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Lopina N. A Mathematical Model Based on Stratifying the Severity of Medical Errors for Building Scenarios for Clinical Cases With Branching. Cureus 2024; 16:e58089. [PMID: 38738126 PMCID: PMC11088723 DOI: 10.7759/cureus.58089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/11/2024] [Indexed: 05/14/2024] Open
Abstract
Background There are no mathematical models or score systems available for assessing and creating clinical case simulations based on branching scenario scripts. Objective This study aimed to develop a mathematical model based on stratifying the severity of medical errors for building clinical cases with branching scenarios for clinical simulation. Methods This study was undertaken from August 2020 to August 2023. To build a mathematical model for building scenarios of clinical cases with branching, the classification of the seriousness of medication errors was used. A mathematical model was built for predicting and modeling the development of a clinical situation and as an assessment strategy. The study recruited a total of 34 participants, with 16 participants assigned to the branching scenarios without the mathematical model group and 18 participants assigned to the branching scenarios with the mathematical model group. Results A simple diagram of score based on stratification of the severity of medical errors and correct decisions in clinical practice for building interactive training scenarios with branching was proposed. According to this score system algorithm, each clinical decision-making step is scored points with plus or minus, from 0 to 10. The sum of the points for each block in the decision-making process is then added up. Each step in the overall clinical decision-making strategy is stratified by the proposed algorithm, and finally, the results of internal validation and implementation are presented. Conclusion A mathematical model and score system for building clinical case scenarios based on branching and classification of the seriousness of medication errors was developed. This system could help in the prediction and modeling of the development of events in particular clinical situations and the assessment of competency formation in medical simulation as well.
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Affiliation(s)
- Nataliia Lopina
- Simulation Training Platform "ClinCaseQuest", Med Inform Group LLC, Kharkiv, UKR
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Ballit A, Hivert M, Rubod C, Dao TT. Fast soft-tissue deformations coupled with mixed reality toward the next-generation childbirth training simulator. Med Biol Eng Comput 2023:10.1007/s11517-023-02864-5. [PMID: 37382859 DOI: 10.1007/s11517-023-02864-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Accepted: 06/07/2023] [Indexed: 06/30/2023]
Abstract
High-quality gynecologist and midwife training is particularly relevant to limit medical complications and reduce maternal and fetal morbimortalities. Physical and virtual training simulators have been developed. However, physical simulators offer a simplified model and limited visualization of the childbirth process, while virtual simulators still lack a realistic interactive system and are generally limited to imposed predefined gestures. Objective performance assessment based on the simulation numerical outcomes is still not at hand. In the present work, we developed a virtual childbirth simulator based on the Mixed-Reality (MR) technology coupled with HyperMSM (Hyperelastic Mass-Spring Model) formulation for real-time soft-tissue deformations, providing intuitive user interaction with the virtual physical model and a quantitative assessment to enhance the trainee's gestures. Microsoft HoloLens 2 was used and the MR simulator was developed including a complete holographic obstetric model. A maternal pelvis system model of a pregnant woman (including the pelvis bone, the pelvic floor muscles, the birth canal, the uterus, and the fetus) was generated, and HyperMSM formulation was applied to simulate the soft tissue deformations. To induce realistic reactions to free gestures, the virtual replicas of the user's detected hands were introduced into the physical simulation and were associated with a contact model between the hands and the HyperMSM models. The gesture of pulling any part of the virtual models with two hands was also implemented. Two labor scenarios were implemented within the MR childbirth simulator: physiological labor and forceps-assisted labor. A scoring system for the performance assessment was included based on real-time biofeedback. As results, our developed MR simulation application was developed in real-time with a refresh rate of 30-50 FPS on the HoloLens device. HyperMSM model was validated using FE outcomes: high correlation coefficients of [0.97-0.99] and weighted root mean square relative errors of 9.8% and 8.3% were obtained for the soft tissue displacement and energy density respectively. Experimental tests showed that the implemented free-user interaction system allows to apply the correct maneuvers (in particular the "Viennese" maneuvers) during the labor process, and is capable to induce a truthful reaction of the model. Obtained results confirm also the possibility of using our simulation's outcomes to objectively evaluate the trainee's performance with a reduction of 39% for the perineal strain energy density and 5.6 mm for the vertical vaginal diameter when the "Viennese" technique is applied. This present study provides, for the first time, an interactive childbirth simulator with an MR immersive experience with direct free-hand interaction, real-time soft-tissue deformation feedback, and an objective performance assessment based on numerical outcomes. This offers a new perspective for enhancing next-generation training-based obstetric teaching. The used models of the maternal pelvic system and the fetus will be enhanced, and more delivery scenarios (e.g. instrumental delivery, breech delivery, shoulder dystocia) will be designed and integrated. The third stage of labor will be also investigated to include the delivery of the placenta, and the clamping and cutting of the umbilical cord.
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Affiliation(s)
- Abbass Ballit
- Univ. Lille, CNRS, Centrale Lille, UMR 9013-LaMcube-Laboratoire de Mécanique, Multiphysique, Multiéchelle, Lille, F-59000, France
| | - Mathieu Hivert
- Université Lille Nord de France, Faculté de Médecine, F-59000, Lille, France
- CHU Lille, Service de Chirurgie Gynécologique, F-59000, Lille, France
| | - Chrystèle Rubod
- Univ. Lille, CNRS, Centrale Lille, UMR 9013-LaMcube-Laboratoire de Mécanique, Multiphysique, Multiéchelle, Lille, F-59000, France
- Université Lille Nord de France, Faculté de Médecine, F-59000, Lille, France
- CHU Lille, Service de Chirurgie Gynécologique, F-59000, Lille, France
| | - Tien-Tuan Dao
- Univ. Lille, CNRS, Centrale Lille, UMR 9013-LaMcube-Laboratoire de Mécanique, Multiphysique, Multiéchelle, Lille, F-59000, France.
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Chatzi AV, Malliarou M. The need for a nursing specific patient safety definition, a viewpoint paper. INTERNATIONAL JOURNAL OF HEALTH GOVERNANCE 2023. [DOI: 10.1108/ijhg-12-2022-0110] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/18/2023]
Abstract
PurposeThis viewpoint article discusses and analyses the need and benefits of a patient safety definition within the context of nursing.Design/methodology/approachThis viewpoint article is supported by literature review, statutory documents and expert knowledge evidence. All these sources provided a unified narrative of the background, current aspects and future needs of patient safety.FindingsThe need for strengthening patient safety and the nurses' role within healthcare's actions towards patient safety are discussed. The predominant role of nurses due to the proportionate size and significant role along with the need for clarification of patient safety in nursing terms is recognised. Research evidence of nursing areas with safety issues and relevant nursing interventions are presented. Based on all findings, a research-based nursing specific patient safety definition is proposed. This definition includes three axes: what is patient harm, how this harm can be eliminated or reduced and which are the areas of nursing practice that are identified to provide opportunity for patient harm. These axes include nursing specifications of the patient safety definition.Originality/valueIt is the first time that a nurse specific patient safety definition is proposed. This definition strives to enhance nurse practitioners' understanding and engagement with patient safety by clarifying aspects of patient safety within everyday nursing practice.
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Shorey S, Wong PZE. Vicarious Trauma Experienced by Health Care Providers Involved in Traumatic Childbirths: A Meta-Synthesis. TRAUMA, VIOLENCE & ABUSE 2022; 23:1585-1598. [PMID: 33945337 DOI: 10.1177/15248380211013135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Health care providers are often "second victims" of traumatic childbirth events and should be adequately supported by their organizations to alleviate occupational stress and burnout. Therefore, this review aimed to explore and understand the vicarious traumatic childbirth experiences of health care providers, including obstetricians, midwives, nurses, and students. A systematic review of qualitative studies was conducted. Seven electronic databases, namely, PubMed, CINAHL, Embase, PsycINFO, Cochrane, Scopus, and Web of Science, were searched from each database's inception to May 2020. In total, 1,575 studies were retrieved and screened according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Seventeen studies were included in this review and were meta-summarized and then meta-synthesized using the Sandelowski and Barroso approach. The overarching theme of "Tunneling through the trauma with a hope of finding an end" was derived, and four main themes along with 15 subthemes were identified. The four main themes were (1) "instantaneous response to the trauma," (2) "finding hope in the midst of chaos," (3) "dealing with the aftermath," and (4) "resolution to move on." Communication and teamwork among health care team members were identified as challenges contributed by professional hierarchy and lack of role clarity. Midwives and labor and delivery nurses expressed powerlessness in advocating for women on many occasions, and health care providers often had feelings of guilt and self-blame after adverse events. Health care providers also reported inadequate support from their colleagues and organizations, which influenced their ability to cope with the aftermath of trauma and their decision to stay in the profession.
