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Managing women with acute physiological deterioration: Student midwives performance in a simulated setting. Women Birth 2012; 25:e27-36. [DOI: 10.1016/j.wombi.2011.08.009] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2011] [Revised: 08/22/2011] [Accepted: 08/24/2011] [Indexed: 11/17/2022]
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Meyer LD, Raymond CB, Rodrigue CMJ. Development and evaluation of a checklist for medication order review by pharmacists. Can J Hosp Pharm 2012; 64:199-206. [PMID: 22479055 DOI: 10.4212/cjhp.v64i3.1023] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
BACKGROUND To create a checklist of the tasks that a pharmacist must perform during medication order review in the hospital setting and to evaluate the utility of and pharmacists' satisfaction with the checklist. METHODS An evidence-based checklist for medication order review was developed, with items related to order urgency, verification of patients' identity, therapeutic review, and actionable items. Pharmacists were educated about the checklist, and it was made available at 2 community hospitals in an urban setting. Pharmacists completed a nonvalidated satisfaction survey and participated in focus groups or interviews within 3 months after implementation of the checklist. Qualitative descriptive theory was used to identify themes within the data. Near-miss occurrence reports for the 3 months before and after implementation of the checklist were quantified. RESULTS Of 16 pharmacists who were involved in the implementation phase, 14 participated in focus groups or an interview, and 11 responded to the survey. All respondents felt that the primary role of the checklist was for training. They felt that the checklist could be useful when reviewing high-alert or unfamiliar medications or therapy for patients with complex medications. The checklist was most helpful when it was used as a reminder, on an as-needed basis. Nine (82%) of the 11 survey respondents indicated that the checklist standardized the process of medication order review, the same number felt that it prevented accidental omission of critical checks, and 8 (73%) felt that it improved patient safety. Education was necessary to reinforce the purpose of the checklist and its self-check nature. There was no difference in the number of near misses in the pharmacy between the 3-month periods before and after implementation of the checklist. CONCLUSION Pharmacists participating in the study felt that a checklist for medication order review had a role in training new pharmacists and standardizing processes.
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Affiliation(s)
- Lindsay D Meyer
- , BSc, BSP, ACPR, was, at the time this study was completed, a Pharmacy Resident with the Winnipeg Regional Health Authority, Winnipeg, Manitoba. She is now a Clinical Pharmacist with Alberta Health Services, Edmonton, Alberta
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Does Every Code Need a “Reader?” Improvement of Rare Event Management With a Cognitive Aid “Reader” During a Simulated Emergency. Simul Healthc 2012; 7:1-9. [DOI: 10.1097/sih.0b013e31822c0f20] [Citation(s) in RCA: 88] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Kramer DR, Halpern CH, Connolly PJ, Jaggi JL, Baltuch GH. Error Reduction with Routine Checklist Use during Deep Brain Stimulation Surgery. Stereotact Funct Neurosurg 2012; 90:255-9. [DOI: 10.1159/000338091] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2011] [Accepted: 02/27/2012] [Indexed: 11/19/2022]
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Abstract
Airway management in the intensive care unit is more problematic than during anaesthesia. In general, critically ill patients have less physiological reserve and complications are more common, both during the initial airway intervention (which includes risks associated with induction of anaesthesia), and later once the airway has been secured. Despite these known risks, those managing the airway of a critically ill patient, particularly out of hours, may be relatively inexperienced. Solutions to these challenging airway problems include: recognition of those patients with a potential airway problem; implementation of a plan to deal with their airway; immediate availability of a difficult airway trolley; use of capnography for every airway intervention and continuously in all ventilator-dependent patients; and appropriate training of all intensive care unit staff including use of simulation.
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Affiliation(s)
- J P Nolan
- Anaesthesia and Intensive Care Medicine, Royal United Hospital, Bath, UK.
