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Corazza F, Fiorese E, Arpone M, Tardini G, Frigo AC, Cheng A, Da Dalt L, Bressan S. The impact of cognitive aids on resuscitation performance in in-hospital cardiac arrest scenarios: a systematic review and meta-analysis. Intern Emerg Med 2022; 17:2143-2158. [PMID: 36031672 PMCID: PMC9420676 DOI: 10.1007/s11739-022-03041-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2021] [Accepted: 06/20/2022] [Indexed: 11/24/2022]
Abstract
Different cognitive aids have been recently developed to support the management of cardiac arrest, however, their effectiveness remains barely investigated. We aimed to assess whether clinicians using any cognitive aids compared to no or alternative cognitive aids for in-hospital cardiac arrest (IHCA) scenarios achieve improved resuscitation performance. PubMed, EMBASE, the Cochrane Library, CINAHL and ClinicalTrials.gov were systematically searched to identify studies comparing the management of adult/paediatric IHCA simulated scenarios by health professionals using different or no cognitive aids. Our primary outcomes were adherence to guideline recommendations (overall team performance) and time to critical resuscitation actions. Random-effects model meta-analyses were performed. Of the 4.830 screened studies, 16 (14 adult, 2 paediatric) met inclusion criteria. Meta-analyses of eight eligible adult studies indicated that the use of electronic/paper-based cognitive aids, in comparison with no aid, was significantly associated with better overall resuscitation performance [standard mean difference (SMD) 1.16; 95% confidence interval (CI) 0.64; 1.69; I2 = 79%]. Meta-analyses of the two paediatric studies, showed non-significant improvement of critical actions for resuscitation (adherence to guideline recommended sequence of actions, time to defibrillation, rate of errors in defibrillation, time to start chest compressions), except for significant shorter time to amiodarone administration (SMD - 0.78; 95% CI - 1.39; - 0.18; I2 = 0). To conclude, the use of cognitive aids appears to have benefits in improving the management of simulated adult IHCA scenarios, with potential positive impact on clinical practice. Further paediatric studies are necessary to better assess the impact of cognitive aids on the management of IHCA scenarios.
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Affiliation(s)
- Francesco Corazza
- Division of Pediatric Emergency Medicine, University Hospital of Padova, Padova, Italy
| | - Elena Fiorese
- Department of Women's and Children's Health, University of Padova, Padova, Italy
| | - Marta Arpone
- Department of Women's and Children's Health, University of Padova, Padova, Italy
| | - Giacomo Tardini
- Department of Women's and Children's Health, University of Padova, Padova, Italy
| | - Anna Chiara Frigo
- Biostatistics, Epidemiology and Public Health Unit, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova, Padova, Italy
| | - Adam Cheng
- Departments of Paediatrics and Emergency Medicine, Alberta Children's Hospital, University of Calgary, Calgary, Canada
| | - Liviana Da Dalt
- Division of Pediatric Emergency Medicine, University Hospital of Padova, Padova, Italy
- Department of Women's and Children's Health, University of Padova, Padova, Italy
| | - Silvia Bressan
- Division of Pediatric Emergency Medicine, University Hospital of Padova, Padova, Italy.
- Department of Women's and Children's Health, University of Padova, Padova, Italy.
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Claeys A, Van Den Eynde R, Rex S. The use of cognitive aids in the operating room: a systematic review. ACTA ANAESTHESIOLOGICA BELGICA 2022. [DOI: 10.56126/73.3.18] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/05/2022]
Abstract
Background: Cognitive aids (CAs) are clinical tools guiding clinical decision-making during critical events in the operating room. They may counteract the adverse effects of stress on the non-technical skills of the attending clinician(s). Although most clinicians acknowledge the importance of CAs, their uptake in clinical practice seems to be lagging behind. This situation has led us to investigate which features of CAs may enhance their uptake. Therefore, in this systematic review we explored the optimums regarding the 1) timing to consult the CA, 2) person consulting the CA, 3) location of the CA in the operating room, 4) CA design (paper vs. electronic), 5) CA lay-out, 6) reader of the CA and 7) if the use of CAs in the form of decision support tools lead to improved outcome.
Methods: Seven PICO-questions guided our literature search in 4 biomedical databases (MEDLINE, Embase, Web of Science and Google Scholar). We selected English-language randomized controlled trials (RCTs), observational studies and expert opinions discussing the use of cognitive aids during life-threatening events in the operating theatre. Articles discussing non-urgent or non-operating room settings were excluded. The quality of evidence was evaluated with the Grading of Recommendations Assessment, Development and Evaluation (GRADE).
Results: We found 7 RCTs, 14 observational studies and 6 expert opinions. All trials were conducted in a simulation environment. The person who should trigger the use of a cognitive aid and the optimal timing of its initiation, could not be defined by the current literature. The ideal location of the cognitive aids remains also unclear.
A favorable lay-out of an aid should be well-structured, standardized and easily readable. In addition, several potentially beneficial design features are described.
RCT’s could not demonstrate a possible superiority of either electronic or paper-based aids. Both have their advantages and disadvantages. Furthermore, electronic decision support tools are potentially associated with an enhanced performance of the clinician. Likewise, the presence of a reader was associated with an improved performance of key steps in the management of a critical event. However, it remains unclear who should fulfill this role.
