizinische Fakultät, Universität Bonn, Gebäude 02 (Auenbruggerhaus), Venusberg-Campus 1, 53127, Bonn, Deutschland.
- Institut und Poliklinik für Arbeits‑, Sozial- und Umweltmedizin, Klinikum der Universität München, München, Deutschland.
| | - Julia Schreyer
- Institut und Poliklinik für Arbeits‑, Sozial- und Umweltmedizin, Klinikum der Universität München, München, Deutschland
| |
Collapse
|
27
|
Heier L, Gambashidze N, Hammerschmidt J, Riouchi D, Weigl M, Neal A, Icks A, Brossart P, Geiser F, Ernstmann N. Safety Performance of Healthcare Professionals: Validation and Use of the Adapted Workplace Health and Safety Instrument. Int J Environ Res Public Health 2021; 18:7816. [PMID: 34360109 PMCID: PMC8345542 DOI: 10.3390/ijerph18157816] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/14/2021] [Revised: 07/12/2021] [Accepted: 07/20/2021] [Indexed: 11/21/2022]
Abstract
Improving patient safety and reducing occupational accidents are two of the main challenges in healthcare. Instruments to measure safety performance and occupational safety are rare. This study aimed to prepare and validate a German version of the adapted workplace health and safety instrument to assess the safety performance of healthcare professionals. Overall, 168 healthcare professionals participated in this explorative cross-sectional study. The instrument consists of 16 items related to safety performance in four dimensions. We calculated mean values and standard deviations for each individual item and those of the four dimensions of the instrument. We evaluated internal consistency and construct validity, explored the dimensionality of the instrument through exploratory factor analysis, and tested how our data fit with the original model with confirmatory factor analysis. Among the participants, 73.8% were nurses and nurses in training, with the majority of the sample being female (71.9%) and younger than 30 (52.5%). Cronbach's alpha for all four dimensions was >0.7. All items were loaded on factors according to the original theoretical model. Confirmatory factor analysis showed good model fit (normed χ²/df = 1.43 (≤2.5), root mean square error of approximation = 0.06 (≤0.07), goodness of fit index = 0.90 (>0.90), comparative fit index = 0.95 (≥0.90), and Tucker-Lewis index = 0.93 (>0.90). The German version of the instrument demonstrated acceptable properties and was a good fit to the original theoretical model, allowing measurement of healthcare professionals' safety knowledge, motivation, compliance, and participation.
Collapse
Affiliation(s)
- Lina Heier
- Institute for Patient Safety (IfPS), University Hospital Bonn, 53127 Bonn, Germany; (J.H.); (D.R.); (M.W.); (F.G.); (N.E.)
- Center for Health Communication and Health Services Research (CHSR), Department for Psychosomatic Medicine and Psychotherapy, University Hospital Bonn, 53127 Bonn, Germany
| | - Nikoloz Gambashidze
- Institute for Patient Safety (IfPS), University Hospital Bonn, 53127 Bonn, Germany; (J.H.); (D.R.); (M.W.); (F.G.); (N.E.)
| | - Judith Hammerschmidt
- Institute for Patient Safety (IfPS), University Hospital Bonn, 53127 Bonn, Germany; (J.H.); (D.R.); (M.W.); (F.G.); (N.E.)
| | - Donia Riouchi
- Institute for Patient Safety (IfPS), University Hospital Bonn, 53127 Bonn, Germany; (J.H.); (D.R.); (M.W.); (F.G.); (N.E.)
| | - Matthias Weigl
- Institute for Patient Safety (IfPS), University Hospital Bonn, 53127 Bonn, Germany; (J.H.); (D.R.); (M.W.); (F.G.); (N.E.)
| | - Andrew Neal
- School of Psychology, Faculty of Health and Behavioral Sciences, University of Queensland, Brisbane 4027, Australia;
| | - Andrea Icks
- Institute for Health Services Research and Health Economics, Centre for Health and Society, Medical Faculty and University Hospital Düsseldorf, Heinrich-Heine-University Düsseldorf, 40225 Düsseldorf, Germany;
| | - Peter Brossart
- Department of Oncology, Hematology, Immuno-Oncology and Rheumatology, University Hospital Bonn, 53127 Bonn, Germany;
| | - Franziska Geiser
- Institute for Patient Safety (IfPS), University Hospital Bonn, 53127 Bonn, Germany; (J.H.); (D.R.); (M.W.); (F.G.); (N.E.)
- Department for Psychosomatic Medicine and Psychotherapy, University Hospital Bonn, 53127 Bonn, Germany
| | - Nicole Ernstmann
- Institute for Patient Safety (IfPS), University Hospital Bonn, 53127 Bonn, Germany; (J.H.); (D.R.); (M.W.); (F.G.); (N.E.)
- Center for Health Communication and Health Services Research (CHSR), Department for Psychosomatic Medicine and Psychotherapy, University Hospital Bonn, 53127 Bonn, Germany
| |
Collapse
|
28
|
Pokora R, Kutschbach S, Weigl M, Braun D, Epple A, Lorenz E, Grund S, Hecht J, Hollich H, Rietschel P, Schneider F, Sohmen R, Taylor K, Dienstbuehl I. Investigation of superspreading COVID-19 outbreak events in meat and poultry processing plants in Germany: A cross-sectional study. PLoS One 2021; 16:e0242456. [PMID: 34111143 PMCID: PMC8191887 DOI: 10.1371/journal.pone.0242456] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Accepted: 05/24/2021] [Indexed: 12/22/2022] Open
Abstract
Since May 2020, several COVID-19 outbreaks have occurred in the German meat industry despite various protective measures, and temperature and ventilation conditions were considered as possible high-risk factors. This cross-sectional study examined meat and poultry plants to assess possible risk factors. Companies completed a self-administered questionnaire on the work environment and protective measures taken to prevent SARS-CoV-2 infection. Multivariable logistic regression analysis adjusted for the possibility to distance at least 1.5 meters, break rules, and employment status was performed to identify risk factors associated with COVID-19 cases. Twenty-two meat and poultry plants with 19,072 employees participated. The prevalence of COVID-19 in the seven plants with more than 10 cases was 12.1% and was highest in the deboning and meat cutting area with 16.1%. A subsample analysis where information on maximal ventilation rate per employee was available revealed an association with the ventilation rate (adjusted odds ratio (AOR) 0.996, 95% CI 0.993-0.999). When including temperature as an interaction term in the working area, the association with the ventilation rate did not change. When room temperatures increased, the chance of testing positive for COVID-19 (AOR 0.90 95% CI 0.82-0.99) decreased, and the chance for testing positive for COVID-19for the interaction term (AOR 1.001, 95% CI 1.000-1.003) increased. Employees who work where a minimum distance of less than 1.5 m between workers was the norm had a higher chance of testing positive (AOR 3.61; 95% CI 2.83-4.6). Our results further indicate that climate conditions and low outdoor air flow are factors that can promote the spread of SARS-CoV-2 aerosols. A possible requirement for pandemic mitigation strategies in industrial workplace settings is to increase the ventilation rate.
