1
|
Peduzzi M, Fernandes Agreli HL, da Silva JAM, Hara Koyama MA, Fracolli LA, Xyrichis A. Team climate and patients' perception of primary healthcare attributes in Brazil: a cross-sectional study. J Interprof Care 2024; 38:705-712. [PMID: 38755950 DOI: 10.1080/13561820.2024.2351006] [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: 05/04/2023] [Accepted: 04/28/2024] [Indexed: 05/18/2024]
Abstract
Team climate and attributes of primary healthcare (PHC) are key elements for collaborative practice. Few researchers have explored the relationship between team climate and patients' perceptions of PHC. This study aimed to assess the association between team climate and patients' perceptions of primary healthcare attributes. A quantitative approach was adopted. In Stage 1, Team climate was assessed using Team Climate Inventory in 118 Family Health Strategy (FHS) teams at a PHC setting. In Stage 2, Patients' perceptions of PHC attributes were assessed using the Primary Care Assessment Tool (PCATool) in a sample of 844 patients enrolled in teams studied in Stage 1. Cluster analysis was used to identify team climate groups. The analysis used multilevel linear regression models. Patients assigned to teams with the highest team climate scores had the highest PHC attributes scores. Patients who reported affiliation at the team level had the highest PCATool scores overall. They also scored higher on the attributes of comprehensiveness and coordinated care compared to patients with affiliation to the health unit. In conclusion, patients under the care of FHS teams exhibiting a more favorable team climate had more positive patient perceptions of PHC attributes.
Collapse
Affiliation(s)
- Marina Peduzzi
- School of Nursing, University of São Paulo, São Paulo, Brazil
| | | | | | | | | | - Andreas Xyrichis
- Florence Nightingale Faculty of Nursing & Midwifery, King's College London, London, UK
| |
Collapse
|
2
|
Goldhaber NH, Mehta S, Longhurst CA, Malachowski E, Jones M, Clary BM, Schaefer RL, McHale M, Rhodes LP, Mekeel KL, Reeves JJ. Call me Ishmael: addressing the white whale of team communication in the operating room with labelled surgical caps at an academic medical centre. BMJ Open Qual 2024; 13:e002453. [PMID: 38589054 PMCID: PMC11015231 DOI: 10.1136/bmjoq-2023-002453] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2023] [Accepted: 02/12/2024] [Indexed: 04/10/2024] Open
Abstract
INTRODUCTION Effective communication in the operating room (OR) is crucial. Addressing a colleague by their name is respectful, humanising, entrusting and associated with improved clinical outcomes. We aimed to enhance team communication in the perioperative environment by offering personalised surgical caps labelled with name and provider role to all OR team members at a large academic medical centre. MATERIALS AND METHODS This was a quasi-experimental, uncontrolled, before-and-after quality improvement study. A survey regarding perceptions of team communication, knowledge of names and roles, communication barriers, and culture was administered before and after cap delivery. Survey results were measured on a 5-point Likert Scale; descriptive statistics and mean scores were compared. All cause National Surgical Quality Improvement Project (NSQIP) morbidity and mortality outcomes for surgical specialties were examined. RESULTS 1420 caps were delivered across the institution. Mean survey scores increased for knowing the names and roles of providers around the OR, feeling that people know my name and feeling comfortable communicating without barriers across disciplines. The mean score for team communication around the OR is excellent was unchanged. The highest score both before and after was knowing the name of an interdisciplinary team member is important for patient care. A total of 383 and 212 providers participated in the study before and after cap delivery, respectively. Participants agreed or strongly agreed that labelled surgical caps made it easier to talk to colleagues (64.9%) while improving communication (66.0%), team culture (60.5%) and patient care (56.8%). No significant differences were noted in NSQIP outcomes. CONCLUSIONS Personalised labelled surgical caps are a simple, inexpensive tool that demonstrates promise in improving perioperative team communication. Creating highly reliable surgical teams with optimal communication channels requires a multifaceted approach with engaged leadership, empowered front-line providers and an institutional commitment to continuous process improvement.
Collapse
Affiliation(s)
| | - Shivani Mehta
- School of Medicine, University of California San Diego, La Jolla, California, USA
| | - Christopher A Longhurst
- Department of Pediatrics, Department of Medicine, Division of Biomedical Informatics, University of California San Diego, La Jolla, California, USA
| | - Elizabeth Malachowski
- Perioperative Services, University of California San Diego, La Jolla, California, USA
| | - Melissa Jones
- Perioperative Services, University of California San Diego, La Jolla, California, USA
| | - Bryan M Clary
- Department of Surgery, University of California San Diego, La Jolla, California, USA
| | - Robin L Schaefer
- Perioperative Services, University of California San Diego, La Jolla, California, USA
| | - Michael McHale
- Department of OBGYN, University of California San Diego, La Jolla, California, USA
| | - Lisa P Rhodes
- Perioperative Services, University of California San Diego, La Jolla, California, USA
| | - Kristin L Mekeel
- Department of Surgery, University of California San Diego, La Jolla, California, USA
| | - J Jeffery Reeves
- Department of Surgery, University of California San Diego, La Jolla, California, USA
| |
Collapse
|
3
|
Fernandes CJ, Gautham KS. Organization of care of infants with congenital diaphragmatic hernia-Building a high-functioning CDH program. J Perinatol 2024; 44:339-347. [PMID: 37798339 DOI: 10.1038/s41372-023-01789-z] [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: 05/14/2023] [Revised: 09/09/2023] [Accepted: 09/20/2023] [Indexed: 10/07/2023]
Abstract
Infants born with congenital diaphragmatic hernia have high mortality and morbidity and require coordinated multidisciplinary care for optimal outcomes. Over the past several decades numerous articles have been published on the technical aspects of the care of these patients demonstrating both the variation in management across institutions as well as the desirability and need for standardization of care. Unfortunately, none have focused on the organization of care for CDH patients encompassing the range from early prenatal diagnosis to long-term postnatal care. However, to achieve optimal care and optimal outcomes, it is important to not only have excellent technical surgical and medical care but also to have an organized, systematic, and purposefully designed program for the delivery of healthcare to infants with this condition. In this article, based on our experience and drawing on general principles of building clinical programs, we describe the important elements of an ideal CDH program.
Collapse
Affiliation(s)
- Caraciolo J Fernandes
- Department of Pediatrics, Division of Neonatology, Baylor College of Medicine/Texas Children's Hospital, Houston, TX, USA.
| | - Kanekal S Gautham
- Nemours Children's Health System, University of Central Florida College of Medicine, Orlando, FL, USA
| |
Collapse
|
4
|
Davidson M, Brennan E, Garg M, Oeppen RS, Brennan PA. Briefings in surgical teams: a pilot study of experiences and attitudes. Br J Oral Maxillofac Surg 2024; 62:197-202. [PMID: 38320922 DOI: 10.1016/j.bjoms.2023.12.004] [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: 11/29/2023] [Accepted: 12/05/2023] [Indexed: 02/08/2024]
Abstract
While healthcare should not be compared to other high reliability organisations (HROs), many lessons, attitudes, and transferable practices can be applied and adapted from them to improve patient safety and team morale. Despite briefings improving both patient safety and effective team working, some in healthcare have not valued or actively engaged with them, deeming them to be irrelevant. In this pilot study we explored the experiences of, and attitudes to, briefings using a 10-question Survey Monkey. This was promoted during a human factors session at the 2023 Association of Surgeons in Training Conference (ASiT) and at a large NHS trust. Questions were asked about the number of briefings per day, attitudes, engagement, and respondents' attitudes to them. In total, 109 responses were received. A total of 85% reported at least one briefing on a normal operating day, 65% felt them to be interactive, 67% reported that briefings were led by the most senior surgical team member, and 58% lasted four minutes or more. Eighteen per cent of respondents felt they were of little benefit, and 56% did not routinely de-brief at the end of the day. This study has highlighted variable attitudes to team briefings, with some colleagues still seeing them as a 'tick box' exercise. While culture has changed following the introduction of the WHO checklist, the importance of active engagement and education to improve the delivery and value of effective briefings cannot be overestimated. It is also an opportunity to create a 'safe space' for team members and to confirm zero tolerance for any inappropriate behaviour, including sexual misconduct.
Collapse
Affiliation(s)
- M Davidson
- BALPA, 1 Heathrow Boulevard, 278 Bath Road, West Drayton UB7 0DQ, UK
| | - E Brennan
- University of Bristol Medical School, Bristol, BS8 1UD, UK
| | - M Garg
- Maxillofacial Unit, Oxford University NHS Trust, Oxford, OX3 9DU, UK
| | - R S Oeppen
- University Hospitals Southampton, SO16 6YD, UK
| | - P A Brennan
- Maxillofacial Unit, Queen Alexandra Hospital, Portsmouth PO6 3LY, UK.
| |
Collapse
|
5
|
Rodríguez-Fernández R, Sánchez-Barriopedro L, Merino-Hernández A, González-Sánchez MI, Pérez-Moreno J, Toledo Del Castillo B, González Martínez F, Díaz de Mera Aranda C, Eizaguirre Fernández-Palacios T, Dominguez Rodríguez A, Tierraseca Serrano E, Sánchez Jiménez M, Sanchez Lloreda O, Carballo Nuria M. [Impact of the "daily huddle" on the safety of pediatric hospitalized patients]. J Healthc Qual Res 2023; 38:268-276. [PMID: 37003929 DOI: 10.1016/j.jhqr.2023.03.002] [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: 11/15/2022] [Revised: 02/05/2023] [Accepted: 03/06/2023] [Indexed: 06/19/2023]
Abstract
INTRODUCTION In 2017, the Joint Commission proposed daily meetings called "huddle" as an indicator of quality of care. They are brief daily meetings of the multidisciplinary team, where security problems of the last 24h are shared and risks are anticipated. The objectives were to describe the most frequent safety events in Pediatric wards, implement improvements in patient safety, improve team communication, implement international safety protocols, and measure the satisfaction of the staff involved. MATERIAL AND METHODS Prospective, longitudinal and analytical design (June 2020-February 2022), with previous educational intervention. Safety incidents, data related to unequivocal identification, allergy and pain records, data from the Scale for the Early Detection of Deficiencies (SAPI) and the Scale for the Secure Transmission of Information (SBAR) were collected. The degree of satisfaction of the professionals was evaluated. RESULTS Three hundred forty-eight security incidents were recorded. Medication prescription or administration errors stood out (n=103). Drug prescription or administration errors stood out (n=103), especially those related to high-risk medication: acetaminophen (n=14) (×10 doses of acetaminophen; n=6), insulin (n=6), potassium (n=5) and morphic (n=5). An improvement was observed in the pain record; 5% versus 80% (P<.01), in the SAPI registry 5% versus 70% (P<.01), in SBAER scale 40% vs 100% (P<.01), in unequivocal identification of the patient 80% versus 100%; (P<.01) and in the application of analgesic techniques 60% versus 85% (P=.01). In the survey of professionals, a degree of satisfaction of 8 (7-9.5)/10 was obtained. CONCLUSIONS Huddles made it possible to learn about security events in our environment and increase the safety of hospitalized patients, and improved communication and the relationship of the multidisciplinary team.