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Affiliation(s)
- Shefaly Shorey
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, 37580National University of Singapore, Level 2, Clinical Research Centre, Singapore
| | - Phyllis Zhi En Wong
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, 37580National University of Singapore, Level 2, Clinical Research Centre, Singapore
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Catling C, Rossiter C, Cummins A, McIntyre E. Midwifery workplace culture in Sydney, Australia. Women Birth 2021; 35:e379-e388. [PMID: 34266786 DOI: 10.1016/j.wombi.2021.07.001] [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: 03/08/2021] [Revised: 07/01/2021] [Accepted: 07/05/2021] [Indexed: 10/20/2022]
Abstract
PROBLEM Aspects of the midwifery workplace culture have previously been measured as negative with limited leadership or support. Support for midwives is essential for them to face the complexity and workloads in Australian maternity units. BACKGROUND Understanding the culture of the midwifery workplace is important to develop strategies to stem workforce attrition and to optimise care of women and their families. AIMS This study aimed to assess midwives' perceptions of workplace culture in two maternity units in Sydney, Australia, and compare the results with a national study using the same validated instrument. METHOD This study reports results using the Australian Midwifery Workplace Culture instrument (n = 49 midwives) and stakeholder groups (n = 10). Simple descriptive statistics were used, and the qualitative responses were analysed thematically. FINDINGS Compared to the national sample, participants rated their workplace more favourably, especially their relationships with managers and colleagues. Over one-third (36.7%) considered that their workplace had a positive culture, compared with 27.9%e. However, they rated their workplaces more negatively on time constraints and staff resources, and reported limited autonomy. Workplaces were highly medicalised which impacted their philosophy of woman-centred care and their ability to work autonomously. DISCUSSION Factors related to collegiality in the workplace, relationship with managers, midwives' intention to leave the profession and time constraints are discussed in comparison to the national study, as well as other relevant research. Conclusion Workplace collaboration, support, respect and understanding were extremely important to midwives, as were adequate staffing levels, teamwork and opportunities for further education.
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Affiliation(s)
- Christine Catling
- Centre for Midwifery, Child and Family Health, School of Nursing and Midwifery, Faculty of Health, University of Technology Sydney, Australia.
| | - Chris Rossiter
- Centre for Midwifery, Child and Family Health, School of Nursing and Midwifery, Faculty of Health, University of Technology Sydney, Australia
| | - Allison Cummins
- Centre for Midwifery, Child and Family Health, School of Nursing and Midwifery, Faculty of Health, University of Technology Sydney, Australia
| | - Erica McIntyre
- Institute for Sustainable Futures, University of Technology Sydney, Australia; School of Public Health, Faculty of Health, University of Technology Sydney, Australia
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Abstract
Potentially life-threatening gynecologic emergencies are high-risk conditions that may serve as a useful framework to improve quality and safety in emergency care. OBJECTIVE: To define and assess the prevalence of potentially life-threatening gynecologic emergencies among women presenting for acute pelvic pain for the purpose of developing measures to audit quality of care in emergency departments. METHODS: We conducted a mixed-methods multicenter study at gynecologic emergency departments in France and Belgium. A modified Delphi procedure was first conducted in 2014 among health care professionals to define relevant combinations of potentially life-threatening conditions and near misses in the field of gynecologic emergency care. A prospective case–cohort study in the spring of 2015 then assessed the prevalence of these potentially life-threatening emergencies and near misses among women of reproductive age presenting for acute pelvic pain. Women in the case group were identified at 21 participating centers. The control group consisted of a sample of women hospitalized for acute pelvic pain not caused by a potentially life-threatening condition and a 10% random sample of outpatients. RESULTS: Eight gynecologic emergencies and 17 criteria for near misses were identified using the Delphi procedure. Among the 3,825 women who presented for acute pelvic pain, 130 (3%) were considered to have a potentially life-threatening condition. The most common diagnoses were ectopic pregnancies with severe bleeding (n=54; 42%), complex pelvic inflammatory disease (n=30; 23%), adnexal torsion (n=20; 15%), hemorrhagic miscarriage (n=15; 12%), and severe appendicitis (n=6; 5%). The control group comprised 225 hospitalized women and 381 outpatients. Diagnostic errors occurred more frequently among women with potentially life-threatening emergencies than among either hospitalized (odds ratio [OR] 1.7, 95% CI 1.1–2.7) or outpatient (OR 14.7, 95% CI 8.1–26.8) women in the control group. Of the women with potentially life-threatening conditions, 26 met near-miss criteria compared with six with not potentially life-threatening conditions (OR 25.6, 95% CI 10.9–70.7). CONCLUSIONS: Potentially life-threatening gynecologic emergencies are high-risk conditions that may serve as a useful framework to improve quality and safety in emergency care.
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Balding C, Leggat S. Making high quality care an organisational strategy: Results of a longitudinal mixed methods study in Australian hospitals. Health Serv Manage Res 2020; 34:148-157. [PMID: 32698625 DOI: 10.1177/0951484820943601] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Significant resources are spent on monitoring and improving the quality and safety of hospital care; however, evidence suggests that this investment is achieving disproportionately limited results. Accreditation and expectations of funders have focused hospital service quality management on compliance, with an over emphasis on the 'control' aspect of Juran's Quality Trilogy. This study compared the impact of the implementation of a strategic quality management system with existing compliance-focused quality management systems in a sample of Australian hospitals. Through action research, mixed methods data were tracked and compared implementation progress and outcomes between four experimental and four control hospitals from 2015 to 2017. While three years was not enough time to observe quality changes resulting from the implementation, three experimental hospitals made high quality care a strategic priority for their organisation and developed organisation-wide processes to achieve it. These hospitals demonstrated that including a strategic quality planning component in quality system design and implementation, as advocated by Juran but absent in many hospital quality systems, was a positive lever for staff commitment to delivering consistently high quality care.
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Kakemam E, Kalhor R, Khakdel Z, Khezri A, West S, Visentin D, Cleary M. Occupational stress and cognitive failure of nurses and associations with self-reported adverse events: A national cross-sectional survey. J Adv Nurs 2020; 75:3609-3618. [PMID: 31531990 DOI: 10.1111/jan.14201] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2018] [Revised: 08/07/2019] [Accepted: 09/04/2019] [Indexed: 11/30/2022]
Abstract
AIM To determine correlations for nurse self-reported occupational stress, prevalence of cognitive failure (CF), and adverse events. DESIGN Cross-sectional nationwide survey. METHODS Tertiary-level public hospitals (N = 115) from 13 provinces in Iran were recruited and 2,895 nurses surveyed (August 2016-December 2017). Participants' self-reported demographic information, occupational stress, CF, and frequency of adverse events were analysed using chi-square, t tests, and binary logistic regression. RESULTS This study showed that 29.1% of nurses had experienced adverse events in the past six months. Significant predictors for reported adverse events from logistic regression were 'Role stressors', 'Interpersonal relations stressors', and 'Action', while 'Working environment stressors' was protective for reported adverse events. Demographic predictors of adverse events were longer work hours and male gender, while those working in critical care units, general wards, and other wards had higher reported adverse events than for emergency wards. CONCLUSIONS Occupational stress and CF are associated with the reporting of adverse events. Further research is needed to assess interventions to address occupational stress and CF to reduce adverse events. IMPACT Adverse events compromise patient safety, lead to increased healthcare costs, and impact nursing staff. Higher self-reported adverse events were associated with higher reported stressors and CF. Understanding the factors that influence occupational stress, CF, and adverse events will support quality patient care and safety.
