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Verhoeff TL, Janssen JJ, Hietbrink F, Hoff RG. Team- and task-related knowledge in shared mental models in operating room teams: A survey study. Heliyon 2023; 9:e16990. [PMID: 37332942 PMCID: PMC10272475 DOI: 10.1016/j.heliyon.2023.e16990] [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] [Received: 11/07/2022] [Revised: 04/28/2023] [Accepted: 06/02/2023] [Indexed: 06/20/2023] Open
Abstract
Objective The operating room is a highly complex environment, where patient care is delivered by interprofessional teams. Unfortunately, issues with communication and teamwork occur, potentially leading to patient harm. A shared mental model is one prerequisite to function effectively as a team, and consists of task- and team-related knowledge. We aimed to explore potential differences in task- and team-related knowledge between the different professions working in the operating room. The assessed team-related knowledge consisted of knowledge regarding other professions' training and work activities, and of perceived traits of a high-performing and underperforming colleague. Task-related knowledge was assessed by mapping the perceived allocation of responsibilities for certain tasks, using a Likert-type scale. Design A single sample cross-sectional study. Setting The study was performed in three hospitals in the Netherlands, one academic center and two regional teaching hospitals. Participants 106 health care professionals participated, of four professions. Most respondents (77%) were certified professionals, the others were still in training. Results Participants generally were well informed about each other's training and work activities and nearly everyone mentioned the importance of adequate communication and teamwork. Discrepancies were also observed. The other professions knew on average the least about the profession of anesthesiologists and most about the profession of surgeons. When assessing the responsibilities regarding tasks we found consensus in well-defined and/or protocolized tasks, but variation in less clearly defined tasks. Conclusions Team- and task-related knowledge in the operating room team is reasonably well developed, but irregularly, with potentially crucial differences in knowledge related to patient care. Awareness of these discrepancies is the first step in further optimization of team performance.
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Affiliation(s)
- Tessa L. Verhoeff
- Department of Anesthesiology, University Medical Center Utrecht, Heidelberglaan 100, 3584 GA, Utrecht, the Netherlands
| | - Jeroen J.H.M. Janssen
- Department of Education, Utrecht University, Heidelberglaan 1, 3584 CS, Utrecht, the Netherlands
| | - Falco Hietbrink
- Department of Surgery, University Medical Center Utrecht, Heidelberglaan 100, 3584 GA, Utrecht, the Netherlands
| | - Reinier G. Hoff
- Department of Anesthesiology, University Medical Center Utrecht, Heidelberglaan 100, 3584 GA, Utrecht, the Netherlands
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Wiggins D, Downie A, Engel RM, Brown BT. Factors that influence scope of practice of the five largest health care professions in Australia: a scoping review. HUMAN RESOURCES FOR HEALTH 2022; 20:87. [PMID: 36564798 PMCID: PMC9786531 DOI: 10.1186/s12960-022-00783-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/24/2022] [Accepted: 11/25/2022] [Indexed: 06/17/2023]
Abstract
INTRODUCTION A well-functioning health system delivers quality services to all people when and where they need them. To help navigate the complex realm of patient care, it is essential that health care professions have a thorough understanding of their scope of practice. However, a lack of uniformity regarding scope of practice across the regulated health professions in Australia currently exists. This has led to ambiguity about what comprises scope of practice in some health care professions in the region. OBJECTIVE The objective of this review was to explore the literature on the factors that influence scope of practice of the five largest health care professions in Australia. METHODS This study employed scoping review methodology to document the current state of the literature on factors that influence scope of practice of the five largest health care professions in Australia. The search was conducted using the following databases: AMED (Allied and Complementary Medicine Database), CINAHL (Cumulative Index to Nursing and Allied Health Literature), Cochrane Library, EMBASE (Excerpta Medica Database), MANTIS (Manual, Alternative and Natural Therapy Index System), MEDLINE, PubMed, and SCOPUS. Additional data sources were searched from Google and ProQuest. RESULTS A total of 12 771 publications were identified from the literature search. Twenty-three documents fulfilled the inclusion criteria and were included in the final analysis. Eight factors were identified across three professions (nursing & midwifery, pharmacy and physiotherapy) that influenced scope of practice: education, competency, professional identity, role confusion, legislation and regulatory policies, organisational structures, financial factors, and professional and personal factors. CONCLUSION The results of this study will inform a range of stakeholders including the private and public arms of the healthcare system, educators, employers, funding bodies, policymakers and practitioners about the factors that influence scope of practice of health professions in Australia.
