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Sarfaraz K, Nemeth J, Chew N. Just the facts: integrating human and environmental factors in trauma resuscitation with Zero Point Survey. CAN J EMERG MED 2024; 26:524-529. [PMID: 38805121 DOI: 10.1007/s43678-024-00712-5] [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: 07/11/2023] [Accepted: 04/27/2024] [Indexed: 05/29/2024]
Affiliation(s)
- Khurram Sarfaraz
- Department of Emergency Medicine, McGill University, Montreal, QC, Canada
| | - Joe Nemeth
- Department of Emergency Medicine, McGill University, Montreal, QC, Canada
| | - Natalie Chew
- Department of Emergency Medicine, McGill University, Montreal, QC, Canada.
- Department of Emergency Medicine, Faculty of Medicine and Health Sciences, McGill University, Montreal, QC, Canada.
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2
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Copeland S, Hinrichs-Krapels S, Fecondo F, Santizo ER, Bal R, Comes T. A resilience view on health system resilience: a scoping review of empirical studies and reviews. BMC Health Serv Res 2023; 23:1297. [PMID: 38001460 PMCID: PMC10675888 DOI: 10.1186/s12913-023-10022-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Accepted: 09/11/2023] [Indexed: 11/26/2023] Open
Abstract
BACKGROUND Prompted by recent shocks and stresses to health systems globally, various studies have emerged on health system resilience. Our aim is to describe how health system resilience is operationalised within empirical studies and previous reviews. We compare these to the core conceptualisations and characteristics of resilience in a broader set of domains (specifically, engineering, socio-ecological, organisational and community resilience concepts), and trace the different schools, concepts and applications of resilience across the health literature. METHODS We searched the Pubmed database for concepts related to 'resilience' and 'health systems'. Two separate analyses were conducted for included studies: a total of n = 87 empirical studies on health system resilience were characterised according to part of health systems covered, type of threat, resilience phase, resilience paradigm, and approaches to building resilience; and a total of n = 30 reviews received full-text review and characterised according to type of review, resilience concepts identified in the review, and theoretical framework or underlying resilience conceptualisation. RESULTS The intersection of health and resilience clearly has gained importance in the academic discourse with most papers published since 2018 in a variety of journals and in response to external threats, or in reference to more frequent hospital crisis management. Most studies focus on either resilience of health systems generally (and thereby responding to an external shock or stress), or on resilience within hospitals (and thereby to regular shocks and operations). Less attention has been given to community-based and primary care, whether formal or informal. While most publications do not make the research paradigm explicit, 'resilience engineering' is the most prominent one, followed by 'community resilience' and 'organisational resilience'. The social-ecological systems roots of resilience find the least application, confirming our findings of the limited application of the concept of transformation in the health resilience literature. CONCLUSIONS Our review shows that the field is fragmented, especially in the use of resilience paradigms and approaches from non-health resilience domains, and the health system settings in which these are used. This fragmentation and siloed approach can be problematic given the connections within and between the complex and adaptive health systems, ranging from community actors to local, regional, or national public health organisations to secondary care. Without a comprehensive definition and framework that captures these interdependencies, operationalising, measuring and improving resilience remains challenging.
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Affiliation(s)
- Samantha Copeland
- Faculty of Technology, Policy and Management, Delft University of Technology, Jaffalaan 5, 2628 BX, Delft, The Netherlands
| | - Saba Hinrichs-Krapels
- Faculty of Technology, Policy and Management, Delft University of Technology, Jaffalaan 5, 2628 BX, Delft, The Netherlands.
| | - Federica Fecondo
- Faculty of Technology, Policy and Management, Delft University of Technology, Jaffalaan 5, 2628 BX, Delft, The Netherlands
| | - Esteban Ralon Santizo
- Faculty of Technology, Policy and Management, Delft University of Technology, Jaffalaan 5, 2628 BX, Delft, The Netherlands
| | - Roland Bal
- Erasmus School of Health Policy & Management, Erasmus University Rotterdam, Burg. Oudlaan 50, Rotterdam, The Netherlands
| | - Tina Comes
- Faculty of Technology, Policy and Management, Delft University of Technology, Jaffalaan 5, 2628 BX, Delft, The Netherlands
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3
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Brindley PG, Mosier JM, Hicks CM. Pandemic airway management: A cognitive aid to increase safety and team cohesion during intubation, donning, and doffing. J Intensive Care Soc 2023; 24:18-19. [PMID: 38602961 PMCID: PMC7251622 DOI: 10.1177/1751143720931614] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Affiliation(s)
- Peter G Brindley
- Department of Critical Care Medicine, Department of Anesthesiology and Pain Medicine and the Dosseter Ethics Centre, University of Alberta, Edmonton, Canada
| | - Jarrod M Mosier
- Department of Emergency Medicine, Division of Pulmonary, Allergy, Critical Care and Sleep, University of Arizona College of Medicine, Tucson, AZ, USA
- Department of Medicine, Division of Pulmonary, Allergy, Critical Care and Sleep, University of Arizona College of Medicine, Tucson, AZ, USA
| | - Christopher M Hicks
- Department of Emergency Medicine, St Michael's Hospital, University of Toronto, Ontario, Canada
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4
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Schwindenhammer V, Rimmelé T, Duclos A, Haesebaert J, Lilot M, Abraham P. A new standardized tool for quantification of closed-loop communication in trauma care: CAST Grid reliability study. Injury 2023; 54:110851. [PMID: 37336655 DOI: 10.1016/j.injury.2023.110851] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Revised: 05/11/2023] [Accepted: 05/26/2023] [Indexed: 06/21/2023]
Abstract
BACKROUND The CAST Grid has been developed to evaluate the use of closed-loop communication (CLC) in the trauma bay. METHODS The CAST Grid and two validated non-technical team performance assessment tools (the TEAM and T-NOTECHS grids) were completed by 2 independent reviewers based on trauma care simulation videos from a French Level 1 trauma center. Intra- and inter-rater agreements were evaluated for CLC parameters and non-technical performance, and correlations between these parameters were analyzed. RESULTS The study analyzed 11 videos. The intra- and inter-rater agreement for the number of CLC per minute (CLC/min) was moderate and good, respectively, based on Lin's concordance correlation coefficient [95%CI] (0.57 [-0.40;0.94] and 0.77 [0.33;0.94]). However, the agreement was poor for the percentage of CLC (0.37 [-0.58;0.89] and -0.36 [-0.71;0.14], respectively). The study found that a lower number of CLC/min was correlated with an increased duration of the simulation (r = -0.75 [-0.93; -0.25]). CONCLUSION The CAST Grid showed a relatively good inter-rater agreement to quantify the number of CLC/min which was inversely correlated with the duration of care. This tool opens up the possibility of quantifying CLC and allows for new analyses of team functioning and interactions.
