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Garcia SI, Finch AS, Ridgeway JL, Beckman TJ, Montori VM, Rivera M, Gajic O, Kennedy CC, Kelm DJ. Understanding Team Dynamics and Culture of Safety Using Video Reflexive Ethnography during Real-Time Emergent Intubation. Ann Am Thorac Soc 2024; 21:1065-1073. [PMID: 38470228 DOI: 10.1513/annalsats.202310-901oc] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2023] [Accepted: 03/08/2024] [Indexed: 03/13/2024] Open
Abstract
Rationale: Endotracheal intubation is the third most common bedside procedure in U.S. hospitals. In over 40% of intubations, preventable complications attributable to human factors occur. A better understanding of team dynamics during intubation may improve patient safety. Objectives: To explore team dynamics and safety-related actions during emergent endotracheal intubations in the emergency department and intensive care unit and to engage members of the care team in reflection for process improvement through a novel video-based team debriefing technique. Methods: Video-reflexive ethnography involves in situ video recording and reflexive discussions with practitioners to scrutinize behaviors and to identify opportunities for improvement. In this study, real-time intubations were recorded in the emergency department and intensive care unit at Mayo Clinic Rochester, and facilitated video-reflexive sessions were conducted with the multidisciplinary procedural teams. Themes about team dynamics and safety-related action were identified inductively from transcriptions of recorded sessions. Results: Between December 2022 and January 2023, eight video-reflexive sessions were conducted with a total of 78 participants. Multidisciplinary members included nurses (n = 23), respiratory therapists (n = 16), pharmacists (n = 7), advanced practitioners (n = 5), and physicians (n = 26). In video-reflexive discussions, major safety gaps were identified and several solutions were proposed related to the use of a multidisciplinary intubation checklist, standardized communication and team positioning, developing a culture of safety, and routinely debriefing after the procedure. Conclusions: The findings of this study may inform the development of a team supervision model for emergent endotracheal intubations. This approach could integrate key components such as a multidisciplinary intubation checklist, standardized communication and team positioning, a culture of safety, and debriefing as part of the procedure itself.
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Affiliation(s)
| | | | - Jennifer L Ridgeway
- Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, Minnesota
| | | | | | | | - Ognjen Gajic
- Division of Pulmonary, Critical Care, and Sleep Medicine
| | - Cassie C Kennedy
- Division of Pulmonary, Critical Care, and Sleep Medicine
- Division of Healthcare Delivery Research, Mayo Clinic College of Medicine and Science, Rochester, Minnesota; and
| | - Diana J Kelm
- Division of Pulmonary, Critical Care, and Sleep Medicine
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Steinbach TC, Jennerich AL, Çoruh B. Effective Behaviors of Leaders During Clinical Emergencies: A Qualitative Study of Followers' Perspectives. Chest 2024:S0012-3692(24)00685-8. [PMID: 38838955 DOI: 10.1016/j.chest.2024.05.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2024] [Revised: 04/29/2024] [Accepted: 05/04/2024] [Indexed: 06/07/2024] Open
Abstract
BACKGROUND To manage a clinical emergency effectively, physicians need well-developed leadership skills, yet limited structured leadership training is available for critical care trainees. To develop an effective curriculum, leadership competencies first must be defined. RESEARCH QUESTION During clinical emergencies, what leadership behaviors do followers value? STUDY DESIGN AND METHODS We conducted qualitative interviews with members of multidisciplinary critical care teams at a large academic health system, with participants including resident physicians, nurses, and respiratory therapists (N = 15). Thematic analysis was used to categorize leadership behaviors that followers perceived to be effective. RESULTS We identified three themes related to leadership during clinical emergencies: control, collaboration, and common understanding. Participants described behaviors they believed resulted in both effective and ineffective leadership. For effective leaders, control, the most dominant theme, included behaviors that clearly established roles for the leader and followers, allowing the leader to guide care during a clinical emergency. Collaboration referenced the ability of a leader to maintain a collegial environment. Finally, common understanding reflected a leader's ability to manage communication in a way that fostered a shared mental model across team members. INTERPRETATION During clinical emergencies, followers value leaders who assert themselves while also maintaining positive team interaction and encouraging an organized flow of information. Our findings provide a potential framework to develop a leadership curriculum for critical care trainees.
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Affiliation(s)
- Trevor C Steinbach
- Division of Pulmonary Sciences and Critical Care Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO.
| | - Ann L Jennerich
- Division of Pulmonary, Critical Care and Sleep Medicine, University of Washington, Seattle, WA
| | - Başak Çoruh
- Division of Pulmonary, Critical Care and Sleep Medicine, University of Washington, Seattle, WA
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Valdivia de la Fuente M, Palacios Castañeda DJ, Martínez Sanz N. The human factor and ergonomics in Patient Safety. Med Intensiva 2024:S2173-5727(24)00106-1. [PMID: 38763833 DOI: 10.1016/j.medine.2024.03.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2023] [Accepted: 03/29/2024] [Indexed: 05/21/2024]
Abstract
The human condition is linked to error in any activity that is performed, and the healthcare world is no exception. The origin of human error does not lie within the perversity of human nature, instead, it has its origins in latent failures in the healthcare environment and is a consequence of the processes and procedures applied. The science of the Human Factor deals with the application of knowledge to people (capabilities, characteristics and limitations), with the design and the management of the equipment they use and with the environments in which they work and the activities they carry out. Part of the Human Factor are the non-technical skills. These skills greatly influence people's behavior and, therefore, their performance and the quality of healthcare in a very complex socio-technical system.
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Affiliation(s)
- Miguel Valdivia de la Fuente
- Servicio de Medicina Intensiva, Hospital Universitario Puerta de Hierro Majadahonda, Majadahonda, Madrid, Spain.
| | | | - Nuria Martínez Sanz
- Servicio de Medicina Intensiva, Hospital Universitario Puerta de Hierro Majadahonda, Majadahonda, Madrid, Spain
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Clarke-Romain B. Supporting nurses in acute and emergency care settings to speak up. Emerg Nurse 2024; 32:16-21. [PMID: 37723863 DOI: 10.7748/en.2023.e2162] [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] [Accepted: 06/28/2023] [Indexed: 09/20/2023]
Abstract
Nurses' competence and confidence in raising concerns with senior clinicians is integral to patient safety and the quality of patient care. If nurses do not speak up when needed it can contribute to incidences of failure to rescue. There are many barriers to nurses speaking up in busy emergency departments and complex major trauma patient cases. Assessment and communication tools such as the SBAR (situation, background, assessment, recommendation) approach and communication techniques such as graded assertiveness can help to overcome some of these barriers. This article uses a case study to discuss how nurses can respectfully but efficiently escalate their concerns to the trauma team leader. It describes barriers to nurses speaking up and tools that can support nurses to speak up, with a focus on graded assertiveness.
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Affiliation(s)
- Binx Clarke-Romain
- emergency department, Royal London Hospital, Barts Health NHS Trust, London, England
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Eid J, Brattebø G, Jacobsen JK, Espevik R, Johnsen BH. Distributed team processes in healthcare services: a scoping review. Front Med (Lausanne) 2023; 10:1291877. [PMID: 38162887 PMCID: PMC10756666 DOI: 10.3389/fmed.2023.1291877] [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: 09/11/2023] [Accepted: 11/27/2023] [Indexed: 01/03/2024] Open
Abstract
Objective High-quality healthcare services is delivered by teams rather than individuals and depends heavily on multidisciplinary cooperation between dispersed healthcare professionals. The aim of this scoping review is to identify common barriers and innovative applications of technology supporting team processes and patient safety, in geographically dispersed healthcare services. Methods Studies were identified from searches in APA PsychINFO, Epistemonikos and Medline databases, from 2010 to 2023. A detailed search strategy was performed, and studies were included, based on prior established criteria. Results Among the 19 studies that fulfilled our inclusion criteria, the majority (85%) were from Europe or North America, and most studies (53%) were quantitative, with a cross-sectional study design. Several reported observed distributed team processes in training and education. Most studies described barriers and detailed how innovative approaches and technological solutions were introduced to improve communication, coordination, and shared mental models in distributed healthcare settings. A small proportion of studies (16%) used health services data to examine interpersonal exchange and team processes. Conclusion The scoping review offer recommendations to enhance future research on distributed team processes in healthcare services.
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Affiliation(s)
- Jarle Eid
- Centre for Crisis Psychology, University of Bergen, Bergen, Norway
| | - Guttorm Brattebø
- Department of Anaesthesia and Intensive Care, Norwegian National Advisory Unit on Emergency Medical Communication, Haukeland University Hospital, Bergen, Norway
- Department of Clinical Medicine, University of Bergen, Bergen, Norway
| | | | - Roar Espevik
- Department of Leadership, Command and Control, Swedish Defence University, Stockholm, Sweden
| | - Bjørn Helge Johnsen
- Department of Leadership, Command and Control, Swedish Defence University, Stockholm, Sweden
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Guetterman TC, Forman J, Fouche S, Simpson K, Fetters MD, Nelson C, Mendel P, Hsu A, Flohr JA, Domeier R, Rahim R, Nallamothu BK, Abir M. A cross-stakeholder approach to improving out-of-hospital cardiac arrest survival. Am Heart J 2023; 266:106-119. [PMID: 37709108 DOI: 10.1016/j.ahj.2023.09.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Revised: 09/01/2023] [Accepted: 09/06/2023] [Indexed: 09/16/2023]
Abstract
BACKGROUND Out-of-hospital cardiac arrest (OHCA) affects over 300,000 individuals per year in the United States with poor survival rates overall. A remarkable 5-fold difference in survival-to-hospital discharge rates exist across United States communities. METHODS We conducted a study using qualitative research methods comparing the system of care across sites in Michigan communities with varying OHCA survival outcomes, as measured by return to spontaneous circulation with pulse upon emergency department arrival. RESULTS Major themes distinguishing higher performing sites were (1) working as a team, (2) devoting resources to coordination across agencies, and (3) developing a continuous quality improvement culture. These themes spanned the chain of survival framework for OHCA. By examining the unique processes, procedures, and characteristics of higher- relative to lower-performing sites, we gleaned lessons learned that appear to distinguish higher performers. The higher performing sites reported being the most collaborative, due in part to facilitation of system integration by progressive leadership that is willing to build bridges among stakeholders. CONCLUSIONS Based on the distinguishing features of higher performing sites, we provide recommendations for toolkit development to improve survival in prehospital systems of care for OHCA.
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Affiliation(s)
- Timothy C Guetterman
- Acute Care Research Unit, University of Michigan, Ann Arbor, MI; Mixed Methods Program and Department of Family Medicine, University of Michigan Medical School, Ann Arbor, MI; Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI
| | - Jane Forman
- Acute Care Research Unit, University of Michigan, Ann Arbor, MI; Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI; Qualitative and Mixed Methods Core, Center for Clinical Management Research, U.S. Department of Veterans Affairs, Ann Arbor, MI
| | - Sydney Fouche
- Acute Care Research Unit, University of Michigan, Ann Arbor, MI
| | - Kaitlyn Simpson
- Acute Care Research Unit, University of Michigan, Ann Arbor, MI; University of Michigan Medical School, Ann Arbor, MI
| | - Michael D Fetters
- Mixed Methods Program and Department of Family Medicine, University of Michigan Medical School, Ann Arbor, MI
| | | | | | - Antony Hsu
- Trinity Health Ann Arbor Hospital, Ann Arbor, MI
| | - Jessica A Flohr
- Acute Care Research Unit, University of Michigan, Ann Arbor, MI
| | - Robert Domeier
- Trinity Health Ann Arbor Hospital, Ann Arbor, MI; Department of Emergency Medicine, University of Michigan Medical School, Ann Arbor, MI
| | - Rebal Rahim
- Department of Clinical Sciences, Anesthesia and Intensive Care, Lund University, Skane University Hospital, Malmo, Sweden
| | - Brahmajee K Nallamothu
- Acute Care Research Unit, University of Michigan, Ann Arbor, MI; Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI; Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, MI; Max Harry Weil Institute for Critical Care Research and Innovation, University of Michigan, Ann Arbor, MI
| | - Mahshid Abir
- Acute Care Research Unit, University of Michigan, Ann Arbor, MI; RAND Corporation, Santa Monica, CA; Department of Emergency Medicine, University of Michigan Medical School, Ann Arbor, MI.