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Affiliation(s)
- Edris Kakemam
- Iranian Center of Excellence in Health Management, School of Management and Medical Informatics, Tabriz University of Medical Sciences, Tabriz, Iran.,Department of Health Management and Economics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Roholla Kalhor
- Social Determinants of Health Research Center, Qazvin University of Medical Sciences, Qazvin, Iran
| | - Zahra Khakdel
- Health Management and Economics Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Ali Khezri
- Student Research Committee, School of Nursing and Midwifery, Bam University of Medical Sciences, Bam, Iran.,Student Research Committee, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Sancia West
- College of Health and Medicine, University of Tasmania, Sydney, NSW, Australia
| | - Denis Visentin
- College of Health and Medicine, University of Tasmania, Sydney, NSW, Australia
| | - Michelle Cleary
- College of Health and Medicine, University of Tasmania, Sydney, NSW, Australia
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Lippke S, Wienert J, Keller FM, Derksen C, Welp A, Kötting L, Hofreuter-Gätgens K, Müller H, Louwen F, Weigand M, Ernst K, Kraft K, Reister F, Polasik A, Huener nee Seemann B, Jennewein L, Scholz C, Hannawa A. Communication and patient safety in gynecology and obstetrics - study protocol of an intervention study. BMC Health Serv Res 2019; 19:908. [PMID: 31779620 PMCID: PMC6883614 DOI: 10.1186/s12913-019-4579-y] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2019] [Accepted: 10/09/2019] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Patient safety is a key target in public health, health services and medicine. Communication between all parties involved in gynecology and obstetrics (clinical staff/professionals, expectant mothers/patients and their partners, close relatives or friends providing social support) should be improved to ensure patient safety, including the avoidance of preventable adverse events (pAEs). Therefore, interventions including an app will be developed in this project through a participatory approach integrating two theoretical models. The interventions will be designed to support participants in their communication with each other and to overcome difficulties in everyday hospital life. The aim is to foster effective communication in order to reduce the frequency of pAEs. If communication is improved, clinical staff should show an increase in work satisfaction and patients should show an increase in patient satisfaction. METHODS The study will take place in two maternity clinics in Germany. In line with previous studies of complex interventions, it is divided into three interdependent phases. Each phase provides its own methods and data. Phase 1: Needs assessment and a training for staff (n = 140) tested in a pre-experimental study with a pre/post-design. Phase 2: Assessment of communication training for patients and their social support providers (n = 423) in a randomized controlled study. Phase 3: Assessment of an app supporting the communication between staff, patients, and their social support providers (n = 423) in a case-control study. The primary outcome is improvement of communication competencies. A range of other implementation outcomes will also be assessed (i.e. pAEs, patient/treatment satisfaction, work satisfaction, safety culture, training-related outcomes). DISCUSSION This is the first large intervention study on communication and patient safety in gynecology and obstetrics integrating two theoretical models that have not been applied to this setting. It is expected that the interventions, including the app, will improve communication practice which is linked to a lower probability of pAEs. The app will offer an effective and inexpensive way to promote effective communication independent of users' motivation. Insights gained from this study can inform other patient safety interventions and health policy developments. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT03855735; date of registration: February 27, 2019.
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Affiliation(s)
- Sonia Lippke
- Jacobs University Bremen gGmbH, Germany Campus Ring 1, 28759 Bremen, Germany
| | - Julian Wienert
- Jacobs University Bremen gGmbH, Germany Campus Ring 1, 28759 Bremen, Germany
| | | | - Christina Derksen
- Jacobs University Bremen gGmbH, Germany Campus Ring 1, 28759 Bremen, Germany
| | - Annalena Welp
- Jacobs University Bremen gGmbH, Germany Campus Ring 1, 28759 Bremen, Germany
| | - Lukas Kötting
- Jacobs University Bremen gGmbH, Germany Campus Ring 1, 28759 Bremen, Germany
| | - Kerstin Hofreuter-Gätgens
- Die Techniker; Unternehmenszentrale, Fachbereich Versorgungsmanagement, Bramfelder Str. 140, 22305 Hamburg, Germany
| | - Hardy Müller
- Die Techniker; Unternehmenszentrale, Fachbereich Versorgungsmanagement, Bramfelder Str. 140, 22305 Hamburg, Germany
- Aktionsbündnis Patientensicherheit, Am Zirkus 2, 10117 Berlin, Germany
| | - Frank Louwen
- Klinik für Frauenheilkunde und Geburtshilfe, Universitätsklinikum Frankfurt Goethe-Universität, Theodor-Stern-Kai 7, 60596 Frankfurt am Main, Germany
| | - Marcel Weigand
- Aktionsbündnis Patientensicherheit, Am Zirkus 2, 10117 Berlin, Germany
| | - Kristina Ernst
- Universitätsklinikum Ulm, Prittwitzstr. 43, 89075 Ulm, Germany
| | - Katrina Kraft
- Universitätsklinikum Ulm, Prittwitzstr. 43, 89075 Ulm, Germany
| | - Frank Reister
- Universitätsklinikum Ulm, Albert-Einstein-Allee 23, 89070 Ulm, Germany
| | - Arkadius Polasik
- Universitätsklinikum Ulm, Albert-Einstein-Allee 23, 89070 Ulm, Germany
| | | | - Lukas Jennewein
- Klinik für Frauenheilkunde und Geburtshilfe, Universitätsklinikum Frankfurt Goethe-Universität, Theodor-Stern-Kai 7, 60596 Frankfurt am Main, Germany
| | - Christoph Scholz
- Universitätsklinikum Ulm, Albert-Einstein-Allee 23, 89070 Ulm, Germany
| | - Annegret Hannawa
- Center for the Advancement of Healthcare Quality and Patient Safety (CAHQS), Faculty of CommunicationSciences, Università della Svizzera Italiana, Lugano, Switzerland
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Woodham LA, Round J, Stenfors T, Bujacz A, Karlgren K, Jivram T, Riklefs V, Poulton E, Poulton T. Virtual patients designed for training against medical error: Exploring the impact of decision-making on learner motivation. PLoS One 2019; 14:e0215597. [PMID: 31013295 PMCID: PMC6478293 DOI: 10.1371/journal.pone.0215597] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2018] [Accepted: 04/04/2019] [Indexed: 11/23/2022] Open
Abstract
Objectives Medical error is a significant cause of patient harms in clinical practice, but education and training are recognised as having a key role in minimising their incidence. The use of virtual patient (VP) activities targeting training in medical error allows learners to practice patient management in a safe environment. The inclusion of branched decision-making elements in the activities has the potential to drive additional generative cognitive processing and improved learning outcomes, but the increased cognitive load on learning risks negatively affecting learner motivation. The aim of this study is to better understand the impact that the inclusion of decision-making and inducing errors within the VP activities has on learner motivation. Methods Using a repeated study design, over a period of six weeks we provided undergraduate medical students at six institutions in three countries with a series of six VPs written around errors in paediatric practice. Participants were divided into two groups and received either linearly structured VPs or ones that incorporated branched decision-making elements. Having completed all the VPs, each participant was asked to complete a survey designed to assess their motivation and learning strategies. Results Our analysis showed that in general, there was no significant difference in learner motivation between those receiving the linear VPs and those who received branched decision-making VPs. The same results were generally reflected across all six institutions. Conclusions The findings demonstrated that the inclusion of decision-making elements did not make a significant difference to undergraduate medical students’ motivation, perceived self-efficacy or adopted learning strategies. The length of the intervention was sufficient for learners to overcome any increased cognitive load associated with branched decision-making elements being included in VPs. Further work is required to establish any immediate impact within periods shorter than the length of our study or upon achieved learning outcomes.