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Affiliation(s)
- Victor Schwindenhammer
- Pôle Anesthésie-Réanimation, Centre Hospitalier Universitaire Grenoble - Alpes, La Tronche, France; Université Claude Bernard Lyon 1, Centre Lyonnais d'Enseignement par la Simulation en Santé (CLESS), Lyon, France.
| | - Thomas Rimmelé
- Université Claude Bernard Lyon 1, Centre Lyonnais d'Enseignement par la Simulation en Santé (CLESS), Lyon, France; EA 7426, PI3 (Pathophysiology of Injury-Induced Immunosuppression), Claude Bernard University Lyon 1-Biomérieux-Hospices Civils de Lyon, Lyon, France; Service d'Anesthésie-Réanimation, Hôpital Edouard Herriot, Hospices Civils de Lyon, Lyon, France
| | - Antoine Duclos
- Research on Healthcare Performance RESHAPE, INSERM U1290, Université Lyon 1, CEDEX 08, F-69373 Lyon, France
| | - Julie Haesebaert
- Research on Healthcare Performance RESHAPE, INSERM U1290, Université Lyon 1, CEDEX 08, F-69373 Lyon, France; Pôle Santé Publique, Service d'épidémiologie et de recherche clinique, F-69003, Hospices Civils de Lyon, Lyon, France
| | - Marc Lilot
- Université Claude Bernard Lyon 1, Centre Lyonnais d'Enseignement par la Simulation en Santé (CLESS), Lyon, France; Research on Healthcare Performance RESHAPE, INSERM U1290, Université Lyon 1, CEDEX 08, F-69373 Lyon, France; Hospices Civils de Lyon, Department of paediatric cardio-thoracic anesthesia and intensive care, Louis Pradel Hospital, Lyon, France
| | - Paul Abraham
- Université Claude Bernard Lyon 1, Centre Lyonnais d'Enseignement par la Simulation en Santé (CLESS), Lyon, France; Service d'Anesthésie-Réanimation, Hôpital Edouard Herriot, Hospices Civils de Lyon, Lyon, France; Service de Médecine Intensive Adulte, Centre Hospitalier Universitaire Vaudois, 1011 Lausanne, Suisse
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5
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Hurley S, Green RS. Communicating key information in trauma: it's time to gain the advantage we need. CAN J EMERG MED 2023; 25:359-360. [PMID: 37142856 DOI: 10.1007/s43678-023-00491-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/06/2023]
Affiliation(s)
- Sean Hurley
- Department of Emergency Medicine, Dalhousie University, Room 1-026B Centennial Building, 1276 South Park Street, Halifax, NS, B3H 4R2, Canada
- Trauma Nova Scotia, Nova Scotia Health Authority, Halifax, NS, B3H 2Y9, Canada
| | - Robert S Green
- Department of Emergency Medicine, Dalhousie University, Room 1-026B Centennial Building, 1276 South Park Street, Halifax, NS, B3H 4R2, Canada.
- Trauma Nova Scotia, Nova Scotia Health Authority, Halifax, NS, B3H 2Y9, Canada.
- Department of Critical Care, Dalhousie University, Halifax, NS, B3H 4R2, Canada.
- Department of Surgery, Dalhousie University, Halifax, NS, B3H 2Y9, Canada.
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6
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Brazil V, Orr R, Canetti EFD, Isaacson W, Stevenson N, Purdy E. Exploring participant experience to optimize the design and delivery of stress exposure simulations in emergency medicine. AEM EDUCATION AND TRAINING 2023; 7:e10852. [PMID: 37008650 PMCID: PMC10061575 DOI: 10.1002/aet2.10852] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Revised: 01/25/2023] [Accepted: 01/27/2023] [Indexed: 06/19/2023]
Abstract
OBJECTIVES Emergency department (ED) teams frequently perform under conditions of high stress. Stress exposure simulation (SES) is specifically designed to train recognition and management of stress responses under these conditions. Current approaches to design and delivery of SES in emergency medicine are based on principles derived from other contexts and from anecdotal experience. However, the optimal design and delivery of SES in emergency medicine are not known. We aimed to explore participant experience to inform our approach. METHODS We performed an exploratory study in our Australian ED with doctors and nurses participating in SES sessions. We used a three-part framework-sources of stress, the impacts of that stress, and the strategies to mitigate-to inform our SES design and delivery and to guide our exploration of participant experience. Data were collected through a narrative survey and participant interviews and analyzed thematically. RESULTS There were 23 total participants (doctors n = 12, nurses n = 11) across the three sessions. Sixteen survey responses and eight interview transcripts were analyzed, each with equal numbers of doctors and nurses. Five themes were identified in data analysis: (1) experience of stress, (2) managing stress, (3) design and delivery of SES, (4) learning conversations, and (5) transfer to practice. CONCLUSIONS We suggest that design and delivery of SES should follow health care simulation best practice, with stress adequately induced by authentic clinical scenarios and to avoid trickery or adding extraneous cognitive load. Facilitators leading learning conversations in SES sessions should develop a deep understanding of stress and emotional activation and focus on team-based strategies to mitigate harmful impacts of stress on performance.