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Urwin R, Pavithra A, McMullan RD, Churruca K, Loh E, Moore C, Li L, Westbrook JI. Hospital staff reports of coworker positive and unprofessional behaviours across eight hospitals: who reports what about whom? BMJ Open Qual 2023; 12:e002413. [PMID: 37963673 PMCID: PMC10649603 DOI: 10.1136/bmjoq-2023-002413] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Accepted: 10/26/2023] [Indexed: 11/16/2023] Open
Abstract
BACKGROUND Workplace behaviours of healthcare staff impact patient safety, staff well-being and organisational outcomes. A whole-of-hospital culture change programme, Ethos, was implemented by St. Vincent's Health Australia across eight hospitals. Ethos includes a secure online submission system that allows staff across all professional groups to report positive (Feedback for Recognition) and negative (Feedback for Reflection) coworker behaviours. We analysed these submissions to determine patterns and rates of submissions and identify the coworker behaviours reported. METHOD All Ethos submissions between 2017 and 2020 were deidentified and analysed. Submissions include structured data elements (eg, professional role of the reporter and subjects, event and report dates) and a narrative account of the event and coworker behaviours. Descriptive statistics were calculated to assess use and reporting patterns. Coding of the content of submissions was performed to classify types of reported coworker behaviours. RESULTS There were a total of 2504 Ethos submissions, including 1194 (47.7%) Recognition and 1310 (52.3%) Reflection submissions. Use of the submission tool was highest among nurses (20.14 submissions/100 nursing staff) and lowest among non-clinical services staff (5.07/100 non-clinical services staff). Nurses were most frequently the subject of Recognition submissions (7.56/100 nurses) while management and administrative staff were the least (4.25/100 staff). Frequently reported positive coworker behaviours were non-technical skills (79.3%, N=947); values-driven behaviours (72.5%, N=866); and actions that enhanced patient care (51.3%, N=612). Medical staff were the most frequent subjects of Reflection submissions (12.59/100 medical staff), and non-clinical services staff the least (4.53/100 staff). Overall, the most frequently reported unprofessional behaviours were being rude (53.8%, N=705); humiliating or ridiculing others (26%, N=346); and ignoring others' opinions (24.6%, N=322). CONCLUSION Hospital staff across all professional groups used the Ethos messaging system to report both positive and negative coworker behaviours. High rates of Recognition submissions demonstrate a strong desire of staff to reward and encourage positive workplace behaviours, highlighting the importance of culture change programmes which emphasise these behaviours. The unprofessional behaviours identified in submissions are consistent with behaviours previously reported in surveys of hospital staff, suggesting that submissions are a reliable indicator of staff experiences.
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Affiliation(s)
- Rachel Urwin
- Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
| | - Antoinette Pavithra
- Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
| | - Ryan D McMullan
- Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
| | - Kate Churruca
- Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
| | - Erwin Loh
- St Vincent's Health Australia Ltd Fitzroy, Fitzroy, Victoria, Australia
| | - Carolyn Moore
- St Vincent's Health Australia Ltd Fitzroy, Fitzroy, Victoria, Australia
| | - Ling Li
- Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
| | - Johanna I Westbrook
- Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
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Chen YC, Issenberg SB, Chiu YJ, Chen HW, Issenberg Z, Kang YN, Lin CW, Wu JC. Exploration of students' reaction in medical error events and the impact of personalized training on the speaking-up behavior in medical error events. MEDICAL TEACHER 2023; 45:368-374. [PMID: 36288746 DOI: 10.1080/0142159x.2022.2137394] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
BACKGROUND The ability of medical students to speak up before a medical error occurs is a timely and necessary interaction to prevent potential patient harm. As it may be crucial to improve patient safety, we explored how medical students react to a medical error and provided them appropriate training regarding speaking up about medical issues. METHODS A quasi-experimental study was conducted in Taiwan involving 153 medical students who participated in a speaking-up simulation course. They were divided into two groups. The first group participated in a non-life-threatening scenario before the intervention, followed by a personalized debriefing session, then a life-threatening scenario after the intervention. The second group participated in a life-threatening scenario before the intervention, followed by a personalized debriefing session, then a non-life-threatening scenario after the intervention. Students also completed patient safety attitude survey. RESULTS During the preintervention scenario, the overall medical students' speaking-up rate to medical error was 45.1%. The speaking-up rate of medical students in life-threatening scenario was significantly higher than the rate in non-life-threatening scenario before the intervention (64.6% vs 24.3%, p < 0.001). After personalized debriefing, the speaking-up rate to medical errors was significantly improved both in life-threatening scenarios (95.9%, p < 0.001) and in non-life-threatening scenarios (100%, p < 0.001). Male medical students had significantly higher speaking-up rates than female students in life-threatening scenario (76.2% vs 51.4%, p = 0.02). On post-intervention surveys, students provided several reasons for their likelihood of speaking up or remaining silent during a medical error event. CONCLUSIONS Medical students' rate of speaking-up to medical error was higher in a simulated life-threatening scenario than in a simulated non-life-threatening scenario. Faculty-led personalized debriefing can facilitate medical students' adoption of communication strategies to speak up more in medical error events. Educators should also consider gender differences when they design effective assertive communication courses.[Box: see text].
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Affiliation(s)
- Yi-Chun Chen
- Department of Emergency Medicine, Taipei Medical University Hospital, Taipei, Taiwan
| | - S Barry Issenberg
- Michael S. Gordon Center for Simulation and Innovation in Medical Education, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Yu-Jui Chiu
- Department of Emergency Medicine, Taipei Medical University Hospital, Taipei, Taiwan
| | - Hui-Wen Chen
- NP, Department of Nursing, College of Nursing, National Yang Ming Chiao Tung University, Taipei, Taiwan, R.O.C
| | | | - Yi-No Kang
- Department of Medical Education and Humanities, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
- Institute of Health Policy & Management, College of Public Health, National Taiwan University, Taipei, Taiwan
- Department of Health Care Management, College of Health Technology, National Taipei University of Nursing Health Sciences, Taipei, Taiwan
- Evidence-Based Medicine Center, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan
| | - Che-Wei Lin
- Department of Medical Education and Humanities, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
- Department of Emergency, Taipei Medical University Shuang Ho Hospital, Taipei, Taiwan
| | - Jen-Chieh Wu
- Department of Emergency Medicine, Taipei Medical University Hospital, Taipei, Taiwan
- Department of Medical Education and Humanities, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
- Department of Education, Taipei Medical University Hospital, Taipei, Taiwan
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Gartland R, Conlon L, Livingston S, Glick JE, Bach G, Abboud ME. Resuscitation Leadership Training: A Simulation Curriculum for Emergency Medicine Residents. MEDEDPORTAL : THE JOURNAL OF TEACHING AND LEARNING RESOURCES 2022; 18:11278. [PMID: 36300144 PMCID: PMC9550795 DOI: 10.15766/mep_2374-8265.11278] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 03/16/2022] [Accepted: 08/08/2022] [Indexed: 06/16/2023]
Abstract
INTRODUCTION Throughout training, emergency medicine (EM) residents must learn to work within, and eventually lead, multidisciplinary teams in high-acuity dynamic situations. Most residents do not undergo formal resuscitation team leadership training but learn these skills through mentorship by and observation of senior physicians. We designed and implemented a formal simulation-based leadership training program for EM residents. METHODS We developed a resuscitation team leadership curriculum in which 24 junior EM residents participated in an initial simulation of a critically ill patient before undergoing a didactic presentation regarding crisis resource management (CRM) principles. Residents applied those principles in three subsequent simulations. Faculty observers evaluated each case using EM Milestones, the Ottawa Global Rating Scale (GRS), and critical actions checklists. Residents then completed surveys evaluating their own leadership and communication skills before and after the course. RESULTS Scores from the Ottawa GRS, critical actions checklists, and several of the EM Milestones were significantly better in the latter three cases (after completing the CRM didactics) than in the first case. After completing this curriculum, residents felt that their ability to both lead resuscitations and communicate effectively with their team improved. DISCUSSION Implementation of the resuscitation team leadership curriculum improved EM residents' leadership performance in critically ill patient scenarios. The curriculum also improved residents' comfort in leading and communicating with a team. Similar formal leadership development curricula, especially when combined with simulation, may enhance EM physician training. Future studies will include other multidisciplinary team members to create a more realistic and inclusive learning environment.
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Affiliation(s)
- Rachel Gartland
- Instructor of Clinical Emergency Medicine, Department of Emergency Medicine, University of Rochester Medical Center
| | - Lauren Conlon
- Associate Professor, Department of Emergency Medicine, Perelman School of Medicine at the University of Pennsylvania
| | - Scott Livingston
- Second-Year Resident, Department of Emergency Medicine, Hospital of the University of Pennsylvania
| | - Joshua E. Glick
- Assistant Professor, Department of Emergency Medicine, Perelman School of Medicine at the University of Pennsylvania
| | - Gillian Bach
- First-Year Fellow, Department of Emergency Medicine, Hospital of the University of Pennsylvania
| | - Michael E. Abboud
- Assistant Professor, Department of Emergency Medicine, Perelman School of Medicine at the University of Pennsylvania
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Interdisziplinäre und interprofessionelle Kommunikation im Team. Med Klin Intensivmed Notfmed 2022; 117:588-594. [DOI: 10.1007/s00063-022-00955-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2022] [Accepted: 08/16/2022] [Indexed: 10/14/2022]
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11
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Doorey AJ, Turi ZG, Lazzara EH, Casey M, Kolm P, Garratt KN, Weintraub WS. Safety gaps in medical team communication: Closing the loop on quality improvement efforts in the cardiac catheterization lab. Catheter Cardiovasc Interv 2022; 99:1953-1962. [PMID: 35419927 DOI: 10.1002/ccd.30189] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2022] [Revised: 03/08/2022] [Accepted: 03/14/2022] [Indexed: 11/06/2022]
Abstract
Closed-loop communication (CLC) is a fundamental aspect of effective communication, critical in the cardiac catheterization laboratory (cath lab) where physician orders are verbal. Complete CLC is typically a hospital and national mandate. Deficiencies in CLC have been shown to impair quality of care. Single center observational study, CLC for physician verbal orders in the cath lab were assessed by direct observation during a 5-year quality improvement effort. Performance feedback and educational efforts were used over this time frame to improve CLC, and the effects of each intervention assessed. Responses to verbal orders were characterized as complete (all important parameters of the order repeated, the mandated response), partial, acknowledgment only, or no response. During the first observational period of 101 cases, complete CLC occurred in 195 of 515 (38%) medication orders and 136 of 235 (50%) equipment orders. Complete CLC improved over time with various educational efforts, (p < 0.001) but in the final observation period of 117 cases, complete CLC occurred in just 259 of 328 (79%) medication orders and 439 of 581 (76%) equipment orders. Incomplete CLC was associated with medication and equipment errors. CLC of physician verbal orders was used suboptimally in this medical team setting. Baseline data indicate that physicians and staff have normalized weak, unreliable communication methods. Such lapses were associated with errors in order implementation. A subsequent 5-year quality improvement program resulted in improvement but a sizable minority of unacceptable responses. This represents an opportunity to improve patient safety in cath labs.
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Affiliation(s)
- Andrew J Doorey
- Center for Heart and Vascular Health, ChristianaCare, Newark, Delaware, USA.,Division of Cardiology, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Zoltan G Turi
- Hackensack University Medical Center, Hackensack, New Jersey, USA
| | - Elizabeth H Lazzara
- Department of Human Factors, Embry-Riddle Aeronautical University, Daytona Beach, Florida, USA
| | - Molly Casey
- Philadelphia College of Osteopathic Medicine, Philadelphia, Pennsylvania, USA
| | - Paul Kolm
- MedStar Washington Health Research Institute, Washington, District of Columbia, USA
| | - Kirk N Garratt
- Center for Heart and Vascular Health, ChristianaCare, Newark, Delaware, USA
| | - William S Weintraub
- Center for Heart and Vascular Health, ChristianaCare, Newark, Delaware, USA.,MedStar Washington Health Research Institute, Washington, District of Columbia, USA.,Division of Cardiology, Georgetown University, Washington, District of Columbia, USA
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12
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Toren O, Lipschuetz M, Lehmann A, Regev G, Arad D. Improving Patient Safety in General Hospitals Using Structured Handoffs: Outcomes From a National Project. Front Public Health 2022; 10:777678. [PMID: 35372215 PMCID: PMC8965813 DOI: 10.3389/fpubh.2022.777678] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Accepted: 02/16/2022] [Indexed: 11/21/2022] Open
Abstract
Background Promoting quality and patient safety is one of the health policy pillars of Israel's Ministry of Health. Communication among healthcare professionals is of utmost importance and can be improved using a standardized, well-known handoff tool such as the Introduction, Situation, Background, Assessment, and Recommendations (ISBAR). This study aims to present implementation process and participants' satisfaction of a national project that used a standardized tool for team communication. Methods This national intervention project included process implementation teams from 17 Israeli general hospitals evaluating the ISBAR implementation process for transferring patients from intensive care units to medical/surgical wards. The project, conducted between January 2017 and March 2018, used Fischer's test and logistic regression. The project evaluation was based on the participants' assessment of and satisfaction with the handoff process. Results Eighty-seven process implementers completed the questionnaire. A statistically significant increase in satisfaction scores in terms of four variables (p < 0.001) was observed following the implementation of the project. Nurses reported higher satisfaction at the end of the process (0.036). Participants who perceived less missing information during handoffs were more satisfied with the process of information flow between wards (84.9%) than those who perceived more missing information (15.6%). Participants who responded that there was no need to improve information flow were more satisfied with the project information flow (95.6%) compared to the group which responded that it was necessary to improve information flow (58.2%). Three out of four variables predicted satisfaction with the process. Being a nurse also predicted satisfaction with information flow with a point estimate of 2.4. The C value of the total model was 0.87. Conclusions Implementation of a safety project at a national level requires careful planning and the close involvement of the participating teams. A standardized instrument, a well-defined process, and external controls to monitor and manage the project are essential for success. Disparities found in the responses of nurses vs. physicians suggest the need for a different approach for each profession in planning and executing a similar project in the future.
