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Plaum P, Visser LN, de Groot B, Morsink ME, Duijst WL, Candel BG. Using case vignettes to study the presence of outcome, hindsight, and implicit bias in acute unplanned medical care: a cross-sectional study. Eur J Emerg Med 2024; 31:260-266. [PMID: 38364049 PMCID: PMC11198948 DOI: 10.1097/mej.0000000000001127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2023] [Accepted: 01/16/2024] [Indexed: 02/18/2024]
Abstract
BACKGROUND AND IMPORTANCE Various biases can impact decision-making and judgment of case quality in the Emergency Department (ED). Outcome and hindsight bias can lead to wrong retrospective judgment of care quality, and implicit bias can result in unjust treatment differences in the ED based on irrelevant patient characteristics. OBJECTIVES First, to evaluate the extent to which knowledge of an outcome influences physicians' quality of care assessment. Secondly, to examine whether patients with functional disorders receive different treatment compared to patients with a somatic past medical history. DESIGN A web-based cross-sectional study in which physicians received case vignettes with a case description and care provided. Physicians were informed about vignette outcomes in a randomized way (no, good, or bad outcome). Physicians rated quality of care for four case vignettes with different outcomes. Subsequently, they received two more case vignettes. Physicians were informed about the past medical history of the patient in a randomized way (somatic or functional). Physicians made treatment and diagnostic decisions for both cases. SETTING AND PARTICIPANTS One hundred ninety-one Dutch emergency physicians (EPs) and general practitioners (GPs) participated. OUTCOME MEASURES AND ANALYSIS Quality of care was rated on a Likert scale (0-5) and dichotomized as adequate (yes/no). Physicians estimated the likelihood of patients experiencing a bad outcome for hindsight bias. For the second objective, physicians decided on prescribing analgesics and additional diagnostic tests. MAIN RESULTS Large differences existed in rated quality of care for three out of four vignettes based on different case outcomes. For example, physicians rated the quality of care as adequate in 44% (95% CI 33-57%) for an abdominal pain case with a bad outcome, compared to 88% (95% CI 78-94%) for a good outcome, and 84% (95% CI 73-91%) for no outcome ( P < 0.01). The estimated likelihood of a bad outcome was higher if physicians received a vignette with a bad patient outcome. Fewer diagnostic tests were performed and fewer opioids were prescribed for patients with a functional disorder. CONCLUSION Outcome, hindsight, and implicit bias significantly influence decision-making and care quality assessment by Dutch EPs and GPs.
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Affiliation(s)
- Patricia Plaum
- Emergency Department, Zuyderland Medical Centre, Heerlen
| | | | - Bas de Groot
- Emergency Department, Radboud University Medical Centre, Nijmegen
| | | | - Wilma L.J.M. Duijst
- Faculty of Law and Criminology, Maastricht University, Maastricht
- GGD IJsselland, Zwolle
| | - Bart G.J. Candel
- Emergency Department, Leiden University Medical Centre, Leiden, The Netherlands
- Emergency Department, Fiona Stanley Hospital, Perth, Australia
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Pulia MS, Papanagnou D, Croskerry P. The Quest for Diagnostic Excellence in the Emergency Department. Jt Comm J Qual Patient Saf 2024; 50:475-477. [PMID: 38824059 DOI: 10.1016/j.jcjq.2024.05.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2024]
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Ran Y, Qin W, Qin C, Li X, Liu Y, Xu L, Mu X, Yan L, Wang B, Dai Y, Chen J, Han D. A high-quality dataset featuring classified and annotated cervical spine X-ray atlas. Sci Data 2024; 11:625. [PMID: 38871800 PMCID: PMC11176335 DOI: 10.1038/s41597-024-03383-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2024] [Accepted: 05/15/2024] [Indexed: 06/15/2024] Open
Abstract
Recent research in computational imaging largely focuses on developing machine learning (ML) techniques for image recognition in the medical field, which requires large-scale and high-quality training datasets consisting of raw images and annotated images. However, suitable experimental datasets for cervical spine X-ray are scarce. We fill the gap by providing an open-access Cervical Spine X-ray Atlas (CSXA), which includes 4963 raw PNG images and 4963 annotated images with JSON format (JavaScript Object Notation). Every image in the CSXA is enriched with gender, age, pixel equivalent, asymptomatic and symptomatic classifications, cervical curvature categorization and 118 quantitative parameters. Subsequently, an efficient algorithm has developed to transform 23 keypoints in images into 77 quantitative parameters for cervical spine disease diagnosis and treatment. The algorithm's development is intended to assist future researchers in repurposing annotated images for the advancement of machine learning techniques across various image recognition tasks. The CSXA and algorithm are open-access with the intention of aiding the research communities in experiment replication and advancing the field of medical imaging in cervical spine.
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Affiliation(s)
- Yu Ran
- School of Life Sciences, Beijing University of Chinese Medicine, Beijing, 102488, China
| | - Wanli Qin
- Department of Dermatology, Air Force Medical Center, Air Force Medical University, Beijing, 710000, China
| | - Changlong Qin
- Department of Orthopedics and Traumatology, Qiannan Traditional Chinese Medicine Hospital, Guizhou, 558000, China
| | - Xiaobin Li
- Shenzhen Hospital of Beijing University of Chinese Medicine, Shenzhen, 518172, China
| | - Yixing Liu
- School of Management, Beijing University of Chinese Medicine, Beijing, 102488, China
| | - Lin Xu
- Department of Orthopedics, Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, 100700, China
| | - Xiaohong Mu
- Department of Orthopedics, Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, 100700, China
| | - Li Yan
- School of Humanities, Beijing University of Chinese Medicine, Beijing, 102488, China
| | - Bei Wang
- School of Life Sciences, Beijing University of Chinese Medicine, Beijing, 102488, China
| | - Yuxiang Dai
- Longhua Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, 200032, China
| | - Jiang Chen
- Department of Orthopedics, Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, 100700, China.
| | - Dongran Han
- School of Life Sciences, Beijing University of Chinese Medicine, Beijing, 102488, China.
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Schmutz T, Le Terrier C, Ribordy V, Guechi Y. No waiting lying in a corridor: a quality improvement initiative in an emergency department. BMJ Open Qual 2023; 12:e002431. [PMID: 37640478 PMCID: PMC10462955 DOI: 10.1136/bmjoq-2023-002431] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Accepted: 08/09/2023] [Indexed: 08/31/2023] Open
Abstract
BACKGROUND Overcrowding in the emergency department (ED) is a global problem and a source of morbidity and mortality and exhaustion for the teams. Despite multiple strategies proposed to overcome overcrowding, the accumulation of patients lying in bed awaiting treatment or hospitalisation is often inevitable and a major obstacle to quality of care. We initiated a quality improvement project with the objective of zero patients lying in bed awaiting care/referral outside a care area. METHODS Several plan-do-study-act (PDSA) cycles were tested and implemented to achieve and especially maintain the goal of having zero patients waiting for care outside the ED care area. The project team introduced and adapted five rules during these cycles: (1) no patients lying down outside of a care unit; (2) forward movement; (3) examination room always available; (4) team huddle and (5) an organisation overcrowding plan. RESULTS Adaptation of ED organisation in the form of PDSA cycles allowed to obtain a collective team dimension to patient flow management. Since December 2021, despite an increase in activity, no patient is placed in a lying-in waiting area outside a care zone, irrespective of their care level. Vital distress and fragile patients who need to be kept in a supine position are treated immediately. In 2022, waiting time before medical contact was <2 hours for 90% of all patients combined. CONCLUSIONS The PDSA strategy based on these five measures allowed to remove in-house obstacles to the internal flow of patients and to fight against their installation outside the care area. These measures are easily replicable by other management teams. Quality indicators of EDs are often heterogeneous, but we propose that the absence of patients lying on a stretcher outside a care area could be part of these indicators, and thus contribute to the improvement and safety of care provided to all patients.
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Affiliation(s)
- Thomas Schmutz
- Emergency Department, Fribourg Hospitals, Fribourg, Switzerland
| | - Christophe Le Terrier
- Emergency Department, Fribourg Hospitals, Fribourg, Switzerland
- Division of Intensive care unit, University hospitals of Geneva, Geneva, Switzerland
| | - Vincent Ribordy
- Emergency Department, Fribourg Hospitals, Fribourg, Switzerland
| | - Youcef Guechi
- Emergency Department, Fribourg Hospitals, Fribourg, Switzerland
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Bijok B, Jaulin F, Picard J, Michelet D, Fuzier R, Arzalier-Daret S, Basquin C, Blanié A, Chauveau L, Cros J, Delmas V, Dupanloup D, Gauss T, Hamada S, Le Guen Y, Lopes T, Robinson N, Vacher A, Valot C, Pasquier P, Blet A. Guidelines on human factors in critical situations 2023. Anaesth Crit Care Pain Med 2023; 42:101262. [PMID: 37290697 DOI: 10.1016/j.accpm.2023.101262] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
OBJECTIVE To provide guidelines to define the place of human factors in the management of critical situations in anaesthesia and critical care. DESIGN A committee of nineteen experts from the SFAR and GFHS learned societies was set up. A policy of declaration of links of interest was applied and respected throughout the guideline-producing process. Likewise, the committee did not benefit from any funding from a company marketing a health product (drug or medical device). The committee followed the GRADE® method (Grading of Recommendations Assessment, Development and Evaluation) to assess the quality of the evidence on which the recommendations were based. METHODS We aimed to formulate recommendations according to the GRADE® methodology for four different fields: 1/ communication, 2/ organisation, 3/ working environment and 4/ training. Each question was formulated according to the PICO format (Patients, Intervention, Comparison, Outcome). The literature review and recommendations were formulated according to the GRADE® methodology. RESULTS The experts' synthesis work and application of the GRADE® method resulted in 21 recommendations. Since the GRADE® method could not be applied in its entirety to all the questions, the guidelines used the SFAR "Recommendations for Professional Practice" A means of secured communication (RPP) format and the recommendations were formulated as expert opinions. CONCLUSION Based on strong agreement between experts, we were able to produce 21 recommendations to guide human factors in critical situations.