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Affiliation(s)
- Victoria Brazil
- Translational Simulation Collaborative, Faculty of Health Sciences and MedicineBond UniversityGold CoastQueenslandAustralia
- Emergency DepartmentGold Coast Health ServiceGold CoastQueenslandAustralia
| | - Robin Orr
- Tactical Research Unit, Faculty of Health Sciences and MedicineBond UniversityGold CoastQueenslandAustralia
| | - Elisa F. D. Canetti
- Tactical Research Unit, Faculty of Health Sciences and MedicineBond UniversityGold CoastQueenslandAustralia
| | - Warwick Isaacson
- Emergency DepartmentGold Coast Health ServiceGold CoastQueenslandAustralia
| | - Nikki Stevenson
- Emergency DepartmentGold Coast Health ServiceGold CoastQueenslandAustralia
| | - Eve Purdy
- Translational Simulation Collaborative, Faculty of Health Sciences and MedicineBond UniversityGold CoastQueenslandAustralia
- Emergency DepartmentGold Coast Health ServiceGold CoastQueenslandAustralia
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7
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Schouten AM, Flipse SM, van Nieuwenhuizen KE, Jansen FW, van der Eijk AC, van den Dobbelsteen JJ. Operating Room Performance Optimization Metrics: a Systematic Review. J Med Syst 2023; 47:19. [PMID: 36738376 PMCID: PMC9899172 DOI: 10.1007/s10916-023-01912-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2022] [Accepted: 11/26/2022] [Indexed: 02/05/2023]
Abstract
Literature proposes numerous initiatives for optimization of the Operating Room (OR). Despite multiple suggested strategies for the optimization of workflow on the OR, its patients and (medical) staff, no uniform description of 'optimization' has been adopted. This makes it difficult to evaluate the proposed optimization strategies. In particular, the metrics used to quantify OR performance are diverse so that assessing the impact of suggested approaches is complex or even impossible. To secure a higher implementation success rate of optimisation strategies in practice we believe OR optimisation and its quantification should be further investigated. We aim to provide an inventory of the metrics and methods used to optimise the OR by the means of a structured literature study. We observe that several aspects of OR performance are unaddressed in literature, and no studies account for possible interactions between metrics of quality and efficiency. We conclude that a systems approach is needed to align metrics across different elements of OR performance, and that the wellbeing of healthcare professionals is underrepresented in current optimisation approaches.
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Affiliation(s)
- Anne M Schouten
- Biomedical Engineering Department, Technical University of Delft, Mekelweg 5, 2628 CD, Delft, the Netherlands.
| | - Steven M Flipse
- Science Education and Communication Department, Technical University of Delft, Mekelweg 5, 2628 CD, Delft, the Netherlands
| | - Kim E van Nieuwenhuizen
- Gynecology Department, Leiden University Medical Center, Albinusdreef 2, 2333 ZA, Leiden, the Netherlands
| | - Frank Willem Jansen
- Biomedical Engineering Department, Technical University of Delft, Mekelweg 5, 2628 CD, Delft, the Netherlands
- Gynecology Department, Leiden University Medical Center, Albinusdreef 2, 2333 ZA, Leiden, the Netherlands
| | - Anne C van der Eijk
- Operation Room Centre, Leiden University Medical Center, Albinusdreef 2, 2333 ZA, Leiden, the Netherlands
| | - John J van den Dobbelsteen
- Biomedical Engineering Department, Technical University of Delft, Mekelweg 5, 2628 CD, Delft, the Netherlands
- Gynecology Department, Leiden University Medical Center, Albinusdreef 2, 2333 ZA, Leiden, the Netherlands
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8
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Massive Hemorrhage Protocol. Emerg Med Clin North Am 2023; 41:51-69. [DOI: 10.1016/j.emc.2022.09.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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9
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Jamshed S, Majeed N. Mapping knowledge-sharing behavior through emotional intelligence and team culture toward optimized team performance. TEAM PERFORMANCE MANAGEMENT 2023. [DOI: 10.1108/tpm-06-2022-0052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
Purpose
Research unveiled that interdisciplinary health-care teams are often found to be ineffective because of deprived team mechanisms. Considering effective team functioning, a leader’s non-cognitive abilities, knowledge-sharing behavior and the role of culture remain central concerns of health-care teams. This study aims to investigate how a leader’s emotional intelligence (EI) in a prevailing team culture can nurture the sharing of knowledge and enhance team EI that influences team performance.
Design/methodology/approach
The authors used multisource data representing a sample of 195 teams (735 respondents) to examine the hypothesized relationships by using the analytic strategy of partial least squares-structural equation modeling. This study bridged the methodological gap by using the repeated indicator approach that includes the reflective-formative second-order hierarchical latent variable model.
Findings
The results revealed a standpoint that leaders practicing the ability of EI influences team performance by understanding each other emotions in the leader–member relationship. Further, culture adds value and maps knowledge-sharing behavior which is tailored and beneficial for effective team outcomes.
Practical implications
This study provides valuable inputs by articulating uniquely modeled variables for health-care teams confronting high work demands. This study highlights that leaders' EI can enhance understanding of the emotions of the team and can exchange information by harnessing knowledge-sharing behavior amongst professionals.
Originality/value
This study provides a novel contribution by integrating leaders’ EI, knowledge-sharing behavior, the role of culture and team performance in a single framework. The integrated theoretical model sheds light on team working in the health-care setting and advances the understanding of a leader’s EI and team culture through mapping knowledge sharing particularly being central to enhancing team performance.
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10
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Cassidy DJ, Jogerst K, Coe T, Monette D, Sell N, Eurboonyanum C, Hamdi I, Sampson M, Petrusa E, Stearns D, Gee DW, Chyn A, Saillant N, Takayesu JK. Simulation versus reality: what can interprofessional simulation teach us about team dynamics in the trauma bay? GLOBAL SURGICAL EDUCATION : JOURNAL OF THE ASSOCIATION FOR SURGICAL EDUCATION 2022; 1:56. [PMID: 38013715 PMCID: PMC9614190 DOI: 10.1007/s44186-022-00063-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/21/2022] [Revised: 10/06/2022] [Accepted: 10/11/2022] [Indexed: 11/08/2022]
Abstract
Purpose Surgical consultation and the joint management of trauma patients is a common scenario in the emergency department. The goal of this study was to utilize interprofessional trauma team training to understand the role of simulation and its impact on the overall culture of trauma-related care. Methods Interdisciplinary trauma simulation scenarios were completed by 12 groups of emergency medicine residents, general surgery residents, and emergency medicine nurses across two academic years. Following each simulation, a debriefing session was held to reflect on the scenario, focusing on team interactions. Debriefing sessions were audio-recorded, transcribed, deidentified, and independently, inductively coded by two members of the research team. Using the constant comparative method, a codebook was developed and refined until interrater reliability was confirmed with a kappa of > 0.9. Codes were organized into higher level themes. Results There were 72 participants, including 23 general surgery residents, 19 emergency medicine residents, and 30 emergency medicine nurses. 214 primary codes were collapsed into 29 coding categories, with 6 emerging themes. Pre-trauma bay impact describes how interactions prior to the trauma scenario can impact how team members communicate, trust one another, and ultimately care for the patient. Role and team identity explores the importance of one knowing their individual role in the trauma bay and how it impacts overall team identity. Resource allocation describes the balance of having appropriate resources to efficiently care for patients while not negatively impacting crowd control or role identity. Impact of the simulation experience highlights the impact of the lower stakes simulation scenario on learning and reflection as well as concerns with simulation fidelity. Trauma leader traits and actions outlines inherent traits and learned actions of trauma leaders that impact how the trauma scenario unfolds. Interprofessional team performance describes the overall performance of the trauma team, including but not limited to the type of communication used, teamwork behaviors, and transition of care of the patient. Conclusions Interdisciplinary trauma simulations and structured debriefing sessions provide insights into team dynamics and interprofessional relationships. Simulations and debriefing sessions can promote understanding, respect, and familiarity of team members' roles; recognition of key characteristics of high functioning leaders and teams; and discovery of conflict mitigating strategies for future interdisciplinary team improvement. Simulation sessions allow implementation of quality improvement measures and communication and leadership strategy practice in a safe, collaborative learning environment. The lessons learned from these sessions can encourage participants to reexamine how they interact and function as a team within the real-life trauma bay.