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Affiliation(s)
- Orly Toren
- Patient Safety and Risk Management, Hadassah-Hebrew University Medical Center, Jerusalem, Israel.,Nursing Department, Ono Academic College, Kiryat Ono, Israel
| | - Michal Lipschuetz
- Patient Safety and Risk Management, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | | | - Gil Regev
- Psyfas, Teamwork and Healthcare, Herzliya, Israel
| | - Dana Arad
- Patient Safety Division, The Israeli Ministry of Health, Jerusalem, Israel
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Structured communication during emergency response driving: Safety-critical points identified by Finnish emergency response driving experts. Australas Emerg Care 2022; 25:308-315. [DOI: 10.1016/j.auec.2022.03.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2022] [Revised: 03/07/2022] [Accepted: 03/09/2022] [Indexed: 11/23/2022]
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Granholm ME, Holand IS, Mozelius P, Stjernström O. Information sharing during cross‐border collaboration from a dialect continua perspective. JOURNAL OF CONTINGENCIES AND CRISIS MANAGEMENT 2021. [DOI: 10.1111/1468-5973.12389] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Martina Eva Granholm
- Department of Information Systems and Technology Mid Sweden University Sundsvall Sweden
| | - Ivar S. Holand
- Faculty of Social Sciences Nord University Steinkjer Norway
| | - Peter Mozelius
- Department of Computer and System Science Mid Sweden University Ostersund Sweden
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Kelz RR, Tong J. Examining Quality Improvement in Medicine and Business. J Am Coll Surg 2021; 233:809-810. [PMID: 34823683 DOI: 10.1016/j.jamcollsurg.2021.09.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2021] [Accepted: 09/13/2021] [Indexed: 10/19/2022]
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Communication failures contributing to patient injury in anaesthesia malpractice claims☆. Br J Anaesth 2021; 127:470-478. [PMID: 34238547 DOI: 10.1016/j.bja.2021.05.030] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Revised: 05/18/2021] [Accepted: 05/27/2021] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Communication amongst team members is critical to providing safe, effective medical care. We investigated the role of communication failures in patient injury using the Anesthesia Closed Claims Project database. METHODS Claims associated with surgical/procedural and obstetric anaesthesia and postoperative pain management for adverse events from 2004 or later were included. Communication was defined as transfer of information between two or more parties. Failure was defined as communication that was incomplete, inaccurate, absent, or not timely. We classified root causes of failures as content, audience, purpose, or occasion with inter-rater reliability assessed by kappa. Claims with communication failures contributing to injury (injury-related communication failures; n=389) were compared with claims without any communication failures (n=521) using Fisher's exact test, t-test, or Mann-Whitney U-tests. RESULTS At least one communication failure contributing to patient injury occurred in 43% (n=389) out of 910 claims (κ=0.885). Patients in claims with injury-related communication failures were similar to patients in claims without failures, except that failures were more common in outpatient settings (34% vs 26%; P=0.004). Fifty-two claims had multiple communication failures for a total of 446 injury-related failures, and 47% of failures occurred during surgery, 28% preoperatively, and 23% postoperatively. Content failures (insufficient, inaccurate, or no information transmitted) accounted for 60% of the 446 communication failures. CONCLUSIONS Communication failure contributed to patient injury in 43% of anaesthesia malpractice claims. Patient/case characteristics in claims with communication failures were similar to those without failures, except that failures were more common in outpatient settings.
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Mathew R, Kumar A, Sahu A, Wali S, Aggarwal P. High-Dose Nitroglycerin Bolus for Sympathetic Crashing Acute Pulmonary Edema: A Prospective Observational Pilot Study. J Emerg Med 2021; 61:271-277. [PMID: 34215472 DOI: 10.1016/j.jemermed.2021.05.011] [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: 01/30/2021] [Revised: 05/19/2021] [Accepted: 05/30/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND Sympathetic crashing acute pulmonary edema (SCAPE) is a severe form of hypertensive acute heart failure with a dramatic presentation. Rapid identification and management in the emergency department (ED) is key to saving these patients and preventing morbidity associated with endotracheal intubation and intensive care treatment. Use of high-dose nitroglycerin (NTG) and noninvasive ventilation (NIV) has been advocated in management of such patients. OBJECTIVE To study the feasibility and safety of high-dose NTG combined with NIV in SCAPE. METHODS This was a prospective observational pilot study done in the ED of a tertiary care hospital. All patients were treated with high-dose NTG and NIV. The primary objective was to study the feasibility and safety of the SCAPE management protocol in terms of the outcome of the patient. Resolution of symptoms in 6 h and need for intubation were recorded as endpoints. Any complications associated with high-dose NTG were also recorded. RESULTS A total of 25 patients were recruited. The mean bolus dose of NTG given was 872 μg, and mean cumulative dose, 35 mg. There was no incidence of hypotension after the bolus dose of nitroglycerin. Eleven patients had resolution of symptoms at 3 h of therapy. Twenty-four patients were discharged from the ED itself after a brief period of observation, and one patient was intubated and shifted to the intensive care unit. CONCLUSION Use of our specific SCAPE treatment algorithm, which included high-dose NTG and NIV, was safe and provided rapid resolution of symptoms.
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Affiliation(s)
- Roshan Mathew
- Department of Emergency Medicine, All India Institute of Medical Science (AIIMS), New Delhi, India
| | - Akshay Kumar
- Department of Emergency Medicine, All India Institute of Medical Science (AIIMS), New Delhi, India.
| | - Ankit Sahu
- Department of Emergency Medicine, All India Institute of Medical Science (AIIMS), New Delhi, India
| | - Sachin Wali
- Department of Emergency Medicine, All India Institute of Medical Science (AIIMS), New Delhi, India
| | - Praveen Aggarwal
- Department of Emergency Medicine, All India Institute of Medical Science (AIIMS), New Delhi, India
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Schmidt J, Gambashidze N, Manser T, Güß T, Klatthaar M, Neugebauer F, Hammer A. Does interprofessional team-training affect nurses' and physicians' perceptions of safety culture and communication practices? Results of a pre-post survey study. BMC Health Serv Res 2021; 21:341. [PMID: 33853593 PMCID: PMC8048288 DOI: 10.1186/s12913-021-06137-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2020] [Accepted: 02/01/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Many hospitals seek to increase patient safety through interprofessional team-trainings. Accordingly, these trainings aim to strengthen important key aspects such as safety culture and communication. This study was designed to investigate if an interprofessional team-training, administered to a relatively small group of nurses and physicians would promote a change in healthcare professionals' perceptions on safety culture and communication practices throughout the hospital. We further sought to understand which safety culture aspects foster the transfer of trained communication practices into clinical practice. METHODS We conducted a pre-post survey study using six scales to measure participants' perceptions of safety culture and communication practices. Mean values were compared according to profession and participation in training. Using multiple regression models, the relationship between safety culture and communication practices was determined. RESULTS Before and after the training, we found high mean values for all scales. A significant, positive effect was found for the communication practices of the physicians. Participation in the training sessions played a variably relevant role in the communication practices. In addition, the multiple regression analyses showed that specific safety culture aspects have a cross-professional influence on communication practices in the hospital. CONCLUSIONS This study suggest that interprofessional team-trainings of a small group of professionals can successfully be transferred into clinical practice and indicates the importance of safety culture aspects for such transfer processes. Thus, we recommend the consideration of safety culture aspects before starting a training intervention.
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Affiliation(s)
- Jan Schmidt
- Institute for Patient Safety, University Hospital of Bonn, Venusberg-Campus 1, 53127, Bonn, Germany.
| | - Nikoloz Gambashidze
- Institute for Patient Safety, University Hospital of Bonn, Venusberg-Campus 1, 53127, Bonn, Germany
| | - Tanja Manser
- FHNW School of Applied Psychology, University of Applied Sciences and Arts Northwestern Switzerland, Riggenbachstrasse 16, 4600, Olten, Switzerland
| | - Tim Güß
- UKM Trainingszentrum, University Hospital of Muenster, Malmedyweg 17, 48149, Muenster, Germany
| | - Michael Klatthaar
- UKM Trainingszentrum, University Hospital of Muenster, Malmedyweg 17, 48149, Muenster, Germany
| | - Frank Neugebauer
- QM and clinical risk management, University Hospital of Muenster, Domagkstrasse 20, 48149, Muenster, Germany
| | - Antje Hammer
- Institute for Patient Safety, University Hospital of Bonn, Venusberg-Campus 1, 53127, Bonn, Germany
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Kushelev M, Meyers LD, Palettas M, Lawrence A, Weaver TE, Coffman JC, Moran KR, Lipps JA. Perioperative do-not-resuscitate orders: Trainee experiential learning in preserving patient autonomy and knowledge of professional guidelines. Medicine (Baltimore) 2021; 100:e24836. [PMID: 33725954 PMCID: PMC7982162 DOI: 10.1097/md.0000000000024836] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2020] [Accepted: 01/25/2021] [Indexed: 01/05/2023] Open
Abstract
Anesthesiologists and surgeons have demonstrated a lack of familiarity with professional guidelines when providing care for surgical patients with a do-not-resuscitate (DNR) order. This substantially infringes on patient's self-autonomy; therefore, leading to substandard care particularly for palliative surgical procedures. The interventional nature of surgical procedures may create a different mentality of surgical "buy-in," that may unintentionally prioritize survivability over maintaining patient self-autonomy. While previous literature has demonstrated gains in communication skills with simulation training, no specific educational curriculum has been proposed to specifically address perioperative code status discussions. We designed a simulated standardized patient actor (SPA) encounter at the beginning of post-graduate year (PGY) 2, corresponding to the initiation of anesthesiology specific training, allowing residents to focus on the perioperative discussion in relation to the SPA's DNR order.Forty four anesthesiology residents volunteered to participate in the study. PGY-2 group (n = 17) completed an immediate post-intervention assessment, while PGY-3 group (n = 13) completed the assessment approximately 1 year after the educational initiative to ascertain retention. PGY-4 residents (n = 14) did not undergo any specific educational intervention on the topic, but were given the same assessment. The assessment consisted of an anonymized survey that examined familiarity with professional guidelines and hospital policies in relation to perioperative DNR orders. Subsequently, survey responses were compared between classes.Study participants that had not participated in the educational intervention reported a lack of prior formalized instruction on caring for intraoperative DNR patients. Second and third year residents outperformed senior residents in being aware of the professional guidelines that detail perioperative code status decision-making (47%, 62% vs 21%, P = .004). PGY-3 residents outperformed PGY-4 residents in correctly identifying a commonly held misconception that institutional policies allow for automatic perioperative DNR suspensions (85% vs 43%; P = .02). Residents from the PGY-3 class, who were 1 year removed the educational intervention while gaining 1 additional year of clinical anesthesiology training, consistently outperformed more senior residents who never received the intervention.Our training model for code-status training with anesthesiology residents showed significant gains. The best results were achieved when combining clinical experience with focused educational training.