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Affiliation(s)
- Luke A. Woodham
- Department of Learning, Informatics, Management and Ethics, Karolinska Institutet, Stockholm, Sweden
- Institute of Medical and Biomedical Education, St George’s, University of London, London, United Kingdom
- * E-mail:
| | - Jonathan Round
- Institute of Medical and Biomedical Education, St George’s, University of London, London, United Kingdom
| | - Terese Stenfors
- Department of Learning, Informatics, Management and Ethics, Karolinska Institutet, Stockholm, Sweden
| | - Aleksandra Bujacz
- Department of Learning, Informatics, Management and Ethics, Karolinska Institutet, Stockholm, Sweden
| | - Klas Karlgren
- Department of Learning, Informatics, Management and Ethics, Karolinska Institutet, Stockholm, Sweden
| | - Trupti Jivram
- Institute of Medical and Biomedical Education, St George’s, University of London, London, United Kingdom
| | | | - Ella Poulton
- Institute of Medical and Biomedical Education, St George’s, University of London, London, United Kingdom
- Karaganda Medical University, Karaganda, Kazakhstan
| | - Terry Poulton
- Institute of Medical and Biomedical Education, St George’s, University of London, London, United Kingdom
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Greer JA, Haischer-Rollo G, Delorey D, Kiser R, Sayles T, Bailey J, Blosser C, Middlebrooks R, Ennen CS. In-situ Interprofessional Perinatal Drills: The Impact of a Structured Debrief on Maximizing Training While Sensing Patient Safety Threats. Cureus 2019; 11:e4096. [PMID: 31032156 PMCID: PMC6472716 DOI: 10.7759/cureus.4096] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2018] [Accepted: 02/19/2019] [Indexed: 11/25/2022] Open
Abstract
Introduction In-situ interprofessional emergency team training improves participants' with confidence and knowledge and identifies latent safety threats. This study examined the impact of a structured debrief on an interprofessional perinatal team's ability to identify latent safety threats and assess competency in managing perinatal emergencies. It was hypothesized that latent safety threats would be reduced and checklist compliance would increase during subsequent in-situ perinatal team training. Methods Two in-situ training sessions were held six months apart. The perinatal emergency response team provided care for a standardized patient with preterm twin gestation. Each session included off-ward delivery and resuscitation of the first infant, transportation to appropriate inpatient units, cesarean delivery, and resuscitation of the second twin. Postpartum hemorrhage ensued, requiring massive transfusion protocol activation. Medical experts assessed team performance with critical action checklists. A structured debrief identified latent safety threats, developed action plans, and reviewed checklist compliance. Checklist compliance rates were analyzed using a z-ratio test. Results The first training session: seven teams (75 staff) completed 75% (292/391) critical action checklist items and identified 34 latent safety threats. Second training session: four teams (45 staff) completed 89% (94/106) critical action checklist items. Ten latent safety threats were mitigated during the second session. Utilizing a z-ratio, a significant difference was detected between the overall checklist compliance rates of the two sessions, z = -3.069, p = .002. Post-hoc power calculation was <10%. Conclusions In-situ interprofessional perinatal emergency team training is feasible, identifies latent patient safety threats, and may improve team competency.
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Affiliation(s)
- Joy A Greer
- Obstetrics and Gynecology, Naval Medical Center, Portsmouth, USA
| | | | | | - Rebecca Kiser
- Obstetrics and Gynecology, Naval Medical Center, Portsmouth, USA
| | - Timothy Sayles
- Obstetrics and Gynecology, Naval Medical Center, Portsmouth, USA
| | - Jennifer Bailey
- Obstetrics and Gynecology, Naval Medical Center, Portsmouth, USA
| | - Colleen Blosser
- Obstetrics and Gynecology, Naval Medical Center, Portsmouth, USA
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Rönnerhag M, Severinsson E, Haruna M, Berggren I. A qualitative evaluation of healthcare professionals’ perceptions of adverse events focusing on communication and teamwork in maternity care. J Adv Nurs 2018; 75:585-593. [DOI: 10.1111/jan.13864] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2018] [Revised: 07/26/2018] [Accepted: 09/13/2018] [Indexed: 11/29/2022]
Affiliation(s)
- Maria Rönnerhag
- The Centre for Women's, Family and Child Health, Faculty of Health and Social Sciences; University of South-Eastern Norway; Kongsberg Norway
- Department of Health Sciences; University West; Trollhättan Sweden
| | - Elisabeth Severinsson
- The Centre for Women's, Family and Child Health, Faculty of Health and Social Sciences; University of South-Eastern Norway; Kongsberg Norway
| | - Megumi Haruna
- Division of Health Sciences & Nursing Graduate School of Medicine, Department of Midwifery and Women's Health; The University of Tokyo; Tokyo Japan
| | - Ingela Berggren
- Department of Health Sciences; University West; Trollhättan Sweden
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Antony J, Zarin W, Pham B, Nincic V, Cardoso R, Ivory JD, Ghassemi M, Barber SL, Straus SE, Tricco AC. Patient safety initiatives in obstetrics: a rapid review. BMJ Open 2018; 8:e020170. [PMID: 29982200 PMCID: PMC6042535 DOI: 10.1136/bmjopen-2017-020170] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES This review was commissioned by WHO, South Africa-Country office because of an exponential increase in medical litigation claims related to patient safety in obstetrical care in the country. A rapid review was conducted to examine the effectiveness of quality improvement (QI) strategies on maternal and newborn patient safety outcomes, risk of litigation and burden of associated costs. DESIGN A rapid review of the literature was conducted to provide decision-makers with timely evidence. Medical and legal databases (eg, MEDLINE, Embase, LexisNexis Academic, etc) and reference lists of relevant studies were searched. Two reviewers independently performed study selection, abstracted data and appraised risk of bias. Results were summarised narratively. INTERVENTIONS We included randomised clinical trials (RCTs) of QI strategies targeting health systems (eg, team changes) and healthcare providers (eg, clinician education) to improve the safety of women and their newborns. Eligible studies were limited to trials published in English between 2004 and 2015. PRIMARY AND SECONDARY OUTCOME MEASURES RCTs reporting on patient safety outcomes (eg, stillbirths, mortality and caesarean sections), litigation claims and associated costs were included. RESULTS The search yielded 4793 citations, of which 10 RCTs met our eligibility criteria and provided information on over 500 000 participants. The results are presented by QI strategy, which varied from one study to another. Studies including provider education alone (one RCT), provider education in combination with audit and feedback (two RCTs) or clinician reminders (one RCT), as well as provider education with patient education and audit and feedback (one RCT), reported some improvements to patient safety outcomes. None of the studies reported on litigation claims or the associated costs. CONCLUSIONS Our results suggest that provider education and other QI strategy combinations targeting healthcare providers may improve the safety of women and their newborns during childbirth.
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Affiliation(s)
- Jesmin Antony
- Knowledge Translation Program, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario, Canada
| | - Wasifa Zarin
- Knowledge Translation Program, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario, Canada
| | - Ba' Pham
- Knowledge Translation Program, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario, Canada
- Toronto Health Economics and Technology Assessment, University of Toronto, Toronto, Ontario, Canada
| | - Vera Nincic
- Knowledge Translation Program, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario, Canada
| | - Roberta Cardoso
- Knowledge Translation Program, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario, Canada
| | - John D Ivory
- Knowledge Translation Program, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario, Canada
| | - Marco Ghassemi
- Knowledge Translation Program, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario, Canada
| | | | - Sharon E Straus
- Knowledge Translation Program, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario, Canada
- Department of Geriatric Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Andrea C Tricco
- Knowledge Translation Program, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario, Canada
- Epidemiology Division, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
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Hollesen RVB, Johansen RLR, Rørbye C, Munk L, Barker P, Kjaerbye-Thygesen A. Successfully reducing newborn asphyxia in the labour unit in a large academic medical centre: a quality improvement project using statistical process control. BMJ Qual Saf 2018; 27:633-642. [DOI: 10.1136/bmjqs-2017-006599] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2017] [Revised: 11/20/2017] [Accepted: 12/05/2017] [Indexed: 11/04/2022]
Abstract
BackgroundA safe delivery is part of a good start in life, and a continuous focus on preventing harm during delivery is crucial, even in settings with a good safety record. In January 2013, the labour unit at Copenhagen University Hospital, Hvidovre, undertook a quality improvement (QI) project to prevent asphyxia and reduced the percentage of newborns with asphyxia by 48%.MethodsThe change theory consisted of two primary elements: (1) the clinical content, including three clinical bundles of evidence-based care, a ‘delivery bundle’, an ‘oxytocin bundle’ and a ‘vacuum extraction bundle’; (2) an implementation theory, including improving skills in interpretation of cardiotocography, use of QI methods and participation in a national learning network. The Model for Improvement and Deming’s system of profound knowledge were used as a methodological framework. Data on compliance with the care bundles and the number of deliveries between newborns with asphyxia (Apgar <7 after 5 min or pH <7) were analysed using statistical process control.ResultsCompliance with all three clinical care bundles improved to 95% or more, and the percentages of newborns with pH <7 and Apgar <7 after 5 min were reduced by 48% and 31%, respectively. In general, the QI approach strengthened multidisciplinary teamwork, systematised workflow and structured communication around the deliveries. Changes included making a standard memo in the medical record, the use of a bedside whiteboard, bedside handovers, shared decisions with a peer when using an oxytocin infusion and the use of a checklist before vacuum extractions.ConclusionThis QI project illustrates how aspects of patient safety, such as the prevention of asphyxia, can be improved using QI methods to more reliably implement best practice, even in high-performing systems.
