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Shahid S, Thabane L, Marrin M, Schattauer K, Silenzi L, Borhan S, Singh B, Thomas C, Thomas S. Evaluation of a Modified SBAR Report to Physician Tool to Standardize Communication on Neonatal Transport. Am J Perinatol 2022; 39:216-224. [PMID: 32819017 DOI: 10.1055/s-0040-1715524] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
OBJECTIVE SBAR (situation, background, assessment and recommendation) is a structured format for the effective communication of critically relevant information. This tool was developed as a generic template to provide structure to the communication of clinical information between health care providers. Neonatal transport often presents clinically stressful circumstances where concise and accurate information is required to be shared clearly between multidisciplinary health care providers. A modified SBAR communication tool was designed to facilitate structured communication between nonphysician bedside care providers operating from remote sites and physicians providing decision-making support at receiving care facilities. Prospective interventional study was designed to evaluate the reliability of a "SBAR report to physician tool" in sharing clinically relevant information between multidisciplinary care providers on neonatal transport. STUDY DESIGN The study was conducted between 2011 and 2014 by a dedicated neonatal transport service based at McMaster Children's Hospital which provides care for approximately 500 infants in Southern Ontario annually. In the preintervention phase, 50 calls were randomly selected for the evaluation and 115 consecutively recorded transport calls following adoption of the reporting tool. The quality of calls prior to and after the intervention was assessed by reviewers independently. Inter-rater agreement was also assessed for both periods. RESULTS Inter-rater agreement between raters was moderate to perfect in most components of the SBAR "report to the physician tool" except for the assessment component, which showed fair agreement during both preintervention and postintervention periods. There was an improvement in global score (primary outcome) with a mean difference of 0.95 (95% confidence interval [CI]: 0.77-1.14; p < 0.001) and in cumulative score with a mean difference of 8.55 (95% CI: 7.26-9.84; p < 0.001) in postintervention period. CONCLUSION The use of the SBAR report to physician tool improved the quality of clinical information shared between nonphysician members of the neonatal transport team and neonatal transport physicians. KEY POINTS · Long-Accurate and concise information sharing is crucial for decision-making in neonatal transport.. · Information sharing between multidisciplinary teams can be enhanced by using a commonly understood information sharing template.. · The SBAR report to physician tool improves the quality of information shared between multidisciplinary team members in neonatal transport..
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Affiliation(s)
- Shaneela Shahid
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Canada.,Department of Pediatrics, McMaster University, Hamilton, Canada
| | - Lehana Thabane
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Canada.,Department of Pediatrics, McMaster University, Hamilton, Canada.,Department of Anesthesia, McMaster University; Biostatistics Unit, St Joseph's Healthcare, Hamilton, Canada
| | - Michael Marrin
- Department of Pediatrics, Division of Neonatology, McMaster University, Hamilton, Canada
| | - Karen Schattauer
- Department of Pediatrics, Division of Neonatology, McMaster University, Hamilton, Canada
| | - Laurel Silenzi
- Department of Pediatrics, Division of Neonatology, McMaster University, Hamilton, Canada
| | - Sayem Borhan
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Canada.,Department of Family Medicine, McMaster University, Canada
| | - Balpreet Singh
- Department of Pediatrics, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Cherian Thomas
- Department of Pediatrics, Division of Neonatology, McMaster University, Hamilton, Ontario, Canada
| | - Sumesh Thomas
- Department of Pediatrics, University of Calgary, Calgary, Canada
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El Helou S, Samiee-Zafarghandy S, Fusch G, Wahab MGA, Aliberti L, Bakry A, Barnard D, Doucette J, El Gouhary E, Marrin M, Meyer CL, Mukerji A, Nwebube A, Pogorzelski D, Pugh E, Schattauer K, Shah J, Shivananda S, Thomas S, Twiss J, Williams C, Dutta S, Fusch C. Introduction of microsystems in a level 3 neonatal intensive care unit-an interprofessional approach. BMC Health Serv Res 2017; 17:61. [PMID: 28109276 PMCID: PMC5251231 DOI: 10.1186/s12913-017-1989-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [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: 01/25/2016] [Accepted: 01/06/2017] [Indexed: 11/13/2022] Open
Abstract
Background Growth of neonatal intensive care units in number and size has raised questions towards ability to maintain continuity and quality of care. Structural organization of intensive care units is known as a key element for maintaining the quality of care of these fragile patients. The reconstruction of megaunits of intensive care to smaller care units within a single operational service might help with provision of safe and effective care. Methods/Design The clinical team and patient distribution lay out, admission and discharge criteria and interdisciplinary round model was reorganized to follow the microstructure philosophy. A working group met weekly to formulate the implementation planning, to review the adaptation and adjustment process and to ascertain the quality of implementation following the initiation of the microsystem model. Discussion In depth examination of microsystem model of care in this study, provides systematic evaluation of this model on variable aspects of health care. The individual projects of this trial can be source of solid evidence for guidance of future decisions on optimized model of care for the critically ill newborns. Trial registration ClinicalTrial.gov, NCT02912780. Retrospectively registered on 22 September 2016.