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Affiliation(s)
| | - Kristen Jogerst
- Department of Surgery, Mayo Clinic Hospital, Phoenix, AZ USA
| | - Taylor Coe
- Department of Surgery, Massachusetts General Hospital, Boston, MA USA
| | - Derek Monette
- Department of Emergency Medicine, Massachusetts General Hospital, Boston, MA USA
| | - Naomi Sell
- Department of Surgery, Massachusetts General Hospital, Boston, MA USA
| | | | - Isra Hamdi
- Department of Surgery, Massachusetts General Hospital, Boston, MA USA
| | - Michael Sampson
- Department of Surgery, Massachusetts General Hospital, Boston, MA USA
| | - Emil Petrusa
- Department of Surgery, Massachusetts General Hospital, Boston, MA USA
| | - Dana Stearns
- Department of Emergency Medicine, Massachusetts General Hospital, Boston, MA USA
| | - Denise W. Gee
- Department of Surgery, Massachusetts General Hospital, Boston, MA USA
| | - Angela Chyn
- Department of Emergency Medicine, Massachusetts General Hospital, Boston, MA USA
| | - Noelle Saillant
- Department of Surgery, Massachusetts General Hospital, Boston, MA USA
| | - James K. Takayesu
- Department of Emergency Medicine, Massachusetts General Hospital, Boston, MA USA
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11
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Petrosoniak A, Welsher A, Hicks C. Tubes, lines, and videotape: a new era for quality and safety in trauma resuscitation. CAN J EMERG MED 2022; 24:351-352. [PMID: 35699919 DOI: 10.1007/s43678-022-00323-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2022] [Accepted: 04/26/2022] [Indexed: 11/30/2022]
Affiliation(s)
- Andrew Petrosoniak
- Division of Emergency Medicine, Department of Medicine, University of Toronto, Toronto, ON, Canada.
- St. Michael's Hospital, Toronto, ON, Canada.
| | - Arthur Welsher
- Division of Emergency Medicine, Department of Medicine, University of Toronto, Toronto, ON, Canada
| | - Christopher Hicks
- Division of Emergency Medicine, Department of Medicine, University of Toronto, Toronto, ON, Canada
- St. Michael's Hospital, Toronto, ON, Canada
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12
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The impact of design on workflow: a comparative case study of level I trauma rooms. FACILITIES 2022. [DOI: 10.1108/f-11-2021-0113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose
This study aims to examine trauma room staff’s perception of factors that influence workflow in trauma care from a physical environment standpoint.
Design/methodology/approach
A semi-structured focus group method was used. Trauma team members, representative of various roles within a team, were recruited from five Level I trauma centers in the USA, through a convenience sampling method. A total of 53 participants were recruited to participate in online focus groups. The Systems Engineering Initiative for Patient Safety model was used to analyze the findings.
Findings
In addition to factors directly related to the physical environment, aspects of people and technology, such as crowding and access to technology, were found to be related to the physical environment. Examples of factors that improve or hinder workflow are layout design, appropriate room size, doors, sink locations, access to resources such as X-ray or blood and access to technology. Seamless and uninterrupted workflow is crucial in achieving efficient and safe care in the time-pressured environments of trauma rooms. To support workflow, the physical environment can offer solutions through effective layout design, thoughtful location of resources and technology and room size.
Originality/value
Trauma rooms are time-pressured and complex environments where seconds matter to save a patient’s life. Ensuring safe and efficient care requires seamless workflow. However, the literature on workflow in trauma rooms is limited.
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Davis DP, Bosson N, Guyette FX, Wolfe A, Bobrow BJ, Olvera D, Walker RG, Levy M. Optimizing Physiology During Prehospital Airway Management: An NAEMSP Position Statement and Resource Document. PREHOSP EMERG CARE 2022; 26:72-79. [PMID: 35001819 DOI: 10.1080/10903127.2021.1992056] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Airway management is a critical component of resuscitation but also carries the potential to disrupt perfusion, oxygenation, and ventilation as a consequence of airway insertion efforts, the use of medications, and the conversion to positive-pressure ventilation. NAEMSP recommends:Airway management should be approached as an organized system of care, incorporating principles of teamwork and operational awareness.EMS clinicians should prevent or correct hypoxemia and hypotension prior to advanced airway insertion attempts.Continuous physiological monitoring must be used during airway management to guide the timing of, limit the duration of, and inform decision making during advanced airway insertion attempts.Initial and ongoing confirmation of advanced airway placement must be performed using waveform capnography. Airway devices must be secured using a reliable method.Perfusion, oxygenation, and ventilation should be optimized before, during, and after advanced airway insertion.To mitigate aspiration after advanced airway insertion, EMS clinicians should consider placing a patient in a semi-upright position.When appropriate, patients undergoing advanced airway placement should receive suitable pharmacologic anxiolysis, amnesia, and analgesia. In select cases, the use of neuromuscular blocking agents may be appropriate.