Conclusion: Several features of the design or utilization of CAs may play a role in enhancing the uptake of CAs in clinical practice during the management of a critical event in the operating room. However, robust evidence supporting the use of a certain feature over another is lacking.
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Holtzclaw T, Newman SD, Dwyer M, Simpson J, Goodwin T. Coronavirus Disease 2019 in the Emergency Department: Establishing an Interprofessional Incident Command System. J Emerg Nurs 2022; 48:477-483. [PMID: 35787778 PMCID: PMC9249398 DOI: 10.1016/j.jen.2022.01.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2021] [Revised: 01/04/2022] [Accepted: 01/04/2022] [Indexed: 12/02/2022]
Abstract
Coronavirus disease 2019 was declared a national emergency in the United States on March 13, 2020, at which time the Children’s National Hospital Emergency Department in Washington, DC, mobilized to develop and implement a unit-based Incident Command System. Anticipating that the unique and challenging nature of this pandemic might require a large interprofessional team, emergency nurses, emergency physicians, and emergency physician assistants were placed in traditional Incident Command System roles to provide an organizational framework for the ED response. This framework served multiple purposes but most importantly it helped to efficiently streamline and coordinate communications within the emergency department, with hospital leadership and with other hospital departments. The focus on intentionally taking an interprofessional approach to assigning Incident Command System roles was key to optimize staff safety, patient care, and clinical efficiency. This paper highlights a unique concept of applying the Incident Command System model to a single hospital department in a disaster scenario, using existing ED staff to function in various roles not typically held during regular operations. Given that policies and procedures can be ever-changing during a pandemic, emergency departments can implement an interprofessional incident command structure to provide a framework for communications and operational planning that allows for agility based on evolving priorities. The Children’s National Hospital ED Incident Command System model established during the coronavirus disease 2019 pandemic can serve as a guide for other emergency departments during a disaster response.
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Dewolf P, Vanneste M, Desruelles D, Wauters L. Measuring non-technical skills during prehospital advanced cardiac life support: A pilot study. Resusc Plus 2021; 8:100171. [PMID: 34693380 PMCID: PMC8517196 DOI: 10.1016/j.resplu.2021.100171] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Revised: 09/16/2021] [Accepted: 09/19/2021] [Indexed: 11/05/2022] Open
Abstract
Aim To analyse non-technical skills of mobile medical teams during out-of-hospital cardiac arrests (OHCA) using the validated Team Emergency Assessment Measure (TEAM) tool. To research the correlation between non-technical skills and patient outcome. Methods Adult patients who experienced an out-of-hospital cardiac arrest between July 2016, and June 2018, and were treated by a mobile medical team from the University Hospital Leuven, were eligible for the study. Resuscitations were video recorded from the team leader’s perspective. Video recordings were reviewed and scored by emergency physicians, using the TEAM evaluation form. Results In total 114 OHCAs were analysed. The mean TEAM score was 34.4/44 (SD = 5.5). The mean item score was 3.1/4 (SD = 0.8). On average, ‘effective team communication’ had the lowest score (2.4), while ‘acting with composure and control’ and ‘following of approved standards/guidelines’ scored the highest (3.4). The average non-technical skills theme scores were 2.9 (SD = 0.9) for ‘Leadership’, 3.1 (SD = 0.8) for ‘Teamwork’ and 3.3 (SD = 0.7) for ‘Task management’. ‘Leadership’ was rated significantly lower than ‘Teamwork’ (p = 0.004) and ‘Task management’ (p < 0.001). No significant correlation was found between TEAM and return of spontaneous circulation (p = 0.574) or one month survival (p = 0.225). Conclusion The mean overall TEAM score was categorized as good. Task management scored high, while leadership and team communication received lower scores. Future training programs should thus focus on improving leadership and communication. In this pilot study no correlation was found between non-technical skills and survival.
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Affiliation(s)
- Philippe Dewolf
- Department of Emergency Medicine, University Hospitals Leuven, Herestraat 49, 3000 Leuven, Belgium.,KULeuven, University, Faculty of Medicine, Belgium
| | - Maïté Vanneste
- Department of Emergency Medicine, University Hospitals Leuven, Herestraat 49, 3000 Leuven, Belgium
| | - Didier Desruelles
- Department of Emergency Medicine, University Hospitals Leuven, Herestraat 49, 3000 Leuven, Belgium
| | - Lina Wauters
- Department of Emergency Medicine, University Hospitals Leuven, Herestraat 49, 3000 Leuven, Belgium
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Greif R, Bhanji F, Bigham BL, Bray J, Breckwoldt J, Cheng A, Duff JP, Gilfoyle E, Hsieh MJ, Iwami T, Lauridsen KG, Lockey AS, Ma MHM, Monsieurs KG, Okamoto D, Pellegrino JL, Yeung J, Finn JC. Education, Implementation, and Teams: 2020 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations. Circulation 2020; 142:S222-S283. [PMID: 33084395 DOI: 10.1161/cir.0000000000000896] [Citation(s) in RCA: 64] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
For this 2020 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations, the Education, Implementation, and Teams Task Force applied the population, intervention, comparator, outcome, study design, time frame format and performed 15 systematic reviews, applying the Grading of Recommendations, Assessment, Development, and Evaluation guidance. Furthermore, 4 scoping reviews and 7 evidence updates assessed any new evidence to determine if a change in any existing treatment recommendation was required. The topics covered included training for the treatment of opioid overdose; basic life support, including automated external defibrillator training; measuring implementation and performance in communities, and cardiac arrest centers; advanced life support training, including team and leadership training and rapid response teams; measuring cardiopulmonary resuscitation performance, feedback devices, and debriefing; and the use of social media to improve cardiopulmonary resuscitation application.
