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Pattison N. Critical care outreach and rapid response teams: Are they the panacea to all hospital patient deterioration problems? Intensive Crit Care Nurs 2024; 82:103643. [PMID: 38394981 DOI: 10.1016/j.iccn.2024.103643] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/25/2024]
Affiliation(s)
- Natalie Pattison
- University of Hertfordshire, East and North Herts NHS Trust, Imperial College Healthcare NHS Trust, Imperial College London, UK.
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2
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Abraham P, Dubois N, Rimmelé T, Lilot M, Balança B. Enhancing perioperative care through decontextualized simulation: A game-changer for non-technical skills training. J Clin Anesth 2024; 94:111428. [PMID: 38422954 DOI: 10.1016/j.jclinane.2024.111428] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2023] [Revised: 02/11/2024] [Accepted: 02/23/2024] [Indexed: 03/02/2024]
Affiliation(s)
- Paul Abraham
- Department of Anesthesiology, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland; Centre Lyonnais d'Enseignement par la Simulation en Santé (CLESS), SimuLyon. Claude Bernard University Lyon 1-Hospices Civils de Lyon, Lyon, France.
| | - Nadège Dubois
- Medical Simulation Center, Public Health Department, Liège University, Liège, Belgium
| | - Thomas Rimmelé
- Centre Lyonnais d'Enseignement par la Simulation en Santé (CLESS), SimuLyon. Claude Bernard University Lyon 1-Hospices Civils de Lyon, Lyon, France; EA 7426, PI3 (Pathophysiology of Injury-Induced Immunosuppression), Claude Bernard University Lyon 1-Biomérieux-Hospices Civils de Lyon, Lyon, France
| | - Marc Lilot
- Centre Lyonnais d'Enseignement par la Simulation en Santé (CLESS), SimuLyon. Claude Bernard University Lyon 1-Hospices Civils de Lyon, Lyon, France; Unit of Pediatric and Congenital Cardio-thoracic Anesthesia and Intensive Care, Medical-Surgical Department of Congenital Cardiology of the Fœtus, Child and Adult. Louis Pradel Hospital, Hospices Civils de Lyon, Lyon, France; Claude Bernard University Lyon 1, Research on Healthcare Performance (RESHAPE), INSERM U1290, Lyon, France
| | - Baptiste Balança
- Centre Lyonnais d'Enseignement par la Simulation en Santé (CLESS), SimuLyon. Claude Bernard University Lyon 1-Hospices Civils de Lyon, Lyon, France; Neurologic Intensive care and Anesthesiology, Hospices Civils de Lyon, Pierre Wertheimer Hospital and Claude Bernard University Lyon 1 - Neuroscience Research Center, Lyon, France
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3
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Henshaw AM, Winstead SR. Building Bridges in Palliative Rehabilitation: An Evidence-Based Toolkit to Promote Collaboration. Am J Hosp Palliat Care 2024; 41:601-609. [PMID: 37462170 DOI: 10.1177/10499091231184621] [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] [Indexed: 04/21/2024] Open
Abstract
Background: Palliative care and rehabilitation professionals caring for seriously ill people and their families face barriers to effective, timely collaboration. Barriers such as ineffective communication processes, role misunderstanding across professions, and resource limitations can lead to underutilization of rehabilitation services for this vulnerable population. Objectives: To create practical connections between palliative care and rehabilitation professionals and to provide tools and strategies for teams to develop the core competencies (role clarity, communication, teamwork, and shared values) necessary to provide coordinated, timely, effective care to people living with serious illness. Design: With Interprofessional Education Collaborative (IPEC) Core Competencies1 as a framework for interprofessional collaborative practice, a quality improvement project was conducted at a large academic medical center. The 5-phase project included literature review, expert interviews, identification of barriers and facilitators, development of strategies to mitigate barriers, and pilot testing of select strategies. Results: The PalRehab Toolkit consists of strategies to enhance interprofessional collaborative practice and infuse rehabilitation into palliative care in the acute care setting. Preliminary evaluation of piloted strategies suggests increased communication across professions, improved role clarity, and an increased likelihood of collaboration. Conclusion: Providing educational offerings, establishing efficient communication channels, and infusing rehabilitation concepts into palliative care practices, as outlined in the PalRehab Toolkit, may positively impact interprofessional collaborative practice and improve care delivery for people with serious illness and their families.
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Affiliation(s)
- Ann M Henshaw
- Department of Occupational Therapy, Medstar Georgetown University Hospital, Washington, D.C. USA
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4
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Suzuki H, Furuya J, Nakagawa K, Hidaka R, Yoshimi K, Shimizu Y, Saito K, Hatanaka Y, Mukai T, Itsui Y, Tohara H, Minakuchi S. Impact of oral health management by nurses and dental professionals on oral health status in inpatients eligible for the Nutrition Support Team: A longitudinal study. J Oral Rehabil 2024; 51:938-946. [PMID: 38366354 DOI: 10.1111/joor.13660] [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: 10/31/2023] [Revised: 12/25/2023] [Accepted: 02/05/2024] [Indexed: 02/18/2024]
Abstract
OBJECTIVE As the participation of dental professionals in multidisciplinary care is often limited, instructions on oral health management provided by dental professionals to other professionals are important to achieve transdisciplinary oral health management; however, the effectiveness of such instructions remains unclear. In this longitudinal study, we aimed to determine the impact of oral health management provided by dental professionals and nurses instructed on oral health management by dental professionals on the oral health of inpatients eligible for a Nurition Support Team (NST). METHODS The study participants were 117 patients (66 men and 51 women, mean age: 71.9 ± 12.5 years) who received oral health management during the NST intervention period. The participants received oral health management from nurses (Ns group) or dental professionals (D group). The nurses who conducted the oral health management received instructions from dental professionals. Oral health was assessed at the beginning and end of the NST intervention using the Oral Health Assessment Tool (OHAT). RESULT The Ns and D groups showed significant improvements in the total OHAT scores at the end of the NST intervention. Both groups showed significant improvements in the OHAT subitems of lip, tongue, gums and tissues, saliva, oral cleanliness and dental pain, while only the D group showed a significant improvement in the denture subitem. CONCLUSION Effective oral health management provided by dental professionals or by nurses trained by them improved the oral health status of inpatients eligible for NST at an acute-care hospital.
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Affiliation(s)
- Hiroyuki Suzuki
- Department of Gerodontology and Oral Rehabilitation, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University (TMDU), Tokyo, Japan
- Department of Oral Function Management, Graduate School of Dentistry, Showa University, Tokyo, Japan
| | - Junichi Furuya
- Department of Oral Function Management, Graduate School of Dentistry, Showa University, Tokyo, Japan
- Department of Dysphagia Rehabilitation, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University (TMDU), Tokyo, Japan
| | - Kazuharu Nakagawa
- Department of Dysphagia Rehabilitation, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University (TMDU), Tokyo, Japan
| | - Rena Hidaka
- Department of Oral Health Sciences for Community Welfare, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University (TMDU), Tokyo, Japan
| | - Kanako Yoshimi
- Department of Dysphagia Rehabilitation, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University (TMDU), Tokyo, Japan
| | - Yukue Shimizu
- Department of Nutrition Service, Tokyo Medical and Dental University Hospital, Tokyo, Japan
| | - Keiko Saito
- Department of Nutrition Service, Tokyo Medical and Dental University Hospital, Tokyo, Japan
| | - Yukiko Hatanaka
- Department of Oral Function Management, Graduate School of Dentistry, Showa University, Tokyo, Japan
| | - Tomoko Mukai
- Department of Oral Function Management, Graduate School of Dentistry, Showa University, Tokyo, Japan
| | - Yasuhiro Itsui
- Medical Education Research and Development, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University (TMDU), Tokyo, Japan
| | - Haruka Tohara
- Department of Dysphagia Rehabilitation, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University (TMDU), Tokyo, Japan
| | - Shunsuke Minakuchi
- Department of Gerodontology and Oral Rehabilitation, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University (TMDU), Tokyo, Japan
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5
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El-Andari R, Fialka NM, Bozso SJ, Nagendran J. A multidisciplinary team approach to the long-term management of infective endocarditis: Complex management for complex patients. Int J Cardiol 2024; 404:131936. [PMID: 38447763 DOI: 10.1016/j.ijcard.2024.131936] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/01/2024] [Revised: 02/03/2024] [Accepted: 03/01/2024] [Indexed: 03/08/2024]
Affiliation(s)
- Ryaan El-Andari
- Division of Cardiac Surgery, Department of Surgery, University of Alberta, Edmonton, Alberta, Canada
| | - Nicholas M Fialka
- Division of Cardiac Surgery, Department of Surgery, University of Alberta, Edmonton, Alberta, Canada
| | - Sabin J Bozso
- Division of Cardiac Surgery, Department of Surgery, University of Alberta, Edmonton, Alberta, Canada
| | - Jeevan Nagendran
- Division of Cardiac Surgery, Department of Surgery, University of Alberta, Edmonton, Alberta, Canada.
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Blakeney EAR, Chu F, White AA, Randy Smith G, Woodward K, Lavallee DC, Salas RME, Beaird G, Willgerodt MA, Dang D, Dent JM, Tanner E“I, Summerside N, Zierler BK, O’Brien KD, Weiner BJ. A scoping review of new implementations of interprofessional bedside rounding models to improve teamwork, care, and outcomes in hospitals. J Interprof Care 2024; 38:411-426. [PMID: 34632913 PMCID: PMC8994791 DOI: 10.1080/13561820.2021.1980379] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [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: 02/26/2021] [Revised: 08/13/2021] [Accepted: 08/29/2021] [Indexed: 01/22/2023]
Abstract
Poor communication within healthcare teams occurs commonly, contributing to inefficiency, medical errors, conflict, and other adverse outcomes. Interprofessional bedside rounds (IBR) are a promising model that brings two or more health professions together with patients and families as part of a consistent, team-based routine to share information and collaboratively arrive at a daily plan of care. The purpose of this systematic scoping review was to investigate the breadth and quality of IBR literature to identify and describe gaps and opportunities for future research. We followed an adapted Arksey and O'Malley Framework and PRISMA scoping review guidelines. PubMed, CINAHL, PsycINFO, and Embase were systematically searched for key IBR words and concepts through June 2020. Seventy-nine articles met inclusion criteria and underwent data abstraction. Study quality was assessed using the Mixed Methods Assessment Tool. Publications in this field have increased since 2014, and the majority of studies reported positive impacts of IBR implementation across an array of team, patient, and care quality/delivery outcomes. Despite the preponderance of positive findings, great heterogeneity, and a reliance on quantitative non-randomized study designs remain in the extant research. A growing number of interventions to improve safety, quality, and care experiences in hospital settings focus on redesigning daily inpatient rounds. Limited information on IBR characteristics and implementation strategies coupled with widespread variation in terminology, study quality, and design create challenges in assessing the effectiveness of models of rounds and optimal implementation strategies. This scoping review highlights the need for additional studies of rounding models, implementation strategies, and outcomes that facilitate comparative research.
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Affiliation(s)
- Erin Abu-Rish Blakeney
- Department of Biobehavioral Nursing and Health Informatics,
School of Nursing, University of Washington
| | | | - Andrew A. White
- Department of Medicine, University of Washington School of
Medicine
| | | | | | | | | | | | - Mayumi A. Willgerodt
- Department of Family and Child Nursing, School of Nursing,
University of Washington
| | | | | | | | | | - Brenda K. Zierler
- Department of Biobehavioral Nursing and Health
Informatics, School of Nursing, University of Washington
| | | | - Bryan J. Weiner
- Departments of Global Health and Health Services, School
of Public Health, University of Washington
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7
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Muadtongon K, Rattanaburi A, Ajimakul T, Suphasynth Y, Jiamset I, Nantamongkolkul K, Suntharasaj T, Suwanrath C, Pruksanusak N, Petpichetchian C, Suksai M, Chainarong N, Sawaddisan R, Pranpanus S. Successful multidisciplinary team management of placenta accreta spectrum disorder: A referral center model in a middle-income country. Int J Gynaecol Obstet 2024; 165:813-822. [PMID: 38189162 DOI: 10.1002/ijgo.15339] [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: 04/26/2023] [Revised: 08/12/2023] [Accepted: 12/14/2023] [Indexed: 01/09/2024]
Abstract
OBJECTIVE The aim of the study was to evaluate the outcomes of placenta accreta spectrum (PAS) disorder managed by a multidisciplinary care team (MCT) compared with a conventional care team (CCT) in a PAS referral center in Thailand. METHODS This retrospective single-center cohort study analyzed PAS management outcomes in the PSU PAS Center between January 2010 and December 2022. The incidence of hemorrhage ≥3500 mL and the composite maternal and neonatal outcomes of PAS were compared before and after the introduction of an MCT in 2016. RESULTS Of 227 PAS cases, 219 (96.5%) had pathological confirmation. There were 52 (22.9%) cases of placenta accreta, 119 (52.4%) cases of placenta increta, and 56 (24.7%) cases of placenta percreta. The incidence of estimated blood loss (EBL) ≥3500 mL decreased from 61.8% to 34.3% (P < 0.001) after the establishment of the MCT. The median EBL decreased from 4000 (IQR: 2600,7250) mL to 2250 (1300, 4750) mL (P < 0.001). EBL reduction was statistically significant in the accreta and increta groups (P < 0.001). Red blood cell transfusions decreased from five (3, 9) to two (1, 6) units (P < 0.001) per patient. The length of maternal hospital stays and ICU admissions were statistically shorter when PAS was managed by an MCT (P < 0.001). The length of newborn hospital and ICU stays decreased significantly (P < 0.001). CONCLUSION The incidence of massive postpartum hemorrhage and a composite of maternal and neonatal morbidities in pregnant women with PAS disorder improved significantly after the establishment of an MCT to manage PAS in a middle-income country setting.
