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Closed-Loop Communication in Interprofessional Emergency Teams: A Cross-Sectional Observation Study on the Use of Closed-Loop Communication Among Anesthesia Personnel. J Patient Saf 2023; 19:93-98. [PMID: 36729479 DOI: 10.1097/pts.0000000000001098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVES Communication failure is one of the most common causes of adverse events in hospitals and poses a direct threat to patient safety. Research recommends the use of closed-loop communication in interprofessional emergency teams to prevent such events. Multiple studies have examined closed-loop communication during simulation training, but few have investigated its use in clinical practice. The aim of the study was to explore the use of closed-loop communication by anesthesia personnel in real-life interprofessional emergency teams. METHODS This study had a descriptive, cross-sectional design where structured field observations were used to assess anesthesia personnel's use of closed-loop communication in real-life interprofessional emergency teams. A total of 60 interprofessional teams were observed, including 120 anesthesia personnel at a hospital in South-Eastern Norway. Data were analyzed using descriptive statistics. RESULTS A total of 1626 call outs were registered, in which closed-loop communication was applied in 45%. Closed-loop communication was used more frequently when call outs were directed using eye contact and when the call outs were medication orders. There was no difference in the use of closed-loop communication between nurse anesthetists and anesthesiologists. Closed-loop communication was used more frequently in cardiac arrest teams than in trauma teams. CONCLUSIONS The findings in this study have contributed knowledge about anesthesia personnel's use of closed-loop communication in real-life interprofessional emergency teams and indicate a potential for improvement. Further research is needed about real-life interprofessional emergency teams' communication patterns and potential barriers from using closed-loop communication, with the aim to improve patient safety.
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The Impact of Personal Protective Equipment on Speech Discrimination and Verbal Communication in the Operating Room and the Role of Audio Communication Devices. Simul Healthc 2023; 18:64-70. [PMID: 35307712 DOI: 10.1097/sih.0000000000000646] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
INTRODUCTION Recent work has highlighted communication difficulties when wearing personal protective equipment (PPE) in the clinical setting, but currently, there are little objective data on its effects. We assessed the impact of PPE on verbal communication in a simulated operating room and evaluated use of an audio communication device. METHODOLOGY Frontline health professionals across specialties including surgery, anesthetics, and nursing undertook speech discrimination testing with and without standardized levels of PPE in a simulated operating room environment. Background noise (30- and 70-a-weighted decibel multitalker babble) at 2 distances (2 and 4 m) were selected representative of operating room environments. Bamford-Kowal-Bench (BKB) scoring (192 sentences per participant) was performed. A Digital Multichannel Transceiver System (DMTS) was evaluated. We assessed the effects of PPE use, distance, and use of the DMTS with pairwise comparisons, using a Bonferroni correction, and assessed participant experience via Likert scales. RESULTS Thirty-one healthcare professionals were tested. Without PPE in 70-a-weighted decibel "babble," median BKB sentence scores were 90% and 76% at 2 and 4 m (adjusted P < 0.0005). The median BKB sentence scores dropped to 8% and 4% at 2 and 4 m in PPE (adjusted P < 0.0005). Improved speech discrimination was achieved with DMTS use to 70% and 76% at 2 and 4 m. Personal protective equipment led to a statistically significant reduction in BKB scores across all conditions compared with baseline. Overall participant confidence in PPE clinical communication was low. CONCLUSIONS Addition of PPE dramatically impairs speech discrimination and communication in high levels of background noise characteristic of clinical environments, which can be significantly improved using DMTS. Measures should be taken by teams through both through reduction of background noise and consideration of assistive technologies maximizing patient safety. This may be further rehearsed in a simulation environment.