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Greif R, Bhanji F, Bigham BL, Bray J, Breckwoldt J, Cheng A, Duff JP, Gilfoyle E, Hsieh MJ, Iwami T, Lauridsen KG, Lockey AS, Ma MHM, Monsieurs KG, Okamoto D, Pellegrino JL, Yeung J, Finn JC, Baldi E, Beck S, Beckers SK, Blewer AL, Boulton A, Cheng-Heng L, Yang CW, Coppola A, Dainty KN, Damjanovic D, Djärv T, Donoghue A, Georgiou M, Gunson I, Krob JL, Kuzovlev A, Ko YC, Leary M, Lin Y, Mancini ME, Matsuyama T, Navarro K, Nehme Z, Orkin AM, Pellis T, Pflanzl-Knizacek L, Pisapia L, Saviani M, Sawyer T, Scapigliati A, Schnaubelt S, Scholefield B, Semeraro F, Shammet S, Smyth MA, Ward A, Zace D. Education, Implementation, and Teams: 2020 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations. Resuscitation 2020; 156:A188-A239. [PMID: 33098918 DOI: 10.1016/j.resuscitation.2020.09.014] [Citation(s) in RCA: 76] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
For this 2020 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations, the Education, Implementation, and Teams Task Force applied the population, intervention, comparator, outcome, study design, time frame format and performed 15 systematic reviews, applying the Grading of Recommendations, Assessment, Development, and Evaluation guidance. Furthermore, 4 scoping reviews and 7 evidence updates assessed any new evidence to determine if a change in any existing treatment recommendation was required. The topics covered included training for the treatment of opioid overdose; basic life support, including automated external defibrillator training; measuring implementation and performance in communities, and cardiac arrest centers; advanced life support training, including team and leadership training and rapid response teams; measuring cardiopulmonary resuscitation performance, feedback devices, and debriefing; and the use of social media to improve cardiopulmonary resuscitation application.
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Abstract
OBJECTIVE This study aimed to organize the literature on cognitive aids to allow comparison of findings across studies and link the applied work of aid development to psychological constructs and theories of cognition. BACKGROUND Numerous taxonomies have been developed, all of which label cognitive aids via their surface characteristics. This complicates integration of the literature, as a type of aid, such as a checklist, can provide many different forms of support (cf. prospective memory for steps and decision support for alternative diagnoses). METHOD In this synthesis of the literature, we address the disparate findings and organize them at their most basic level: Which cognitive processes does the aid need to support? Which processes do they support? Such processes include attention, perception, decision making, memory, and declarative knowledge. RESULTS Cognitive aids can be classified into the processes they support. Some studies focused on how an aid supports the cognitive processes demanded by the task (aid function). Other studies focused on supporting the processes needed to utilize the aid (aid usability). CONCLUSION Classifying cognitive aids according to the processes they support allows comparison across studies in the literature and a formalized way of planning the design of new cognitive aids. Once the literature is organized, theory-based guidelines and applied examples can be used by cognitive aid researchers and designers. APPLICATION Aids can be designed according to the cognitive processes they need to support. Designers can be clear about their focus, either examining how to support specific cognitive processes or improving the usability of the aid.
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Petit Dit Dariel O, Cristofalo P. Improving patient safety in two French hospitals: why teamwork training is not enough. J Health Organ Manag 2020; ahead-of-print. [PMID: 32737962 DOI: 10.1108/jhom-02-2020-0045] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE The persistent challenges that healthcare organizations face as they strive to keep patients safe attests to a need for continued attention. To contribute to better understanding the issues currently defying patient safety initiatives, this paper reports on a study examining the aftermath of implementing a national team training program in two hospital units in France. DESIGN/METHODOLOGY/APPROACH Data were drawn from a longitudinal qualitative study analyzing the implementation of a French patient safety program aimed at improving teamwork in hospitals. Data collection took place over a four-year period (2015-2019) in two urban hospitals in France and included multiple interviews with 31 participants and 150 h of observations. FINDINGS Despite explicit efforts to improve inter-professional teamwork, three main obstacles interfered with healthcare professionals' attempts at safeguarding patients: perspectival variations in what constituted "patient safety", a paradoxical injunction to do more with less and conflicting organizational priorities. ORIGINALITY/VALUE This paper exposes patient safety as misleadingly consensual and identifies a lack of alignment between stakeholders in the complex system that is a hospital. This ultimately interferes with patient safety objectives and highlights that even well-equipped, frontline actors cannot achieve long-term results without more systemic organizational changes.