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Affiliation(s)
- Kan Muadtongon
- Department of Obstetrics and Gynecology, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla, Thailand
| | - Athithan Rattanaburi
- Department of Obstetrics and Gynecology, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla, Thailand
| | - Thiti Ajimakul
- Department of Obstetrics and Gynecology, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla, Thailand
| | - Yuthasak Suphasynth
- Department of Obstetrics and Gynecology, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla, Thailand
| | - Ingporn Jiamset
- Department of Obstetrics and Gynecology, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla, Thailand
| | - Kulisara Nantamongkolkul
- Department of Obstetrics and Gynecology, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla, Thailand
| | - Thitima Suntharasaj
- Department of Obstetrics and Gynecology, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla, Thailand
| | - Chitkasaem Suwanrath
- Department of Obstetrics and Gynecology, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla, Thailand
| | - Ninlapa Pruksanusak
- Department of Obstetrics and Gynecology, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla, Thailand
| | - Chusana Petpichetchian
- Department of Obstetrics and Gynecology, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla, Thailand
| | - Manaphat Suksai
- Department of Obstetrics and Gynecology, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla, Thailand
| | - Natthicha Chainarong
- Department of Obstetrics and Gynecology, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla, Thailand
| | - Rapphon Sawaddisan
- Department of Obstetrics and Gynecology, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla, Thailand
| | - Savitree Pranpanus
- Department of Obstetrics and Gynecology, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla, Thailand
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8
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Vatani H, Sharma H, Azhar K, Kochendorfer KM, Valenta AL, Dunn Lopez K. Required data elements for interprofessional rounds through the lens of multiple professions. J Interprof Care 2024; 38:453-459. [PMID: 33190565 DOI: 10.1080/13561820.2020.1832447] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [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: 11/04/2019] [Revised: 09/29/2020] [Accepted: 09/30/2020] [Indexed: 10/23/2022]
Abstract
The lack of a proper system for ongoing open interprofessional communication among care providers increases miscommunications and medical errors. Seamless access to patient information is important for care providers to prevent miscommunication and improve patient safety. A shared understanding of the information needs of different care providers in an interprofessional team is lacking. Our purpose is to identify care providers' information needs from the perspective of different professions for communication, shared understanding about the patient, and decision-making. We conducted semi-structured interviews with 10 subject matter experts representing eight professions, including dentistry, dietetics, medicine, nursing, occupational therapy, pharmacy, physical therapy, and social work in a 465-bed academic hospital at a large urban Midwestern city. We used an in-house rounding tool presenting physicians' information needs and a hypothetical patient scenario to collect participants' feedback. Interview notes were coded using direct content analysis. We identified 22 additional essential data elements for an interprofessional rounding tool. We categorized those into six domains: discharge-related, social determinants of health, hospital safety, nutrition, interprofessional situation awareness, and patient history. A well-designed validated rounding tool that includes an interprofessional team of care providers' information needs could improve communication, care planning, and decision-making among them.
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Affiliation(s)
- Haleh Vatani
- College of Applied Health Sciences, University of Illinois, Chicago, IL, USA
| | - Himanshu Sharma
- College of Applied Health Sciences, University of Illinois, Chicago, IL, USA
| | - Kamel Azhar
- Department of Family Medicine, University of Illinois, Chicago, IL, USA
| | | | - Annette L Valenta
- College of Applied Health Sciences, University of Illinois, Chicago, IL, USA
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9
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Flaherty E, O'Connor S, Steltenpohl CN, Preiss M, Volckaert A, Pepin RL. Geriatric Interprofessional Team Transformation for Primary Care overview. J Am Geriatr Soc 2024; 72 Suppl 2:S4-S12. [PMID: 38038277 DOI: 10.1111/jgs.18637] [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: 05/03/2023] [Revised: 08/29/2023] [Accepted: 09/17/2023] [Indexed: 12/02/2023]
Abstract
BACKGROUND The Geriatric Interprofessional Team Transformation for Primary Care (GITT-PC) is a model developed to deliver optimal care to older adults in primary care. GITT-PC is an expansion of the John A. Hartford Foundation Geriatric Interdisciplinary Team Training (GITT) program developed at New York University and funded from 1995 to 2002 (Fulmer et al., 2004). GITT was designed to create training models that reflect the needs of the changing health care system and the challenge of caring for older adults with complex conditions (Fulmer et al., 2005). The GITT-PC model builds on the lessons learned from GITT and the development of curricula and training materials based on best practices. METHODS Implementation of GITT-PC is accomplished through systems and practices that meet the needs and preferences of patients and their families and that are implemented by teams of health professionals and community service providers. GITT-PC is focused on four core components of high-quality geriatric care: (1) health promotion and prevention, (2) chronic disease management, (3) advanced care planning, and (4) transitional care management, each component corresponding to a Medicare-reimbursable visit. RESULTS Implementation of these reimbursable services enables practices to provide evidence-based geriatric care while realizing a potential significant return on investment. CONCLUSIONS The GITT-PC model has evolved from an academic training program to a financially sustainable model that serves to improve the care of older adults through a systematic team transformation process that makes a clear business case for primary care (Tabbush et al., 2021). The GITT-PC training program can be implemented in primary care practices with a focus on improving or expanding delivery of annual wellness visits (AWVs) and, potentially, registered RN-led AWVs.
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Affiliation(s)
- Ellen Flaherty
- Dartmouth Health Geriatric Center of Excellence, Lebanon, New Hampshire, USA
| | - Sharon O'Connor
- Center for Program Design and Evaluation, Geisel School of Medicine at Dartmouth College, Lebanon, New Hampshire, USA
| | - Crystal N Steltenpohl
- Center for Program Design and Evaluation, Geisel School of Medicine at Dartmouth College, Lebanon, New Hampshire, USA
| | - Michaela Preiss
- Dartmouth Health Geriatric Center of Excellence, Lebanon, New Hampshire, USA
| | | | - Renée L Pepin
- Dartmouth Health Geriatric Center of Excellence, Lebanon, New Hampshire, USA
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10
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McKinley TF, Real FJ, Herrmann LE, Klein M. Teamwork makes medical education research training work. Med Educ 2024; 58:633-634. [PMID: 38362669 DOI: 10.1111/medu.15346] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Accepted: 01/23/2024] [Indexed: 02/17/2024]
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11
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Muck PE. Pulmonary embolism therapies and outcomes: Hospital registries, industry sponsored trials, and the impact of the PERT consortium. J Vasc Surg Venous Lymphat Disord 2024; 12:101824. [PMID: 38631804 DOI: 10.1016/j.jvsv.2024.101824] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2024] [Accepted: 01/17/2024] [Indexed: 04/19/2024]
Affiliation(s)
- Patrick E Muck
- Department of Vascular Surgery, TriHealth - Good Samaritan Hospital Cincinnati, Cincinnati, Ohio, USA
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12
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Cadet T, Cusimano J, McKearney S, Honaker J, O'Neal C, Taheri R, Uhley V, Zhang Y, Dreker M, Cohn JS. Describing the evidence linking interprofessional education interventions to improving the delivery of safe and effective patient care: a scoping review. J Interprof Care 2024; 38:476-485. [PMID: 38124506 PMCID: PMC11009096 DOI: 10.1080/13561820.2023.2283119] [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: 01/10/2023] [Accepted: 11/02/2023] [Indexed: 12/23/2023]
Abstract
Empirical evidence indicates that collaborative interprofessional practice leads to positive health outcomes. Further, there is an abundance of evidence examining student and/or faculty perceptions of learning or satisfaction about the interprofessional education (IPE) learning experience. However, there is a dearth of research linking IPE interventions to patient outcomes. The objective of this scoping review was to describe and summarize the evidence linking IPE interventions to the delivery of effective patient care. A three-step search strategy was utilized for this review with articles that met the following criteria: publications dated 2015-2020 using qualitative, quantitative or mixed methods; the inclusion of healthcare professionals, students, or practitioners who had experienced IPE or training that included at least two collaborators within coursework or other professional education; and at least one of ten Centers for Medicare & Medicaid Services quality measures (length of stay, medication errors, medical errors, patient satisfaction scores, medication adherence, patient and caregiver education, hospice usage, mortality, infection rates, and readmission rates). Overall, n=94 articles were identified, providing overwhelming evidence supporting a positive relationship between IPE interventions and several key quality health measures including length of stay, medical errors, patient satisfaction, patient or caregiver education, and mortality. Findings from this scoping review suggest a critical need for the development, implementation, and evaluation of IPE interventions to improve patient outcomes.
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Affiliation(s)
- Tamara Cadet
- School of Social Policy & Practice, University of Pennsylvania, Philadelphia, PA, USA
| | - Joseph Cusimano
- Bernard J. Dunn School of Pharmacy, Shenandoah University, Winhester, VA, USA
| | - Shelley McKearney
- Interprofessional Education Collaborative, BS Seton Hall University, South Orange, NJ, USA
| | | | - Cynthia O'Neal
- School of Nursing, University of Texas Health Science Center, San Antonio, Texas, USA
| | - Reza Taheri
- Pharmacy Practice Department, Chapman University, Irvine, CA, USA
| | - Virginia Uhley
- Department of Foundational Medical Studies, Department of Family Medicine and Community Health, Oakland University, Rochester, MI, USA
| | - Yingting Zhang
- Department of Medicine, Research Services Librarian Library Faculty, Robert Wood Johnson Library of the Health Sciences, Rutgers, The State University of New Jersey, New Brunswick, NJ, USA
| | - Margaret Dreker
- Hackensack Meridian School of Medicine, Seton Hall University, Nutley, NJ, USA
| | - Judith S Cohn
- Health Sciences Library, Information Services and Department of Health Sciences Libraries Department, George F. Smith Library of the Health Sciences, The State University of New Jersey, Newark, NJ, USA
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13
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Fox S, McAllum K, Ginoux L. Team Care for the Care Team: A Scoping Review of the Relational Dimensions of Collaboration in Healthcare Contexts. Health Commun 2024; 39:960-971. [PMID: 37081769 DOI: 10.1080/10410236.2023.2198673] [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] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/03/2023]
Abstract
Examining team care for the care team, this scoping literature review highlights the relational and compassionate dimensions of collaboration and teamwork that can alleviate healthcare worker suffering and promote well-being in challenging contexts of care. Its goal is to provide greater conceptual clarity about team care and examine the contextual dimensions regarding the needs and facilitators of team care. Analysis of the 48 retained texts identified three broad types of communicative practice that constitute team care: sharing; supporting; and leading with compassion. The environmental conditions facilitating team care included a caring team culture and specific and accessible organizational supports. These results are crystallized into a conceptual model of team care that situates team care within a system of team and organizational needs and anticipated outcomes. Gaps in the literature are noted and avenues for future research are suggested.
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Affiliation(s)
| | | | - Laura Ginoux
- Department of Communication, Université de Montréal
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14
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Kheawwan P, Thanomlikhit C, Narajeeenron K, Rojnawee S. Translation and psychometric validation of the Thai version of TeamSTEPPS® team performance observation tool. J Interprof Care 2024; 38:573-582. [PMID: 38343289 DOI: 10.1080/13561820.2024.2307547] [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: 08/21/2023] [Accepted: 01/13/2024] [Indexed: 04/12/2024]
Abstract
In healthcare, effective communication and teamwork are pivotal in reducing medical errors. Integrating team training into health professions education is crucial. Accurate measurement of team performance during training requires reliable assessment tools. The TeamSTEPPS® Team Performance Observation Tool (TPOT), recently updated by the Agency for Healthcare Research and Quality, serves this purpose. However, it had not been translated and validated for use in Thailand. We aimed to translate and assess the psychometric properties of the Thai version of TPOT. Employing a back-translation process, TPOT was adapted to the Thai context. The resulting Thai TPOT instrument was administered to 518 healthcare professionals who had undergone TeamSTEPPS® training. Participants were asked to evaluate two prerecorded, 7-minute simulated team emergency scenarios using the Thai TPOT instrument. Results exhibited high internal consistency (Cronbach's alpha = .96) and inter-rater reliability (ICC = .98). Confirmatory factor analysis affirmed the construct validity of the Thai TPOT. These findings establish the Thai TPOT as useful for evaluating teamwork within healthcare teams.
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Affiliation(s)
- Pataraporn Kheawwan
- Department of Nursing, King Chulalongkorn Memorial Hospital, Bangkok, Thailand
| | - Chanya Thanomlikhit
- Nursing Professional Development Center, Department of Nursing, King Chulalongkorn Memorial Hospital, Bangkok, Thailand
| | - Khuansiri Narajeeenron
- Department of Emergency Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
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15
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Xyrichis A. Reclaiming the rounds: an interprofessional imperative. J Interprof Care 2024; 38:409-410. [PMID: 38602114 DOI: 10.1080/13561820.2024.2339624] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/12/2024]
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16
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Boudreaux A, Schell RF, Nelson SD, Phibbs F, Stroh J, Depp AF. Improving Medication Management for Inpatients with a Secondary Diagnosis of Parkinson Disease. Am J Nurs 2024; 124:50-57. [PMID: 38661703 DOI: 10.1097/01.naj.0001016384.47848.89] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/26/2024]
Abstract
ABSTRACT Patients who have Parkinson disease require individualized medication regimens to optimize care. A review of the medication management of patients admitted to a tertiary care hospital with a secondary diagnosis of Parkinson disease found significant departures from the patients' home regimen. Medication regimens are often altered by health care teams unfamiliar with Parkinson disease-specific care in order to conform to standard hospital medication orders and administration times, potentially resulting in increased patient falls, delirium, and mortality.A nurse-led multidisciplinary team consisting of pharmacy, nursing, informatics, neurology, and quality personnel implemented a quality improvement (QI) project between July 2020 and July 2022 to identify patients with Parkinson disease, including those with a secondary diagnosis and those undergoing deep brain stimulation, and customize medication management in order to reduce length of stay, mortality, falls, falls with harm, and 30-day readmissions. The QI project team also evaluated patient satisfaction with medication management.Among patients with a secondary diagnosis of Parkinson disease, the proportion who had medication histories conducted by a pharmacy staff member increased from a baseline of 53% to more than 75% per month. For all patients with Parkinson disease, those whose medication history was taken by a pharmacy staff member had orders matching their home regimen 89% of the time, whereas those who did not had orders matching the home regimen only 40% of the time. Among patients with a secondary diagnosis of Parkinson disease, the length-of-stay index decreased from a baseline of 1 to 0.94 and observed-to-expected mortality decreased from 1.03 to 0.78. The proportion of patients experiencing a fall decreased from an average of 5% to 4.08% per quarter, while the proportion of patients experiencing a fall with harm decreased from an average of 1% to 0.75% per quarter. The rate of 30-day readmissions decreased from 10.81% to 4.53% per quarter. Patient satisfaction scores were 1.95 points higher for patients who had medication histories taken by pharmacy than for those who did not (5 versus 3.05).