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Verbal Communication During Airway Management and Emergent Endotracheal Intubation: Observations of Team Behavior Among Multi-institutional Pediatric Intensive Care Unit In Situ Simulations. J Patient Saf 2021; 16:e114-e119. [PMID: 27811586 DOI: 10.1097/pts.0000000000000272] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To assess health-care teams' verbal communication, an observable teamwork behavior, during simulations involving pediatric emergency airway management and intubation. METHODS We conducted video-recorded, risk-informed in situ simulations at 5 hospitals with pediatric intensive care units in the Chicago, Illinois, area. Clinicians participated in their clinical roles (eg, attending physician, bedside nurse) and had access to hospital operational systems (eg, electronic health record, medical imaging, laboratory services). Video-recordings were transcribed; 3 pediatric critical care physicians analyzed the transcripts to assess preintubation communication: (a) the declaration of an airway emergency, (b) intubation medication request(s), and (c) preintubation medication administration. RESULTS Ten pediatric intensive care unit simulations were analyzed. Statements to notify the care team of an airway emergency varied widely. In 3 simulations, a dosage for every medication was verbalized in the physician's initial medication request; however, in 4 simulations, a nurse was the first to verbalize the medication dosage(s) before administration. In 6 of the simulations where preintubation medications were administered, multiple requests for medications were verbalized. A clinician verbally confirmed that each medication was administered in only 2 of the simulations. CONCLUSIONS No uniform statement was identified to declare an airway emergency among the care teams. Preintubation medication dosages were not consistently included in intubation medication orders, and frequently, there were multiple requests to obtain medications. Using standardized language to declare an airway emergency and verbally communicating medication requests and dosages and confirming administration may improve the quality of care in this critical event.
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Alexandrino H, Baptista S, Vale L, Júnior JHZ, Espada PC, Junior DS, Vane LA, Carvalho VH, Marcelo L, Madeira F, Duarte R, Ferreira L, Pereira J, Pinheiro LF, Fraga GP, Mesquita C. Improving Intraoperative Communication in Trauma: The Educational Effect of the Joint DSTC™-DATC™ Courses. World J Surg 2021; 44:1856-1862. [PMID: 32072223 DOI: 10.1007/s00268-020-05421-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND Operative management of severe trauma requires excellent communication among team members. The surgeon and anesthesiologist need to interact efficiently, exchanging vital information. The Definitive Surgical Trauma Care (DSTC) and Definitive Anesthesia Trauma Care (DATC) courses provide an excellent opportunity for teamwork training. Our goal was to study the impact of the joint DSTC-DATC courses in candidates' self-reported assessment in communication skills and techniques in a simulated intraoperative trauma scenario. METHODS Study population consists of 93 candidates (67 surgeons and 26 anesthesiologists) participating in four consecutive joint DSTC-DATC courses in May and June 2019 in Brazil (3) and in Portugal (1). Median age was 30 years; 53 (60%) of subjects were male (46 senior residents and 47 specialists). All participants attended joint lectures, case discussions and surgical skills session, emphasizing intraoperative communication. Post-course survey on several aspects of perioperative communication (responses on a Likert scale) was conducted with participants being asked which aspects of intraoperative communication they valued the most. RESULTS All participants responded to the survey. Results displayed an increase in the self-assessed importance of team briefing and intraoperative communication, particularly routine periodic communication, rather than only at critical moments. Postoperative team debriefing was also valued as highly relevant. Closed-loop and direct, by-name communication were highly rated. Self-reported communication skills improved significantly during the course. CONCLUSIONS Joint training in the DSTC-DATC courses improved candidates' perception and skills on proficient intraoperative communication. Further studies should address both the durability of these changes and the potential impact on patient care.
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Affiliation(s)
- Henrique Alexandrino
- Faculty of Medicine, University of Coimbra, Azinhaga de Santa Comba, 3000-548, Coimbra, Portugal. .,Department of Surgery, Coimbra University Hospital Center, Praceta Mota Pinto, 3000-075, Coimbra, Portugal.
| | - Sérgio Baptista
- Centro Hospitalar Médio Tejo, EPE, Av. Maria de Lurdes Melo e Castro, Ap. 118, 2304-909, Tomar, Portugal
| | - Luís Vale
- Hospital Nélio Mendonça and Regional Emergency Service (SRPC/IPRAM) - Serviço de Saúde da RAM, E.P.E, Avenida Luís de Camões, no 57, 9004-514, Funchal, Portugal
| | - José Hélio Zen Júnior
- Hospital e Maternidade Galileo, Valinhos, São Paulo, Brazil.,Faculdade de Ciências Médicas, Pós Graduação em Ciências Médicas, Universidade Estadual de Campinas/UNICAMP, Rua Tessália Vieira de Camargo, 126. Cidade Universitária Zeferino Vaz, Campinas, SP, CEP 13083-887, Brazil
| | - Paulo César Espada
- Departamento de Cirurgia Geral, Faculdade Medicina de São José do Rio Preto-FAMERP, São José de Rio Preto, Brazil
| | | | - Luiz Antonio Vane
- Faculdade de Ciências Médicas, Avenida Brigadeiro Faria Lima, 811, Putim, São José dos Campos, São Paulo, Brazil
| | - Vanessa Henriques Carvalho
- School of Medical Science - Unicamp - Campinas-Brazil School of Medical Sciences (SMS), University of Campinas (Unicamp), Rua Alexander Fleming, 181, Cidade Universitária "Prof. Zeferino Vaz", Campinas, SP, 13083-970, Brazil
| | - Lara Marcelo
- Centro Hospitalar Universitário do Porto, EPE, Largo Prof. Abel Salazar, 4099-001, Porto, Portugal
| | - Filipa Madeira
- Department of Anesthesiology, Coimbra University Hospital Center, Praceta Mota Pinto, 3000-075, Coimbra, Portugal
| | | | - Luís Ferreira
- Department of Surgery, Coimbra University Hospital Center, Praceta Mota Pinto, 3000-075, Coimbra, Portugal
| | - Jorge Pereira
- Department of Surgery, Tondela-Viseu Hospital Center, Viseu, Portugal
| | | | - Gustavo Pereira Fraga
- Division of Trauma Surgery, Department of Surgery, School of Medical Sciences (SMS), University of Campinas (Unicamp), Rua Alexander Fleming, 181, Cidade Universitária "Prof. Zeferino Vaz", Campinas, SP, 13083-970, Brazil
| | - Carlos Mesquita
- Department of Surgery, Coimbra University Hospital Center, Praceta Mota Pinto, 3000-075, Coimbra, Portugal
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Hampton L, Brindley P, Kirkpatrick A, McKee J, Regehr J, Martin D, LaPorta A, Park J, Vergis A, Gillman L. Strategies to improve communication in telementoring in acute care coordination: a scoping review. Can J Surg 2020; 63:E569-E577. [PMID: 33253511 DOI: 10.1503/cjs.015519] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
Background Telementoring facilitates the coordination of advanced medical care in rural, remote or austere environments. Because the interpersonal element of telementoring has been relatively underexplored, we conducted a scoping review to identify strategies to improve communication in telementoring. Methods Two independent reviewers searched all English-language articles in MEDLINE and Scopus from 1964 to 2017, as well as reference lists of relevant articles to identify articles addressing telementored interactions between health care providers. Search results were gathered in June 2017 and updated in January 2018. Identified articles were categorized by theme. Results We identified 144 articles, of which 56 met our inclusion criteria. Forty-one articles focused on improving dispatcher-directed cardiopulmonary resuscitation (CPR). Major themes included the importance of language in identifying out-of-hospital cardiac arrest and how to provide instructions to enable administration of effective CPR. A standardized approach with scripted questions was associated with improved detection of out-of-hospital cardiac arrest, and a concise script was associated with improved CPR quality compared to no mentoring, unscripted mentoring or more complex instructions. Six articles focused on physician-physician consultation. Use of a handover tool that highlighted critical information outperformed an unstructured approach regarding transmission of vital information. Nine articles examined telementoring in trauma resuscitation. A common theme was the need to establish an understanding between mentor and provider regarding the limitations of the provider and his or her environment. Conclusion The available data suggest that standardization coupled with short, concise validated scripts could improve efficacy, safety and engagement. Improvements will require multidisciplinary input, practice and deliberate efforts to address barriers.
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Affiliation(s)
- Lauren Hampton
- From the Section of General Surgery, Department of Surgery, University of Manitoba, Winnipeg, Man. (Hampton, Park, Vergis, Gillman); the Section of Critical Care Medicine, Department of Internal Medicine, University of Manitoba, Winnipeg, Man. (Gillman); the Department of Emergency Medicine, University of Manitoba, Winnipeg, Man. (Regehr, Martin); the Department of Critical Care Medicine, University of Alberta, Edmonton, Alta. (Brindley, McKee); the Deparments of Surgery and Critical Care Medicine, University of Calgary, Calgary, Alta. (Kirkpatrick); the Trauma Program, University of Calgary, Calgary, Alta. (Kirkpatrick, McKee); and the Rocky Vista University School of Medicine, Parker, Colo. (LaPorta)
| | - Peter Brindley
- From the Section of General Surgery, Department of Surgery, University of Manitoba, Winnipeg, Man. (Hampton, Park, Vergis, Gillman); the Section of Critical Care Medicine, Department of Internal Medicine, University of Manitoba, Winnipeg, Man. (Gillman); the Department of Emergency Medicine, University of Manitoba, Winnipeg, Man. (Regehr, Martin); the Department of Critical Care Medicine, University of Alberta, Edmonton, Alta. (Brindley, McKee); the Deparments of Surgery and Critical Care Medicine, University of Calgary, Calgary, Alta. (Kirkpatrick); the Trauma Program, University of Calgary, Calgary, Alta. (Kirkpatrick, McKee); and the Rocky Vista University School of Medicine, Parker, Colo. (LaPorta)
| | - Andrew Kirkpatrick
- From the Section of General Surgery, Department of Surgery, University of Manitoba, Winnipeg, Man. (Hampton, Park, Vergis, Gillman); the Section of Critical Care Medicine, Department of Internal Medicine, University of Manitoba, Winnipeg, Man. (Gillman); the Department of Emergency Medicine, University of Manitoba, Winnipeg, Man. (Regehr, Martin); the Department of Critical Care Medicine, University of Alberta, Edmonton, Alta. (Brindley, McKee); the Deparments of Surgery and Critical Care Medicine, University of Calgary, Calgary, Alta. (Kirkpatrick); the Trauma Program, University of Calgary, Calgary, Alta. (Kirkpatrick, McKee); and the Rocky Vista University School of Medicine, Parker, Colo. (LaPorta)
| | - Jessica McKee
- From the Section of General Surgery, Department of Surgery, University of Manitoba, Winnipeg, Man. (Hampton, Park, Vergis, Gillman); the Section of Critical Care Medicine, Department of Internal Medicine, University of Manitoba, Winnipeg, Man. (Gillman); the Department of Emergency Medicine, University of Manitoba, Winnipeg, Man. (Regehr, Martin); the Department of Critical Care Medicine, University of Alberta, Edmonton, Alta. (Brindley, McKee); the Deparments of Surgery and Critical Care Medicine, University of Calgary, Calgary, Alta. (Kirkpatrick); the Trauma Program, University of Calgary, Calgary, Alta. (Kirkpatrick, McKee); and the Rocky Vista University School of Medicine, Parker, Colo. (LaPorta)
| | - Julian Regehr
- From the Section of General Surgery, Department of Surgery, University of Manitoba, Winnipeg, Man. (Hampton, Park, Vergis, Gillman); the Section of Critical Care Medicine, Department of Internal Medicine, University of Manitoba, Winnipeg, Man. (Gillman); the Department of Emergency Medicine, University of Manitoba, Winnipeg, Man. (Regehr, Martin); the Department of Critical Care Medicine, University of Alberta, Edmonton, Alta. (Brindley, McKee); the Deparments of Surgery and Critical Care Medicine, University of Calgary, Calgary, Alta. (Kirkpatrick); the Trauma Program, University of Calgary, Calgary, Alta. (Kirkpatrick, McKee); and the Rocky Vista University School of Medicine, Parker, Colo. (LaPorta)
| | - Douglas Martin
- From the Section of General Surgery, Department of Surgery, University of Manitoba, Winnipeg, Man. (Hampton, Park, Vergis, Gillman); the Section of Critical Care Medicine, Department of Internal Medicine, University of Manitoba, Winnipeg, Man. (Gillman); the Department of Emergency Medicine, University of Manitoba, Winnipeg, Man. (Regehr, Martin); the Department of Critical Care Medicine, University of Alberta, Edmonton, Alta. (Brindley, McKee); the Deparments of Surgery and Critical Care Medicine, University of Calgary, Calgary, Alta. (Kirkpatrick); the Trauma Program, University of Calgary, Calgary, Alta. (Kirkpatrick, McKee); and the Rocky Vista University School of Medicine, Parker, Colo. (LaPorta)
| | - Anthony LaPorta
- From the Section of General Surgery, Department of Surgery, University of Manitoba, Winnipeg, Man. (Hampton, Park, Vergis, Gillman); the Section of Critical Care Medicine, Department of Internal Medicine, University of Manitoba, Winnipeg, Man. (Gillman); the Department of Emergency Medicine, University of Manitoba, Winnipeg, Man. (Regehr, Martin); the Department of Critical Care Medicine, University of Alberta, Edmonton, Alta. (Brindley, McKee); the Deparments of Surgery and Critical Care Medicine, University of Calgary, Calgary, Alta. (Kirkpatrick); the Trauma Program, University of Calgary, Calgary, Alta. (Kirkpatrick, McKee); and the Rocky Vista University School of Medicine, Parker, Colo. (LaPorta)