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14
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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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15
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Sieben Punkte für sieben Minuten – Sieben-Punkte-Checkliste für ein medizinisches Briefing in der Luftrettung (7-4-7-Checkliste). Notf Rett Med 2021. [DOI: 10.1007/s10049-020-00799-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Swol J, Brodie D, Willers A, Zakhary B, Belezzo J, Shinar Z, Weingart SD, Haft JW, Lorusso R, Peek GJ. Human factors in ECLS - A keystone for safety and quality - A narrative review for ECLS providers. Artif Organs 2021; 46:40-49. [PMID: 34738639 PMCID: PMC9298045 DOI: 10.1111/aor.14095] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2021] [Revised: 08/12/2021] [Accepted: 10/20/2021] [Indexed: 12/13/2022]
Abstract
INTRODUCTION Although the technology used for extracorporeal life support (ECLS) has improved greatly in recent years, the application of these devices to the patient is quite complex and requires extensive training of team members both individually and together. Human factors is an area that addresses the activities, contexts, environments, and tools which interact with human behavior in determining overall system performance. HYPOTHESIS Analyses of the cognitive behavior of ECLS teams and individual members of these teams with respect to the occurrence of human errors may identify additional opportunities to enhance safety in delivery of ECLS. RESULTS The aim of this article is to support health-care practitioners who perform ECLS, or who are starting an ECLS program, by establishing standards for the safe and efficient use of ECLS with a focus on human factor issues. Other key concepts include the importance of ECLS team leadership and management, as well as controlling the environment and the system to optimize patient care. CONCLUSION Expertise from other industries is extrapolated to improve patient safety through the application of simulation training to reduce error propagation and improve outcomes.
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Affiliation(s)
- Justyna Swol
- Department of Respiratory Medicine, Allergology and Sleep Medicine, Paracelsus Medical University, Nuremberg, Germany
| | - Daniel Brodie
- Department of Medicine and Center for Acute Respiratory Failure, Columbia University College of Physicians and Surgeons/New York-Presbyterian Hospital, New York, New York, USA
| | - Anne Willers
- ECLS Centrum, Cardio-Thoracic Surgery Department, Heart & Vascular Centre, Maastricht University Medical Centre, Cardiovascular Research Institute Maastricht, Maastricht, The Netherlands
| | - Bishoy Zakhary
- Division of Pulmonary and Critical Care Medicine, Oregon Health and Science University, Portland, Oregon, USA
| | - Joseph Belezzo
- Emergency Room Sharp Memorial Hospital, San Diego, California, USA
| | - Zachary Shinar
- Emergency Room Sharp Memorial Hospital, San Diego, California, USA
| | - Scott D Weingart
- Department of Emergency Medicine, Division of Emergency Critical Care, Resuscitation and Acute Critical Care Unit, Stony Brook Hospital, Stony Brook, New York, USA
| | - Jonathan W Haft
- Department of Surgery, University of Michigan Health System, Ann Arbor, Michigan, USA
| | - Roberto Lorusso
- ECLS Centrum, Cardio-Thoracic Surgery Department, Heart & Vascular Centre, Maastricht University Medical Centre, Cardiovascular Research Institute Maastricht, Maastricht, The Netherlands
| | - Giles J Peek
- UF Health Shands Children's Hospital, UF Health Congenital Heart Center, Gainesville, Florida, USA
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17
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Bayramzadeh S, Aghaei P. Technology integration in complex healthcare environments: A systematic literature review. APPLIED ERGONOMICS 2021; 92:103351. [PMID: 33412484 DOI: 10.1016/j.apergo.2020.103351] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/27/2020] [Revised: 12/23/2020] [Accepted: 12/25/2020] [Indexed: 06/12/2023]
Abstract
To support safety and efficient care, effective integration of technology into the timepressured, high-risk healthcare environments is critical. This systematic literature review aimed to highlight the impact of technology on the physical environment as well as the facilitators for and barriers to technology integration into complex healthcare settings, including operating rooms and trauma rooms. PsycINFO, Web of Science, and PubMed databases were utilized, along with a hand search. PRISMA and MMAT guidelines were used for reporting and quality appraisal. Out of 1,001 articles, 20 were eligible. Identified categories included hybrid and integrated environments, technological ambiance, and information technologies. Technology integration has implications for direct patient care, efficiency, throughput, patient safety, teamwork, communication, and the perception of care. The facilitators for and barriers to technology integration included layout design, equipment positioning, and decluttering. The physical environment can improve the impact of technology on factors such as patient safety and efficiency.
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Affiliation(s)
- Sara Bayramzadeh
- Kent State University, College of Architecture and Environmental Design, Healthcare Design Program, 132 S Lincoln St, Kent, OH, 44242, USA.
| | - Parsa Aghaei
- Kent State University, College of Architecture and Environmental Design, Healthcare Design Program, 132 S Lincoln St, Kent, OH, 44242, USA.
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19
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Purdy EI, McLean D, Alexander C, Scott M, Donohue A, Campbell D, Wullschleger M, Berkowitz G, Winearls J, Henry D, Brazil V. Doing our work better, together: a relationship-based approach to defining the quality improvement agenda in trauma care. BMJ Open Qual 2020; 9:bmjoq-2019-000749. [PMID: 32046977 PMCID: PMC7047507 DOI: 10.1136/bmjoq-2019-000749] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2019] [Revised: 12/10/2019] [Accepted: 01/22/2020] [Indexed: 11/06/2022] Open
Abstract
Background Trauma care represents a complex patient journey, requiring multidisciplinary coordinated care. Team members are human, and as such, how they feel about their colleagues and their work affects performance. The challenge for health service leaders is enabling culture that supports high levels of collaboration, co-operation and coordination across diverse groups. We aimed to define and improve relational aspects of trauma care at Gold Coast University Hospital. Methods We conducted a mixed-methods collaborative ethnography using the relational coordination survey—an established tool to analyse the relational dimensions of multidisciplinary teamwork—participant observation, interviews and narrative surveys. Findings were presented to clinicians in working groups for further interpretation and to facilitate co-creation of targeted interventions designed to improve team relationships and performance. Findings We engaged a complex multidisciplinary network of ~500 care providers dispersed across seven core interdependent clinical disciplines. Initial findings highlighted the importance of relationships in trauma care and opportunities to improve. Narrative survey and ethnographic findings further highlighted the centrality of a translational simulation programme in contributing positively to team culture and relational ties. A range of 16 interventions—focusing on structural, process and relational dimensions—were co-created with participants and are now being implemented and evaluated by various trauma care providers. Conclusions Through engagement of clinicians spanning organisational boundaries, relational aspects of care can be measured and directly targeted in a collaborative quality improvement process. We encourage healthcare leaders to consider relationship-based quality improvement strategies, including translational simulation and relational coordination processes, in their efforts to improve care for patients with complex, interdependent journeys.