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Affiliation(s)
- Arlene Boudreaux
- Arlene Boudreaux is a clinical nurse specialist at Vanderbilt University Medical Center, Nashville, TN, where Ryan F. Schell is a clinical pharmacy manager, Scott D. Nelson and Fenna Phibbs are associate professors, Jessica Stroh is a patient care coordinator, and Amanda Fraley Depp is a clinical pharmacist. Contact author: Arlene Boudreaux, . The authors have disclosed no potential conflicts of interest, financial or otherwise
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17
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Buchanan CJ, Young E, Mastalerz KA. Engaging resident physicians in the design, implementation, and assessment of bedside interdisciplinary rounds. J Interprof Care 2024; 38:469-475. [PMID: 36814080 DOI: 10.1080/13561820.2023.2176471] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [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: 10/21/2021] [Revised: 10/28/2022] [Accepted: 01/07/2023] [Indexed: 02/24/2023]
Abstract
Bedside interdisciplinary rounds (IDR) improve teamwork, communication, and collaborative culture in inpatient settings. Implementation of bedside IDR in academic settings depends on engagement from resident physicians; however, little is known about their knowledge and preferences related to bedside IDR. The goal of this program was to identify medical resident perceptions about bedside IDR and to engage resident physicians in the design, implementation, and assessment of bedside IDR in an academic setting. This is a pre-post mixed methods survey assessing resident physicians' perceptions surrounding a stakeholder-informed bedside IDR quality improvement project. Resident physicians in the University of Colorado Internal Medicine Residency Program (n = 77 pre-implementation survey responses from 179 eligible participants - response rate 43%) were recruited via e-mail to participate in surveys assessing perceptions surrounding the inclusion of interprofessional team members, timing, and preferred structure of bedside IDR. A bedside IDR structure was created based on input from resident and attending physicians, patients, nurses, care coordinators, pharmacists, social workers, and rehabilitation specialists. This rounding structure was implemented on acute care wards in June 2019 at a large academic regional VA hospital in Aurora, CO. Resident physicians were surveyed post implementation (n = 58 post-implementation responses from 141 eligible participants - response rate 41%) about interprofessional input, timing, and satisfaction with bedside IDR. The pre-implementation survey revealed several important resident needs during bedside IDR. Post-implementation survey results revealed high overall satisfaction with bedside IDR among residents, improved perceived efficiency of rounds, preserved quality of education, and value added by interprofessional input. Results also suggested areas for future improvement including timeliness of rounds and enhanced systems-based teaching. This project successfully engaged residents as stakeholders in system-level interprofessional change by incorporating their values and preferences into a bedside IDR framework.
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Affiliation(s)
- Cole J Buchanan
- Department of Internal Medicine, University of Colorado Internal Medicine Residency Program, Denver, CO, USA
| | - Eric Young
- Department of Hospital Medicine, Eastern Colorado VA Healthcare System, Aurora, CO, USA
- Department of Hospital Medicine, University of Colorado School of Medicine, Aurora, CO, USA
| | - Katarzyna A Mastalerz
- Department of Hospital Medicine, University of Colorado School of Medicine, Aurora, CO, USA
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18
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Affiliation(s)
- Jack Ende
- Perelman School of Medicine of the University of Pennsylvania, Philadelphia, PA, USA.
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19
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Schwartz JI, Gonzalez-Colaso R, Gan G, Deng Y, Kaplan MH, Vakos PA, Kenyon K, Ashman A, Sofair AN, Huot SJ, Chaudhry SI. Structured interdisciplinary bedside rounds improve interprofessional communication and workplace efficiency among residents and nurses on an inpatient internal medicine unit. J Interprof Care 2024; 38:427-434. [PMID: 33433262 DOI: 10.1080/13561820.2020.1863932] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [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: 01/30/2020] [Revised: 11/06/2020] [Accepted: 12/08/2020] [Indexed: 10/22/2022]
Abstract
Structured Interdisciplinary Bedside Rounds (SIBR) is a standardized, team-based intervention for hospitals to deliver high quality interprofessional care. Despite its potential for improving IPC and the workplace environment, relatively little is known about SIBR's effect on these outcomes. Our study aimed to assess the fidelity of SIBR implementation on an inpatient medicine teaching unit and its effects on perceived IPC and workplace efficiency. We conducted a quasi-experimental study with 88 residents and 44 nurses at a large academic medical center and observed 1308 SIBR encounters over 24 weeks. Of these 1308 encounters, the bedside nurse was present for 96.7%, physician for 97.6%, and care manager for 94.7, and 64.7% occurred at the bedside. Following SIBR implementation, perceived IPC improved significantly among residents (93.3% versus 67.9%, p < .024) and nurses (73.7% versus 36.0%, p < .008) compared to before implementation. Moreover, residents perceived greater workplace efficiency operationalized as being paged less frequently with questions by nurses (20.0% versus 49.1%, p = .01). No statistically significant improvements were reported regarding burnout, meaning at work, and workplace satisfaction. Our implementation of SIBR significantly improved perceived IPC and workplace efficiency, which are two important domains of healthcare quality. Future work should examine the impact of SIBR on patient-centered outcomes such as patient experience.
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Affiliation(s)
- Jeremy I Schwartz
- Department of Internal Medicine, Yale School of Medicine, New Haven, CT, USA
| | | | - Geliang Gan
- Yale Center for Analytic Sciences, Yale School of Public Health, New Haven, CT, USA
| | - Yanhong Deng
- Yale Center for Analytic Sciences, Yale School of Public Health, New Haven, CT, USA
| | - Michael H Kaplan
- Department of Medicine, Icahn School of Medicine, New York, NY, USA
| | | | | | | | - Andre N Sofair
- Department of Internal Medicine, Yale School of Medicine, New Haven, CT, USA
| | - Stephen J Huot
- Department of Internal Medicine, Yale School of Medicine, New Haven, CT, USA
| | - Sarwat I Chaudhry
- Department of Internal Medicine, Yale School of Medicine, New Haven, CT, USA
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20
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Benjamins J, de Vet E, Haveman-Nies A. Enhancing interprofessional teamwork between youth care professionals using an electronic health record; a mixed methods intervention study. J Interprof Care 2024; 38:553-563. [PMID: 38414288 PMCID: PMC11018063 DOI: 10.1080/13561820.2024.2314461] [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: 05/11/2023] [Accepted: 01/27/2024] [Indexed: 02/29/2024]
Abstract
We aimed to investigate whether using a shared electronic patient record (EPR-Youth) strengthened interprofessional teamwork among professionals in youth care and child healthcare. Using a mixed-methods design, we compared two partly overlapping samples of professionals, who completed questionnaires before the introduction of EPR-Youth (n = 117) and 24 months thereafter (n = 127). Five components of interprofessional teamwork (interdependence, newly created professional activities, flexibility, collective ownership of goals, and reflection on processes) were assessed for this study. Midway through the study period, focus groups were held with 12 professionals to examine how EPR-Youth contributed to interprofessional teamwork. Professionals reported significantly more flexibility after the introduction of EPR-Youth than before. Professionals scored slightly -but not significantly- more positively on the other components of teamwork. Focus group participants reported that using EPR-Youth strengthened their sense of interdependence and collective ownership of goals, and contributed to newly created professional activities. At baseline, levels of interprofessional teamwork differed between organizations. Focus group participants confirmed these differences and attributed them to differences in facilitation of interprofessional teamwork. Our findings suggest that using EPR-Youth can foster interprofessional teamwork. Organizational differences underline that implementing an EPR alone is inadequate: shared definitions of teamwork and organizational facilities are needed to strengthen interprofessional teamwork.
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Affiliation(s)
- Janine Benjamins
- Icare JGZ, department Jeugdgezondheidszorg, Meppel, the Netherlands
- Chair group Consumption and Healthy Lifestyles, Wageningen University and Research, Wageningen, the Netherlands
| | - Emely de Vet
- Chair group Consumption and Healthy Lifestyles, Wageningen University and Research, Wageningen, the Netherlands
| | - Annemien Haveman-Nies
- Chair group Consumption and Healthy Lifestyles, Wageningen University and Research, Wageningen, the Netherlands
- GGD Noord- en Oost-Gelderland, department Jeugdgezondheid, Warnsveld, the Netherlands
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21
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Carenzo L, Mercalli C, Reitano E, Tartaglione M, Ceolin M, Cimbanassi S, Del Fabbro D, Sammartano F, Cecconi M, Coniglio C, Chiara O, Gamberini L. State of the art of trauma teams in Italy: A nationwide study. Injury 2024; 55:111388. [PMID: 38316572 DOI: 10.1016/j.injury.2024.111388] [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: 07/31/2023] [Revised: 01/05/2024] [Accepted: 01/24/2024] [Indexed: 02/07/2024]
Abstract
Trauma teams play a vital role in providing prompt and specialized care to trauma patients. This study aims to provide a comprehensive description of the presence and organization of trauma teams in Italy. A nationwide cross-sectional epidemiological study was conducted between July and October 2022, involving interviews with 137 designated trauma centers. Centers were stratified based on level: higher specialized trauma centers (CTS), intermediate level trauma centers (CTZ + N) and district general hospital with trauma capacity (CTZ). A standardized structured interview questionnaire was used to gather information on hospital characteristics, trauma team prevalence, activation pathways, structure, components, leadership, education, and governance. Descriptive statistics were used for analysis. Results showed that 53 % of the centers had a formally defined trauma team, with higher percentages in CTS (73 %) compared to CTZ + N (49 %) and CTZ (39 %). The trauma team activation pathway varied among centers, with pre-alerts predominantly received from emergency medical services. The study also highlighted the lack of formally defined massive transfusion protocols in many centers. The composition of trauma teams typically included airway and procedure doctors, nurses, and healthcare assistants. Trauma team leadership was predetermined in 59 % of the centers, with anesthesiologists/intensive care physicians often assuming this role. The study revealed gaps in trauma team education and governance, with a lack of specific training for trauma team leaders and low utilization of simulation-based training. These findings emphasize the need for improvements in trauma management education, governance, and the formalization of trauma teams. This study provides valuable insights that can guide discussions and interventions aimed at enhancing trauma care at both local and national levels in Italy.
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Affiliation(s)
- Luca Carenzo
- Department of Anesthesia and Intensive Care Medicine, IRCCS Humanitas Research Hospital, Via Manzoni 56, 20089, Rozzano (MI), Italy.
| | - Cesare Mercalli
- Humanitas University, Department of Biomedical Sciences, Via Rita Levi Montalcini 4, 20090, Pieve Emanuele, Milan, Italy
| | - Elisa Reitano
- Department of Translational Medicine, University of Eastern Piedmont, Via Solaroli 17, 28100, Novara, Italy
| | - Marco Tartaglione
- Department of Anesthesia, Intensive Care and Prehospital Emergency, Maggiore Hospital Carlo Alberto Pizzardi, Bologna, Italy
| | - Martina Ceolin
- Department of Trauma and Acute Care Surgery, IRCCS Humanitas Research Hospital, Via Manzoni 56, 20089, Rozzano (MI), Italy
| | - Stefania Cimbanassi
- Trauma Team, ASST GOM Niguarda, Piazza Ospedale Maggiore 3, 20162, Milan, Italy; Department of Pathophysiology and Transplants, Università degli Studi di Milano, Via Festa del Perdono 7, 20122, Milan, Italy
| | - Daniele Del Fabbro
- Department of Trauma and Acute Care Surgery, IRCCS Humanitas Research Hospital, Via Manzoni 56, 20089, Rozzano (MI), Italy
| | - Fabrizio Sammartano
- Department of Trauma Surgery, San Carlo Borromeo Hospital, ASST Santi Paolo e Carlo, 20162, Milan, Italy
| | - Maurizio Cecconi
- Department of Anesthesia and Intensive Care Medicine, IRCCS Humanitas Research Hospital, Via Manzoni 56, 20089, Rozzano (MI), Italy; Humanitas University, Department of Biomedical Sciences, Via Rita Levi Montalcini 4, 20090, Pieve Emanuele, Milan, Italy
| | - Carlo Coniglio
- Department of Anesthesia, Intensive Care and Prehospital Emergency, Maggiore Hospital Carlo Alberto Pizzardi, Bologna, Italy
| | - Osvaldo Chiara
- Trauma Team, ASST GOM Niguarda, Piazza Ospedale Maggiore 3, 20162, Milan, Italy; Department of Pathophysiology and Transplants, Università degli Studi di Milano, Via Festa del Perdono 7, 20122, Milan, Italy
| | - Lorenzo Gamberini
- Department of Anesthesia, Intensive Care and Prehospital Emergency, Maggiore Hospital Carlo Alberto Pizzardi, Bologna, Italy
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22
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Loganathan S, Smyth SL, Mykula R, Soleymani Majd H. The role of the multidisciplinary team in surgical management of intractable tubo-ovarian abscess as a late sequelae of challenging Crohn's disease in the modern era: A case report and review of current literature. Int J Gynaecol Obstet 2024; 165:535-541. [PMID: 37882505 DOI: 10.1002/ijgo.15196] [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: 07/23/2023] [Accepted: 09/28/2023] [Indexed: 10/27/2023]
Abstract
Chronic, severe Crohn's disease in a young female patient can result in surgical complexity. The rarity of the presentation of intractable pelvic abscesses within this etiology with additional considerations given to fertility concerns and hence requirement for input from a multi-disciplinary team makes this a vital case in building a consensus for evidence-based surgical management. A 29-year-old nulliparous woman was referred to our tertiary centre for surgical management of Crohn's disease with known tubo-ovarian abscess and abdominoperineal and abdominal wall sinuses. Her previous surgical history included 4 midline laparotomies, subtotal colectomy and proctectomy with stoma formation. The patient underwent egg collection to preserve fertility. This was followed by midline laparotomy and abdominoperineal resection, which involved a retrograde radical modified hysterectomy using the Hudson technique, alongside excision of the perineal sinus, with reconstruction of the perineal defect using an internal pudendal artery perforator gluteal fold flap, and in addition to excision and drainage of the abdominal wall abscess. Involvement was sought from gynecological oncology, colorectal, urology, plastics, stoma, fertility, microbiology, and gastroenterology teams, which enabled successful preservation of end organ function and improvement in patient psychological well-being. This case is a paradigm of surgical challenge, requiring expert gynecological oncology techniques including a retroperitoneal approach, nerve and vessel sparing considerations alongside colorectal and urological procedures. Moreover, we believe that our blueprint for effective multi-disciplinary practice will inform the future management of gynecological surgery. Therefore this report aims to contribute towards the optimum management of the gynecological sequelae of Crohn's disease.