| | - Jason Park
- From the Section of General Surgery, Department of Surgery, University of Manitoba, Winnipeg, Man. (Hampton, Park, Vergis, Gillman); the Section of Critical Care Medicine, Department of Internal Medicine, University of Manitoba, Winnipeg, Man. (Gillman); the Department of Emergency Medicine, University of Manitoba, Winnipeg, Man. (Regehr, Martin); the Department of Critical Care Medicine, University of Alberta, Edmonton, Alta. (Brindley, McKee); the Deparments of Surgery and Critical Care Medicine, University of Calgary, Calgary, Alta. (Kirkpatrick); the Trauma Program, University of Calgary, Calgary, Alta. (Kirkpatrick, McKee); and the Rocky Vista University School of Medicine, Parker, Colo. (LaPorta)
| | - Ashley Vergis
- From the Section of General Surgery, Department of Surgery, University of Manitoba, Winnipeg, Man. (Hampton, Park, Vergis, Gillman); the Section of Critical Care Medicine, Department of Internal Medicine, University of Manitoba, Winnipeg, Man. (Gillman); the Department of Emergency Medicine, University of Manitoba, Winnipeg, Man. (Regehr, Martin); the Department of Critical Care Medicine, University of Alberta, Edmonton, Alta. (Brindley, McKee); the Deparments of Surgery and Critical Care Medicine, University of Calgary, Calgary, Alta. (Kirkpatrick); the Trauma Program, University of Calgary, Calgary, Alta. (Kirkpatrick, McKee); and the Rocky Vista University School of Medicine, Parker, Colo. (LaPorta)
| | - Lawrence Gillman
- From the Section of General Surgery, Department of Surgery, University of Manitoba, Winnipeg, Man. (Hampton, Park, Vergis, Gillman); the Section of Critical Care Medicine, Department of Internal Medicine, University of Manitoba, Winnipeg, Man. (Gillman); the Department of Emergency Medicine, University of Manitoba, Winnipeg, Man. (Regehr, Martin); the Department of Critical Care Medicine, University of Alberta, Edmonton, Alta. (Brindley, McKee); the Deparments of Surgery and Critical Care Medicine, University of Calgary, Calgary, Alta. (Kirkpatrick); the Trauma Program, University of Calgary, Calgary, Alta. (Kirkpatrick, McKee); and the Rocky Vista University School of Medicine, Parker, Colo. (LaPorta)
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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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Jowsey T, Petersen L, Mysko C, Cooper-Ioelu P, Herbst P, Webster CS, Wearn A, Marshall D, Torrie J, Lin MJP, Beaver P, Egan J, Bacal K, O’Callaghan A, Weller J. Performativity, identity formation and professionalism: Ethnographic research to explore student experiences of clinical simulation training. PLoS One 2020; 15:e0236085. [PMID: 32730277 PMCID: PMC7392231 DOI: 10.1371/journal.pone.0236085] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2019] [Accepted: 06/30/2020] [Indexed: 01/01/2023] Open
Abstract
Developing professional identity is a vital part of health professionals' education. In Auckland four tertiary institutions have partnered to run an interprofessional simulation training course called Urgent and Immediate Patient Care Week (UIPCW) which is compulsory for Year Five medical, Year Four pharmacy, Year Three paramedicine and Year Three nursing students. We sought to understand student experiences of UIPCW and how those experiences informed student ideas about professional identity and their emergent practice as health professionals within multidisciplinary teams. In 2018, we commenced ethnographic research involving participant observation, field notes, interviews, photography and observational ethnographic film. A total of 115 students participated in this research. The emergent findings concern the potentially transformative learning opportunity presented within high fidelity multi-disciplinary simulations for students to develop their professional identity in relation to peers from other professions. Our work also exposes the heightened anxiety and stress which can be experienced by students in such interdisciplinary simulations. Student experience suggests this is due to a range of factors including students having to perform in front of peers and staff in such simulation scenarios when their own professional identity and capabilities are still in emergent stages. Staff-led simulation debriefs form a critical success factor for transformative learning to be able to occur in any such simulations so that students can reflect on, and move beyond, the emotion and uncertainty of such experiences to develop future-focused concepts of professional identity and strategies to support effective interprofessional teamwork.
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Affiliation(s)
- Tanisha Jowsey
- Centre for Medical and Health Sciences Education, The University of Auckland, Auckland, New Zealand
| | - Lynne Petersen
- School of Pharmacy, The University of Auckland, Auckland, New Zealand
| | - Chris Mysko
- Waitemata District Health Board, Auckland, New Zealand
| | - Pauline Cooper-Ioelu
- Learning and Teaching Unit, Faculty of Medical and Health Sciences, The University of Auckland, Auckland, New Zealand
| | | | - Craig S. Webster
- Centre for Medical and Health Sciences Education and Department of Anaesthesiology, The University of Auckland, Auckland, New Zealand
| | - Andy Wearn
- The University of Auckland, Auckland, New Zealand
| | - Dianne Marshall
- School of Nursing, The University of Auckland, Auckland, New Zealand
| | - Jane Torrie
- The University of Auckland, Auckland, New Zealand
| | | | - Peter Beaver
- Centre for Medical and Health Sciences Education, The University of Auckland, Auckland, New Zealand
| | - Johanne Egan
- Waitemata District Health Board, Auckland, New Zealand
| | - Kira Bacal
- Medical Programme Directorate, The University of Auckland, Auckland, New Zealand
| | - Anne O’Callaghan
- Auckland City Hospital, Auckland, New Zealand
- Department of Psychological Medicine, The University of Auckland, Auckland, New Zealand
| | - Jennifer Weller
- Auckland City Hospital, Auckland, New Zealand
- Centre for Medical and Health Sciences Education, School of Medicine, The University of Auckland, Auckland, New Zealand
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Stollings JL, Devlin JW, Lin JC, Pun BT, Byrum D, Barr J. Best Practices for Conducting Interprofessional Team Rounds to Facilitate Performance of the ICU Liberation (ABCDEF) Bundle. Crit Care Med 2020; 48:562-570. [PMID: 32205603 DOI: 10.1097/ccm.0000000000004197] [Citation(s) in RCA: 36] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVES Daily ICU interprofessional team rounds, which incorporate the ICU Liberation ("A" for Assessment, Prevention, and Manage Pain; "B" for Both Spontaneous Awakening Trials and Spontaneous Breathing Trials; "C" for Choice of Analgesia and Sedation; "D" for Delirium Assess, Prevent, and Manage; "E" for Early Mobility and Exercise; "F" for Family Engagement and Empowerment [ABCDEF]) Bundle, support both the care coordination and regular provider communication necessary for Bundle execution. This article describes evidence-based practices for conducting effective interprofessional team rounds in the ICU to improve Bundle performance. DESIGN Best practice synthesis. METHODS The authors, each extensively involved in the Society of Critical Care Medicine's ICU Liberation Campaign, reviewed the pertinent literature to identify how ICU interprofessional team rounds can be optimized to increase ICU Liberation adherence. RESULTS Daily ICU interprofessional team rounds that foster ICU Liberation Bundle use support both care coordination and regular provider communication within and between teams. Evidence-based best practices for conducting effective interprofessional team rounds in the ICU include the optimal structure for ICU interprofessional team rounds; the importance of conducting rounds at patients' bedside; essential participants in rounds; the inclusion of ICU patients and their families in rounds-based discussions; and incorporation of the Bundle into the Electronic Health Record. Interprofessional team rounds in the ICU ideally employ communication strategies to foster inclusive and supportive behaviors consistent with interprofessional collaboration in the ICU. Patient care discussions during interprofessional team rounds benefit from being patient-centered and goal-oriented. Documentation of ICU Liberation Bundle elements in the Electronic Health Record may help facilitate team communication and decision-making. CONCLUSIONS Conducting high-quality interprofessional team rounds in the ICU is a key strategy to support ICU Liberation Bundle use.
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Affiliation(s)
- Joanna L Stollings
- Department of Pharmaceutical Services, Vanderbilt University Medical Center, Nashville, TN
- Critical Illness, Brain Dysfunction and Survivorship (CIBS) Center, Vanderbilt University Medical Center, Nashville, TN
| | - John W Devlin
- School of Pharmacy, Northeastern University, Boston, MA
- Division of Pulmonary, Critical Care and Sleep Medicine, Tufts Medical Center, Boston, MA
| | - John C Lin
- Division of Pediatrics and Critical Care Medicine, Washington University School of Medicine, Saint Louis, MO
| | - Brenda T Pun
- Critical Illness, Brain Dysfunction and Survivorship (CIBS) Center, Vanderbilt University Medical Center, Nashville, TN
- Department of Medicine, Pulmonary and Critical Care, Vanderbilt University Medical Center, Nashville, TN
| | - Diane Byrum
- Innovative Solutions for Healthcare Education, LLC, Charlotte, NC
| | - Juliana Barr
- Anesthesiology and Perioperative Care Service, VA Palo Alto Health Care System, Palo Alto, CA
- Department of Anesthesiology, Perioperative, and Pain Medicine, Stanford University School of Medicine, Stanford, CA
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Spranzi F, Norton C. From handover to takeover: should we consider a new conceptual model of communication? ACTA ACUST UNITED AC 2020. [DOI: 10.12968/bjom.2020.28.3.156] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Objective This service evaluation aimed to collect data on clinical handover on labour ward and compare them with the local guideline. Design and methods This service evaluation was structured in four stages, each using a different design and research methods. Setting The study was undertaken between September 2013 and August 2014 in a maternity unit in a large NHS teaching hospital in London, UK. Findings and conclusion Communication breakdown is widely considered to be a significant factor contributing to poor patient outcomes, with handover being a major risk point. The discrepancy between the local guideline and current clinical practice reinforces the belief that urgent action is needed to improve clinical handover on labour ward. The results of this service evaluation suggest that a drastic overhaul of the communication model during handover should be considered, ie from handover to takeover, and that the mnemonic SBAR may not be fit-for-purpose in maternity care and should be replaced with a different format that reflects the chronological flow of clinical events.
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Affiliation(s)
- Francesca Spranzi
- Risk management support midwife, Imperial College Healthcare, NHS Trust
| | - Christine Norton
- Professor of clinical nursing research, Florence Nightingale faculty of nursing, midwifery and palliative care, King's College London
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Hanson J, Walsh S, Mason M, Wadsworth D, Framp A, Watson K. 'Speaking up for safety': A graded assertiveness intervention for first year nursing students in preparation for clinical placement: Thematic analysis. NURSE EDUCATION TODAY 2020; 84:104252. [PMID: 31698289 DOI: 10.1016/j.nedt.2019.104252] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/07/2019] [Revised: 09/11/2019] [Accepted: 10/16/2019] [Indexed: 06/10/2023]
Abstract
BACKGROUND The international literature highlights patient safety as a critical issue in contemporary health care. Poor interpersonal relationships and ineffective health care team communication are identified as dominant human factors contributing to clinical errors and adverse events. Of concern is that some students appear to lack the skills to speak up for themselves, their patients and others when witnessing unsafe practice on clinical placement. STUDY AIMS To elicit student and staff perspectives on the quality, effectiveness and appropriateness of an assertiveness-based communication activity prior to clinical placement. DESIGN The study used a qualitative design. A communication module was offered in the second week of the practice laboratory and involved the use of two graded assertiveness frameworks. SETTING School of Nursing, Midwifery and Paramedicine, at a regional university in South East Queensland, Australia. PARTICIPANTS Of the 535 first year undergraduate nursing students enrolled in the laboratory courses, 73 (13.6%) completed an anonymous online survey. Individual interviews were conducted with a university student wellbeing coordinator and student mentor to gain their perspectives of the data. METHODS An evaluation survey with seven qualitative questions and individual semi-structured interviews were employed. Data was analysed using a thematic approach. RESULTS Five major themes emerged from the survey data: vicarious learning, establishing boundaries, support in practice, advocacy awareness and practice utility. Three themes emerged from the interviews: empowerment and confidence; support and preparation for advocacy; and authentic learning. CONCLUSIONS Findings indicate that teaching assertiveness skills and establishing a preparatory framework for 'speaking up for safety' early in a nursing students tertiary education can have important psychosocial implications for their confidence, empowerment and success. The activity provided an authentic learning experience with perceived practical application to the workplace and, has the potential to enhance first year curricula by improving communication tools used for students preparing for practice.