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Matava CT, Kovatsis PG, Summers JL, Castro P, Denning S, Yu J, Lockman JL, Von Ungern-Sternberg B, Sabato S, Lee LK, Ayad I, Mireles S, Lardner D, Whyte S, Szolnoki J, Jagannathan N, Thompson N, Stein ML, Dalesio N, Greenberg R, McCloskey J, Peyton J, Evans F, Haydar B, Reynolds P, Chiao F, Taicher B, Templeton T, Bhalla T, Raman VT, Garcia-Marcinkiewicz A, Gálvez J, Tan J, Rehman M, Crockett C, Olomu P, Szmuk P, Glover C, Matuszczak M, Galvez I, Hunyady A, Polaner D, Gooden C, Hsu G, Gumaney H, Pérez-Pradilla C, Kiss EE, Theroux MC, Lau J, Asaf S, Ingelmo P, Engelhardt T, Hervías M, Greenwood E, Javia L, Disma N, Yaster M, Fiadjoe JE. Pediatric Airway Management in COVID-19 Patients: Consensus Guidelines From the Society for Pediatric Anesthesia's Pediatric Difficult Intubation Collaborative and the Canadian Pediatric Anesthesia Society. Anesth Analg 2020; 131:61-73. [PMID: 32287142 PMCID: PMC7173403 DOI: 10.1213/ane.0000000000004872] [Citation(s) in RCA: 98] [Impact Index Per Article: 24.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/10/2020] [Indexed: 12/14/2022]
Abstract
The severe acute respiratory syndrome coronavirus 2 (coronavirus disease 2019 [COVID-19]) pandemic has challenged medical systems and clinicians globally to unforeseen levels. Rapid spread of COVID-19 has forced clinicians to care for patients with a highly contagious disease without evidence-based guidelines. Using a virtual modified nominal group technique, the Pediatric Difficult Intubation Collaborative (PeDI-C), which currently includes 35 hospitals from 6 countries, generated consensus guidelines on airway management in pediatric anesthesia based on expert opinion and early data about the disease. PeDI-C identified overarching goals during care, including minimizing aerosolized respiratory secretions, minimizing the number of clinicians in contact with a patient, and recognizing that undiagnosed asymptomatic patients may shed the virus and infect health care workers. Recommendations include administering anxiolytic medications, intravenous anesthetic inductions, tracheal intubation using video laryngoscopes and cuffed tracheal tubes, use of in-line suction catheters, and modifying workflow to recover patients from anesthesia in the operating room. Importantly, PeDI-C recommends that anesthesiologists consider using appropriate personal protective equipment when performing aerosol-generating medical procedures in asymptomatic children, in addition to known or suspected children with COVID-19. Airway procedures should be done in negative pressure rooms when available. Adequate time should be allowed for operating room cleaning and air filtration between surgical cases. Research using rigorous study designs is urgently needed to inform safe practices during the COVID-19 pandemic. Until further information is available, PeDI-C advises that clinicians consider these guidelines to enhance the safety of health care workers during airway management when performing aerosol-generating medical procedures. These guidelines have been endorsed by the Society for Pediatric Anesthesia and the Canadian Pediatric Anesthesia Society.
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Affiliation(s)
- Clyde T. Matava
- From the Department of Anesthesia, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Pete G. Kovatsis
- Department of Anesthesiology, Perioperative and Pain Medicine, Children’s Hospital of Boston, Harvard School of Medicine, Boston, Massachusetts
| | - Jennifer Lee Summers
- Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University, Baltimore, Maryland
| | - Pilar Castro
- Department of Anesthesiology and Pain Management, Children’s Hospital of Cleveland Clinic, Cleveland, Ohio
| | - Simon Denning
- From the Department of Anesthesia, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Julie Yu
- From the Department of Anesthesia, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Justin L. Lockman
- Department of Anesthesiology and Critical Care Medicine, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
| | | | - Stefano Sabato
- Department of Anaesthesia and Pain Management, The Royal Children’s Hospital, Victoria, Australia
| | - Lisa K. Lee
- Department of Anesthesiology, University of California at Los Angeles, Los Angeles, California
| | - Ihab Ayad
- Department of Anesthesiology, University of California at Los Angeles, Los Angeles, California
| | - Sam Mireles
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University Medical Center, Stanford, California
| | - David Lardner
- Department of Anesthesia, Alberta Children’s Hospital, Calgary, Alberta, Canada
| | - Simon Whyte
- Department of Anesthesiology, BC Children’s Hospital, Vancouver, British Columbia, Canada
| | - Judit Szolnoki
- Department of Anesthesiology; University of Colorado Anschutz Medical Campus, Children’s Hospital Colorado, Aurora, Colorado
| | | | - Nicole Thompson
- Department of Anesthesiology, Shriners Hospitals for Children, Chicago, Illinois
| | - Mary Lyn Stein
- Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University, Baltimore, Maryland
| | - Nicholas Dalesio
- Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University, Baltimore, Maryland
| | - Robert Greenberg
- Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University, Baltimore, Maryland
| | - John McCloskey
- Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University, Baltimore, Maryland
| | - James Peyton
- From the Department of Anesthesia, The Hospital for Sick Children, Toronto, Ontario, Canada
- Department of Anesthesiology, Perioperative and Pain Medicine, Children’s Hospital of Boston, Harvard School of Medicine, Boston, Massachusetts
- Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University, Baltimore, Maryland
- Department of Anesthesiology and Pain Management, Children’s Hospital of Cleveland Clinic, Cleveland, Ohio
- Department of Anesthesiology and Critical Care Medicine, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
- Department of Anesthesiology and Pain Management, University of Western Australia, Crawley, Australia