Collapse
Affiliation(s)
- Roman Pokora
- Division of Prevention, Berufsgenossenschaft Nahrungsmittel und Gastgewerbe (BGN), Germany
- Institute of Medical Biostatistics, Epidemiology and Informatics, University hospital of the Johannes Gutenberg-University Mainz, Mainz, Germany
| | - Susan Kutschbach
- Division of Prevention, Berufsgenossenschaft Nahrungsmittel und Gastgewerbe (BGN), Germany
| | - Matthias Weigl
- Division of Prevention, Berufsgenossenschaft Nahrungsmittel und Gastgewerbe (BGN), Germany
| | - Detlef Braun
- Division of Prevention, Berufsgenossenschaft Nahrungsmittel und Gastgewerbe (BGN), Germany
| | - Annegret Epple
- Division of Prevention, Berufsgenossenschaft Nahrungsmittel und Gastgewerbe (BGN), Germany
| | - Eva Lorenz
- Institute of Medical Biostatistics, Epidemiology and Informatics, University hospital of the Johannes Gutenberg-University Mainz, Mainz, Germany
- Infectious Disease Epidemiology, Bernhard Nocht Institute for Tropical Medicine, Hamburg, Germany
- German Center for Infection Research (DZIF), Hamburg-Borstel-Lübeck-Riems, Germany
| | - Stefan Grund
- Division of Prevention, Berufsgenossenschaft Nahrungsmittel und Gastgewerbe (BGN), Germany
| | - Juergen Hecht
- Division of Prevention, Berufsgenossenschaft Nahrungsmittel und Gastgewerbe (BGN), Germany
| | - Helmut Hollich
- Division of Prevention, Berufsgenossenschaft Nahrungsmittel und Gastgewerbe (BGN), Germany
| | - Peter Rietschel
- Division of Prevention, Berufsgenossenschaft Nahrungsmittel und Gastgewerbe (BGN), Germany
| | - Frank Schneider
- Division of Prevention, Berufsgenossenschaft Nahrungsmittel und Gastgewerbe (BGN), Germany
| | - Roland Sohmen
- Division of Prevention, Berufsgenossenschaft Nahrungsmittel und Gastgewerbe (BGN), Germany
| | - Katherine Taylor
- Institute of Medical Biostatistics, Epidemiology and Informatics, University hospital of the Johannes Gutenberg-University Mainz, Mainz, Germany
| | - Isabel Dienstbuehl
- Division of Prevention, Berufsgenossenschaft Nahrungsmittel und Gastgewerbe (BGN), Germany
| |
Collapse
|
29
|
Kerschan-Schindl K, Hackl M, Boschitsch E, Föger-Samwald U, Nägele O, Skalicky S, Weigl M, Grillari J, Pietschmann P. Diagnostic Performance of a Panel of miRNAs (OsteomiR) for Osteoporosis in a Cohort of Postmenopausal Women. Calcif Tissue Int 2021; 108:725-737. [PMID: 33427926 PMCID: PMC8166674 DOI: 10.1007/s00223-020-00802-3] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Accepted: 12/17/2020] [Indexed: 12/03/2022]
Abstract
A specific signature of 19 circulating miRNAs (osteomiRs) has been reported to be associated with fragility fractures due to postmenopausal osteoporosis. However, it is unknown whether osteoporotic fractures or low BMD phenotypes are independently contributing to changes in osteomiR serum levels. The first aim was to characterize the abundance, sensitivity to hemolysis, and correlation of osteomiR serum levels, the second objective to evaluate the diagnostic accuracy of osteomiRs for osteoporosis according to the WHO criteria and on basis of major osteoporotic fracture history. Fifty postmenopausal women with osteoporosis (with or without fragility fracture) and 50 non-osteoporotic women were included in this cross-sectional study. The diagnostic performance of osteomiRs for osteoporosis based on the WHO definition or fracture history was evaluated using multiple logistic regression and receiver-operator curve (AUC) analysis. The osteomiR® signature is composed of four clusters of miRNAs providing good performance for the diagnosis of osteoporosis in postmenopausal women defined by WHO criteria (AUC = 0.830) and based on history of major osteoporotic fractures (AUC = 0.834). The classification performance for the WHO criteria and for fracture risk is driven by miR-375 and miR-203a, respectively. OsteomiRs, a signature of 19 emerging miRNA bone biomarkers, are measurable in human serum samples. They constitute a panel of independent bone and muscle biomarkers, which in combination could serve as diagnostic biomarkers for osteoporosis in postmenopausal women.
Collapse
Affiliation(s)
- K Kerschan-Schindl
- Department of Physical Medicine, Rehabilitation and Occupational Medicine, Medical University of Vienna, Vienna, Austria.
| | - M Hackl
- TAmiRNA GmbH, Vienna, Austria
- Austrian Cluster for Tissue Regeneration, Vienna, Austria
| | - E Boschitsch
- KLIMAX Menopause and Osteoporosis Clinic, Vienna, Austria
| | - U Föger-Samwald
- Institute of Pathophysiology and Allergy Research, Center for Pathophysiology, Infectiology and Immunology, Medical University of Vienna, Vienna, Austria
| | - O Nägele
- KLIMAX Menopause and Osteoporosis Clinic, Vienna, Austria
| | | | - M Weigl
- TAmiRNA GmbH, Vienna, Austria
- Austrian Cluster for Tissue Regeneration, Vienna, Austria
| | - J Grillari
- Austrian Cluster for Tissue Regeneration, Vienna, Austria
- Christian Doppler Laboratory for Biotechnology of Skin Aging, Department of Biotechnology, BOKU - University of Natural Resources and Life Sciences Vienna, Vienna, Austria
- Ludwig Boltzmann Institute for Experimental and Clinical Traumatology, 1220, Vienna, Austria
| | - P Pietschmann
- Institute of Pathophysiology and Allergy Research, Center for Pathophysiology, Infectiology and Immunology, Medical University of Vienna, Vienna, Austria
| |
Collapse
|
30
|
Offenbächer M, Toussaint L, Weigl M, Dezutter J, Kohls N, Vallejo M, Rivera J, Sirois F, Hirsch J. POS1484-HPR THE ASSOCIATION OF STIGMA WITH DISEASE VARIABLES IN PATIENTS WITH FIBROMYALGIA (FM). Ann Rheum Dis 2021. [DOI: 10.1136/annrheumdis-2021-eular.1974] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Background:Stigma, defined as social devaluation of an individual, can be an important stressor for chronic pain patients [1]. Not every condition is stigmatized. A relevant factor for illness stigmatization seems to be whether the cause is mental-behavioural or physical. Chronic pain is often regarded as an imaginary illness or caused by psychological problems [2]. Sources of stigma for chronic pain patients are perceived negative attitudes from family members, the general public, and physicians [1]..Objectives:To assess perceived stigma and the associations with disease variables in a cohort of patients with FM.Methods:We invited 18 FM self-help groups in Germany to participate anonymously in our survey, and we sent the survey battery to 192 potential participants via postal mail. To measure perceived stigma, we used the Chronic Pain Stigma Scale (CPSS) developed by Reed [3], which has 30 items and 3 subscales (public, physicians, family). We also assessed sociodemographic characteristics, disease related variables (e.g., pain, stress, depression, anxiety), and other health-related factors, including health related quality of life [Healthy Days Core Module (CDC HDQOL-4)], disease specific impact (FIQ), fear avoidance belief questionnaire (physical activity subscale) (FABQ-PA), pain catastrophizing scale (PCS) and pain self-efficacy questionnaire (PSEQ).Results:In total 162 FM patients participated (=84% response rate). Their mean age was 58 years (SD=10), 84% (N=135) were female. Highest level of education was: Elementary School 29%, Junior High School 35%, High School 15%, College 12%, and other 10%. Duration of chronic pain was 18.2 years (SD=12.0). There was no significant gender difference in the stigma subscales, nor was there an association with duration of chronic pain. Table 1 presents the significant Pearson correlations.Table 1.Correlations of CPSS stigma subscales with health variables. *<.05; **<.01; ns=not significant.CPSS-publicCPSS-physicianCPSS-familyRegional pain scalens.19*.20*VAS pain todaynsnsNsFIQ.20*.16*.22**HADS-anxiety.37*.20*.24*HADS-depression.41**.16*.25**CDC-HDQOL-4 General health.19*.18*.22** Physical health.19*nsns Mental health.20*ns.21* Impairment.24*nsnsPerceived stress scale.44**.24**.37**FABQ-PAns-.17*nsPCS.21*nsnsPSEQ.19*ns.18*Conclusion:Perceived stigma in our FM patient cohort has an important impact on a variety of different disease variables including mental and general health, physical functioning, and on pain coping. Stigmatizing attitudes perceived from the general public exhibited the greatest association with most variables in our chronic pain patients. Perceived stigma from physicians and the family were also related to negative disease consequences in our FM patients. To conclude, we assert that assessing and addressing multi-source perceived stigmatization in routine clinical care may improve the management and wellbeing of patients with FM.References:[1]Waugh OC, Byrne DG, Nicholas MK. Internalized stigma in people living with chronic pain. J Pain 2014;15(5):550 e1-10.[2]Werner A, Isaksen LW, Malterud K. ‘I am not the kind of woman who complains of everything’: illness stories on self and shame in women with chronic pain. Soc Sci Med 2004;59(5): 1035-45[3]Reed P. Chronic pain stigma: developement of the Chronic Pain Stigma Scale. 2005.Disclosure of Interests:None declared
Collapse
|
31
|