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Kennedy-Metz LR, Barbeito A, Dias RD, Zenati MA. Importance of high-performing teams in the cardiovascular intensive care unit. J Thorac Cardiovasc Surg 2022; 163:1096-1104. [PMID: 33931232 PMCID: PMC8481338 DOI: 10.1016/j.jtcvs.2021.02.098] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Revised: 02/22/2021] [Accepted: 02/23/2021] [Indexed: 12/14/2022]
Affiliation(s)
- Lauren R. Kennedy-Metz
- Department of Surgery, Harvard Medical School, Boston, Mass,Division of Cardiac Surgery, VA Boston Healthcare System, Boston, Mass
| | - Atilio Barbeito
- Anesthesiology Service, Durham VA Health Care System, Durham, NC,Department of Anesthesiology, Duke University, Durham, NC
| | - Roger D. Dias
- Department of Emergency Medicine, Harvard Medical School, Boston, Mass
| | - Marco A. Zenati
- Department of Surgery, Harvard Medical School, Boston, Mass,Division of Cardiac Surgery, VA Boston Healthcare System, Boston, Mass
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Ulmer FF, Lutz AM, Müller F, Riva T, Bütikofer L, Greif R. Communication Patterns During Routine Patient Care in a Pediatric Intensive Care Unit: The Behavioral Impact of In Situ Simulation. J Patient Saf 2022; 18:e573-e579. [PMID: 34224500 DOI: 10.1097/pts.0000000000000872] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVE Effective communication minimizes medical errors and leads to improved team performance while treating critically ill patients. Closed-loop communication is routinely applied in high-risk industries but remains underutilized in healthcare. Simulation serves as an educational tool to introduce, practice, and appreciate the efficacy of closed-loop communication. METHODS This observational before-and-after study investigates behavioral changes in communication among nurses brought on by simulation team training in a pediatric intensive care unit (PICU). The communication patterns of PICU nurses, who had no prior simulation experience, were observed during routine bedside care before and after undergoing in situ simulation.One month before and 1 and 3 months after simulation (intervention), 2 trained raters recorded nurse communications relative to callouts, uttered by the sender, and callbacks, reciprocated by the recipient. The impact of simulation on communication patterns was analyzed quantitatively. RESULTS Among the 15 PICU nurses included in this study, significant changes in communication behavior were observed during patient care after communication-focused in situ simulation. The PICU nurses were significantly less likely to let a callout go unanswered during clinical routine. The effect prevailed both 1 month (P = 0.039) and 3 months (P = 0.033) after the educational exposure. CONCLUSIONS This observational before-and-after study describes the prevalence and pattern of communication among PICU nurses during routine patient care and documents PICU nurses transferring simulation-acquired communication skills into their clinical environment after a single afternoon of in situ simulation. This successful transfer of simulation-acquired skills has the potential to improve patient safety and outcome.
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Affiliation(s)
- Francis F Ulmer
- From the Department of Pediatrics, Section of Pediatric Critical Care
| | - Andrea M Lutz
- Department of Anesthesiology and Pain Therapy, Bern University Hospital, University of Bern
| | - Fabienne Müller
- From the Department of Pediatrics, Section of Pediatric Critical Care
| | - Thomas Riva
- Department of Anesthesiology and Pain Therapy, Bern University Hospital, University of Bern
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van Dalen ASH, Swinkels JA, Coolen S, Hackett R, Schijven MP. Improving teamwork and communication in the operating room by introducing the theatre cap challenge. J Perioper Pract 2022; 32:4-9. [PMID: 35001734 PMCID: PMC8750134 DOI: 10.1177/17504589211046723] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/05/2022]
Abstract
Objective One of the steps of the Surgical Safety Checklist is for the team members to
introduce themselves. The objective of this study was to implement a tool to
help remember and use each other’s names and roles in the operating
theatre. Methods This study was part of a pilot study in which a video and medical data
recorder was implemented in one operating theatre and used as a tool for
postoperative multidisciplinary debriefings. During these debriefings, name
recall was evaluated. Following the implementation of the medical data
recorder, this study was started by introducing the theatre cap challenge,
meaning the use of name (including role) stickers on the surgical cap in the
operating theatre. Findings In total, 41% (n = 40 out of 98) of the operating theatre members were able
to recall all the names of their team at the team briefings. On average
44.8% (n = 103) was wearing the name sticker. Conclusions The time-out stage of the Surgical Safety Checklist might be inadequate for
correctly remembering and using your operating theatre team members’ names.
For this, the theatre cap challenge may help.