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Affiliation(s)
| | | | - Roman Mykula
- Plastic Surgery, University of Oxford, Oxford, UK
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23
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O'Bryan L, Oxendahl T, Chen X, McDuff D, Segarra S, Wettergreen M, Beier ME, Sabharwal A. Objective Communication Patterns Associated With Team Member Effectiveness in Real-World Virtual Teams. Hum Factors 2024; 66:1414-1430. [PMID: 36562114 DOI: 10.1177/00187208221147341] [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] [Indexed: 06/17/2023]
Abstract
OBJECTIVE We explore the relationships between objective communication patterns displayed during virtual team meetings and established, qualitative measures of team member effectiveness. BACKGROUND A key component of teamwork is communication. Automated measures of objective communication patterns are becoming more feasible and offer the ability to measure and monitor communication in a scalable, consistent and continuous manner. However, their validity in reflecting meaningful measures of teamwork processes are not well established, especially in real-world settings. METHOD We studied real-world virtual student teams working on semester-long projects. We captured virtual team meetings using the Zoom video conferencing platform throughout the semester and periodic surveys comprising peer ratings of team member effectiveness. Leveraging audio transcripts, we examined relationships between objective measures of speaking time, silence gap duration and vocal turn-taking and peer ratings of team member effectiveness. RESULTS Speaking time, speaking turn count, degree centrality and (marginally) speaking turn duration, but not silence gap duration, were positively related to individual-level team member effectiveness. Time in dyadic interactions and interaction count, but not interaction length, were positively related to dyad-level team member effectiveness. CONCLUSION Our study highlights the relevance of objective measures of speaking time and vocal turn-taking to team member effectiveness in virtual project-based teams, supporting the validity of these objective measures and their use in future research. APPLICATION Our approach offers a scalable, easy-to-use method for measuring communication patterns and team member effectiveness in virtual teams and opens the opportunity to study these patterns in a more continuous and dynamic manner.
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Affiliation(s)
| | | | - Xu Chen
- Rice University, Houston, Texas, USA
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24
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Flaherty E, Fulmer T. Using geriatric interprofessional team transformation for primary care to improve the care of older adults in a rural setting. J Am Geriatr Soc 2024; 72 Suppl 2:S1-S3. [PMID: 38038389 DOI: 10.1111/jgs.18669] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2023] [Revised: 08/24/2023] [Accepted: 09/17/2023] [Indexed: 12/02/2023]
Affiliation(s)
- Ellen Flaherty
- Dartmouth Health, Lebanon, New Hampshire, USA
- Geisel School of Medicine at Dartmouth College, Lebanon, New Hampshire, USA
| | - Terry Fulmer
- John A. Hartford Foundation, New York, New York, USA
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25
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Vukmir RB. Medicolegal aspects of documentation and the electronic health record. Med Clin (Barc) 2024; 162:e9-e14. [PMID: 38448298 DOI: 10.1016/j.medcli.2024.01.006] [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: 12/19/2023] [Revised: 01/16/2024] [Accepted: 01/25/2024] [Indexed: 03/08/2024]
Abstract
INTRODUCTION The busiest times in the hospital are often met by the greatest challenges in complete and comprehensive documentation of the patient care event. The near complete transition to the Electronic Health Record (EHR) was to be the solution to a host of provider documentation concerns. It is clear the EHR provides reliability, reproducibility, integration, evidence based decision-making, multidisciplinary contribution across the entire healthcare spectrum. METHODS The use of a consensus of expert opinion supplemented by focused literature review allows a balanced evidence based presentation of data. RESULTS Documentation is not a perfect tool however, as issues with efficiency, reliability, use of shortcut maneuvers and potential for increased medico-legal risk have been raised. The solution is attention to documentation detail, and creation of systems that facilitate excellence. The focus on electronic documentation systems should include continual evaluation, ongoing improvement, involvement of a multidisciplinary patient care team and vendor receptiveness to in EHR development and operations. CONCLUSION The most effective use of the EHR as a risk management tool requires documentation knowledge, targeted analysis, product improvement and co-development of clinical-commercial resource.
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Paxino J, Szabo RA, Marshall S, Story D, Molloy E. What and when to debrief: a scoping review examining interprofessional clinical debriefing. BMJ Qual Saf 2024; 33:314-327. [PMID: 38160060 DOI: 10.1136/bmjqs-2023-016730] [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: 09/14/2023] [Accepted: 12/08/2023] [Indexed: 01/03/2024]
Abstract
INTRODUCTION Clinical debriefing (CD) improves teamwork and patient care. It is implemented across a range of clinical contexts, but delivery and structure are variable. Furthermore, terminology to describe CD is also inconsistent and often ambiguous. This variability and the lack of clear terminology obstructs understanding and normalisation in practice. This review seeks to examine the contextual factors relating to different CD approaches with the aim to differentiate them to align with the needs of different clinical contexts. METHODS Articles describing CD were extracted from Medline, CINAHL, ERIC, PubMed, PsychINFO and Academic Search Complete. Empirical studies describing CD that involved two or more professions were eligible for inclusion. Included papers were charted and analysed using the Who-What-When-Where-Why-How model to examine contextual factors which were then used to develop categories of CD. Factors relating to what prompted debriefing and when debriefing occurred were used to differentiate CD approaches. RESULTS Forty-six papers were identified. CD was identified as either prompted or routine, and within these overarching categories debriefing was further differentiated by the timing of the debrief. Prompted CD was either immediate or delayed and routine CD was postoperative or end of shift. Some contextual factors were unique to each category while others were relatively heterogeneous. These categories help clarify the alignment between the context and the intention of CD. CONCLUSIONS The proposed categories offer a practical way to examine and discuss CD which may inform decisions about implementation. By differentiating CD according to relevant contextual factors, these categories may reduce confusion which currently hinders discourse and implementation. The findings from this review promote context-specific language and a shift away from conceptions of CD that embody a one-size-fits-all approach.
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Affiliation(s)
- Julia Paxino
- Department of Medical Education, The University of Melbourne, Melbourne, Victoria, Australia
| | - Rebecca A Szabo
- Department of Medical Education, The University of Melbourne, Melbourne, Victoria, Australia
- Department of Obstetrics and Gynaecology, The University of Melbourne, Melbourne, Victoria, Australia
- Department of Critical Care, The University of Melbourne, Melbourne, Victoria, Australia
| | - Stuart Marshall
- Department of Critical Care, The University of Melbourne, Melbourne, Victoria, Australia
| | - David Story
- Department of Critical Care, The University of Melbourne, Melbourne, Victoria, Australia
| | - Elizabeth Molloy
- Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Melbourne, Victoria, Australia
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27
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Ohta R, Nitta T, Shimizu A, Sano C. Role of family medicine physicians in providing nutrition support to older patients admitted to orthopedics departments: a grounded theory approach. BMC Prim Care 2024; 25:121. [PMID: 38641569 PMCID: PMC11027398 DOI: 10.1186/s12875-024-02379-4] [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] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/12/2023] [Accepted: 04/09/2024] [Indexed: 04/21/2024]
Abstract
BACKGROUND Care of older adults requires comprehensive management and control of systemic diseases, which can be effectively managed by family physicians. Complicated medical conditions in older patients admitted to orthopedic departments (orthopedic patients) necessitate interprofessional collaboration. Nutrition is one of the essential components of management involved in improving the systemic condition of older patients. Nutrition support teams play an important role in nutrition management and can be supported by family physicians. However, the role of family physicians in nutrition support teams is not well documented. This study aimed to investigate the role of family physicians in supporting nutrition management in orthopedic patients. METHODS This qualitative study was conducted between January and June 2023 using constructivist grounded theory methodology. Eight family medicine physicians, three orthopedic surgeons, two nurses, two pharmacists, four rehabilitation therapists, four nutritionists, and one laboratory technician working in Japanese rural hospitals participated in the research. Data collection was performed through ethnography and semi-structured interviews. The analysis was performed iteratively during the study. RESULTS Using a grounded theory approach, four theories were developed regarding family physicians' role in providing nutrition support to orthopedic patients: hierarchical and relational limitation, delay of onset and detection of the need for geriatric care in orthopedic patients, providing effective family medicine in hospitals, and comprehensive management through the nutrition support team. CONCLUSIONS The inclusion of family physicians in nutrition support teams can help with early detection of the rapid deterioration of orthopedic patients' conditions, and comprehensive management can be provided by nutrition support teams. In rural primary care settings, family physicians play a vital role in providing geriatric care in community hospitals in collaboration with specialists. Family medicine in hospitals should be investigated in other settings for better geriatric care and to drive mutual learning among healthcare professionals.
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Affiliation(s)
- Ryuichi Ohta
- Community Care, Unnan City Hospital, 96-1 Iida, Daito-cho, Unnan, Shimane, 699-1221, Japan.
| | - Tachiko Nitta
- Community Care, Unnan City Hospital, 96-1 Iida, Daito-cho, Unnan, Shimane, 699-1221, Japan
| | - Akiko Shimizu
- Community Care, Unnan City Hospital, 96-1 Iida, Daito-cho, Unnan, Shimane, 699-1221, Japan
| | - Chiaki Sano
- Department of Community Medicine Management, Faculty of Medicine, Shimane University, 89-1 Enya cho, Izumo, Shimane, 693-8501, Japan
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Ambrose JW, Catchpole K, Evans HL, Nemeth LS, Layne DM, Nichols M. Healthcare team resilience during COVID-19: a qualitative study. BMC Health Serv Res 2024; 24:459. [PMID: 38609968 PMCID: PMC11010334 DOI: 10.1186/s12913-024-10895-3] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2023] [Accepted: 03/25/2024] [Indexed: 04/14/2024] Open
Abstract
BACKGROUND Resilience, in the field of Resilience Engineering, has been identified as the ability to maintain the safety and the performance of healthcare systems and is aligned with the resilience potentials of anticipation, monitoring, adaptation, and learning. In early 2020, the COVID-19 pandemic challenged the resilience of US healthcare systems due to the lack of equipment, supply interruptions, and a shortage of personnel. The purpose of this qualitative research was to describe resilience in the healthcare team during the COVID-19 pandemic with the healthcare team situated as a cognizant, singular source of knowledge and defined by its collective identity, purpose, competence, and actions, versus the resilience of an individual or an organization. METHODS We developed a descriptive model which considered the healthcare team as a unified cognizant entity within a system designed for safe patient care. This model combined elements from the Patient Systems Engineering Initiative for Patient Safety (SEIPS) and the Advanced Team Decision Making (ADTM) models. Using a qualitative descriptive design and guided by our adapted model, we conducted individual interviews with healthcare team members across the United States. Data were analyzed using thematic analysis and extracted codes were organized within the adapted model framework. RESULTS Five themes were identified from the interviews with acute care professionals across the US (N = 22): teamwork in a pressure cooker, consistent with working in a high stress environment; healthcare team cohesion, applying past lessons to present challenges, congruent with transferring past skills to current situations; knowledge gaps, and altruistic behaviors, aligned with sense of duty and personal responsibility to the team. Participants' described how their ability to adapt to their environment was negatively impacted by uncertainty, inconsistent communication of information, and emotions of anxiety, fear, frustration, and stress. Cohesion with co-workers, transferability of skills, and altruistic behavior enhanced healthcare team performance. CONCLUSION Working within the extreme unprecedented circumstances of COVID-19 affected the ability of the healthcare team to anticipate and adapt to the rapidly changing environment. Both team cohesion and altruistic behavior promoted resilience. Our research contributes to a growing understanding of the importance of resilience in the healthcare team. And provides a bridge between individual and organizational resilience.