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Affiliation(s)
- Benjamin Bijok
- Pôle Anesthésie-Réanimation, Bloc des Urgences/Déchocage, CHU de Lille, Lille, France; Pôle de l'Urgence, Bloc des Urgences/Déchocage, CHU de Lille, Lille, France.
| | - François Jaulin
- Président du Groupe Facteurs Humains en Santé, France; Directeur Général et Cofondateur Patient Safety Database, France; Directeur Général et Cofondateur Safe Team Academy, France.
| | - Julien Picard
- Pôle Anesthésie-Réanimation, Réanimation Chirurgicale Polyvalente - CHU Grenoble Alpes, Grenoble, France; Centre d'Evaluation et Simulation Alpes Recherche (CESAR) - ThEMAS, TIMC, UMR, CNRS 5525, Université Grenoble Alpes, Grenoble, France; Comité Analyse et Maîtrise du Risque (CAMR) de la Société Française d'Anesthésie Réanimation (SFAR), France
| | - Daphné Michelet
- Département d'Anesthésie-Réanimation du CHU de Reims, France; Laboratoire Cognition, Santé, Société - Université Reims-Champagne Ardenne, France
| | - Régis Fuzier
- Unité d'Anesthésiologie, Institut Claudius Regaud. IUCT-Oncopole de Toulouse, France
| | - Ségolène Arzalier-Daret
- Département d'Anesthésie-Réanimation, CHU de Caen Normandie, Avenue de la Côte de Nacre, 14000 Caen, France; Comité Vie Professionnelle-Santé au Travail (CVP-ST) de la Société Française d'Anesthésie-Réanimation (SFAR), France
| | - Cédric Basquin
- Département Anesthésie-Réanimation, CHU de Rennes, 2 Rue Henri le Guilloux, 35000 Rennes, France; CHP Saint-Grégoire, Groupe Vivalto-Santé, 6 Bd de la Boutière CS 56816, 35760 Saint-Grégoire, France
| | - Antonia Blanié
- Département d'Anesthésie-Réanimation Médecine Périopératoire, CHU Bicêtre, 78 Rue du Général Leclerc, 94270 Le Kremlin-Bicêtre, France; Laboratoire de Formation par la Simulation et l'Image en Médecine et en Santé (LabForSIMS) - Faculté de Médecine Paris Saclay - UR CIAMS - Université Paris Saclay, France
| | - Lucille Chauveau
- Service des Urgences, SMUR et EVASAN, Centre Hospitalier de la Polynésie Française, France; Maison des Sciences de l'Homme du Pacifique, C9FV+855, Puna'auia, Polynésie Française, France
| | - Jérôme Cros
- Service d'Anesthésie et Réanimation, Polyclinique de Limoges Site Emailleurs Colombier, 1 Rue Victor-Schoelcher, 87038 Limoges Cedex 1, France; Membre Co-Fondateur Groupe Facteurs Humains en Santé, France
| | - Véronique Delmas
- Service d'Accueil des Urgences, Centre Hospitalier Le Mans, 194 Avenue Rubillard, 72037 Le Mans, France; CAp'Sim, Centre d'Apprentissage par la Simulation, Centre Hospitalier Le Mans, 194 Avenue Rubillard, 72037 Le Mans, France
| | - Danièle Dupanloup
- IADE, Cadre de Bloc, CHU de Nancy, 29 Avenue du Maréchal de Lattre de Tassigny, 54000 Nancy, France; Comité IADE de la Société Française d'Anesthésie Réanimation (SFAR), France
| | - Tobias Gauss
- Pôle Anesthésie-Réanimation, Bloc des Urgences/Déchocage, CHU Grenoble Alpes, Grenoble, France
| | - Sophie Hamada
- Université Paris Cité, APHP, Hôpital Européen Georges Pompidou, Service d'Anesthésie Réanimation, F-75015, Paris, France; CESP, INSERM U 10-18, Université Paris-Saclay, France
| | - Yann Le Guen
- Pôle Anesthésie-Réanimation, CHU Grenoble Alpes, Grenoble, France
| | - Thomas Lopes
- Service d'Anesthésie-Réanimation, Hôpital Privé de Versailles, 78000 Versailles, France
| | | | - Anthony Vacher
- Unité Recherche et Expertise Aéromédicales, Institut de Recherche Biomédicale des Armées, Brétigny Sur Orge, France
| | | | - Pierre Pasquier
- 1ère Chefferie du Service de Santé, Villacoublay, France; Département d'Anesthésie-Réanimation, Hôpital d'Instruction des Armées Percy, Clamart, France; École du Val-de-Grâce, Paris, France
| | - Alice Blet
- Lyon University Hospital, Department of Anaesthesiology and Critical Care, Croix Rousse University Hospital, Hospices Civils de Lyon, Lyon, France; INSERM U1052, Cancer Research Center of Lyon, Lyon, France
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Pulia MS, Papanagnou D, Santhosh L. Time to reimagine diagnosis in the acute care setting. Acad Emerg Med 2023. [PMID: 36764669 DOI: 10.1111/acem.14693] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Accepted: 02/07/2023] [Indexed: 02/12/2023]
Affiliation(s)
- Michael S Pulia
- BerbeeWalsh Department of Emergency Medicine, University of Wisconsin Madison School of Medicine and Public Health, Madison, Wisconsin, USA.,Department of Industrial and Systems Engineering, College of Engineering, University of Wisconsin-Madison, Madison, Wisconsin, USA
| | - Dimitrios Papanagnou
- Department of Emergency Medicine, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Lekshmi Santhosh
- Division of Pulmonary and Critical Care Medicine, University of California San Franscisco, San Franscisco, California, USA
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Can an End-to-End Telesepsis Solution Improve the Severe Sepsis and Septic Shock Management Bundle-1 Metrics for Sepsis Patients Admitted From the Emergency Department to the Hospital? Crit Care Explor 2022; 4:e0767. [PMID: 36248316 PMCID: PMC9553400 DOI: 10.1097/cce.0000000000000767] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
UNLABELLED Early detection and treatment for sepsis patients are key components to improving sepsis care delivery and increased The Severe Sepsis and Septic Shock Management Bundle (SEP-1) compliance may correlate with improved outcomes. OBJECTIVES We assessed the impact of implementing a partially automated end-to-end sepsis solution including electronic medical record-linked automated monitoring, early detection, around-the-clock nurse navigators, and teleconsultation, on SEP-1 compliance in patients with primary sepsis, present at admission, admitted through the emergency department (ER). DESIGN SETTING AND PARTICIPANTS After a "surveillance only" training period between September 3, 2020, and October 5, 2020, the automated end-to-end sepsis solution intervention period occurred from October 6, 2020, to January 1, 2021 in five ERs in an academic health system. Patients who screened positive for greater than or equal to 3 sepsis screening criteria (systemic inflammatory response syndrome, quick Sequential Organ Failure Assessment, pulse oximetry), had evidence of infection and acute organ dysfunction, and were receiving treatment consistent with infection or sepsis were included. MAIN OUTCOMES AND MEASURES SEP-1 compliance during the "surveillance only" period compared to the intervention period. RESULTS During the intervention period, 56,713 patients presented to the five ERs; 20,213 (35.6%) met electronic screening criteria for potential sepsis; 1,233 patients had a primary diagnosis of sepsis, present at admission, and were captured by the nurse navigators. Median age of the cohort was 68 years (interquartile range, 57-79 yr); 55.3% were male; 63.5% were White/Caucasian, 26.3% Black/African-American; was 16.7%, and 879 patients (71.3%) were presumed bacterial sepsis, nonviral etiology, and SEP-1 bundle eligible. Nurse navigator real-time classification of this group increased from 51.7% during the "surveillance only" period to 71.8% during the intervention period (p = 0.0002). Five hospital SEP-1 compliance for the period leading into the study period (July 1, 2020-August 31, 2020) was 62% (p < 0.0001), during the "surveillance only" period, it was 68.4% and during the intervention period it was 78.3% (p = 0.002). CONCLUSIONS AND RELEVANCE During an 11-week period of sepsis screening, monitoring, and teleconsultation in 5 EDs, SEP-1 compliance improved significantly compared with institutional SEP-1 reporting metrics and to a "surveillance only" training period.
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Truchot J, Boucher V, Li W, Martel G, Jouhair E, Raymond-Dufresne É, Petrosoniak A, Emond M. Is in situ simulation in emergency medicine safe? A scoping review. BMJ Open 2022; 12:e059442. [PMID: 36219737 PMCID: PMC9301797 DOI: 10.1136/bmjopen-2021-059442] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVES To provide an overview of the available evidence regarding the safety of in situ simulation (ISS) in the emergency department (ED). DESIGN Scoping review. METHODS Original articles published before March 2021 were included if they investigated the use of ISS in the field of emergency medicine. INFORMATION SOURCES MEDLINE, EMBASE, Cochrane and Web of Science. RESULTS A total of 4077 records were identified by our search strategy and 2476 abstracts were screened. One hundred and thirty full articles were reviewed and 81 full articles were included. Only 33 studies (40%) assessed safety-related issues, among which 11 chose a safety-related primary outcome. Latent safety threats (LSTs) assessment was conducted in 24 studies (30%) and the cancellation rate was described in 9 studies (11%). The possible negative impact of ISS on real ED patients was assessed in two studies (2.5%), through a questionnaire and not through patient outcomes. CONCLUSION Most studies use ISS for systems-based or education-based applications. Patient safety during ISS is often evaluated in the context of identifying or mitigating LSTs and rarely on the potential impact and risks to patients simultaneously receiving care in the ED. Our scoping review identified knowledge gaps related to the safe conduct of ISS in the ED, which may warrant further investigation.