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Affiliation(s)
- Julie Hanson
- School of Nursing, Midwifery and Paramedicine, University of the Sunshine Coast, Locked Bag 4, Maroochydore DC, QLD 4558, Australia.
| | - Samantha Walsh
- School of Nursing, Midwifery and Paramedicine, University of the Sunshine Coast, Locked Bag 4, Maroochydore DC, QLD 4558, Australia.
| | - Matthew Mason
- School of Nursing, Midwifery and Paramedicine, University of the Sunshine Coast, Locked Bag 4, Maroochydore DC, QLD 4558, Australia.
| | - Daniel Wadsworth
- School of Nursing, Midwifery and Paramedicine, University of the Sunshine Coast, Locked Bag 4, Maroochydore DC, QLD 4558, Australia.
| | - Ann Framp
- School of Nursing, Midwifery and Paramedicine, University of the Sunshine Coast, Locked Bag 4, Maroochydore DC, QLD 4558, Australia.
| | - Karen Watson
- School of Nursing, Midwifery and Paramedicine, University of the Sunshine Coast, Locked Bag 4, Maroochydore DC, QLD 4558, Australia.
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Yee DJ, Wiggins MW, Searle BJ. Higher social cue utilisation improves communication, reduces perceived workload, and improves performance amongst ad hoc dyads in simulated rail control. ERGONOMICS 2020; 63:31-47. [PMID: 31663427 DOI: 10.1080/00140139.2019.1680872] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/06/2017] [Accepted: 09/21/2019] [Indexed: 06/10/2023]
Abstract
The objective was to examine whether ad hoc dyads with different collective social cue utilisation would record differences in performance and perceptions of workload during a simulated rail control task that incorporated distinct levels of demand. The frequency of two types of communicative statements was also examined as mediating factors: closing the loop and informative responding. A quasi-experimental design was employed using 40 dyadic teams. The results indicated that ad hoc teams whose members comprised higher social cue utilisation recorded relatively faster response times and perceived lower levels of workload, and engaged in a greater frequency of communicative statements that involved 'closing the loop' and 'informative responses'. Social cue utilisation also exerted an indirect effect on perceived workload through informative responding. The outcomes have theoretical implications for models of ad hoc team performance, and practical implications for the selection and training of teams that operate on an ad hoc basis. Practitioner summary: This study indicates that, in the context of simulation tasks requiring teamwork, higher social cue utilisation amongst ad hoc team members is associated with communication, workload perception, and overall performance.
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Affiliation(s)
- Daniel J Yee
- Department of Psychology, Macquarie University, Sydney, Australia
| | - Mark W Wiggins
- Department of Psychology, Macquarie University, Sydney, Australia
| | - Ben J Searle
- Department of Psychology, Macquarie University, Sydney, Australia
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Lauridsen KG, Watanabe I, Løfgren B, Cheng A, Duval-Arnould J, Hunt EA, Good GL, Niles D, Berg RA, Nishisaki A, Nadkarni VM. Standardising communication to improve in-hospital cardiopulmonary resuscitation. Resuscitation 2019; 147:73-80. [PMID: 31891790 DOI: 10.1016/j.resuscitation.2019.12.013] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2019] [Revised: 12/12/2019] [Accepted: 12/19/2019] [Indexed: 11/25/2022]
Abstract
AIM Recommendations for standardised communication to reduce chest compression (CC) pauses are lacking. We aimed to achieve consensus and evaluate feasibility and efficacy using standardised communication during cardiopulmonary resuscitation (CPR) events. METHODS Modified Delphi consensus process to design standardised communication elements. Feasibility was pilot tested in 16 simulated CPR scenarios (8 scenarios with physician team leaders and 8 with chest compressors) randomized (1:1) to standardised [INTERVENTION] vs. closed-loop communication [CONTROL]. Adherence and efficacy (duration of CC pauses for defibrillation, intubation, rhythm check) was assessed by audiovisual recording. Mental demand and frustration were assessed by NASA task load index subscales. RESULTS Consensus elements for standardised communication included: 1) team preparation 15-30 s before CC interruption, 2) pre-interruption countdown synchronized with last 5 CCs, 3) specific action words for defibrillation, intubation, and interrupting/resuming CCs. Median (Q1,Q3) adherence to standardised phrases was 98% (80%,100%). Efficacy analysis showed a median [Q1,Q3] peri-shock pause of 5.1 s. [4.4; 5.8] vs. 7.5 s. [6.3; 8.8] seconds, p < 0.001, intubation pause of 3.8 s. [3.6; 5.0] vs. 6.9 s. [4.8; 10.1] seconds, p = 0.03, rhythm check pause of 4.2 [3.2,5.7] vs. 8.6 [5.0,10.5] seconds, p < 0.001, median frustration index of 10/100 [5,20] vs. 35/100 [25,50], p < 0.001, and median mental demand load of 55/100 [30,70] vs. 65/100 [50,85], p = 0.41 for standardised vs. closed loop communication. CONCLUSION This pilot study demonstrated feasibility of using consensus-based standardised communication that was associated with shorter CC pauses for defibrillation, intubation, and rhythm checks without increasing frustration index or mental demand compared to current best practice, closed loop communication.
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Affiliation(s)
- Kasper Glerup Lauridsen
- Research Center for Emergency Medicine, Aarhus University Hospital, Denmark; Department of Internal Medicine, Randers Regional Hospital, Denmark; Center for Simulation, Advanced Education and Innovation, Children's Hospital of Philadelphia, USA; Department of Anesthesiology and Critical Care Medicine, Children's Hospital of Philadelphia, USA.
| | - Ichiro Watanabe
- Center for Simulation, Advanced Education and Innovation, Children's Hospital of Philadelphia, USA
| | - Bo Løfgren
- Research Center for Emergency Medicine, Aarhus University Hospital, Denmark; Department of Internal Medicine, Randers Regional Hospital, Denmark; Department of Cardiology, Aarhus University Hospital, USA
| | - Adam Cheng
- Department of Pediatrics, Cumming School of Medicine, University of Calgary
| | - Jordan Duval-Arnould
- Simulation Center, Johns Hopkins Medicine, Johns Hopkins University Hospital, USA
| | - Elizabeth A Hunt
- Simulation Center, Johns Hopkins Medicine, Johns Hopkins University Hospital, USA; Division of Health Informatics, Johns Hopkins University Hospital, Johns Hopkins Pediatric Hospital, USA; Department of Pediatrics, Johns Hopkins University School of Medicine
| | - Grace L Good
- Center for Simulation, Advanced Education and Innovation, Children's Hospital of Philadelphia, USA
| | - Dana Niles
- Department of Anesthesiology and Critical Care Medicine, Children's Hospital of Philadelphia, USA
| | - Robert A Berg
- Department of Anesthesiology and Critical Care Medicine, Children's Hospital of Philadelphia, USA
| | - Akira Nishisaki
- Center for Simulation, Advanced Education and Innovation, Children's Hospital of Philadelphia, USA; Department of Anesthesiology and Critical Care Medicine, Children's Hospital of Philadelphia, USA
| | - Vinay M Nadkarni
- Center for Simulation, Advanced Education and Innovation, Children's Hospital of Philadelphia, USA; Department of Anesthesiology and Critical Care Medicine, Children's Hospital of Philadelphia, USA
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Curley LE, Jensen M, McNabb C, Ram S, Torrie J, Jowsey T, McDonald M. Pharmacy Students' Perspectives on Interprofessional Learning in a Simulated Patient Care Ward Environment. AMERICAN JOURNAL OF PHARMACEUTICAL EDUCATION 2019; 83:6848. [PMID: 31507282 PMCID: PMC6718511 DOI: 10.5688/ajpe6848] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/13/2017] [Accepted: 02/15/2018] [Indexed: 05/22/2023]
Abstract
Objective. To assess pharmacy students' opinions of an interprofessional learning (IPL) course in their final year of the Bachelor of Pharmacy program at The University of Auckland. Methods. Pharmacy students participated in the second day of a two-day simulation-based course, WardSim, alongside medical and nursing students in an acute care, hospital ward setting. After finishing the course, all students were asked to complete a questionnaire. The responses of pharmacy, nursing, and medical students on the scaled questions were compared. An in-depth thematic analysis of the pharmacy students' responses to the open-ended questions was completed using an iterative process. Results. Significant differences were found among the students' responses regarding the prioritization of care, systematic assessment of patients, and communication strategies. Pharmacy students had less favourable responses regarding the IPL experience than medical and nursing students. However, overall responses were positive. Some of the themes that emerged among the pharmacy students' responses included: learning communication tools, being assertive in communicating with other health care professionals, and understanding their own and others' roles in the health care team. Furthermore, some pharmacy students reported feeling underprepared for and underutilized during patient care scenarios. Conclusion. An IPL experience in an acute patient care setting demonstrated clear and beneficial learning outcomes for pharmacy students, especially in regards to communicating and understanding their roles and those of others on their team. Tailoring the pre-work or scenarios for the IPL experience to be more pharmacy orientated and having pharmacy students participate on both days may improve the preparedness for IPL.
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Affiliation(s)
- Louise E. Curley
- School of Pharmacy, Faculty of Medical and Health Sciences, The University of Auckland, Auckland, New Zealand
| | - Maree Jensen
- School of Pharmacy, Faculty of Medical and Health Sciences, The University of Auckland, Auckland, New Zealand
| | - Carolyn McNabb
- School of Pharmacy, Faculty of Medical and Health Sciences, The University of Auckland, Auckland, New Zealand
| | - Sanya Ram
- School of Pharmacy, Faculty of Medical and Health Sciences, The University of Auckland, Auckland, New Zealand
| | - Jane Torrie
- Department of Anaesthesiology, Faculty of Medical and Health Sciences, The University of Auckland, Auckland, New Zealand
| | - Tanisha Jowsey
- Centre for Medical and Health Sciences Education, Faculty of Medical and Health Sciences, The University of Auckland, Auckland, New Zealand
| | - Maureen McDonald
- School of Pharmacy, Faculty of Medical and Health Sciences, The University of Auckland, Auckland, New Zealand
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Son HK, Hee Kim D. Effect of SEGUE-based communication education on nursing simulation practice: a quasi-experimental design. Contemp Nurse 2019; 55:330-340. [PMID: 31280701 DOI: 10.1080/10376178.2019.1641421] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Background: Effective educational approaches are required to enhance nursing students' communication competency.Objectives: To evaluate the effectiveness of SEGUE ('set the stage,' 'elicit information,' 'give information,' 'understand the patient's perspective,' and 'end the encounter')-based communication education.Design: A non-equivalent control group pretest-posttest design.Methods: Students were randomized into the control group (n = 41) and experimental group (n = 57). Communication competency and efficacy were measured via a self-report questionnaire and via ratings of the students from professor and standardized patient.Results: Scores by students (self-evaluations; p < .001), professor (p < .001), and standardized patient (p < .042) showed higher communication competency in the experimental group. Compared with the control group, the pre-post difference in communication efficacy in the experimental group was increased (p = .004).Conclusions: Simulation practice to reflect the various clinical situation is recommended to improve students' communication.Impact statement: SEGUE-based communication education in nursing simulation practice with the standardized patient was an effective strategy for improving nursing students' communication.
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Affiliation(s)
- Hae Kyoung Son
- College of Nursing, Eulji University, 553, Sanseong-daero, Sujeong-gu, Seongnam-si, Gyeonggi-do 13135, Korea
| | - Dong Hee Kim
- College of Nursing, Sungshin University, 76 Ga-gil 55 Dobong-ro, Kangbuk-gu, Seoul 01133, Korea
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Commentary: Communication: The Most Important “Procedure” in Healthcare and Bioethics. Camb Q Healthc Ethics 2019; 28:415-421. [DOI: 10.1017/s0963180119000331] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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Ergonomic Challenges Inherent in Neonatal Resuscitation. CHILDREN-BASEL 2019; 6:children6060074. [PMID: 31163596 PMCID: PMC6617094 DOI: 10.3390/children6060074] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/01/2019] [Revised: 05/21/2019] [Accepted: 05/22/2019] [Indexed: 11/17/2022]
Abstract
Neonatal resuscitation demands that healthcare professionals perform cognitive and technical tasks while working under time pressure as a team in order to provide efficient and effective care. Neonatal resuscitation teams simultaneously process and act upon multiple data streams, perform ergonomically challenging technical procedures, and coordinate their actions within a small physical space. An understanding and application of human factors and ergonomics science broadens the areas of need in resuscitation research, and will lead to enhanced technologies, systems, and work environments that support human limitations and maximize human performance during neonatal resuscitation.