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Review article: simulation in anesthesia: state of the science and looking forward. Can J Anaesth 2011; 59:193-202. [PMID: 22179792 DOI: 10.1007/s12630-011-9638-8] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2011] [Accepted: 11/16/2011] [Indexed: 10/14/2022] Open
Abstract
PURPOSE Within the field of anesthesia, simulation has been used as a tool for training and assessment for over 30 years. The purpose of this review is to evaluate the state of the science in terms of its effectiveness as an approach to both training and assessment in anesthesia. Articles in the area of simulation and anesthesia published up to and including 2011 were reviewed for inclusion in this narrative review. PRINCIPAL FINDINGS Simulation-based training is generally well received by participants, it can lead to improved performance in subsequent simulation events, and some transfer of learning to the clinical setting is evident. There is also some early evidence that well-designed performance assessments could have the required reliability and validity to support high-stakes examinations. However, further work is needed in order to set standards and establish the predictive validity to support such assessments. CONCLUSION For simulation to realize its potential impact, further research is needed to understand how to optimize this modality of learning more effectively, how to transfer knowledge of research findings to practice, and also how to broaden the simulation modalities used in anesthesia. In future, the optimal use of simulation will depend on a clear understanding of what can and cannot be accomplished with simulation and its various modalities.
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Rodrigo-Rincón M, Tirapu-León B, Zabalza-López P, Martín-Vizcaino M, de La Fuente-Calixto A, Villalgordo-Ortín P, Domench-Mañero L, Gost-Garde J. Percepción de los profesionales sobre la utilización y la utilidad del listado de verificación quirúrgica. ACTA ACUST UNITED AC 2011; 26:380-5. [DOI: 10.1016/j.cali.2011.03.005] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2011] [Revised: 03/15/2011] [Accepted: 03/16/2011] [Indexed: 11/25/2022]
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Thomassen Ø, Espeland A, Søfteland E, Lossius HM, Heltne JK, Brattebø G. Implementation of checklists in health care; learning from high-reliability organisations. Scand J Trauma Resusc Emerg Med 2011; 19:53. [PMID: 21967747 PMCID: PMC3205016 DOI: 10.1186/1757-7241-19-53] [Citation(s) in RCA: 76] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2011] [Accepted: 10/03/2011] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Checklists are common in some medical fields, including surgery, intensive care and emergency medicine. They can be an effective tool to improve care processes and reduce mortality and morbidity. Despite the seemingly rapid acceptance and dissemination of the checklist, there are few studies describing the actual process of developing and implementing such tools in health care. The aim of this study is to explore the experiences from checklist development and implementation in a group of non-medical, high reliability organisations (HROs). METHOD A qualitative study based on key informant interviews and field visits followed by a Delphi approach. Eight informants, each with 10-30 years of checklist experience, were recruited from six different HROs. RESULTS The interviews generated 84 assertions and recommendations for checklist implementation. To achieve checklist acceptance and compliance, there must be a predefined need for which a checklist is considered a well suited solution. The end-users ("sharp-end") are the key stakeholders throughout the development and implementation process. Proximity and ownership must be assured through a thorough and wise process. All informants underlined the importance of short, self-developed, and operationally-suited checklists. Simulation is a valuable and widely used method for training, revision, and validation. CONCLUSION Checklists have been a cornerstone of safety management in HROs for nearly a century, and are becoming increasingly popular in medicine. Acceptance and compliance are crucial for checklist implementation in health care. Experiences from HROs may provide valuable input to checklist implementation in healthcare.
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Affiliation(s)
- Øyvind Thomassen
- Department of Anaesthesia & Intensive Care, Haukeland University Hospital, Bergen, Norway
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Fausett MB, Propst A, Van Doren K, Clark BT. How to develop an effective obstetric checklist. Am J Obstet Gynecol 2011; 205:165-70. [PMID: 22071047 DOI: 10.1016/j.ajog.2011.06.003] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2011] [Revised: 05/19/2011] [Accepted: 06/02/2011] [Indexed: 10/18/2022]
Abstract
Checklists to guide critical procedures are becoming an increasingly important part of medical practice. These tools have proved effective in improving outcome in a variety of medical settings, including obstetrics. In this review, we outline essential principles of successful checklist creation and implementation and review our experience with checklist development in a worldwide, multi-institutional health care delivery system.