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Affiliation(s)
- Jennifer Truchot
- Département de médecine familiale et de médecine d'urgence, Université Laval Faculté de médecine, Quebec, Quebec, Canada
- Emergency Department, CHU de Québec-Université Laval, Quebec, Quebec, Canada
- Emergency Department, CHU Cochin- Université de Paris, APHP, Paris, France
- Axe Santé des populations et pratiques optimales en santé, Centre de recherche du CHU de Québec-Université Laval, Quebec, Quebec, Canada
| | - Valérie Boucher
- Axe Santé des populations et pratiques optimales en santé, Centre de recherche du CHU de Québec-Université Laval, Quebec, Quebec, Canada
- Centre d'excellence sur le vieillissement de Québec, Québec, Quebec, Canada
| | - Winny Li
- 5Division of Emergency Medicine, Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Guillaume Martel
- Département de médecine familiale et de médecine d'urgence, Université Laval Faculté de médecine, Quebec, Quebec, Canada
| | - Eva Jouhair
- Département de médecine familiale et de médecine d'urgence, Université Laval Faculté de médecine, Quebec, Quebec, Canada
- Axe Santé des populations et pratiques optimales en santé, Centre de recherche du CHU de Québec-Université Laval, Quebec, Quebec, Canada
| | - Éliane Raymond-Dufresne
- Département de médecine familiale et de médecine d'urgence, Université Laval Faculté de médecine, Quebec, Quebec, Canada
- Emergency Department, CHU de Québec-Université Laval, Quebec, Quebec, Canada
| | - Andrew Petrosoniak
- 5Division of Emergency Medicine, Department of Medicine, University of Toronto, Toronto, Ontario, Canada
- Department of Emergency Medicine, St. Michael's Hospital, Toronto, Ontario, Canada
| | - Marcel Emond
- Département de médecine familiale et de médecine d'urgence, Université Laval Faculté de médecine, Quebec, Quebec, Canada
- Emergency Department, CHU de Québec-Université Laval, Quebec, Quebec, Canada
- Axe Santé des populations et pratiques optimales en santé, Centre de recherche du CHU de Québec-Université Laval, Quebec, Quebec, Canada
- Centre d'excellence sur le vieillissement de Québec, Québec, Quebec, Canada
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Guo F, Qin Y, Fu H, Xu F. The impact of COVID-19 on Emergency Department length of stay for urgent and life-threatening patients. BMC Health Serv Res 2022; 22:696. [PMID: 35610608 PMCID: PMC9127479 DOI: 10.1186/s12913-022-08084-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2021] [Accepted: 05/12/2022] [Indexed: 01/08/2023] Open
Abstract
OBJECTIVES To determine the impact of the Coronavirus disease-2019 (COVID-19) pandemic on the length of stay (LOS) and prognosis of patients in the resuscitation area. METHODS A retrospective analysis of case data of patients in the resuscitation area during the early stages of the COVID-19 pandemic (January 15, 2020- January 14, 2021) was performed and compared with the pre-COVID-19 period (January 15, 2019 - January 14, 2020) in the First Affiliated Hospital of Soochow University. The patients' information, including age, sex, length of stay, and death, was collected. The Wilcoxon Rank sum test was performed to compare the LOS difference between the two periods. Fisher's Exact test and Chi-Squared test were used to analyze the prognosis of patients. The LOS and prognosis in different departments of the resuscitation area (emergency internal medicine, emergency surgery, emergency neurology, and other departments) were further analyzed. RESULTS Of the total 8278 patients, 4159 (50.24%) were enrolled in the COVID-19 pandemic period group, and 4119 (49.76%) were enrolled pre-COVID-19 period group. The length of stay was prolonged significantly in the COVID-19 period compared with the pre-COVID-19 period (13h VS 9.8h, p < 0.001). The LOS in the COVID-19 period was prolonged in both emergency internal medicine (15.3h VS 11.3h, p < 0.001) and emergency surgery (8.7h VS 4.9h, p < 0.001) but not in emergency neurology or other emergency departments. There was no significant difference in mortality between the two cohorts (4.8% VS 5.3%, p = 0.341). CONCLUSION The COVID-19 pandemic was associated with a significant increase in the length of resuscitation area stay, which may lead to resuscitation area crowding. The influence of the COVID-19 pandemic on patients of different departments was variable. There was no significant impact on the LOS of emergency neurology. According to different departments of the resuscitation area, the COVID-19 pandemic didn't significantly impact the prognosis of patients.
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Affiliation(s)
- Fengbao Guo
- Department of Emergency Medicine, the First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China
| | - Yan Qin
- Department of Emergency Medicine, the First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China
| | - Hailong Fu
- Clinical laboratory, the First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China.
| | - Feng Xu
- Department of Emergency Medicine, the First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China.
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Pasquier P, Saleten M, Laitselart P, Martinez T, Descamps C, Debien B, Boutonnet M. Who's who in the trauma bay? Association between wearing of identification jackets and trauma teamwork performance: A simulation study. J Emerg Trauma Shock 2022; 15:139-145. [DOI: 10.4103/jets.jets_168_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Revised: 04/05/2022] [Accepted: 05/20/2022] [Indexed: 11/04/2022] Open
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Freund Y, Chauvin A, Jimenez S, Philippon AL, Curac S, Fémy F, Gorlicki J, Chouihed T, Goulet H, Montassier E, Dumont M, Lozano Polo L, Le Borgne P, Khellaf M, Bouzid D, Raynal PA, Abdessaied N, Laribi S, Guenezan J, Ganansia O, Bloom B, Miró O, Cachanado M, Simon T. Effect of a Diagnostic Strategy Using an Elevated and Age-Adjusted D-Dimer Threshold on Thromboembolic Events in Emergency Department Patients With Suspected Pulmonary Embolism: A Randomized Clinical Trial. JAMA 2021; 326:2141-2149. [PMID: 34874418 PMCID: PMC8652602 DOI: 10.1001/jama.2021.20750] [Citation(s) in RCA: 40] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
IMPORTANCE Uncontrolled studies suggest that pulmonary embolism (PE) can be safely ruled out using the YEARS rule, a diagnostic strategy that uses varying D-dimer thresholds. OBJECTIVE To prospectively validate the safety of a strategy that combines the YEARS rule with the pulmonary embolism rule-out criteria (PERC) rule and an age-adjusted D-dimer threshold. DESIGN, SETTINGS, AND PARTICIPANTS A cluster-randomized, crossover, noninferiority trial in 18 emergency departments (EDs) in France and Spain. Patients (N = 1414) who had a low clinical risk of PE not excluded by the PERC rule or a subjective clinical intermediate risk of PE were included from October 2019 to June 2020, and followed up until October 2020. INTERVENTIONS Each center was randomized for the sequence of intervention periods. In the intervention period (726 patients), PE was excluded without chest imaging in patients with no YEARS criteria and a D-dimer level less than 1000 ng/mL and in patients with 1 or more YEARS criteria and a D-dimer level less than the age-adjusted threshold (500 ng/mL if age <50 years or age in years × 10 in patients ≥50 years). In the control period (688 patients), PE was excluded without chest imaging if the D-dimer level was less than the age-adjusted threshold. MAIN OUTCOMES AND MEASURES The primary end point was venous thromboembolism (VTE) at 3 months. The noninferiority margin was set at 1.35%. There were 8 secondary end points, including chest imaging, ED length of stay, hospital admission, nonindicated anticoagulation treatment, all-cause death, and all-cause readmission at 3 months. RESULTS Of the 1414 included patients (mean age, 55 years; 58% female), 1217 (86%) were analyzed in the per-protocol analysis. PE was diagnosed in the ED in 100 patients (7.1%). At 3 months, VTE was diagnosed in 1 patient in the intervention group (0.15% [95% CI, 0.0% to 0.86%]) vs 5 patients in the control group (0.80% [95% CI, 0.26% to 1.86%]) (adjusted difference, -0.64% [1-sided 97.5% CI, -∞ to 0.21%], within the noninferiority margin). Of the 6 analyzed secondary end points, only 2 showed a statistically significant difference in the intervention group compared with the control group: chest imaging (30.4% vs 40.0%; adjusted difference, -8.7% [95% CI, -13.8% to -3.5%]) and ED median length of stay (6 hours [IQR, 4 to 8 hours] vs 6 hours [IQR, 5 to 9 hours]; adjusted difference, -1.6 hours [95% CI, -2.3 to -0.9]). CONCLUSIONS AND RELEVANCE Among ED patients with suspected PE, the use of the YEARS rule combined with the age-adjusted D-dimer threshold in PERC-positive patients, compared with a conventional diagnostic strategy, did not result in an inferior rate of thromboembolic events. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT04032769.