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Daboval T, Ward N, Schoenherr JR, Moore GP, Carew C, Lambrinakos-Raymond A, Ferretti E. Testing a Communication Assessment Tool for Ethically Sensitive Scenarios: Protocol of a Validation Study. JMIR Res Protoc 2019; 8:e12039. [PMID: 31066707 PMCID: PMC6530261 DOI: 10.2196/12039] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2018] [Revised: 03/02/2019] [Accepted: 03/29/2019] [Indexed: 11/21/2022] Open
Abstract
Background Although well-designed instruments to assess communication during medical interviews and complex encounters exist, assessment tools that differentiate between communication, empathy, decision-making, and moral judgment are needed to assess different aspects of communication during situations defined by ethical conflict. To address this need, we developed an assessment tool that differentiates competencies associated with practice in ethically challenging situations. The competencies are grouped into three distinct categories: communication skills, civility and respectful behavior, clinical and ethical judgment and decision-making. Objective The overall objective of this project is to develop an assessment tool for ethically sensitive scenarios that measures the degree of respect for the attitudes and beliefs of patients and family members, the demands of clinical decision-making, and the success in dealing with ethical conflicts in the clinical context. In this article, we describe the research method we will use during the pilot-test study using the neonatal context to provide validity evidence to support the features of the Assessment Communication Tool for Ethics (ACT4Ethics) instrument. Methods This study is part of a multiphase project designed according to modern validity principles including content, response process, internal structure, relation to other variables, and social consequences. The design considers threats to validity such as construct underrepresentation and factors exerting nonrandom influence on scores. This study consists of two primary steps: (1) train the raters in the use of the new tool and (2) pilot-test a simulation using an Objective Structured Clinical Examination. We aim to obtain a total of 90 independent assessments based on the performance of 30 trainees rated by 15 trained raters for analysis. A comparison of raters’ responses will allow us to compute a measure of interrater reliability. We will additionally compare the results of ACT4Ethics with another existing instrument. Results This study will take approximately 18 months to complete and the results should be available by September 2019. Conclusions ACT4Ethics should allow clinician-teachers to assess and monitor the development of competency of trainees’ judgments and communication skills when facing ethically sensitive clinical situations. The instrument will also guide the provision of meaningful feedback to ensure that trainees develop specific communication, empathy, decision-making, and ethical competencies. International Registered Report Identifier (IRRID) PRR1-10.2196/12039
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Affiliation(s)
- Thierry Daboval
- Department of Pediatrics, Children's Hospital of Eastern Ontario, University of Ottawa, Ottawa, ON, Canada
| | - Natalie Ward
- Performance and Evaluation, Genome Canada, Ottawa, ON, Canada
| | | | - Gregory P Moore
- Department of Pediatrics, Children's Hospital of Eastern Ontario, University of Ottawa, Ottawa, ON, Canada
| | - Caitlin Carew
- Department of Pediatrics, Children's Hospital of Eastern Ontario, University of Ottawa, Ottawa, ON, Canada
| | - Alicia Lambrinakos-Raymond
- Department of Pediatrics, Children's Hospital of Eastern Ontario, University of Ottawa, Ottawa, ON, Canada
| | - Emanuela Ferretti
- Department of Pediatrics, Children's Hospital of Eastern Ontario, University of Ottawa, Ottawa, ON, Canada
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Doorey AJ, Turi ZG, Lazzara EH, Mendoza EG, Garratt KN, Weintraub WS. Safety gaps in medical team communication: Results of quality improvement efforts in a cardiac catheterization laboratory. Catheter Cardiovasc Interv 2019; 95:136-144. [PMID: 31025508 DOI: 10.1002/ccd.28298] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2018] [Revised: 03/28/2019] [Accepted: 04/05/2019] [Indexed: 11/06/2022]
Abstract
OBJECTIVES To assess closed-loop communications (readback), a fundamental aspect of effective communication, among cardiovascular teams and assess improvement efforts. BACKGROUND Effective communication within teams is essential to assure safety and optimal outcomes. Readback of verbal physician orders is a hospital and national requirement. METHODS Single-center observational study, where the readback responses to physician verbal orders in the catheterization laboratory were characterized over three distinct time intervals from 2015 to 2017. Performance feedback and focused education on the value of readbacks was provided to the teams in two waves, with subsequent remeasurement. Responses to verbal orders were characterized as complete (all important parameters of the order repeated for verification), partial, acknowledgement only, or no response. Changes in readback performance after quality interventions were assessed. RESULTS During the first-observational period of 101 cases, complete readback occurred in 195 of 515 (38%) medication orders and 136 of 235 (58%) equipment orders. After initial quality improvement efforts, 102 cases were observed. In these, 298 of 480 (62%) medication orders had complete readback, and 210 of 420 (50%) equipment orders had complete readback. After additional quality improvement efforts, 168 cases were observed. In these, 506 of 723 (70%) medication orders had complete readback, and 630 of 1,061 (59%) equipment orders had complete readback. Overall, medication order readback improved over time (correlation = 0.26 [-0.30, -0.21]; p < 0.001), but equipment order readback did not (correlation = 0.02 [-0.07, 0.03]; p = 0.44). CONCLUSIONS Closed-loop communication of physician verbal orders was used infrequently in this medical team setting and proved difficult to fully improve. This is an important safety gap.
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Affiliation(s)
- Andrew J Doorey
- Department of Medicine, Center for Heart and Vascular Health, Christiana Care Health System, Newark, Delaware
| | - Zoltan G Turi
- Department of Medicine, Hackensack University Medical Center, Hackensack, New Jersey
| | - Elizabeth H Lazzara
- Department of Human Factors, Embry-Riddle Aeronautical University, Daytona Beach, Florida
| | - Erika G Mendoza
- Department of Biological Sciences, Delaware State University, Dover, Delaware
| | - Kirk N Garratt
- Department of Medicine, Center for Heart and Vascular Health, Christiana Care Health System, Newark, Delaware
| | - William S Weintraub
- Department of Medicine, Center for Heart and Vascular Health, Christiana Care Health System, Newark, Delaware.,Department of Medicine, MedStar Washington Hospital Center, Washington, District of Columbia
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Microlearning for patient safety: Crew resource management training in 15-minutes. PLoS One 2019; 14:e0213178. [PMID: 30845165 PMCID: PMC6405193 DOI: 10.1371/journal.pone.0213178] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2018] [Accepted: 02/15/2019] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVES We sought to establish the feasibility of chunking crew resource management (CRM) training into micro-size interventions and to compare different training approaches in the context of micro-learning. DESIGN We evaluated whether participants in micro-learning CRM activities achieved learning objectives following training. In a between-subjects design, groups were observed for behaviour during a simulation that was part of a 15-minute modular intervention and tested for recollection afterwards. PARTICIPANTS The 129 participants recruited for this study were medical students, who already had relevant experience treating patients. INTERVENTIONS The experimental setting involved three 5-minute components: video, simulation, and debriefing. Different groups viewed videos involving different didactic concepts: one group observed a videotaped concrete example of a medical care team applying a CRM tool (example group), and one group observed a videotaped lecture on the same topic (lecture group). MAIN OUTCOME MEASURES All simulations were videotaped and coded in detail for the occurrence of and time spent engaging in team behaviour and medical care. Questionnaires were administered before, immediately after, and two weeks after the intervention. We compared the groups' behaviour during the simulation (team cooperation and medical care), retention of knowledge from the training content, and results of the evaluation. RESULTS Both groups exhibited most of the behaviours included in the content of the instructional videos during the simulations and recollected information 2 weeks later. The example group exhibited significantly more of the training content during the simulation and demonstrated better retention 2 weeks later. Although the example group spent more time on team coordination, there was no difference in the number of executed medical measures. CONCLUSION Delivering CRM training in chunks of relatively short and highly standardised interventions appears feasible. In this study, the form of didactical presentation caused a difference in learning success between groups: a traditional lecture was outperformed by an instructional video demonstrating a practical example.
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Omura M, Levett‐Jones T, Stone TE. Design and evaluation of an assertiveness communication training programme for nursing students. J Clin Nurs 2019; 28:1990-1998. [DOI: 10.1111/jocn.14813] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2018] [Revised: 01/14/2019] [Accepted: 01/20/2019] [Indexed: 11/26/2022]
Affiliation(s)
- Mieko Omura
- School of Nursing and Midwifery, Faculty of Health and Medicine The University of Newcastle Callaghan New South Wales Australia
| | - Tracy Levett‐Jones
- Faculty of Health University of Technology Sydney Ultimo New South Wales Australia
| | - Teresa E. Stone
- Faculty of Nursing Chiang Mai University Chiang Mai Thailand
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Gundrosen S, Thomassen G, Wisborg T, Aadahl P. Team talk and team decision processes: a qualitative discourse analytical approach to 10 real-life medical emergency team encounters. BMJ Open 2018; 8:e023749. [PMID: 30391920 PMCID: PMC6231597 DOI: 10.1136/bmjopen-2018-023749] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
OBJECTIVES Explore the function of three specific modes of talk (discourse types) in decision-making processes. DESIGN Ten real-life admissions of patients with critical illness were audio/video recorded and transcribed. Activity-type analysis (a qualitative discourse analytical method) was applied. SETTING Interdisciplinary emergency teams admitting patients with critical illness in a Norwegian university hospital emergency department (ED). PARTICIPANTS All emergency teams consisted of at least two internal medicine physicians, two ED nurses, one anaesthetist and one nurse anaesthetist. The number of healthcare professionals involved in each emergency team varied between 11 and 20, and some individuals were involved with more than one team. RESULTS The three discourse types played significant roles in team decision-making processes when negotiating meaning. Online commentaries (ONC) and metacommentaries (MC) created progression while offline commentaries (OFC) temporarily placed decisions on hold. Both ONC and MC triggered action and distributed tasks, resources and responsibility in the team. OFC sought mutual understanding and created a broader base for decisions. CONCLUSION A discourse analytical perspective on team talk in medical emergencies illuminates both the dynamics and complexity of teamwork. Here, we draw attention to the way specific modes of talk function in negotiating mutual understanding and distributing tasks and responsibilities in non-algorithm-driven activities. The analysis uncovers a need for an enhanced focus on how language can trigger safe team practice and integrate this knowledge in teamwork training to improve communication skills in ad hoc emergency teams.
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Affiliation(s)
- Stine Gundrosen
- Department of Circulation and Medical Imaging, The Norwegian University of Science and Technology, Trondheim, Norway
- Department of Anaesthesia and Intensive Care Medicine, St. Olavs hospital, Trondheim University Hospital, Trondheim, Norway
| | - Gøril Thomassen
- Department of Language and Literature, The Norwegian University of Science and Technology, Trondheim, Norway
| | - Torben Wisborg
- Department of Anaesthesiology and Intensive Care, Finnmarkssykehuset, Hammerfest, Norway
- Department of Clinical Medicine, University of Tromsø, Tromsø, Norway
| | - Petter Aadahl
- Department of Circulation and Medical Imaging, The Norwegian University of Science and Technology, Trondheim, Norway
- Department of Anaesthesia and Intensive Care Medicine, St. Olavs hospital, Trondheim University Hospital, Trondheim, Norway
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Williams T. Educate students about human factors in acute care. CLINICAL TEACHER 2018; 16:533-535. [PMID: 30298985 DOI: 10.1111/tct.12957] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Mertens F, de Groot E, Meijer L, Wens J, Gemma Cherry M, Deveugele M, Damoiseaux R, Stes A, Pype P. Workplace learning through collaboration in primary healthcare: A BEME realist review of what works, for whom and in what circumstances: BEME Guide No. 46. MEDICAL TEACHER 2018; 40:117-134. [PMID: 29094626 DOI: 10.1080/0142159x.2017.1390216] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
BACKGROUND Changes in healthcare practice toward more proactive clinical, organizational and interprofessional working require primary healthcare professionals to learn continuously from each other through collaboration. This systematic review uses realist methodology to consolidate knowledge on the characteristics of workplace learning (WPL) through collaboration by primary healthcare professionals. METHODS Following several scoping searches, five electronic bibliographic databases were searched from January 1990 to December 2015 for relevant gray and published literature written in English, French, German and Dutch. Reviewers worked in pairs to identify relevant articles. A set of statements, based on the findings of our scoping searches, was used as a coding tree to analyze the papers. Interpretation of the results was done in alternating pairs, discussed within the author group and triangulated with stakeholders' views. RESULTS Out of 6930 references, we included 42 publications that elucidated who, when, how and what primary healthcare professionals learn through collaboration. Papers were both qualitative and quantitative in design, and focused largely on WPL of collaborating general practitioners and nurses. No striking differences between different professionals within primary healthcare were noted. Professionals were often unaware of the learning that occurs through collaboration. WPL happened predominantly through informal discussions about patient cases and modeling for other professionals. Any professionals could both learn and facilitate others' learning. Outcomes were diverse, but contextualized knowledge seemed to be important. DISCUSSION/CONCLUSIONS Primary care professionals' WPL is multifaceted. Existing social constructivist and social cognitivist learning theories form a framework from which to interpret these findings. Primary care policy makers and managers should ensure that professionals have access to protected time, earmarked for learning. Time is required for reflection, to learn new ways of interaction and to develop new habits within clinical practice.