Offenbächer M, Toussaint L, Hirsch J, Weigl M, Kohls N, Vallejo M, Rivera J, Sirois F, Dezutter J. AB0889-HPR PERCEIVED SATISFACTION WITH CHRONIC PAIN CARE IN GERMAN PATIENTS WITH FIBROMYALGIA (FM). Ann Rheum Dis 2021. [DOI: 10.1136/annrheumdis-2021-eular.1993] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Background:In chronic pain care a multidimensional perspective with attention to patients’ cognitions, emotions, and their ability to cope is needed (1). Previous studies are also pointing to the role of experiencing meaningfulness in life in the adjustment to disability.Therefore care should additionally focus on the existential domain of patients’ lives to live up to a holistic care approach (2). However, there are only a few studies on how FM patients are satisfied with practitioners’ attention to multiple aspects of life with a chronic pain condition.Objectives:To assess perceived satisfaction with chronic pain care and its associations with health variables in a cohort of patients with FM.Methods:We invited 18 FM self-help groups in Germany to participate anonymously in our survey and sent them in total 192 paper-and-pencil surveys. Sociodemographics, disease related variables (e.g. pain, general health) and psychological variables [e.g. depression, anxiety, hope, stress] were assessed with standardized instruments, including 5 items (answer format 1=very unsatisfied – 10=very satisfied) assessing subjective satisfaction with medical care in different domains with the following questions: How satisfied are you with the attention of your treatment team/physician at home for physiological aspects of your pain (Physio)/ the consequences of the pain on your physical functioning (Physical)/ on your psychological well-being (Mental)/ on your social life (Social)/ on your meaning in life (Meaning).Results:In total 162 FM patients participated (=84% response rate). Their mean age was 58 years (SD=10), 84% (N=135) were female. Highest level of education was: Elementary School 29%, Junior High School 35%, High School 15%, College 12%, and other 10%. Duration of chronic pain was 18.2 years (SD=12.0). The satisfaction with care scale showed good internal consistency and measured one factor. The means of the subscale were: Physio 5.7 (SD=2.5)/ Physical 5.5 (SD=2.5)/ Mental 5.5 (SD=2.6)/ Social 5.0 (SD=2.5)/ Meaning 5.3 (SD=2.6). Correlations of the subscales are depicted in Table 1. There were no associations between pain variables and satisfaction with care, but satisfaction with care was associated with mental health, but not physical health, outcomes.Table 1.Correlations of satisfaction of care with different health variables. Subscales physiological and physical aspects and HADS-anxiety were not significantly correlated. *<.05; **<.01; ns=not significant.PhysioPhysicalMentalSocialMeaningHADS-depression-.10 (ns)-.12 (ns)-.19*-.16*-.14 (ns)General Health .02 (ns) .14 (ns) .13 (ns) .18* .12 (ns)Stress-.15 (ns)-.14 (ns)-.17*-.17*-.13 (ns)Hope .18 (ns) .18 (ns) .26** .26* .22*Conclusion:In this cohort of German FM patients the average satisfaction with care overall, as well as the specific aspects of care, was only moderate. Interestingly we found associations between satisfaction with care in mental, social and meaning in life aspects with psychological well-being pointing to the fact that care for chronic pain patients should also include those aspects in addition to just addressing biomedical aspects.References:[1]Flor H and Turk D. Chronic pain: an integrated approach. Seattle, WA: IASP Press, 2011.[2]Dezutter J, Casalin S, Wacholtz A, et al. Meaning in life: An important factor for the psychological well-being of chronically ill patients? Rehabilitat Psychol 2013; 58:334–341.Disclosure of Interests:None declared
Collapse
|
32
|
Schreyer J, Koch A, Herlemann A, Becker A, Schlenker B, Catchpole K, Weigl M. RAS-NOTECHS: validity and reliability of a tool for measuring non-technical skills in robotic-assisted surgery settings. Surg Endosc 2021; 36:1916-1926. [PMID: 33844085 PMCID: PMC8505574 DOI: 10.1007/s00464-021-08474-2] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2020] [Accepted: 03/26/2021] [Indexed: 12/24/2022]
Abstract
Background Non-technical skills (NTS) are essential for safe surgical practice as they impact workflow and patient outcomes. Observational tools to measure operating room (OR) teams’ NTS have been introduced. However, there are none that account for the specific teamwork challenges introduced by robotic-assisted surgery (RAS). We set out to develop and content-validate a tool to assess multidisciplinary NTS in RAS. Methodology Stepwise, multi-method procedure. Observations in different surgical departments and a scoping literature review were first used to compile a set of RAS-specific teamwork behaviours. This list was refined and expert validated using a Delphi consensus approach consisting of qualitative interviews and a quantitative survey. Then, RAS-specific behaviours were merged with a well-established assessment tool on OR teamwork (NOTECHS II). Finally, the new tool—RAS-NOTECHS—was applied in standardized observations of real-world procedures to test its reliability (inter-rater agreement via intra-class correlations). Results Our scoping review revealed 5242 articles, of which 21 were included based on pre-established inclusion criteria. We elicited 16 RAS-specific behaviours from the literature base. These were synthesized with further 18 behavioural markers (obtained from 12 OR-observations) into a list of 26 behavioural markers. This list was reviewed by seven RAS experts and condensed to 15 expert-validated RAS-specific behavioural markers which were then merged into NOTECHS II. For five observations of urologic RAS procedures (duration: 13 h and 41 min), inter-rater agreement for identification of behavioural markers was strong. Agreement of RAS-NOTECHS scores indicated moderate to strong agreement. Conclusions RAS-NOTECHS is the first observational tool for multidisciplinary NTS in RAS. In preliminary application, it has been shown to be reliable. Since RAS is rapidly increasing and challenges for effective and safe teamwork remain at the forefront of quality and safety of surgical care, RAS-NOTECHS may contribute to training and improvement efforts in technology-facilitated surgeries. Supplementary Information The online version contains supplementary material available at 10.1007/s00464-021-08474-2.
Collapse
Affiliation(s)
- Julia Schreyer
- Institute and Clinic for Occupational, Social and Environmental Medicine, University Hospital, LMU Munich, Ziemssenstrasse 1, 80336, Munich, Germany. .,Institute for Medical Information Processing, Biometry and Epidemiology (IBE), LMU Munich, Munich, Germany.
| | - Amelie Koch
- Institute and Clinic for Occupational, Social and Environmental Medicine, University Hospital, LMU Munich, Ziemssenstrasse 1, 80336, Munich, Germany
| | - Annika Herlemann
- Department of Urology, University Hospital Grosshadern, Ludwig-Maximilians-University Munich, Munich, Germany
| | - Armin Becker
- Department of Urology, University Hospital Grosshadern, Ludwig-Maximilians-University Munich, Munich, Germany
| | - Boris Schlenker
- Department of Urology, University Hospital Grosshadern, Ludwig-Maximilians-University Munich, Munich, Germany
| | - Ken Catchpole
- Department of Anesthesia and Perioperative Medicine, Medical University of South Carolina, Charleston, USA
| | - Matthias Weigl
- Institute and Clinic for Occupational, Social and Environmental Medicine, University Hospital, LMU Munich, Ziemssenstrasse 1, 80336, Munich, Germany.,Institute for Patient Safety, University Hospital, Bonn University, Bonn, Germany
| |
Collapse
|
33
|
Passauer-Baierl S, Stumpf U, Weigl M. [Teamwork and stress in routine interventions: an observational study of multiprofessional OR teams]. Unfallchirurg 2021; 125:130-137. [PMID: 33666678 PMCID: PMC8813711 DOI: 10.1007/s00113-021-00977-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/19/2021] [Indexed: 11/12/2022]
Abstract
Hintergrund Effektive interprofessionelle Teamarbeit im Operationssaal (OP) und intraoperativer Stress sind von großer Bedeutung für Patientensicherheit und Versorgungsqualität. Dennoch gibt es nur wenige systematische Studien zum Zusammenhang von Teamarbeit im OP und Arbeitsstress. Ziele der Arbeit Untersuchung des Zusammenhangs von Teamarbeit und empfundenem Stress bei Routineeingriffen – für das OP-Team als Gesamtheit sowie für die einzelnen Professionen Chirurgie, Anästhesie und Pflege. Material und Methoden Durchgeführt wurde eine Mehrmethodenstudie bestehend aus Expertenbeobachtungen mittels eines standardisierten Beobachtungsinstruments (OTAS-D) und systematischer Selbstberichte des gesamten OP-Teams. Erfasst wurden 64 elektive Routineeingriffe unterschiedlicher chirurgischer Fachbereiche. Die statistischen Zusammenhangsanalysen unter Kontrolle prozeduraler Einflussfaktoren wurden mit „Mixed-effects“-Regressionsmodellen berechnet. Ergebnisse Die Güte der intraoperativen Teamarbeit lag auf mittlerem Niveau. Der situative Stress während des Eingriffs wurde durch die Befragten eher auf niedrigerem Niveau berichtet, mit signifikanten Unterschieden zwischen den Professionen Chirurgie, Pflege und Anästhesie. Mitglieder des chirurgischen Teams berichteten im Durchschnitt die höchsten Stressniveaus. Ein genereller Zusammenhang zwischen Teamarbeit und Stresserleben konnte nicht beobachtet werden, allerdings für die einzelnen Professionen: Für das chirurgische Team ergaben sich signifikante, positive Zusammenhänge, sowie für die Teamarbeitsdimensionen Zusammenarbeit und Führung. Signifikante negative Zusammenhänge ergaben sich für das Pflegeteam hinsichtlich der Qualität der interdisziplinären Teamarbeit insgesamt sowie für die Teamarbeitsdimension Team-Monitoring. Diskussion Die Effekte interprofessioneller Zusammenarbeit im OP auf subjektives Stressempfinden bei Routineeingriffen hängen von Professionszugehörigkeit, Aufgabe und Tätigkeit ab. Weitere Forschungsarbeit ist notwendig, inwiefern gute Teamarbeit bei Routineeingriffen innerhalb und über die Professionen hinweg intraoperativen Stress beeinflusst. Zusatzmaterial online Die Online-Version dieses Beitrags (10.1007/s00113-021-00977-w) enthält eine vollständige Liste mit Kurzbeschreibungen der beobachteten Eingriffe. Beitrag und Zusatzmaterial stehen Ihnen auf www.springermedizin.de/link/10.1007/s00113-021-00977-w zur Verfügung. ![]()
Collapse
Affiliation(s)
- Stefanie Passauer-Baierl
- Institut und Poliklinik für Arbeits‑, Sozial- und Umweltmedizin, Klinikum der Ludwig-Maximilians-Universität München, München, Deutschland. .,Beratung und Training, Human Factors und Patientensicherheit, Parkstetten, Deutschland.