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Affiliation(s)
- Salhab El Helou
- Division of Neonatology, Department of Pediatrics, McMaster University, Hamilton, 1280 Main Street West, Hamilton, ON, L8S 4K1, Canada
| | - Samira Samiee-Zafarghandy
- Division of Neonatology, Department of Pediatrics, McMaster University, Hamilton, 1280 Main Street West, Hamilton, ON, L8S 4K1, Canada
| | - Gerhard Fusch
- Division of Neonatology, Department of Pediatrics, McMaster University, Hamilton, 1280 Main Street West, Hamilton, ON, L8S 4K1, Canada
| | - Muzafar Gani Abdul Wahab
- Division of Neonatology, Department of Pediatrics, McMaster University, Hamilton, 1280 Main Street West, Hamilton, ON, L8S 4K1, Canada
| | - Lynda Aliberti
- Division of Neonatology, Department of Pediatrics, McMaster University, Hamilton, 1280 Main Street West, Hamilton, ON, L8S 4K1, Canada
| | - Ahmad Bakry
- Division of Neonatology, Department of Pediatrics, McMaster University, Hamilton, 1280 Main Street West, Hamilton, ON, L8S 4K1, Canada
| | - Deborah Barnard
- Division of Neonatology, Department of Pediatrics, McMaster University, Hamilton, 1280 Main Street West, Hamilton, ON, L8S 4K1, Canada
| | - Joanne Doucette
- Division of Neonatology, Department of Pediatrics, McMaster University, Hamilton, 1280 Main Street West, Hamilton, ON, L8S 4K1, Canada
| | - Enas El Gouhary
- Division of Neonatology, Department of Pediatrics, McMaster University, Hamilton, 1280 Main Street West, Hamilton, ON, L8S 4K1, Canada
| | - Michael Marrin
- Division of Neonatology, Department of Pediatrics, McMaster University, Hamilton, 1280 Main Street West, Hamilton, ON, L8S 4K1, Canada
| | - Carrie-Lynn Meyer
- Division of Neonatology, Department of Pediatrics, McMaster University, Hamilton, 1280 Main Street West, Hamilton, ON, L8S 4K1, Canada
| | - Amit Mukerji
- Division of Neonatology, Department of Pediatrics, McMaster University, Hamilton, 1280 Main Street West, Hamilton, ON, L8S 4K1, Canada
| | - Anne Nwebube
- Division of Neonatology, Department of Pediatrics, McMaster University, Hamilton, 1280 Main Street West, Hamilton, ON, L8S 4K1, Canada
| | - David Pogorzelski
- Division of Neonatology, Department of Pediatrics, McMaster University, Hamilton, 1280 Main Street West, Hamilton, ON, L8S 4K1, Canada
| | - Edward Pugh
- Division of Neonatology, Department of Pediatrics, McMaster University, Hamilton, 1280 Main Street West, Hamilton, ON, L8S 4K1, Canada
| | - Karen Schattauer
- Division of Neonatology, Department of Pediatrics, McMaster University, Hamilton, 1280 Main Street West, Hamilton, ON, L8S 4K1, Canada
| | - Jay Shah
- Division of Neonatology, Department of Pediatrics, McMaster University, Hamilton, 1280 Main Street West, Hamilton, ON, L8S 4K1, Canada
| | - Sandesh Shivananda
- Division of Neonatology, Department of Pediatrics, McMaster University, Hamilton, 1280 Main Street West, Hamilton, ON, L8S 4K1, Canada
| | - Sumesh Thomas
- Division of Neonatology, Department of Pediatrics, McMaster University, Hamilton, 1280 Main Street West, Hamilton, ON, L8S 4K1, Canada
| | - Jennifer Twiss
- Division of Neonatology, Department of Pediatrics, McMaster University, Hamilton, 1280 Main Street West, Hamilton, ON, L8S 4K1, Canada
| | - Connie Williams
- Division of Neonatology, Department of Pediatrics, McMaster University, Hamilton, 1280 Main Street West, Hamilton, ON, L8S 4K1, Canada
| | - Sourabh Dutta
- Division of Neonatology, Department of Pediatrics, McMaster University, Hamilton, 1280 Main Street West, Hamilton, ON, L8S 4K1, Canada
| | - Christoph Fusch
- Division of Neonatology, Department of Pediatrics, McMaster University, Hamilton, 1280 Main Street West, Hamilton, ON, L8S 4K1, Canada. .,Department of Pediatrics, General Hospital, Paracelsus Medical School, Nuremberg, Germany.