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Fischer SA, Jones J, Verran JA. Consensus achievement of leadership, organisational and individual factors that influence safety climate: Implications for nursing management. J Nurs Manag 2017; 26:50-58. [PMID: 28940765 DOI: 10.1111/jonm.12519] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/25/2017] [Indexed: 11/26/2022]
Abstract
AIM To validate a framework of factors that influence the relationship of transformational leadership and safety climate, and to enable testing of safety chain factors by generating hypotheses regarding their mediating and moderating effects. BACKGROUND Understanding the patient safety chain and mechanisms by which leaders affect a strong climate of safety is essential to transformational leadership practice, education, and research. METHODS A systematic review of leadership and safety literature was used to develop an organising framework of factors proposed to influence the climate of safety. A panel of 25 international experts in leadership and safety engaged a three-round modified Delphi study with Likert-scored surveys. RESULTS Eighty per cent of participating experts from six countries were retained to the final survey round. Consensus (>66% agreement) was achieved on 40 factors believed to influence safety climate in the acute care setting. CONCLUSIONS Consensus regarding specific factors that play important roles in an organisation's climate of safety can be reached. Generally, the demonstration of leadership commitment to safety is key to cultivating a culture of patient safety. IMPLICATIONS FOR NURSING MANAGEMENT Transformational nurse leaders should consider and employ all three categories of factors in daily leadership activities and decision-making to drive a strong climate of patient safety.
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Affiliation(s)
- Shelly A Fischer
- Fay W. Whitney School of Nursing, University of Wyoming, Laramie, WY, USA
| | | | - Joyce A Verran
- College of Nursing, University of Colorado, Aurora, CO, USA
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Elmontsri M, Banarsee R, Majeed A. Key priority areas for patient safety improvement strategy in Libya: a protocol for a modified Delphi study. BMJ Open 2017; 7:e014770. [PMID: 28674137 PMCID: PMC5734567 DOI: 10.1136/bmjopen-2016-014770] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
INTRODUCTION Patient safety is a global public health problem. Estimates and size of the problem of patient safety in low-income and developing countries are scarce. A systems approach is needed for ensuring that patients are protected from harm while receiving care. The primary objective of this study will be to use a consensus-based approach to identify the key priority areas for patient safety improvement in Libya as a developing country. DESIGN A modified Delphi study. METHODS AND ANALYSIS A three-phase modified Delphi study will be conducted using an anonymous web-based questionnaires. 15 international experts in the field of patient safety will be recruited to prioritise areas of patient safety that are vital to developing countries such as Libya. The participants will be given the opportunity to rank a list of elements on five criteria. The participants will also be asked to list five barriers that they believe hinder the implementation of patient safety systems. Descriptive statistics will be used to evaluate consensus agreement, including percentage agreement and coefficient of variation. Kendall's coefficient of concordance will be used to evaluate consensus across all participants. ETHICS AND DISSEMINATION Ethical approval has been granted from Imperial College Research Ethics Committee (ICREC: 16IC3598). The findings of the study will be published in a PhD thesis. A manuscript will also be prepared for publication in a high-impact peer-reviewed journal describing the Delphi process and the findings of the study.
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Affiliation(s)
- Mustafa Elmontsri
- Department of Primary Care and Public Health, School of Public Health, Imperial College London, London, UK
| | - Ricky Banarsee
- Department of Primary Care and Public Health, School of Public Health, Imperial College London, London, UK
| | - Azeem Majeed
- Department of Primary Care and Public Health, School of Public Health, Imperial College London, London, UK
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Abstract
The quality of health care is now recognized to vary widely in all medical specialties, including perinatal medicine. A national focus on quality improvement (QI) and patient safety is prompting providers to change and improve the care given to patients. All QI and safety efforts require the use of an improvement model to manage the complex process of improving care. This article reviews the most common frameworks in use today, including the Model for Improvement, Six Sigma, and Lean. Specific tools such as affinity, key driver and fishbone diagrams, process maps and statistical process control, as well as checklists are reviewed, with examples from the perinatal literature to illustrate their use in perinatal QI efforts.
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Affiliation(s)
- Amy T Nathan
- Department of Pediatrics, Perinatal Institute, Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave, MLC #7009, Cincinnati, OH 45229.
| | - Heather C Kaplan
- Department of Pediatrics, Perinatal Institute, Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave, MLC #7009, Cincinnati, OH 45229; Department of Pediatrics, James M. Anderson Center for Health Systems Excellence, Cincinnati Children's Hospital Medical Center, Cincinnati, OH
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Hewitt T, Chreim S, Forster A. Incident reporting systems: a comparative study of two hospital divisions. ACTA ACUST UNITED AC 2016; 74:34. [PMID: 27529024 PMCID: PMC4983791 DOI: 10.1186/s13690-016-0146-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2016] [Accepted: 06/07/2016] [Indexed: 11/10/2022]
Abstract
BACKGROUND Previous studies of incident reporting in health care organizations have largely focused on single cases, and have usually attended to earlier stages of reporting. This is a comparative case study of two hospital divisions' use of an incident reporting system, and considers the different stages in the process and the factors that help shape the process. METHOD The data was comprised of 85 semi-structured interviews of health care practitioners in general internal medicine, obstetrics and neonatology; thematic analysis of the transcribed interviews was undertaken. Inductive and deductive themes are reported. This work is part of a larger qualitative study found elsewhere in the literature. RESULTS The findings showed that there were major differences between the two divisions in terms of: a) what comprised a typical report (outcome based vs communication and near-miss based); b) how the reports were investigated (individual manager vs interdisciplinary team); c) learning from reporting (interventions having ambiguous linkages to the reporting system vs interventions having clear linkages to reported incidents); and d) feedback (limited feedback vs multiple feedback). CONCLUSIONS The differences between the two divisions can be explained in terms of: a) the influence of litigation on practice, b) the availability or lack of interprofessional training, and c) the introduction of the reporting system (top-down vs bottom-up approach). A model based on the findings portraying the influences on incident reporting and learning is provided. Implications for practice are addressed.
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Affiliation(s)
- Tanya Hewitt
- Population Health, University of Ottawa, 25 University Private, Ottawa, ON Canada K1N 7K4
| | - Samia Chreim
- Telfer School of Management, University of Ottawa, 55 Laurier Avenue East, Ottawa, ON K1N 6N5 Canada
| | - Alan Forster
- Department of Medicine, Faculty of Medicine, University of Ottawa, Civic Campus, 1053 Carling Avenue, Box 684, Administrative Services Building, Ottawa, ON K1Y 4E9 Canada ; Ottawa Hospital Research Institute Ottawa Hospital, Civic Campus, 1053 Carling Avenue, Box 684, Administrative Services Building, Ottawa, ON K1Y 4E9 Canada
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Abstract
The purposes of this study were to describe changes in perinatal nurse (n = 70) and physician (n = 88) perceptions of teamwork and safety climate after implementing a 6-month Crew Resource Management training program and compare responses between nurses and physicians. The Teamwork and Safety Climate Survey was administered prior to and 1 year after the intervention. There were significant improvements in nurse and physician perceptions of teamwork and safety climate; however, physicians perceived teamwork more positive than nurses.
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20
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Pedagogical childbirth simulators: utility in obstetrics. Eur J Obstet Gynecol Reprod Biol 2016; 197:41-7. [DOI: 10.1016/j.ejogrb.2015.11.011] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2015] [Revised: 10/13/2015] [Accepted: 11/17/2015] [Indexed: 11/19/2022]
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Implementation of an Interprofessional Team Review of Adverse Events in Obstetrics Using a Standardized Computer Tool: A Mixed Methods Study. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2016; 38:168-76. [DOI: 10.1016/j.jogc.2015.12.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2015] [Accepted: 09/10/2015] [Indexed: 11/22/2022]
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Leveraging Social Science-Healthcare Collaborations to Improve Teamwork and Patient Safety. Curr Probl Pediatr Adolesc Health Care 2015; 45:370-7. [PMID: 26573242 DOI: 10.1016/j.cppeds.2015.10.005] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2015] [Accepted: 10/07/2015] [Indexed: 11/20/2022]
Abstract
Effective teamwork is critical to the provision of safe, effective healthcare. High functioning teams adapt to rapidly changing patient and environmental factors, preventing diagnostic and treatment errors. While the emphasis on teamwork and patient safety is relatively new, significant team-related foundational and implementation research exists in disciplines outside of healthcare. Social scientists, including, organizational psychologists, have expertise in the study of teams, multi-team units, and organizations. This article highlights guiding team science principles from the organizational psychology literature that can be applied to the study of teams in healthcare. The authors' goal is to provide some common language and understanding around teams and teamwork. Additionally, they hope to impart an appreciation for the potential synergy present within clinician-social scientist collaborations.