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Hofer RE, Nikolaus OB, Pawlina W. Using checklists in a gross anatomy laboratory improves learning outcomes and dissection quality. ANATOMICAL SCIENCES EDUCATION 2011; 4:249-255. [PMID: 21786427 DOI: 10.1002/ase.243] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/27/2011] [Revised: 06/01/2011] [Accepted: 06/20/2011] [Indexed: 05/31/2023]
Abstract
Checklists have been widely used in the aviation industry ever since aircraft operations became more complex than any single pilot could reasonably remember. More recently, checklists have found their way into medicine, where cognitive function can be compromised by stress and fatigue. The use of checklists in medical education has rarely been reported, especially in the basic sciences. We explored whether the use of a checklist in the gross anatomy laboratory would improve learning outcomes, dissection quality, and students' satisfaction in the first-year Human Structure didactic block at Mayo Medical School. During the second half of a seven-week anatomy course, dissection teams were each day given a hardcopy checklist of the structures to be identified during that day's dissection. The first half of the course was considered the control, as students did not receive any checklists to utilize during dissection. The measured outcomes were scored on four practice practical examinations and four dissection quality assessments, two each from the first half (control) and second half of the course. A student satisfaction survey was distributed at the end of the course. Examination and dissection scores were analyzed for correlations between practice practical examination score and checklist use. Our data suggest that a daily hardcopy list of anatomical structures for active use in the gross anatomy laboratory increases practice practical examination scores and dissection quality. Students recommend the use of these checklists in future anatomy courses.
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Weiss CH, Moazed F, McEvoy CA, Singer BD, Szleifer I, Amaral LAN, Kwasny M, Watts CM, Persell SD, Baker DW, Sznajder JI, Wunderink RG. Prompting physicians to address a daily checklist and process of care and clinical outcomes: a single-site study. Am J Respir Crit Care Med 2011; 184:680-6. [PMID: 21616996 DOI: 10.1164/rccm.201101-0037oc] [Citation(s) in RCA: 146] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
RATIONALE Checklists may reduce errors of omission for critically ill patients. OBJECTIVES To determine whether prompting to use a checklist improves process of care and clinical outcomes. METHODS We conducted a cohort study in the medical intensive care unit (MICU) of a tertiary care university hospital. Patients admitted to either of two independent MICU teams were included. Intervention team physicians were prompted to address six parameters from a daily rounding checklist if overlooked during morning work rounds. The second team (control) used the identical checklist without prompting. MEASUREMENTS AND MAIN RESULTS One hundred and forty prompted group patients were compared with 125 control and 1,283 preintervention patients. Compared with control, prompting increased median ventilator-free duration, decreased empirical antibiotic and central venous catheter duration, and increased rates of deep vein thrombosis and stress ulcer prophylaxis. Prompted group patients had lower risk-adjusted ICU mortality compared with the control group (odds ratio, 0.36; 95% confidence interval, 0.13-0.96; P = 0.041) and lower hospital mortality compared with the control group (10.0 vs. 20.8%; P = 0.014), which remained significant after risk adjustment (odds ratio, 0.34; 95% confidence interval, 0.15-0.76; P = 0.008). Observed-to-predicted ICU length of stay was lower in the prompted group compared with control (0.59 vs. 0.87; P = 0.02). Checklist availability alone did not improve mortality or length of stay compared with preintervention patients. CONCLUSIONS In this single-site, preliminary study, checklist-based prompting improved multiple processes of care, and may have improved mortality and length of stay, compared with a stand-alone checklist. The manner in which checklists are implemented is of great consequence in the care of critically ill patients.
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Affiliation(s)
- Curtis H Weiss
- Division of Pulmonary and Critical Care Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL 60611, USA.