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Affiliation(s)
- Anne Sophie Hm van Dalen
- Department of Surgery, Amsterdam Gastroenterology and Metabolism, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Jan A Swinkels
- Department of Psychiatry, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Stan Coolen
- Department of Surgery, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Robert Hackett
- Department of Anesthesiology, 2205Royal Prince Alfred Hospital, 2205Royal Prince Alfred Hospital, Sydney, Australia
| | - Marlies P Schijven
- Department of Surgery, Amsterdam Gastroenterology and Metabolism, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
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Paige JT, Bonanno LS, Garbee DD, Yu Q, Kiselov VJ, Badeaux JA, Martin JB, Kalil DM, Devlin RJ. Team Training for Interprofessional Insight, Networking and Guidance (T 2IPING) points: a study protocol. Simul Healthc 2022. [DOI: 10.54531/fqax8042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Effective teamwork remains a crucial component in providing high-quality care to patients in today’s complex healthcare environment. A prevalent ‘us’ versus ‘them’ mentality among professions, however, impedes reliable team function in the clinical setting. More importantly, its corrosive influence extends to health professional students who model the ineffective behaviour as they learn from practicing clinicians. Simulation-based training (SBT) of health professional students in team-based competencies recognized to improve performance could potentially mitigate such negative influences. This quasi-experimental prospective study will evaluate the effectiveness and impact of incorporating a multi-year, health science centre-wide SBT curriculum for interprofessional student teams. It targets health professional students from the Schools of Medicine, Nursing and Allied Health at Louisiana State University (LSU) Health New Orleans. The intervention will teach interprofessional student teams key team-based competencies for highly reliable team behaviour using SBT. The study will use the Kirkpatrick framework to evaluate training effectiveness. Primary outcomes will focus on the impact of the training on immediate improvements in team-based skills and attitudes (Level 2). Secondary outcomes include students’ perception of the SBT (Level 1), its immediate impact on attitudes towards interprofessional education (Level 2) and its impact on team-based attitudes over time (Level 3).The Institutional Review Board at LSU Health New Orleans approved this research as part of an exempt protocol with a waiver of documentation of informed consent due to its educational nature. The research description for participants provides information on the nature of the project, privacy, dissemination of results and opting out of the research.
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Affiliation(s)
- John T Paige
- 1Department of Surgery, Louisiana State University (LSU) Health New Orleans School of Medicine, New Orleans, LA, USA
| | - Laura S Bonanno
- 2Nurse Anesthesia Program, LSU Health New Orleans School of Nursing, New Orleans, LA
| | - Deborah D Garbee
- 3Office of the Dean, LSU Health New Orleans School of Nursing, New Orleans, LA
| | - Qingzhao Yu
- 4Department of Biostatistics, LSU Health New Orleans School of Public Health, New Orleans, LA
| | | | - Jennifer A Badeaux
- 2Nurse Anesthesia Program, LSU Health New Orleans School of Nursing, New Orleans, LA
| | - Jennifer B Martin
- 2Nurse Anesthesia Program, LSU Health New Orleans School of Nursing, New Orleans, LA
| | - David M Kalil
- 2Nurse Anesthesia Program, LSU Health New Orleans School of Nursing, New Orleans, LA
| | - Raymond J Devlin
- 2Nurse Anesthesia Program, LSU Health New Orleans School of Nursing, New Orleans, LA
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Paige JT, Bonanno LS, Garbee DD, Yu Q, Kiselov VJ, Badeaux JA, Martin JB, Kalil DM, Devlin RJ. Team Training for Interprofessional Insight, Networking and Guidance (T 2IPING) points: a study protocol. Simul Healthc 2022. [DOI: 10.54531/ijohs/ijaa015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Effective teamwork remains a crucial component in providing high-quality care to patients in today’s complex healthcare environment. A prevalent ‘us’ versus ‘them’ mentality among professions, however, impedes reliable team function in the clinical setting. More importantly, its corrosive influence extends to health professional students who model the ineffective behaviour as they learn from practicing clinicians. Simulation-based training (SBT) of health professional students in team-based competencies recognized to improve performance could potentially mitigate such negative influences. This quasi-experimental prospective study will evaluate the effectiveness and impact of incorporating a multi-year, health science centre-wide SBT curriculum for interprofessional student teams. It targets health professional students from the Schools of Medicine, Nursing and Allied Health at Louisiana State University (LSU) Health New Orleans. The intervention will teach interprofessional student teams key team-based competencies for highly reliable team behaviour using SBT. The study will use the Kirkpatrick framework to evaluate training effectiveness. Primary outcomes will focus on the impact of the training on immediate improvements in team-based skills and attitudes (Level 2). Secondary outcomes include students’ perception of the SBT (Level 1), its immediate impact on attitudes towards interprofessional education (Level 2) and its impact on team-based attitudes over time (Level 3).The Institutional Review Board at LSU Health New Orleans approved this research as part of an exempt protocol with a waiver of documentation of informed consent due to its educational nature. The research description for participants provides information on the nature of the project, privacy, dissemination of results and opting out of the research.