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Learning from Adverse Events in Obstetrics: Is a Standardized Computer Tool an Effective Strategy for Root Cause Analysis? JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2015; 37:728-735. [PMID: 26474230 DOI: 10.1016/s1701-2163(15)30178-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVE Adverse events occur in up to 10% of obstetric cases, and up to one half of these could be prevented. Case reviews and root cause analysis using a structured tool may help health care providers to learn from adverse events and to identify trends and recurring systems issues. We sought to establish the reliability of a root cause analysis computer application called Standardized Clinical Outcome Review (SCOR). METHODS We designed a mixed methods study to evaluate the effectiveness of the tool. We conducted qualitative content analysis of five charts reviewed by both the traditional obstetric quality assurance methods and the SCOR tool. We also determined inter-rater reliability by having four health care providers review the same five cases using the SCOR tool. RESULTS The comparative qualitative review revealed that the traditional quality assurance case review process used inconsistent language and made serious, personalized recommendations for those involved in the case. In contrast, the SCOR review provided a consistent format for recommendations, a list of action points, and highlighted systems issues. The mean percentage agreement between the four reviewers for the five cases was 75%. The different health care providers completed data entry and assessment of the case in a similar way. Missing data from the chart and poor wording of questions were identified as issues affecting percentage agreement. CONCLUSION The SCOR tool provides a standardized, objective, obstetric-specific tool for root cause analysis that may improve identification of risk factors and dissemination of action plans to prevent future events.
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Sørensen JL, van der Vleuten C, Rosthøj S, Østergaard D, LeBlanc V, Johansen M, Ekelund K, Starkopf L, Lindschou J, Gluud C, Weikop P, Ottesen B. Simulation-based multiprofessional obstetric anaesthesia training conducted in situ versus off-site leads to similar individual and team outcomes: a randomised educational trial. BMJ Open 2015; 5:e008344. [PMID: 26443654 PMCID: PMC4611309 DOI: 10.1136/bmjopen-2015-008344] [Citation(s) in RCA: 57] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVE To investigate the effect of in situ simulation (ISS) versus off-site simulation (OSS) on knowledge, patient safety attitude, stress, motivation, perceptions of simulation, team performance and organisational impact. DESIGN Investigator-initiated single-centre randomised superiority educational trial. SETTING Obstetrics and anaesthesiology departments, Rigshospitalet, University of Copenhagen, Denmark. PARTICIPANTS 100 participants in teams of 10, comprising midwives, specialised midwives, auxiliary nurses, nurse anaesthetists, operating theatre nurses, and consultant doctors and trainees in obstetrics and anaesthesiology. INTERVENTIONS Two multiprofessional simulations (clinical management of an emergency caesarean section and a postpartum haemorrhage scenario) were conducted in teams of 10 in the ISS versus the OSS setting. PRIMARY OUTCOME Knowledge assessed by a multiple choice question test. EXPLORATORY OUTCOMES Individual outcomes: scores on the Safety Attitudes Questionnaire, stress measurements (State-Trait Anxiety Inventory, cognitive appraisal and salivary cortisol), Intrinsic Motivation Inventory and perceptions of simulations. Team outcome: video assessment of team performance. Organisational impact: suggestions for organisational changes. RESULTS The trial was conducted from April to June 2013. No differences between the two groups were found for the multiple choice question test, patient safety attitude, stress measurements, motivation or the evaluation of the simulations. The participants in the ISS group scored the authenticity of the simulation significantly higher than did the participants in the OSS group. Expert video assessment of team performance showed no differences between the ISS versus the OSS group. The ISS group provided more ideas and suggestions for changes at the organisational level. CONCLUSIONS In this randomised trial, no significant differences were found regarding knowledge, patient safety attitude, motivation or stress measurements when comparing ISS versus OSS. Although participant perception of the authenticity of ISS versus OSS differed significantly, there were no differences in other outcomes between the groups except that the ISS group generated more suggestions for organisational changes. TRIAL REGISTRATION NUMBER NCT01792674.
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Affiliation(s)
- Jette Led Sørensen
- Juliane Marie Centre for Children, Women and Reproduction, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Cees van der Vleuten
- Faculty of Health, Medicine and Life Sciences, Department of Educational Development and Research, Maastricht University, Maastricht, The Netherlands
| | - Susanne Rosthøj
- Faculty of Health and Medical Sciences, Section of Biostatistics, Institute of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Doris Østergaard
- Danish Institute for Medical Simulation, Herlev Hospital, Capital Region of Denmark and University of Copenhagen, Herlev, Denmark
| | - Vicki LeBlanc
- University of Ottawa Skills and Simulation Centre, The Ottawa Hospital, University of Ottawa, Ottawa, Canada
| | - Marianne Johansen
- Department of Obstetrics, Juliane Marie Centre for Children, Women and Reproduction, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Kim Ekelund
- Department of Anaesthesiology, Juliane Marie Centre for Children, Women and Reproduction, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Liis Starkopf
- Faculty of Health and Medical Sciences, Section of Biostatistics, Institute of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Jane Lindschou
- Copenhagen Trial Unit, Centre for Clinical Intervention Research, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Christian Gluud
- Copenhagen Trial Unit, Centre for Clinical Intervention Research, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Pia Weikop
- Laboratory of Neuropsychiatry, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Bent Ottesen
- Juliane Marie Centre for Children, Women and Reproduction, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
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Moaveni DM, Cohn JH, Zahid ZD, Ranasinghe JS. Obstetric Anesthesiologists as Perioperative Physicians: Improving Peripartum Care and Patient Safety. CURRENT ANESTHESIOLOGY REPORTS 2015. [DOI: 10.1007/s40140-014-0094-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Sinni SV, Wallace EM, Cross WM. Perinatal staff perceptions of safety and quality in their service. BMC Health Serv Res 2014; 14:591. [PMID: 25430702 PMCID: PMC4258038 DOI: 10.1186/s12913-014-0591-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2013] [Accepted: 11/10/2014] [Indexed: 11/25/2022] Open
Abstract
Background Ensuring safe and appropriate service delivery is central to a high quality maternity service. With this in mind, over recent years much attention has been given to the development of evidence-based clinical guidelines, staff education and risk reporting systems. Less attention has been given to assessing staff perceptions of a service’s safety and quality and what factors may influence that. In this study we set out to assess staff perceptions of safety and quality of a maternity service and to explore potential influences on service safety. Methods The study was undertaken within a new low risk metropolitan maternity service in Victoria, Australia with a staffing profile comprising midwives (including students), neonatal nurses, specialist obstetricians, junior medical staff and clerical staff. In depth open-ended interviews using a semi-structured questionnaire were conducted with 23 staff involved in the delivery of perinatal care, including doctors, midwives, nurses, nursing and midwifery students, and clerical staff. Data were analyzed using naturalistic interpretive inquiry to identify emergent themes. Results Staff unanimously reported that there were robust systems and processes in place to maintain safety and quality. Three major themes were apparent: (1) clinical governance, (2) dominance of midwives, (3) inter-professional relationships. Overall, there was a strong sense that, at least in this midwifery-led service, midwives had the greatest opportunity to be an influence, both positively and negatively, on the safe delivery of perinatal care. The importance of understanding team dynamics, particularly mutual respect, trust and staff cohesion, were identified as key issues for potential future service improvement. Conclusions Senior staff, particularly midwives and neonatal nurses, play central roles in shaping team behaviors and attitudes that may affect the safety and quality of service delivery. We suggest that strategies targeting senior staff to enhance their performance in their roles, particularly in the training and teamwork role-modeling of the transitory junior workforce, are important for the development and maintenance of a high quality and safe maternity service.
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Affiliation(s)
- Suzanne V Sinni
- The Ritchie Centre, Department of Obstetrics and Gynaecology, Monash University and MIMR-PHI Institute of Medical Research, 246 Clayton Road, Clayton, Victoria, 3168, Australia.
| | - Euan M Wallace
- The Ritchie Centre, Department of Obstetrics and Gynaecology, Monash University and MIMR-PHI Institute of Medical Research, 246 Clayton Road, Clayton, Victoria, 3168, Australia.
| | - Wendy M Cross
- School of Nursing and Midwifery, Monash University, Clayton, Victoria, Australia.