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Bissonnette F, Cohen J, Collins J, Cowan L, Dale S, Dill S, Greene C, Gysler M, Hanck B, Hughes E, Leader A, McDonald S, Marrin M, Martin R, Min J, Mortimer D, Mortimer S, Smith J, Tsang B, van Vugt D, Yuzpe A. Incidence and complications of multiple gestation in Canada: proceedings of an expert meeting. Reprod Biomed Online 2007; 14:773-90. [PMID: 17582911 DOI: 10.1016/s1472-6483(10)60681-5] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
This paper reports the proceedings of a consensus meeting on the incidence and complications of multiple gestation in Canada. In addition to background presentations about current and possible future practice in Canada, the expert panel also developed a set of consensus points. The need for infertility to be understood, and funded, as a healthcare problem was emphasized, along with recognition of the emotional impact of infertility. It was agreed that the goal of assisted reproduction treatment is the delivery of a single healthy infant and that even though many positive outcomes have resulted from twin or even triplet pregnancies, the potential risks associated with multiple pregnancy require that every effort be made to achieve this goal. The evidence shows that treatments other than IVF (such as superovulation and clomiphene citrate) contribute significantly to the incidence of multiple pregnancy. There is an urgent need for studies to understand better the usage and application of these other fertility technologies within Canada, as well as the non-financial barriers to treatment. The final consensus of the expert panel was that with adequate funding and good access to treatment, it will be possible to achieve the goal of reducing IVF-related multiple pregnancy rates in Canada by 50%.
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MESH Headings
- Canada/epidemiology
- Delivery, Obstetric/economics
- Female
- Fetal Diseases/epidemiology
- Hospitalization/economics
- Humans
- Infant, Newborn
- Infant, Premature
- Infant, Premature, Diseases/epidemiology
- Insurance, Health
- Parents/psychology
- Patient Education as Topic
- Pregnancy
- Pregnancy Complications/economics
- Pregnancy Complications/epidemiology
- Pregnancy, Multiple/statistics & numerical data
- Prevalence
- Reproductive Techniques, Assisted/adverse effects
- Reproductive Techniques, Assisted/economics
- Reproductive Techniques, Assisted/ethics
- Societies, Medical
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Mitchell-DiCenso A, Guyatt G, Marrin M, Goeree R, Willan A, Southwell D, Hewson S, Paes B, Rosenbaum P, Hunsberger M, Baumann A. A controlled trial of nurse practitioners in neonatal intensive care. Pediatrics 1996; 98:1143-8. [PMID: 8951267] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
OBJECTIVE To compare a clinical nurse specialist/neonatal practitioner (CNS/NP) team with a pediatric resident team in the delivery of neonatal intensive care. DESIGN Randomized, controlled trial. SETTING A 33-bed tertiary-level neonatal intensive care unit. PATIENTS Of 821 infants admitted to the neonatal intensive care unit between September 1991 and September 1992, 414 were randomized to care by the CNS/NP team, and 407 were randomized to care by the pediatric resident team. INTERVENTION Infants assigned to the CNS/NPs team were cared for by CNS/NPs during the day and by pediatric residents during the night. Infants assigned to the pediatric resident team were cared for by pediatric residents around the clock. Neonatologists supervised both teams. MEASURES Outcome measures included mortality; number of neonatal complications; length of stay; quality of care, as assessed by a quantitative indicator condition approach; parent satisfaction with care, measured using the Neonatal Index of Parent Satisfaction; long-term outcomes, measured using the Minnesota Infant Development Inventory; and costs. RESULTS There were 19 (4.6%) deaths in the CNS/NP group and 24 (5.9%) in the resident group (relative risk [RR], 0.78; confidence interval [CI], 0.43 to 1.40). In the CNS/NP group, 230 (55.6%) neonates had complications, in comparison with 220 (54.1%) in the resident group (RR, 1.03; CI 0.91 to 1.16). Mean lengths of stay were 12.5 days in the CNS/NP group and 11.7 days in the resident group (difference in means, 0.8 days; CI, -1.1 to 2.7). The performance on the indicator conditions was comparable in the two groups except for two instances, jaundice and charting, both of which favored the CNS/NP group. Mean scores on the Neonatal Index of Parent Satisfaction were 140 in the CNS/NP group and 139 in the resident group (difference in means, 1.0; CI, -3.6 to 5.6). In the CNS/NP group, 6 (2.6%) infants performed 30% or more below their age level in the Minnesota Infant Development Inventory, in comparison with 2 (0.9%) in the resident group (RR, 2.87; CI, 0.59 to 14.06) The cost per infant in the CNS/NP group was $14,245 and in the resident group $13,267 (difference in means, $978; CI, -1303.18 to 3259.05). CONCLUSIONS CNS/NP and resident teams are similar with respect to all tested measures of performance. These results support the use of CNS/NPs as an alternative to pediatric residents in delivering care to critically ill neonates.
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