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Wolf AV, Hedrick KN, Begerowski SR, Wiper DW, Carter DR, Shuffler ML. Making Every Meeting Count: A Qualitative Investigation of Multiteam Meeting Events and Their Role in Supporting Coordinated Cancer Care Delivery. JCO Oncol Pract 2023; 19:e53-e66. [PMID: 36356278 DOI: 10.1200/op.22.00388] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
PURPOSE This research considers how cross-disciplinary cancer care meetings can facilitate coordination within the multiteam systems (MTSs) that provide inpatient hospital care. We conducted a series of interviews and observations with members of a single cancer care MTS to address the following research questions: (1) what are the key characteristics of MTS cancer care meetings (with regard to composition, focus, and structure)? and (2) how is cross-team coordination acknowledged and addressed during these meetings? METHODS In this single-site case study of a MTS operating to provide gynecologic oncology care within a teaching hospital, two types of meetings, called rounds and huddles, were held consistently. We used qualitative methods, including interviews with health care professional subject matter experts and 30 hours of observations of cancer care meetings, and analyzed the data in three stages of qualitative coding. RESULTS Our analyses resulted in a thematic framework detailing key processes, and subprocesses, identified as central to the activities of observed cancer care meetings. Key processes include information sharing, gaining clarity, strategizing, and pedagogy. Discussions and explanations of this framework showcase the ways in which MTS meetings can bolster cross-team coordination and facilitate MTS activities. CONCLUSION Inpatient cancer care meetings provide opportunities to facilitate MTS coordination in several ways, yet doing so does not come without challenges. Considering these results together with insights from meeting science and MTS research, this article concludes by putting forward practical recommendations for leveraging opportunities and overcoming challenges to use cancer care meetings as tools to support cross-team coordination.
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Martín-Rodríguez F, López-Izquierdo R, Sanz-García A, Ortega GJ, Del Pozo Vegas C, Delgado-Benito JF, Castro Villamor MA, Soriano JB. Prehospital Respiratory Early Warning Score for airway management in-ambulance: A score comparison. Eur J Clin Invest 2023; 53:e13875. [PMID: 36121346 DOI: 10.1111/eci.13875] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2022] [Revised: 08/30/2022] [Accepted: 09/15/2022] [Indexed: 12/15/2022]
Abstract
BACKGROUND Prehospital Respiratory Early Warning Scores to estimate the requirement for advanced respiratory support is needed. To develop a prehospital Respiratory Early Warning Score to estimate the requirement for advanced respiratory support. METHODS Multicentre, prospective, emergency medical services (EMS)-delivered, longitudinal cohort derivationvalidation study carried out in 59 ambulances and five hospitals across five Spanish provinces. Adults with acute diseases evaluated, supported and discharged to the Emergency Department with high priority were eligible. The primary outcome was the need for invasive or non-invasive respiratory support (NIRS or IRS) in the prehospital scope at the first contact with the patient. The measures included the following: epidemiological endpoints, prehospital vital signs (respiratory rate, pulse oximetry saturation, fraction of inspired oxygen, systolic and diastolic mean blood pressure, heart rate, tympanic temperature and consciousness level by the GCS). RESULTS Between 26 Oct 2018 and 26 Oct 2021, we enrolled 5793 cases. For NIRS prediction, the final model of the logistic regression included respiratory rate and pulse oximetry saturation/fraction of inspired oxygen ratio. For the IRS case, the motor response from the Glasgow Coma Scale was also included. The REWS showed an AUC of 0.938 (95% CI: 0.918-0.958), a calibration-in-large of 0.026 and a higher net benefit as compared with the other scores. CONCLUSIONS Our results showed that REWS is a remarkably aid for the decision-making process in the management of advanced respiratory support in prehospital care. Including this score in the prehospital scenario could improve patients' care and optimise the resources' management.