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Affiliation(s)
- Yonathan Freund
- Sorbonne Université, Improving Emergency Care FHU, Paris, France
- Emergency Department, Hôpital Pitié–Salpêtrière, Assistance Publique–Hôpitaux de Paris, Paris, France
| | - Anthony Chauvin
- Emergency Department, Hôpital Lariboisière, Assistance Publique–Hôpitaux de Paris, Paris, France
| | - Sonia Jimenez
- Emergency Department, Hospital Clínic, IDIBAPS, Barcelona, University of Barcelona, Catalonia, Spain
| | - Anne-Laure Philippon
- Sorbonne Université, Improving Emergency Care FHU, Paris, France
- Emergency Department, Hôpital Pitié–Salpêtrière, Assistance Publique–Hôpitaux de Paris, Paris, France
| | - Sonja Curac
- Emergency Department, Hôpital Beaujon, Assistance Publique–Hôpitaux de Paris, Clichy, France
| | - Florent Fémy
- Emergency Department, Hôpital Européen Georges Pompidou, Assistance Publique–Hôpitaux de Paris, Paris University, Paris, France
- Toxicology and Chemical Risks Department, French Armed Forces Biomedical Institute, Bretigny-Sur-Orges, France
| | - Judith Gorlicki
- Emergency Department, Hôpital Avicenne, Assistance Publique–Hôpitaux de Paris, INSERM U942-MASCOT, Bobigny, France
| | - Tahar Chouihed
- Emergency Department, University Hospital of Nancy, Université de Lorraine, UMR_S 1116, Nancy, France
| | - Hélène Goulet
- Emergency Department, Hôpital Tenon, Assistance Publique–Hôpitaux de Paris, Paris, France
| | | | - Margaux Dumont
- Emergency Department, Hôpital Pitié–Salpêtrière, Assistance Publique–Hôpitaux de Paris, Paris, France
| | - Laura Lozano Polo
- Emergency Department, Hospital de la Santa Creu i Sant Pau, Barcelona, Universitat Autònoma de Barcelona, Catalonia, Spain
| | - Pierrick Le Borgne
- Emergency Department, Hôpitaux Universitaires de Strasbourg, Strasbourg, France
| | - Mehdi Khellaf
- Emergency Department, CHU Henri Mondor, INSERM U955, Assistance Publique–Hôpitaux de Paris, Paris, France
| | - Donia Bouzid
- Université de Paris, INSERM, IAME, F-75006 Paris, France
- Emergency Department, Bichat-Claude Bernard University Hospital, Assistance Publique–Hôpitaux de Paris, Paris, France
| | - Pierre-Alexis Raynal
- Emergency Department, Hôpital St-Antoine, Assistance Publique–Hôpitaux de Paris, Paris, France
| | - Nizar Abdessaied
- Emergency Department, Centre Hospitalier de St Denis, St Denis, France
| | - Saïd Laribi
- Tours University, Emergency Medicine Department, Tours University Hospital, Tours, France
| | - Jeremy Guenezan
- Emergency Department, University Hospital of Poitiers, Poitiers, France
| | - Olivier Ganansia
- Emergency Department, Groupe Hospitalier Paris–St Joseph, Paris, France
| | - Ben Bloom
- Emergency Department, Barts Health NHS Trust, London, United Kingdom
| | - Oscar Miró
- Emergency Department, Hôpital Lariboisière, Assistance Publique–Hôpitaux de Paris, Paris, France
| | - Marine Cachanado
- Department of Clinical Pharmacology and Clinical Research Platform Paris-East (URCEST-CRC-CRB), Assistance Publique–Hôpitaux de Paris, Sorbonne University, St Antoine Hospital, Paris, France
| | - Tabassome Simon
- Sorbonne Université, Improving Emergency Care FHU, Paris, France
- Department of Clinical Pharmacology and Clinical Research Platform Paris-East (URCEST-CRC-CRB), Assistance Publique–Hôpitaux de Paris, Sorbonne University, St Antoine Hospital, Paris, France
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12
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Abensur Vuillaume L, Laudren G, Bosio A, Thévenot P, Pelaccia T, Chauvin A. A Didactic Escape Game for Emergency Medicine Aimed at Learning to Work as a Team and Making Diagnoses: Methodology for Game Development. JMIR Serious Games 2021; 9:e27291. [PMID: 34463628 PMCID: PMC8441606 DOI: 10.2196/27291] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2021] [Revised: 03/30/2021] [Accepted: 06/28/2021] [Indexed: 01/23/2023] Open
Abstract
Background In the health care environment, teamwork is paramount, especially when referring to patient safety. We are interested in recent and innovative solutions such as escape games, which is a type of adventure game that may be highly useful as an educational tool, potentially combining good communication skills with successful gamification. They involve teams of 5 to 10 individuals who are “locked” in the same room and must collaborate to solve puzzles while under pressure from a timer. Objective The purpose of this paper was to describe the steps involved in creating and implementing an educational escape game. This tool can then be put into service or further developed by trainers who wish to use it for learning interprofessional collaboration. Therefore, we started with an experience of creating an educational escape game for emergency medicine teams. Methods We chose to develop an educational escape game by using 6 successive steps. First, we built a team. Second, we chose the pedagogical objectives. Third, we gamified (switched from objectives to scenario). Next, we found the human and material resources needed. Thereafter, we designed briefing and debriefing. Lastly, we tested the game. Results By following these 6 steps, we created the first ambulant educational escape game that teaches people, or nurses, doctors, and paramedics, working in emergency medicine to work as a team. Conclusions From a pedagogic point of view, this game may be a good tool for helping people in multidisciplinary fields (medical and paramedical teams) to learn how to work collaboratively and to communicate as a group. Above all, it seems to be an innovative tool that complements medical simulation–based learning and thus consolidates traditional education.
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Affiliation(s)
| | - Garry Laudren
- Intensive Care and Anesthesiology, Pediatric Necker Hospital, Paris, France
| | - Alexandre Bosio
- Emergency Department, Hospital Center of Verdun, Verdun, France
| | | | - Thierry Pelaccia
- University of Strasbourg Medical School, Strasbourg, France.,Prehospital Emergency Care Service (SAMU 67), Center for Training and Research in Health Sciences Education, Strasbourg University Hospital, Strasbourg, France
| | - Anthony Chauvin
- Emergency Department, Lariboisière Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
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13
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Designing healthcare spaces to improve teamwork and patient outcomes: a systems approach. Eur J Emerg Med 2021; 28:171-173. [PMID: 33904525 DOI: 10.1097/mej.0000000000000829] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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14
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Etherington NB, Clancy C, Jones RB, Dine CJ, Diemer G. Peer Discussion Decreases Practice Intensity and Increases Certainty in Clinical Decision-Making Among Internal Medicine Residents. J Grad Med Educ 2021; 13:371-376. [PMID: 34178262 PMCID: PMC8207905 DOI: 10.4300/jgme-d-20-00948.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2020] [Revised: 12/22/2020] [Accepted: 03/01/2021] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND Team-based decision-making has been shown to reduce diagnostic error, increase clinical certainty, and decrease adverse events. OBJECTIVE This study aimed to assess the effect of peer discussion on resident practice intensity (PI) and clinical certainty (CC). METHODS A vignette-based instrument was adapted to measure PI, defined as the likelihood of ordering additional diagnostic tests, consultations or empiric treatment, and CC. Internal medicine residents at 7 programs in the Philadelphia area from April 2018 to June 2019 were eligible for inclusion in the study. Participants formed groups and completed each item of the instrument individually and as a group with time for peer discussion in between individual and group responses. Predicted group PI and CC scores were compared with measured group PI and CC scores, respectively, using paired t testing. RESULTS Sixty-nine groups participated in the study (response rate 34%, average group size 2.88). The measured group PI score (2.29, SD = 0.23) was significantly lower than the predicted group PI score (2.33, SD = 0.22) with a mean difference of 0.04 (SD = 0.10; 95% CI 0.02-0.07; P = .0002). The measured group CC score (0.493, SD = 0.164) was significantly higher than the predicted group CC score (0.475, SD = 0.136) with a mean difference of 0.018 (SD = 0.073; 95% CI 0.0006-0.0356; P = .022). CONCLUSIONS In this multicenter study of resident PI, peer discussion reduced PI and increased CC more than would be expected from averaging group members' individual scores.