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Affiliation(s)
- John W Ambrose
- College of Nursing, Medical University of South Carolina, Charleston, SC, USA.
| | - Ken Catchpole
- Department of Anesthesia and Perioperative Medicine, College of Medicine, Medical University of South Carolina, Charleston, SC, USA
| | - Heather L Evans
- Department of Surgery, College of Medicine, Medical University of South Carolina, Charleston, SC, USA
| | - Lynne S Nemeth
- College of Nursing, Medical University of South Carolina, Charleston, SC, USA
| | - Diana M Layne
- College of Nursing, Medical University of South Carolina, Charleston, SC, USA
| | - Michelle Nichols
- College of Nursing, Medical University of South Carolina, Charleston, SC, USA
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Bloomfield K, Hikaka J, Brookes J, Tatton A, Calvert C, Wu Z, Boyd M, Peri K, Bramley D, Connolly MJ. Changing the script: medicine optimisation recommendations made during proactive multidisciplinary meetings with older adults. N Z Med J 2024; 137:96-98. [PMID: 38603794 DOI: 10.26635/6965.6443] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/13/2024]
Affiliation(s)
- Katherine Bloomfield
- Faculty of Medical and Health Sciences, The University of Auckland, Takapuna, New Zealand; Te Whatu Ora Waitematā, Auckland, New Zealand
| | - Joanna Hikaka
- Faculty of Medical and Health Sciences, The University of Auckland, Takapuna, New Zealand
| | | | - Annie Tatton
- Faculty of Medical and Health Sciences, The University of Auckland, Takapuna, New Zealand
| | - Cheryl Calvert
- Te Whatu Ora Te Toka Tumai, Auckland, New Zealand; Te Whatu Ora Counties Manukau, Auckland, New Zealand
| | - Zhenqiang Wu
- Faculty of Medical and Health Sciences, The University of Auckland, Takapuna, New Zealand
| | - Michal Boyd
- Faculty of Medical and Health Sciences, The University of Auckland, Takapuna, New Zealand
| | - Kathy Peri
- Faculty of Medical and Health Sciences, The University of Auckland, Takapuna, New Zealand
| | | | - Martin J Connolly
- Faculty of Medical and Health Sciences, The University of Auckland, Takapuna, New Zealand; Te Whatu Ora Waitematā, Auckland, New Zealand
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Frosch ZAK, Meshack C, Meeker C, Varshavsky-Yanovsky A, Khanal R, Bromberg M, Chandar A, Quien E, Carter J, Nakhoda SK, Messmer M, Montgomery C, Incorvati JA, Ali ND, Styler MJ, Fang CY. YIA24-002: Patients' Perspectives on Being Treated by Multiple Care Teams for Autologous Transplant/CAR-T Eligible Lymphoma and Multiple Myeloma. J Natl Compr Canc Netw 2024; 22:YIA24-002. [PMID: 38580229 DOI: 10.6004/jnccn.2023.7123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/07/2024]
Affiliation(s)
| | | | | | | | - Rashmi Khanal
- 1Fox Chase Cancer Center, Philadelphia PA
- 2Temple University Hospital, Philadelphia, PA
| | | | | | | | | | | | | | | | | | - Nadia D Ali
- 2Temple University Hospital, Philadelphia, PA
| | - Michael J Styler
- 1Fox Chase Cancer Center, Philadelphia PA
- 2Temple University Hospital, Philadelphia, PA
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Price B. Understanding and investigating potential problematic behaviour towards colleagues. Nurs Manag (Harrow) 2024; 31:34-41. [PMID: 38240040 DOI: 10.7748/nm.2024.e2115] [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] [Accepted: 11/15/2023] [Indexed: 04/05/2024]
Abstract
Behaviour towards colleagues within the nursing team that undermines teamwork and conflicts with standards and policies can be described as problematic. It is important that nurse managers understand and investigate potential problematic behaviour towards colleagues, particularly in today's healthcare environment where team cohesion and morale are constantly under threat. In this article, the author highlights the challenges for nurse managers and describes the sensitive and respectful exploratory process they need to undertake. Nurses' behaviours are underpinned by beliefs, values and attitudes so investigating potential problematic behaviour warrants an exploration of these aspects with individual nurses and with the nursing team. Therefore, the author also suggests a way for nurse managers to conduct a collective exploration of the team's values.
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Biringer A, Morson N, Walji S, Tregaskiss N, Merritt S, Makuwaza T, Forte M. Recreating the village: the patient experience with a hybrid model of Group Perinatal Care (GPPC) in an academic family health team. BMC Pregnancy Childbirth 2024; 24:227. [PMID: 38566095 PMCID: PMC10986064 DOI: 10.1186/s12884-024-06405-2] [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: 09/05/2023] [Accepted: 03/11/2024] [Indexed: 04/04/2024] Open
Abstract
BACKGROUND Group prenatal care (GPC) has been shown to have a positive impact on social support, patient knowledge and preparedness for birth. We developed an interprofessional hybrid model of care whereby the group perinatal care (GPPC) component was co-facilitated by midwives (MW) and family medicine residents (FMR) and alternating individual visits were provided by family physicians (FP's) within our academic family health team (FHT) In this qualitative study, we sought to explore the impact of this program and how it supports patients through pregnancy and the early newborn period. METHODS Qualitative study that was conducted using semi-structured telephone interviews with 18 participants who had completed GPPC in the Mount Sinai Academic Family Health Team in Toronto, Canada and delivered between November 2016 and October 2018. Interviews were audio-recorded and transcribed verbatim. Thematic analysis was conducted by team members using grounded theory. RESULTS Four over-arching themes emerged from the data: (i) Participants highly valued information they received from multiple trusted sources, (ii) Participants felt well cared for by the collaborative and coordinated interprofessional team, (iii) The design of GPPC enabled a shared experience, allowing for increased support of the pregnant person, and (iv) GPPC facilitated a supportive transition into the community which positively impacted participants' emotional well- being. CONCLUSIONS The four constructs of social support (emotional, informational, instrumental and appraisal) were central to the value that participants found in GPPC. This support from the team of healthcare providers, peers and partners had a positive impact on participants' mental health and helped them face the challenges of their transition to parenthood.
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Affiliation(s)
- Anne Biringer
- Ray D. Wolfe Department of Family Medicine, Sinai Health, 60 Murray Street, Box 25, Toronto, ON, M5T 3L9, Canada.
- Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada.
| | - Natalie Morson
- Ray D. Wolfe Department of Family Medicine, Sinai Health, 60 Murray Street, Box 25, Toronto, ON, M5T 3L9, Canada
- Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada
| | - Sakina Walji
- Ray D. Wolfe Department of Family Medicine, Sinai Health, 60 Murray Street, Box 25, Toronto, ON, M5T 3L9, Canada
- Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada
| | - Natalie Tregaskiss
- Ray D. Wolfe Department of Family Medicine, Sinai Health, 60 Murray Street, Box 25, Toronto, ON, M5T 3L9, Canada
| | - Susannah Merritt
- Ray D. Wolfe Department of Family Medicine, Sinai Health, 60 Murray Street, Box 25, Toronto, ON, M5T 3L9, Canada
| | - Tutsirai Makuwaza
- Ray D. Wolfe Department of Family Medicine, Sinai Health, 60 Murray Street, Box 25, Toronto, ON, M5T 3L9, Canada
- Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada
| | - Milena Forte
- Ray D. Wolfe Department of Family Medicine, Sinai Health, 60 Murray Street, Box 25, Toronto, ON, M5T 3L9, Canada
- Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada
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Hellinger A, Hörscher D, Biber FC, Haasenritter J, Jost K, Kreuzer T, Müller HH, Wächtershäuser EM, Weber J, Weise C, Opitz E. [Safety of patient care on an interprofessional training ward in visceral surgery]. Chirurgie (Heidelb) 2024; 95:299-306. [PMID: 38319344 DOI: 10.1007/s00104-024-02034-9] [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] [Subscribe] [Scholar Register] [Accepted: 01/09/2024] [Indexed: 02/07/2024]
Abstract
BACKGROUND Interprofessional training wards (ITW) are increasingly being integrated into teaching and training concepts in visceral surgery clinics. OBJECTIVE How safe is patient care on an ITW in visceral surgery? MATERIAL AND METHODS Data collection took place from November 2021 to December 2022. In this nonrandomized prospective evaluation study the frequency and severity of adverse events (AE) in 3 groups of 100 patients each in a tertiary referral center hospital for visceral surgery were investigated. The groups consisted of patients on the ITW and on the conventional ward before and after implementation of the ITW. The Global Trigger Tool (GTT) was used to search for AE. Simultaneously, a survey of the treatment was conducted according to the Picker method to measure patient reported outcome. RESULTS Baseline characteristics and clinical outcome parameters of the patients in the three groups were comparable. The GTT analysis found 74 nonpreventable and 5 preventable AE in 63 (21%) of the patients and 12 AE occurred before the hospital stay. During the hospital stay 50 AE occurred in the operating theater and 17 on the conventional ward. None of the five preventable AE (in 1.7% of the patients) was caused by the treatment on the ITW. Patients rated the safety on the ITW better than in 90% of the hospitals included in the Picker benchmark cohort and as good as on the normal ward. CONCLUSION The GTT-based data as well as from the patients' point of view show that patient care on a carefully implemented ITW in visceral surgery is safe.
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Affiliation(s)
- A Hellinger
- Klinik für Allgemein‑, Viszeral‑, Endokrine und Onkologische Chirurgie, Klinikum Fulda gAG, Campus Fulda der Universitätsmedizin Marburg, Pacelliallee 4, 36043, Fulda, Deutschland.
| | - D Hörscher
- Klinik für Allgemein‑, Viszeral‑, Endokrine und Onkologische Chirurgie, Klinikum Fulda gAG, Campus Fulda der Universitätsmedizin Marburg, Pacelliallee 4, 36043, Fulda, Deutschland
| | - F C Biber
- Klinik für Allgemein‑, Viszeral‑, Endokrine und Onkologische Chirurgie, Klinikum Fulda gAG, Campus Fulda der Universitätsmedizin Marburg, Pacelliallee 4, 36043, Fulda, Deutschland
| | - J Haasenritter
- Institut für Allgemeinmedizin, Philipps-Universität Marburg, Marburg, Deutschland
| | - K Jost
- Klinik für Allgemein‑, Viszeral‑, Endokrine und Onkologische Chirurgie, Klinikum Fulda gAG, Campus Fulda der Universitätsmedizin Marburg, Pacelliallee 4, 36043, Fulda, Deutschland
| | - T Kreuzer
- Studiendekanat des Fachbereichs Medizin, Philipps-Universität Marburg, Marburg, Deutschland
| | - H-H Müller
- Institut für Medizinische Bioinformatik und Biostatistik, Philipps-Universität Marburg, Marburg, Deutschland
| | - E M Wächtershäuser
- Klinik für Allgemein‑, Viszeral‑, Endokrine und Onkologische Chirurgie, Klinikum Fulda gAG, Campus Fulda der Universitätsmedizin Marburg, Pacelliallee 4, 36043, Fulda, Deutschland
| | - J Weber
- Apotheke, Klinikum Fulda gAG, Campus Fulda der Universitätsmedizin Marburg, Fulda, Deutschland
| | - C Weise
- Medizinische Klinik III - Nephrologie, Klinikum Fulda gAG, Campus Fulda der Universitätsmedizin Marburg, Fulda, Deutschland
| | - E Opitz
- Studiendekanat des Fachbereichs Medizin, Philipps-Universität Marburg, Marburg, Deutschland
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Dahl VN, Burke A, Fløe A, Bruchfeld J, Schön T, Wejse CM, Andersen AB, Svensson E, van Ingen J, Davies Forsman L. Advantages and limitations of virtual multi-disciplinary team meetings on difficult-to-treat mycobacteria. Int J Tuberc Lung Dis 2024; 28:212-213. [PMID: 38563342 DOI: 10.5588/ijtld.23.0551] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/04/2024] Open
Affiliation(s)
- V N Dahl
- Department of Infectious Diseases, Aarhus University Hospital, Aarhus, Denmark, International Reference Laboratory of Mycobacteriology, Statens Serum Institut, Copenhagen, Denmark
| | - A Burke
- Department of Thoracic Medicine, The Prince Charles Hospital, Brisbane, QLD, Australia
| | - A Fløe
- Department of Respiratory Diseases, Aarhus University Hospital, Aarhus, Denmark; Departments of
| | - J Bruchfeld
- Infectious Diseases, and, Medicine, Division of Infectious Diseases, Karolinska Institutet, Solna, Sweden
| | - T Schön
- Infectious Diseases, and, Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden, Department of Infectious Diseases, Region Östergötland and Kalmar County Hospital, Linköping University, Linköping, Sweden
| | - C M Wejse
- Department of Infectious Diseases, Aarhus University Hospital, Aarhus, Denmark
| | - A B Andersen
- Department of Infectious Diseases, Rigshospitalet, Copenhagen, Denmark
| | - E Svensson
- International Reference Laboratory of Mycobacteriology, Statens Serum Institut, Copenhagen, Denmark
| | - J van Ingen
- Department of Medical Microbiology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - L Davies Forsman
- Infectious Diseases, and, Medicine, Division of Infectious Diseases, Karolinska Institutet, Solna, Sweden
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Zhang Y, Wu Y, Li X, Turner SR, Zheng B. Increased team familiarity for surgical time savings: Effective primarily in complex surgical cases. Surgeon 2024; 22:80-87. [PMID: 37880073 DOI: 10.1016/j.surge.2023.10.005] [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: 07/06/2023] [Revised: 10/05/2023] [Accepted: 10/10/2023] [Indexed: 10/27/2023]
Abstract
BACKGROUND Cohesion between team members is critical for surgical performance. Our previous study has shown that the experience of working together (measured by Team Familiarity Score, TFS) helps reduce procedure time (PT). However, that conclusion was found in a relatively small sample size. With a large dataset including mixed general surgical procedures, we hypothesize that team familiarity makes a significant contribution to the improvement of team performance in complex cases, rather than in medium or basic surgical cases, measured by the procedure time, length of hospital stays (LOS), and surgical cost (COST). STUDY DESIGN Patient demographics, operation, and patient outcome data of 922 general surgery cases were included. The cases were divided into three subgroups, including basic, medium, and complex surgical procedures. TFS and an Index of Difficulty of Surgery (IDS) were calculated for each procedure. Simple linear regression and random forest regressions were performed to analyze the association between surgical outcomes and all included independent variables (TFS, IDS, patient age, patient weight, and team size). RESULTS When applied to complex cases, procedure time (r = -0.21) and cost (r = -0.23) dropped as TFS increases. In basic and medium surgical cases, increasing team familiarity failed to shorten the procedure time on average. CONCLUSION Team familiarity is more important in complex cases because there is greater potential for improvement through team collaboration compared to basic and medium cases. Caution will be needed when applying team familiarity scores for examining surgical team performance in large databases with skewed to basic surgical cases.