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Affiliation(s)
- Desmond Wiggins
- Department of Chiropractic, Macquarie University, Sydney, Australia.
| | - Aron Downie
- Department of Chiropractic, Macquarie University, Sydney, Australia
| | - Roger M Engel
- Department of Chiropractic, Macquarie University, Sydney, Australia
| | - Benjamin T Brown
- Department of Chiropractic, Macquarie University, Sydney, Australia
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Stevenson C, Bhangu A, Jung JJ, MacDonald A, Nolan B. The development and measurement properties of the trauma NOn-TECHnical skills (T-NOTECHS) scale: A scoping review. Am J Surg 2022; 224:1115-1125. [DOI: 10.1016/j.amjsurg.2022.05.027] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2022] [Revised: 05/16/2022] [Accepted: 05/23/2022] [Indexed: 12/26/2022]
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Evans JC, Evans MB, Slack M, Peddle M, Lingard L. Examining non-technical skills for ad hoc resuscitation teams: a scoping review and taxonomy of team-related concepts. Scand J Trauma Resusc Emerg Med 2021; 29:167. [PMID: 34863278 PMCID: PMC8642998 DOI: 10.1186/s13049-021-00980-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2021] [Accepted: 11/15/2021] [Indexed: 12/02/2022] Open
Abstract
Background Non-technical skills (NTS) concepts from high-risk industries such as aviation have been enthusiastically applied to medical teams for decades. Yet it remains unclear whether—and how—these concepts impact resuscitation team performance. In the context of ad hoc teams in prehospital, emergency department, and trauma domains, even less is known about their relevance and impact. Methods This scoping review, guided by PRISMA-ScR and Arksey & O’Malley’s framework, included a systematic search across five databases, followed by article selection and extracting and synthesizing data. Articles were eligible for inclusion if they pertained to NTS for resuscitation teams performing in prehospital, emergency department, or trauma settings. Articles were subjected to descriptive analysis, coherence analysis, and citation network analysis. Results Sixty-one articles were included. Descriptive analysis identified fourteen unique non-technical skills. Coherence analysis revealed inconsistencies in both definition and measurement of various NTS constructs, while citation network analysis suggests parallel, disconnected scholarly conversations that foster discordance in their operationalization across domains. To reconcile these inconsistencies, we offer a taxonomy of non-technical skills for ad hoc resuscitation teams. Conclusion This scoping review presents a vigorous investigation into the literature pertaining to how NTS influence optimal resuscitation performance for ad hoc prehospital, emergency department, and trauma teams. Our proposed taxonomy offers a coherent foundation and shared vocabulary for future research and education efforts. Finally, we identify important limitations regarding the traditional measurement of NTS, which constrain our understanding of how and why these concepts support optimal performance in team resuscitation. Graphical abstract ![]()
Supplementary Information The online version contains supplementary material available at 10.1186/s13049-021-00980-5.
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Affiliation(s)
- J Colin Evans
- Division of Emergency Medicine, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada.