| | - Ulla Stumpf
- Klinik für Allgemeine, Unfall- und Wiederherstellungschirurgie, Klinikum der Ludwig-Maximilians-Universität München, München, Deutschland
| | - Matthias Weigl
- Institut und Poliklinik für Arbeits‑, Sozial- und Umweltmedizin, Klinikum der Ludwig-Maximilians-Universität München, München, Deutschland.,Institut für Patientensicherheit, Universitätsklinikum Bonn, Bonn, Deutschland
| |
Collapse
|
34
|
Augenstein T, Schneider A, Wehler M, Weigl M. Multitasking behaviors and provider outcomes in emergency department physicians: two consecutive, observational and multi-source studies. Scand J Trauma Resusc Emerg Med 2021; 29:14. [PMID: 33413575 PMCID: PMC7792086 DOI: 10.1186/s13049-020-00824-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2020] [Accepted: 12/13/2020] [Indexed: 11/23/2022] Open
Abstract
Background Multitasking is a key skill for emergency department (ED) providers. Yet, potentially beneficial or debilitating effects for provider functioning and cognition are underexplored. We therefore aimed to investigate the role of multitasking for ED physicians’ work stress and situation awareness (SA). Methods Two consecutive, multi-source studies utilizing standardized expert observations in combination with physicians’ self-reports on stress and SA were set out in an academic ED. To control for ED workload, measures of patient acuity, patient counts, and ED staff on duty were included. Regression analyses estimated associations between observed proportion of time spent in multitasking with matched ED physicians’ reports on stress (study 1) and SA (study 2). Results ED physicians engaged between 18.7% (study 1) and 13.0% (study 2) of their worktime in multitasking. Self-reported as well as expert-observed multitasking were significantly associated. This confirms the internal validity of our observational approach. After controlling for ED workload, we found that physicians who engaged more frequently in multitasking perceived higher work stress (Beta = .02, 95%CI .001–.03; p = .01). In study 2, ED physicians with more frequent multitasking behaviors reported higher SA (B = .08, 95%CI .02–.14; p = .009). Conclusions Multitasking is often unavoidable in ED care. Our findings suggest that ED physicians’ multitasking increases stress experiences, yet, may facilitate professional’s experiences of situation awareness. Our results warrant further investigation into potentially ambivalent effects of ED providers’ multitasking in effectively sharing time between competing demands while maintaining performance and safety.
Collapse
Affiliation(s)
- Tobias Augenstein
- Institute and Clinic for Occupational, Social and Environmental Medicine, University Hospital, LMU Munich, Ziemssenstrasse 1, 80336, Munich, Germany.,Department of Emergency Medicine and Department of General, Visceral and Trauma Surgery, Academic Hospital Porz am Rhein, Urbacher Weg 19, 51149, Cologne, Germany
| | - Anna Schneider
- Institute and Clinic for Occupational, Social and Environmental Medicine, University Hospital, LMU Munich, Ziemssenstrasse 1, 80336, Munich, Germany.,Institute of Medical Sociology and Rehabilitation Science, Charité - Universitaetsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Germany
| | - Markus Wehler
- Department of Emergency Medicine and Department of Medicine IV, University Hospital Augsburg, Stenglinstrasse 2, 86156, Augsburg, Germany
| | - Matthias Weigl
- Institute and Clinic for Occupational, Social and Environmental Medicine, University Hospital, LMU Munich, Ziemssenstrasse 1, 80336, Munich, Germany. .,Institute for Patient Safety, University Hospital Bonn, Bonn, Germany.
| |
Collapse
|
35
|
Weigl M, Herbig B, Hornung S. Rezension der deutschsprachigen Adaptation des Work Design Questionnaire (WDQ). Zeitschrift für Arbeits- und Organisationspsychologie A&O 2020. [DOI: 10.1026/0932-4089/a000344] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Affiliation(s)
- Matthias Weigl
- AG Angewandte Medizin und Psychologie in der Arbeit, Institut und Poliklinik für Arbeits-, Sozial- und Umweltmedizin, LMU München
| | - Britta Herbig
- AG Angewandte Medizin und Psychologie in der Arbeit, Institut und Poliklinik für Arbeits-, Sozial- und Umweltmedizin, LMU München
| | - Severin Hornung
- Fachbereich Angewandte Psychologie, Institut für Psychologie, Leopold-Franzens-Universität Innsbruck
| |
Collapse
|
36
|
Weigl M, Catchpole K, Wehler M, Schneider A. Workflow disruptions and provider situation awareness in acute care: An observational study with emergency department physicians and nurses. Appl Ergon 2020; 88:103155. [PMID: 32678775 DOI: 10.1016/j.apergo.2020.103155] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/10/2019] [Revised: 03/24/2020] [Accepted: 05/10/2020] [Indexed: 06/11/2023]
Abstract
BACKGROUND The fast-paced and rapidly changing environment of an Emergency Department (ED) requires providers to have a high level of situation awareness (SA). However, acute clinical care also encompasses a multitude of interruption-laden work processes that might degrade SA. It is therefore important to understand how frequent interruptions affect ED provider cognition in general and SA in particular. OBJECTIVE We aimed to examine how sources and contents of provider workflow interruptions influence situation awareness of ED physicians and nurses. METHODS This prospective, multi-method study combined standardized observations, self-reports of ED providers, and ED administrative data of staffing and patient load. Expert observers identified ED providers' workflow interruptions during 90min observation sessions. Afterwards, each provider reported perceived disruptiveness and situation awareness. Controlling for patient load, patient acuity and staffing, we conducted regression analyses to explore prospective associations between interruptions and provider outcomes. RESULTS During 74 observation sessions of overall 110h and 40min, we observed 1205 workflow interruptions (mean rate: 10.9 interruptions/hour). Provider situation awareness was fairly high (M = 7.10; scale 0-10) with no difference between ED physicians and nurses. After controlling for ED workload data, we observed that high rates of interruptions were associated with lower levels of situation awareness (β = -0.27). Further analyses revealed that particularly interruptions by telephone/beeper, technical malfunctions as well as interruptive communication related to completed cases were correlated to low SA. DISCUSSION This study in a naturalistic ED setting shows that ED physicians and nurses continuously cope with disruptions and interruptions. Our findings reveal that highly interruptive workflow environments impede providers' situation awareness. Moreover, it sheds light on specific sources and contents of interruptions that influence providers' SA in acute care. CONCLUSION Frequent workflow interruptions can degrade ED providers' situation awareness. A deeper understanding of how avoidable and unavoidable interruptions affect provider cognitions with particular focus on social and technology-related disruptions is required. Further emphasis should be placed on the effective application of work re-design in this context to foster safe and efficient patient care.