- Department of Anaesthesia and Pain Management, The Royal Children’s Hospital, Victoria, Australia
- Department of Anesthesiology, University of California at Los Angeles, Los Angeles, California
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University Medical Center, Stanford, California
- Department of Anesthesia, Alberta Children’s Hospital, Calgary, Alberta, Canada
- Department of Anesthesiology, BC Children’s Hospital, Vancouver, British Columbia, Canada
- Department of Anesthesiology; University of Colorado Anschutz Medical Campus, Children’s Hospital Colorado, Aurora, Colorado
- Department of Anesthesiology, Lurie Children’s Hospital of Chicago, Chicago, Illinois
- Department of Anesthesiology, Shriners Hospitals for Children, Chicago, Illinois
- Department of Pediatric Anesthesiology, University of Michigan Health Center, Ann Arbor, Michigan
- Department of Anesthesiology, Weill Cornell Medical College, New York, New York
- Department of Anesthesiology, Duke University, Durham, North Carolina
- Department of Anesthesiology, Wake Forest School of Medicine, Wake Forest, North Carolina
- Department of Anesthesiology and Pain Medicine, Akron Children’s Hospital, Northeast Ohio Medical University, Akron, Ohio
- Department of Anesthesiology and Pain Medicine, Nationwide Children’s Hospital, Ohio State University, Columbus, Ohio
- Department of Anesthesiology, Vanderbilt University School of Medicine, Nashville, Tennessee
- Department of Anesthesiology and Pain Management, University of Texas Southwestern and Children’s Health System of Texas, Dallas, Texas
- Department of Anesthesiology, Texas Children’s Hospital, Baylor College of Medicine, Houston, Texas
- Department of Anesthesiology, University of Texas Medical School at Houston, Houston, Texas
- Department of Anesthesia, Hospital Son Espases, Illes Balears, Spain
- Department of Anesthesiology and Pain Medicine, Seattle Children’s Hospital, University of Washington School of Medicine, Seattle, Washington
- Department of Anesthesiology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York
- Department of Clinical Anesthesiology & Critical Care, Perelman School of Medicine at the University of Pennsylvania, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
- Department of Anesthesiology, Instituto de Ortopedia Infantil Roosevelt, Bogotá, Colombia
- Department of Anesthesiology, University of Texas Southwestern Medical Center and Children’s Health System of Texas, Dallas, Texas
- Department of Anesthesiology and Pediatrics, Sidney Kimmel School of Medicine, Thomas Jefferson University, Philadelphia, Pennsylvania
- Department of Anesthesiology, Children’s Hospital Los Angeles, Los Angeles, California
- Department of Anesthesiology, Arkansas Children’s Hospital & University of Arkansas & Medical Science Center, Little Rock, Arkansas
- Montreal Children’s Hospital, McGill University Health Center, McGill University, Montreal, Canada
- /label>Pediatric Anesthesia Unit, Cardiac and Neonatal Section, Gregorio Marañón University Hospital, Madrid, Spain
- Department of Otorhinolaryngology Head and Neck Surgery, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
- Department of Pediatric Anesthesia, Istituto Giannina Gaslini, Genova, Italy
| | - Faye Evans
- Department of Anesthesiology, Perioperative and Pain Medicine, Children’s Hospital of Boston, Harvard School of Medicine, Boston, Massachusetts
| | - Bishr Haydar
- Department of Pediatric Anesthesiology, University of Michigan Health Center, Ann Arbor, Michigan
| | - Paul Reynolds
- Department of Pediatric Anesthesiology, University of Michigan Health Center, Ann Arbor, Michigan
| | - Franklin Chiao
- Department of Anesthesiology, Weill Cornell Medical College, New York, New York
| | - Brad Taicher
- Department of Anesthesiology, Duke University, Durham, North Carolina
| | - Thomas Templeton
- Department of Anesthesiology, Wake Forest School of Medicine, Wake Forest, North Carolina
| | - Tarun Bhalla
- Department of Anesthesiology and Pain Medicine, Akron Children’s Hospital, Northeast Ohio Medical University, Akron, Ohio
| | - Vidya T. Raman
- Department of Anesthesiology and Pain Medicine, Nationwide Children’s Hospital, Ohio State University, Columbus, Ohio
| | | | - Jorge Gálvez
- Department of Anesthesiology and Critical Care Medicine, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Jonathan Tan
- Department of Anesthesiology and Critical Care Medicine, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Mohamed Rehman
- From the Department of Anesthesia, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Christy Crockett
- Department of Anesthesiology, Vanderbilt University School of Medicine, Nashville, Tennessee
| | - Patrick Olomu
- Department of Anesthesiology and Pain Management, University of Texas Southwestern and Children’s Health System of Texas, Dallas, Texas
| | - Peter Szmuk
- Department of Anesthesiology, Texas Children’s Hospital, Baylor College of Medicine, Houston, Texas
| | - Chris Glover
- Department of Anesthesiology, Texas Children’s Hospital, Baylor College of Medicine, Houston, Texas
| | - Maria Matuszczak
- Department of Anesthesiology, University of Texas Medical School at Houston, Houston, Texas
| | - Ignacio Galvez
- Department of Anesthesia, Hospital Son Espases, Illes Balears, Spain
| | - Agnes Hunyady
- Department of Anesthesiology and Pain Medicine, Seattle Children’s Hospital, University of Washington School of Medicine, Seattle, Washington
| | - David Polaner
- Department of Anesthesiology and Pain Medicine, Seattle Children’s Hospital, University of Washington School of Medicine, Seattle, Washington
| | - Cheryl Gooden
- Department of Anesthesiology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York
| | - Grace Hsu
- Department of Clinical Anesthesiology & Critical Care, Perelman School of Medicine at the University of Pennsylvania, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Harshad Gumaney
- Department of Clinical Anesthesiology & Critical Care, Perelman School of Medicine at the University of Pennsylvania, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