Collapse
Affiliation(s)
- R Rodríguez-Fernández
- Servicio de Pediatría, Hospital Infantil Gregorio Marañón, Madrid, España; Instituto de Investigación Sanitaria Gregorio Marañón (IISGM), Madrid, España.
| | | | - A Merino-Hernández
- Servicio de Pediatría, Hospital Infantil Gregorio Marañón, Madrid, España
| | - M I González-Sánchez
- Servicio de Pediatría, Hospital Infantil Gregorio Marañón, Madrid, España; Instituto de Investigación Sanitaria Gregorio Marañón (IISGM), Madrid, España
| | - J Pérez-Moreno
- Servicio de Pediatría, Hospital Infantil Gregorio Marañón, Madrid, España; Instituto de Investigación Sanitaria Gregorio Marañón (IISGM), Madrid, España
| | - B Toledo Del Castillo
- Servicio de Pediatría, Hospital Infantil Gregorio Marañón, Madrid, España; Instituto de Investigación Sanitaria Gregorio Marañón (IISGM), Madrid, España
| | - F González Martínez
- Servicio de Pediatría, Hospital Infantil Gregorio Marañón, Madrid, España; Instituto de Investigación Sanitaria Gregorio Marañón (IISGM), Madrid, España
| | | | | | | | | | - M Sánchez Jiménez
- Servicio de Pediatría, Hospital Infantil Gregorio Marañón, Madrid, España
| | - O Sanchez Lloreda
- Servicio de Pediatría, Hospital Infantil Gregorio Marañón, Madrid, España
| | - M Carballo Nuria
- Servicio de Pediatría, Hospital Infantil Gregorio Marañón, Madrid, España
| |
Collapse
|
6
|
Goldhaber NH, Reeves JJ, Puri D, Berumen JA, Tran M, Clay BJ, Longhurst CA, Fergerson B. Surgery and Anesthesia Preoperative "Virtual Huddle": A Pilot Trial to Enhance Communication across the Drape. Appl Clin Inform 2023; 14:772-778. [PMID: 37758227 PMCID: PMC10533219 DOI: 10.1055/s-0043-1772687] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2023] [Accepted: 07/19/2023] [Indexed: 09/30/2023] Open
Abstract
OBJECTIVES Effective communication between surgeons and anesthesiologists is critical for high-quality, safe, and efficient perioperative patient care. Despite widespread implementation of surgical safety checklists and time-outs, ineffective team communication remains a leading cause of patient safety events in the operating room. To promote effective communication, we conducted a pilot trial of a "virtual huddle" between anesthesiologists and surgeons. METHODS Attending anesthesiologists and surgeons at an academic medical center were recruited by email to participate in this feasibility trial. An electronic health record-based smartphone application was utilized to create secure group chats among trial participants the day before a surgery. Text notifications connected a surgeon/anesthesiologist pair in order to introduce colleagues, facilitate a preoperative virtual huddle, and enable open-ended, text message-based communication. A 5-point Likert scale-based survey with a free-text component was used to evaluate the utility of the virtual huddle and usability of the electronic platform. RESULTS A total of 51 unique virtual huddles occurred between 16 surgeons and 12 anesthesiologists over 99 operations. All postintervention survey questions received a positive rating (range: 3.50/5.00-4.53/5.00) and the virtual huddle was considered to be easy to use (4.47/5.00), improve attending-to-attending communication (4.29/5.00), and improve patient care (4.22/5.00). There were no statistically significant differences in the ratings between surgery and anesthesia. In thematic analysis of qualitative survey results, Participants indicated the intervention was particularly useful in interdisciplinary relationship-building and reducing room turnover. The huddle was less useful for simple, routine cases or when participation was one sided. CONCLUSION A preoperative virtual huddle may be a simple and effective intervention to improve communication and teamwork in the operating room. Further study and consideration of broader implementation is warranted.
Collapse
Affiliation(s)
- Nicole H. Goldhaber
- Department of Surgery, University of California, San Diego, La Jolla, California, United States
| | - J. Jeffery Reeves
- Department of Surgery, University of California, San Diego, La Jolla, California, United States
| | - Dhruv Puri
- School of Medicine, University of California, San Diego, La Jolla, California, United States
| | - Jennifer A. Berumen
- Department of Surgery, University of California, San Diego, La Jolla, California, United States
| | - Minh Tran
- Department of Anesthesiology, University of California, San Diego, La Jolla, California, United States
| | - Brian J. Clay
- Department of Medicine, Division of Biomedical Informatics, University of California, San Diego, La Jolla, California, United States
| | - Christopher A. Longhurst
- Department of Medicine, Division of Biomedical Informatics, University of California, San Diego, La Jolla, California, United States
| | - Byron Fergerson
- Department of Anesthesiology, University of California, San Diego, La Jolla, California, United States
| |
Collapse
|
7
|
Zamudio J, Kanji FF, Lusk C, Shouhed D, Sanchez BR, Catchpole K, Anger JT, Cohen TN. Identifying Workflow Disruptions in Robotic-Assisted Bariatric Surgery: Elucidating Challenges Experienced by Surgical Teams. Obes Surg 2023; 33:2083-2089. [PMID: 37147465 PMCID: PMC10162850 DOI: 10.1007/s11695-023-06620-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Revised: 04/24/2023] [Accepted: 04/25/2023] [Indexed: 05/07/2023]
Abstract
PURPOSE Bariatric surgery is an effective and durable treatment for weight loss for patients with extreme obesity. Although traditionally approached laparoscopically, robotic bariatric surgery (RBS) has unique benefits for both surgeons and patients. Nonetheless, the technological complexity of robotic surgery presents new challenges for OR teams and the wider clinical system. Further assessment of the role of RBS in delivering quality care for patients with obesity is necessary and can be done through a human factors approach. This observational study sought to investigate the impact of RBS on the surgical work system via the study of flow disruptions (FDs), or deviations from the natural workflow progression. MATERIALS AND METHODS RBS procedures were observed between October 2019 and March 2022. FDs were recorded in real time and subsequently classified into one of nine work system categories. Coordination FDs were further classified into additional sub-categories. RESULTS Twenty-nine RBS procedures were observed at three sites. An average FD rate of 25.05 (CI = ± 2.77) was observed overall. FDs were highest between insufflation and robot docking (M = 29.37, CI = ± 4.01) and between patient closing and wheels out (M = 30.00, CI = ± 6.03). FD rates due to coordination issues were highest overall, occurring once every 4 min during docking (M = 14.28, CI = ± 3.11). CONCLUSION FDs occur roughly once every 2.4 min and happen most frequently during the final patient transfer and robot docking phases of RBS. Coordination challenges associated with waiting for staff/instruments not readily available and readjusting equipment contributed most to these disruptions.
Collapse
Affiliation(s)
- Jennifer Zamudio
- Department of Surgery, Cedars-Sinai Medical Center, 6500 Wilshire Blvd, Los Angeles, CA, 90048, USA.
| | - Falisha F Kanji
- Department of Surgery, Cedars-Sinai Medical Center, 6500 Wilshire Blvd, Los Angeles, CA, 90048, USA
| | - Connor Lusk
- Department of Anesthesia and Perioperative Medicine, Medical University of South Carolina, Charleston, SC, 29425, USA
| | - Daniel Shouhed
- Department of Surgery, Cedars-Sinai Medical Center, 436 N Bedford Dr Suite 311, Beverly Hills, CA, 90210, USA
| | - Barry R Sanchez
- Department of Surgery, Ventura County Medical Center, 300 Hillmont Ave, Ventura, CA, 93003, USA
| | - Ken Catchpole
- Department of Anesthesia and Perioperative Medicine, Medical University of South Carolina, Charleston, SC, 29425, USA
| | - Jennifer T Anger
- Department of Urology, University of California San Diego, 9400 Campus Point Drive #7897, La Jolla, CA, 92037, USA
| | - Tara N Cohen
- Department of Surgery, Cedars-Sinai Medical Center, 8700 Beverly Blvd, Los Angeles, CA, 90048, USA
| |
Collapse
|
8
|
Timm-Holzer E, Tschan F, Keller S, Semmer NK, Zimmermann J, Huber SA, Hübner M, Candinas D, Demartines N, Weber M, Beldi G. No signs of check-list fatigue - introducing the StOP? intra-operative briefing enhances the quality of an established pre-operative briefing in a pre-post intervention study. Front Psychol 2023; 14:1195024. [PMID: 37457099 PMCID: PMC10338924 DOI: 10.3389/fpsyg.2023.1195024] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Accepted: 06/07/2023] [Indexed: 07/18/2023] Open
Abstract
Background The team timeout (TTO) is a safety checklist to be performed by the surgical team prior to incision. Exchange of critical information is, however, important not only before but also during an operation and members of surgical teams frequently feel insufficiently informed by the operating surgeon about the ongoing procedure. To improve the exchange of critical information during surgery, the StOP?-protocol was developed: At appropriate moments during the procedure, the leading surgeon briefly interrupts the operation and informs the team about the current Status (St) and next steps/objectives (O) of the operation, as well as possible Problems (P), and encourages questions of other team members (?). The StOP?-protocol draws attention to the team. Anticipating the occurrence of StOP?-protocols may support awareness of team processes and quality issues from the beginning and thus support other interventions such as the TTO; however, it also may signal an additional demand and contribute to a phenomenon akin to "checklist fatigue." We investigated if, and how, the introduction of the StOP?-protocol influenced TTO quality. Methods This was a prospective intervention study employing a pre-post design. In the visceral surgical departments of two university hospitals and one urban hospital the quality of 356 timeouts (out of 371 included operation) was assessed by external observers before (154) and after (202) the introduction of the StOP?-briefing. Timeout quality was rated in terms of timeout completeness (number of checklist items mentioned) and timeout quality (engagement, pace, social atmosphere, noise). Results As compared to the baseline, after the implementation of the StOP?-protocol, observed timeouts had higher completeness ratings (F = 8.69, p = 0.003) and were rated by observers as higher in engagement (F = 13.48, p < 0.001), less rushed (F = 14.85, p < 0.001), in a better social atmosphere (F = 5.83, p < 0.016) and less noisy (F = 5.35, p < 0.022). Conclusion Aspects of TTO are affected by the anticipation of StOP?-protocols. However, rather than harming the timeout goals by inducing "checklist fatigue," it increases completeness and quality of the team timeout.
Collapse
Affiliation(s)
- Eliane Timm-Holzer
- Institute for Work and Organizational Psychology, University of Neuchâtel, Neuchâtel, Switzerland
| | - Franziska Tschan
- Institute for Work and Organizational Psychology, University of Neuchâtel, Neuchâtel, Switzerland
| | - Sandra Keller
- Institute for Work and Organizational Psychology, University of Neuchâtel, Neuchâtel, Switzerland
- Department of Visceral Surgery and Medicine, Berne University Hospital, University of Berne, Berne, Switzerland
| | | | - Jasmin Zimmermann
- Institute for Work and Organizational Psychology, University of Neuchâtel, Neuchâtel, Switzerland
| | - Simon A. Huber
- Department of Psychology, University of Berne, Berne, Switzerland
| | - Martin Hübner
- Department of Visceral Surgery, University Hospital Lausanne (CHUV), Lausanne, Switzerland
| | - Daniel Candinas
- Department of Visceral Surgery and Medicine, Berne University Hospital, University of Berne, Berne, Switzerland
| | - Nicolas Demartines
- Department of Visceral Surgery, University Hospital Lausanne (CHUV), Lausanne, Switzerland
| | - Markus Weber
- Department of Surgery, Triemli Hospital, Zurich, Switzerland
| | - Guido Beldi
- Department of Visceral Surgery and Medicine, Berne University Hospital, University of Berne, Berne, Switzerland
| |
Collapse
|
9
|
Teles D, Silva M, Berger-Estilita J, Pereira H. Practice of debriefing of critical events: a survey-based cross-sectional study of Portuguese anesthesiologists. Porto Biomed J 2023; 8:215. [PMID: 37362021 PMCID: PMC10289546 DOI: 10.1097/j.pbj.0000000000000215] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Accepted: 04/20/2023] [Indexed: 06/28/2023] Open
Abstract
Debriefing is an essential procedure for identifying medical errors, improving communication, reviewing team performance, and providing emotional support after a critical event. This study aimed to describe the current practice and limitations of debriefing and gauge opinions on the best timing, effectiveness, need for training, use of established format, and expected goals of debriefing among Portuguese anesthesiologists. Methods We performed a national cross-sectional online survey exploring the practice of anesthesiologists' debriefing practice after critical events in Portuguese hospitals. The questionnaire was distributed using a snowball sampling technique from July to September 2021. Data were descriptively and comparatively analyzed. Results We had replies from 186 anesthesiologists (11.3% of the Portuguese pool). Acute respiratory event was the most reported type of critical event (96%). Debriefing occurred rarely or never in 53% of cases, 59% of respondents needed more training in debriefing, and only 4% reported having specific tools in their institutions to carry it out. There was no statistical association between having a debriefing protocol and the occurrence of critical events (P=.474) or having trained personnel (P=.95). The existence of protocols was associated with lower frequencies of debriefing (P=.017). Conclusions Portuguese anesthesiologists know that debriefing is an essential process that increases patient safety, but among those surveyed, there is a need for an adequate debriefing culture or practice. Trial registration Research registry 7741 (https://www.researchregistry.com/browse-the-registry#home).