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Affiliation(s)
- Yao Zhang
- Department of Surgery, University of Alberta, Canada
| | - Yun Wu
- Department of Surgery, University of Alberta, Canada
| | - Xinming Li
- Department of Mechanic Engineering, University of Alberta, Canada
| | | | - Bin Zheng
- Department of Surgery, University of Alberta, Canada.
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Sagoschen I, Scibior B, Farmakis IT, Keller K, Graafen D, Griemert EV, Vosseler M, Treede H, Münzel T, Knorr M, Gori T, Konstantinides S, Hobohm L. A multidisciplinary pulmonary embolism response team (PERT): first experience from a single center in Germany. Clin Res Cardiol 2024; 113:581-590. [PMID: 38112742 PMCID: PMC10954947 DOI: 10.1007/s00392-023-02364-4] [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: 08/20/2023] [Accepted: 12/07/2023] [Indexed: 12/21/2023]
Abstract
BACKGROUND Over the last few years, the concept of multidisciplinary pulmonary embolism response teams (PERTs) has emerged to encounter the increasing variety and complexity in managing acute pulmonary embolism (PE). PURPOSE To investigate PERT's composition and added clinical value in a university center in Germany. METHODS Over 4 years (01/2019-11/2022), patients with confirmed PE were enrolled in a prospective single-center cohort study (PERT Mainz). We investigated the composition of PERT and compared, after propensity score matching, patients with acute PE before and after the initiation of PERT at our Medical University Centre. The primary outcome was in-hospital PE-related mortality. RESULTS From 2019 to 2022, 88 patients with acute PE with a PERT decision were registered. Of those, 13 (14.8%) patients died during the in-hospital stay. Patients evaluated by a PERT had a median age of 68; 48.9% were females, and 21.7% suffered from malignancy. Right ventricular dysfunction was present in 76.1% of all patients. In total, 42.0% were classified as intermediate-high-risk PE and 11.4% as high-risk PE. First PERT contact mainly originated from emergency departments (33.3%) and intensive care units (30.0%), followed by chest pain units (21.3%) and regular wards (12.0%). The participation rate of medical specialties demonstrated that cardiologists (100%) or cardiac/vascular surgeons (98.6%) were included in almost all PERT consultations, followed by radiologists (95.9%) and anesthesiologists (87.8%). Compared to the PERT era, more patients in the pre-PERT era were classified as simplified pulmonary embolism severity index (sPESI) ≥ 1 (78.4% vs 71.6%) and as high-risk PE according to ESC 2019 guidelines (18.2% vs. 11.4%). In the pre-PERT era, low- and intermediate-low patients with PE received more frequently advanced reperfusion therapies such as systemic thrombolysis or surgical embolectomy compared to the PERT era (10.7% vs. 2.5%). Patients in the pre-PERT were found to have a considerably higher all-cause mortality and PE-related mortality rate (31.8% vs. 14.8%) compared to patients in the PERT era (22.7% vs. 13.6%). After propensity matching (1:1) by including parameters as age, sex, sPESI, and ESC risk classes, univariate regression analyses demonstrated that the PE management based on a PERT decision was associated with lower risk of all-cause mortality (OR, 0.37 [95%CI 0.18-0.77]; p = 0.009). For PE-related mortality, a tendency for reduction was observed (OR, 0.54 [95%CI 0.24-1.18]; p = 0.121). CONCLUSION PERT implementation was associated with a lower risk of all-cause mortality rate in patients with acute PE. Large prospective studies are needed further to explore the impact of PERTs on clinical outcomes.
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Affiliation(s)
- Ingo Sagoschen
- Department of Cardiology, University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany
| | - Barbara Scibior
- Center for Thrombosis and Hemostasis (CTH), University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
| | - Ioannis T Farmakis
- Center for Thrombosis and Hemostasis (CTH), University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
| | - Karsten Keller
- Department of Cardiology, University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany
- Center for Thrombosis and Hemostasis (CTH), University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
- Medical Clinic VII, University Hospital Heidelberg, Heidelberg, Germany
| | - Dirk Graafen
- Department of Diagnostic and Interventional Radiology, University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany
| | - Eva-Verena Griemert
- Department of Anesthesiology, University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany
| | - Markus Vosseler
- Department of Cardiology, University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany
| | - Hendrik Treede
- Department for Cardiac and Vascular Surgery, University Medical Center Mainz of the Johannes Gutenberg-University Mainz, Mainz, Germany
| | - Thomas Münzel
- Department of Cardiology, University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany
| | - Maike Knorr
- Department of Cardiology, University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany
| | - Tommaso Gori
- Department of Cardiology, University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany
| | - Stavros Konstantinides
- Center for Thrombosis and Hemostasis (CTH), University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
- Department of Cardiology, Democritus University of Thrace, Komotini, Greece
| | - Lukas Hobohm
- Department of Cardiology, University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany.
- Center for Thrombosis and Hemostasis (CTH), University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany.
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Philipps A, Paruschke L. Inside regular lab meetings: The social construction of a research team and ideas in optical physics. Soc Stud Sci 2024; 54:257-280. [PMID: 37606215 PMCID: PMC10981201 DOI: 10.1177/03063127231188132] [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] [Indexed: 08/23/2023]
Abstract
Scheduled meetings are associated with standardization and understood as a bureaucratic form of coordination, control, and rule observation. In attending assemblies of a research team in optical physics for over a year, we found regular lab meetings are compulsory for all their members and are an avenue to announce and give information about new and changed institutional regulations, to supervise members' activities and their output. But more importantly, they offer an environment for continuous thinking through talk that goes beyond announcements. Meetings are a protected space to comment on conducted research, to amend experimental set-ups, to test argumentation, and to outline potentially new directions of research. By participating in these practices, researchers, become members of the team as they get acquainted with the ongoing research; its scope, problems, and limits; the solutions at hand; and the know-how within the team. In functional terms, observed internal meetings seem to (a) ensure that the research team focuses on a specific research agenda by talking about and discussing ongoing research in the lab, (b) be used to discuss and assure the quality of the team's research output, and (c) generate and inspire new research within the team. Our findings suggest regular internal meetings, like shop talk, are constitutive of doing science by talking about ongoing research.
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Green M. Building support for team-based care. Can Fam Physician 2024; 70:288. [PMID: 38627008 DOI: 10.46747/cfp.7004288] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/19/2024]
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Donald EM, Oren D, DeFilippis EM, Rubinstein G, Moeller CM, Lee HY, Maldonado A, Portera MV, Fuselier B, Jackson R, Clerkin KJ, Fried JA, Raikhelkar J, Lee SH, Latif F, Lytrivi ID, Zuckerman WA, Richmond ME, Sayer G, Uriel N. Long-term outcomes for pediatric heart transplant recipients transitioning to adult care teams. Clin Transplant 2024; 38:e15282. [PMID: 38546027 DOI: 10.1111/ctr.15282] [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: 11/22/2023] [Revised: 01/08/2024] [Accepted: 02/19/2024] [Indexed: 04/20/2024]
Abstract
BACKGROUND There are limited data evaluating the success of a structured transition plan specifically for pediatric heart transplant (HT) recipients following their transfer of care to an adult specialist. We sought to identify risk factors for poor adherence, graft failure, and mortality following the transfer of care to adult HT care teams. METHODS We retrospectively reviewed all patients who underwent transition from the pediatric to adult HT program at our center between January 2011 and June 2021. Demographic characteristics, comorbid conditions, and psychosocial history were collected at the time of HT, the time of transition, and the most recent follow-up. Adverse events including mortality, graft rejection, infection, and renal function were also captured before and after the transition. RESULTS Seventy-two patients were identified (54.1% male, 54.2% Caucasian). Mean age at the time of transition was 23 years after a median of 11.6 years in the pediatric program. The use of calcineurin inhibitors was associated with reduced mortality (HR .04, 95% CI .0-.6, p = .015), while prior psychiatric hospitalization (HR 45.3, 95% CI, 6.144-333.9, p = .0001) was associated with increased mortality following transition. Medication nonadherence and young age at the time of transition were markers for high-risk individuals prior to the transition of care. CONCLUSIONS Transition of HT recipients from a pediatric program to an adult program occurs during a vulnerable time of emerging adulthood, and we have identified risk factors for mortality following transition. Development of a formalized transition plan with a large multidisciplinary team with focused attention on high-risk patients, including those with psychiatric comorbidities, may favorably influence outcomes.
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Affiliation(s)
- Elena M Donald
- Department of Medicine, Division of Cardiology New York Presbyterian Hospital/Columbia University Irving Medical Center, New York, New York, USA
| | - Daniel Oren
- Department of Medicine, Division of Cardiology New York Presbyterian Hospital/Columbia University Irving Medical Center, New York, New York, USA
| | - Ersilia M DeFilippis
- Department of Medicine, Division of Cardiology New York Presbyterian Hospital/Columbia University Irving Medical Center, New York, New York, USA
| | - Gal Rubinstein
- Department of Medicine, Division of Cardiology New York Presbyterian Hospital/Columbia University Irving Medical Center, New York, New York, USA
| | - Catherine M Moeller
- Department of Medicine, Division of Cardiology New York Presbyterian Hospital/Columbia University Irving Medical Center, New York, New York, USA
| | - Hannah Y Lee
- Department of Pediatrics, Division of Cardiology, New York Presbyterian Hospital/Morgan Stanley Children's Hospital, New York, New York, USA
| | - Alejandro Maldonado
- Department of Medicine, Division of Cardiology New York Presbyterian Hospital/Columbia University Irving Medical Center, New York, New York, USA
| | - Mary Virginia Portera
- Department of Medicine, Division of Cardiology New York Presbyterian Hospital/Columbia University Irving Medical Center, New York, New York, USA
| | - Byron Fuselier
- Department of Medicine, Division of Cardiology New York Presbyterian Hospital/Columbia University Irving Medical Center, New York, New York, USA
| | - Ruslana Jackson
- Department of Medicine, Division of Cardiology New York Presbyterian Hospital/Columbia University Irving Medical Center, New York, New York, USA
| | - Kevin J Clerkin
- Department of Medicine, Division of Cardiology New York Presbyterian Hospital/Columbia University Irving Medical Center, New York, New York, USA
| | - Justin A Fried
- Department of Medicine, Division of Cardiology New York Presbyterian Hospital/Columbia University Irving Medical Center, New York, New York, USA
| | - Jayant Raikhelkar
- Department of Medicine, Division of Cardiology New York Presbyterian Hospital/Columbia University Irving Medical Center, New York, New York, USA
| | - Sun Hi Lee
- Department of Medicine, Division of Cardiology New York Presbyterian Hospital/Columbia University Irving Medical Center, New York, New York, USA
| | - Farhana Latif
- Department of Medicine, Division of Cardiology New York Presbyterian Hospital/Columbia University Irving Medical Center, New York, New York, USA
| | - Irene D Lytrivi
- Department of Pediatrics, Division of Cardiology, New York Presbyterian Hospital/Morgan Stanley Children's Hospital, New York, New York, USA
| | - Warren A Zuckerman
- Department of Pediatrics, Division of Cardiology, New York Presbyterian Hospital/Morgan Stanley Children's Hospital, New York, New York, USA
| | - Marc E Richmond
- Department of Pediatrics, Division of Cardiology, New York Presbyterian Hospital/Morgan Stanley Children's Hospital, New York, New York, USA
| | - Gabriel Sayer
- Department of Medicine, Division of Cardiology New York Presbyterian Hospital/Columbia University Irving Medical Center, New York, New York, USA
| | - Nir Uriel
- Department of Medicine, Division of Cardiology New York Presbyterian Hospital/Columbia University Irving Medical Center, New York, New York, USA
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Gabriel J, Gabriel A, Shafik L, Alanbuki A, Larner T. Artificial intelligence in the urology multidisciplinary team meeting: can ChatGPT suggest European Association of Urology guideline-recommended prostate cancer treatments? BJU Int 2024; 133:407-409. [PMID: 38009391 DOI: 10.1111/bju.16240] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2023]
Affiliation(s)
- Joseph Gabriel
- Department of Urology, Princess Royal Hospital, Haywards Heath, Sussex, UK
| | | | - Lidia Shafik
- Department of Medicine, Frimley Health NHS Foundation Trust, Frimley, UK
| | - Ammar Alanbuki
- Department of Urology, Princess Royal Hospital, Haywards Heath, Sussex, UK
| | - Tim Larner
- Department of Urology, Princess Royal Hospital, Haywards Heath, Sussex, UK
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Chambers AJ, Enoch JF, Wong J, Spigelman A. When teams disagree: Investigating the incidence and causes of dissent occurring in cancer multidisciplinary team meetings. Asia Pac J Clin Oncol 2024; 20:234-239. [PMID: 36670329 DOI: 10.1111/ajco.13919] [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: 09/18/2022] [Revised: 12/05/2022] [Accepted: 12/26/2022] [Indexed: 01/22/2023]
Abstract
AIM Multidisciplinary teams (MDT) are commonly involved in the care of patients with cancer. How frequently dissent occurs within MDT has not been studied. This study aimed to determine how frequently dissent was documented in cancer MDT meetings at our institution, the reasons for this, and the opinions of MDT members on how dissent should be documented and communicated. METHODS A retrospective review of records from cancer MDT meetings at our institution from 2016 to 2020 was performed to identify cases where dissent was documented and the reasons for this. MDT members were invited to complete an online survey assessing their perceptions of how frequently dissent occurred, how comfortable they felt voicing dissenting opinions, and their opinions on how dissent should be documented and communicated. RESULTS Dissent was recorded in 30 of 7737 MDT case discussions (0.39%). The incidence of dissent varied from 0 to 1.2% between cancer streams. The most common reason for dissent involved the role of surgery. 27% of survey respondents felt either very or somewhat uncomfortable voicing dissenting opinions. Only 3% felt that dissent should not be documented, and none that it should not be communicated in some way, although there were wide ranging of views on how this should occur. CONCLUSION Dissent was rarely documented within cancer MDT meetings at our institution, likely due to underreporting. Measuring the incidence of dissent within an MDT may be a useful performance metric. MDT should develop policies for how dissent should be managed, documented, and communicated.