| | | | - Edgar E. Kiss
- Department of Anesthesiology, University of Texas Southwestern Medical Center and Children’s Health System of Texas, Dallas, Texas
| | - Mary C. Theroux
- Department of Anesthesiology and Pediatrics, Sidney Kimmel School of Medicine, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Jennifer Lau
- Department of Anesthesiology, Children’s Hospital Los Angeles, Los Angeles, California
| | - Saeedah Asaf
- Department of Anesthesiology, Arkansas Children’s Hospital & University of Arkansas & Medical Science Center, Little Rock, Arkansas
| | - Pablo Ingelmo
- Montreal Children’s Hospital, McGill University Health Center, McGill University, Montreal, Canada
| | - Thomas Engelhardt
- Montreal Children’s Hospital, McGill University Health Center, McGill University, Montreal, Canada
| | - Mónica Hervías
- /label>Pediatric Anesthesia Unit, Cardiac and Neonatal Section, Gregorio Marañón University Hospital, Madrid, Spain
| | - Eric Greenwood
- From the Department of Anesthesia, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Luv Javia
- Department of Otorhinolaryngology Head and Neck Surgery, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Nicola Disma
- Department of Pediatric Anesthesia, Istituto Giannina Gaslini, Genova, Italy
| | - Myron Yaster
- Department of Anesthesiology, Lurie Children’s Hospital of Chicago, Chicago, Illinois
| | - John E. Fiadjoe
- Department of Anesthesiology, University of Texas Southwestern Medical Center and Children’s Health System of Texas, Dallas, Texas
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Cognitive aids with roles defined (CARD) for obstetrical crises: a multisite before-and-after cohort study. Can J Anaesth 2020; 67:970-980. [PMID: 32415478 DOI: 10.1007/s12630-020-01685-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2019] [Revised: 03/04/2020] [Accepted: 03/04/2020] [Indexed: 10/24/2022] Open
Abstract
PURPOSE Patient outcome during an obstetrical emergency depends on prompt coordination of an interprofessional team. The cognitive aids with roles defined (CARD) is a cognitive aid that addresses the issue of teamwork in crisis management. This study evaluated the clinical impact of implementing the CARD cognitive aid during emergency Cesarean deliveries. METHODS We conducted a prospective before-and-after cohort trial at the maternity units of two Canadian academic hospital campuses. Both sites received didactic online training regarding teamwork during crises, which involved training on using CARD for the "CARD" campus (intervention) and no mention of CARD at the "no CARD" campus (control). The primary outcome was the total time to delivery after the call for an emergency Cesarean delivery. Secondary outcomes included specific intervals of time within the time to delivery and clinical outcomes for both the babies and mothers. RESULTS We analyzed data from 267 eligible emergency Cesarean deliveries that occurred between January 11 2014 and December 31 2017. The use of CARD did not significantly change the median [interquartile range] time to delivery of the baby during an emergency Cesarean delivery from the pre-intervention to the post-intervention time period (17 [12-28] vs 15 [13-20], respectively; median difference, 2; 95% confidence interval, -1 to 5; P = 0.36). The clinical outcomes for the baby or the mother and other secondary outcomes also did not change. CONCLUSIONS The CARD cognitive aid did not significantly improve time-based or clinical maternal and neonatal outcomes of emergency Cesarean delivery at our academic maternity unit.
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11
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Geary M, Ruiter PJA, Yasseen AS. Examining the effects of an obstetrics interprofessional programme on reductions to reportable events and their related costs. J Interprof Care 2018:1-9. [PMID: 30407883 DOI: 10.1080/13561820.2018.1543255] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2017] [Revised: 10/10/2018] [Accepted: 10/15/2018] [Indexed: 10/27/2022]
Abstract
There are many ways to account for the return on investment (ROI) in healthcare: improved communication, teamwork, culture, patient satisfaction, staff satisfaction, and clinical outcomes are but a few. Some of these are easier to quantify and associate to an intervention than others. What if the outcomes listed were not just independent results, but beget one another? In 2001, the Society of Obstetricians and Gynaecologists of Canada created the Managing Obstetrical Risk Efficiently (MOREOB) programme, to improve healthcare culture and patient outcomes in obstetrics by leveraging front-line ownership. Our study provides evidence that MOREOB lowers the frequency and cost of reportable events in maternity units. We sought to review the impact of this intervention on the frequency and cost of reportable events at the insurer level of a clinically focused, three-year interprofessional culture change intervention applied to the maternity unit. We compared the impact of reportable events both in the obstetrical and in the non-obstetrical areas of the same hospitals during the same time periods. We analysed these data using an interrupted time series (ITS) design, among 34 Ontario Canada hospitals. The ITS design assessed changes in the frequency and cost of reportable events before and after the implementation of the intervention. The method was ideally suited as the various maternity units had differing programme commencement and completion dates. The frequency of reportable events showed little change during the three-year intervention. As culture change grew, the changes in behaviour and processes that impact patient outcomes took longer to accrue. A large reduction in the frequency of reportable events occurred in the following three-year (14% reduction) and six-year (25% reduction) tranches. Our results show statistically significant reductions in the frequency and costs associated with reportable events at the level of an insurer. The results also give insight as to the investment of time required to achieve a level of sustainability.