| | - M Blair Evans
- Department of Psychology, Western University, London, ON, Canada
| | - Meagan Slack
- Middlesex-London Paramedic Service, London, ON, Canada
| | - Michael Peddle
- Division of Emergency Medicine, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada
| | - Lorelei Lingard
- Centre for Education Research and Innovation, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada
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Lyman K. The relationship between post-resuscitation debriefings and perceptions of teamwork in emergency department nurses. Int Emerg Nurs 2021; 57:101005. [PMID: 34252748 DOI: 10.1016/j.ienj.2021.101005] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2020] [Revised: 03/18/2021] [Accepted: 03/26/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND Emergency department nurses are faced with traumatic patient events while functioning as members of multidisciplinary teams. Postresuscitation debriefings have been shown to benefit health care professionals and patient clinical outcomes. The purpose of this study was to examine the relationship between the use of post resuscitation debriefings and perceptions of teamwork in emergency department nurses. The study also addressed the type and timing of debriefing to determine whether these factors are associated with perceptions of teamwork. METHODS A nationwide survey was disseminated to emergency department nurses throughout the United States. The design aimed to compare the results from the Nursing Teamwork Survey with the data regarding frequency, type, and timing of debriefings. An ANOVA and Scheffe post hoc was done as well. RESULTS The 68 responses which were included in the data were from 27 different states. Results showed that when debriefings were done more frequently (η = .41, p = .02), were conducted using a formal debriefing method (η = .36, p = .01), and were held immediately after a situation (η = .36, p = .03), there was a significant positive relationship (eta coefficient) with higher levels of trust, team orientation, backup, shared mental model, and leadership. CONCLUSION Findings may be used to increase utilization of debriefings and improve perceptions of teamwork among emergency department nurses.
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Abstract
OBJECTIVES This study investigated the costs of 2-hour multiprofessional in situ hospital trauma team simulation training and its effects on teams' non-technical skills using the T-NOTECHS instrument. BACKGROUND Simulation is a feasible and effective teaching and learning method. Calculating the costs of simulated trauma team training in medical emergency situations can yield valuable information for improving its overall cost-effectiveness. DESIGN A prospective cohort study. SETTING Trauma resuscitation room in Central Finland Hospital, Finland. PARTICIPANTS 475 medical professionals in 81 consecutive, simulated trauma teams. PRIMARY AND SECONDARY OUTCOME MEASURES Team simulation training costs in 2017 and 2018 were analysed in the following two phases: (1) start-up costs and (2) costs of education. Primary outcome measures were training costs per participant and training costs per team. Secondary outcome measures were non-technical skills, which were measured on a 5-25-point scale using the T-NOTECHS instrument. RESULTS The annual mean total costs of trauma team simulation training were €58 000 for 40 training sessions and 238 professionals. Mean cost per participant was €203. Mean cost per team was €1220. The annual costs of simulation training markedly decreased when at least 70-80 teams participated in the training. Mean change in T-NOTECHS score after simulation training was +2.86 points (95% CI 1.97 to 3.75;+14.5%). CONCLUSIONS The greater the number of teams trained per year, the lower the costs per trauma team. In this study, we developed an activity-based costing method to calculate the costs of trauma team simulation training to help stakeholders make decisions about whether to initiate or increase existing trauma team simulation training or to obtain these services elsewhere.
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Affiliation(s)
- Eerika Rosqvist
- Department of Educational Services, The Center of Medical Expertise, Central Finland Central Hospital, Jyvaskyla, Finland
| | - Marika Ylönen
- Department of Anesthesiology and Intensive Care, Central Finland Central Hospital, Jyvaskyla, Finland
| | - Paulus Torkki
- Department of Public Health, Helsingin Yliopisto, Helsinki, Finland
| | - Jussi P Repo
- Department of Orthopaedics and Traumatology, Unit of Muskuloskeletal Surgery, Tampere University Hospital, Tampere, Finland
- University of Tampere, Tampere, Finland
| | - Juha Paloneva
- Department of Surgery, Central Finland Central Hospital, Jyvaskyla, Finland
- University of Eastern Finland, Kuopio, Finland
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Sethuraman KN, Chang WTW, Zhou AL, Xia B, Gingold DB, McCunn M. Collaboration and Decision-Making on Trauma Teams: A Survey Assessment. West J Emerg Med 2021; 22:278-283. [PMID: 33856312 PMCID: PMC7972389 DOI: 10.5811/westjem.2020.10.48698] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2020] [Accepted: 10/04/2020] [Indexed: 11/11/2022] Open
Abstract
Introduction Leadership, communication, and collaboration are important in well-managed trauma resuscitations. We surveyed resuscitation team members (attendings, fellows, residents, and nurses) in a large urban trauma center regarding their impressions of collaboration among team members and their satisfaction with patient care decisions. Methods The Collaboration and Satisfaction About Care Decisions in Trauma (CSACD.T) survey was administered to members of ad hoc trauma teams immediately after resuscitations. Survey respondents self-reported their demographic characteristics; the CSACD.T scores were then compared by gender, occupation, self-identified leader role, and level of training. Results The study population consisted of 281 respondents from 52 teams; 111 (39.5%) were female, 207 (73.7%) were self-reported White, 78 (27.8%) were nurses, and 140 (49.8%) were physicians. Of the 140 physician respondents, 38 (27.1%) were female, representing 13.5% of the total surveyed population. Nine of the 52 teams had a female leader. Men, physicians (vs nurses), fellows (vs attendings), and self-identified leaders trended toward higher satisfaction across all questions of the CSACD.T. In addition to the comparison groups mentioned, women and general team members (vs non-leaders) gave lower scores. Conclusion Female residents, nurses, general team members, and attendings gave lower CSACD.T scores in this study. Identification of nuances and underlying causes of lower scores from female members of trauma teams is an important next step. Gender-specific training may be necessary to change negative team dynamics in ad hoc trauma teams.
