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Webster CS, Coomber T, Liu S, Allen K, Jowsey T. Interprofessional Learning in Multidisciplinary Healthcare Teams Is Associated With Reduced Patient Mortality: A Quantitative Systematic Review and Meta-analysis. J Patient Saf 2024; 20:57-65. [PMID: 37921751 DOI: 10.1097/pts.0000000000001170] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2023]
Abstract
OBJECTIVE The aim of the study is to identify quantitative evidence for the efficacy of interprofessional learning (IPL) to improve patient outcomes. METHODS We conducted a systematic review and meta-analysis of quantitative patient outcomes after IPL in multidisciplinary healthcare teams reported in the Medline, Scopus, PsycInfo, Embase, and CINAHL databases. RESULTS In 2022, we screened 15,248 reports to include 20 and extracted rates of mortality and primary outcomes in conventional care groups and intervention groups (involving initiatives to promote IPL in multidisciplinary teams). The meta-analysis of the 13 studies reporting mortality outcomes demonstrated that the 7166 patients in the intervention group had a significant 28% (95% confidence interval [CI], 40%-14%; P < 0.0003) reduced risk of dying compared with the 6809 patients in the conventional care group. The meta-analysis of the 14 studies reporting other treatment-related adverse outcomes demonstrated that the 4789 patients in the intervention group had a significant 23% (95% CI, 33%-12%; P < 0.0001) reduced risk of experiencing an adverse outcome during care compared with the 4129 patients in the conventional care group. Sensitivity analysis, involving the exclusion of the 20% of individual studies with the widest 95% CIs, confirmed the precision and reliability of our findings. CONCLUSIONS We believe that our results are the first to demonstrate significant quantitative evidence for the efficacy of IPL to translate into changes in clinical practice and improved patient outcomes. Our results reinforce earlier qualitative work of the value of IPL, but further prospective quantitative and mixed-methods research is needed to better define such benefits.
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Affiliation(s)
- Craig S Webster
- From the Centre for Medical and Health Sciences Education, School of Medicine, University of Auckland, Auckland, New Zealand
| | - Ties Coomber
- From the Centre for Medical and Health Sciences Education, School of Medicine, University of Auckland, Auckland, New Zealand
| | - Sue Liu
- Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Australia
| | - Kaitlin Allen
- From the Centre for Medical and Health Sciences Education, School of Medicine, University of Auckland, Auckland, New Zealand
| | - Tanisha Jowsey
- Faculty of Health Sciences and Medicine, Bond University, Gold Coast, Australia
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Budowski AD, Bergauer L, Castellucci C, Braun J, Nöthiger CB, Spahn DR, Tscholl DW, Roche TR. Improved Task Performance, Low Workload, and User-Centered Design in Medical Diagnostic Equipment Enhance Decision Confidence of Anesthesia Providers: A Meta-Analysis and a Multicenter Online Survey. Diagnostics (Basel) 2022; 12:diagnostics12081835. [PMID: 36010187 PMCID: PMC9406815 DOI: 10.3390/diagnostics12081835] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Accepted: 07/26/2022] [Indexed: 11/16/2022] Open
Abstract
Decision confidence—the subjective belief to have made the right decision—is central in planning actions in a complex environment such as the medical field. It is unclear by which factors it is influenced. We analyzed a pooled data set of eight studies and performed a multicenter online survey assessing anesthesiologists’ opinions on decision confidence. By applying mixed models and using multiple imputation to determine the effect of missing values from the dataset on the results, we investigated how task performance, perceived workload, the utilization of user-centered medical diagnostic devices, job, work experience, and gender affected decision confidence. The odds of being confident increased with better task performance (OR: 1.27, 95% CI: 0.94 to 1.7; p = 0.12; after multiple imputation OR: 3.19, 95% CI: 2.29 to 4.45; p < 0.001) and when user-centered medical devices were used (OR: 5.01, 95% CI: 3.67 to 6.85; p < 0.001; after multiple imputation OR: 3.58, 95% CI: 2.65 to 4.85; p < 0.001). The odds of being confident decreased with higher perceived workload (OR: 0.94, 95% CI: 0.93 to 0.95; p < 0.001; after multiple imputation, OR: 0.94, 95% CI: 0.93 to 0.95; p < 0.001). Other factors, such as gender, job, or professional experience, did not affect decision confidence. Most anesthesiologists who participated in the online survey agreed that task performance (25 of 30; 83%), perceived workload (24 of 30; 80%), work experience (28 of 30; 93%), and job (21 of 30; 70%) influence decision confidence. Improved task performance, lower perceived workload, and user-centered design in medical equipment enhanced the decision confidence of anesthesia providers.
