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Janssens S, Simon R, Beckmann M, Marshall S. Shared Leadership in Healthcare Action Teams: A Systematic Review. J Patient Saf 2021; 17:e1441-e1451. [PMID: 29870514 DOI: 10.1097/pts.0000000000000503] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES The aims of this review were to consolidate the reported literature describing shared leadership in healthcare action teams (HCATs) and to review the reported outcomes related to leadership sharing in healthcare emergencies. METHODS A systematic search of the English language literature before November 2017 was performed using PsycINFO, MEDLINE, PubMed, CINAHL, and EMBASE. Articles describing sharing of leadership functions in HCATs were included. Healthcare teams performing routine work were excluded. Studies were reviewed for type of leadership sharing and sharing-related outcomes. RESULTS Thirty-three articles met the inclusion criteria. A variety of shared leadership models were described across the following three categories: spontaneous collaboration, intuitive working relations, and institutionalized practices. While leadership sharing has the potential for both positive and negative influences on team performance, only six articles reported outcomes potentially attributable to shared leadership. CONCLUSIONS Despite strong evidence for a positive relationship between shared leadership and team performance in other domains, there is limited literature describing shared leadership models in HCATs. The association between shared leadership and team performance in HCATs is a rich area for further investigation.
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Gansera L, Ulm B, Bramlage P, Krapf S, Oertel F, Mueller-Honold T, von Scheidt W, Thilo C. Utility of conventional aortic root shot angiography for SAPIEN 3 prosthesis sizing in TAVI: feasibility and inter-reader variability. Open Heart 2020; 6:e001201. [PMID: 31921431 PMCID: PMC6937417 DOI: 10.1136/openhrt-2019-001201] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2019] [Revised: 12/10/2019] [Accepted: 12/12/2019] [Indexed: 11/30/2022] Open
Abstract
Background The gold-standard approach to prosthesis sizing before transcatheter aortic valve implantation (TAVI) is multislice computed tomography (MSCT). We aimed to investigate whether conventional aortic root angiography (CA) alone can reliably facilitate valve selection and to describe its inter-reader variability. Methods Five TAVI specialists (3 interventional cardiologists and 2 cardiac surgeons) independently reviewed preprocedural CAs for 50 patients implanted with the Edwards SAPIEN 3 valve. Results The prosthesis size selected based on visual CA appraisal matched that based on MSCT in 60% of cases (range: 50%–68%), with undersizing in 11% (4%–33%) and oversizing in 29% (10%–46%; p=0.187 for equality of the proportions test). Agreement between CA-based and MSCT-based valve selection was moderate (K=0.41; Kw=0.61). Reassessment of choice following awareness of the annulus long-axis diameter did not significantly improve this agreement (0.40 and 0.63, respectively), though more undersizing (14%) and less oversizing (25%) occurred. Correct valve selection was more common in interventional cardiologists than cardiac surgeons (66% vs 53%; p=0.0391), who made more oversizing errors. Conclusions There is a modest agreement between CA-based and MSCT-based SAPIEN 3 selection. Although the former should not be performed routinely, it may be informative in settings where MSCT and transoesophageal echocardiography are unavailable.
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Affiliation(s)
- Laura Gansera
- Department of Cardiology, Klinikum Augsburg, Herzzentrum Augsburg-Schwaben, Augsburg, Germany
| | - Bernhard Ulm
- USBBU, Unabhängige statistische Beratung, Munich, Germany
| | - Peter Bramlage
- Institute for Pharmacology and Preventive Medicine, Cloppenburg, Germany
| | - Stephan Krapf
- Department of Cardiology, Klinikum Augsburg, Herzzentrum Augsburg-Schwaben, Augsburg, Germany
| | - Frank Oertel
- Department of Cardiology, Klinikum Augsburg, Herzzentrum Augsburg-Schwaben, Augsburg, Germany
| | - Tobias Mueller-Honold
- Department of Cardiology, Klinikum Augsburg, Herzzentrum Augsburg-Schwaben, Augsburg, Germany
| | - Wolfgang von Scheidt
- Department of Cardiac and Thoracic Surgery, Klinikum Augsburg, Herzzentrum Augsburg-Schwaben, Augsburg, Germany
| | - Christian Thilo
- Department of Cardiology, Klinikum Augsburg, Herzzentrum Augsburg-Schwaben, Augsburg, Germany
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Jorde UP, Shah AM, Sims DB, Madan S, Siddiqi N, Luke A, Saeed O, Patel SR, Murthy S, Shin J, Oviedo J, Watts S, Jakobleff W, Forest S, Vukelic S, Belov D, Puius Y, Minamoto G, Muggia V, Carlese A, Leung S, Rahmanian M, Leff J, Goldstein D. Continuous-Flow Left Ventricular Assist Device Survival Improves With Multidisciplinary Approach. Ann Thorac Surg 2019; 108:508-516. [PMID: 30853587 DOI: 10.1016/j.athoracsur.2019.01.063] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2018] [Revised: 01/14/2019] [Accepted: 01/21/2019] [Indexed: 12/24/2022]