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Affiliation(s)
- Kinjal N Sethuraman
- University of Maryland School of Medicine, Department of Emergency Medicine, Baltimore, Maryland.,University of Maryland School of Medicine, Program in Trauma, Baltimore, Maryland
| | - Wan-Tsu W Chang
- University of Maryland School of Medicine, Department of Emergency Medicine, Baltimore, Maryland.,University of Maryland School of Medicine, Program in Trauma, Baltimore, Maryland
| | - Amy L Zhou
- University of Maryland, College Park, Maryland
| | - Boyan Xia
- University of Maryland, College Park, Maryland
| | - Daniel B Gingold
- University of Maryland School of Medicine, Department of Emergency Medicine, Baltimore, Maryland
| | - Maureen McCunn
- University of Maryland School of Medicine, Program in Trauma, Baltimore, Maryland.,University of Maryland School of Medicine, Department of Anesthesiology, Baltimore, Maryland
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What happens in the shock room stays in the shock room? A time-based audio/video audit framework for trauma team performance analysis. Eur J Emerg Med 2020; 27:121-124. [PMID: 31490786 PMCID: PMC7050797 DOI: 10.1097/mej.0000000000000627] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Supplemental Digital Content is available in the text. A precise tool for analysis of trauma team performance is missing.
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Gustafson ML, Hensley B, Dotson M, Broce M, Tager A. Comparison of Manikin Versus Porcine Trachea Models When Teaching Emergent Cricothyroidotomy Among Emergency Medicine Residents. AEM EDUCATION AND TRAINING 2019; 3:280-285. [PMID: 31360821 PMCID: PMC6637022 DOI: 10.1002/aet2.10333] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/27/2018] [Revised: 02/22/2019] [Accepted: 02/25/2019] [Indexed: 06/03/2023]
Abstract
OBJECTIVES Emergent cricothyroidotomy (EC) is a rarely used yet lifesaving procedure that is important for an emergency physician to master throughout his or her training. We evaluated the difference in utilization of a manikin or porcine model among emergency medicine (EM) residents when teaching EC. We also evaluated the difference in the models using two different commonly utilized and taught techniques: "scalpel-finger-bougie" (SFB) technique and the Melker technique (MT). METHODS This was a prospective crossover design. Instructions about the procedure were provided; study participants were randomly assigned to one of two groups and performed cricothyrotomy on both manikin and porcine simulators using both the Melker and the SFB techniques. Each group was started with the technique on the second simulator opposite what they started with on the first simulator. After the procedures, study participants completed a questionnaire that used the same format for both groups. All survey questions required a 7-point Likert scale response. Confidence, difficulty, reality of the anatomy, and landmarks were compared. RESULTS Fifteen EM residents participated in the study. Compared to the porcine-first group, the manikin-first group rated the anatomy more realistic (question 5) after their first attempt (6.29 vs. 5.87) than their second attempt (using the porcine model; 4.29 vs. 5.62; main effect for attempts [first vs. second] p = 0.027; interaction p = 0.074). Interestingly, the porcine model-first group rated the landmarks (question 6) significantly easier to find in both attempts (6.87 vs. 5.86 on the first attempt and 6.50 vs. 5.57 on the second attempt; p = 0.012). Twelve participants (80%) chose SFB as their preferred technique to use in real-life scenario. CONCLUSION The Manikin model tends to be more realistic in cricothyrotomy simulation than the porcine model. The influence of fresh pig skin overlying the porcine model may require further research. Landmark identification during the procedure was easier on both models when participants start with the porcine model. Participants prefer the SFB over MT if faced with a real-life scenario.