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Affiliation(s)
- Alexandra D. Budowski
- Department of Anesthesiology, University of Zurich, University Hospital Zurich, 8091 Zurich, Switzerland; (A.D.B.); (L.B.); (C.C.); (C.B.N.); (D.R.S.); (D.W.T.)
| | - Lisa Bergauer
- Department of Anesthesiology, University of Zurich, University Hospital Zurich, 8091 Zurich, Switzerland; (A.D.B.); (L.B.); (C.C.); (C.B.N.); (D.R.S.); (D.W.T.)
| | - Clara Castellucci
- Department of Anesthesiology, University of Zurich, University Hospital Zurich, 8091 Zurich, Switzerland; (A.D.B.); (L.B.); (C.C.); (C.B.N.); (D.R.S.); (D.W.T.)
| | - Julia Braun
- Department of Epidemiology and Biostatistics, University of Zurich, 8006 Zurich, Switzerland;
| | - Christoph B. Nöthiger
- Department of Anesthesiology, University of Zurich, University Hospital Zurich, 8091 Zurich, Switzerland; (A.D.B.); (L.B.); (C.C.); (C.B.N.); (D.R.S.); (D.W.T.)
| | - Donat R. Spahn
- Department of Anesthesiology, University of Zurich, University Hospital Zurich, 8091 Zurich, Switzerland; (A.D.B.); (L.B.); (C.C.); (C.B.N.); (D.R.S.); (D.W.T.)
| | - David W. Tscholl
- Department of Anesthesiology, University of Zurich, University Hospital Zurich, 8091 Zurich, Switzerland; (A.D.B.); (L.B.); (C.C.); (C.B.N.); (D.R.S.); (D.W.T.)
| | - Tadzio R. Roche
- Department of Anesthesiology, University of Zurich, University Hospital Zurich, 8091 Zurich, Switzerland; (A.D.B.); (L.B.); (C.C.); (C.B.N.); (D.R.S.); (D.W.T.)
- Correspondence: ; Tel.: +41-432530255
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Costs, benefits and the prevention of patient deterioration. J Clin Monit Comput 2022; 36:1245-1247. [PMID: 35616798 DOI: 10.1007/s10877-022-00874-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2022] [Accepted: 05/05/2022] [Indexed: 10/18/2022]
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Ljubenovic A, Said S, Braun J, Grande B, Kolbe M, Spahn DR, Nöthiger CB, Tscholl DW, Roche TR. Anesthesia providers' visual attention in simulated anesthesia emergencies using conventional number-based and avatar-based patient monitoring: a prospective, eye-tracking study. JMIR Serious Games 2022; 10:e35642. [PMID: 35172958 PMCID: PMC8984829 DOI: 10.2196/35642] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Revised: 02/05/2022] [Accepted: 02/17/2022] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND Inadequate situational awareness accounts for two-thirds of preventable complications in anesthesia. An essential tool for situational awareness in the perioperative setting is the patient monitor. However, the conventional monitor has several weaknesses. Avatar-based patient monitoring may address these shortcomings and promote situation awareness, a prerequisite for good decision making. OBJECTIVE The spatial distribution of visual attention is a fundamental process for achieving adequate situation awareness and thus a potential quantifiable surrogate for situation awareness. Moreover, measuring visual attention with a head-mounted eye-tracker may provide insights into usage and acceptance of the new avatar-based patient monitoring modality. METHODS This prospective eye-tracking study compared anesthesia providers' visual attention on conventional and avatar-based patient monitors during simulated critical anesthesia events. We defined visual attention, measured as fixation count and dwell time, as our primary outcome. We correlated visual attention with the potential confounders: performance in managing simulated critical anesthesia events (task performance), work experience, and profession. We used mixed linear models to analyze the results. RESULTS Fifty-two teams performed 156 simulations. After a manual quality check of the eye-tracking footage, we excluded 57 simulations due to technical problems and quality issues. Participants had a median of 198 (IQR 92.5 - 317.5) fixations on the patient monitor with a median dwell time of 30.2 (IQR 14.9 - 51.3) seconds. We found no significant difference