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Affiliation(s)
- John T Paige
- 1Department of Surgery, Louisiana State University (LSU) Health New Orleans School of Medicine, New Orleans, LA, USA
| | - Laura S Bonanno
- 2Nurse Anesthesia Program, LSU Health New Orleans School of Nursing, New Orleans, LA
| | - Deborah D Garbee
- 3Office of the Dean, LSU Health New Orleans School of Nursing, New Orleans, LA
| | - Qingzhao Yu
- 4Department of Biostatistics, LSU Health New Orleans School of Public Health, New Orleans, LA
| | | | - Jennifer A Badeaux
- 2Nurse Anesthesia Program, LSU Health New Orleans School of Nursing, New Orleans, LA
| | - Jennifer B Martin
- 2Nurse Anesthesia Program, LSU Health New Orleans School of Nursing, New Orleans, LA
| | - David M Kalil
- 2Nurse Anesthesia Program, LSU Health New Orleans School of Nursing, New Orleans, LA
| | - Raymond J Devlin
- 2Nurse Anesthesia Program, LSU Health New Orleans School of Nursing, New Orleans, LA
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Paige JT, Garbee DD, Yu Q, Zahmjahn J, Baroni de Carvalho R, Zhu L, Rusnak V, Kiselov VJ. Brick in the wall? Linking quality of debriefing to participant learning in team training of interprofessional students. BMJ SIMULATION & TECHNOLOGY ENHANCED LEARNING 2021; 7:360-365. [PMID: 35515739 PMCID: PMC8936698 DOI: 10.1136/bmjstel-2020-000685] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 12/07/2020] [Indexed: 11/03/2022]
Abstract
Background The evidence for the conventional wisdom that debriefing quality determines the effectiveness of learning in simulation-based training is lacking. We investigated whether the quality of debriefing in using simulation-based training in team training correlated with the degree of learning of participants. Methods Forty-two teams of medical and undergraduate nursing students participated in simulation-based training sessions using a two-scenario format with after-action debriefing. Observers rated team performance with an 11-item Teamwork Assessment Scales (TAS) instrument (three subscales, team-based behaviours (5-items), shared mental model (3-items), adaptive communication and response (3-items)). Two independent, blinded raters evaluated video-recorded facilitator team prebriefs and debriefs using the Objective Structured Assessment of Debriefing (OSAD) 8-item tool. Descriptive statistics were calculated, t-test comparisons made and multiple linear regression and univariate analysis used to compare OSAD item scores and changes in TAS scores. Results Statistically significant improvements in all three TAS subscales occurred from scenario 1 to 2. Seven faculty teams taught learners with all scores ≥3.0 (except two) for prebriefs and all scores ≥ 3.5 (except one) for debriefs (OSAD rating 1=done poorly to 5=done well). Linear regression analysis revealed a single statistically significant correlation between debrief engagement and adaptive communication and response score without significance on univariate analysis. Conclusions Quality of debriefing does not seem to increase the degree of learning in interprofessional education using simulation-based training of prelicensure student teams. Such a finding may be due to the relatively high quality of the prebrief and debrief of the faculty teams involved in the training.
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Affiliation(s)
- John T Paige
- School of Medicine, Department of Surgery, LSU Health New Orleans Health Sciences Center, New Orleans, Louisiana, USA
| | - Deborah D Garbee
- School of Nursing, LSU Health New Orleans Health Sciences Center, New Orleans, Louisiana, USA
| | - Qingzhao Yu
- School of Public Health, LSU Health New Orleans Health Sciences Center, New Orleans, Louisiana, USA
| | - John Zahmjahn
- School of Allied Health Professions, LSU Health New Orleans Health Sciences Center, New Orleans, Louisiana, USA
| | | | - Lin Zhu
- Bristol-Myers Squibb Co, New York, New York, USA
| | - Vadym Rusnak
- School of Medicine, Department of Medicine, Tulane University Health Sciences Center, New Orleans, Louisiana, USA
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9
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Schulthess P, Bohnen J, Grantcharov T, Palter V. The OR Black Box Nursing Education Curriculum: Using Video Review to Optimize Patient Safety. AORN J 2020; 112:536-544. [DOI: 10.1002/aorn.13218] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2020] [Accepted: 06/04/2020] [Indexed: 11/06/2022]
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10
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Dabney C, Appling NA, Herr MJ. An Interprofessional Branching Simulation to Introduce RN First Assistant Students to Their Role in the Perioperative Setting. AORN J 2020; 112:471-477. [PMID: 33113198 DOI: 10.1002/aorn.13211] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2019] [Revised: 10/03/2019] [Accepted: 12/02/2019] [Indexed: 11/08/2022]
Abstract
Simulation can be an effective tool for educating health profession students and can enhance interprofessional education by involving roles across multiple disciplines. Perioperative nurse educators at one institution used a five-part branching simulation of preoperative, intraoperative, and postoperative events for a single patient undergoing a procedure to introduce RN first assistant (RNFA) students to their role in the perioperative environment. The simulation participants included student RN anesthetists, a surgeon, an RN circulator (played by an actor), and a standardized patient. The objectives for this simulation were to assess the implementation of the didactic RNFA curriculum and to enhance the RNFA students' transition into their role in the perioperative setting. The simulation and multiple debriefings reinforced the concepts of role acquisition, surgical conscience, closed-loop communication, and interprofessional collaboration. Perioperative nurse educators can use this type of educational activity to teach these concepts to their students.