Abstract
BACKGROUND Continuous-flow left ventricular assist devices have revolutionized the management of advanced heart failure. Device complications continue to limit survival, but enhanced management strategies have shown promise. This study compared outcomes for HeartMate II recipients before and after implementation of a multidisciplinary continuous support heart team (HTMCS) strategy. METHODS Between January 2012 and December 2016, 124 consecutive patients underwent primary HeartMate II implantation at our institution. In January 2015, we instituted a HTMCS approach consisting of (1) daily simultaneous cardiology/cardiac surgery/critical care/pharmacy/coordinator rounds, (2) pharmacist-directed anticoagulation, (3) speed optimization echocardiogram before discharge, (4) comprehensive device thrombosis screening and early intervention, (5) blood pressure clinic with pulsatility-adjusted goals, (6) early follow-up after discharge and individual long-term coordinator/cardiologist assignment, and (7) systematic basic/advanced/expert training and credentialing of ancillary in-hospital providers. All patients completed 1-year of follow-up. RESULTS Demographic characteristics for pre-HTMCS (n = 71) and HTMCS (n = 53) groups, including age (55.8 ± 12.1 versus 52.5 ± 14.1 years, p = not significant), percentage of men (77.5% versus 71.7%, p = not significant), and Interagency Registry for Mechanically Assisted Circulatory Support class 3 (84.5% versus 83.0%, p = not significant), were comparable. One-year survival was 74.6% versus 100% for the pre-HTMCS and HTMCS groups, respectively (p = 0.0002). One-year survival free of serious adverse events (reoperation to replace device or disabling stroke) was 70.4% versus 84.9% for the pre-HTMCS and HTMCS groups, respectively (p = 0.059). Event per patient-year rates for disabling stroke (0.15 versus 0, p = 0.019), gastrointestinal bleeding (0.87 versus 0.51, p = 0.11), and driveline infection (0.24 versus 0.10, p = 0.18) were lower for the HTMCS group, whereas pump thrombosis requiring device exchange was higher (0.09 versus 0.18, p = 0.14). CONCLUSIONS Implementing a comprehensive multidisciplinary approach substantially improved outcomes for recipients of continuous-flow left ventricular assist devices.
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Affiliation(s)
- Ulrich P Jorde
- Department of Internal Medicine, Division of Cardiovascular Medicine, Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, New York.
| | - Aman M Shah
- Department of Internal Medicine, Division of Cardiovascular Medicine, Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, New York
| | - Daniel B Sims
- Department of Internal Medicine, Division of Cardiovascular Medicine, Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, New York
| | - Shivank Madan
- Department of Internal Medicine, Division of Cardiovascular Medicine, Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, New York
| | - Nida Siddiqi
- Department of Internal Medicine, Division of Cardiovascular Medicine, Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, New York
| | - Anne Luke
- Department of Internal Medicine, Division of Cardiovascular Medicine, Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, New York
| | - Omar Saeed
- Department of Internal Medicine, Division of Cardiovascular Medicine, Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, New York
| | - Snehal R Patel
- Department of Internal Medicine, Division of Cardiovascular Medicine, Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, New York
| | - Sandhya Murthy
- Department of Internal Medicine, Division of Cardiovascular Medicine, Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, New York
| | - Jooyoung Shin
- Department of Internal Medicine, Division of Cardiovascular Medicine, Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, New York
| | - Johanna Oviedo
- Department of Internal Medicine, Division of Cardiovascular Medicine, Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, New York
| | - Sade Watts
- Department of Internal Medicine, Division of Cardiovascular Medicine, Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, New York
| | - William Jakobleff
- Department of Surgery, Division of Cardiothoracic and Vascular Surgery, Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, New York
| | - Stephen Forest
- Department of Surgery, Division of Cardiothoracic and Vascular Surgery, Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, New York
| | - Sasa Vukelic
- Department of Internal Medicine, Division of Cardiovascular Medicine, Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, New York
| | - Dimitri Belov
- Department of Internal Medicine, Division of Cardiovascular Medicine, Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, New York
| | - Yoram Puius
- Department of Internal Medicine, Division of Infectious Disease, Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, New York
| | - Grace Minamoto
- Department of Internal Medicine, Division of Infectious Disease, Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, New York