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Affiliation(s)
- Eve Isabelle Purdy
- Emergency Medicine, Queen's University, Kingston, Ontario, Canada .,Emergency Department, Gold Coast University Hospital, Southport, Queensland, Australia
| | - Darren McLean
- Centre for Health Innovation, Gold Coast University Hospital, Southport, Queensland, Australia
| | - Charlotte Alexander
- Emergency Department, Gold Coast University Hospital, Southport, Queensland, Australia
| | - Matthew Scott
- Trauma Service, Gold Coast University Hospital, Southport, Queensland, Australia
| | - Andrew Donohue
- Anaesthetics, Gold Coast University Hospital, Southport, Queensland, Australia
| | - Don Campbell
- Trauma Service/Emergency Department, Gold Coast University Hospital, Southport, Queensland, Australia
| | - Martin Wullschleger
- Trauma Service/General Surgery, Gold Coast University Hospital, Southport, Queensland, Australia
| | - Gary Berkowitz
- High Acuity Response Unit, Queensland Ambulance Service, Southport, Queensland, Australia
| | - James Winearls
- Intensive Care Unit, Gold Coast University Hospital, Southport, Queensland, Australia
| | - Doug Henry
- Department of Anthropology, University of North Texas, Denton, Texas, USA
| | - Victoria Brazil
- Emergency Department, Gold Coast University Hospital, Southport, Queensland, Australia.,Faculty of Health Sciences and Medicine, Bond University, Robina, Queensland, Australia
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20
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Coggins A, Santos ADL, Zaklama R, Murphy M. Interdisciplinary clinical debriefing in the emergency department: an observational study of learning topics and outcomes. BMC Emerg Med 2020; 20:79. [PMID: 33028206 PMCID: PMC7542715 DOI: 10.1186/s12873-020-00370-7] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Accepted: 09/24/2020] [Indexed: 11/24/2022] Open
Abstract
Background Defined as a ‘guided reflective learning conversation’, ‘debriefing’ is most often undertaken in small groups following healthcare simulation training. Clinical debriefing (CD) following experiences in the working environment has the potential to enhance learning and improve performance. Methods Prior to the study, a literature review was completed resulting in a standardised approach to CD that was used for training faculty. A pilot study of CD (n = 10) was then performed to derive a list of discussion topics and optimise the faculty training. The resulting debriefing approach was based on the “S.T.O.P.” structure (Summarise the case; Things that went well; Opportunities for improvement; Points of action). A debriefing aid, with suggested scripting, was provided. A subsequent observational study assessed CD within 1-h of clinical events. ‘Significantly distressing’ or ‘violent’ events were excluded. Data was collected on participant characteristics, discussion topics, and team recommendations. Study forms were non-identifiable. Subsequent analysis was performed by two investigators using content analysis of the debriefing forms (n = 71). Discussion topics (learning points) were coded using a modified version of the Promoting Excellence and Reflective Learning in Simulation (PEARLS) framework. One month after completion of the study, ED management staff were surveyed for reports of “harm” as the result of CD. Results During the study period, 71 CDs were recorded with a total of 506 participants. Mean debriefing length was 10.93 min (SD 5.6). Mean attendance was 7.13 (SD 3.3) participants. CD topics discussed were divided into ‘plus’ (well-done) and ‘delta’ (need to improve) groupings. 232 plus domains were recorded of which 195 (84.1%) aligned with the PEARLS debriefing framework, suggesting simulation debriefing skills may be translatable to a clinical setting. Topics discussed outside the PEARLS framework included family issues, patient outcome and environmental factors. CD reports led to preventative interventions for equipment problems and to changes in existing protocols. There were no recorded incidents of participant harm resulting from CD. Conclusions Topics discussed in CD predominantly aligned to those commonly observed in simulation-based medical education. Collective recommendations from CD can be used as evidence for improving existing protocols and models of care.
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Affiliation(s)
- Andrew Coggins
- Department of Emergency Medicine, Westmead Hospital, Hawkesbury Road, Sydney, NSW, 2145, Australia.
| | - Aaron De Los Santos
- Department of Emergency Medicine, Westmead Hospital, Hawkesbury Road, Sydney, NSW, 2145, Australia
| | - Ramez Zaklama
- Department of Emergency Medicine, Westmead Hospital, Hawkesbury Road, Sydney, NSW, 2145, Australia
| | - Margaret Murphy
- Department of Emergency Medicine, Westmead Hospital, Hawkesbury Road, Sydney, NSW, 2145, Australia
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Brydges R, Campbell DM, Beavers L, Khodadoust N, Iantomasi P, Sampson K, Goffi A, Caparica Santos FN, Petrosoniak A. Lessons learned in preparing for and responding to the early stages of the COVID-19 pandemic: one simulation's program experience adapting to the new normal. Adv Simul (Lond) 2020; 5:8. [PMID: 32514385 PMCID: PMC7267752 DOI: 10.1186/s41077-020-00128-y] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Accepted: 05/19/2020] [Indexed: 12/22/2022] Open
Abstract
Use of simulation to ensure an organization is ready for significant events, like COVID-19 pandemic, has shifted from a "backburner" training tool to a "first choice" strategy for ensuring individual, team, and system readiness. In this report, we summarize our simulation program's response during the COVID-19 pandemic, including the associated challenges and lessons learned. We also reflect on anticipated changes within our program as we adapt to a "new normal" following this pandemic. We intend for this report to function as a guide for other simulation programs to consult as this COVID-19 crisis continues to unfold, and during future challenges within global healthcare systems. We argue that this pandemic has cemented simulation programs as fundamental for any healthcare organization interested in ensuring its workforce can adapt in times of crisis. With the right team and set of partners, we believe that sustained investments in a simulation program will amplify into immeasurable impacts across a healthcare system.