Collapse
Affiliation(s)
- Matthias Weigl
- Institute and Clinic for Occupational, Social and Environmental Medicine, University Hospital, LMU Munich, Ziemssenstrasse 1, 80336, Munich, Germany.
| | - Ken Catchpole
- Department of Anesthesia and Perioperative Medicine, Medical University of South Carolina, SC, USA
| | - Markus Wehler
- University Hospital Augsburg, Department of Emergency Medicine and Department of Medicine IV, Stenglinstrasse 2, 86156, Augsburg, Germany
| | - Anna Schneider
- Institute and Clinic for Occupational, Social and Environmental Medicine, University Hospital, LMU Munich, Ziemssenstrasse 1, 80336, Munich, Germany; Institute of Medical Sociology and Rehabilitation Science, Charité - Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Germany
| |
Collapse
|
37
|
Kaltenegger HC, Becker L, Rohleder N, Nowak D, Weigl M. Association of working conditions including digital technology use and systemic inflammation among employees: study protocol for a systematic review. Syst Rev 2020; 9:221. [PMID: 32988415 PMCID: PMC7523305 DOI: 10.1186/s13643-020-01463-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2020] [Accepted: 08/21/2020] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND With the dynamic advancement of digitalization, working environments are changing and risk for employee stress may be increasing. Work stress has been associated with a dysregulation of inflammatory processes as a component of immune function. Systemic low-grade inflammation is discussed as a key player in the relation between stress exposure and chronic illness, such as cardiovascular diseases. The objective of this investigation will be to evaluate the association of working conditions including digital technology use and systemic inflammation among employees. METHODS We designed and registered a study protocol for a systematic review of randomized controlled trials and prospective non-randomized studies (e.g., cohort, interrupted time series, or before-after studies). We will include studies conducted among adult workers reporting associations of working conditions and inflammatory activity. The outcome will be biomarkers of systemic low-grade inflammation on cell, plasma molecule and intracellular level, such as C-reactive protein, or different types of leukocytes, cytokines, etc. Literature searches will be conducted in several electronic databases (from January 1982 onwards), including PubMed/MEDLINE, Embase, PsycINFO, Web of Science, and CENTRAL. Two reviewers will independently screen all retrieved records, full-text articles, and extract data. The study methodological quality (or bias) will be appraised using appropriate tools. Our results will be described qualitatively. Random effects meta-analysis will be conducted, if feasible and appropriate. Additional analyses will be performed to explore potential sources of heterogeneity. DISCUSSION This systematic review and meta-analysis will provide a synthesis of studies evaluating the association of working conditions and systemic inflammation. We anticipate our findings to identify knowledge gaps in the literature that future research should address. Moreover, results of our review may provide implications for corporate and public policy action for employee health promotion and prevention of occupational stress. SYSTEMATIC REVIEW REGISTRATION PROSPERO ID: CRD42020166887.
Collapse
Affiliation(s)
- Helena C. Kaltenegger
- Institute and Clinic for Occupational, Social and Environmental Medicine, University Hospital, Ludwig-Maximilians-University of Munich, Ziemssenstraße 1, 80336 München, Germany
| | - Linda Becker
- Chair of Health Psychology, Institute of Psychology, Friedrich-Alexander University Erlangen-Nürnberg, Erlangen, Germany
| | - Nicolas Rohleder
- Chair of Health Psychology, Institute of Psychology, Friedrich-Alexander University Erlangen-Nürnberg, Erlangen, Germany
| | - Dennis Nowak
- Institute and Clinic for Occupational, Social and Environmental Medicine, University Hospital, Ludwig-Maximilians-University of Munich, Ziemssenstraße 1, 80336 München, Germany
| | - Matthias Weigl
- Institute and Clinic for Occupational, Social and Environmental Medicine, University Hospital, Ludwig-Maximilians-University of Munich, Ziemssenstraße 1, 80336 München, Germany
| |
Collapse
|
38
|
Schneider A, Williams DJ, Kalynych C, Wehler M, Weigl M. Physicians' and nurses' work time allocation and workflow interruptions in emergency departments: a comparative time-motion study across two countries. Emerg Med J 2020; 38:263-268. [PMID: 32759349 DOI: 10.1136/emermed-2019-208508] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2019] [Revised: 11/22/2019] [Accepted: 03/03/2020] [Indexed: 11/04/2022]
Abstract
BACKGROUND Globally, emergency department (ED) work is fast-paced and subject to interruptions, placing high coordination and communication demands on staff. Our study aimed to compare ED staffs' work time allocation and interruption rates across professional roles and two national settings. METHODS We conducted a time-motion study with standardised expert observations of ED physicians and nurses in Germany and the USA. Observers coded ED staffs' activities and workflow interruptions. General and generalised linear models were used to examine differences in activities and interruption rates between countries and ED professions. RESULTS 28 observations were conducted in the USA and 30 in Germany. Overall, the largest portion of time spent by ED staff in both settings was in documentation (22.0%). Physicians spent more time in verbal interaction with patients (9.9% vs 5.2% in nurses; p=0.006), in documentation (29.4% vs 15.6%; p<0.001) and other professional activities (13.0% vs 4.8%; p=0.002). Nurses allocated significantly more time to therapeutic (22.3% vs 6.0% in physicians; p<0.001) and organisational activities (20.4% vs 9.5%; p<0.001). Overall mean interruption rate per hour was 10.16 (US ED: 8.15, German ED: 12.04; p<0.001). American physicians and German nurses were most often disrupted by colleagues of the same profession (country: B=-.27, p=0.027; profession: B=0.35, p=0.006). German ED staff were interrupted more often by patients (B=-.78, p=0.001) and other sources (B=-.76, p<0.001) than American ED staff. DISCUSSION Our findings corroborate that professional roles largely determine time allocation to specific activities. However, interruption rates indicate differences between countries, suggesting the need for context-specific solutions to work stressors.
Collapse
Affiliation(s)
- Anna Schneider
- Institute and Clinic for Occupational, Social and Environmental Medicine, University Hospital, LMU Munich, Munich, Germany .,Institute of Medical Sociology and Rehabilitation Science, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Deborah J Williams
- Department of Emergency Medicine, University of Florida, College of Medicine Jacksonville, Jacksonville, Florida, USA
| | - Colleen Kalynych
- Department of Emergency Medicine, University of Florida, College of Medicine Jacksonville, Jacksonville, Florida, USA
| | - Markus Wehler
- Department of Emergency Medicine and Department of Medicine IV, University Hospital Augsburg, Augsburg, Germany
| | - Matthias Weigl
- Institute and Clinic for Occupational, Social and Environmental Medicine, University Hospital, LMU Munich, Munich, Germany
| |
Collapse
|
39
|
Koch A, Burns J, Catchpole K, Weigl M. Associations of workflow disruptions in the operating room with surgical outcomes: a systematic review and narrative synthesis. BMJ Qual Saf 2020; 29:1033-1045. [DOI: 10.1136/bmjqs-2019-010639] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2019] [Revised: 04/27/2020] [Accepted: 04/28/2020] [Indexed: 11/04/2022]
Abstract
BackgroundPerformance in the operating room is an important determinant of surgical safety. Flow disruptions (FDs) represent system-related performance problems that affect the efficiency of the surgical team and have been associated with a risk to patient safety. Despite the growing evidence base on FDs, a systematic synthesis has not yet been published.ObjectiveOur aim was to identify, evaluate and summarise the evidence on relationships between intraoperative FD events and provider, surgical process and patient outcomes.MethodsWe systematically searched databases MEDLINE, Embase and PsycINFO (last update: September 2019). Two reviewers independently screened the resulting studies at the title/abstract and full text stage in duplicate, and all inconsistencies were resolved through discussion. We assessed the risk of bias of included studies using established and validated tools. We summarised effects from included studies through a narrative synthesis, stratified based on predefined surgical outcome categories, including surgical process, provider and patient outcomes.ResultsWe screened a total of 20 481 studies. 38 studies were found to be eligible. Included studies were highly heterogeneous in terms of methodology, medical specialty and context. Across studies, 20.5% of operating time was attributed to FDs. Various other process, patient and provider outcomes were reported. Most studies reported negative or non-significant associations of FDs with surgical outcomes.ConclusionApart from the identified relationship of FDs with procedure duration, the evidence base concerning the impact of FDs on provider, surgical process and patient outcomes is limited and heterogeneous. We further provide recommendations concerning use of methods, relevant outcomes and avenues for future research on associated effects of FDs in surgery.