| | - Victoria Muggia
- Department of Internal Medicine, Division of Infectious Disease, Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, New York
| | - Anthony Carlese
- Department of Internal Medicine, Division of Critical Care Medicine, Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, New York
| | - Sharon Leung
- Department of Internal Medicine, Division of Critical Care Medicine, Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, New York
| | - Marjan Rahmanian
- Department of Internal Medicine, Division of Critical Care Medicine, Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, New York
| | - Jonathan Leff
- Department of Anesthesiology, Division of Cardiothoracic Anesthesia, Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, New York
| | - Daniel Goldstein
- Department of Surgery, Division of Cardiothoracic and Vascular Surgery, Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, New York
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Mishra V, Fiane AE, Geiran O, Sørensen G, Khushi I, Hagen TP. Hospital costs fell as numbers of LVADs were increasing: experiences from Oslo University Hospital. J Cardiothorac Surg 2012; 7:76. [PMID: 22925716 PMCID: PMC3515474 DOI: 10.1186/1749-8090-7-76] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2012] [Accepted: 08/13/2012] [Indexed: 11/29/2022] Open
Abstract
Background The current study was undertaken to examine total hospital costs per patient of a consecutive implantation series of two 3rd generation Left Ventricle Assist Devices (LVAD). Further we analyzed if increased clinical experience would reduce total hospital costs and the gap between costs and the diagnosis related grouped (DRG)-reimbursement. Method Cost data of 20 LVAD implantations (VentrAssist™) from 2005-2009 (period 1) were analyzed together with costs from nine patients using another LVAD (HeartWare™) from 2009-June 2011 (period 2). For each patient, total costs were calculated for three phases - the pre-LVAD implantation phase, the LVAD implantation phase and the post LVAD implant phase. Patient specific costs were obtained prospectively from patient records and included personnel resources, medication, blood products, blood chemistry and microbiology, imaging and procedure costs including operating room costs. Overhead costs were registered retrospectively and allocated to the specific patient by predefined allocation keys. Finally, patient specific costs and overhead costs were aggregated into total hospital costs for each patient. All costs were calculated in 2011-prices. We used regression analyses to analyze cost variations over time and between the different devices. Results The average total hospital cost per patient for the pre-LVAD, LVAD and post-LVAD for period 1 was $ 585, 513 (range 132, 640- 1 247, 299), and the corresponding DRG- reimbursement (2009) was $ 143, 192 . The mean LOS was 54 days (range 12- 127). For period 2 the total hospital cost per patient was $ 413, 185 (range 314, 540- 622, 664) and the corresponding DRG- reimbursement (2010) was $ 136, 963. The mean LOS was 49 days (range 31- 93). The estimates from the regression analysis showed that the total hospital costs, excluding device costs, per patient were falling as the number of treated patients increased. The estimate from the trend variable was -14, 096 US$ (CI -3, 842 to -24, 349, p < 0.01). Conclusion There were significant reductions in total hospital costs per patient as the numbers of patients were increasing. This can possibly be explained by a learning effect including better logistics, selection and management of patients.
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Affiliation(s)
- Vinod Mishra
- Department of Finance and Resource Management Unit, Oslo University Hospital, Oslo, Norway.
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Toeg HD, Labinaz M, Hudson C, Ruel M. Aortic valve cusp shearing and migration into the left main coronary artery during transcatheter aortic valve implantation. Can J Cardiol 2012; 28:611.e1-3. [PMID: 22608355 DOI: 10.1016/j.cjca.2012.03.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2012] [Revised: 03/02/2012] [Accepted: 03/03/2012] [Indexed: 10/28/2022] Open
Abstract
In inoperable or high-risk patients with severe aortic stenosis, transcatheter aortic valve implantation (TAVI) provides an efficacious and safe alternative to surgical aortic valve replacement. In this case report, TAVI resulted in aortic valve cusp shearing and migration into the left main coronary artery, resulting in occlusion of coronary blood flow and cardiac arrest. The patient underwent immediate cardiopulmonary support and surgical intervention with a favourable outcome. With this case report, we illustrate the etiology and management of this complication, which can be recognized nonsurgically only if a high index of suspicion exists.
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Affiliation(s)
- Hadi Daood Toeg
- Division of Cardiac Surgery, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
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