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Affiliation(s)
- Ryan Brydges
- Unity Health Toronto – Simulation Program, St. Michael’s Hospital, Unity Health Toronto, Toronto, Canada
- Department of Medicine, University of Toronto, Toronto, Canada
| | - Douglas M. Campbell
- Unity Health Toronto – Simulation Program, St. Michael’s Hospital, Unity Health Toronto, Toronto, Canada
- Department of Paediatrics, University of Toronto, Toronto, Canada
| | - Lindsay Beavers
- Unity Health Toronto – Simulation Program, St. Michael’s Hospital, Unity Health Toronto, Toronto, Canada
- Department of Physical Therapy, University of Toronto, Toronto, Canada
| | - Nazanin Khodadoust
- Unity Health Toronto – Simulation Program, St. Michael’s Hospital, Unity Health Toronto, Toronto, Canada
| | - Paula Iantomasi
- Unity Health Toronto – Simulation Program, St. Michael’s Hospital, Unity Health Toronto, Toronto, Canada
| | - Kristen Sampson
- Unity Health Toronto – Simulation Program, St. Michael’s Hospital, Unity Health Toronto, Toronto, Canada
| | - Alberto Goffi
- Department of Medicine, Division of Critical Care Medicine, St. Michael’s Hospital, Unity Health Toronto, Toronto, Canada
- Department of Medicine and Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, Canada
| | - Filipe N. Caparica Santos
- Department of Anesthesia, St. Michael’s Hospital, Unity Health Toronto, Toronto, Canada
- Department of Anesthesiology and Pain Medicine, University of Toronto, Toronto, Canada
| | - Andrew Petrosoniak
- Unity Health Toronto – Simulation Program, St. Michael’s Hospital, Unity Health Toronto, Toronto, Canada
- Department of Medicine, University of Toronto, Toronto, Canada
- Department of Emergency Medicine, St. Michael’s Hospital, Toronto, Canada
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22
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Purdy E, Alexander C, Shaw R, Brazil V. The team briefing: setting up relational coordination for your resuscitation. Clin Exp Emerg Med 2020; 7:1-4. [PMID: 32252127 PMCID: PMC7141984 DOI: 10.15441/ceem.19.021] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2019] [Accepted: 04/15/2019] [Indexed: 11/23/2022] Open
Affiliation(s)
- Eve Purdy
- Department of Emergency Medicine, Queen's University, Kingston, ON, Canada.,Emergency Department, Gold Coast University Hospital, Southport, QLD, Australia
| | - Charlotte Alexander
- Emergency Department, Gold Coast University Hospital, Southport, QLD, Australia
| | - Rebecca Shaw
- Emergency Department, Gold Coast University Hospital, Southport, QLD, Australia
| | - Victoria Brazil
- Emergency Department, Gold Coast University Hospital, Southport, QLD, Australia.,Faculty of Health Sciences and Medicine, Bond University, Robina, QLD, Australia
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23
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Parsons M, Bailitz J, Chung AS, Mannix A, Battaglioli N, Clinton M, Gottlieb M. Evidence-Based Interventions that Promote Resident Wellness from the Council of Emergency Residency Directors. West J Emerg Med 2020; 21:412-422. [PMID: 32191199 PMCID: PMC7081870 DOI: 10.5811/westjem.2019.11.42961] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2019] [Accepted: 11/19/2019] [Indexed: 12/15/2022] Open
Abstract
Initiatives for addressing resident wellness are a recent requirement of the Accreditation Council for Graduate Medical Education in response to high rates of resident burnout nationally. We review the literature on wellness and burnout in residency education with a focus on assessment, individual-level interventions, and systemic or organizational interventions.
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Affiliation(s)
- Melissa Parsons
- University of Florida College of Medicine, Department of Emergency Medicine, Jacksonville, Florida
| | - John Bailitz
- Northwestern University Feinberg School of Medicine, Department of Emergency Medicine, Chicago, Illinois
| | - Arlene S Chung
- Maimonides Medical Center, Department of Emergency Medicine, Brooklyn, New York
| | - Alexandra Mannix
- University of Florida College of Medicine, Department of Emergency Medicine, Jacksonville, Florida
| | - Nicole Battaglioli
- Maimonides Medical Center, Department of Emergency Medicine, Brooklyn, New York
| | - Michelle Clinton
- Carilion Clinic, Department of Emergency Medicine, Roanoke, Virginia
| | - Michael Gottlieb
- Rush Medical Center, Department of Emergency Medicine, Chicago, Illinois
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24
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Fitzgerald M, Reilly S, Smit DV, Kim Y, Mathew J, Boo E, Alqahtani A, Chowdhury S, Darez A, Mascarenhas JB, O'Keeffe F, Noonan M, Nickson C, Marquez M, Li WA, Zhang YL, Williams K, Mitra B. The World Health Organization trauma checklist versus Trauma Team Time-out: A perspective. Emerg Med Australas 2019; 31:882-885. [PMID: 31081585 PMCID: PMC6851662 DOI: 10.1111/1742-6723.13306] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2019] [Accepted: 04/08/2019] [Indexed: 11/29/2022]
Abstract
Time‐out protocols have reportedly improved team dynamics and patients’ safety in various clinical settings – particularly in the operating room. In 2016, the World Health Organization (WHO) introduced a Trauma Care checklist, which outlines steps to follow immediately after the primary and secondary surveys and prior to the team leaving the patient. The WHO Trauma Care checklist's main perceived benefit is the prompting of clinicians to complete trauma admissions as per evidence‐based guidelines. The WHO Trauma Care checklist, while likely to be successful in reducing errors of omission related to hospital admission, may be limited in its ability to reduce errors that occur in the initial 30 min of trauma reception – when most of the life‐saving decisions are made. To address this limitation a Trauma Team Time‐out protocol is proposed for initial trauma resuscitation, targeting the critical first 30 min of hospital reception.