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Affiliation(s)
- Michael Geary
- a Department of Obstetrics & Gynaecology , St. Michael's Hospital , Toronto , Canada
- b Obstetrics & Gynaecology , University of Toronto , Canada
| | | | - Abdool S Yasseen
- d Methodological design and statistical data analysis , Children's Hospital of Eastern Ontario, Research Institute , Ontario , Canada
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12
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Boet S, Etherington N, Larrigan S, Yin L, Khan H, Sullivan K, Jung JJ, Grantcharov TP. Measuring the teamwork performance of teams in crisis situations: a systematic review of assessment tools and their measurement properties. BMJ Qual Saf 2018; 28:327-337. [PMID: 30309910 DOI: 10.1136/bmjqs-2018-008260] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2018] [Revised: 08/08/2018] [Accepted: 08/09/2018] [Indexed: 01/03/2023]
Abstract
BACKGROUND Educational interventions to improve teamwork in crisis situations have proliferated in recent years with substantial variation in teamwork measurement. This systematic review aimed to synthesise available tools and their measurement properties in order to identify the most robust tool for measuring the teamwork performance of teams in crisis situations. METHODS Searches were conducted in Embase (via OVID), PsycINFO, Cumulative Index to Nursing and Allied Health Literature, Education Resources Information Center, Medline and Medline In-Process (via OVID) (through 12 January 2017). Studies evaluating the measurement properties of teamwork assessment tools for teams in clinical or simulated crisis situations were included. Two independent reviewers screened studies based on predetermined criteria and completed data extraction. Risk of bias was assessed using the COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN) checklist. RESULTS The search yielded 1822 references. Twenty studies were included, representing 13 assessment tools. Tools were primarily assessed in simulated resuscitation scenarios for emergency department teams. The Team Emergency Assessment Measure (TEAM) had the most validation studies (n=5), which demonstrated three sources of validity (content, construct and concurrent) and three sources of reliability (internal consistency, inter-rater reliability and test-retest reliability). Most studies of TEAM's measurement properties were at no risk of bias. CONCLUSIONS A number of tools are available for assessing teamwork performance of teams in crisis situations. Although selection will ultimately depend on the user's context, TEAM may be the most promising tool given its measurement evidence. Currently, there is a lack of tools to assess teamwork performance during intraoperative crisis situations. Additional research is needed in this regard.
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Affiliation(s)
- Sylvain Boet
- Anesthesiology and Pain Medicine, The Ottawa Hospital, Ottawa Hospital Research Institute, Ottawa, Canada
| | - Nicole Etherington
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Canada
| | - Sarah Larrigan
- University of Ottawa Faculty of Medicine, Ottawa, Canada
| | - Li Yin
- University of Ottawa Faculty of Medicine, Ottawa, Canada
| | - Hira Khan
- Department of Health Sciences, Faculty of Science , Carleton University, Ottawa, Canada
| | - Katrina Sullivan
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Canada
| | - James J Jung
- Division of General Surgery, St. Michael's Hospital, Toronto, Canada
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13
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Nhan C, Young M, Bank I, Nugus P, Fisher R, Azzam M, Nguyen LHP. Interdisciplinary Crisis Resource Management Training: How Do Otolaryngology Residents Compare? A Survey Study. OTO Open 2018; 2:2473974X18770409. [PMID: 30480212 PMCID: PMC6239147 DOI: 10.1177/2473974x18770409] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2017] [Revised: 12/04/2017] [Accepted: 03/22/2018] [Indexed: 11/15/2022] Open
Abstract
Objective Emergent medical crises, such as acute airway obstruction, are often managed by interdisciplinary teams. However, resident training in crisis resource management traditionally occurs in silos. Our objective was to compare the current state of interdisciplinary crisis resource management (IDCRM) training of otolaryngology residents with other disciplines. Methods A survey study examining (1) the frequency with which residents are involved in interdisciplinary crises, (2) the current state of interdisciplinary training, and (3) the desired training was conducted targeting Canadian residents in the following disciplines: otolaryngology, anesthesiology, emergency medicine, general surgery, obstetrics and gynecology, internal medicine, pediatric emergency medicine, and pediatric/neonatal intensive care. Results A total of 474 surveys were completed (response rate, 12%). On average, residents were involved in 13 interdisciplinary crises per year. Only 8% of otolaryngology residents had access to IDCRM training, as opposed to 66% of anesthesiology residents. Otolaryngology residents reported receiving an average of 0.3 hours per year of interdisciplinary training, as compared with 5.4 hours per year for pediatric emergency medicine residents. Ninety-six percent of residents desired more IDCRM training, with 95% reporting a preference for simulation-based training. Discussion Residents reported participating in crises managed by interdisciplinary teams. There is strong interest in IDCRM and crisis resource management training; however, it is not uniformly available across Canadian residency programs. Despite their pivotal role in managing critical emergencies such as acute airway obstruction, otolaryngology residents received the least training. Implication IDCRM should be explicitly taught since it reflects reality and may positively affect patient outcomes.