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Affiliation(s)
- Fien Mertens
- a Department of Family Medicine and Primary Health Care , Ghent University , Gent , Belgium
| | - Esther de Groot
- b The Julius Center for Health Sciences and Primary Care , University Medical Center Utrecht , Utrecht , The Netherlands
| | - Loes Meijer
- b The Julius Center for Health Sciences and Primary Care , University Medical Center Utrecht , Utrecht , The Netherlands
| | - Johan Wens
- c Department of Primary and Interdisciplinary Care Antwerp , University of Antwerp , Antwerp , Belgium
| | - Mary Gemma Cherry
- d Psychology of Healthcare Research Group, Department of Psychological Sciences , Institute of Psychology, Health and Society, University of Liverpool , Liverpool , UK
| | - Myriam Deveugele
- a Department of Family Medicine and Primary Health Care , Ghent University , Gent , Belgium
| | - Roger Damoiseaux
- b The Julius Center for Health Sciences and Primary Care , University Medical Center Utrecht , Utrecht , The Netherlands
| | - Ann Stes
- e Antwerp School of Education, Centre for Excellence in Higher Education , University of Antwerp , Antwerp , Belgium
| | - Peter Pype
- a Department of Family Medicine and Primary Health Care , Ghent University , Gent , Belgium
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The effectiveness of assertiveness communication training programs for healthcare professionals and students: A systematic review. Int J Nurs Stud 2017; 76:120-128. [DOI: 10.1016/j.ijnurstu.2017.09.001] [Citation(s) in RCA: 55] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2017] [Revised: 08/19/2017] [Accepted: 09/03/2017] [Indexed: 11/21/2022]
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Tarrant C, Leslie M, Bion J, Dixon-Woods M. A qualitative study of speaking out about patient safety concerns in intensive care units. Soc Sci Med 2017; 193:8-15. [PMID: 28987982 PMCID: PMC5669358 DOI: 10.1016/j.socscimed.2017.09.036] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2017] [Revised: 09/19/2017] [Accepted: 09/20/2017] [Indexed: 11/23/2022]
Abstract
Much policy focus has been afforded to the role of "whistleblowers" in raising concerns about quality and safety of patient care in healthcare settings. However, most opportunities for personnel to identify and act on these concerns are likely to occur much further upstream, in the day-to-day mundane interactions of everyday work. Using qualitative data from over 900 h of ethnographic observation and 98 interviews across 19 English intensive care units (ICUs), we studied how personnel gave voice to concerns about patient safety or poor practice. We observed much low-level social control occurring as part of day-to-day functioning on the wards, with challenges and sanctions routinely used in an effort to prevent or address mistakes and norm violations. Pre-emptions were used to intervene when patients were at immediate risk, and included strategies such as gentle reminders, use of humour, and sharp words. Corrective interventions included education and evidence-based arguments, while sanctions that were applied when it appeared that a breach of safety had occurred included "quiet words", bantering, public exposure or humiliation, scoldings and brutal reprimands. These forms of social control generally functioned effectively to maintain safe practice. But they were not consistently effective, and sometimes risked reinforcing norms and idiosyncratic behaviours that were not necessarily aligned with goals of patient safety and high-quality healthcare. Further, making challenges across professional boundaries or hierarchies was sometimes problematic. Our findings suggest that an emphasis on formal reporting or communication training as the solution to giving voice to safety concerns is simplistic; a more sophisticated understanding of social control is needed.
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Affiliation(s)
- Carolyn Tarrant
- Department of Health Sciences, University of Leicester, Leicester, UK
| | - Myles Leslie
- Cumming School of Medicine, University of Calgary, Calgary, Canada
| | - Julian Bion
- Institute of Clinical Sciences, University of Birmingham, Birmingham, UK
| | - Mary Dixon-Woods
- Cambridge Centre for Health Services Research, University of Cambridge, Cambridge, UK.
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Improving Nursing Communication Skills in an Intensive Care Unit Using Simulation and Nursing Crew Resource Management Strategies: An Implementation Project. J Nurs Care Qual 2017; 32:331-339. [PMID: 27875384 DOI: 10.1097/ncq.0000000000000241] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Effective interprofessional communication is critical to patient safety. This pre-/postimplementation project used a multifaceted educational strategy with high-fidelity simulation to introduce evidence-based communication tools, adapted from Nursing Crew Resource Management, to intensive care unit nurses. Results indicated that participants were satisfied with the education, and their perceptions of interprofessional communication and knowledge improved. Teams (n = 16) that used the communication tools during simulation were more likely to identify the problem, initiate key interventions, and have positive outcomes.
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Matava CT, Echaniz G, Parkes W, Papsin BC, Propst EJ, Cushing SL. Monopoly Airplane Lands in Esophagus Leading to Difficult Extraction: A Case Report on Anesthesia and Surgical Considerations. ACTA ACUST UNITED AC 2017; 9:193-196. [PMID: 28542053 DOI: 10.1213/xaa.0000000000000562] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
A 2-year-old child presented with an airplane game piece from the board game Monopoly lodged in her esophagus. The airplane's wings, engines, and winglets acted like fish hooks that entered the esophageal mucosa easily but were difficult to extract. Chest radiographs were used to estimate the airplane wingspan dimensions, and a Foley catheter was used to dilate the esophagus to allow foreign body extraction via rigid esophagoscopy with optical forceps. Deliberate deep placement of the endotracheal tube facilitated surgical manipulation. This case report highlights the importance of teamwork, communication, and the involvement of multiple disciplines, each with their unique experience and expertise, to formulate a plan of action for patients during unique surgical emergencies.
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Affiliation(s)
- Clyde T Matava
- From the Departments of *Anesthesia and Pain Medicine and †Otolaryngology-Head & Neck Surgery, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
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Yee DJ, Wiggins MW, Searle BJ. The Role of Social Cue Utilization and Closing-the-Loop Communication in the Performance of Ad Hoc Dyads. HUMAN FACTORS 2017; 59:1009-1021. [PMID: 28796973 DOI: 10.1177/0018720817699512] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
OBJECTIVE To examine whether social cue utilization impacts the performance of ad hoc dyads through its relationship with closing the loop, a communication process whereby team members respond more frequently to initiating statements made by others. BACKGROUND There lacks unequivocal experimental evidence for any single cognitive-based process that might predict the performance of ad hoc teams. METHOD Using a quasi-experimental design, 80 participants were classified into 40 dyads based on their levels of social cue utilization and attempted a team problem-solving task. A serial mediation model revealed an indirect effect of social cue utilization on the performance of ad hoc dyads through closing the loop. RESULTS Analyses indicated that social cue utilization impacts on the performance of ad hoc dyads independently of nonverbal reasoning ability and emotional intelligence. Further, the level of social cue utilization within dyads exhibits a positive indirect impact on the performance of ad hoc dyads through closing the loop. CONCLUSION Ad hoc dyads with higher levels of social cue utilization engaged in a greater frequency of closing-the-loop statements and showed better subsequent performance on a problem-solving task in comparison to dyads with lower levels of social cue utilization. APPLICATION Potential applications include the optimization of ad hoc team composition within high reliability environments like aviation and power control as well as improving training interventions with a specific mechanism for improving the performance of ad hoc teams.
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Davis WA, Jones S, Crowell-Kuhnberg AM, O'Keeffe D, Boyle KM, Klainer SB, Smink DS, Yule S. Operative team communication during simulated emergencies: Too busy to respond? Surgery 2017; 161:1348-1356. [DOI: 10.1016/j.surg.2016.09.027] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2016] [Revised: 09/09/2016] [Accepted: 09/16/2016] [Indexed: 11/30/2022]
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Brindley PG, O'Dochartaigh D, Volney C, Ryan S, Douma MJ. Time delays associated with vasoactive medication preparation and delivery in simulated patients at risk of cardiac arrest. J Crit Care 2017; 40:149-153. [PMID: 28402925 DOI: 10.1016/j.jcrc.2017.04.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2016] [Revised: 03/30/2017] [Accepted: 04/05/2017] [Indexed: 10/19/2022]
Abstract
PURPOSE To compare, quantify, and describe the time-delays associated with four common methods of adrenaline administration in the simulated setting of impending cardiac arrest. METHODS Using sham medication and a high-fidelity simulator, experienced Nurses prepared, then delivered, adrenaline by: i) bolus, ii) lower-concentration infusion iii) higher-concentration infusion, and iv) higher-concentration infusion plus carrier-line. We recorded medication preparation and delivery time, plus administration errors and self-reported competence. RESULTS Median total delay was i) 120s for bolus (95% CI 112-128s); ii) 179s for lower concentration infusion (95% CI 172-186s); iii) 296s for higher concentration infusion (95% CI 285-307s); and iv) 411s for higher concentration infusion plus carrier line (95% CI 399-423s). Time to prepare/deliver a bolus was less than any infusion (p<0.001). Time to prepare/deliver a lower-concentration infusion was less than either higher-concentration infusion (p<0.001). No substantial equipment failures or medication errors were observed. Participants reported high-competence. The majority of delay was from drug preparation not delivery. CONCLUSIONS We highlight potentially dangerous delays with administration of life-saving medications by all four methods. We should prioritize boluses, and focus on improving drug preparation times and human performance, more than drug delivery and equipment.
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Affiliation(s)
- P G Brindley
- Critical Care Medicine, Medical Ethics, Anesthesiology, University of Alberta Hospital, Edmonton, Alberta T6G2B7, Canada.
| | - D O'Dochartaigh
- Shock Trauma Air Rescue Society, Emergency Departments Edmonton Zone, RM 1G1:55, Department of Emergency Medicine, University of Alberta Hospital, Edmonton, Alberta, Canada.
| | - C Volney
- Saba University School of Medicine Dutch Caribbean, Netherlands
| | - S Ryan
- Shock Trauma Air Rescue Service, Edmonton, Alberta, Canada.
| | - M J Douma
- Royal Alexandra Hospital Emergency Department, Edmonton, Alberta, Canada.
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Brindley PG, Beed M, Law JA, Hung O, Levitan R, Murphy MF, Duggan LV. Airway management outside the operating room: how to better prepare. Can J Anaesth 2017; 64:530-539. [DOI: 10.1007/s12630-017-0834-z] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2016] [Revised: 12/08/2016] [Accepted: 01/27/2017] [Indexed: 12/19/2022] Open
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Simulation Testing for Selection of Critical Care Medicine Trainees. A Pilot Feasibility Study. Ann Am Thorac Soc 2017; 13:529-35. [PMID: 26967948 DOI: 10.1513/annalsats.201601-012oc] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
RATIONALE Selection of physicians into anesthesiology, intensive care, and emergency medicine training has traditionally relied on evaluation of curriculum vitae, letters of recommendation, and interviews, despite these methods being poor predictors of subsequent workplace performance. OBJECTIVES In this study, we evaluated the feasibility and face validity of incorporating assessment of nontechnical skills in simulation and personality traits into an existing junior doctor selection framework. METHODS Candidates short-listed for a critical care residency position were invited to participate in the study. On the interview day, consenting candidates participated in a simulation scenario and debriefing and completed a personality test (16 Personality Factor Questionnaire) and a survey. Timing of participants' progression through the stations and faculty staff numbers were evaluated. Nontechnical skills were evaluated and candidates ranked using the Ottawa Crisis Resource Management Global Rating Scale (Ottawa GRS). Nontechnical skills ranking and traditional selection method ranking were compared using the concordance correlation coefficient. Interrater reliability was assessed using the concordance correlation coefficient. MEASUREMENTS AND MAIN RESULTS Thirteen of 20 eligible participants consented to study inclusion. All participants completed the necessary stations without significant time delays. Eighteen staff members were required to conduct interviews, simulation, debriefing, and personality testing. Participants rated the simulation station to be acceptable, fair, and relevant and as providing an opportunity to demonstrate abilities. Personality testing was rated less fair, less relevant, and less acceptable, and as giving less opportunity to demonstrate abilities. Participants reported that simulation was equally as stressful as the interview, whereas personality testing was rated less stressful. Assessors rated both personality testing and simulation as acceptable and able to provide additional information about candidates. The Ottawa GRS showed moderate interrater concordance. There was moderate concordance between rankings based on traditional selection methods and Ottawa GRS rankings (ρ = 0.52; 95% confidence interval, -0.02 to 0.82; P = 0.06). CONCLUSIONS A multistation selection process involving interviews, simulation, and personality testing is feasible and has face validity. A potential barrier to adoption is the high number of faculty required to conduct the process.
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