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Affiliation(s)
- Mark Fitzgerald
- Trauma Services, The Alfred Hospital, Melbourne, Victoria, Australia.,National Trauma Research Institute, Monash University, Melbourne, Victoria, Australia
| | - Stephanie Reilly
- Trauma Services, The Alfred Hospital, Melbourne, Victoria, Australia.,National Trauma Research Institute, Monash University, Melbourne, Victoria, Australia
| | - De Villiers Smit
- National Trauma Research Institute, Monash University, Melbourne, Victoria, Australia.,Emergency and Trauma Centre, The Alfred Hospital, Melbourne, Victoria, Australia
| | - Yesul Kim
- National Trauma Research Institute, Monash University, Melbourne, Victoria, Australia
| | - Joseph Mathew
- Trauma Services, The Alfred Hospital, Melbourne, Victoria, Australia.,National Trauma Research Institute, Monash University, Melbourne, Victoria, Australia.,Emergency and Trauma Centre, The Alfred Hospital, Melbourne, Victoria, Australia
| | - Ellaine Boo
- National Trauma Research Institute, Monash University, Melbourne, Victoria, Australia
| | - Abdulrahman Alqahtani
- Trauma Service, King Saud Medical City, Ministry of Health, Riyadh, Kingdom of Saudi Arabia
| | - Sharfuddin Chowdhury
- Trauma Service, King Saud Medical City, Ministry of Health, Riyadh, Kingdom of Saudi Arabia
| | - Ahamed Darez
- Tamil Nadu Accident and Emergency Initiative, Government of Tamil Nadu, Chennai, India
| | - Jma Bruno Mascarenhas
- Tamil Nadu Accident and Emergency Initiative, Government of Tamil Nadu, Chennai, India
| | - Francis O'Keeffe
- National Trauma Research Institute, Monash University, Melbourne, Victoria, Australia.,Emergency Services, The Mater Misericordiae University Hospital, Dublin, Ireland
| | - Michael Noonan
- Trauma Services, The Alfred Hospital, Melbourne, Victoria, Australia.,National Trauma Research Institute, Monash University, Melbourne, Victoria, Australia.,Emergency and Trauma Centre, The Alfred Hospital, Melbourne, Victoria, Australia
| | - Chris Nickson
- Intensive Care, The Alfred Hospital, Melbourne, Victoria, Australia
| | - Marc Marquez
- Emergency and Trauma Centre, The Alfred Hospital, Melbourne, Victoria, Australia
| | - Wang An Li
- Trauma Service, Huizhou First Hospital, Guangdong, China
| | - Yan Ling Zhang
- Trauma Service, Huizhou First Hospital, Guangdong, China
| | - Kim Williams
- Trauma Services, The Alfred Hospital, Melbourne, Victoria, Australia.,National Trauma Research Institute, Monash University, Melbourne, Victoria, Australia
| | - Biswadev Mitra
- National Trauma Research Institute, Monash University, Melbourne, Victoria, Australia.,Emergency and Trauma Centre, The Alfred Hospital, Melbourne, Victoria, Australia.,Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
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25
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Murphy M, McCloughen A, Curtis K. Enhancing the training of trauma resuscitation flash teams: A mixed methods study. Australas Emerg Care 2018; 21:143-149. [PMID: 30998890 DOI: 10.1016/j.auec.2018.10.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2018] [Revised: 09/28/2018] [Accepted: 10/04/2018] [Indexed: 11/26/2022]
Abstract
AIMS To determine whether simulated multidisciplinary team training influences teamwork practices and experiences when resuscitating critically injured patients and to generate evidence for training trauma resuscitation flash teams. BACKGROUND Trauma teams perform in stressful situations. They are 'flash' teams, mobilised quickly and comprise of different specialties and disciplines. Simulation is promoted as a training strategy. Significant gaps remain in evaluating the impact of this training on clinical practice. Further research is warranted to determine the most effective way to train trauma resuscitation flash team. DESIGN Final integration phase of a mixed methods embedded experimental study. METHODS Primary quantitative results (time to critical operations, facilitators and barriers to teamwork) were merged with supplementary qualitative results (team members' experiences and perspectives) to explain the influences of simulated multidisciplinary trauma team training on teamwork and patient outcomes. RESULTS Four main themes were developed: communication needs to be specific to the emergency context; collaborative decision-making influences resuscitation situations; standardisation promotes efficient trauma care; proficient leadership empowers multidisciplinary teamwork. CONCLUSION Frontline clinicians identified real-world experiences that enable or impede team performance in trauma resuscitations. Our findings ascertain why multidisciplinary team training enhances team performance and what content should be incorporated in training programmes.
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Affiliation(s)
- Margaret Murphy
- Sydney Nursing School, University of Sydney, Sydney, NSW, Australia; Emergency Department, Westmead Hospital, Westmead, NSW, Australia.
| | | | - Kate Curtis
- Sydney Nursing School, University of Sydney, Sydney, NSW, Australia; Emergency Department, Illawarra Shoalhaven, Australia
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Lapostolle F, Loeb T, Lecarpentier E, Vivien B, Pasquier P, Raux M. Comment appréhender une tuerie de masse pour les équipes Smur primo-intervenantes ? ANNALES FRANCAISES DE MEDECINE D URGENCE 2018. [DOI: 10.3166/afmu-2018-0084] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Le risque terroriste présent sur l’ensemble de notre territoire depuis plusieurs années conduit les équipes de Samu–Smur à intervenir sur les lieux d’une tuerie de masse aux côtés de forces de sécurité, voire en tant que primointervenants. De telles circonstances exposent les équipes à un environnement de travail inhabituel et hostile. Cette mise au point, proposée en complément de la recommandation formalisée d’experts sur la prise en charge de tuerie de masse, répond aux interrogations qui naissent sur le terrain en pareilles circonstances. Elle facilite une juste appréciation des événements, aide à réguler ses émotions, dans le but d’augmenter la capacité des soignants à agir, tout en réduisant la phase de sidération initiale, elle-même responsable d’une inertie à même d’impacter le pronostic des blessés en choc hémorragique. Des procédures anticipées, sous forme de check-lists, guident les actions à mener de manière sereine. Les équipes médicales préhospitalières doivent apporter sur le terrain non seulement une compétence médicale, mais également une compétence tactique et décisionnelle pour accélérer les flux d’évacuation. Le premier médecin engagé doit aider à la décision aux côtés du commandant des opérations de secours, du commandant des opérations de police et de gendarmerie et des médecins intégrés aux forces de sécurité intérieure en attendant le directeur des secours médicaux. Il doit donc également faire preuve d’une compétence de chef d’équipe.
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27
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Lai S, Jain A, Mason J, Grock A. Beyond ATLS: Demystifying the Expert Resuscitationist. Ann Emerg Med 2018; 72:299-301. [DOI: 10.1016/j.annemergmed.2018.07.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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