Collapse
|
40
|
Weigl M, Heinrich M, Keil J, Wermelt JZ, Bergmann F, Hubertus J, Hoffmann F. Team performance during postsurgical patient handovers in paediatric care. Eur J Pediatr 2020; 179:587-596. [PMID: 31858255 DOI: 10.1007/s00431-019-03547-w] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2019] [Revised: 11/20/2019] [Accepted: 12/05/2019] [Indexed: 01/23/2023]
Abstract
Postsurgical handover of paediatric patients from operating rooms to intensive care units is a critical moment. This process is susceptible to errors and inefficiencies particularly if poor teamwork in this multidisciplinary and ad hoc collaboration occurs. Through combining provider- and observer-rated team performance, we aimed to determine agreement levels on team performance and associations with mental demands, disruptions, and stress. An observational and multisource study of provider and concomitant expert-observer ratings was established. In an Academic Paediatric Hospital, we conducted standardized observations of postsurgical handovers to PICU. We applied established observational and self-reported teamwork tools. Nested fixed and mixed models were established to estimate agreement within teams, between providers' and observer's ratings, as well as for estimations between team performance and mental demands, disruptions, and stress outcomes. Thirty-one postsurgical patient handovers were included with overall 109 ratings of involved providers. Provider-perceived team performance was rated high. Within the receiving sub-team, situation awareness was perceived lower compared to the handoff sub-team [F(df = 1) = 4.41, p = .04]. Inter-provider agreement on handover team performance was low for the overall team yet higher within handover sub-teams. We observed that high level of distractions during the handover was associated with inferior team performance rated by observers (B = - 0.72, 95% CI = - 1.44, - 0.01).Conclusion: We observed substantial disagreements on how involved professionals as well as observers rated teamwork during patient transfers. Investigations into paediatric teamwork and particular team-based handovers should carefully consider if concurrent provider and observer assessments are a valid and reliable way to evaluate teamwork in paediatric care. Common handover language should be established and mandatory before jointly evaluating this process. Our findings advocate also that handovers should be performed under low levels of distractions.What is Known:• Efficient teamwork during transfers of critically ill children is fundamental to quality and safety of handover practice.• Postoperative handovers are often performed by ad hoc teams of caregivers with multiple backgrounds and are prone to suboptimal team performance, communication, and information transfer.What is New:• Our provider and expert evaluations of team performance during OR-PICU handovers showed poor agreement for team performance. Our findings challenge previous results drawing upon single source assessments and inform future studies to carefully consider what approach of team performance assessments is required.• We further demonstrate that high levels of disruptions are associated with poor team performance during patient handovers and that efforts to ensure undisrupted handover practices in clinical care are necessary.
Collapse
Affiliation(s)
- Matthias Weigl
- Institute and Outpatient Clinic for Occupational, Social, and Environmental Medicine, Ludwig-Maximilians-University Munich, Ziemssenstrasse 1, D-80336, Munich, Germany.
| | - Maria Heinrich
- Institute and Outpatient Clinic for Occupational, Social, and Environmental Medicine, Ludwig-Maximilians-University Munich, Ziemssenstrasse 1, D-80336, Munich, Germany
| | - Julia Keil
- Dr. von Hauner University Children's Hospital, Ludwig-Maximilians-University Munich, Munich, Germany
| | - Julius Z Wermelt
- Department of Anaesthesiology, Ludwig-Maximilians-University Munich, Munich, Germany
| | - Florian Bergmann
- Department of Pediatric Surgery, Dr. von Hauner University Children's Hospital, Ludwig-Maximilians-University Munich, Munich, Germany
| | - Jochen Hubertus
- Department of Pediatric Surgery, Dr. von Hauner University Children's Hospital, Ludwig-Maximilians-University Munich, Munich, Germany
| | - Florian Hoffmann
- Dr. von Hauner University Children's Hospital, Ludwig-Maximilians-University Munich, Munich, Germany
| |
Collapse
|
41
|
Weigl M, Händl T, Wehler M, Schneider A. [Time-allocation study of nurse and physician activities in the emergency department]. Med Klin Intensivmed Notfmed 2020; 116:229-237. [PMID: 32072195 PMCID: PMC8016769 DOI: 10.1007/s00063-020-00657-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2019] [Revised: 11/09/2019] [Accepted: 12/22/2019] [Indexed: 12/01/2022]
Abstract
Hintergrund Systematische und vergleichende Analysen der Tätigkeiten des ärztlichen und pflegerischen Personals in der Notaufnahme fehlen für den deutschsprachigen Bereich. Ziel der Arbeit Analyse der Aktivitäten des pflegerischen und ärztlichen Personals einer Notaufnahme sowie der Anteile direkten Patientenkontakts und stündlicher Tätigkeitswechsel. Material und Methoden Tätigkeitsanalysen auf Basis teilnehmender Beobachtungen (je 90 min) bei Pflegekräften und Ärzt*innen einer interdisziplinären Notaufnahme eines süddeutschen Krankenhauses der Maximalversorgung. Beobachtete Tätigkeiten wurden anhand eines Klassifikationssystems mitsamt Zeitdauern kodiert. Insgesamt wurden 160 Einzelbeobachtungen (mit einer Gesamtzeit von ca. 240 h) durchgeführt; 99 bei Pflegekräften sowie 61 bei Ärzt*innen. Ergebnisse Notaufnahmeärzt*innen arbeiten 30 % ihrer Zeit in direktem Patientenkontakt, Pflegekräfte hingegen 44 %. Für die Einzeltätigkeiten entfielen die größten Zeitanteile ärztlicher Tätigkeit auf Dokumentation und Schriftarbeit (29,3 %), interne Kommunikation mit Personal (16,9 %) sowie mit Patient*innen (13,6 %). Pflegekräfte verwenden die meiste Zeit auf therapeutische und Behandlungsaktivitäten (27,6 %) sowie interne Kommunikation (17,9 %). Diese Tätigkeiten waren stark fragmentiert: Im Durchschnitt erfassten wir 41,3 Einzeltätigkeiten pro Stunde mit einer durchschnittlichen Dauer von 1,5 min. Pflegekräfte hatten signifikant kürzere Tätigkeitsdauern als Ärzt*innen (F[df = 1] = 4,5; p = 0,04). Tätigkeitsspezifische Analysen ergaben weitere Professionsunterschiede. Diskussion Unsere Ergebnisse liefern erstmalig fundierte Einsichten in die Verteilung und Dauer von ärztlichen sowie pflegerischen Tätigkeiten in der akutmedizinischen Versorgung in der Notaufnahme. Zukünftige Arbeiten sollten sich insbesondere einhergehenden Auswirkungen auf die Leistungsfähigkeit und Beanspruchung des Personals wie auch der Sicherheit und Qualität der Versorgung widmen. Zusatzmaterial online Die Online-Version dieses Beitrags (10.1007/s00063-020-00657-4) enthält die Tabelle S1. Beitrag und Zusatzmaterial stehen Ihnen auf www.springermedizin.de zur Verfügung. Bitte geben Sie dort den Beitragstitel in die Suche ein, das Zusatzmaterial finden Sie beim Beitrag unter „Ergänzende Inhalte“. ![]()
Collapse
Affiliation(s)
- M Weigl
- Institut und Poliklinik für Arbeits‑, Sozial- und Umweltmedizin, Klinikum der Ludwig-Maximilians-Universität München, Ziemssenstr. 1, 80336, München, Deutschland.
| | - T Händl
- Zentrale Notaufnahme und IV. Medizinische Klinik, Universitätsklinikum Augsburg, Augsburg, Deutschland
| | - M Wehler
- Zentrale Notaufnahme und IV. Medizinische Klinik, Universitätsklinikum Augsburg, Augsburg, Deutschland
| | - A Schneider
- Institut und Poliklinik für Arbeits‑, Sozial- und Umweltmedizin, Klinikum der Ludwig-Maximilians-Universität München, Ziemssenstr. 1, 80336, München, Deutschland.,Institut für Medizinische Soziologie und Rehabilitationswissenschaft, Charité Universitätsmedizin Berlin, Berlin, Deutschland
| |
Collapse
|
42
|
Stefan P, Pfandler M, Lazarovici M, Weigl M, Navab N, Euler E, Fürmetz J, Weidert S. Three-dimensional–Printed Computed Tomography–Based Bone Models for Spine Surgery Simulation. ACTA ACUST UNITED AC 2020; 15:61-66. [DOI: 10.1097/sih.0000000000000417] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
|
43
|
Abstract
STUDY DESIGN Observational simulation study. OBJECTIVE The goal of this study was to investigate the relationship between technical and nontechnical skills (NTS) in a simulated surgical procedure. SUMMARY OF BACKGROUND DATA Although surgeons' technical and NTS during surgery are crucial determinants for clinical outcomes, little literature is available in spine surgery. Moreover, evidence regarding how surgeons' technical and NTS are related is limited. METHODS A mixed-reality and full-scale simulated operating room environment was employed for the surgical team. Eleven surgeons performed the vertebroplasty procedure (VP). Technical skills (TS) were assessed using Objective Structured Assessment of Technical Skill scores and senior expert-evaluated VP outcome assessment. NTS were assessed with the Observational Teamwork Assessment for Surgery. Kendall-Tau-b tests were performed for correlations. We further controlled the influence of surgeons' experience (based on professional tenure and number of previous VPs performed). RESULT Surgeons' NTS correlated significantly with their technical performance (τ = 0.63; P = 0.006) and surgical outcome scores (τ = 0.60; P = 0.007). This association was attenuated when controlling for surgeons' experience. CONCLUSION Our results suggest that spine surgeons with higher levels of TS also apply better communication, leadership, and coordination behaviors during the procedure. Yet, the role of surgeons' experience needs further investigation for improving surgeons' intraoperative performance during spine surgery. LEVEL OF EVIDENCE 3.