in participants' visual attention when using avatar-based patient monitoring or conventional patient monitoring. However, we found that with each percentage point of better task performance, the number of fixations decreased by about 1.39 (coefficient -1.39; 95%CI: -2.44 to -0.34; P=.02), and the dwell time diminished by 0.23 seconds (coefficient -0.23; 95%CI: -0.4 to -0.06; P=.01). CONCLUSIONS Using eye-tracking, we found no significant difference in visual attention when anesthesia providers used avatar-based monitoring or conventional patient monitoring in simulated critical anesthesia events. However, we identified visual attention in conjunction with task performance as a surrogate for situational awareness. CLINICALTRIAL Business Management System for Ethics Committees Number Req-2020-00059.
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Affiliation(s)
- Arsène Ljubenovic
- Institute of Anesthesiology, University of Zurich and University Hospital Zurich, Rämistrasse 100, Zurich, CH
| | - Sadiq Said
- Institute of Anesthesiology, University of Zurich and University Hospital Zurich, Rämistrasse 100, Zurich, CH
| | - Julia Braun
- Departments of Epidemiology and Biostatistics, Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, CH
| | - Bastian Grande
- Institute of Anesthesiology, University of Zurich and University Hospital Zurich, Rämistrasse 100, Zurich, CH.,Simulation Centre, University Hospital Zurich, Zurich, CH
| | - Michaela Kolbe
- Simulation Centre, University Hospital Zurich, Zurich, CH
| | - Donat R Spahn
- Institute of Anesthesiology, University of Zurich and University Hospital Zurich, Rämistrasse 100, Zurich, CH
| | - Christoph B Nöthiger
- Institute of Anesthesiology, University of Zurich and University Hospital Zurich, Rämistrasse 100, Zurich, CH
| | - David W Tscholl
- Institute of Anesthesiology, University of Zurich and University Hospital Zurich, Rämistrasse 100, Zurich, CH
| | - Tadzio R Roche
- Institute of Anesthesiology, University of Zurich and University Hospital Zurich, Rämistrasse 100, Zurich, CH
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Kim JY, Moore MR, Culwick MD, Hannam JA, Webster CS, Merry AF. Analysis of medication errors during anaesthesia in the first 4000 incidents reported to webAIRS. Anaesth Intensive Care 2021; 50:204-219. [PMID: 34871511 DOI: 10.1177/0310057x211027578] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Medication error is a well-recognised cause of harm to patients undergoing anaesthesia. From the first 4000 reports in the webAIRS anaesthetic incident reporting system, we identified 462 reports of medication errors. These reports were reviewed iteratively by several reviewers paying particular attention to their narratives. The commonest error category was incorrect dose (29.4%), followed by substitution (28.1%), incorrect route (7.6%), omission (6.5%), inappropriate choice (5.8%), repetition (5.4%), insertion (4.1%), wrong timing (3.5%), wrong patient (1.5%), wrong side (1.5%) and others (6.5%). Most (58.9%) of the errors resulted in at least some harm (20.8% mild, 31.0% moderate and 7.1% severe). Contributing factors to the medication errors included the presence of look-alike medications, storage of medications in the incorrect compartment, inadequate labelling of medications, pressure of time, anaesthetist fatigue, unfamiliarity with the medication, distraction, involvement of multiple people and poor communication. These data add to current evidence suggesting a persistent and concerning failure effectively to address medication safety in anaesthesia. The wide variation in the nature of the errors and contributing factors underline the need for increased systematic and multifaceted efforts underpinned by a strengthening of the current focus on safety culture to improve medication safety in anaesthesia. This will require the concerted and committed engagement of all concerned, from practitioners at the clinical workface, to those who fund and manage healthcare.