Collapse
Affiliation(s)
- Daniel Teles
- Department of Anaesthesiology, University Hospital Centre of São João, Porto, Portugal
| | - Mariana Silva
- Department of Anaesthesiology, University Hospital Centre of São João, Porto, Portugal
| | - Joana Berger-Estilita
- Institute for Medical Education, University of Bern, Bern, Switzerland
- CINTESIS—Centre for Health Technology and Services Research, Faculty of Medicine, Porto, Portugal
| | - Helder Pereira
- Department of Anaesthesiology, University Hospital Centre of São João, Porto, Portugal
- Surgery and Physiology Department, Faculty of Medicine, University of Porto, Porto, Portugal
| |
Collapse
|
10
|
Kolbe M, Grande B, Lehmann-Willenbrock N, Seelandt JC. Helping healthcare teams to debrief effectively: associations of debriefers' actions and participants' reflections during team debriefings. BMJ Qual Saf 2023; 32:160-172. [PMID: 35902231 DOI: 10.1136/bmjqs-2021-014393] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2021] [Accepted: 06/21/2022] [Indexed: 11/04/2022]
Abstract
BACKGROUND Debriefings help teams learn quickly and treat patients safely. However, many clinicians and educators report to struggle with leading debriefings. Little empirical knowledge on optimal debriefing processes is available. The aim of the study was to evaluate the potential of specific types of debriefer communication to trigger participants' reflection in debriefings. METHODS In this prospective observational, microanalytic interaction analysis study, we observed clinicians while they participated in healthcare team debriefings following three high-risk anaesthetic scenarios during simulation-based team training. Using the video-recorded debriefings and INTERACT coding software, we applied timed, event-based coding with DE-CODE, a coding scheme for assessing debriefing interactions. We used lag sequential analysis to explore the relationship between what debriefers and participants said. We hypothesised that combining advocacy (ie, stating an observation followed by an opinion) with an open-ended question would be associated with participants' verbalisation of a mental model as a particular form of reflection. RESULTS The 50 debriefings with overall 114 participants had a mean duration of 49.35 min (SD=8.89 min) and included 18 486 behavioural transitions. We detected significant behavioural linkages from debriefers' observation to debriefers' opinion (z=9.85, p<0.001), from opinion to debriefers' open-ended question (z=9.52, p<0.001) and from open-ended question to participants' mental model (z=7.41, p<0.001), supporting our hypothesis. Furthermore, participants shared mental models after debriefers paraphrased their statements and asked specific questions but not after debriefers appreciated their actions without asking any follow-up questions. Participants also triggered reflection among themselves, particularly by sharing personal anecdotes. CONCLUSION When debriefers pair their observations and opinions with open-ended questions, paraphrase participants' statements and ask specific questions, they help participants reflect during debriefings.
Collapse
Affiliation(s)
- Michaela Kolbe
- Simulation Centre, University Hospital Zurich, Zurich, Switzerland .,ETH Zürich, Zurich, Switzerland
| | - Bastian Grande
- Simulation Centre, University Hospital Zurich, Zurich, Switzerland.,Institute of Anesthesiology, University Hospital Zurich, Zurich, Switzerland
| | | | | |
Collapse
|
11
|
Matsumoto H, Franzone JM, Sinha R, Roye BD, Glotzbeker MP, Skaggs DL, Flynn JM, Lenke LG, Sponseller PD, Vitale MG. A novel risk calculator predicting surgical site infection after spinal surgery in patients with cerebral palsy. Dev Med Child Neurol 2022; 64:1034-1043. [PMID: 35229288 DOI: 10.1111/dmcn.15193] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2021] [Revised: 01/28/2022] [Accepted: 02/08/2022] [Indexed: 11/30/2022]
Abstract
AIM To develop and validate a risk calculator based on preoperative factors to predict the probability of surgical site infection (SSI) in patients with cerebral palsy (CP) undergoing spinal surgery. METHOD This was a multicenter retrospective cohort study of pediatric patients with CP who underwent spinal fusion. In the development stage, preoperative known factors were collected, and a risk calculator was developed by comparing multiple models and choosing the model with the highest discrimination and calibration abilities. This model was then tested with a separate population in the validation stage. RESULTS Among the 255 patients in the development stage, risk of SSI was 11%. A final prediction model included non-ambulatory status (odds ratio [OR] 4.0), diaper dependence (OR 2.5), age younger than 12 years (OR 2.5), major coronal curve magnitude greater than 90° (OR 1.3), behavioral disorder/delay (OR 1.3), and revision surgery (OR 1.3) as risk factors. This model had a predictive ability of 73.4% for SSI, along with excellent calibration ability (p = 0.878). Among the 390 patients in the validation stage, risk of SSI was 8.2%. The discrimination of the model in the validation phase was 0.743 and calibration was p = 0.435, indicating 74.3% predictive ability and no difference between predicted and observed values. INTERPRETATION This study provides a risk calculator to identify the risk of SSI after spine surgery for patients with CP. This will allow us to enhance decision-making and patient care while providing valid hospital comparisons, public reporting mechanisms, and reimbursement determinations.
Collapse
Affiliation(s)
- Hiroko Matsumoto
- Division of Pediatric Orthopaedic Surgery, Department of Orthopaedic Surgery, Columbia University Irving Medical Center, New York, New York, USA.,Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York, USA
| | - Jeanne M Franzone
- Division of Pediatric Orthopaedic Surgery, Department of Orthopaedic Surgery, Columbia University Irving Medical Center, New York, New York, USA
| | - Rishi Sinha
- Division of Pediatric Orthopaedic Surgery, Department of Orthopaedic Surgery, Columbia University Irving Medical Center, New York, New York, USA
| | - Benjamin D Roye
- Division of Pediatric Orthopaedic Surgery, Department of Orthopaedic Surgery, Columbia University Irving Medical Center, New York, New York, USA
| | - Michael P Glotzbeker
- Department of Orthopaedic Surgery, University Hospital Cleveland Medical Center, Rainbow Babies and Children's Hospital, Cleveland, Ohio, USA
| | - David L Skaggs
- Spine Center, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - John M Flynn
- Division of Orthopaedic Surgery, Children's Hospital of Philadelphia, Philadelphia, Philadelphia, USA
| | - Lawrence G Lenke
- Division of Pediatric Orthopaedic Surgery, Department of Orthopaedic Surgery, Columbia University Irving Medical Center, New York, New York, USA
| | - Paul D Sponseller
- Department of Orthopaedic Surgery, The Johns Hopkins University, Baltimore, Maryland, USA.,Bloomberg Children's Center, Baltimore, Maryland, USA
| | - Michael G Vitale
- Division of Pediatric Orthopaedic Surgery, Department of Orthopaedic Surgery, Columbia University Irving Medical Center, New York, New York, USA
| |
Collapse
|
12
|
Stockheim J, Perrakis A, Sabel BA, Waschipky R, Croner RS. RoCS: Robotic Curriculum for young Surgeons. J Robot Surg 2022; 17:495-507. [PMID: 35810233 PMCID: PMC10076401 DOI: 10.1007/s11701-022-01444-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Accepted: 06/26/2022] [Indexed: 11/26/2022]
Abstract
Robotic-assisted procedures gain increasing acceptance for daily surgical routine. However, structured training programs are designed for surgeons with high expertise. Hence, a comprehensive training curriculum was established to ensure a basic competence in robotic abdominal surgery for young surgeons during their residency. The aim of the current work is to propose a feasible and effective training concept. The development process of this training curriculum is based on a comprehensive literature review which led to the concept of "robotic curriculum for young surgeons" (RoCS). It was implemented in the daily routine of a German university hospital starting in 2020. The robotic assessment questionnaire (RAQ) was used for electronic data collection. After the initial phase adjustments, it led to an improvement of the initial version of the curriculum. RoCS is a multimodal training program containing basic training through assistance at the operation table during robotic-assisted operations and basic console training. Key elements are the robotic team time-out (rTTO), perioperative process standardization including feasible personnel scheduling and useful procedure clustering into organ systems, procedural steps and procedural step complexity. Evaluation of standardized communication, performance assessment, patient factors and individual overall workload using NASA Task Load Index is realizable. Flexibility and adaptability to internal organization processes of surgical departments are the main advantages of the concept. RoCS is a strong training tool to meet the specific needs of young surgeons and evaluate their learning success of robotic procedural training. Furthermore, comparison within the different robotic systems should be considered. Further studies are needed to validate a multicenter concept design.
Collapse
Affiliation(s)
- Jessica Stockheim
- Department of General, Visceral, Vascular and Transplant Surgery, University Hospital Magdeburg, Otto-Von-Guericke University Magdeburg, Leipziger Str. 44, 39120, Magdeburg, Germany.
| | - Aristotelis Perrakis
- Department of General, Visceral, Vascular and Transplant Surgery, University Hospital Magdeburg, Otto-Von-Guericke University Magdeburg, Leipziger Str. 44, 39120, Magdeburg, Germany
| | - Bernhard A Sabel
- Institute of Medical Psychology, Otto-Von-Guericke University Magdeburg, Magdeburg, Germany
| | - Robert Waschipky
- Department of Information Technology (IT) and Medical Engineering, Otto-Von-Guericke University Magdeburg, Magdeburg, Germany
| | - Roland S Croner
- Department of General, Visceral, Vascular and Transplant Surgery, University Hospital Magdeburg, Otto-Von-Guericke University Magdeburg, Leipziger Str. 44, 39120, Magdeburg, Germany
| |
Collapse
|
13
|
Caruso C, Arias-Shah A, Rent S, Mukthapuram S, Dadiz R. Fellows as Teachers: Supporting Future Educators. Neoreviews 2022; 23:e438-e447. [PMID: 35773507 DOI: 10.1542/neo.23-7-e438] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Teaching is inherent to the practice of medicine, as physicians are relied on to educate those around them, including staff, trainees, colleagues, and the patients and families for whom they provide care. Neonatal-perinatal medicine fellows uniquely serve as both trainee and subspecialty expert and are additionally expected to be strong teachers. In this article, the authors review the benefits of developing fellows as teachers, the challenges and potential mitigating strategies of fulfilling this objective, and the educational foundations and future directions that may inform the development of curricula for training fellows as teachers.
Collapse
Affiliation(s)
- Catherine Caruso
- Division of Neonatology, Department of Pediatrics, Oregon Health and Science University, Portland, OR
| | - AnnaMarie Arias-Shah
- Division of Neonatology, Department of Pediatrics, Children's Hospital of Orange County, Orange, CA
| | - Sharla Rent
- Division of Neonatology, Department of Pediatrics, Duke University School of Medicine, Durham, NC
| | - Shanmukha Mukthapuram
- The Perinatal Institute, Section of Neonatology, Perinatal and Pulmonary Biology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH.,Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH
| | - Rita Dadiz
- Division of Neonatology, Department of Pediatrics, University of Rochester Medical Center, Rochester, NY
| |
Collapse
|
14
|
Paquay M, Dubois N, Diep AN, Graas G, Sassel T, Piazza J, Servotte JC, Ghuysen A. “Debriefing and Organizational Lessons Learned” (DOLL): A Qualitative Study to Develop a Classification Framework for Reporting Clinical Debriefing Results. Front Med (Lausanne) 2022; 9:882326. [PMID: 35814768 PMCID: PMC9263566 DOI: 10.3389/fmed.2022.882326] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Accepted: 05/26/2022] [Indexed: 11/13/2022] Open
Abstract
BackgroundThe COVID-19 crisis has radically affected our healthcare institutions. Debriefings in clinical settings provide a time for the clinicians to reflect on the successes (pluses) and difficulties (deltas) encountered. Debriefings tend to be well-received if included in the broader management of the unit. The goal of this study was to develop a framework to categorize these debriefings and to assess its worthiness.MethodsA qualitative approach based on a grounded theory research method was adopted resulting in the “Debriefing and Organizational Lessons Learned” (DOLL) framework. Debriefings were conducted within two Emergency Departments of a Belgian University Hospital during an 8-week period. In the first step, three researchers used debriefing transcripts to inductively develop a tentative framework. During the second step, these three researchers conducted independent categorizations of the debriefings using the developed framework. In step 3, the team analyzed the data to understand the utility of the framework. Chi-square was conducted to examine the associations between the item types (pluses and deltas) and the framework's dimensions.ResultsThe DOLL is composed of seven dimensions and 13 subdimensions. Applied to 163 debriefings, the model identified 339 items, including 97 pluses and 242 deltas. Results revealed that there was an association between the frequency of pluses and deltas and the dimensions (p < 0.001). The deltas were mainly related to the work environment (equipment and maintenance) (p < 0.001) while the pluses identified tended to be related to the organization of the unit (communication and roles) (p < 0.001). With leadership's support and subsequent actions, clinicians were more enthusiastic about participating and the researchers anecdotally detected a switch toward a more positive organizational learning approach.ConclusionThe framework increases the potential value of clinical debriefings because it organizes results into actionable areas. Indeed, leadership found the DOLL to be a useful management tool. Further research is needed to investigate how DOLL may work in non-crisis circumstances and further apply the DOLL into incident reporting and risk management process of the unit.