Collapse
Affiliation(s)
- Michael Pfandler
- Institute and Outpatient Clinic for Occupational, Social, and Environmental Medicine, University Hospital, Ludwig Maximilians University, Munich, Germany
| | - Philipp Stefan
- Chair for Computer Aided Medical Procedures & Augmented Reality, Department of Informatics/I-16, Technical University of Munich, Munich, Germany
| | - Christoph Mehren
- Spine Center Schön Clinic Munich Harlaching, Munich, Germany; Academic Teaching Hospital Paracelsus Medical University (PMU), Salzburg, Austria
| | - Marc Lazarovici
- Institute for Emergency Medicine and Management in Medicine (INM), University Hospital, Ludwig Maximilians University, Munich, Germany
| | - Matthias Weigl
- Institute for Emergency Medicine and Management in Medicine (INM), University Hospital, Ludwig Maximilians University, Munich, Germany
| |
Collapse
|
44
|
Weigl M, Schmuck F, Heiden B, Angerer P, Müller A. Associations of understaffing and cardiovascular health of hospital care providers: A multi-source study. Int J Nurs Stud 2019; 99:103390. [DOI: 10.1016/j.ijnurstu.2019.103390] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2019] [Revised: 07/29/2019] [Accepted: 07/30/2019] [Indexed: 10/26/2022]
|
45
|
Weigl M, Marbler C, Haas S, Laskowski W. Participatory research in the field of early childhood interventions - how can this be achieved? Eur J Public Health 2019. [DOI: 10.1093/eurpub/ckz186.147] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
The Austrian early childhood interventions programme (“Frühe Hilfen”) is an overall concept of health promotion measures, aiming to support families depending on their individual needs to create good conditions for raising their children. This should contribute to long-term health of the children. The manifold effects of this complex intervention on the families are to be investigated in the future. To do so, a research concept shall be developed using a participatory research approach. A selective literature search was carried out to identify concrete recommendations for participatory research and previous experiences on the participation of parents. Based on these results, semi-structured interviews and group discussions with families were carried out. According to literature, parents have rarely been used as co-researchers. Our experiences show that access to families in burdened life circumstances is possible via the low-threshold structures of our early childhood interventions programme. In 2018, 21 families participated in interviews and group discussions. The latter method is particularly well suited for obtaining targeted information from families and building trust for long-term cooperation. Still, the stressful family situations make it difficult to participate in research activities. Therefore, specific conditions are required. At present, it is clear that it is feasible to involve families and test research methods together. The next step, an equal cooperation of families and researchers, shall be achieved by the use of a research group. A small group started in Spring 2019, eventually being involved in the implementation of some methods during fall 2019. Whether families are willing to participate continuously for a long time in research activities remains unclear, so far.
Key messages
Participatory research with families in stressful situations needs time and patience as well as specific conditions, but it is possible. Participation of the target group in the planning phase of further research can lead to relevant insights for programme improvements.
Collapse
Affiliation(s)
- M Weigl
- Austrian Public Health Institute (Gesundheit Oesterreich GmbH), Vienna, Austria
| | - C Marbler
- Austrian Public Health Institute (Gesundheit Oesterreich GmbH), Vienna, Austria
| | - S Haas
- Austrian Public Health Institute (Gesundheit Oesterreich GmbH), Vienna, Austria
| | - W Laskowski
- Upper Austrian Health Insurance, Linz, Austria
| |
Collapse
|
46
|
Soukup T, Lamb BW, Weigl M, Green JSA, Sevdalis N. An Integrated Literature Review of Time-on-Task Effects With a Pragmatic Framework for Understanding and Improving Decision-Making in Multidisciplinary Oncology Team Meetings. Front Psychol 2019; 10:1245. [PMID: 31354555 PMCID: PMC6634259 DOI: 10.3389/fpsyg.2019.01245] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2018] [Accepted: 05/13/2019] [Indexed: 01/04/2023] Open
Abstract
Multidisciplinary oncology team meetings (MDMs) or tumor boards, like other MDMs in healthcare, facilitate the incorporation of diverse clinical expertise into treatment planning for patients. Decision-making (DM) in relation to treatment planning in MDMs is carried out repeatedly until all patients put forward for discussion have been reviewed. Despite continuing financial pressure and staff shortages, the workload of cancer MDMs, and therefore meeting duration continue to increase (up to 5 h) with patients often receiving less than 2 min of team input. This begs the question as to whether the current set-up is conducive to achieve optimal DM, which these multi-specialty teams were set out to achieve in the first place. Much of what it is known, however, about the effects of prolonged cognitive activity comes from various subfields of science, leaving a gap in applied knowledge relating to complex healthcare environments. The objective of this review was thus to synthesize theory, evidence and clinical practice in order to bring the current understanding of prolonged, repeated DM into the context of cancer MDMs. We explore how and why time spent on a task affects performance in such settings, and what strategies can be employed by cancer teams to counteract negative effects and improve quality and safety. In the process, we propose a pragmatic framework of repeated DM that encompasses the strength, the process and the cost-benefit models of self-control as applied to real-world contexts of cancer MDMs. We also highlight promising research avenues for closing the research-to-practice gap. Theoretical and empirical evidence reviewed in this paper suggests that over prolonged time spent on a task, repeated DM is cognitively taxing, leading to performance detriments. This deterioration is associated with various cognitive-behavioral pitfalls, including decreased attentional capacity and reduced ability to effectively evaluate choices, as well as less analytical DM and increased reliance on heuristics. As a short to medium term improvement for ensuring safety, consistently high quality of care for all patients, and the clinician wellbeing, future research and interventions in cancer MDMs should address time-on-task effects with a combination of evidence-based cognitive strategies. We propose in this review multiple measures that range from food intake, short breaks, rewards, and mental exercises. As a long term imperative, however, capacity within cancer services needs to be reviewed as well as how best to plan workforce development and service delivery models to achieve population coverage whilst maintaining safety and quality of care. Hence the performance detriments that arise in healthcare workers as a result of the intensity (time spent on a task) and complexity of the workload require not only more research, but also wider regulatory focus and recognition.
Collapse
Affiliation(s)
- Tayana Soukup
- Centre for Implementation Science, Health Service and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, United Kingdom
| | - Benjamin W. Lamb
- Department of Urology, Cambridge University Healthcare NHS Foundation Trust, Cambridge, United Kingdom
| | - Matthias Weigl
- Institute and Outpatient Clinic for Occupational, Social, and Environmental Medicine, University Hospital, Ludwig-Maximilians-University Munich, Munich, Germany
| | - James S. A. Green
- Centre for Implementation Science, Health Service and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, United Kingdom
- Whipps Cross University Hospital, Barts Health NHS Trust, London, United Kingdom
| | - Nick Sevdalis
- Centre for Implementation Science, Health Service and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, United Kingdom
| |
Collapse
|
47
|
Catchpole K, Bisantz A, Hallbeck MS, Weigl M, Randell R, Kossack M, Anger JT. Human factors in robotic assisted surgery: Lessons from studies 'in the Wild'. Appl Ergon 2019; 78:270-276. [PMID: 29478667 PMCID: PMC6105731 DOI: 10.1016/j.apergo.2018.02.011] [Citation(s) in RCA: 38] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/24/2017] [Revised: 11/20/2017] [Accepted: 02/16/2018] [Indexed: 05/23/2023]
Abstract
This article reviews studies conducted "in the wild" that explore the "ironies of automation" in Robotic Assisted Surgery (RAS). Workload may be reduced for the surgeon, but increased for other team members, with postural stress relocated rather than reduced, and the introduction of a range of new challenges, for example, in the need to control multiple arms, with multiple instruments; and the increased demands of being physically separated from the team. Workflow disruptions were not compared with other surgeries; however, the prevalence of equipment and training disruptions differs from other types of surgeries. A consistent observation is that communication and coordination problems are relatively frequent, suggesting that the surgical team may need to be trained to use specific verbal and non-verbal cues during surgery. RAS also changes the necessary size of the operating room instrument cleaning processes. These studies demonstrate the value of clinically-based human factors engineers working alongside surgical teams to improve the delivery of RAS.