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Thomassen O, Brattebø G, Heltne JK, Søfteland E, Espeland A. Checklists in the operating room: Help or hurdle? A qualitative study on health workers' experiences. BMC Health Serv Res 2010; 10:342. [PMID: 21171967 PMCID: PMC3009978 DOI: 10.1186/1472-6963-10-342] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2010] [Accepted: 12/20/2010] [Indexed: 11/30/2022] Open
Abstract
Background Checklists have been used extensively as a cognitive aid in aviation; now, they are being introduced in many areas of medicine. Although few would dispute the positive effects of checklists, little is known about the process of introducing this tool into the health care environment. In 2008, a pre-induction checklist was implemented in our anaesthetic department; in this study, we explored the nurses' and physicians' acceptance and experiences with this checklist. Method Focus group interviews were conducted with a purposeful sample of checklist users (nurses and physicians) from the Department of Anaesthesia and Intensive Care in a tertiary teaching hospital. The interviews were analysed qualitatively using systematic text condensation. Results Users reported that checklist use could divert attention away from the patient and that it influenced workflow and doctor-nurse cooperation. They described senior consultants as both sceptical and supportive; a head physician with a positive attitude was considered crucial for successful implementation. The checklist improved confidence in unfamiliar contexts and was used in some situations for which it was not intended. It also revealed insufficient equipment standardisation. Conclusion Our findings suggest several issues and actions that may be important to consider during checklist use and implementation.
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Affiliation(s)
- Oyvind Thomassen
- Department of Anaesthesia and Intensive Care, Haukeland University Hospital, Bergen, Norway.
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Wiegmann DA, Eggman AA, Elbardissi AW, Parker SH, Sundt TM. Improving cardiac surgical care: a work systems approach. APPLIED ERGONOMICS 2010; 41:701-12. [PMID: 20202623 PMCID: PMC2879339 DOI: 10.1016/j.apergo.2009.12.008] [Citation(s) in RCA: 52] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/28/2008] [Accepted: 09/30/2009] [Indexed: 05/11/2023]
Abstract
Over the past 50 years, significant improvements in cardiac surgical care have been achieved. Nevertheless, surgical errors that significantly impact patient safety continue to occur. In order to further improve surgical outcomes, patient safety programs must focus on rectifying work system factors in the operating room (OR) that negatively impact the delivery of reliable surgical care. The goal of this paper is to provide an integrative review of specific work system factors in the OR that may directly impact surgical care processes, as well as the subsequent recommendations that have been put forth to improve surgical outcomes and patient safety. The important role that surgeons can play in facilitating work system changes in the OR is also discussed. The paper concludes with a discussion of the challenges involved in assessing the impact that interventions have on improving surgical care. Opportunities for future research are also highlighted throughout the paper.
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Affiliation(s)
- Douglas A Wiegmann
- Department of Industrial and Systems Engineering, 1513 University Ave, 3214 Mechanical Engineering Bldg, University of Wisconsin-Madison, Madison, WI 53706, USA.