Collapse
Affiliation(s)
- Méryl Paquay
- Department of Emergency, Quartier Hôpital, University Hospital of Liege, Liège, Belgium
- Center for Medical Simulation of Liege, Quartier Hôpital, University of Liege, Liège, Belgium
- *Correspondence: Méryl Paquay
| | - Nadège Dubois
- Center for Medical Simulation of Liege, Quartier Hôpital, University of Liege, Liège, Belgium
| | - Anh Nguyet Diep
- Biostatistics Unit, Quartier Hôpital, University of Liège, Liège, Belgium
| | - Gwennaëlle Graas
- Center for Medical Simulation of Liege, Quartier Hôpital, University of Liege, Liège, Belgium
| | - Tamara Sassel
- Center for Medical Simulation of Liege, Quartier Hôpital, University of Liege, Liège, Belgium
| | - Justine Piazza
- Department of Emergency, Quartier Hôpital, University Hospital of Liege, Liège, Belgium
- Center for Medical Simulation of Liege, Quartier Hôpital, University of Liege, Liège, Belgium
| | | | - Alexandre Ghuysen
- Department of Emergency, Quartier Hôpital, University Hospital of Liege, Liège, Belgium
- Center for Medical Simulation of Liege, Quartier Hôpital, University of Liege, Liège, Belgium
| |
Collapse
|
15
|
Etherington C, Kitto S, Burns JK, Adams TL, Birze A, Britton M, Singh S, Boet S. How gender shapes interprofessional teamwork in the operating room: a qualitative secondary analysis. BMC Health Serv Res 2021; 21:1357. [PMID: 34923992 PMCID: PMC8684702 DOI: 10.1186/s12913-021-07403-2] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Accepted: 12/10/2021] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Despite substantial implications for healthcare provider practice and patient outcomes, gender has yet to be systematically explored with regard to interprofessional operating room (OR) teamwork. We aimed to explore and describe how gender and additional social identity factors shape experiences and perceptions of teamwork in the OR. METHODS This study was a qualitative secondary analysis of semi-structured interviews with OR team members conducted between November 2018 and July 2019. Participants were recruited across hospitals in Ontario, Canada. We conducted both purposive and snowball sampling until data saturation was reached. Transcripts were analyzed thematically by two independent research team members, moving from open to axial coding. RESULTS Sixty-six interviews of OR healthcare professionals were completed: anesthesia (n=17), nursing (n=19), perfusion (n=2), and surgery (n=26). Traditional gender roles, norms, and stereotypes were perceived and experienced by both women and men, but with different consequences. Both women and men participants described challenges that women face in the OR, such as being perceived negatively for displaying leadership behaviours. Participants also reported that interactions and behaviours vary depending on the team gender composition, and that other social identities, such as age and race, often interact with gender. Nevertheless, participants indicated a belief that the influence of gender in the OR may be modified. CONCLUSIONS The highly gendered reality of the OR creates an environment conducive to breakdowns in communuication and patient safety risks in addition to diminishing team morale, psychological safety, and provider well-being. Consequently, until teamwork interventions adequately account for gender, they are unlikely to be optimally effective or sustainable.
Collapse
Affiliation(s)
- Cole Etherington
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, 501 Smyth Rd, Ottawa, ON, K1H 8L6, Canada
- Department of Anesthesiology and Pain Medicine, The Ottawa Hospital, University of Ottawa, General Campus, 501 Smyth Rd, Critical Care Wing 1401, Ottawa, Ontario, K1H 8L6, Canada
| | - Simon Kitto
- Department of Innovation in Medical Education, University of Ottawa, 451 Smyth Rd, Ottawa, ON, K1H 8M5, Canada
| | - Joseph K Burns
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, 501 Smyth Rd, Ottawa, ON, K1H 8L6, Canada
| | - Tracey L Adams
- Department of Sociology, Social Science Centre, Western University, London, ON, N6A 5C2, Canada
| | - Arija Birze
- Dalla Lana School of Public Health, University of Toronto, 155 College St, Toronto, ON, M5T 3M7, Canada
| | - Meghan Britton
- Main Operating Room, The Ottawa Hospital, 501 Smyth Rd, Ottawa, ON, K1H 8L6, Canada
| | - Sukhbir Singh
- Department of Obstetrics, Gynecology & Newborn Care, University of Ottawa, 501 Smyth Rd, Ottawa, ON, K1H 8L6, Canada
| | - Sylvain Boet
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, 501 Smyth Rd, Ottawa, ON, K1H 8L6, Canada.
- Department of Anesthesiology and Pain Medicine, The Ottawa Hospital, University of Ottawa, General Campus, 501 Smyth Rd, Critical Care Wing 1401, Ottawa, Ontario, K1H 8L6, Canada.
- Department of Innovation in Medical Education, University of Ottawa, 451 Smyth Rd, Ottawa, ON, K1H 8M5, Canada.
- Francophone Affairs, Faculty of Medicine, University of Ottawa, 451 Smyth Rd, Ottawa, ON, K1H 8M5, Canada.
- Faculty of Education, University of Ottawa, 145 Jean-Jacques-Lussier Private, Ottawa, ON, K1N 6N5, Canada.
| |
Collapse
|
16
|
Taras J, Raghavan G, Downey K, Balki M. Obstetric Emergencies requiring Rapid response team activation: A retrospective cohort study in a high-risk tertiary care centre. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2021; 44:167-174.e5. [PMID: 34656770 DOI: 10.1016/j.jogc.2021.09.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Revised: 09/14/2021] [Accepted: 09/15/2021] [Indexed: 11/17/2022]
Abstract
OBJECTIVE The purpose of this study was to better understand obstetric codes requiring rapid response team (RRT) activation by examining their incidence, indications, team response and patient outcomes. METHODS This was a retrospective study in peripartum women who required activation of "Code 77 (C77)" (obstetric emergency), "Code Blue (CB)" (cardiopulmonary compromise) or "Code Omega (CO)" (massive transfusion) during hospitalization during January 2014-May 2018. Hospital database and health records were interrogated to identify and review cases. Data on code characteristics, resuscitative measures, and maternal/ neonatal outcomes were collected. RESULTS 147 codes were identified (C77, n=110; CO, n=25; CB, n=12) during the study period, with an incidence of 1:203 deliveries (C77 - 1:271 deliveries, CO - 1:1,194 deliveries and CB - 1:2,488 deliveries). The common indications for C77 were cord prolapse (33%) and fetal bradycardia (32%), and for CO and CB were postpartum hemorrhage (84%) and cardiac arrest (42%), respectively. Most (67%) codes occurred afterhours. The median (IQR) decision-to-delivery interval (DDI) was 8 (5, 15) min after C77. Emergency cesarean delivery (CD) was performed after 57% of obstetric emergencies and general anesthesia was administered in 63% of CDs. Maternal and neonatal mortality rates were 0.68% and 7%, respectively. Major maternal morbidity was seen in 33% cases. Debrief was documented in 4% codes. CONCLUSION RRT activation was required more commonly in C77 than in CO or CB. Their response time and DDIs were rapid. Mortality was low, however, one-third parturients had major morbidity. We suggest closer patient monitoring, immediate availability of resources, and appropriate documentation and debriefing.
Collapse
Affiliation(s)
- Jillian Taras
- Department of Anesthesiology and Pain Medicine, University of Toronto, Toronto, ON
| | - Gita Raghavan
- Department of Anesthesiology and Pain Medicine, Mount Sinai Hospital, University of Toronto, Toronto, ON
| | - Kristi Downey
- Department of Anesthesiology and Pain Medicine, Mount Sinai Hospital, University of Toronto, Toronto, ON
| | - Mrinalini Balki
- Department of Anesthesiology and Pain Medicine, Mount Sinai Hospital, University of Toronto, Toronto, ON; Department of Obstetrics & Gynaecology, Mount Sinai Hospital, University of Toronto, Toronto, ON; Department of Physiology, Mount Sinai Hospital, University of Toronto, Toronto, ON; Lunenfeld-Tanenbaum Research Institute, Toronto, ON.
| |
Collapse
|
17
|
Leonard LD, Shaw M, Moyer A, Tevis S, Schulick R, McIntyre R, Ballou M, Reiter K, Lace C, Weitzel N, Wiler J, Meacham R, Cumbler E, Steward L. The surgical debrief: Just another checklist or an instrument to drive cultural change? Am J Surg 2021; 223:120-125. [PMID: 34407917 DOI: 10.1016/j.amjsurg.2021.07.043] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2021] [Revised: 07/21/2021] [Accepted: 07/22/2021] [Indexed: 01/29/2023]
Abstract
INTRODUCTION Post-procedural debrief is recommended to improve patient safety. We examined operating room (OR) clinicians' perceptions of the impact of a multi-disciplinary debrief on OR culture. METHODS A survey was administered to 182 OR clinicians at a major academic medical center. Attitudes toward the surgical debrief and its effect on patient safety and OR culture were evaluated. RESULTS Majority of clinicians (58.2%) believed creating a culture of safety in the OR was a shared care team responsibility, however, surgical attendings and trainees were more likely to assign this responsibility to the surgical attending. Few circulating nurses and trainees felt comfortable initiating a surgical debrief. Overall clinicians agreed that a debrief would impact both patient safety outcomes and OR culture. CONCLUSIONS Clinicians felt implementation of a surgical debrief would positively affect the OR culture of safety by improving interdisciplinary communication and influencing the power hierarchy that exists in many ORs.
Collapse
Affiliation(s)
- Laura D Leonard
- Department of Surgery, University of Colorado, Anschutz Medical Campus, 12631 East 17th Ave. Room 6000, Aurora, CO, 80045, USA.
| | - Maxwell Shaw
- UCHealth at University of Colorado Anschutz Medical Campus, 1300 E. 17th Place, Aurora, CO, 80045, USA
| | - Amber Moyer
- Department of Surgery, University of Colorado, Anschutz Medical Campus, 12631 East 17th Ave. Room 6000, Aurora, CO, 80045, USA
| | - Sarah Tevis
- Department of Surgery, University of Colorado, Anschutz Medical Campus, 12631 East 17th Ave. Room 6000, Aurora, CO, 80045, USA
| | - Richard Schulick
- Department of Surgery, University of Colorado, Anschutz Medical Campus, 12631 East 17th Ave. Room 6000, Aurora, CO, 80045, USA
| | - Robert McIntyre
- Department of Surgery, University of Colorado, Anschutz Medical Campus, 12631 East 17th Ave. Room 6000, Aurora, CO, 80045, USA
| | - Michelle Ballou
- UCHealth at University of Colorado Anschutz Medical Campus, 1300 E. 17th Place, Aurora, CO, 80045, USA
| | - Kaye Reiter
- UCHealth at University of Colorado Anschutz Medical Campus, 1300 E. 17th Place, Aurora, CO, 80045, USA
| | - Christopher Lace
- Department of Anesthesiology, University of Colorado, Anschutz Medical Campus, 12401 East 17th Ave. 7th Floor, Aurora, CO, 80045, USA
| | - Nathaen Weitzel
- Department of Anesthesiology, University of Colorado, Anschutz Medical Campus, 12401 East 17th Ave. 7th Floor, Aurora, CO, 80045, USA
| | - Jennifer Wiler
- UCHealth at University of Colorado Anschutz Medical Campus, 1300 E. 17th Place, Aurora, CO, 80045, USA; Department of Emergency Medicine, University of Colorado, Anschutz Medical Campus, 12401 East 17th Ave. 7th Floor, Aurora, CO 80045, USA
| | - Randall Meacham
- Department of Surgery, University of Colorado, Anschutz Medical Campus, 12631 East 17th Ave. Room 6000, Aurora, CO, 80045, USA
| | - Ethan Cumbler
- Department of Surgery, University of Colorado, Anschutz Medical Campus, 12631 East 17th Ave. Room 6000, Aurora, CO, 80045, USA; Department of Medicine, University of Colorado, Anschutz Medical Campus, 12631 East 17th Ave. Room 8601, Aurora, CO, 80045, USA
| | - Lauren Steward
- Department of Surgery, University of Colorado, Anschutz Medical Campus, 12631 East 17th Ave. Room 6000, Aurora, CO, 80045, USA
| |
Collapse
|
18
|
Seelandt JC, Walker K, Kolbe M. "A debriefer must be neutral" and other debriefing myths: a systemic inquiry-based qualitative study of taken-for-granted beliefs about clinical post-event debriefing. Adv Simul (Lond) 2021; 6:7. [PMID: 33663598 PMCID: PMC7931165 DOI: 10.1186/s41077-021-00161-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Accepted: 02/15/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The goal of this study was to identify taken-for-granted beliefs and assumptions about use, costs, and facilitation of post-event debriefing. These myths prevent the ubiquitous uptake of post-event debriefing in clinical units, and therefore the identification of process, teamwork, and latent safety threats that lead to medical error. By naming these false barriers and assumptions, the authors believe that clinical event debriefing can be implemented more broadly. METHODS We interviewed an international sample of 37 clinicians, educators, scholars, researchers, and healthcare administrators from hospitals, universities, and healthcare organizations in Western Europe and the USA, who had a broad range of debriefing experience. We adopted a systemic-constructivist approach that aimed at exploring in-depth assumptions about debriefing beyond obvious constraints such as time and logistics and focused on interpersonal relationships within organizations. Using circular questions, we intended to uncover new and tacit knowledge about barriers and facilitators of regular clinical debriefings. All interviews were transcribed and analyzed following a comprehensive process of inductive open coding. RESULTS In total, 1508.62 min of interviews (25 h, 9 min, and 2 s) were analyzed, and 1591 answers were categorized. Many implicit debriefing theories reflected current scientific evidence, particularly with respect to debriefing value and topics, the complexity and difficulty of facilitation, the importance of structuring the debriefing and engaging in reflective practice to advance debriefing skills. We also identified four debriefing myths which may prevent post-event debriefing from being implemented in clinical units. CONCLUSION The debriefing myths include (1) debriefing only when disaster strikes, (2) debriefing is a luxury, (3) senior clinicians should determine debriefing content, and (4) debriefers must be neutral and nonjudgmental. These myths offer valuable insights into why current debriefing practices are ad hoc and not embedded into daily unit practices. They may help ignite a renewed momentum into the implementation of post-event debriefing in clinical settings.