Collapse
Affiliation(s)
- Ken Catchpole
- Department of Anesthesia and Perioperative Medicine, Medical University of South Carolina, 167 Ashley Avenue, Suite 301, MSC 912, Charleston, SC 29425, USA.
| | - Ann Bisantz
- Department of Industrial and Systems Engineering, University at Buffalo, 342 Bell Hall, Buffalo, NY 14260, USA.
| | - M Susan Hallbeck
- Department of Health Sciences Research, Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, 200 First St. SW, Rochester, MN 55905, USA.
| | - Matthias Weigl
- Institute for Occupational, Social, and Environmental Medicine, Ludwig-Maximilians-University Munich, Ziemssenstr, 1 80336 München, Germany.
| | - Rebecca Randell
- School of Healthcare, Baines Wing, University of Leeds, Leeds, LS2 9JT, UK.
| | - Merrick Kossack
- Human Factors Engineering, UL Wiklund 300 Baker Avenue, Suite 200, Concord, MA 01742, USA.
| | - Jennifer T Anger
- Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, La Cienega Blvd., Beverly Hills, CA 90211, USA
| |
Collapse
|
48
|
Stefan P, Pfandler M, Wucherer P, Habert S, Fürmetz J, Weidert S, Euler E, Eck U, Lazarovici M, Weigl M, Navab N. [Team training and assessment in mixed reality-based simulated operating room : Current state of research in the field of simulation in spine surgery exemplified by the ATMEOS project]. Unfallchirurg 2019; 121:271-277. [PMID: 29546445 DOI: 10.1007/s00113-018-0467-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
Surgical simulators are being increasingly used as an attractive alternative to clinical training in addition to conventional animal models and human specimens. Typically, surgical simulation technology is designed for the purpose of teaching technical surgical skills (so-called task trainers). Simulator training in surgery is therefore in general limited to the individual training of the surgeon and disregards the participation of the rest of the surgical team. The objective of the project Assessment and Training of Medical Experts based on Objective Standards (ATMEOS) is to develop an immersive simulated operating room environment that enables the training and assessment of multidisciplinary surgical teams under various conditions. Using a mixed reality approach, a synthetic patient model, real surgical instruments and radiation-free virtual X‑ray imaging are combined into a simulation of spinal surgery. In previous research studies, the concept was evaluated in terms of realism, plausibility and immersiveness. In the current research, assessment measurements for technical and non-technical skills are developed and evaluated. The aim is to observe multidisciplinary surgical teams in the simulated operating room during minimally invasive spinal surgery and objectively assess the performance of the individual team members and the entire team. Moreover, the effectiveness of training methods and surgical techniques or success critical factors, e. g. management of crisis situations, can be captured and objectively assessed in the controlled environment.
Collapse
Affiliation(s)
- P Stefan
- Lehrstuhl für Informatikanwendungen in der Medizin & Augmented Reality, Institut für Informatik/I‑16, Technische Universität München, Boltzmannstr. 3, 85748, Garching b. München, Deutschland.
| | - M Pfandler
- Institut und Poliklinik für Arbeits‑, Sozial- und Umweltmedizin, Klinikum der Universität München, München, Deutschland
| | - P Wucherer
- Lehrstuhl für Informatikanwendungen in der Medizin & Augmented Reality, Institut für Informatik/I‑16, Technische Universität München, Boltzmannstr. 3, 85748, Garching b. München, Deutschland
| | - S Habert
- Lehrstuhl für Informatikanwendungen in der Medizin & Augmented Reality, Institut für Informatik/I‑16, Technische Universität München, Boltzmannstr. 3, 85748, Garching b. München, Deutschland
| | - J Fürmetz
- Klinik für Allgemeine, Unfall- und Wiederherstellungschirurgie, Klinikum der Universität München, München, Deutschland
| | - S Weidert
- Klinik für Allgemeine, Unfall- und Wiederherstellungschirurgie, Klinikum der Universität München, München, Deutschland
| | - E Euler
- Klinik für Allgemeine, Unfall- und Wiederherstellungschirurgie, Klinikum der Universität München, München, Deutschland
| | - U Eck
- Lehrstuhl für Informatikanwendungen in der Medizin & Augmented Reality, Institut für Informatik/I‑16, Technische Universität München, Boltzmannstr. 3, 85748, Garching b. München, Deutschland
| | - M Lazarovici
- Institut für Notfallmedizin und Medizinmanagement, Klinikum der Universität München, München, Deutschland
| | - M Weigl
- Institut und Poliklinik für Arbeits‑, Sozial- und Umweltmedizin, Klinikum der Universität München, München, Deutschland
| | - N Navab
- Lehrstuhl für Informatikanwendungen in der Medizin & Augmented Reality, Institut für Informatik/I‑16, Technische Universität München, Boltzmannstr. 3, 85748, Garching b. München, Deutschland
| |
Collapse
|
49
|
Souders CP, Catchpole K, Hannemann A, Lyon R, Eilber KS, Bresee C, Cohen T, Weigl M, Anger JT. Flow disruptions in robotic-assisted abdominal sacrocolpopexy: does robotic surgery introduce unforeseen challenges for gynecologic surgeons? Int Urogynecol J 2019; 30:2177-2182. [PMID: 31041500 DOI: 10.1007/s00192-019-03929-6] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2018] [Accepted: 03/13/2019] [Indexed: 11/25/2022]
Abstract
INTRODUCTION AND HYPOTHESIS The purpose of this study was to apply a human factors research approach to identify flow disruptions, deviations in the optimal course of care, in robotic abdominal sacrocolpopexy procedures with the ultimate goal of developing system interventions to improve the safety and efficiency of robotic surgery. METHODS Twenty-four robotic abdominal sacrocolpopexy procedures were observed for flow disruptions. Surgeries were divided into four phases: (1) patient arrival and induction of anesthesia; (2) port placement and robot docking; (3) console time; (4) undocking of robot, incision closure, and patient exiting the OR. RESULTS Flow disruptions were observed at a rate of 10.9 ± 5.1 per hour. The most frequently observed flow disruptions involved training issues (2.8 ± 2.4 flow disruptions per hour), equipment (2.2 ± 1.6 flow disruptions per hour), and poor coordination (2.0 ± 1.3 flow disruptions per hour). The rate of flow disruptions was highest in phase 2 (19.2 ± 14.4 flow disruptions per hour). Cases with more experienced surgeons involved shorter console times by 1.5 h (95% CI: 0.1, 3.0, p = 0.033) and 1.8 fewer (95% CI: 1.2, 2.6, p = 0.001) flow disruptions per hour. Surgeries were 1 h shorter on average (95% CI: 0.1, 1.9, p = 0.034) in cases in which the patient was > 65 years old. Da Vinci S console times were 0.8 h longer (95% CI: 0.01, 1.5, p = 0.047) than Si. CONCLUSIONS Flow disruptions in robotic abdominal sacrocolpopexy surgery occur about every 6 min. Flow disruption rates are highest during the most complex portions of the surgery. More experienced surgeons have lower flow disruption rates and operate more quickly.
Collapse
Affiliation(s)
| | - Ken Catchpole
- Medical University of South Carolina, Charleston, SC, USA
| | | | - Ronit Lyon
- Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | | | | | - Tara Cohen
- Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Matthias Weigl
- Ludwig-Maximilians-University of Munich, Munich, Germany
| | - Jennifer T Anger
- Cedars-Sinai Medical Center, Los Angeles, CA, USA.
- , Beverly Hills, USA.
| |
Collapse
|
50
|
Heinrichs K, Angerer P, Li J, Loerbroks A, Weigl M, Müller A. Changes in the association between job decision latitude and work engagement at different levels of work experience: A 10-year longitudinal study. Work & Stress 2019. [DOI: 10.1080/02678373.2019.1577310] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- Katherina Heinrichs
- Institute of Occupational, Social, and Environmental Medicine, Centre for Health and Society, Faculty of Medicine, University of Düsseldorf, Düsseldorf, Germany
| | - Peter Angerer
- Institute of Occupational, Social, and Environmental Medicine, Centre for Health and Society, Faculty of Medicine, University of Düsseldorf, Düsseldorf, Germany
| | - Jian Li
- Institute of Occupational, Social, and Environmental Medicine, Centre for Health and Society, Faculty of Medicine, University of Düsseldorf, Düsseldorf, Germany
| | - Adrian Loerbroks
- Institute of Occupational, Social, and Environmental Medicine, Centre for Health and Society, Faculty of Medicine, University of Düsseldorf, Düsseldorf, Germany
| | - Matthias Weigl
- Institute and Outpatient Clinic for Occupational, Social, and Environmental Medicine, Ludwig-Maximilians-University, Munich, Germany
| | - Andreas Müller
- Institute of Psychology, Work and Organizational Psychology, University of Duisburg-Essen, Essen, Germany
| |
Collapse
|