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Weiser TG, Haynes AB, Lashoher A, Dziekan G, Boorman DJ, Berry WR, Gawande AA. Perspectives in quality: designing the WHO Surgical Safety Checklist. Int J Qual Health Care 2010; 22:365-70. [DOI: 10.1093/intqhc/mzq039] [Citation(s) in RCA: 197] [Impact Index Per Article: 14.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Oliver M, Stacey M. Failed intubation in obstetrics. ANAESTHESIA AND INTENSIVE CARE MEDICINE 2010. [DOI: 10.1016/j.mpaic.2010.05.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Teams Create Safety. PATIENT SAFETY 2010. [DOI: 10.1002/9781444323856.ch18] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
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Hewson-Conroy KM, Elliott D, Burrell AR. Quality and safety in intensive care-A means to an end is critical. Aust Crit Care 2010; 23:109-29. [PMID: 20083413 DOI: 10.1016/j.aucc.2009.12.001] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2009] [Revised: 11/24/2009] [Accepted: 12/01/2009] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND To achieve improvement in healthcare quality and safety, all four domains (outcome, process, structure and culture) must be considered in conjunction with the best available clinical evidence to improve patient care and reduce harm. A range of improvement initiatives have targeted processes of care in recognition of: (1) complexities of patient care and (2) evidence that a large portion of adverse events are preventable, occur during ongoing care, and result in poorer patient outcomes. PURPOSE The aims of this paper are to: (1) outline national and international quality and safety initiatives; (2) identify evidence-based processes of care applicable to the general adult ICU patient population; (3) summarise the literature on relevant quality improvement strategies. METHODS An integrative literature review was conducted by: (1) database search of Ovid Medline, CINAHL, EMBASE and Cochrane for articles published between 1996 and October 2009; (2) identification of additional studies from articles obtained; (3) purposive internet search identifying relevant quality and safety initiatives. FINDINGS Quality improvement initiatives across the globe were identified, with ensuing focus on how the development, implementation and evaluation of evidence-based processes of care can lead to improvements in the delivery and outcomes of intensive care practice. Variation in practice and methodological limitations of existing studies were also noted, highlighting the need for innovative approaches to improving processes in the ICU. CONCLUSION This integrative review has outlined potential for achieving practice improvements in intensive care and highlighted the need for further evaluative research to improve patient care at the bedside.
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Grande L. [Improving safety in the operating room reduces hospital mortality]. Cir Esp 2009; 86:329-30. [PMID: 19783243 DOI: 10.1016/j.ciresp.2009.07.018] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2009] [Accepted: 07/21/2009] [Indexed: 11/18/2022]
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Böttger TC, Hermeneit S, Müller M, Terzic A, Rodehorst A, Elad L, Schamberger M. Modifiable surgical and anesthesiologic risk factors for the development of cardiac and pulmonary complications after laparoscopic colorectal surgery. Surg Endosc 2009; 23:2016-25. [PMID: 19462205 DOI: 10.1007/s00464-008-9916-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2007] [Revised: 01/28/2008] [Accepted: 02/12/2008] [Indexed: 01/14/2023]
Abstract
BACKGROUND In contrast to patient-related risk factors, which are difficult to influence, factors relating to surgery and anesthesia that can be influenced have hardly been investigated. This study aimed to identify such risk factors. METHODS Pre- and intraoperative surgical and anesthesiologic factors of 388 colonic and 112 rectal procedures performed by a single surgeon within 50 months were recorded and analyzed for correlations with postoperative complications requiring treatment. RESULTS Higher American Society of Anesthesiology (ASA) emergency interventions and intraoperative factors (bleeding, long operating time) had an elevated risk for general complications. Furthermore, patients benefited from the clinical experience of the anesthesiologist, especially in terms of emergency procedures, hemorrhagic complications, and a longer operating time. CONCLUSIONS Standardization of the surgical technique, "bloodless" surgery, standardization of intraoperative monitoring, and the use of board-certified anesthesiologists for high-risk cases, emergency procedures, and patients with high ASA stages are able to reduce postoperative morbidity.