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Affiliation(s)
- Carol Nhan
- Department of Otolaryngology-Head and Neck Surgery, McGill University, Montréal, Québec, Canada
| | - Meredith Young
- Center for Medical Education, McGill University, Montréal, Québec, Canada.,Department of Medicine, McGill University, Montréal, Québec, Canada
| | - Ilana Bank
- Center for Medical Education, McGill University, Montréal, Québec, Canada.,Department of Pediatric Emergency Medicine, McGill University, Montréal, Québec, Canada
| | - Peter Nugus
- Center for Medical Education, McGill University, Montréal, Québec, Canada.,Department of Family Medicine, McGill University, Montréal, Québec, Canada
| | - Rachel Fisher
- Department of Anesthesiology, McGill University, Montréal, Québec, Canada
| | - Milène Azzam
- Department of Anesthesiology, McGill University, Montréal, Québec, Canada
| | - Lily H P Nguyen
- Department of Otolaryngology-Head and Neck Surgery, McGill University, Montréal, Québec, Canada.,Center for Medical Education, McGill University, Montréal, Québec, Canada
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Ciporen J, Gillham H, Noles M, Dillman D, Baskerville M, Haley C, Spight D, Turner RC, Lucke-Wold BP. Crisis Management Simulation: Establishing a Dual Neurosurgery and Anesthesia Training Experience. J Neurosurg Anesthesiol 2018; 30:65-70. [PMID: 29219894 DOI: 10.1097/ana.0000000000000401] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
BACKGROUND Simulation training has been shown to be an effective teaching tool. Learner management of an intraoperative crisis such as a major cerebrovascular bleed requires effective teamwork, communication, and implementation of key skill sets at appropriate time points. This study establishes a first of a kind simulation experience in a neurosurgery/anesthesia resident (learners) team working together to manage an intraoperative crisis. METHODS Using a cadaveric cavernous carotid injury perfusion model, 7 neurosurgery and 6 anesthesia learners, were trained on appropriate vascular injury management using an endonasal endoscopic technique. Learners were evaluated on communication skills, crisis management algorithms, and implementation of appropriate skill sets at the right time. A preanatomic and postanatomic examination and postsimulation survey was administered to neurosurgery learners. Anesthesia learners provided posttraining evaluation through a tailored realism and teaching survey. RESULTS Neurosurgery learners' anatomic examination score improved from presimulation (33.89%) to postsimulation (86.11%). No significant difference between learner specialties was observed for situation awareness, decision making, communications and teamwork, or leadership evaluations. Learners reported the simulation realistic, beneficial, and highly instructive. CONCLUSIONS Realistic, first of kind, clinical simulation scenarios were presented to a neurosurgery/anesthesia resident team who worked together to manage an intraoperative crisis. Learners were effectively trained on crisis management, the importance of communication, and how to develop algorithms for future implementation in difficult scenarios. Learners were highly satisfied with the simulation training experience and requested that it be integrated more consistently into their residency training programs.
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Affiliation(s)
| | | | - Michele Noles
- Anesthesiology and Perioperative Medicine, Oregon Health and Science University, Portland, OR
| | - Dawn Dillman
- Anesthesiology and Perioperative Medicine, Oregon Health and Science University, Portland, OR
| | - Mark Baskerville
- Anesthesiology and Perioperative Medicine, Oregon Health and Science University, Portland, OR
| | - Caleb Haley
- Anesthesiology and Perioperative Medicine, Oregon Health and Science University, Portland, OR
| | - Donn Spight
- Anesthesiology and Perioperative Medicine, Oregon Health and Science University, Portland, OR
| | - Ryan C Turner
- Department of Neurosurgery, West Virginia University School of Medicine, Morgantown, WV
| | - Brandon P Lucke-Wold
- Department of Neurosurgery, West Virginia University School of Medicine, Morgantown, WV
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Reime MH, Johnsgaard T, Kvam FI, Aarflot M, Engeberg JM, Breivik M, Brattebø G. Learning by viewing versus learning by doing: A comparative study of observer and participant experiences during an interprofessional simulation training. J Interprof Care 2016; 31:51-58. [DOI: 10.1080/13561820.2016.1233390] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Affiliation(s)
- Marit Hegg Reime
- Department of Nursing, Faculty of Health and Social Sciences, Bergen University College, Bergen, Norway
| | - Tone Johnsgaard
- Department of Nursing, Faculty of Health and Social Sciences, Bergen University College, Bergen, Norway
| | - Fred Ivan Kvam
- Department of Nursing, Faculty of Health and Social Sciences, Bergen University College, Bergen, Norway
| | - Morten Aarflot
- Department of Nursing, Faculty of Health and Social Sciences, Bergen University College, Bergen, Norway
| | | | - Marit Breivik
- Department of Nursing, Faculty of Health and Social Sciences, Bergen University College, Bergen, Norway
| | - Guttorm Brattebø
- Department of Anaesthesia & Intensive Care, Haukeland University Hospital, Bergen, Norway
- Department of Clinical Medicine, University of Bergen, Bergen, Norway
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