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11
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Boet S, Etherington N, Crnic A, Kenna J, Jung J, Cairns M, Posner G, Grantcharov T. La définition des moments critiques et non critiques en salle d'opération : une étude de consensus Delphi modifiée. Can J Anaesth 2020; 67:949-958. [PMID: 32377936 DOI: 10.1007/s12630-020-01688-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2019] [Revised: 01/17/2020] [Accepted: 03/02/2020] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND While the operating room (OR) has significantly benefited from aviation strategies to improve safety, the rate of avoidable human errors remains relatively high. One key aviation strategy that has yet to be formally established in the OR is the "sterile cockpit" rule, which prohibits all non-essential behaviours during critical moments of a flight. Applying this rule to the OR may enhance patient safety, but the critical moments of surgery need to be defined first. METHODS This study used a modified Delphi methodology to determine critical moments during surgery according to OR team members across institutions, professions, and specialties. Analysis occurred after each round. The stopping criterion was consensus on 80% of survey items or no change in the mean score for any individual item between two consecutive rounds. RESULTS The first round included 304 respondents. Of these, 115 completed the second-round survey, and 75 completed all three rounds (27 nurses, 29 anesthesiologists, 19 surgeons). Critical moments obtained by consensus were: induction of anesthesia; emergence from anesthesia; preoperative briefing; final counts at the end of the procedure; anesthesiologist- or surgeon-relevant intraoperative event; handovers; procedure-specific high-risk surgical moments; crisis resource management situations; medication and equipment preparation; and key medication administration. CONCLUSIONS By defining the most critical moments of surgery, future research can determine the relative importance of behaviour and actions at each stage and target interventions to these stages.
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Affiliation(s)
- Sylvain Boet
- Department of Anesthesiology and Pain Medicine, University of Ottawa, Ottawa, ON, Canada.,Clinical Epidemiology Program, Ottawa Hospital Research Institute - Centre for Practice Changing Research, 501 Smyth Rd, Ottawa, ON, K1H 8L6, Canada.,Department of Innovation in Medical Education, University of Ottawa, Ottawa, ON, Canada
| | - Nicole Etherington
- Department of Anesthesiology and Pain Medicine, University of Ottawa, Ottawa, ON, Canada. .,Clinical Epidemiology Program, Ottawa Hospital Research Institute - Centre for Practice Changing Research, 501 Smyth Rd, Ottawa, ON, K1H 8L6, Canada.
| | - Agnes Crnic
- Department of Anesthesiology and Pain Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Julie Kenna
- The Ottawa Hospital, Main Operating Room, Ottawa, ON, Canada
| | - James Jung
- Department of Surgery, University of Toronto, Toronto, ON, Canada.,International Centre for Surgical Safety, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, ON, Canada
| | - Martin Cairns
- Department of Anesthesiology and Pain Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Glen Posner
- Department of Obstetrics, Gynecology and Newborn Care, University of Ottawa, Ottawa, ON, Canada
| | - Teodor Grantcharov
- Department of Surgery, University of Toronto, Toronto, ON, Canada.,International Centre for Surgical Safety, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, ON, Canada
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12
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Diaz MCG, Dawson K. Impact of Simulation-Based Closed-Loop Communication Training on Medical Errors in a Pediatric Emergency Department. Am J Med Qual 2020; 35:474-478. [PMID: 32204598 DOI: 10.1177/1062860620912480] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
Closed-loop communication (CLC) promotes a shared understanding of information. The authors hypothesized that simulation-based CLC training would improve staff perceptions of CLC ability and decrease medical errors. Participants experienced 2 hands-on CLC simulations one month apart. A retrospective chart review of Emergency Severity Index (ESI) 1 patients was conducted 4 months pre and post CLC simulation-based training. Seventy simulations were held over 13 weeks. Staff perceptions of CLC ability improved and were sustained after one month. Nine ESI 1 patients were seen pre CLC, and 9 post; 8/9 pre-CLC ESI 1 patients had medical errors, with 19 total errors noted; 5/9 post-CLC ESI 1 patients had medical errors, with 5 total errors noted (rate ratio [99% CI] = 3.8 [1.4, 10.2]; P = .008). This simulation-based CLC training curriculum improved staff perceptions of their CLC ability and was associated with a significant decrease in the number of medical errors in ESI 1 patients.