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Affiliation(s)
- Th C Böttger
- Klinik für Viszeral-, Thorax- und Gefässchirurgie, Zentrum für minimalinvasive Chirurgie, Klinikum Bremerhaven Reinkenheide, Bremerhaven, Germany
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The Error of Omission: A Simple Checklist Approach for Improving Operating Room Safety. Plast Reconstr Surg 2009; 123:399-402. [DOI: 10.1097/prs.0b013e318193472f] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Rodriguez-Paz JM, Mark LJ, Herzer KR, Michelson JD, Grogan KL, Herman J, Hunt D, Wardlow L, Armour EP, Pronovost PJ. A Novel Process for Introducing a New Intraoperative Program: A Multidisciplinary Paradigm for Mitigating Hazards and Improving Patient Safety. Anesth Analg 2009; 108:202-10. [DOI: 10.1213/ane.0b013e31818ca423] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Verdaasdonk EGG, Stassen LPS, Widhiasmara PP, Dankelman J. Requirements for the design and implementation of checklists for surgical processes. Surg Endosc 2008; 23:715-26. [DOI: 10.1007/s00464-008-0044-4] [Citation(s) in RCA: 70] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2007] [Revised: 04/27/2008] [Accepted: 05/30/2008] [Indexed: 11/27/2022]
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Gardner R, Raemer DB. Simulation in Obstetrics and Gynecology. Obstet Gynecol Clin North Am 2008; 35:97-127, ix. [DOI: 10.1016/j.ogc.2007.12.008] [Citation(s) in RCA: 63] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
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Schüpfer G, Gfrörer R, Schleppers A. [Anaesthetists learn--do institutions also learn? Importance of institutional learning and corporate culture in clinics]. Anaesthesist 2008; 56:983-91. [PMID: 17898964 DOI: 10.1007/s00101-007-1265-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
In only a few contexts is the need for substantial learning more pronounced than in health care. For a health care provider, the ability to learn is essential in a changing environment. Although individual humans are programmed to learn naturally, organisations are not. Learning that is limited to individual professions and traditional approaches to continuing medical education is not sufficient to bring about substantial changes in the learning capacity of an institution. Also, organisational learning is an important issue for anaesthesia departments. Future success of an organisation often depends on new capabilities and competencies. Organisational learning is the capacity or processes within an organisation to maintain or improve performance based on experience. Learning is seen as a system-level phenomenon as it stays in the organisation regardless of the players involved. Experience from other industries shows that learning strategies tend to focus on single loop learning, with relatively little double loop learning and virtually no meta-learning or non-learning. The emphasis on team delivery of health care reinforces the need for team learning. Learning organisations make learning an intrinsic part of their organisations and are a place where people continually learn how to learn together. Organisational learning practice can help to improve existing skills and competencies and to change outdated assumptions, procedures and structures. So far, learning theory has been ignored in medicine, due to a wide variety of complex political, economic, social, organisational culture and medical factors that prevent innovation and resist change. The organisational culture is central to every stage of the learning process. Learning organisations move beyond simple employee training into organisational problem solving, innovation and learning. Therefore, teamwork and leadership are necessary. Successful organisations change the competencies of individuals, the systems, the organisation, the strategy and the culture.
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Affiliation(s)
- G Schüpfer
- Institut für Anästhesie, chirurgische Intensivmedizin und Schmerztherapie, Kantonsspital Luzern, 6000, Luzern 16, Schweiz.
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Langford R, Gale TCE, Mayor AH. Anaesthetic machine checking guidelines: have we improved our practice? Eur J Anaesthesiol 2007; 24:1050-6. [PMID: 17261213 DOI: 10.1017/s0265021506002377] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND AND OBJECTIVES This study follows up an initial audit in 1992 indicating that anaesthetic machine checking practices were often incomplete. The aims were to ascertain if there has been any improvement during this period with special reference to the latest guidelines. METHODS Following the Association of Anaesthetists of Great Britain and Ireland machine checking guidelines, a structured questionnaire, was used to interview 41 anaesthetists in the South West region on one particular day. RESULTS Despite 80% of subjects stating that they had read the latest guidelines recently, only one undertook a complete check and 39/41 (95%) performed partial checks (omitting one or more steps in the guidelines). Steps most commonly omitted were additional monitoring, ventilator function, availability of an alternative means of ventilation and function of ancillary equipment such as laryngoscopes. Only 5/41 subjects performed any check between cases. Several of these checks have been introduced in the 2004 guidelines. CONCLUSIONS Although there has been a significant increase in the proportion of anaesthetists undertaking machine checks since 1992 (P = 0.0007), we conclude that machine checking guidelines are still poorly followed, with checks specific to the latest guidelines most likely to be omitted.
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Affiliation(s)
- R Langford
- Royal Cornwall Hospital, Anaesthetic Department, Truro, Cornwall, UK.