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Larizgoitia I, Bouesseau MC, Kelley E. WHO Efforts to Promote Reporting of Adverse Events and Global Learning. J Public Health Res 2013; 2:e29. [PMID: 25170500 PMCID: PMC4147748 DOI: 10.4081/jphr.2013.e29] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2013] [Accepted: 11/01/2013] [Indexed: 12/04/2022] Open
Abstract
Despite the importance of reporting systems to learn about the casual chain and consequences of patient safety incidents, this is an area that requires of further conceptual and technical developments to conduce reporting to effective learning. The World Health Organization, through its Patient Safety Programme, adopted as a priority the objective to facilitate and stimulate global learning through enhanced reporting of patient safety incidents. Landmark developments were the WHO Draft Guidelines for Adverse Event Reporting and Learning Systems, and the Conceptual Framework for the International Classification for Patient Safety, as well as the Global Community of Practice for Reporting and Learning Systems. WHO is currently working with a range of scientists, medical informatics specialists and healthcare officials from various countries around the world, to arrive at a Minimal Information Model that could serve as a basis to structure the core of reporting systems in a comparable manner across the world. Undoubtedly, there is much need for additional scientific developments in this challenging and innovative area. For effective reporting systems and enhanced global learning, other key contextual factors are essential for reporting to serve to the needs of clinicians, patients and the healthcare system at large. Moreover, the new data challenges and needs of organizations must be assessed as the era of big data comes to heath care. These considerations delineate a broad agenda for action, which offer an ambitious challenge for WHO and their partners interested in strengthening learning for improving through reporting and communicating about patient safety incidents. Significance for public healthUnderstanding the causes and consequences of incidents is cornerstone for patient safety improvement. Likewise, setting up systems to facilitate such understanding and communicate the learning across all healthcare actors is crucial. Over the past decade, the World Health Organization has convened an area of work, with the support of a growing number of collaborating agencies, institutions and experts worldwide to facilitate the identification of global directions aiming to facilitate the development and management of patient safety incident reporting systems as well as the extraction and communication of useful learning. Exchange and sharing of best practices and experiences has been at the essence of this work. This paper describes such efforts and also reflects on other areas of work which are essential to enhance patient safety by learning from the failures of the health care.
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Affiliation(s)
- Itziar Larizgoitia
- Service Delivery and Safety, World Health Organization, Geneva, Switzerland
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Raab CA, Will SEB, Richards SL, O'Mara E. The effect of collaboration on obstetric patient safety in three academic facilities. J Obstet Gynecol Neonatal Nurs 2013; 42:606-16. [PMID: 24004008 DOI: 10.1111/1552-6909.12234] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
Interprofessional collaboration is critical to the provision of safe patient care and provider satisfaction. Collaboration is an active process that can help maximize positive patient outcomes. Three academic institutions implemented collaborative processes as part of their perinatal patient safety initiatives based on anecdotal experiences and safety culture surveys that demonstrated positive outcomes. Reliable tools and additional research are needed to measure the extent and impact of collaboration on patient outcomes in perinatal care.
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Rabøl LI, McPhail MA, Østergaard D, Andersen, HB, Mogensen T. Promoters and barriers in hospital team communication. A focus group study. ACTA ACUST UNITED AC 2013. [DOI: 10.1179/1753807612y.0000000009] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
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Sørensen JL, Van der Vleuten C, Lindschou J, Gluud C, Østergaard D, LeBlanc V, Johansen M, Ekelund K, Albrechtsen CK, Pedersen BW, Kjærgaard H, Weikop P, Ottesen B. 'In situ simulation' versus 'off site simulation' in obstetric emergencies and their effect on knowledge, safety attitudes, team performance, stress, and motivation: study protocol for a randomized controlled trial. Trials 2013; 14:220. [PMID: 23870501 PMCID: PMC3716971 DOI: 10.1186/1745-6215-14-220] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2013] [Accepted: 07/01/2013] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Unexpected obstetric emergencies threaten the safety of pregnant women. As emergencies are rare, they are difficult to learn. Therefore, simulation-based medical education (SBME) seems relevant. In non-systematic reviews on SBME, medical simulation has been suggested to be associated with improved learner outcomes. However, many questions on how SBME can be optimized remain unanswered. One unresolved issue is how 'in situ simulation' (ISS) versus 'off site simulation' (OSS) impact learning. ISS means simulation-based training in the actual patient care unit (in other words, the labor room and operating room). OSS means training in facilities away from the actual patient care unit, either at a simulation centre or in hospital rooms that have been set up for this purpose. METHODS AND DESIGN The objective of this randomized trial is to study the effect of ISS versus OSS on individual learning outcome, safety attitude, motivation, stress, and team performance amongst multi-professional obstetric-anesthesia teams.The trial is a single-centre randomized superiority trial including 100 participants. The inclusion criteria were health-care professionals employed at the department of obstetrics or anesthesia at Rigshospitalet, Copenhagen, who were working on shifts and gave written informed consent. Exclusion criteria were managers with staff responsibilities, and staff who were actively taking part in preparation of the trial. The same obstetric multi-professional training was conducted in the two simulation settings. The experimental group was exposed to training in the ISS setting, and the control group in the OSS setting. The primary outcome is the individual score on a knowledge test. Exploratory outcomes are individual scores on a safety attitudes questionnaire, a stress inventory, salivary cortisol levels, an intrinsic motivation inventory, results from a questionnaire evaluating perceptions of the simulation and suggested changes needed in the organization, a team-based score on video-assessed team performance and on selected clinical performance. DISCUSSION The perspective is to provide new knowledge on contextual effects of different simulation settings. TRIAL REGISTRATION ClincialTrials.gov NCT01792674.
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Affiliation(s)
- Jette Led Sørensen
- Department of Obstetrics, Department of Anaesthesia and Juliane Marie Centre for Children, Women and Reproduction, Rigshospitalet, Copenhagen University Hospital, Blegdamsvej 9, Copenhagen, Denmark
| | - Cees Van der Vleuten
- Department of Educational Development and Research, Faculty of Health, Medicine and Life Sciences, Maastricht University, P.O. Box 616, 6200, MD Maastricht, The Netherlands
| | - Jane Lindschou
- Copenhagen Trial Unit, Centre for Clinical Intervention Research, Rigshospitalet, Copenhagen University Hospital, Blegdamsvej 9, Copenhagen, Denmark
| | - Christian Gluud
- Copenhagen Trial Unit, Centre for Clinical Intervention Research, Rigshospitalet, Copenhagen University Hospital, Blegdamsvej 9, Copenhagen, Denmark
| | - Doris Østergaard
- Danish Institute for Medical Simulation, Herlev Hospital, Capital Region of Denmark and Copenhagen University, Herlev Ringvej 75, 2730 Herlev, Denmark
| | - Vicki LeBlanc
- The Wilson Centre, University of Toronto, 200 Elizabeth Street, 1ES-565, Toronto, Ontario M5G 2C4 Canada
| | - Marianne Johansen
- Department of Obstetrics, Department of Anaesthesia and Juliane Marie Centre for Children, Women and Reproduction, Rigshospitalet, Copenhagen University Hospital, Blegdamsvej 9, Copenhagen, Denmark
| | - Kim Ekelund
- Department of Obstetrics, Department of Anaesthesia and Juliane Marie Centre for Children, Women and Reproduction, Rigshospitalet, Copenhagen University Hospital, Blegdamsvej 9, Copenhagen, Denmark
| | - Charlotte Krebs Albrechtsen
- Department of Obstetrics, Department of Anaesthesia and Juliane Marie Centre for Children, Women and Reproduction, Rigshospitalet, Copenhagen University Hospital, Blegdamsvej 9, Copenhagen, Denmark
| | - Berit Woetman Pedersen
- Department of Obstetrics, Department of Anaesthesia and Juliane Marie Centre for Children, Women and Reproduction, Rigshospitalet, Copenhagen University Hospital, Blegdamsvej 9, Copenhagen, Denmark
| | - Hanne Kjærgaard
- Department of Obstetrics, Department of Anaesthesia and Juliane Marie Centre for Children, Women and Reproduction, Rigshospitalet, Copenhagen University Hospital, Blegdamsvej 9, Copenhagen, Denmark
| | - Pia Weikop
- Laboratory of Neuropsychiatry, Rigshospitalet, Copenhagen University Hospital, Blegdamsvej 9, Copenhagen, Denmark
| | - Bent Ottesen
- Department of Obstetrics, Department of Anaesthesia and Juliane Marie Centre for Children, Women and Reproduction, Rigshospitalet, Copenhagen University Hospital, Blegdamsvej 9, Copenhagen, Denmark
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A Framework for Patient Safety: A Defense Nuclear Industry–Based High-Reliability Model. Jt Comm J Qual Patient Saf 2013; 39:233-40. [DOI: 10.1016/s1553-7250(13)39031-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Medical error, disclosure and patient safety: a global view of quality care. Clin Biochem 2013; 46:1161-9. [PMID: 23578740 DOI: 10.1016/j.clinbiochem.2013.03.025] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2012] [Revised: 03/25/2013] [Accepted: 03/26/2013] [Indexed: 11/21/2022]
Abstract
Medical errors are a prominent issue in health care. Numerous studies point at the high prevalence of adverse events, many of which are preventable. Although there is a range of severity in errors, they all cause harm, to the patient, to the system, or both. While errors have many causes, including human interactions and system inadequacies, the focus on individuals rather than the system has led to an unsuitable culture for improving patient safety. Important areas of focus are diagnostic procedures and clinical laboratories because their results play a major role in guiding clinical decisions in patient management. Proper disclosure of medical errors and adverse events is also a key area for improvement. Globally, system improvements are beginning to take place, however, in Canada, policies on disclosure, error reporting and protection for physicians remain non-uniform. Achieving a national standard with mandatory reporting, in addition to a non-punitive system is recommended to move forward.