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Affiliation(s)
- Neha Bansal Etherington
- Neha Bansal Etherington, MD, is Assistant Professor of Clinical Medicine and Director of the Internal Medicine Sub-Internship, Lewis Katz School of Medicine, Temple University, Division of Hospital Medicine, Temple University Health System
| | - Caitlin Clancy
- Caitlin Clancy, MD, is Instructor of Clinical Medicine, Division of Pulmonary, Allergy and Critical Care, University of Pennsylvania Health System, Perelman School of Medicine, University of Pennsylvania
| | - R. Benson Jones
- R. Benson Jones, MD, is a Fellow, Division of Endocrinology, Diabetes, and Metabolism, University of Pennsylvania Health System
| | - C. Jessica Dine
- C. Jessica Dine, MD, MHSP, is Associate Professor of Medicine, Division of Pulmonary, Allergy and Critical Care, University of Pennsylvania Health System, and Associate Dean of Faculty Development, Perelman School of Medicine, Leonard Davis Institute of Health Economics, University of Pennsylvania
| | - Gretchen Diemer
- Gretchen Diemer, MD, is Professor of Medicine, Vice Chair of Education for Medicine, and Senior Associate Dean of Graduate Medical Education and Affiliations, Sidney Kimmel Medical College, Thomas Jefferson University
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15
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Kasick RT, Melvin JE, Perera ST, Perry MF, Black JD, Bode RS, Groner JI, Kersey KE, Klamer BG, Bai S, McClead RE. A diagnostic time-out to improve differential diagnosis in pediatric abdominal pain. Diagnosis (Berl) 2021; 8:209-217. [PMID: 31677376 DOI: 10.1515/dx-2019-0054] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2019] [Accepted: 10/17/2019] [Indexed: 12/02/2023]
Abstract
BACKGROUND Pediatric abdominal pain is challenging to diagnose and often results in unscheduled return visits to the emergency department. External pressures and diagnostic momentum can impair physicians from thoughtful reflection on the differential diagnosis (DDx). We implemented a diagnostic time-out intervention and created a scoring tool to improve the quality and documentation rates of DDx. The specific aim of this quality improvement (QI) project was to increase the frequency of resident and attending physician documentation of DDx in pediatric patients admitted with abdominal pain by 25% over 6 months. METHODS We reviewed a total of 165 patients admitted to the general pediatrics service at one institution. Sixty-four history and physical (H&P) notes were reviewed during the baseline period, July-December 2017; 101 charts were reviewed post-intervention, January-June 2018. Medical teams were tasked to perform a diagnostic time-out on all patients during the study period. Metrics tracked monthly included percentage of H&Ps with a 'complete' DDx and quality scores (Qs) using our Differential Diagnosis Scoring Rubric. RESULTS At baseline, 43 (67%) resident notes and 49 (77%) attending notes documented a 'complete' DDx. Post-intervention, 59 (58%) resident notes and 69 (68%) attending notes met this criteria. Mean Qs, pre- to post-intervention, for resident-documented differential diagnoses increased slightly (2.41-2.47, p = 0.73), but attending-documented DDx did not improve (2.85-2.82, p = 0.88). CONCLUSIONS We demonstrated a marginal improvement in the quality of resident-documented DDx. Expansion of diagnoses considered within a DDx may contribute to higher diagnostic accuracy.
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Affiliation(s)
- Rena T Kasick
- Department of Pediatrics, Division of Hospital Pediatrics, Nationwide Children's Hospital, Columbus, OH, USA
| | - Jennifer E Melvin
- Department of Pediatrics, Division of Emergency Medicine, Nationwide Children's Hospital, Columbus, OH, USA
| | - Sajithya T Perera
- Department of Pediatrics, Division of Hospital Pediatrics, Nationwide Children's Hospital, Columbus, OH, USA
| | - Michael F Perry
- Department of Pediatrics, Division of Hospital Pediatrics, Nationwide Children's Hospital, Columbus, OH, USA
| | - Joshua D Black
- Department of Pediatrics, Division of Hospital Pediatrics, Nationwide Children's Hospital, Columbus, OH, USA
| | - Ryan S Bode
- Department of Pediatrics, Division of Hospital Pediatrics, Nationwide Children's Hospital, Columbus, OH, USA
| | - Jonathan I Groner
- Department of Pediatric Surgery, Nationwide Children's Hospital, Columbus, OH, USA
| | - Kelly E Kersey
- Quality Improvement Services, Nationwide Children's Hospital, Columbus, OH, USA
| | - Brett G Klamer
- Biostatistics Resources, Nationwide Children's Hospital, Columbus, OH, USA
- Center for Biostatistics, The Ohio State University, Columbus, OH, USA (B.G. Klamer) (S. Bai)
| | - Shasha Bai
- Biostatistics Resources, Nationwide Children's Hospital, Columbus, OH, USA
- Center for Biostatistics, The Ohio State University, Columbus, OH, USA (B.G. Klamer) (S. Bai)
| | - Richard E McClead
- Department of Pediatrics, Nationwide Children's Hospital, Columbus, OH, USA
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16
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Bouillon-Minois JB, Raconnat J, Clinchamps M, Schmidt J, Dutheil F. Emergency Department and Overcrowding During COVID-19 Outbreak; a Letter to Editor. ARCHIVES OF ACADEMIC EMERGENCY MEDICINE 2021; 9:e28. [PMID: 34027423 PMCID: PMC8126354 DOI: 10.22037/aaem.v9i1.1167] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Affiliation(s)
- Jean-Baptiste Bouillon-Minois
- Emergency Medicine, CHU Clermont-Ferrand, Université Clermont Auvergne, F-63000 Clermont-Ferrand, France.,CNRS, LaPSCo, Physiological and Psychosocial Stress, F-63000 Clermont-Ferrand, France
| | - Julien Raconnat
- Emergency Medicine, CHU Clermont-Ferrand, Université Clermont Auvergne, F-63000 Clermont-Ferrand, France
| | - Maelys Clinchamps
- Preventive and Occupational Medicine, CHU Clermont-Ferrand, F-63000 Clermont-Ferrand, France
| | - Jeannot Schmidt
- Emergency Medicine, CHU Clermont-Ferrand, Université Clermont Auvergne, F-63000 Clermont-Ferrand, France.,CNRS, LaPSCo, Physiological and Psychosocial Stress, F-63000 Clermont-Ferrand, France
| | - Frédéric Dutheil
- CNRS, LaPSCo, Physiological and Psychosocial Stress, F-63000 Clermont-Ferrand, France.,Preventive and Occupational Medicine, CHU Clermont-Ferrand, F-63000 Clermont-Ferrand, France
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17
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Saban M, Drach-Zahavy A, Dagan E. A novel reflective practice intervention improves quality of care in the emergency department. Int Emerg Nurs 2021; 56:100977. [PMID: 33819845 DOI: 10.1016/j.ienj.2021.100977] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2020] [Revised: 12/08/2020] [Accepted: 02/07/2021] [Indexed: 11/18/2022]
Abstract
INTRODUCTION Most interventions to improve clinical outcomes in the emergency department (ED) are based on structural changes. This study embraced a different strategy and examined the impact of a reflective practice intervention (RPI) on ED quality of care. METHODS A pre-post-intervention quasi-experimental nested design was conducted between January 2017 and June 2018 in an Israeli public tertiary academic ED. Nighty-six ED teams (triage and staff nurses and a physician) were included pre and post RPI. Data were collected pre and post RPI at patient-triage nurse encounters using triage-accuracy questionnaires. Time to decision, length-of-stay, and hospitalization and mortality rates were retrieved from the medical charts of 1920 patients (20 per team). RESULTS Accurate triage was significantly higher post than pre intervention (4.84 ± 1.45 vs. 3.87 ± 1.48; range 1-7; p < .001), whereas time to decision (253.30 ± 246.75 vs. 304.64 ± 249.14 min), hospitalization rates (n = 291, 30.3% vs. n = 374, 39.0%; p < .001), and hospital length-of-stay (5.73 ± 6.72 vs. 6.69 ± 6.20; p = .04) significantly decreased. CONCLUSIONS By adapting organizational reflective practice principles to the ED dynamic environment, the RPI was associated with a significant improvement in ED quality-of-care measures.
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Affiliation(s)
- Mor Saban
- The Gertner Institute for Epidemiology and Health Policy Research, Ramat Gan, Israel.
| | - Anat Drach-Zahavy
- The Cheryl Spencer Department of Nursing, The Faculty of Social Welfare and Health Sciences, University of Haifa, Haifa, Israel
| | - Efrat Dagan
- The Cheryl Spencer Department of Nursing, The Faculty of Social Welfare and Health Sciences, University of Haifa, Haifa, Israel
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18
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Plint AC, Stang A, Newton AS, Dalgleish D, Aglipay M, Barrowman N, Tse S, Neto G, Farion K, Creery WD, Johnson DW, Klassen TP, Calder LA. Adverse events in the paediatric emergency department: a prospective cohort study. BMJ Qual Saf 2021; 30:216-227. [PMID: 32350128 PMCID: PMC7907581 DOI: 10.1136/bmjqs-2019-010055] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2019] [Revised: 03/09/2020] [Accepted: 04/06/2020] [Indexed: 11/04/2022]
Abstract
BACKGROUND Understanding adverse events among children treated in the emergency department (ED) offers an opportunity to improve patient safety by providing evidence of where to focus efforts in a resource-restricted environment. OBJECTIVE To estimate the risk of adverse events, their type, preventability and severity, for children seen in a paediatric ED. METHODS This prospective cohort study examined outcomes of patients presenting to a paediatric ED over a 1-year period. The primary outcome was the proportion of patients with an adverse event (harm to patient related to healthcare received) related to ED care within 3 weeks of their visit. We conducted structured telephone interviews with all patients and families over a 3-week period following their visit to identify flagged outcomes (such as repeat ED visits, worsening symptoms) and screened admitted patients' health records with a validated trigger tool. For patients with flagged outcomes or triggers, three ED physicians independently determined whether an adverse event occurred. RESULTS Of 1567 eligible patients, 1367 (87.2%) were enrolled and 1319 (96.5%) reached in follow-up. Median patient age was 4.34 years (IQR 1.5 to 10.57 years) and most (n=1281; 93.7%) were discharged. Among those with follow-up, 33 (2.5%, 95% CI 1.8% to 3.5%) suffered an adverse event related to ED care. None experienced more than one event. Twenty-nine adverse events (87.9%, 95% CI 72.7% to 95.2%) were deemed preventable. The most common types of adverse events (not mutually exclusive) were management issues (51.5%), diagnostic issues (45.5%) and suboptimal follow-up (15.2%). CONCLUSION One in 40 children suffered adverse events related to ED care. A high proportion of events were preventable. Management and diagnostic issues warrant further study.