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Hales BM, Pronovost PJ. The checklist--a tool for error management and performance improvement. J Crit Care 2006; 21:231-5. [PMID: 16990087 DOI: 10.1016/j.jcrc.2006.06.002] [Citation(s) in RCA: 319] [Impact Index Per Article: 17.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2006] [Accepted: 06/21/2006] [Indexed: 11/28/2022]
Abstract
Levels of cognitive function are often compromised with increasing levels of stress and fatigue, as is often the norm in certain complex, high-intensity fields of work. Aviation, aeronautics, and product manufacturing have come to rely heavily on checklists to aid in reducing human error. The checklist is an important tool in error management across all these fields, contributing significantly to reductions in the risk of costly mistakes and improving overall outcomes. Such benefits also translate to improving the delivery of patient care. Despite demonstrated benefits of checklists in medicine and critical care, the integration of checklists into practice has not been as rapid and widespread as with other fields. This narrative is a guide to the evolution of medical and critical care checklists, and a discussion of the barriers and risks to the implementation of checklists.
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Affiliation(s)
- Brigette M Hales
- Department of Medicine, Sunnybrook Health Sciences Centre, Toronto, ON, Canada M4N 3M5.
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Hewson KM, Burrell AR. A pilot study to test the use of a checklist in a tertiary intensive care unit as a method of ensuring quality processes of care. Anaesth Intensive Care 2006; 34:322-8. [PMID: 16802484 DOI: 10.1177/0310057x0603400222] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
This pilot study aimed to test the use of a checklist as a method of ensuring that certain processes of care are performed routinely and systematically in a tertiary intensive care unit. The pilot involved the development of a process indicator checklist, its implementation and review. The checklist contained 16 items sourced from the literature or deemed important by local clinicians. Checklists were completed on the morning round for all adult patients admitted to the unit for approximately one month. Baseline and evaluation surveys were conducted with medical staff to assess both the benefits and shortcomings of using the checklist. Results demonstrated good compliance in completing the checklist (81%) and that when checked, certain aspects of care were not always delivered when appropriate. At the conclusion of the study the majority of medical staff believed that care in the intensive care unit actually improved with the use of the checklist, and all thought that it assisted in ensuring that good quality care was delivered. The checklist is a useful tool that can be readily applied to facilitate best practice and quality in everyday clinical care, ultimately leading to better health outcomes for patients.
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Affiliation(s)
- K M Hewson
- NSW Intensive Care Coordination and Monitoring Unit, Penrith, New South Wales, Australia
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Abstract
We evaluated empirically the extent to which the use of a cognitive aid during a high-fidelity simulation of a malignant hyperthermia (MH) event facilitated the correct and prompt treatment of MH. We reviewed the management of 48 simulated adult MH scenarios; 24 involving CA 1 and 24 involving CA 2 residents. In the CA 1 group, 19 of the 24 teams (79%) used a cognitive aid, but only 8 of the 19 teams used it frequently or extensively. In the CA 2 group, 18 of the 23 teams (78%) used a cognitive aid but only 6 of them used it frequently or extensively. The frequency of cognitive aid use correlated significantly with the MH treatment score for the CA 1 group (Spearman r = 0.59, P < 0.01) and CA 2 group (Spearman r = 0.68, P < 0.001). The teams that performed the best in treating MH used a cognitive aid extensively throughout the simulation. Although the effect was less pronounced in the more experienced CA 2 cohort, there was still a strong correlation between performance and cognitive aid use. We were able to show a strong correlation between the use of a cognitive aid and the correct treatment of MH.
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Affiliation(s)
- T Kyle Harrison
- Patient Simulation Center of Innovation at VA Palo Alto Health Care System and the Department of Anesthesia, Stanford University School of Medicine, Stanford, California 94304, USA.
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Schwarz SKW. Can Items on an Aviation-Style Checklist for Preparation of Cesarean Delivery Under General Anesthesia Present a Threat for Patient Safety? Anesth Analg 2006; 102:970; author reply 970. [PMID: 16492870 DOI: 10.1213/01.ane.0000190875.15804.14] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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