Collapse
Affiliation(s)
- Julia Carolin Seelandt
- Simulation Center, University Hospital Zurich, Rämistrasse 100, 8091 Zürich, Switzerland
| | - Katie Walker
- New York City, Health + Hospitals Simulation Center, 1400 Pelham Parkway South, Building 4, 2nd Floor, Bronx, NY 10461 USA
| | - Michaela Kolbe
- Simulation Center, University Hospital Zurich, Rämistrasse 100, 8091 Zürich, Switzerland
| |
Collapse
|
19
|
Gregory ME, Hughes AM, Benishek LE, Sonesh SC, Lazzara EH, Woodard LD, Salas E. Toward the Development of the Perfect Medical Team: Critical Components for Adaptation. J Patient Saf 2021; 17:e47-e70. [PMID: 33635843 DOI: 10.1097/pts.0000000000000598] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Medical teams play a vital role in the delivery of safe and effective patient care. Toward the goal of becoming a high-reliability health system, the authors posit that the "perfect" medical team is one that develops their attitudes, behaviors, and cognitions (ABCs) to facilitate adaptation. METHODS The authors synthesized the literature (frameworks, measures, and conceptual models) on teamwork in healthcare (k = 161) to develop an evidence-based model of ABCs, which current evidence suggests, are requisite for medical team adaptation. Clinical vignettes were garnered from the media and other sources to illustrate how these ABCs-or failure in using these ABCs-can lead to positive or negative events in healthcare. RESULTS The resulting model contains the most frequently included ABCs in healthcare teamwork models, measures, and frameworks: psychological safety (41, 25.5%), situation assessment (66, 41.0%), shared mental models (56, 34.8%), team leadership behaviors (78, 48.4%), role awareness (64, 39.7%), team decision-making (61, 37.9%) and planning (41, 25.5%), conflict management (51, 31.7%), task coordination (71, 44.1%), adaptation (46, 28.6%), and backup behavior (54, 33.5%). The authors posit that communication and organizational conditions-other highly cited components-(141, 87.6%, and 90, 55.9%, respectively) serve as moderators of these relationships. CONCLUSIONS The authors argue that each of these ABCs is critical for enhancing team adaptation and subsequently increasing patient safety. A list of practical tools and educational strategies that teams and organizations can use to improve their performance on each of these ABCs is provided.
Collapse
Affiliation(s)
| | - Ashley M Hughes
- Department of Biomedical and Health Information Sciences, University of Illinois at Chicago, Chicago, Illinois
| | - Lauren E Benishek
- Department of Anesthesiology and Critical Care Medicine, Armstrong Institute for Patient Safety and Quality, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | | | - Elizabeth H Lazzara
- Department of Human Factors and Behavioral Neurobiology, Embry-Riddle Aeronautical University, Daytona Beach, Florida
| | | | - Eduardo Salas
- Department of Psychological Sciences, Rice University, Houston, Texas
| |
Collapse
|
20
|
Morton CH, Hall MF, Shaefer SJM, Karsnitz D, Pratt SD, Klassen M, Semenuk K, Chazotte C. National Partnership for Maternal Safety: Consensus Bundle on Support After a Severe Maternal Event. J Obstet Gynecol Neonatal Nurs 2021; 50:88-101. [PMID: 33220179 DOI: 10.1016/j.jogn.2020.09.160] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/01/2020] [Indexed: 11/20/2022] Open
Abstract
Supporting women, families, and clinicians with information, emotional support, and health care resources should be part of an institutional response after a severe maternal event. A multidisciplinary approach is needed for an effective response during and after the event. As a member of the maternity care team, the nurse's role includes coordination, documentation, and ensuring patient safety in emergency situations. The National Partnership for Maternal Safety, under the guidance of the Council on Patient Safety in Women's Health Care, has developed interprofessional work groups to develop safety bundles on diverse topics. This article provides the rationale and supporting evidence for the support after a severe maternal event bundle, which includes structure- and evidence-based resources for women, families, and maternity care providers. The bundle is organized into four domains: Readiness, Recognition, Response, and Reporting and Systems Learning, and it may be adapted by nurses and multidisciplinary leaders in birthing facilities for implementation as a standardized approach to providing support for everyone involved in a severe maternal event.
Collapse
|
21
|
Abstract
Effective teamwork, both in and out of the operating room, is an essential component of safe and efficient surgical performance. There are multiple available assessment tools for evaluating teamwork and important contributors to teamwork such as safety culture and nontechnical skills. Multiple types of interventions exist to improve and train providers on teamwork, and many have been demonstrated to improve not only teamwork but also patient outcomes. Teamwork strategies can be adapted to different contexts, based on provider needs and resources.
Collapse
Affiliation(s)
- Akemi L Kawaguchi
- Department of Pediatric Surgery, McGovern Medical School at the University of Texas Health Science Center at Houston, 6431 Fannin Street, MSB 5.246, Houston, TX 77030, USA.
| | - Lillian S Kao
- Division of Acute Care Surgery, Department of Surgery, McGovern Medical School at the University of Texas Health Science Center at Houston, 6431 Fannin Street, MSB 4.264, Houston, TX 77030, USA
| |
Collapse
|
22
|
Hardie J, Oeppen R, Shaw G, Holden C, Tayler N, Brennan P. You Have Control: aviation communication application for safety-critical times in surgery. Br J Oral Maxillofac Surg 2020; 58:1073-1077. [PMID: 32933788 PMCID: PMC7449978 DOI: 10.1016/j.bjoms.2020.08.104] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2020] [Accepted: 08/20/2020] [Indexed: 12/26/2022]
Abstract
High-risk organisations (HRO), including aviation, undergo formal communication training, with emphasis on safety-critical moments. Such training is not widespread or mandatory in healthcare, and while there are many differences both share the 'human element' with circumstances leading to an increased risk of harm. A typical operating theatre consists of an operating surgeon, and an assisting surgeon, roles that may change throughout the course of a procedure. Similarly, a training aircraft or multi-crew cockpit (flight deck) has a pilot in control, or 'pilot flying', and a 'pilot not flying'. Both interact with wider teams, for example the scrub team and air traffic controllers, respectively. Surgical error is the second most prevalent cause of preventable harm to patients after drug errors. Every year in the UK National Health Service (NHS), there are typically 500 never events, 21,000 serious incidents, and many more episodes of physical or psychological harm. Ineffective communication (46%) is the most common behavioural factor leading to a never event. In this review, we examine the concept of 'sterile cockpit', use of unambiguous terminology, callsigns, important information readback, sharing of mental models, and the mini-brief, and how these may be used to reduce patient harm during safety-critical moments.
Collapse
Affiliation(s)
- J.A. Hardie
- Trauma & Orthopaedic Department, Frimley Park Hospital, Camberley, GU16 7UJ, UK,Corresponding author
| | - R.S. Oeppen
- Department of Clinical Radiology, University Hospitals Southampton, SO16 6YD, UK
| | - G. Shaw
- Captain B777/787, C/o Critical Factors, 2 Melrose Avenue, Borehamwood, WD6 2BJ, UK
| | - C. Holden
- Captain B777/787, C/o Critical Factors, 2 Melrose Avenue, Borehamwood, WD6 2BJ, UK
| | - N. Tayler
- Captain B777/787, C/o Critical Factors, 2 Melrose Avenue, Borehamwood, WD6 2BJ, UK
| | - P.A. Brennan
- Maxillofacial Unit, Queen Alexandra Hospital, Portsmouth, PO6 3LY, UK
| |
Collapse
|
23
|
Katsevman GA, Sedney CL, Braca Iii JA, Hatchett L. Interdisciplinary differences in needlestick injuries among healthcare professionals in training: Improving situational awareness to prevent high-risk injuries. Work 2020; 65:635-645. [PMID: 32116282 DOI: 10.3233/wor-203118] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Needlestick injuries among healthcare professionals continue to be an occupational hazard, frequently and incorrectly regarded as low-risk, and exacerbated by underreporting. We aimed to investigate rates of needlestick injury, reasons for underreporting, and how explicit announcements that patients are "high-risk" (i.e., human immunodeficiency virus, hepatitis, or intravenous drug abuse history) might affect the actions of those at risk of sustaining an injury. METHODS A cross-sectional survey was administered to medical students (MS), nursing students (NS), and residents. RESULTS 30/224 (13%) of MS, 6/65 (9%) of NS, and 67/126 (53%) of residents experienced needlestick injuries. 37% of MS, 33% of NS, and 46% of residents attributed "lack of concentration" as cause of injury. Residents had the lowest percentage of underreporting (33%), with rates of 40% and 83% among MS and NS, respectively. Top reasons for non-reporting included the injury being perceived as "trivial" (22%) and patient being "low-risk" (18%). A majority stated pre-operative "high-risk" announcements should be required (91%), and would promote "culture of safety" (82%), reporting of injuries (85%), and increased concentration during procedures (70%). CONCLUSIONS We recommend routine announcements during pre-operative time-out and nursing/resident hand-offs that state a patient is "high-risk" if applicable. We hypothesize such policy will promote a "culture of safety," situational awareness, and incident reporting.
Collapse
Affiliation(s)
- Gennadiy A Katsevman
- Department of Neurological Surgery, West Virginia University, Morgantown, WV, USA
| | - Cara L Sedney
- Department of Neurological Surgery, Indiana University, Indianapolis, IN, USA
| | - John A Braca Iii
- Department of Neurological Surgery, Indiana University, Indianapolis, IN, USA
| | - Lena Hatchett
- Neiswanger Institute for Bioethics and Health Policy, Loyola University Medical Center, Maywood, IL, USA
| |
Collapse
|
24
|
Ravindran S, Matharoo M, Coleman M, Marshall S, Healey C, Penman I, Thomas-Gibson S. Teamworking in endoscopy: a human factors toolkit for the COVID-19 era. Endoscopy 2020; 52:879-883. [PMID: 32572861 PMCID: PMC7516366 DOI: 10.1055/a-1204-5212] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2020] [Accepted: 06/22/2020] [Indexed: 12/13/2022]
Abstract
BACKGROUND Endoscopy services have had to rapidly adapt their working practices in response to COVID-19. As recovery of endoscopy services proceeds, our workforce faces numerous challenges that can impair effective teamworking. We designed and developed a novel toolkit to support teamworking in endoscopy during the pandemic. METHODS A human factors model was developed to understand the impact of COVID-19 on endoscopy teams. From this, we identified a set of key teamworking goals, which informed the development of a toolkit to support several team processes. The toolkit was refined following expert input and refinement over a 6-week period. RESULTS The toolkit consists of four cognitive aids that can be used to support team huddles, briefings, and debriefs, alongside techniques to optimize endoscopic nontechnical skills across the patient-procedure pathway. We describe the processes that local endoscopy units can employ to implement this toolkit. CONCLUSION A toolkit of cognitive aids, based on human factors principles, may be useful in supporting teams, helping them adapt to working safely in the era of COVID-19.