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Affiliation(s)
- Mark L. Gustafson
- Department of Emergency MedicineGraduate Medical EducationCharleston Area Medical CenterCharlestonWV
- Life Support Training and Simulation CenterCharleston Area Medical CenterCharlestonWV
| | - Brian Hensley
- Department of Emergency MedicineGraduate Medical EducationCharleston Area Medical CenterCharlestonWV
| | - Marc Dotson
- Department of Emergency MedicineGraduate Medical EducationCharleston Area Medical CenterCharlestonWV
| | - Mike Broce
- Health Education and Research InstituteCharleston Area Medical CenterCharlestonWV
| | - Alfred Tager
- Department of Emergency MedicineGraduate Medical EducationCharleston Area Medical CenterCharlestonWV
- Health Education and Research InstituteCharleston Area Medical CenterCharlestonWV
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Wen A, Wong L, Ma C, Arndt R, Katz AR, Richardson K, Deutsch M, Masaki K. An interprofessional team simulation exercise about a complex geriatric patient. GERONTOLOGY & GERIATRICS EDUCATION 2019; 40:16-29. [PMID: 30513067 DOI: 10.1080/02701960.2018.1554568] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Interprofessional collaboration is an essential skill to optimize the care of older adults with complex problems. We successfully developed and evaluated an interprofessional teamwork simulation exercise for medical, nursing, pharmacy, and social work students. Pharmacy students participated via video conferencing. Before the simulation, students watched a teamwork video and reviewed the patient case. Following an icebreaker exercise, interdisciplinary faculty facilitated a discussion highlighting effective teamwork strategies. Students then collaborated to develop a discharge plan, followed by a simulated family meeting with a theater student. Interdisciplinary faculty again provided structured debriefing highlighting principles of effective teamwork. Students self-rated interprofessional practice core competencies were evaluated using a retrospective pre/post survey and analyzed using paired t-tests. We qualitatively examined the use of distance technology and assessed learner's satisfaction with the project. All core competency categories for all disciplines demonstrated significant improvements in mean scores. Students' qualitative comments demonstrated positive impact on learning interprofessional core competencies.
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Affiliation(s)
- Aida Wen
- a The John A. Hartford Foundation Center of Excellence in Geriatrics, Department of Geriatric Medicine, John A. Burns School of Medicine , University of Hawaii at Manoa , Honolulu , HI , USA
| | - Lorrie Wong
- b School of Nursing and Dental Hygiene , University of Hawaii at Manoa , Honolulu , HI , USA
| | - Carolyn Ma
- c The Daniel K. Inouye College of Pharmacy , University of Hawaii at Hilo , Hilo , HI , USA
| | - Robin Arndt
- d Myron B. Thompson School of Social Work , University of Hawaii at Manoa , Honolulu , HI , USA
| | - Alan R Katz
- e Office of Public Health Studies , University of Hawaii at Manoa , Honolulu , HI , USA
| | - Karol Richardson
- b School of Nursing and Dental Hygiene , University of Hawaii at Manoa , Honolulu , HI , USA
| | - Melodee Deutsch
- b School of Nursing and Dental Hygiene , University of Hawaii at Manoa , Honolulu , HI , USA
| | - Kamal Masaki
- a The John A. Hartford Foundation Center of Excellence in Geriatrics, Department of Geriatric Medicine, John A. Burns School of Medicine , University of Hawaii at Manoa , Honolulu , HI , USA
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Analysis of Emergency Health Care Workforce and Service Readiness for a Mass Casualty Event in the Republic of Ireland. Disaster Med Public Health Prep 2018; 13:243-255. [DOI: 10.1017/dmp.2018.45] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
ABSTRACTObjectiveUltimately, a country’s capacity for a large-scale major emergency response will be directly related to the competence of its health care provider (HCP) workforce and communication between emergency responders and hospitals. The purpose of this study was to assess HCP preparedness and service readiness for a major emergency involving mass casualties (mass casualty event or MCE) in Ireland.MethodsA cross-sectional study using a 53-item survey was administered to a purposive sample of emergency responders and HCPs in the Republic of Ireland. Data collection was achieved using the Qualtrics® Research Suite. Descriptive statistics and appropriate tests of comparison between professional disciplines were conducted using Stata 13.ResultsA total of 385 respondents, registered nurses (43.4%), paramedics (37.9%), medical doctors (10.1%), and administrators/managers (8.6%), participated in the study. In general, a level of knowledge of MCEs and knowledge of clinical response activities and self-assessed clinical competence varied drastically across many aspects of the survey. Knowledge and confidence also varied across professional disciplines (P<0.05) with nurses, in general, reporting the least knowledge and/or confidence.ConclusionsThe results demonstrate that serious deficits exist in HCP knowledge, skills, and self-perceived abilities to participate in a large-scale MCE. Results also suggest a poor knowledge base of existing major emergency response plans. (Disaster Med Public Health Preparedness. 2019;13:243–255)