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13
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Ha EH. Effects of peer-led debriefing using simulation with case-based learning: Written vs. observed debriefing. NURSE EDUCATION TODAY 2020; 84:104249. [PMID: 31683133 DOI: 10.1016/j.nedt.2019.104249] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/08/2019] [Revised: 09/26/2019] [Accepted: 10/15/2019] [Indexed: 06/10/2023]
Abstract
BACKGROUND Peer-led written debriefing (PLWD) and peer-led observed debriefing (PLOD) are types of peer-led debriefing. Despite their advantages, these methods are sparingly used among debriefing experts. OBJECTIVE To identify effects of peer-led debriefing (written versus observed) using simulation with case-based learning (CBL) and compare levels of satisfaction with CBL, debriefing, and simulation-based learning (SBL) between the two groups. DESIGN Quasi-experimental study used a pretest-posttest non-equivalent control group. SETTING Department of Nursing in C province, South Korea. PARTICIPANTS Sixty-nine third-year undergraduate nursing students (PLWD, n = 33; PLOD, n = 36). METHODS Differences in clinical performance competency, and satisfaction of CBL, SBL, and debriefing between the PLWD and PLOD groups were determined. RESULTS Clinical performance competency scores of posttest in both the PLWD and PLOD groups were significantly higher than those of pretest. There were no significant differences in any item except for item of 'communication' (t = -2.150, p = .047) between the PLWD and PLOD groups. There were no significant differences in satisfaction with CBL (t = -0.874, p = .385), simulation (t = -0.701, p = .485), or debriefing (t = -1.024, p = .309) between the two groups. CONCLUSION This study suggests that both the PLWD and PLOD could be used to achieve students' learning outcomes when debriefing experts are unavailable.
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Affiliation(s)
- Eun-Ho Ha
- Department of Nursing, Jungwon University, 85, Munmu-ro, Goesan-eup, Goesan-gun, Chungbuk 367-805, Republic of Korea.
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Katrina C D, Elliott R H. Competing patient safety concerns about surgical scrub caps – Infection control vs. breakdowns in communication. JOURNAL OF PATIENT SAFETY AND RISK MANAGEMENT 2019. [DOI: 10.1177/2516043519886514] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Affiliation(s)
- Duncan Katrina C
- Department of Surgery, University of British Columbia, Vancouver, Canada
| | - Haut Elliott R
- Division of Acute Care Surgery, Department of Surgery, The Johns Hopkins University School of Medicine, Baltimore, USA
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15
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Hemingway M, Osgood P. Nurses' Perceptions of Personal Communication Devices in the Perioperative Environment. AORN J 2019; 110:395-402. [PMID: 31560424 DOI: 10.1002/aorn.12804] [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] [Indexed: 11/05/2022]
Abstract
Personal communication devices (PCDs) support reliable information sharing between clinical personnel to ease workflow processes. Perioperative leaders at a major medical center conducted a long-term quality improvement project evaluating perioperative nurse perceptions regarding PCDs. Perioperative nurses completed two surveys and the investigators conducted an independent group t test (2-tailed) to test for differences in RN perceptions of PCDs from initial use during a pilot study and after the nurses had used the technology for four years. The authors also used qualitative content analysis to assess the qualitative items on the survey. The RNs noted that the PCDs were particularly beneficial when contacting team members for assistance and that response times improved. Overhead pages decreased from 125 per six-hour period to an average of less than one per six-hour period. The perioperative nurses' perceptions of the PCDs have improved four years after implementation.
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16
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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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