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Affiliation(s)
- Jee Young Kim
- Department of Anaesthesia and Perioperative Medicine, 58991Auckland City Hospital, Auckland City Hospital, Auckland, New Zealand
| | - Matthew R Moore
- Department of Anaesthesiology, University of Auckland, Auckland, New Zealand
| | - Martin D Culwick
- Department of Anaesthesia, Royal Brisbane and Women's Hospital, Brisbane, Australia
| | - Jacqueline A Hannam
- Department of Pharmacology and Clinical Pharmacology, University of Auckland, Auckland, New Zealand
| | - Craig S Webster
- Department of Anaesthesiology, University of Auckland, Auckland, New Zealand
| | - Alan F Merry
- Department of Anaesthesia and Perioperative Medicine, 58991Auckland City Hospital, Auckland City Hospital, Auckland, New Zealand.,Department of Anaesthesiology, University of Auckland, Auckland, New Zealand
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Webster CS. Determining improvements in medication safety in anesthesia. Can J Anaesth 2021; 68:1572-1573. [PMID: 34109547 DOI: 10.1007/s12630-021-02045-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Revised: 05/13/2021] [Accepted: 05/14/2021] [Indexed: 11/28/2022] Open
Affiliation(s)
- Craig S Webster
- Department of Anaesthesiology, and Centre for Medical and Health Sciences Education, School of Medicine, University of Auckland, Auckland, New Zealand.
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Positive communication behaviour during handover and team-based clinical performance in critical situations: a simulation randomised controlled trial. Br J Anaesth 2021; 126:854-861. [PMID: 33422288 DOI: 10.1016/j.bja.2020.12.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2020] [Revised: 11/27/2020] [Accepted: 12/06/2020] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Positive communication behaviour within anaesthesia teams may decrease stress response and improve clinical performance. We aimed to evaluate the effect of positive communication during medical handover on the subsequent team-based clinical performance in a simulated critical situation. We also assessed the effect of positive communication behaviour on stress response. METHODS This single-centre RCT involved anaesthesia teams composed of a resident and a nurse in a high-fidelity scenario of anaesthesia-related paediatric laryngospasm after a standardised handover. During the handover, similar information was provided to all teams, but positive communication behaviour was adopted only for teams in the intervention group. Primary outcome was team-based clinical performance, assessed by an independent blinded observer, using video recordings and a 0-to 100-point scenario-specific scoring tool. Three categories of tasks were considered: safety checks before the incision, diagnosis/treatment of laryngospasm, and crisis resource management/non-technical skills. Individual stress response was monitored by perceived level of stress and HR variability. RESULTS The clinical performance of 64 anaesthesia professionals (grouped into 32 teams) was analysed. The mean (standard deviation) team-based performance score in the intervention group was 44 (10) points vs 35 (12) in the control group (difference: +8.4; CI95% [0.4-16.4]; P=0.04). The effects were homogeneous over the three categories of tasks. Perceived level of stress and HR variability were not significantly different between groups. CONCLUSIONS Positive communication behaviour between healthcare professionals during medical handover improved team-based performance in a simulation-based critical situation. CLINICAL TRIAL REGISTRATION NCT03375073.