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Affiliation(s)
- Amy C Plint
- CHEO, Ottawa, Ontario, Canada
- Pediatrics and Emergency Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Antonia Stang
- Pediatrics, University of Calgary, Calgary, Alberta, Canada
- Alberta Children's Hospital, Calgary, Alberta, Canada
| | - Amanda S Newton
- Pediatrics, University of Alberta, Edmonton, Alberta, Canada
- Stollery Children's Hospital, Edmonton, Alberta, Canada
| | | | - Mary Aglipay
- St. Michael's Hospital, Toronto, Ontario, Canada
| | - Nick Barrowman
- CHEO Research Institute, Ottawa, Ontario, Canada
- Pediatrics, University of Ottawa, Ottawa, Ontario, Canada
| | - Sandy Tse
- CHEO, Ottawa, Ontario, Canada
- Pediatrics and Emergency Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Gina Neto
- CHEO, Ottawa, Ontario, Canada
- Pediatrics and Emergency Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Ken Farion
- CHEO, Ottawa, Ontario, Canada
- Pediatrics and Emergency Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Walter David Creery
- CHEO, Ottawa, Ontario, Canada
- Pediatrics, University of Ottawa, Ottawa, Ontario, Canada
| | - David W Johnson
- Pediatrics, University of Calgary, Calgary, Alberta, Canada
- Alberta Children's Hospital, Calgary, Alberta, Canada
| | - Terry P Klassen
- Pediatrics, University of Manitoba, Winnipeg, Manitoba, Canada
- Children's Hospital Research Institute of Manitoba, Winnipeg, Manitoba, Canada
| | - Lisa A Calder
- Emergency Medicine, University of Ottawa, Ottawa, Ontario, Canada
- Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
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Meyer FM, Filipovic MG, Balestra GM, Tisljar K, Sellmann T, Marsch S. Diagnostic Errors Induced by a Wrong a Priori Diagnosis: A Prospective Randomized Simulator-Based Trial. J Clin Med 2021; 10:jcm10040826. [PMID: 33670489 PMCID: PMC7922172 DOI: 10.3390/jcm10040826] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2021] [Revised: 02/12/2021] [Accepted: 02/14/2021] [Indexed: 11/26/2022] Open
Abstract
Preventive strategies against diagnostic errors require the knowledge of underlying mechanisms. We examined the effects of a wrong a priori diagnosis on diagnostic accuracy of a focussed assessment in an acute myocardial infarction scenario. One-hundred-and-fifty-six medical students (cohort 1) were randomized to three study arms differing in the a priori diagnosis revealed: no diagnosis (control group), myocardial infarction (correct diagnosis group), and pulmonary embolism (wrong diagnosis group). Forty-four physicians (cohort 2) were randomized to the control group and the wrong diagnosis group. Primary endpoint was the participants’ final presumptive diagnosis. Among students, the correct diagnosis of an acute myocardial infarction was made by 48/52 (92%) in the control group, 49/52 (94%) in the correct diagnosis group, and 14/52 (27%) in the wrong diagnosis group (p < 0.001 vs. both other groups). Among physicians, the correct diagnosis was made by 20/21 (95%) in the control group and 15/23 (65%) in the wrong diagnosis group (p = 0.023). In the wrong diagnosis group, 31/52 (60%) students and 6/23 (19%) physicians indicated their initially given wrong a priori diagnosis pulmonary embolism as final diagnosis. A wrong a priori diagnosis significantly increases the likelihood of a diagnostic error during a subsequent patient encounter.
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Affiliation(s)
- Felix M.L. Meyer
- Department of Intensive Care, Kantonsspital Luzern, 6000 Luzern, Switzerland;
| | - Mark G. Filipovic
- Institute of Anesthesiology, Kantonsspital Winterthur, 8400 Winterthur, Switzerland;
| | - Gianmarco M. Balestra
- Department of Intensive Care, University of Basel Hospital, 4031 Basel, Switzerland; (G.M.B.); (K.T.)
| | - Kai Tisljar
- Department of Intensive Care, University of Basel Hospital, 4031 Basel, Switzerland; (G.M.B.); (K.T.)
| | - Timur Sellmann
- Department of Anaesthesiology, Witten/Herdecke University, 58455 Witten, Germany;
- Department of Anaesthesiology, Bethesda Hospital, 47053 Duisburg, Germany
| | - Stephan Marsch
- Department of Intensive Care, University of Basel Hospital, 4031 Basel, Switzerland; (G.M.B.); (K.T.)
- Correspondence:
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Dryver E, Lundager Forberg J, Hård Af Segerstad C, Dupont WD, Bergenfelz A, Ekelund U. Medical crisis checklists in the emergency department: a simulation-based multi-institutional randomised controlled trial. BMJ Qual Saf 2021; 30:697-705. [PMID: 33597283 DOI: 10.1136/bmjqs-2020-012740] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2020] [Revised: 01/14/2021] [Accepted: 02/10/2021] [Indexed: 12/14/2022]
Abstract
BACKGROUND Studies carried out in simulated environments suggest that checklists improve the management of surgical and intensive care crises. Whether checklists improve the management of medical crises simulated in actual emergency departments (EDs) is unknown. METHODS Eight crises (anaphylactic shock, life-threatening asthma exacerbation, haemorrhagic shock from upper gastrointestinal bleeding, septic shock, calcium channel blocker poisoning, tricyclic antidepressant poisoning, status epilepticus, increased intracranial pressure) were simulated twice (once with and once without checklist access) in each of four EDs-of which two belong to an academic centre-and managed by resuscitation teams during their clinical shifts. A checklist for each crisis listing emergency interventions was derived from current authoritative sources. Checklists were displayed on a screen visible to all team members. Crisis and checklist access were allocated according to permuted block randomisation. No team member managed the same crisis more than once. The primary outcome measure was the percentage of indicated emergency interventions performed. RESULTS A total of 138 participants composing 41 resuscitation teams performed 76 simulations (38 with and 38 without checklist access) including 631 interventions. Median percentage of interventions performed was 38.8% (95% CI 35% to 46%) without checklist access and 85.7% (95% CI 80% to 88%) with checklist access (p=7.5×10-8). The benefit of checklist access was similar in the four EDs and independent of senior physician and senior nurse experience, type of crisis and use of usual cognitive aids. On a Likert scale of 1-6, most participants agreed (gave a score of 5 or 6) with the statement 'I would use the checklist if I got a similar case in reality'. CONCLUSION In this multi-institution study, checklists markedly improved local resuscitation teams' management of medical crises simulated in situ, and most personnel reported that they would use the checklists if they had a similar case in reality.
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Affiliation(s)
- Eric Dryver
- Department of Emergency and Internal Medicine, Skåne University Hospital Lund, Lund, Sweden .,Department of Clinical Sciences, Lund University, Lund, Sweden.,Practicum Clinical Skills Centre, Office for Medical Services, Region Skåne, Sweden
| | | | | | - William D Dupont
- Department of Biostatistics, Vanderbilt University, Nashville, Tennessee, USA
| | - Anders Bergenfelz
- Department of Clinical Sciences, Lund University, Lund, Sweden.,Practicum Clinical Skills Centre, Office for Medical Services, Region Skåne, Sweden
| | - Ulf Ekelund
- Department of Emergency and Internal Medicine, Skåne University Hospital Lund, Lund, Sweden.,Department of Clinical Sciences, Lund University, Lund, Sweden
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Saban M, Dagan E, Drach-Zahavy A. The Effects of a Novel Mindfulness-based Intervention on Nurses' State Mindfulness and Patient Satisfaction in the Emergency Department. J Emerg Nurs 2020; 47:412-425. [PMID: 33272560 DOI: 10.1016/j.jen.2020.09.009] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2020] [Revised: 09/18/2020] [Accepted: 09/29/2020] [Indexed: 12/30/2022]
Abstract
INTRODUCTION The objective of this study was to examine the effect of a novel mindfulness-based time-out intervention on state of mindfulness among emergency nurses and, accordingly, on patient satisfaction. METHODS A pre-post intervention design among nurses in the emergency department was used with a between-subjects factor of patients who were nested within each nurse. The study was conducted between January 2017 and June 2018 among 48 nurses in the emergency department of a public tertiary academic hospital. For each nurse, a consecutive sample of 20 patients who attended the emergency department was recruited (n = 1920 patients; 960 in each phase). The mindfulness-based time-out intervention was based on theoretical mindfulness principles and carried out every 4 hours with direct communication to the patient at their bedside. Nurses' sociodemographic and professional characteristics and trait mindfulness were collected preintervention. Pre- and postintervention, data was collected on patients' sociodemographic and satisfaction, nurses' state mindfulness, and ED workload. RESULTS An increase in nurses' state mindfulness and patients' satisfaction was found after the mindfulness-based time-out intervention compared with before the intervention (4.35 [SD = 0.64] vs 4.03 [0.82], P < .001 and 4.03 [0.41] vs 3.16 [0.44], P < .001, respectively). A positive correlation was found between patients' satisfaction and nurses' state mindfulness (r = 0.29, P < .001). The findings also demonstrated that state mindfulness was higher among nurses, characterized by high trait mindfulness, after the mindfulness-based time-out intervention implementation. DISCUSSION By adapting mindfulness principles to the dynamic environment of the emergency department, we showed that the mindfulness-based time-out intervention was associated with a significant improvement in state mindfulness and patient satisfaction. The findings elucidate the interrelation among several conceptualizations of mindfulness that are increasingly reported in the literature, namely trait and state mindfulness, and interventions to promote mindfulness.