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Affiliation(s)
- Anthony J Chambers
- Department of Surgical Oncology, St Vincent's Hospital Sydney, Sydney, New South Wales, Australia
- School of Clinical Medicine, St Vincent's Healthcare Clinical Campus, Faculty of Medicine and Health, UNSW Sydney, Sydney, New South Wales, Australia
| | - Jade F Enoch
- Department of Surgical Oncology, St Vincent's Hospital Sydney, Sydney, New South Wales, Australia
- School of Clinical Medicine, St Vincent's Healthcare Clinical Campus, Faculty of Medicine and Health, UNSW Sydney, Sydney, New South Wales, Australia
| | - Jasmine Wong
- Department of Surgical Oncology, St Vincent's Hospital Sydney, Sydney, New South Wales, Australia
| | - Allan Spigelman
- School of Clinical Medicine, St Vincent's Healthcare Clinical Campus, Faculty of Medicine and Health, UNSW Sydney, Sydney, New South Wales, Australia
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Leeper WR, James N. Trauma Bay Evaluation and Resuscitative Decision-Making. Surg Clin North Am 2024; 104:293-309. [PMID: 38453303 DOI: 10.1016/j.suc.2024.01.002] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/09/2024]
Abstract
The reader of this article will now have the ability to reflect on all aspects of high-quality trauma bay care, from resuscitation to diagnosis and leadership to debriefing. Although there is no replacement for experience, both clinically and in a simulation environment, trauma clinicians are encouraged to make use of this article both as a primer at the beginning of a trauma rotation and a reference text to revisit after difficult cases in the trauma bay. Also, periods of reflection seem appropriate in the busy but, of course, rewarding career in trauma care.
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Affiliation(s)
- William Robert Leeper
- Department of Surgery, Western University, Victoria Campus, London Health Sciences Center, Room E2-215, 800 Commissioners Road East, London, Ontario N6A 5W9, Canada; Trauma Program at London Health Sciences Center, Division of Critical Care, Department of Surgery, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada.
| | - Nicholas James
- London Health Sciences Center, Victoria Campus, Room E2-214, 800 Commissioners Road East, London, Ontario N6A 5W9, Canada; Trauma Program at London Health Sciences Center, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
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Schouten L, Kaiser U, Petzke F. [Interdisciplinary multimodal assessment : Interprofessional interaction in team meetings and final talks]. Schmerz 2024; 38:146-156. [PMID: 37563328 PMCID: PMC10959808 DOI: 10.1007/s00482-023-00740-7] [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: 03/31/2023] [Revised: 04/27/2023] [Accepted: 05/02/2023] [Indexed: 08/12/2023]
Abstract
BACKGROUND In PAIN2020 (Innovation Fund, 01NVF17049), an outpatient interdisciplinary multimodal assessment (IMA) was introduced early in the course of the disease. The central quality feature is the close interdisciplinary collaboration of pain medicine, physiotherapy and psychology, which requires a complex organizational and coordination process, especially in team meetings and final discussions. OBJECTIVES The (different) views of the professional groups involved are brought together in the team process as a common consensus. The process of shaping the interaction of the professional groups among each other in the team meeting and final discussion as well as with the patients is examined (qualitatively) and discussed. METHODS In PAIN2020, a workshop on IMA was held to jointly reflect on the insights and experiences gained in the process so far through monitoring with staff or teams of the PAIN2020 centers. In one of three work phases, interprofessionally composed groups gathered statements from participants on the design of the interaction in team meeting and final discussion in three rotating rounds within the framework of a World Café. RESULTS It was possible to identify conducive and obstructive factors for the design of interdisciplinary collaboration in team meetings and final discussions, which were brought together in a superordinate framework model. DISCUSSION The provision of the new care service as an interdisciplinary task in a team goes beyond existing structural and process parameters in the definition of framework conditions in interdisciplinary multimodal pain therapy and should therefore also take personal competencies and professional competencies into account. Therefore, new dimensions arise for the implementation of the IMA, which should be discussed in the future.
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Affiliation(s)
- Leonie Schouten
- Schmerzmedizin, Klinik für Anästhesiologie, Universitätsmedizin Göttingen, Robert-Koch-Str. 40, 37075, Göttingen, Deutschland.
| | - Ulrike Kaiser
- Klinik für Anästhesiologie und Intensivmedizin, Universitätsklinikum Schleswig-Holstein, Ratzeburger Allee 160, 23538, Lübeck, Deutschland
| | - Frank Petzke
- Schmerzmedizin, Klinik für Anästhesiologie, Universitätsmedizin Göttingen, Robert-Koch-Str. 40, 37075, Göttingen, Deutschland
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Ma A, O'Shea R, Wedd L, Wong C, Jamieson RV, Rankin N. What is the power of a genomic multidisciplinary team approach? A systematic review of implementation and sustainability. Eur J Hum Genet 2024; 32:381-391. [PMID: 38378794 PMCID: PMC10999446 DOI: 10.1038/s41431-024-01555-5] [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: 06/13/2023] [Revised: 12/07/2023] [Accepted: 01/26/2024] [Indexed: 02/22/2024] Open
Abstract
Due to the increasing complexity of genomic data interpretation, and need for close collaboration with clinical, laboratory, and research expertise, genomics often requires a multidisciplinary team (MDT) approach. This systematic review aims to establish the evidence for effectiveness of the genomic multidisciplinary team, and the implementation components of this model that can inform precision care. MEDLINE, Embase and PsycINFO databases were searched in 2022 and 2023. We included qualitative and quantitative studies of the genomic MDT, including observational and cohort studies, for diagnosis and management, and implementation outcomes of effectiveness, adoption, efficiency, safety, and acceptability. A narrative synthesis was mapped against the Genomic Medicine Integrative Research framework. 1530 studies were screened, and 17 papers met selection criteria. All studies pointed towards the effectiveness of the genomic MDT approach, with 10-78% diagnostic yield depending on clinical context, and an increased yield of 6-25% attributed to the MDT. The genomic MDT was found to be highly efficient in interpretation of variants of uncertain significance, timeliness for a rapid result, made a significant impact on management, and was acceptable for adoption by a wide variety of subspecialists. Only one study utilized an implementation science based approach. The genomic MDT approach appears to be highly effective and efficient, facilitating higher diagnostic rates and improved patient management. However, key gaps remain in health systems readiness for this collaborative model, and there is a lack of implementation science based research especially addressing the cost, sustainability, scale up, and equity of access.
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Affiliation(s)
- Alan Ma
- Specialty of Genomic Medicine, University of Sydney, Sydney, NSW, Australia.
- Department of Clinical Genetics, Children's Hospital at Westmead, The Sydney Children's Hospitals Network, Sydney, NSW, Australia.
- Eye Genetics Research Unit, Children's Medical Research Institute, Sydney, NSW, Australia.
| | - Rosie O'Shea
- Specialty of Genomic Medicine, University of Sydney, Sydney, NSW, Australia
| | - Laura Wedd
- Department of Clinical Genetics, Children's Hospital at Westmead, The Sydney Children's Hospitals Network, Sydney, NSW, Australia
- Eye Genetics Research Unit, Children's Medical Research Institute, Sydney, NSW, Australia
| | - Claire Wong
- Specialty of Genomic Medicine, University of Sydney, Sydney, NSW, Australia
- Department of Clinical Genetics, Children's Hospital at Westmead, The Sydney Children's Hospitals Network, Sydney, NSW, Australia
| | - Robyn V Jamieson
- Specialty of Genomic Medicine, University of Sydney, Sydney, NSW, Australia
- Department of Clinical Genetics, Children's Hospital at Westmead, The Sydney Children's Hospitals Network, Sydney, NSW, Australia
- Eye Genetics Research Unit, Children's Medical Research Institute, Sydney, NSW, Australia
| | - Nicole Rankin
- Melbourne School of Population and Global Health, University of Melbourne, Melbourne, VIC, Australia
- Sydney School of Public Health, University of Sydney, Sydney, NSW, Australia
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Nilges P, Arnold B. [Control center team in interdisciplinary multimodal pain therapy]. Schmerz 2024; 38:139-145. [PMID: 37081191 DOI: 10.1007/s00482-023-00718-5] [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: 02/08/2023] [Revised: 03/03/2023] [Accepted: 03/08/2023] [Indexed: 04/22/2023]
Abstract
The topic of this article is the team in interdisciplinary multimodal pain therapy (IMPT) in the context of the development of the team concept. The starting points are historical developments, both social and scientific. After World War II numerous war victims continued to suffer from persistent pain. On the part of medicine, the consequences were the failure of the usual procedures for acute pain and the resulting helplessness. Both the concept of pain as a symptom of physical injury and also the previous treatment options were no longer adequate. Very early on an interdisciplinary approach to pain management was organized. This involved the communication of experts from various disciplines with very different competencies and opinions. Various medical disciplines and psychotherapy were the core subjects. Crucial for functioning teams is an effective cooperation and interaction. Related organizational issues, conflicts, peculiarities, and possibilities for solutions are presented. In the meantime, IMPT as a procedure has become a regular service provided in health care.
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Affiliation(s)
- Paul Nilges
- Institut für klinische Psychologie, Weiterbildungsstudiengang Psychologische Psychotherapie, Johannes Gutenberg-Universität Mainz, Wallstr. 7a, 55122, Mainz, Deutschland.
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Orlowski C, Lai J, Vereker M, Antill Y, Richardson G, White M, Gregory P, Kemp S, Morgan J, Ooi C, Senior J, David S. Impact of multidisciplinary team meetings on the management of patients with breast cancer in a large private healthcare facility. Asia Pac J Clin Oncol 2024; 20:285-291. [PMID: 36791022 DOI: 10.1111/ajco.13947] [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: 10/14/2021] [Revised: 09/26/2022] [Accepted: 01/29/2023] [Indexed: 02/16/2023]
Abstract
AIMS Multidisciplinary meetings (MDMs) play a crucial role in decision-making in breast cancer patient care. This study aimed to firstly assess the impact of breast cancer MDMs in decision-making for breast cancer patients and secondly to determine the concordance between MDM recommendations and implementation of clinical practice. METHODS Patient cases to be presented at the weekly breast cancer MDMs were identified and prospectively enrolled. Management plans were predicted by the treating surgeon with the pre-MDM management plans then compared to MDM recommendations. Changes in decision-making were assessed in the following domains: further surgery, systemic therapy (endocrine, chemotherapy or targeted), radiotherapy, enrolment in a clinical trial, further investigations, and referral to other specialists or services. Patient records were subsequently reviewed at 3 months post-MDM to assess the rate of implementation of MDM recommendations and any reasons for discordance. RESULTS Out of 50 cases, 66% (CI 53-79%; p < .005) experienced a change in management plan as a result of MDM discussion, with a total of 66 episodes of recorded change per decision-making domain affecting the following: further surgery (7.6%), endocrine therapy (4.5%), chemotherapy (19.7%), targeted therapy (4.5%), radiotherapy (18.2%), enrolment for a clinical trial (12.1%), additional investigations (22.7%), and further referrals (10.6%). MDM recommendations were implemented in 83.7% of cases. CONCLUSION The breast cancer MDMs were found to substantially impact on the management plans for breast cancer patients, with 83.7% of MDM recommendations being implemented into clinical practice. This study reinforces the importance of MDMs in the management of these patients, as well as highlighting the need for further investigating and addressing the potential barriers to the implementation of MDM recommendations.