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Self-assessment of team performance using T-NOTECHS in simulated pediatric trauma resuscitation is not consistent with expert assessment. Am J Surg 2018; 216:630-635. [PMID: 29366483 DOI: 10.1016/j.amjsurg.2018.01.010] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2017] [Revised: 12/19/2017] [Accepted: 01/03/2018] [Indexed: 12/21/2022]
Abstract
BACKGROUND The Trauma NOn-TECHnical Skills (T-NOTECHS) tool has been used to assess teamwork in trauma resuscitation, but its reliability and validity for self-assessment is unknown. Our purpose was to determine the reliability and validity of self-administered T-NOTECHS in pediatric trauma resuscitation. METHODS Simulated in situ resuscitations were evaluated using T-NOTECHS in real time by experts and immediately afterwards by team members. Reliability was analyzed with linear-weighted kappa and intra-class correlation. T-NOTECHS scores were compared between expert (gold-standard) and self-assessment. RESULTS Fifteen simulations were examined. T-NOTECHS scores were similar between self- and expert assessment for leadership. Self-assessment scores were higher than expert for the other domains and total composite score. Inter-rater reliability for total score was similar between the two groups, but differences were observed in the domains. CONCLUSIONS Self-assessment is not interchangeable with expert rating when using T-NOTECHS. Future studies need to determine how self-assessment can be best utilized. LEVEL OF EVIDENCE Studies of diagnostic accuracy - Level 2.
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O'Rourke J, Horsley TL, Doolen J, Mariani B, Pariseault C. Integrative Review of Interprofessional Simulation in Nursing Practice. J Contin Educ Nurs 2018; 49:91-96. [DOI: 10.3928/00220124-20180116-09] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2017] [Accepted: 11/13/2017] [Indexed: 11/20/2022]
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Abstract
BACKGROUND Briefing of the trauma team before patient arrival is unstructured in many centers. We surveyed trauma teams regarding agreement on patient care priorities and evaluated the impact of a structured, physician-led briefing on concordance during simulated resuscitations. METHODS Trauma nurses at our Level II center were surveyed, and they participated in four resuscitation scenarios, randomized to "briefed" or "nonbriefed." For nonbriefed scenarios, nurses independently reviewed triage sheets with written information. Briefed scenarios had a structured 4-minute physician-led briefing reviewing triage sheets identical to nonbriefed scenarios. Teams included three to four nurses (subjects) and two to four confederates (physicians, respiratory therapists). Each team served as their own control group. Confederates were blinded to nurses' briefed or nonbriefed status. Immediately before, and at the midpoint of each scenario, nurses estimated patients' morbidity and mortality and ranked the top 3 of 16 designated immediate care priorities. Briefed and nonbriefed groups' responses were compared for (1) agreement using intraclass correlation coefficient, (2) concordance with physicians' responses using the Fisher exact test, (3) teamwork via T-NOTECHS ratings by nurses and physicians using t-test, and (4) time to complete clinical tasks using t test. RESULTS Thirty-eight nurses participated. Ninety-seven percent "agreed/strongly agreed" briefing is important, but only 46% agreed briefing was done well. Comparing briefed versus nonbriefed scenarios, nurses' estimation of morbidity and mortality in the briefed scenarios showed significantly greater agreement with each other and with physicians' answers (p < 0.01). Rank lists also better agreed with each other (intraclass correlation coefficient, 0.64 vs 0.59) and with physicians' answers in the briefed scenarios. T-NOTECHS Leadership ratings were significantly higher in the briefed scenarios (3.70 vs 3.39; p < 0.01). Time to completion of key clinical tasks was significantly faster for one of the briefed scenarios. CONCLUSIONS Discordant perceptions of patient care goals was frequently observed. Structured physician-led briefing seemed to improve interprofessional team concordance, leadership, and task completion in simulated trauma resuscitations.