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22
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Hartigan S, Brooks M, Hartley S, Miller RE, Santen SA, Hemphill RR. Review of the Basics of Cognitive Error in Emergency Medicine: Still No Easy Answers. West J Emerg Med 2020; 21:125-131. [PMID: 33207157 PMCID: PMC7673867 DOI: 10.5811/westjem.2020.7.47832] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Accepted: 07/23/2020] [Indexed: 12/11/2022] Open
Abstract
Emergency physicians (EP) make clinical decisions multiple times daily. In some instances, medical errors occur due to flaws in the complex process of clinical reasoning and decision-making. Cognitive error can be difficult to identify and is equally difficult to prevent. To reduce the risk of patient harm resulting from errors in critical thinking, it has been proposed that we train physicians to understand and maintain awareness of their thought process, to identify error-prone clinical situations, to recognize predictable vulnerabilities in thinking, and to employ strategies to avert cognitive errors. The first step to this approach is to gain an understanding of how physicians make decisions and what conditions may predispose to faulty decision-making. We review the dual-process theory, which offers a framework to understand both intuitive and analytical reasoning, and to identify the necessary conditions to support optimal cognitive processing. We also discuss systematic deviations from normative reasoning known as cognitive biases, which were first described in cognitive psychology and have been identified as a contributing factor to errors in medicine. Training physicians in common biases and strategies to mitigate their effect is known as debiasing. A variety of debiasing techniques have been proposed for use by clinicians. We sought to review the current evidence supporting the effectiveness of these strategies in the clinical setting. This discussion of improving clinical reasoning is relevant to medical educators as well as practicing EPs engaged in continuing medical education.
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Affiliation(s)
- Sarah Hartigan
- Virginia Commonwealth University School of Medicine/VCU Health, Department of Internal Medicine, Richmond, Virginia
| | - Michelle Brooks
- Virginia Commonwealth University School of Medicine/VCU Health, Department of Internal Medicine, Richmond, Virginia
| | - Sarah Hartley
- University of Michigan, Department of Internal Medicine, Ann Arbor, Michigan
| | - Rebecca E Miller
- Virginia Commonwealth University School of Medicine/VCU Health, Department of Internal Medicine, Richmond, Virginia
| | - Sally A Santen
- Virginia Commonwealth University School of Medicine/VCU Health, Department of Emergency Medicine, Richmond, Virginia
| | - Robin R Hemphill
- Virginia Commonwealth University School of Medicine/VCU Health, Department of Emergency Medicine, Richmond, Virginia
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Olson APJ, Durning SJ, Fernandez Branson C, Sick B, Lane KP, Rencic JJ. Teamwork in clinical reasoning - cooperative or parallel play? ACTA ACUST UNITED AC 2020; 7:307-312. [PMID: 32697754 DOI: 10.1515/dx-2020-0020] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2020] [Accepted: 05/25/2020] [Indexed: 11/15/2022]
Abstract
Teamwork is fundamental for high-quality clinical reasoning and diagnosis, and many different individuals are involved in the diagnostic process. However, there are substantial gaps in how these individuals work as members of teams and, often, work is done in parallel, rather than in an integrated, collaborative fashion. In order to understand how individuals work together to create knowledge in the clinical context, it is important to consider social cognitive theories, including situated cognition and distributed cognition. In this article, the authors describe existing gaps and then describe these theories as well as common structures of teams in health care and then provide ideas for future study and improvement.
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Affiliation(s)
- Andrew P J Olson
- Department of Medicine, University of Minnesota Medical School, Minneapolis, MN, USA.,Departments of Pediatrics, University of Minnesota Medical School, Minneapolis, MN, USA
| | - Steven J Durning
- Departments of Medicine and Pathology, Uniformed Services University of the Health Sciences, Bethesda, MD, USA
| | | | - Brian Sick
- Department of Medicine, University of Minnesota Medical School, Minneapolis, MN, USA.,Departments of Pediatrics, University of Minnesota Medical School, Minneapolis, MN, USA
| | - Kathleen P Lane
- Department of Medicine, University of Minnesota Medical School, Minneapolis, MN, USA
| | - Joseph J Rencic
- Department of Medicine, Boston University School of Medicine, Boston, MA, USA
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Philippon AL, Dumont M, Jimenez S, Salhi S, Cachanado M, Durand-Zaleski I, Simon T, Freund Y. MOdified DIagnostic strateGy to safely ruLe-out pulmonary embolism In the emergency depArtment: study protocol for the Non-Inferiority MODIGLIANI cluster cross-over randomized trial. Trials 2020; 21:458. [PMID: 32493383 PMCID: PMC7268276 DOI: 10.1186/s13063-020-04379-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Accepted: 05/05/2020] [Indexed: 12/02/2022] Open
Abstract
Introduction In the work-up strategy for pulmonary embolism (PE) in the ED, the recently introduced YEARS rule allows the raising of the D-dimer threshold to 1000 ng/ml in patients with no signs of deep venous thrombosis and no hemoptysis and in whom PE is not the most likely diagnosis. However, this decision rule has never been prospectively compared to the usual strategy. Furthermore, it is unclear if the YEARS rule can be used on top of the Pulmonary Embolism Rule-out Criteria (PERC). We aim to assess the non-inferiority of YEARS compared to current guidelines to rule out PE among PERC-positive ED patients with suspicion of PE. Methods/design The MODIGLIANI study is a multicenter, European, non-inferiority, cluster-randomized, two periods cross-over, controlled trial. Each center will be randomized for the sequence of two 4-month periods: intervention (MOdified Diagnostic Strategy: MODS) followed by control (usual care), or control followed by intervention with 1 month of “wash-out” between the two periods. In the control period, the threshold will be as usual (500 ng/ml for patients aged 50 years or younger and age × 10 for older patients). In the MODS period, the threshold of D-dimers to rule out PE will be raised to 1000 ng/ml if no item of the YEARS score is present or will remain unchanged otherwise. Patients will be included if they have a suspicion of PE, defined as chest pain, dyspnea, or syncope. Non-inclusion criteria comprise a high clinical probability of PE or PERC-negative patients with low clinical probability. Ethics and dissemination The study has received the following approvals: Comité de protection des personnes Ile de France XI (France) and Comité de Ética de la Investigación con medicamentos del Hospital Clínic de Barcelona (Spain). Results will be made available to all included participants and other researchers. Trial registration ClinicalTrials.gov, NCT04032769. Registered on 24 July 2019.
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Affiliation(s)
- Anne-Laure Philippon
- Emergency department, Hôpital Pitié-Salpêtrière, Assistance Publique - Hôpitaux de Paris, APHP, Sorbonne Université, Paris, France
| | - Margaux Dumont
- Emergency department, Hôpital Pitié-Salpêtrière, Assistance Publique - Hôpitaux de Paris, APHP, Sorbonne Université, Paris, France
| | - Sonia Jimenez
- Emergency Department, Hospital Clinic, Barcelona, Spain
| | - Sarah Salhi
- Department of clinical pharmacology and Clinical Research Platform of East of Paris (URCEST-CRC-CRB), APHP.Sorbonne Universite, hôpital Saint Antoine, Paris, France
| | - Marine Cachanado
- Department of clinical pharmacology and Clinical Research Platform of East of Paris (URCEST-CRC-CRB), APHP.Sorbonne Universite, hôpital Saint Antoine, Paris, France
| | - Isabelle Durand-Zaleski
- Sorbonne Université, Paris, France.,Health economics research unit, Hopital de l'Hotel Dieu APHP, Paris, France
| | - Tabassome Simon
- Department of clinical pharmacology and Clinical Research Platform of East of Paris (URCEST-CRC-CRB), APHP.Sorbonne Universite, hôpital Saint Antoine, Paris, France.,Sorbonne Université, Paris, France
| | - Yonathan Freund
- Emergency department, Hôpital Pitié-Salpêtrière, Assistance Publique - Hôpitaux de Paris, APHP, Sorbonne Université, Paris, France. .,Sorbonne Université, Paris, France.
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Gershengorn HB, Pilcher DV, Litton E, Anstey M, Garland A, Wunsch H. Association Between Consecutive Days Worked by Intensivists and Outcomes for Critically Ill Patients. Crit Care Med 2020; 48:594-598. [PMID: 32205608 DOI: 10.1097/ccm.0000000000004202] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To evaluate the association between consecutive days worked by intensivists and ICU patient outcomes. DESIGN Retrospective cohort study linked with survey data. SETTING Australia and New Zealand ICUs. PATIENTS Adults (16+ yr old) admitted to ICU in the Australia New Zealand Intensive Care Society Centre for Outcome and Resource Evaluation Registries (July 1, 2016, to June 30, 2018). INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS We linked data on staffing schedules for each unit from the Critical Care Resources Registry 2016-2017 annual survey with patient-level data from the Adult Patient Database. The a priori chosen primary outcome was ICU length of stay. Secondary outcomes included hospital length of stay, ICU readmissions, and mortality (ICU and hospital). We used multilevel multivariable regression modeling to assess the association between days of consecutive intensivist service and patient outcomes; the predicted probability of death was included as a covariate and individual ICU as a random effect. The cohort included 225,034 patients in 109 ICUs. Intensivists were scheduled for seven or more consecutive days in 43 (39.4%) ICUs; 27 (24.7%) scheduled intensivists for 5 days, 22 (20.1%) for 4 days, seven (6.4%) for 3 days, four (3.7%) for 2 days, and six (5.5%) for less than or equal to 1 day. Compared with care by intensivists working 7+ consecutive days (adjusted ICU length of stay = 2.85 d), care by an intensivist working 3 or fewer consecutive days was associated with shorter ICU length of stay (3 consecutive days: 0.46 d fewer, p = 0.010; 2 consecutive days: 0.77 d fewer, p < 0.001; ≤ 1 consecutive days: 0.68 d fewer, p < 0.001). Shorter schedules of consecutive intensivist days worked were also associated with trends toward shorter hospital length of stay without increases in ICU readmissions or hospital mortality. CONCLUSIONS Care by intensivists working fewer consecutive days is associated with reduced ICU length of stay without negatively impacting mortality.