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Affiliation(s)
| | - John Lai
- Cabrini Health, Melbourne, Victoria, Australia
- Epworth Freemasons Hospital, Melbourne, Victoria, Australia
| | - Melissa Vereker
- Cabrini Institute, Cabrini Health, Melbourne, Victoria, Australia
| | - Yoland Antill
- Cabrini Health, Melbourne, Victoria, Australia
- Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Victoria, Australia
| | - Gary Richardson
- Cabrini Health, Melbourne, Victoria, Australia
- Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Victoria, Australia
| | | | | | - Sarah Kemp
- Cabrini Health, Melbourne, Victoria, Australia
| | | | - Corinne Ooi
- Cabrini Health, Melbourne, Victoria, Australia
| | | | - Steven David
- Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
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Rogers JL, Wall T, Acquaye-Mallory AA, Boris L, Kim Y, Aldape K, Quezado MM, Butman JA, Smirniotopoulos JG, Chaudhry H, Tsien CI, Chittiboina P, Zaghloul K, Aboud O, Avgeropoulos NG, Burton EC, Cachia DM, Dixit KS, Drappatz J, Dunbar EM, Forsyth P, Komlodi-Pasztor E, Mandel J, Ozer BH, Lee EQ, Ranjan S, Lukas RV, Raygada M, Salacz ME, Smith-Cohn MA, Snyder J, Soldatos A, Theeler BJ, Widemann BC, Camphausen KA, Heiss JD, Armstrong TS, Gilbert MR, Penas-Prado M. Virtual multi-institutional tumor board: a strategy for personalized diagnoses and management of rare CNS tumors. J Neurooncol 2024; 167:349-359. [PMID: 38427131 PMCID: PMC11023967 DOI: 10.1007/s11060-024-04613-6] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2023] [Accepted: 02/17/2024] [Indexed: 03/02/2024]
Abstract
PURPOSE Multidisciplinary tumor boards (MTBs) integrate clinical, molecular, and radiological information and facilitate coordination of neuro-oncology care. During the COVID-19 pandemic, our MTB transitioned to a virtual and multi-institutional format. We hypothesized that this expansion would allow expert review of challenging neuro-oncology cases and contribute to the care of patients with limited access to specialized centers. METHODS We retrospectively reviewed records from virtual MTBs held between 04/2020-03/2021. Data collected included measures of potential clinical impact, including referrals to observational or therapeutic studies, referrals for specialized neuropathology analysis, and whether molecular findings led to a change in diagnosis and/or guided management suggestions. RESULTS During 25 meetings, 32 presenters discussed 44 cases. Approximately half (n = 20; 48%) involved a rare central nervous system (CNS) tumor. In 21% (n = 9) the diagnosis was changed or refined based on molecular profiling obtained at the NIH and in 36% (n = 15) molecular findings guided management. Clinical trial suggestions were offered to 31% (n = 13), enrollment in the observational NCI Natural History Study to 21% (n = 9), neuropathology review and molecular testing at the NIH to 17% (n = 7), and all received management suggestions. CONCLUSION Virtual multi-institutional MTBs enable remote expert review of CNS tumors. We propose them as a strategy to facilitate expert opinions from specialized centers, especially for rare CNS tumors, helping mitigate geographic barriers to patient care and serving as a pre-screening tool for studies. Advanced molecular testing is key to obtaining a precise diagnosis, discovering potentially actionable targets, and guiding management.
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Affiliation(s)
- James L Rogers
- Neuro-Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, 9030 Old Georgetown Rd, Bethesda, MD, 20892, USA
| | - Thomas Wall
- Neuro-Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, 9030 Old Georgetown Rd, Bethesda, MD, 20892, USA
| | - Alvina A Acquaye-Mallory
- Neuro-Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, 9030 Old Georgetown Rd, Bethesda, MD, 20892, USA
| | - Lisa Boris
- Neuro-Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, 9030 Old Georgetown Rd, Bethesda, MD, 20892, USA
| | - Yeonju Kim
- Neuro-Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, 9030 Old Georgetown Rd, Bethesda, MD, 20892, USA
- Wayne State University School of Medicine, 540 E Canfield St, Detroit, MI, 48201, USA
| | - Kenneth Aldape
- Laboratory of Pathology, Center for Cancer Research, National Cancer Institute, National Institutes of Health, 10 Center Dr, Bethesda, MD, 20892, USA
| | - Martha M Quezado
- Laboratory of Pathology, Center for Cancer Research, National Cancer Institute, National Institutes of Health, 10 Center Dr, Bethesda, MD, 20892, USA
| | - John A Butman
- Radiology and Imaging Sciences, Clinical Center, National Institutes of Health, 10 Center Dr, Bethesda, MD, 20892, USA
| | - James G Smirniotopoulos
- Neuro-Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, 9030 Old Georgetown Rd, Bethesda, MD, 20892, USA
| | - Huma Chaudhry
- Radiation Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, 10 Center Dr, Bethesda, MD, 20892, USA
| | - Christina I Tsien
- Neuro-Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, 9030 Old Georgetown Rd, Bethesda, MD, 20892, USA
- Proton Therapy Center, Sibley Memorial Hospital, Johns Hopkins Medicine, 5255 Loughboro Rd NW, Washington, DC, 20016, USA
| | - Prashant Chittiboina
- Surgical Neurology Branch,, National Institute of Neurological Disorders and Stroke, National Institutes of Health, 10 Center Dr, Bethesda, MD, 20892, USA
| | - Kareem Zaghloul
- Surgical Neurology Branch,, National Institute of Neurological Disorders and Stroke, National Institutes of Health, 10 Center Dr, Bethesda, MD, 20892, USA
| | - Orwa Aboud
- Department of Neurology and Neurological Surgery, UC Davis Comprehensive Cancer Center, 4860 Y Street, Sacramento, CA, 95817, USA
| | - Nicholas G Avgeropoulos
- Brain and Spine Tumor Program, Orlando Health Cancer Institute, 1400 S. Orange Ave, Orlando, FL, 32806, USA
- Global Medical Affairs, Novocure GmbH, D4 Pk. 6, 6039, Root, Switzerland
| | - Eric C Burton
- Neuro-Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, 9030 Old Georgetown Rd, Bethesda, MD, 20892, USA
| | - David M Cachia
- Department of Hematology/Oncology, University of Massachusetts, 55 Lake Ave, Worcester, MA, 01655, USA
| | - Karan S Dixit
- Lou and Jean Malnati Brain Tumor Institute, Northwestern University Feinberg School of Medicine, 675 N St Clair St, Chicago, IL, 60611, USA
| | - Jan Drappatz
- Department of Neurology, University of Pittsburgh Medical Center, 5115 Centre Ave, Pittsburgh, PA, 15232, USA
| | - Erin M Dunbar
- Piedmont Brain Tumor Center, Piedmont Atlanta Hospital, Atlanta, GA, 2001 Peachtree St30309, USA
| | - Peter Forsyth
- Department of Neuro-Oncology, Moffitt Cancer Center, 12902 USF Magnolia Drive, Tampa, FL, 33612, USA
| | - Edina Komlodi-Pasztor
- Neuro-Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, 9030 Old Georgetown Rd, Bethesda, MD, 20892, USA
- Department of Neurology, MedStar Georgetown University Hospital, 3800 Reservoir Road Washington, Washington DC, 20007, USA
| | - Jacob Mandel
- Department of Neurology, Baylor College of Medicine, 7200 Cambridge St, Houston, TX, 77030, USA
| | - Byram H Ozer
- Neuro-Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, 9030 Old Georgetown Rd, Bethesda, MD, 20892, USA
| | - Eudocia Q Lee
- Center for Neuro-Oncology, Dana Farber Cancer Institute, 450 Brookline Ave, Boston, MA, 02215, USA
| | - Surabhi Ranjan
- Department of Neurology, Cleveland Clinic Florida, Weston Hospital, 2950 Cleveland Clinic Boulevard, Weston, FL, 33331, US
| | - Rimas V Lukas
- Lou and Jean Malnati Brain Tumor Institute, Northwestern University Feinberg School of Medicine, 675 N St Clair St, Chicago, IL, 60611, USA
| | - Margarita Raygada
- Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, 1 Center Dr, Bethesda, MD, 20892, USA
| | - Michael E Salacz
- Department of Hematology and Medical Oncology, MD Anderson Cancer Center at Cooper, Cooper University Health Care, Two Cooper Plaza, Camden, NJ, 08103, USA
| | - Matthew A Smith-Cohn
- Neuro-Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, 9030 Old Georgetown Rd, Bethesda, MD, 20892, USA
- Benefis Sletten Cancer Institute, 1117 29Th St. S, Great Falls, MT, 59405, USA
| | - James Snyder
- Hermelin Brain Tumor Center, Henry Ford Cancer Institute, 2800 W Grand Blvd, Detroit, MI, 48202, USA
| | - Ariane Soldatos
- National Institute of Neurological Disorders and Stroke,, National Institutes of Health, 10 Center Dr, Bethesda, MD, 20892, USA
| | - Brett J Theeler
- School of Medicine, Uniformed Services University, 4301 Jones Bridge Rd, Bethesda, MD, 20814, USA
| | - Brigitte C Widemann
- Pediatric Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, 10 Center Dr, Bethesda, MD, 20892, USA
| | - Kevin A Camphausen
- Radiation Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, 10 Center Dr, Bethesda, MD, 20892, USA
| | - John D Heiss
- Surgical Neurology Branch,, National Institute of Neurological Disorders and Stroke, National Institutes of Health, 10 Center Dr, Bethesda, MD, 20892, USA
| | - Terri S Armstrong
- Neuro-Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, 9030 Old Georgetown Rd, Bethesda, MD, 20892, USA
| | - Mark R Gilbert
- Neuro-Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, 9030 Old Georgetown Rd, Bethesda, MD, 20892, USA
| | - Marta Penas-Prado
- Neuro-Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, 9030 Old Georgetown Rd, Bethesda, MD, 20892, USA.
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48
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Weller JM, Mahajan R, Fahey-Williams K, Webster CS. Teamwork matters: team situation awareness to build high-performing healthcare teams, a narrative review. Br J Anaesth 2024; 132:771-778. [PMID: 38310070 DOI: 10.1016/j.bja.2023.12.035] [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: 08/22/2023] [Revised: 12/12/2023] [Accepted: 12/18/2023] [Indexed: 02/05/2024] Open
Abstract
Healthcare today is the prerogative of teams rather than of individuals. In acute care domains such as anaesthesia, intensive care, and emergency medicine, the work is complex and fast-paced, and the team members are diverse and interdependent. Three decades of research into the behaviours of high-performing teams provides us with clear guidance on team training, demonstrating positive effects on patient safety and staff wellbeing. Here we consider team performance through the lens of situation awareness. Maintaining situation awareness is an absolute requirement for safe and effective patient management. Situation awareness is a dynamic process of perceiving cues in the environment, understanding what they mean, and predicting how the situation may evolve. In the context of acute clinical care, situation awareness can be improved if the whole team actively contributes to monitoring the environment, processing information, and planning next steps. In this narrative review, we explore the concept of situation awareness at the level of the team, the conditions required to maintain team situation awareness, and the relationship between team situation awareness, shared mental models, and team performance. Our ultimate goal is to help clinicians create the conditions required for high-functioning teams, and ultimately improve the safety of clinical care.
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Affiliation(s)
- Jennifer M Weller
- Centre for Medical and Health Sciences Education, School of Medicine, University of Auckland, Auckland, New Zealand; Department of Anaesthesia, Auckland City Hospital, Auckland, New Zealand.
| | - Ravi Mahajan
- Centre of Excellence in Critical Care, Apollo Hospitals Group, Chennai, India; Department of Anaesthesia and Intensive Care, University of Nottingham, Nottingham, UK
| | - Kathryn Fahey-Williams
- Centre for Medical and Health Sciences Education, School of Medicine, University of Auckland, Auckland, New Zealand
| | - Craig S Webster
- Centre for Medical and Health Sciences Education, School of Medicine, University of Auckland, Auckland, New Zealand; Department of Anaesthesiology, School of Medicine, University of Auckland, Auckland, New Zealand
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49
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Pinelli V, Mottuel B. [Patient motivation and prehabilitation: assessment often overlooked]. Soins 2024; 69:42-45. [PMID: 38614519 DOI: 10.1016/j.soin.2024.02.010] [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] [Indexed: 04/15/2024]
Abstract
Prehabilitation, which is still in its infancy, is becoming an essential part of oncology treatment. Motivation assessment is crucial for adherence to these programs, which aim to optimize functional capacity before and during the intensive phases of treatment. To date, healthcare teams have had little experience of assessing motivation, which is a weakness in the care strategy. This is partly due to a lack of standardized models and a delay in caregivers changing their position in response to changes in patient' motivations. In this article, we invite to discuss the 'why' and 'how' of motivational assessment in patients undergoing prehabilitation.
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Affiliation(s)
- Virgile Pinelli
- Clinique de l'Union, Ramsay santé, boulevard Ratalens, 31240 Saint-Jean, France.
| | - Bérangère Mottuel
- Clinique de l'Union, Ramsay santé, boulevard Ratalens, 31240 Saint-Jean, France
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50
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Choi JJ, Osterberg LG, Record JD. Exploring Ward Team Handoffs of Overnight Admissions: Key Lessons from Field Observations. J Gen Intern Med 2024; 39:808-814. [PMID: 38038890 PMCID: PMC11043283 DOI: 10.1007/s11606-023-08549-x] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Accepted: 11/21/2023] [Indexed: 12/02/2023]
Abstract
BACKGROUND The diagnostic process is a dynamic, team-based activity that is an important aspect of ward rounds in teaching hospitals. However, few studies have examined how academic ward teams operate in areas such as diagnosis in the handoff of overnight admissions during ward rounds. This study draws key lessons from team interactions in the handoff process during ward rounds. OBJECTIVE To describe how ward teams operate in the handoff of patients admitted overnight during ward rounds, and to characterize the role of the bedside patient evaluation in this context. DESIGN A qualitative ethnographic approach using field observations and documentary analysis. PARTICIPANTS Attending physicians, medical residents, and medical students on general medicine services in a single teaching hospital. APPROACH Thirty-five hours of observations were undertaken over a 4-month period. We purposively approached a diverse group of attendings who cover a range of clinical teaching experience, and obtained informed consent from all ward team members and observed patients. Thirty patient handoffs were observed across 5 ward teams with 45 team members. We conducted thematic analysis of researcher field notes and electronic health record documents using social cognitive theories to characterize the dynamic interactions occurring in the real clinical environment. KEY RESULTS Teams spent less time during ward rounds on verifying history and physical examination findings, performing bedside evaluations, and discussing differential diagnoses than other aspects (e.g., reviewing patient data in conference rooms) in the team handoff process of overnight admissions. Several team-based approaches to diagnosis and bedside patient evaluations were observed, including debriefing for learning and decision-making. CONCLUSIONS This study highlights potential strengths and missed opportunities for teaching, learning, and engaging directly with patients in the ward team handoff of patients admitted overnight. These findings may inform curriculum development, faculty training, and patient safety research.
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Affiliation(s)
- Justin J Choi
- Department of Medicine, Weill Cornell Medicine, New York, NY, USA.
- School of Health Professions Education (SHE), Maastricht University, Maastricht, The Netherlands.
| | - Lars G Osterberg
- Department of Medicine, Stanford University School of Medicine, Stanford, CA, USA
| | - Janet D Record
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
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