Collapse
Affiliation(s)
- Srivathsan Ravindran
- Joint Advisory Group on Gastrointestinal Endoscopy, Royal College of Physicians, London, United Kingdom
- Department of Surgery and Cancer, Imperial College London, United Kingdom
| | - Manmeet Matharoo
- Wolfson Unit for Endoscopy, St Mark’s Hospital and Academic Institute, London, United Kingdom
| | - Mark Coleman
- Joint Advisory Group on Gastrointestinal Endoscopy, Royal College of Physicians, London, United Kingdom
- Department of Colorectal Surgery, University Hospitals Plymouth NHS Trust, Plymouth, United Kingdom
| | - Sarah Marshall
- Wolfson Unit for Endoscopy, St Mark’s Hospital and Academic Institute, London, United Kingdom
- Nurses Association Committee, British Society of Gastroenterology, London, United Kingdom
| | - Chris Healey
- Joint Advisory Group on Gastrointestinal Endoscopy, Royal College of Physicians, London, United Kingdom
- Department of Gastroenterology, Airedale NHS Foundation Trust, Keighley, United Kingdom
| | - Ian Penman
- Centre for Liver and Digestive Disorders, Royal Infirmary of Edinburgh, Edinburgh, United Kingdom
- Endoscopy Section Committee, British Society of Gastroenterology, London, United Kingdom
| | - Siwan Thomas-Gibson
- Department of Surgery and Cancer, Imperial College London, United Kingdom
- Wolfson Unit for Endoscopy, St Mark’s Hospital and Academic Institute, London, United Kingdom
| |
Collapse
|
25
|
Non-technical skills in robotic surgery and impact on near-miss events: a multi-center study. Surg Endosc 2020; 35:5062-5071. [PMID: 32968920 DOI: 10.1007/s00464-020-07988-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Accepted: 09/14/2020] [Indexed: 12/27/2022]
Abstract
BACKGROUND Robotic surgery requires a set of non-technical skills (NTS), because of the complex environment. We aim to study relationship between NTS and near-miss events in robotic surgery. METHODS This is an observational study in five French centers. Three robotic procedures were observed and filmed by one of expert trainers in NTS. They established and scored a non-technical skills in robotic surgery (NTSRS) score, that included eight items, each scored from 1 to 5, to assess the whole surgical teams. The surgical teams also self-assessed their work. The number of near-miss events was recorded and classified as minor, or major but no harm incidents, independently by two surgeons. Correlations were Spearman coefficients. RESULTS Of the 26 procedures included, 15 were prostatectomy (58%), 9 nephrectomy (35%), and 2 pyeloplasty (7.7%). Half of procedures (n = 13) were performed by surgeons with extensive RS experience (more than 150 procedures). Per procedure, there was a median (quartiles) of 9 (7; 11) near-miss events. There was 1 (0; 2) major near-miss events, with no harm. The median NTSRS score was 18 (14; 21), out of 40. The number of near-miss events was strongly correlated with the NTSRS score (r = - 0.92, p < 0.001) but was not correlated with the surgeon's experience. The surgeons for fifteen (58%) procedures, and the bed-side surgeons for 11 (42%) procedures, felt that there was no need for an improvement in the quality of their NTS. None of the surgeons gave a negative self-evaluation for any procedure; in three procedures (12%), the bed-side surgeons self-assessed negatively, on ergonomics. CONCLUSION Occurrence of near-miss events was reduced in teams managing NTS. Specific NTS surgical team training is essential for robotic surgery as it may have a significant impact on risk management.
Collapse
|
26
|
Utilization of a multidisciplinary emergency department sepsis huddle to reduce time to antibiotics and improve SEP-1 compliance. Am J Emerg Med 2020; 38:2400-2404. [PMID: 33041123 DOI: 10.1016/j.ajem.2020.09.014] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Revised: 09/03/2020] [Accepted: 09/06/2020] [Indexed: 11/20/2022] Open
Abstract
Sepsis is a significant public health crisis in the United States, contributing to 50% of inpatient hospital deaths. Given its dramatic health effects and implications in the setting of new CMS care guidelines, ED leaders have renewed focus on appropriate and timely sepsis care, including timely administration of antibiotics in patients at risk for sepsis. Modeling the success of multidisciplinary bedside huddles in improving compliance with appropriate care in other healthcare settings, a Sepsis Huddle was implemented in a large, academic ED, with the goal of driving compliance with standardized sepsis care as described in the CMS SEP-1 measure. A retrospective cohort analysis was performed, with the primary finding that utilization of the Sepsis Huddle resulted in antibiotics being administered on average 41 min sooner than when the Sepsis Huddle was not performed. Given that literature suggests that early administration of appropriate antibiotic therapy is a major driver of mortality reduction in patients with sepsis, this study represents a proof of concept that utilization of a Sepsis Huddle may serve to improve outcomes among ED patients at risk for sepsis.
Collapse
|
27
|
Maestre J, Rábago J, del Moral I. A tool to support the work of surgical teams and face the COVID-19 pandemic. REVISTA ESPAÑOLA DE ANESTESIOLOGÍA Y REANIMACIÓN (ENGLISH EDITION) 2020. [PMCID: PMC7328616 DOI: 10.1016/j.redare.2020.05.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
28
|
A tool to support the work of surgical teams and face the COVID-19 pandemic. ACTA ACUST UNITED AC 2020; 67:355-356. [PMID: 32419707 PMCID: PMC7225717 DOI: 10.1016/j.redar.2020.05.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2020] [Revised: 05/06/2020] [Accepted: 05/10/2020] [Indexed: 11/21/2022]
|
29
|
Brooker KJ, Vikan M, Thyli B. A Qualitative Exploratory Study of Norwegian OR Nurses' Patient Positioning Priorities. AORN J 2020; 111:211-220. [PMID: 31997315 DOI: 10.1002/aorn.12930] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
The purpose of patient positioning is to provide optimal surgical site exposure for surgical team members and prevent negative patient outcomes. This study explores perioperative nurses' experiences when positioning patients for surgery. We collected data using focus group interviews of 17 OR nurses in Norway and used qualitative content analysis to analyze the data. The study findings showed that perioperative nurses emphasized their most important priorities as concepts that can be categorized into three themes: leading and coordinating patient positioning, ensuring patient safety, and promoting efficient use of OR nurses' expertise. The study findings also identify a need to define formal responsibilities in patient positioning and processes for determining positioning outcomes. Perioperative leaders should verify OR nurse competence for patient positioning to help ensure continuity and safety in complex patient pathways.
Collapse
|
30
|
Neuhaus C, Schäfer J, Weigand MA, Lichtenstern C. Impact of a semi-structured briefing on the management of adverse events in anesthesiology: a randomized pilot study. BMC Anesthesiol 2019; 19:232. [PMID: 31852441 PMCID: PMC6921421 DOI: 10.1186/s12871-019-0913-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2019] [Accepted: 12/11/2019] [Indexed: 11/16/2022] Open
Abstract
Background Human factors research has identified mental models as a key component for the effective sharing and organization of knowledge. The challenge lies in the development and application of tools that help team members to arrive at a shared understanding of a situation. The aim of this study was to assess the influence of a semi-structured briefing on the management of a simulated airway emergency. Methods 37 interprofessional teams were asked to perform a simulated rapid-sequence induction in the simulator. Teams were presented with a “cannot ventilate, cannot oxygenate” scenario that ultimately required a cricothyroidotomy. Study group (SG) teams were asked to perform a briefing prior to induction, while controls (CG) were asked to perform their usual routine. Results We observed no difference in the mean time until cricothyroidotomy (SG 8:31 CG 8:16, p = 0.36). There was a significant difference in groups’ choice of alternative means of oxygenation: While SG teams primarily chose supraglottic airway devices, controls initially reverted to mask ventilation (p = 0.005). SG teams spent significantly less time with this alternative airway device and were quicker to advance in the airway algorithm. Conclusions Our study addresses effects on team coordination through a shared mental model as effected by a briefing prior to anesthesia induction. We found measurable improvements in airway management during those stages of the difficult airway algorithm explicitly discussed in the briefing. For those, time spent was shorter and participants were quicker to advance in the airway algorithm.
Collapse
Affiliation(s)
- Christopher Neuhaus
- Department of Anesthesiology, Heidelberg University Hospital, Im Neuenheimer Feld, 110 69120, Heidelberg, Germany.
| | - Johannes Schäfer
- Department of Anesthesiology, Heidelberg University Hospital, Im Neuenheimer Feld, 110 69120, Heidelberg, Germany
| | - Markus A Weigand
- Department of Anesthesiology, Heidelberg University Hospital, Im Neuenheimer Feld, 110 69120, Heidelberg, Germany
| | - Christoph Lichtenstern
- Department of Anesthesiology, Heidelberg University Hospital, Im Neuenheimer Feld, 110 69120, Heidelberg, Germany
| |
Collapse
|
31
|
Raj M, Wilk AS, Platt JE. Dynamics of Physicians' Trust in Fellow Health Care Providers and the Role of Health Information Technology. Med Care Res Rev 2019; 78:338-349. [PMID: 31822195 DOI: 10.1177/1077558719892349] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Physicians are expected and incentivized to coordinate patient care with other providers, including nonphysician clinician (NPC) members of care teams, requiring trust. Trust in the context of care teams has not been well-studied; even less is known about how health information technologies (HIT) may modify trust in these relationships. We conducted semistructured interviews with 30 physicians at a Midwestern academic center to examine how physicians determine they can trust NPCs, and how technology modifies these relationships. A majority of physicians base trust in NPCs on cognitive factors such as competence and reliability. Technology enhances trust between physicians and NPCs by supporting evidence-based decision making; it can also erode trust by limiting opportunities for developing familiarity and comfort with fellow providers. Our work has implications for enhancing HIT to promote trust between providers, and for developing more robust measures of trust that can be used in evaluating and improving teamwork within practices.
Collapse
|
32
|
Abstract
Effective communication is the keystone in the management of delivery room emergencies. A clearly defined framework and "shared mental model" optimize team collaboration and are essential when anticipating and preparing for high-stakes emergent cases. This review defines a framework to build shared mental models using dialogue, pre-briefing, checklists, simulation, debriefing and structured feedback to maintain a cohesive high functioning team. Strategies to approach different emergency lead-times will be discussed, and case examples will be used to illustrate concepts outlined.
Collapse
Affiliation(s)
- Catherine Chang
- Weill Cornell Medicine, 525 E. 68th Street, N-506 New York, NY, 10065, USA.
| | - Jeffrey Perlman
- Weill Cornell Medicine, 525 E. 68th Street, N-506 New York, NY, 10065, USA.
| |
Collapse
|
33
|
Mackenzie WGS, McLeod L, Wang K, Crotty J, Hope JE, Imahiyerobo TA, Ko RR, Anderson RCE, Saiman L, Vitale MG. Team Approach: Preventing Surgical Site Infections in Pediatric Scoliosis Surgery. JBJS Rev 2019; 6:e2. [PMID: 29406434 DOI: 10.2106/jbjs.rvw.16.00121] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Affiliation(s)
- W G Stuart Mackenzie
- Departments of Orthopaedic Surgery (W.G.S.M., K.W., J.C., J.E.H., and M.G.V.), Anesthesiology (R.R.K.), and Neurological Surgery (R.C.E.A.), Columbia University Medical Center, New York, NY
| | - Lisa McLeod
- Children's Hospital Colorado, Aurora, Colorado
| | - Kevin Wang
- Departments of Orthopaedic Surgery (W.G.S.M., K.W., J.C., J.E.H., and M.G.V.), Anesthesiology (R.R.K.), and Neurological Surgery (R.C.E.A.), Columbia University Medical Center, New York, NY
| | - Jennifer Crotty
- Departments of Orthopaedic Surgery (W.G.S.M., K.W., J.C., J.E.H., and M.G.V.), Anesthesiology (R.R.K.), and Neurological Surgery (R.C.E.A.), Columbia University Medical Center, New York, NY
| | - Jennifer E Hope
- Departments of Orthopaedic Surgery (W.G.S.M., K.W., J.C., J.E.H., and M.G.V.), Anesthesiology (R.R.K.), and Neurological Surgery (R.C.E.A.), Columbia University Medical Center, New York, NY
| | - Thomas A Imahiyerobo
- Division of Plastic Surgery, Department of Surgery (T.A.I.), Division of Pediatric Infectious Diseases, Department of Pediatrics (L.S.), and Department of Infection Prevention and Control (L.S.), New York Presbyterian/Columbia University Medical Center, New York, NY
| | - Riva R Ko
- Departments of Orthopaedic Surgery (W.G.S.M., K.W., J.C., J.E.H., and M.G.V.), Anesthesiology (R.R.K.), and Neurological Surgery (R.C.E.A.), Columbia University Medical Center, New York, NY
| | - Richard C E Anderson
- Departments of Orthopaedic Surgery (W.G.S.M., K.W., J.C., J.E.H., and M.G.V.), Anesthesiology (R.R.K.), and Neurological Surgery (R.C.E.A.), Columbia University Medical Center, New York, NY
| | - Lisa Saiman
- Division of Plastic Surgery, Department of Surgery (T.A.I.), Division of Pediatric Infectious Diseases, Department of Pediatrics (L.S.), and Department of Infection Prevention and Control (L.S.), New York Presbyterian/Columbia University Medical Center, New York, NY
| | - Michael G Vitale
- Departments of Orthopaedic Surgery (W.G.S.M., K.W., J.C., J.E.H., and M.G.V.), Anesthesiology (R.R.K.), and Neurological Surgery (R.C.E.A.), Columbia University Medical Center, New York, NY
| |
Collapse
|
34
|
Sethi RK, Yanamadala V, Shah SA, Fletcher ND, Flynn J, Lafage V, Schwab F, Heffernan M, DeKleuver M, Mcleod L, Leveque JC, Vitale M. Improving Complex Pediatric and Adult Spine Care While Embracing the Value Equation. Spine Deform 2019; 7:228-235. [PMID: 30660216 DOI: 10.1016/j.jspd.2018.08.006] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2018] [Revised: 04/02/2018] [Accepted: 08/12/2018] [Indexed: 11/18/2022]
Abstract
INTRODUCTION Value in health care is defined as the quotient of outcomes to cost. Both pediatric and adult spinal deformity surgeries are among the most expensive procedures offered today. With high variability in both outcomes and costs in spine surgery today, surgeons will be expected to consider long-term cost effectiveness when comparing treatment options. METHODS We summarize various methods by which value can be increased in complex spine surgery, both through the improvement of outcomes and the reduction of cost. These methods center around standardization, team-based and collaborative approaches, rigorous outcomes tracking through dashboards and registries, and continuous process improvement. RESULTS This manuscript reviews the expert opinion of leading spine specialists on the improvement of safety, quality and improvement of value of pediatric and adult spinal surgery. CONCLUSION Without surgeon leadership in this arena, suboptimal solutions may result from the isolated intervention of regulatory bodies or payer groups. The cooperative development of standardized, team-based approaches in complex spine surgery will lead to the high-quality, high-value care for patients.