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Affiliation(s)
- Hayley B Gershengorn
- Division of Pulmonary, Critical Care, and Sleep Medicine, University of Miami Miller School of Medicine, Miami, FL
- Division of Critical Care Medicine, Albert Einstein College of Medicine, Bronx, NY
| | - David V Pilcher
- Australian and New Zealand Intensive Care Research Centre, School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
- Centre for Outcome and Resource Evaluation, Australian and New Zealand Intensive Care Society, Melbourne, VIC, Australia
- Department of Intensive Care, Alfred Hospital, Melbourne, VIC, Australia
| | - Edward Litton
- Intensive Care Unit, St John of God Hospital, Subiaco, WA, Australia
- School of Medicine, University of Western Australia, Perth, WA, Australia
| | - Matthew Anstey
- Intensive Care Department, Sir Charles Gairdner Hospital, Nedlands, WA, Australia
- School of Public Health, Curtin University, Bentley, WA, Australia
| | - Allan Garland
- Department of Internal Medicine, University of Manitoba, Winnipeg, MB, Canada
- Department of Community Health Sciences, University of Manitoba, Winnipeg, MB, Canada
- Manitoba Centre for Health Policy, University of Manitoba, Winnipeg, MB, Canada
| | - Hannah Wunsch
- Department of Critical Care Medicine, Sunnybrook Hospital, Toronto, ON, Canada
- Department of Anesthesiology and Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, ON, Canada
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27
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Chouhab Y, Lefebvre T, Forestier C, Parsis P, Martinez M. Analyse des courriers de plainte adressés au service d’urgence d’un centre hospitalier général. ANNALES FRANCAISES DE MEDECINE D URGENCE 2019. [DOI: 10.3166/afmu-2019-0176] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Objectif : L’objectif principal de notre travail était d’analyser les courriers de plainte (CP) adressés à un service d’urgence (SU). L’objectif secondaire était de déterminer s’il existait une corrélation entre CP et temporalité de passage au SU.
Matériel et méthodes : Étude rétrospective monocentrique sur six ans portant sur les CP concernant les prises en charge en SU.
Résultats : Quatre-vingt-un CP ont été analysés, la moyenne annuelle et l’incidence étaient de 13,5 CP/an et de 5,5 CP/ 10 000 passages. L’incidence était de 3,5 CP/10 000 passages pour les enfants vs 6,1 CP/10 000 passages pour les adultes (p = 0,11). Le plaignant était la famille dans 44 CP (55 %) et le patient dans 34 CP (42 %). Il n’y avait pas de différence significative entre le jour et la nuit (5,7 CP/10 000 vs 4,8 CP/ 10 000 passages ; p = 0,57) ni entre horaires de garde et horaires hors garde (5,6 CP/10 000 vs 5,2 CP/10 000 passages ; p = 0,78). Nous avons dénombré 133 doléances, avec une cause médicale dans 64 CP (48 %), une cause organisationnelle dans 44 CP (33 %), une cause relationnelle dans 25 CP (19 %). Une indemnisation financière a été demandée dans 13 CP (16 %) et a été accordée pour deux dossiers (2 %). Aucun CP n’a entraîné de poursuite en justice.
Conclusion : L’incidence des CP de notre SU reste dans la moyenne basse des données retrouvées au niveau national et sans relation avec la temporalité du passage. L’analyse des CP permet d’améliorer la qualité de la prise en charge et de proposer des mesures correctives en relation avec la commission des usagers.
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Abstract
Near misses and unsafe conditions have become more serious for patients in emergency departments (EDs). We aimed to search the near misses and unsafe conditions that occurred in an ED to improve patient safety.This was a retrospective analysis of a 10-year observational period from January 1, 2007 to December 31, 2016. We gained access to the adverse event notification forms (AENFs) sent to the hospital quality department from the ED. Patient age, sex, and date of presentation were recorded. The near misses and unsafe conditions were classified into 7 types: medication errors, falls, management errors, penetrative-sharp tool injuries, incidents due to institution security, incidents due to medical equipment, and forensic events. The outcome of these events was recorded.A total of 220 AENF were reported from 294,673 ED visits. The median age of the 166 patients was 60 (21-95) years. Of these, 57.1% of the patients were females and 47.9% were males. The most commonly reported events were medication errors (32.7%) and management errors (27.3%). The median age of falling patients was 67.5 years. The nurse-patient ratio between 2007 to 2011 and 2011 to 2016 were 1/10 and 1/7, respectively. We found that when this ratio increased, the adverse events results were less significant (P < .003).This was the 1st study investigating the adverse events in ED in Turkey. The reporting ratio of 0.07% for the total ED visits was too low. This showed that adverse events were under-reported.
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Strengthening the Medical Error "Meme Pool". J Gen Intern Med 2019; 34:2264-2267. [PMID: 31292902 PMCID: PMC6816797 DOI: 10.1007/s11606-019-05156-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2018] [Revised: 04/10/2019] [Accepted: 05/08/2019] [Indexed: 12/19/2022]
Abstract
The exact number of patients in the USA who die from preventable medical errors each year is highly debated. Despite uncertainty in the underlying science, two very large estimates have spread rapidly through both the academic and popular media. We utilize Richard Dawkins' concept of the "meme" to explore why these imprecise estimates remain so compelling, and examine what potential harms can occur from their dissemination. We conclude by suggesting that instead of simply providing more precise estimates, physicians should encourage nuance in public medical error discussions, and strive to provide narrative context about the reality of the complex biological and social systems in which we practice medicine.
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Myers CG, Sutcliffe KM, Ferrari BT. Treating the "Not-Invented-Here Syndrome" in Medical Leadership: Learning From the Insights of Outside Disciplines. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2019; 94:1416-1418. [PMID: 31274525 DOI: 10.1097/acm.0000000000002860] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Physicians are being increasingly called upon to engage in leadership at all levels of modern health organizations, leading many to call for greater research and training interventions regarding physician leadership development. Yet, within these calls to action, the authors note a troubling trend toward siloed, medicine-specific approaches to leadership development and a broad failure to learn from the evidence and insight of other relevant disciplines, such as the organizational sciences. The authors describe how this trend reflects what has been called the "not-invented-here syndrome" (NIHS)-a commonly observed reluctance to adopt and integrate insights from outside disciplines-and highlight the pitfalls of NIHS for effective physician leadership development. Failing to learn from research and interventions in the organizational sciences inhibits physician leadership development efforts, leading to redundant rediscoveries of known insights and reinventions of existing best practices. The authors call for physician leaders to embrace ideas that are "proudly developed elsewhere" and work with colleagues in outside disciplines to conduct collaborative research and develop integrated training interventions to best develop physician leaders who are prepared for the complex, dynamic challenges of modern health care.
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Affiliation(s)
- Christopher G Myers
- C.G. Myers is assistant professor, Carey Business School and School of Medicine, and core faculty, Armstrong Institute for Patient Safety and Quality, Johns Hopkins University, Baltimore, Maryland; ORCID: 0000-0001-7788-8595. K.M. Sutcliffe is Bloomberg Distinguished Professor, Carey Business School and School of Medicine, and core faculty, Armstrong Institute for Patient Safety and Quality, Johns Hopkins University, Baltimore, Maryland. B.T. Ferrari is dean emeritus, Carey Business School, Johns Hopkins University, Baltimore, Maryland
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Freund Y, Bloom B. Waterfalls and Handoffs: A Novel Physician Staffing Model to Decrease Handoffs in a Pediatric Emergency Department. Ann Emerg Med 2019; 74:467. [DOI: 10.1016/j.annemergmed.2019.04.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2019] [Indexed: 10/26/2022]
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Currie V, Hartshorn S. Systematic physician cross-checking between emergency department physicians is associated with a significant reduction in adverse events. Arch Dis Child Educ Pract Ed 2019; 104:111. [PMID: 30154133 DOI: 10.1136/archdischild-2018-315850] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Affiliation(s)
- Victoria Currie
- School of Paediatrics, West Midlands Deanery, Birmingham, UK
| | - Stuart Hartshorn
- Emergency Department, Birmingham Children's Hospital, Birmingham, UK
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Riou M, Feral-Pierssens AL, Tourette-Turgis C, Tazarourte K, Freund Y, Pelaccia T, Riou B. Que peuvent apporter les sciences humaines et sociales à la recherche en médecine d’urgence ? ANNALES FRANCAISES DE MEDECINE D URGENCE 2019. [DOI: 10.3166/afmu-2018-0118] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Freund Y, Bloom B, Philippon AL. The Health Care System Flies in the Face of Airline Security Concepts-Reply. JAMA Intern Med 2018; 178:1143. [PMID: 30083746 DOI: 10.1001/jamainternmed.2018.3553] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Yonathan Freund
- Sorbonne Université, Paris, France.,Emergency Department, Hopital Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Ben Bloom
- Emergency Department, Royal London Hospital, Barts Health NHS Trust, London, England
| | - Anne-Laure Philippon
- Emergency Department, Hopital Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris, Paris, France
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Braillon A, Bewley S, Ross N. The Health Care System Flies in the Face of Airline Security Concepts. JAMA Intern Med 2018; 178:1142-1143. [PMID: 30083738 DOI: 10.1001/jamainternmed.2018.3550] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
| | - Susan Bewley
- Department of Women's Health, St Thomas' Hospital, London, United Kingdom
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