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Sustainable quality and safety improvement in healthcare: further lessons from the aviation industry. Br J Anaesth 2020; 125:425-429. [DOI: 10.1016/j.bja.2020.06.045] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2020] [Revised: 06/01/2020] [Accepted: 06/22/2020] [Indexed: 11/17/2022] Open
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Weller J, Long JA, Beaver P, Cumin D, Frampton C, Garden AL, Moore M, Webster CS, Merry A. Evaluation of the effect of multidisciplinary simulation-based team training on patients, staff and organisations: protocol for a stepped-wedge cluster-mixed methods study of a national, insurer-funded initiative for surgical teams in New Zealand public hospitals. BMJ Open 2020; 10:e032997. [PMID: 32079573 PMCID: PMC7045010 DOI: 10.1136/bmjopen-2019-032997] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
INTRODUCTION NetworkZ is a national, insurer-funded multidisciplinary simulation-based team-training programme for all New Zealand surgical teams. NetworkZ is delivered in situ, using full-body commercial simulators integrated with bespoke surgical models. Rolled out nationally over 4 years, the programme builds local capacity through instructor training and provision of simulation resources. We aim to improve surgical patient outcomes by improving teamwork through regular simulation-based multidisciplinary training in all New Zealand hospitals. METHODS AND ANALYSIS Our primary hypothesis is that surgical patient outcomes will improve following NetworkZ. Our secondary hypotheses are that teamwork processes will improve, and treatment injury claims will decline. In addition, we will explore factors that influence implementation and sustainability of NetworkZ and identify organisational changes following its introduction. The study uses a stepped-wedge cluster design. The intervention will roll out at yearly intervals to four cohorts of five District Health Boards. Allocation to cohort was purposive for year 1, and subsequently randomised. The primary outcome measure is Days Alive and Out of Hospital at 90 days using patient data from an existing national administrative database. Secondary outcomes measures will include analysis of postoperative complications and treatment injury claims, surveys of teamwork and safety culture, in-theatre observations and stakeholder interviews. ETHICS AND DISSEMINATION We believe this is the first surgical team training intervention to be implemented on a national scale, and a unique opportunity to evaluate a nation-wide team-training intervention for healthcare teams. By using a pre-existing large administrative data set, we have the potential to demonstrate a difference to surgical patient outcomes. This will be of interest to those working in the field of healthcare teamwork, quality improvement and patient safety. New Zealand Health and Disability Ethic Committee approval (#16/NTB/143). TRIAL REGISTRATION NUMBER Australian and New Zealand Clinical Trials Registry ID ACTRN12617000017325 and the Universal Trial Number is U1111-1189-3992.
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Affiliation(s)
- Jennifer Weller
- Centre for Medical and Health Sciences Education, The University of Auckland, Auckland, New Zealand
| | - Jennifer Anne Long
- Centre for Medical and Health Sciences Education, The University of Auckland, Auckland, New Zealand
| | - Peter Beaver
- Centre for Medical and Health Sciences Education, The University of Auckland, Auckland, New Zealand
| | - David Cumin
- Department of Anaesthesiology, The University of Auckland, Auckland, New Zealand
| | - Chris Frampton
- Department of Medicine, Christchurch School of Medicine and Health Sciences, University of Otago, Christchurch, New Zealand
| | - Alexander L Garden
- Anaesthesia, Wellington Hospital, Wellington, New Zealand
- School of Biological Sciences, Victoria University of Wellington, Wellington, New Zealand
| | - Matthew Moore
- Department of Anaesthesiology, The University of Auckland, Auckland, New Zealand
| | - Craig S Webster
- Centre for Medical and Health Sciences Education, The University of Auckland, Auckland, New Zealand
- Department of Anaesthesiology, The University of Auckland, Auckland, New Zealand
| | - Alan Merry
- Department of Anaesthesiology, The University of Auckland, Auckland, New Zealand
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Calvache JA, Stolker RJ, Klimek M. Rethinking Evidence-Based Medicine in the perioperative safety scenario. Br J Anaesth 2019; 123:e163-e164. [PMID: 31133286 DOI: 10.1016/j.bja.2019.04.050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2019] [Revised: 04/23/2019] [Accepted: 04/24/2019] [Indexed: 10/26/2022] Open
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