Collapse
Affiliation(s)
- Rajiv K Sethi
- Virginia Mason Medical Center, University of Washington, 1100 9th Ave, Seattle, WA 98101, USA.
| | - Vijay Yanamadala
- Virginia Mason Medical Center, University of Washington, 1100 9th Ave, Seattle, WA 98101, USA; and Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114, USA
| | - Suken A Shah
- Dupont Hospital for Children, 1600 Rockland Rd, Wilmington, DE 19803, USA
| | | | - John Flynn
- Children's Hospital of Philadelphia, 3401 Civic Center Blvd, Philadelphia, PA 19104, USA
| | - Virginie Lafage
- Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021
| | - Frank Schwab
- Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021
| | | | - Marinus DeKleuver
- Sint Maartenskliniek, Radboud University Medical Center, PO Box 9011, 6500 GM, Nijmegen, the Netherlands
| | - Lisa Mcleod
- University of Colorado Denver, 1201 Larimer St, Denver, CO 80204, USA
| | - Jean Christophe Leveque
- Virginia Mason Medical Center, University of Washington, 1100 9th Ave, Seattle, WA 98101, USA
| | - Michael Vitale
- Morgan Stanley Children's Hospital, Columbia University, 3959 Broadway, New York, NY 10032, USA
| |
Collapse
|
35
|
Finch EP, Langston M, Erickson D, Pereira K. Debriefing in theOR: A Quality Improvement Project. AORN J 2019; 109:336-344. [DOI: 10.1002/aorn.12616] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
|
36
|
DiBartola AC, Barron C, Smith S, Quatman-Yates C, Chaudhari AMW, Scharschmidt TJ, Moffatt-Bruce SD, Quatman CE. Decreasing Room Traffic in Orthopedic Surgery: A Quality Improvement Initiative. Am J Med Qual 2019; 34:561-568. [PMID: 30654622 DOI: 10.1177/1062860618821180] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Operating room (OR) traffic and door openings increase potential for air contamination in the OR and create distractions for surgical teams. A multidisciplinary intervention was developed among OR staff, surgical staff, vendors, radiology, and anesthesia and approved by the hospital system's patient and quality safety department for implementation. Interventions included education, OR signage, and team-based accountability and behavioral interventions. After interventions were implemented, a second prospective, observational data collection was performed and compared to preintervention OR traffic. A total of 35 cases were observed over the 3-month period in the preintervention group; 42 cases were observed in the postintervention group. Average door openings per minute decreased by 22% (P = .0011) after intervention. All surgical groups excluding anesthesia had significant reductions in OR traffic following the intervention. Behavioral interventions that focus on education, awareness, and efficiency strategies can decrease overall OR traffic for orthopedic cases.
Collapse
Affiliation(s)
| | | | - Scott Smith
- The Ohio State University College of Medicine, Columbus, OH
| | | | | | - Thomas J Scharschmidt
- The Ohio State University, Wexner Medical Center, Columbus, OH.,The Ohio State University College of Medicine, Columbus, OH
| | - Susan D Moffatt-Bruce
- The Ohio State University, Wexner Medical Center, Columbus, OH.,The Ohio State University College of Medicine, Columbus, OH
| | | |
Collapse
|
37
|
Liu JB, Berian JR, Liu Y, Ko CY, Weber SM. Trends in perioperative outcomes of hospitals performing major cancer surgery. J Surg Oncol 2018; 118:694-703. [PMID: 30129674 DOI: 10.1002/jso.25171] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2018] [Accepted: 07/02/2018] [Indexed: 01/18/2023]
Abstract
BACKGROUND AND OBJECTIVES Cancer surgery outcomes at National Cancer Institute-designated cancer centers (NCI-CCs) have been shown to vary, and have not been uniformly better than outcomes among non-NCI-CCs. We aimed to assess whether NCI-CCs have improved their short-term outcomes over time and whether variation across these centers has changed. METHODS Patients who underwent colectomy, esophagectomy, hepatectomy, pancreatectomy, and proctectomy for cancer were identified from the 2010 to 2016 American College of Surgeons' National Surgical Quality Improvement Program registry. Hospital trends in risk-adjusted, smoothed observed-to-expected ratios were assessed to evaluate improvement and variation in perioperative complications, stratified by NCI-CC status. RESULTS Complications occurred in 18.8% of 204 732 patients who underwent major cancer operations at 645 hospitals, and complications occurred in 19.9% of 60,903 patients at 54 NCI-CCs studied. More NCI-CCs than non-NCI-CCs improved over the period (85.2% vs 58.4%, P < 0.001; relative risk [RR] 1.46, 95% confidence interval [CI], 1.28-1.66); this remained significant after adjusting for years of participation (RR 1.33, 95% CI, 1.17-1.51). Variation in performance remained unchanged over time. CONCLUSION NCI-CCs were detected to have improved over a contemporary seven-year period and to have improved more than non-NCI-CCs. However, NCI-CCs do not uniformly outperform non-NCI-CCs, and variation in perioperative outcomes remains, warranting continued quality improvement efforts targeting cancer-specific operations.
Collapse
Affiliation(s)
- Jason B Liu
- Division of Research and Optimal Patient Care, American College of Surgeons, Chicago, IL.,Department of Surgery, University of Chicago Medicine, Chicago, IL
| | - Julia R Berian
- Department of Surgery, University of Chicago Medicine, Chicago, IL
| | - Yaoming Liu
- Division of Research and Optimal Patient Care, American College of Surgeons, Chicago, IL
| | - Clifford Y Ko
- Division of Research and Optimal Patient Care, American College of Surgeons, Chicago, IL.,Department of Surgery, University of California Los Angeles David Geffen School of Medicine, VA Greater Los Angeles Healthcare System, Los Angeles, CA
| | - Sharon M Weber
- Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, WI
| |
Collapse
|
38
|
Dufault CA. Patient Care During Minimally Invasive Lateral Spine Surgery: 1.7 www.aornjournal.org/content/cme. AORN J 2018; 108:127-139. [PMID: 30117551 DOI: 10.1002/aorn.12303] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Perioperative nurses care for patients undergoing a wide range of surgical procedures. One fast-growing surgical specialty is spine surgery performed using minimally invasive techniques. Patients may be candidates for minimally invasive spine surgery based on their presenting signs and symptoms and medical imaging test results. Open anterior and posterior surgical approaches to spine surgery are how surgeons traditionally have performed these procedures. However, new technology has enabled a minimally invasive lateral approach to the spine. This approach minimizes many of the risks and challenges associated with both the anterior and posterior approaches. Minimally invasive lateral interbody fusion requires the perioperative nurse to have a thorough understanding of the necessary patient positioning, spinal anatomy, and OR suite setup to ensure a safe and successful surgical experience for the patient.
Collapse
|
39
|
Cramer JD, Chi DH, Schaitkin BM, Eibling DE, Johnson JT. Teach the teacher: Training otolaryngology fellows to become academic educators. Laryngoscope 2018. [PMID: 29521418 DOI: 10.1002/lary.27156] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
OBJECTIVES/HYPOTHESIS Fellowship is the capstone of academic training and serves as preparation for an academic career. Fellows are expected to educate medical students and residents during and long after fellowship. However, little time is typically spent teaching fellows to become effective educators. We investigate a formal curriculum addressing teaching skills among fellows in otolaryngology-head and neck surgery (OHNS). STUDY DESIGN E-mail survey. METHODS We developed and implemented an educational program called Teach the Teacher to build skills as educators for fellows in OHNS. We conducted a survey of fellows from 2014 to 2017 in OHNS who participated in the course. The survey evaluated demographics, teaching experiences, and teaching limitations structured as yes/no and Likert-style questions (1 = strongly disagree, 5 = strongly agree). RESULTS Thirty fellows were surveyed with a response rate was 80%. Fellowship was rated highly as an experience that will make fellows a better academic educator (mean ± standard deviation: 4.54 ± 0.64). The most important components of teaching during fellowship were role modeling (4.67 ± 0.62), followed by teaching psychomotor skills in the operating room (4.29 ± 0.89), diagnostic reasoning (4.25 ± 0.66), and evidence-based medicine (4.25 ± 0.83). The Teach the Teacher course specifically was rated as a helpful experience (4.00 ± 0.90). The primary limitations to developing teaching skills during fellowship identified were lack of time, patient safety, and inexperience with hospital culture. CONCLUSIONS Fellowship is a key time to improve skills as academic educators. Fellows value formal efforts to teach academic skills. LEVEL OF EVIDENCE NA. Laryngoscope, 128:2034-2048, 2018.
Collapse
Affiliation(s)
- John D Cramer
- Department of Otolaryngology-Head and Neck Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - David H Chi
- Department of Otolaryngology-Head and Neck Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania.,Children's Hospital of Pittsburgh of the University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Barry M Schaitkin
- Department of Otolaryngology-Head and Neck Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - David E Eibling
- Department of Otolaryngology-Head and Neck Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania.,Surgery Service, VA Pittsburgh Healthcare System, Pittsburgh, Pennsylvania, U.S.A
| | - Jonas T Johnson
- Department of Otolaryngology-Head and Neck Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| |
Collapse
|
40
|
Babic B, Volpe AA, Merola S, Mauer E, Cozacov Y, Ko CY, Michelassi F, Saldinger P. Sustained culture and surgical outcome improvement. Am J Surg 2018; 216:841-845. [PMID: 29482831 DOI: 10.1016/j.amjsurg.2018.02.016] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2017] [Revised: 01/30/2018] [Accepted: 02/07/2018] [Indexed: 11/16/2022]
Abstract
BACKGROUND A focus on the culture of safety and patient outcomes continues to grow in importance. Several initiatives targeted at individual deficits have been described but few institutions have shown the effect of a global change in culture on patient outcomes. METHODS Patient care perception was assessed using Safety Attitudes Questionnaire (SAQ) by Pascal Metrics®. A change in culture was initiated, followed by implementation of initiatives targeting communication and patient safety. ACS-NSQIP data was analyzed to assess outcomes during the period of improved culture. RESULTS Our institution had poor outcomes as measured by ACS-NSQIP data and several deficiencies in our culture score. Both statistically improved after initiative implementation. A difference in mean culture score across time (p < 0.001 = .031) was seen from 2013 to 2015, while NSQIP odds ratios falling in the 'exemplary' category increased. CONCLUSION Our results demonstrate an improvement in both culture and outcomes from 2013 to 2015, suggesting a correlation between culture and surgical outcomes.
Collapse
Affiliation(s)
- Bruna Babic
- Department of Surgery, New York Presbyterian-Queens, Flushing, NY, USA; Department of Surgery, Weill Cornell Medicine, New York, NY, USA.
| | | | - Stephen Merola
- Department of Surgery, New York Presbyterian-Queens, Flushing, NY, USA; Department of Surgery, Weill Cornell Medicine, New York, NY, USA
| | - Elizabeth Mauer
- Division of Biostatistics and Epidemiology, Department of Healthcare Policy and Research, New York-Presbyterian/Weill Cornell Medical Center, New York, NY, USA
| | - Yaniv Cozacov
- Department of Surgery, New York Presbyterian-Queens, Flushing, NY, USA
| | - Clifford Y Ko
- Department of Surgery, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA; Division of Research and Optimal Patient Care, American College of Surgeons, Chicago, IL, USA
| | | | - Pierre Saldinger
- Department of Surgery, New York Presbyterian-Queens, Flushing, NY, USA; Department of Surgery, Weill Cornell Medicine, New York, NY, USA
| |
Collapse
|
41
|
Offiah G, Doherty E. Tricks of the trade: time management tips for newly qualified doctors. Postgrad Med J 2017; 94:159-161. [PMID: 29074506 DOI: 10.1136/postgradmedj-2017-135303] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2017] [Revised: 10/12/2017] [Accepted: 10/13/2017] [Indexed: 11/03/2022]
Abstract
BACKGROUND The transition from medical student to doctor is an important milestone. The discovery that their time is no longer their own and that the demands of their job are greater than the time they have available is extremely challenging. METHODS At a recent surgical boot camp training programme, 60 first-year surgical trainees who had just completed their internship were invited to reflect on the lessons learnt regarding effective time management and to recommend tips for their newly qualified colleagues. They were asked to identify clinical duties that were considered urgent and important using the time management matrix and the common time traps encountered by newly qualified doctors. RESULTS The surgical trainees identified several practical tips that ranged from writing a priority list to working on relationships within the team. These tips are generic and so applicable to all newly qualified medial doctors. POTENTIAL IMPLICATION We hope that awareness of these tips from the outset as against learning them through experience will greatly assist newly qualified doctors.