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West KM, Burke W, Korngiebel DM. Identifying "ownership" through role descriptions to support implementing universal colorectal cancer tumor screening for Lynch syndrome. Genet Med 2017; 19:1236-1244. [PMID: 28471433 PMCID: PMC5671377 DOI: 10.1038/gim.2017.39] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2016] [Accepted: 03/08/2017] [Indexed: 12/31/2022] Open
Abstract
Purpose Lynch Syndrome cases are under-identified, and universal colorectal cancer tumor screening for Lynch Syndrome (UTS) has been recommended. UTS implementation is challenging and few successful examples exist to date, and colorectal cancer patients and at-risk family members exhibit low uptake of genetic services. This study sought to identify the elements that could guide the choice of specialties to implement UTS through three main stages: initiating the screen, returning positive screen results, and providing follow-up. Methods To understand stakeholder views on the UTS process, twenty semi-structured interviews were conducted with clinicians from six medical specialties crucial for implementing UTS. Data were analyzed using directed content analysis and additional thematic analysis across content categories. Results Several clinical specialties could fill necessary roles at each of the main stages of UTS implementation. Participants suggested owners based on attributes of specialty roles, clinical settings, and the routes patients take through the system. Conclusion UTS is considered possible in a range of healthcare settings, with tailoring. Health systems need to choose who best fills the role’s needs based on local resources and processes. These results offer implementation guidance based on role needs, not clinical specialty, in resolving the issue of UTS “ownership.”
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Affiliation(s)
- Kathleen M West
- Department of Bioethics and Humanities, Institute for Public Health Genetics, University of Washington, Seattle, Washington, USA
| | - Wylie Burke
- Department of Bioethics and Humanities, University of Washington, Seattle, Washington, USA
| | - Diane M Korngiebel
- Department of Biomedical Informatics and Medical Education, University of Washington School of Medicine, Seattle, Washington, USA
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Lapierre A, Gauvin-Lepage J, Lefebvre H. La collaboration interprofessionnelle lors de la prise en charge d’un polytraumatisé aux urgences : une revue de la littérature. Rech Soins Infirm 2017:73-88. [DOI: 10.3917/rsi.129.0073] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
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Lowe DJ, Millar JE, Dignon N, Ireland A. Top 10 lessons from the Glasgow major incidents. Emerg Med J 2016; 33:596-7. [PMID: 26976660 DOI: 10.1136/emermed-2015-205626] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2015] [Accepted: 02/22/2016] [Indexed: 11/03/2022]
Affiliation(s)
- David J Lowe
- Emergency Department, Glasgow Royal Infirmary, Glasgow, UK Department of Anaesthesia, Critical Care & Pain, University of Glasgow, Glasgow, UK
| | - Jonathan E Millar
- Department of Anaesthesia, Critical Care & Pain, University of Glasgow, Glasgow, UK
| | - Neil Dignon
- Emergency Department, Glasgow Royal Infirmary, Glasgow, UK Emergency Medical Retrieval Service, Glasgow, UK
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