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Glantz JC. Obstetric variation, intervention, and outcomes: doing more but accomplishing less. Birth 2012; 39:286-90. [PMID: 23281946 DOI: 10.1111/birt.12002] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/31/2012] [Indexed: 11/28/2022]
Abstract
Obstetric interventions, particularly induction of labor and cesarean section, are done more and more commonly, although there is a wide variation between hospitals and practitioners in specific rates. This degree of variation implies imprecision and uncertainty about diagnoses and indicated management. Although the net result of this variation has been a "more is better" approach leading to increasing use of obstetric interventions, little evidence of commensurate improvements in outcome is available. A combined package of using currently available evidence, formulating best practices, instituting regular review and feedback to hospitals and practitioners about intervention rates, and a public health approach to educate women has the potential to achieve an acceptable balance between when intervention in the labor and delivery process is warranted and when it is unnecessary.
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Affiliation(s)
- J Christopher Glantz
- Obstetrics, Division of Maternal-Fetal Medicine, School of Medicine, University of Rochester, Rochester, NY 14642, USA
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Kirschbaum KA, Rask JP, Brennan M, Phelan S, Fortner SA. Improved climate, culture, and communication through multidisciplinary training and instruction. Am J Obstet Gynecol 2012; 207:200.e1-7. [PMID: 22840971 DOI: 10.1016/j.ajog.2012.06.036] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2012] [Revised: 05/25/2012] [Accepted: 06/15/2012] [Indexed: 10/28/2022]
Abstract
OBJECTIVE The objective of the study was to determine the effectiveness of multidisciplinary team training on organizational culture and team communication. STUDY DESIGN The training included a 6-step protocol: (1) a pretest survey assessing cultural attitudes and perceptions, (2) a baseline high-fidelity simulation session, (3) invitational medical rhetoric instruction, (4) a second high-fidelity simulation session, (5) a posttest survey assessing changed cultural attitudes and perceptions, and (6) a debriefing with participants. Teams of 4 physicians trained together: 2 obstetricians and 2 anesthesiologists. Forty-four physicians completed the training protocol during 2010 and 2011. RESULTS Paired-sample t tests demonstrated significant decreases in autonomous cultural attitudes and perceptions (t = 8.23, P < .001) and significant increases in teamwork cultural attitudes and perceptions (t = -4.05, P < .001). Paired-sample t tests also demonstrated significant increases in communication climate that invited participation and integrated information from both medical services (t = -5.80, P < .001). CONCLUSION The multidisciplinary team training program specified in this report resulted in increased teamwork among obstetricians and anesthesiologists.
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The case for simulation as part of a comprehensive patient safety program. Am J Obstet Gynecol 2012; 206:451-5. [PMID: 22000670 DOI: 10.1016/j.ajog.2011.09.012] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2011] [Revised: 09/13/2011] [Accepted: 09/13/2011] [Indexed: 11/22/2022]
Abstract
Simulation in obstetrics allows us to practice in a safe environment. Simulations can improve the performance of individuals and obstetric teams. The evidence is overwhelming that, with simulated practice, obstetricians improve their technical and communication skills. Evidence is emerging that simulation ultimately may improve clinical outcomes. It stands to reason that simulation in obstetrics should be incorporated into comprehensive patient safety programs.
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Ruiter J. Patient Safety Series, a comment. Am J Obstet Gynecol 2011; 205:e10. [PMID: 21722871 DOI: 10.1016/j.ajog.2011.05.034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2011] [Accepted: 05/18/2011] [Indexed: 10/18/2022]
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Phelan JP, Korst LM. Establishing a culture of perinatal safety in a community hospital. J Healthc Risk Manag 2011; 31:12-8. [PMID: 21793112 DOI: 10.1002/jhrm.20074] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
While unsafe behavior of frontline hospital staff, primarily physicians and nurses, is sometimes the proximal cause of adverse events, the critical importance of system-wide, hospital organizational factors is now being acknowledged(1,2). These organizational factors create the "safety culture" that influences the occurrence of these proximal failures.(3) The concept of safety culture originated in high-reliability organization theory, which was largely developed by a group of social scientists at the University of California at Berkeley who studied high-risk organizations that have achieved very low accident and error rates, for example, aircraft carrier flight decks, nuclear power plants and air-traffic control systems.(4-6) Safety culture refers to the enduring and shared beliefs and practices of organization members regarding the organization's willingness to detect and learn from errors.(7).
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Fausett MB, Propst A, Van Doren K, Clark BT. How to develop an effective obstetric checklist. Am J Obstet Gynecol 2011; 205:165-70. [PMID: 22071047 DOI: 10.1016/j.ajog.2011.06.003] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2011] [Revised: 05/19/2011] [Accepted: 06/02/2011] [Indexed: 10/18/2022]
Abstract
Checklists to guide critical procedures are becoming an increasingly important part of medical practice. These tools have proved effective in improving outcome in a variety of medical settings, including obstetrics. In this review, we outline essential principles of successful checklist creation and implementation and review our experience with checklist development in a worldwide, multi-institutional health care delivery system.
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Lyndon A, Zlatnik MG, Wachter RM. Effective physician-nurse communication: a patient safety essential for labor and delivery. Am J Obstet Gynecol 2011; 205:91-6. [PMID: 21640970 DOI: 10.1016/j.ajog.2011.04.021] [Citation(s) in RCA: 69] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2011] [Revised: 04/07/2011] [Accepted: 04/11/2011] [Indexed: 11/25/2022]
Abstract
Effective communication is a hallmark of safe patient care. Challenges to effective interprofessional communication in maternity care include differing professional perspectives on clinical management, steep hierarchies, and lack of administrative support for change. We review principles of high reliability as they apply to communication in clinical care and discuss principles of effective communication and conflict management in maternity care. Effective clinical communication is respectful, clear, direct, and explicit. We use a clinical scenario to illustrate an historic style of nurse-physician communication and demonstrate how communication can be improved to promote trust and patient safety. Consistent execution of successful communication requires excellent listening skills, superb administrative support, and collective commitment to move past traditional hierarchy and professional stereotyping.
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Clark SL, Meyers JA, Frye DK, Perlin JA. Patient safety in obstetrics--the Hospital Corporation of America experience. Am J Obstet Gynecol 2011; 204:283-7. [PMID: 21306701 DOI: 10.1016/j.ajog.2010.12.034] [Citation(s) in RCA: 61] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2010] [Revised: 12/11/2010] [Accepted: 12/17/2010] [Indexed: 11/30/2022]
Abstract
We report an update on obstetric patient safety efforts and results in the nation's largest obstetric health care delivery system. The application of principles advocated by the Institute of Medicine a decade ago has resulted in reduced adverse outcomes, as reflected by claims experience. Particular progress has been made in standardization and documentation of critical processes, establishment of national quality benchmarks, reduction in elective deliveries <39 weeks' gestation, and reduction in fatal postcesarean pulmonary embolism. Our experience provides a useful blueprint for similar progress in other health care systems.
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