Collapse
Affiliation(s)
- Gozie Offiah
- Department of Surgery, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Eva Doherty
- Department of Surgical Affairs and Department of Human Factors and Patient Safety, Royal College of Surgeons in Ireland, Dublin, Ireland
| |
Collapse
|
42
|
Yanchus NJ, Ohler L, Crowe E, Teclaw R, Osatuke K. ‘You just can’t do it all’: a secondary analysis of nurses' perceptions of teamwork, staffing and workload. J Res Nurs 2017. [DOI: 10.1177/1744987117710305] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
The purpose of this study was to re-examine data to explore connections between nurses’ perceptions of teamwork, staffing and workload, focusing on salient aspects and connections, from the nurses’ perspective. Insufficient staffing levels and imbalanced workload distributions are prominent challenges in contemporary healthcare which can cause increased incident reports, medical errors and lower patient satisfaction. Using a novel form of secondary analysis – an original qualitative analysis followed by a quantification of the qualitative data, we found themes of teamwork, staffing and workload were interrelated in the data. When facing workload challenges created by understaffing, participants directly attributed their units’ ability to meet the needs of patient care to levels of teamwork on the unit. We suggest that teamwork in healthcare needs targeted organisational support. In other words, healthcare organisations must systematically approach and monitor the status of nursing teamwork, e.g. implement programmes to develop it as needed, particularly when faced with staffing and workload challenges. Healthcare leaders can learn from and the healthcare delivery workplace can be shaped by listening to teamwork perceptions of nurses.
Collapse
Affiliation(s)
- Nancy J Yanchus
- Psychology Technician, Veterans Health Administration National Center for Organization Development, USA
| | - Lindsey Ohler
- Research Intern, Veterans Health Administration National Center for Organization Development, USA
| | - Emily Crowe
- Research Intern, Veterans Health Administration National Center for Organization Development, USA
| | - Robert Teclaw
- Health Scientist, Veterans Health Administration National Center for Organization Development, USA
| | - Katerine Osatuke
- Research Director, Veterans Health Administration National Center for Organization Development, USA
| |
Collapse
|
43
|
Birnbach DJ, Rosen LF, Fitzpatrick M, Paige JT, Arheart KL. Introductions During Time-outs: Do Surgical Team Members Know One Another's Names? Jt Comm J Qual Patient Saf 2017; 43:284-288. [PMID: 28528622 DOI: 10.1016/j.jcjq.2017.03.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
BACKGROUND Introductions are the first item of the time-out in the World Health Organization Surgical Safety Checklist (SSC). It has yet to be established that surgical teams use colleagues' names or consider the use of names important. A study was conducted to determine if using the SSC has a measurable impact on name retention and to assess if operating room (OR) personnel believe it is important to know the names of their colleagues or for their colleagues to know theirs. METHODS All OR personnel were individually interviewed at the end of 25 surgical cases in which the SSC was used. They were asked (1) to name each OR participant, and (2) if they believed it is important to know the names of their team members and (3) for their team members to know their name. RESULTS Of the 150 OR personnel interviewed, 147 (98%) named the surgery attending correctly. The surgery attending named only 44% of other OR staff (p <0.001). Only 62% of the OR staff correctly named the anesthesiology attending. The anesthesiology resident was the least well known but was able to name 82% of the others. The anesthesiology attending named his or her resident 100% of the time; the surgery attending correctly named his or her resident only 68% of the time (p = 0.002). CONCLUSION This study suggests that OR personnel may consider introductions to be another bureaucratic hurdle instead of the safety check they were designed to be. It appears that this first step of the time-out is often being performed perfunctorily.
Collapse
|
44
|
Katsevman G, Braca J, Sedney C, Hatchett L. Needlestick injuries among healthcare professionals in training: using the surgical ‘time-out’ and hand-off protocols to deter high-risk needlesticks. J Hosp Infect 2017; 95:103-104. [DOI: 10.1016/j.jhin.2016.10.018] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2016] [Accepted: 10/27/2016] [Indexed: 11/27/2022]
|
45
|
Leeds IL, Boss EF, George JA, Strockbine V, Wick EC, Jelin EB. Preparing enhanced recovery after surgery for implementation in pediatric populations. J Pediatr Surg 2016; 51:2126-2129. [PMID: 27663124 PMCID: PMC5373552 DOI: 10.1016/j.jpedsurg.2016.08.029] [Citation(s) in RCA: 51] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2016] [Revised: 08/29/2016] [Accepted: 08/30/2016] [Indexed: 01/31/2023]
Abstract
UNLABELLED Standardization in perioperative care has led to major improvements in surgical outcomes during the last two decades. Enhanced recovery after surgery (ERAS) programs are one example of a clinical pathway impacting both surgical outcomes and efficiency of care, but these programs have not yet been widely adapted for surgery in children. In adults, ERAS pathways have been shown to reduce length of stay, reduce complication rates, and improve patient satisfaction. These pathways improve outcomes through standardization of existing evidence-based best practices. Currently, the direct evidence for adapting ERAS pathways to pediatric surgery patients is limited. Challenges for implementation of ERAS programs for children include lack of direct translatability of adult evidence as well as varying levels acceptability of ERAS principles among pediatric providers and patients' families. We describe our newly implemented ERAS program for pediatric colorectal surgery patients in an era of limited direct evidence and discuss what further issues need to be addressed for broader implementation of pediatric ERAS pathways. LEVEL OF EVIDENCE Level 5.
Collapse
Affiliation(s)
- Ira L. Leeds
- Department of Surgery, The Johns Hopkins Hospital and Johns Hopkins University School of Medicine, 600 North Wolfe Street, Blalock 618, Baltimore, MD 21287
| | - Emily F. Boss
- Department of Otolaryngology-Head and Neck Surgery and Health Policy & Management, Johns Hopkins University School of Medicine and Bloomberg School of Public Health, 601 North Caroline Street, 6th Floor, Baltimore, MD 21287
| | - Jessica A. George
- Department of Anesthesiology and Critical Care Medicine, Johns Hopkins Children’s Center and Johns Hopkins University School of Medicine, 1800 Orleans Street, Baltimore, MD 21287
| | - Valerie Strockbine
- Department of Surgery, Johns Hopkins Bloomberg Children’s Center and Johns Hopkins University School of Medicine, 1800 Orleans Street, Bloomberg 7323, Baltimore, MD 21287
| | - Elizabeth C. Wick
- Department of Surgery, The Johns Hopkins Hospital and Johns Hopkins University School of Medicine, 600 North Wolfe Street, Blalock 618, Baltimore, MD 21287
| | - Eric B. Jelin
- Department of Surgery, Johns Hopkins Bloomberg Children’s Center and Johns Hopkins University School of Medicine, 1800 Orleans Street, Bloomberg 7323, Baltimore, MD 21287
| |
Collapse
|
46
|
|
47
|
Noyes K, Baack‐Kukreja J, Messing EM, Schoeniger L, Galka E, Pan W, Xueya C, Fleming FJ, Monson JRT, Mohile SG, Francone T. Surgical readmissions: results of integrating pre-, peri- and postsurgical care. Nurs Open 2016; 3:168-178. [PMID: 27708827 PMCID: PMC5047346 DOI: 10.1002/nop2.52] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2015] [Accepted: 02/29/2016] [Indexed: 12/20/2022] Open
Abstract
AIMS To explore the feasibility of recruiting surgical oncology patients and implementing a surgical integrated discharge (SID) programme led by advanced practice providers (APP). BACKGROUND Burden of illness and complexity of treatment regimen makes it challenging for surgical oncology patients to participate in research. Surgical oncology nurses may have the necessary expertise to overcome this problem. DESIGN Controlled longitudinal prospective observational study. METHODS The SID programme included multidisciplinary care coordination, regular communication among APPs and proactive postdischarge follow-up. Administrative databases were used to identify matching historical controls (n = 113) and evaluate programme outcomes. RESULTS Patient enrolment was 84%. The main challenges for the programme implementation included incompatible health information systems among care settings, variation in care processes among hospital units and need for provider behaviour change. CONCLUSIONS Most surgical oncology patients are willing to participate in outcomes programmes when contacted by familiar clinical personnel but programme implementation requires leadership support, communication among care teams and training and infrastructure.
Collapse
Affiliation(s)
- Katia Noyes
- Surgical Health Outcomes & Research Enterprise (SHORE)RochesterNew YorkUSA
- Department of SurgeryUniversity of Rochester Medical CenterRochesterNew YorkUSA
| | - Janet Baack‐Kukreja
- Department of UrologyUniversity of Rochester Medical CenterRochesterNew YorkUSA
| | - Edward M. Messing
- Department of UrologyUniversity of Rochester Medical CenterRochesterNew YorkUSA
| | - Luke Schoeniger
- Department of SurgeryUniversity of Rochester Medical CenterRochesterNew YorkUSA
| | - Eva Galka
- Department of SurgeryUniversity of Rochester Medical CenterRochesterNew YorkUSA
| | - Wei Pan
- Surgical Health Outcomes & Research Enterprise (SHORE)RochesterNew YorkUSA
| | - Cai Xueya
- Department of Biostatics and Computational BiologyUniversity of Rochester Medical CenterRochesterNew YorkUSA
| | - Fergal J. Fleming
- Surgical Health Outcomes & Research Enterprise (SHORE)RochesterNew YorkUSA
- Department of SurgeryUniversity of Rochester Medical CenterRochesterNew YorkUSA
| | - John RT Monson
- Surgical Health Outcomes & Research Enterprise (SHORE)RochesterNew YorkUSA
- Department of SurgeryUniversity of Rochester Medical CenterRochesterNew YorkUSA
| | - Supriya G. Mohile
- Department of Medicine, Hematology/OncologyWilmot Cancer InstituteUniversity of Rochester Medical CenterRochesterNew YorkUSA
| | - Todd Francone
- Lahey Hospital & Medical CenterBurlingtonMassachusettsUSA
| |
Collapse
|
48
|
Neuhaus C, Hofer S, Hofmann G, Wächter C, Weigand MA, Lichtenstern C. Perioperative Safety. Anesth Analg 2016; 122:2059-63. [DOI: 10.1213/ane.0000000000001315] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
|
49
|
Abstract
PURPOSE OF REVIEW The goal of this review is to provide updates on the evolution of conceptual definitions as they relate to quality in healthcare, existing measurement platforms for performance benchmarking in pediatric surgery, and available tools for quality improvement that are relevant to care of the pediatric surgical patient. RECENT FINDINGS The American College of Surgeon's National Surgical Quality Improvement Program-Pediatric has continued to evolve, now providing risk-adjusted safety outcomes data to over 70 hospitals and broadening its scope of quality measurement to include resource utilization and value-based metrics. Increasing use of checklists and other team-based communication tools show potential for making surgical care safer for children, and thoughtful application of quality improvement methods such as Lean methodology, six-sigma and others are helping to improve efficiency and increase healthcare value. Finally, efforts to define minimal resource standards for pediatric surgical care holds promise to improve outcomes for neonates and other children with complex surgical needs. SUMMARY Over the past decade, significant progress has been made in our ability to measure, benchmark and improve quality in pediatric surgery. Future efforts will need to facilitate broader participation in benchmarking programs and knowledge-sharing collaboratives, and to develop multidisciplinary, 'disease-specific' longitudinal care models where quality measurement extends before and beyond the 'traditional' 30-day perioperative period.
Collapse
|
50
|
Ding M, Bell A, Rixon S, Rixon A, Addae-Bosomprah H, Simon J. Effectiveness of educational communication interventions for health professionals to improve quality of care in emergency departments: a systematic review protocol. JBI DATABASE OF SYSTEMATIC REVIEWS AND IMPLEMENTATION REPORTS 2016; 14:10-19. [PMID: 27532305 DOI: 10.11124/jbisrir-2016-2357] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
The objective of this review is to evaluate the effectiveness of educational communication interventions for health professionals in emergency departments. The end result is to identify the specific types of communication based educational strategies utilized by emergency department health care professionals to enhance the quality of care for patients.
Collapse
Affiliation(s)
- Mingshuang Ding
- 1School of Nursing, Queensland University of Technology, Australia 2Department of Emergency Medicine, Queen Elizabeth II Jubilee Hospital, Queensland, Australia 3School of Medicine, University of Queensland, Australia 4Babel Fish Group, Victoria, Australia 5Centre for Evidence Based Healthy Ageing (CEBHA): an Affiliate Centre of the Joanna Briggs Institute
| | | | | | | | | | | |
Collapse
|