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Affiliation(s)
- Francisco Martín-Rodríguez
- Faculty of Medicine, Valladolid University, Valladolid, Spain.,Advanced Life Support, Emergency Medical Services (SACYL), Valladolid, Spain
| | - Raúl López-Izquierdo
- Faculty of Medicine, Valladolid University, Valladolid, Spain.,Emergency Department, Hospital Universitario Rio Hortega, Valladolid, Spain
| | - Ancor Sanz-García
- Data Analysis Unit, Health Research Institute, Hospital de la Princesa, Madrid, Spain
| | - Guillermo J Ortega
- Data Analysis Unit, Health Research Institute, Hospital de la Princesa, Madrid, Spain.,CONICET, Buenos Aires, Argentina
| | - Carlos Del Pozo Vegas
- Faculty of Medicine, Valladolid University, Valladolid, Spain.,Emergency Department, Hospital Clínico Universitario, Valladolid, Spain
| | | | | | - Joan B Soriano
- Facultad de Medicina, Universidad Autónoma de Madrid, Madrid, Spain.,Servicio de Neumología, Hospital Universitario de La Princesa, Madrid, Spain.,Centro de Investigación en Red de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III (ISCIII), Madrid, Spain
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Evans JC, Evans MB, Slack M, Peddle M, Lingard L. Examining non-technical skills for ad hoc resuscitation teams: a scoping review and taxonomy of team-related concepts. Scand J Trauma Resusc Emerg Med 2021; 29:167. [PMID: 34863278 PMCID: PMC8642998 DOI: 10.1186/s13049-021-00980-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2021] [Accepted: 11/15/2021] [Indexed: 12/02/2022] Open
Abstract
Background Non-technical skills (NTS) concepts from high-risk industries such as aviation have been enthusiastically applied to medical teams for decades. Yet it remains unclear whether—and how—these concepts impact resuscitation team performance. In the context of ad hoc teams in prehospital, emergency department, and trauma domains, even less is known about their relevance and impact. Methods This scoping review, guided by PRISMA-ScR and Arksey & O’Malley’s framework, included a systematic search across five databases, followed by article selection and extracting and synthesizing data. Articles were eligible for inclusion if they pertained to NTS for resuscitation teams performing in prehospital, emergency department, or trauma settings. Articles were subjected to descriptive analysis, coherence analysis, and citation network analysis. Results Sixty-one articles were included. Descriptive analysis identified fourteen unique non-technical skills. Coherence analysis revealed inconsistencies in both definition and measurement of various NTS constructs, while citation network analysis suggests parallel, disconnected scholarly conversations that foster discordance in their operationalization across domains. To reconcile these inconsistencies, we offer a taxonomy of non-technical skills for ad hoc resuscitation teams. Conclusion This scoping review presents a vigorous investigation into the literature pertaining to how NTS influence optimal resuscitation performance for ad hoc prehospital, emergency department, and trauma teams. Our proposed taxonomy offers a coherent foundation and shared vocabulary for future research and education efforts. Finally, we identify important limitations regarding the traditional measurement of NTS, which constrain our understanding of how and why these concepts support optimal performance in team resuscitation. Graphical abstract ![]()
Supplementary Information The online version contains supplementary material available at 10.1186/s13049-021-00980-5.
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Affiliation(s)
- J Colin Evans
- Division of Emergency Medicine, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada.
| | - M Blair Evans
- Department of Psychology, Western University, London, ON, Canada
| | - Meagan Slack
- Middlesex-London Paramedic Service, London, ON, Canada
| | - Michael Peddle
- Division of Emergency Medicine, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada
| | - Lorelei Lingard
- Centre for Education Research and Innovation, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada
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Innis J, Mack K, Bull E, Mazurik L, Page H, Ramage L, Ramsay D, Semple P, Takla F, Tustian V. Interprofessional education using a simulated disaster exercise. ACTA ACUST UNITED AC 2021. [DOI: 10.1016/j.xjep.2020.100411] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Fernandez WG, Benzer JK, Charns MP, Burgess JF. Applying a Model of Teamwork Processes to Emergency Medical Services. West J Emerg Med 2020; 21:264-271. [PMID: 33207175 PMCID: PMC7673905 DOI: 10.5811/westjem.2020.7.47238] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2020] [Accepted: 07/12/2020] [Indexed: 12/13/2022] Open
Abstract
Introduction Effective teamwork has been shown to optimize patient safety. However, research centered on the critical inputs, processes, and outcomes of team effectiveness in emergency medical services (EMS) has only recently begun to emerge. We conducted a theory-driven qualitative study of teamwork processes—the interdependent actions that convert inputs to outputs—by frontline EMS personnel in order to provide a model for use in EMS education and research. Methods We purposively sampled participants from an EMS agency in Houston, TX. Full-time employees with a valid emergency medical technician license were eligible. Using semi-structured format, we queried respondents on task/team functions and enablers/obstacles of teamwork in EMS. Phone interviews were recorded and transcribed. Using a thematic analytic approach, we combined codes into candidate themes through an iterative process. Analytic memos during coding and analysis identified potential themes, which were reviewed/refined and then compared against a model of teamwork processes in emergency medicine. Results We reached saturation once 32 respondents completed interviews. Among participants, 30 (94%) were male; the median experience was 15 years. The data demonstrated general support for the framework. Teamwork processes were clustered into four domains: planning; action; reflection; and interpersonal processes. Additionally, we identified six emergent concepts during open coding: leadership; crew familiarity; team cohesion; interpersonal trust; shared mental models; and procedural knowledge. Conclusion In this thematic analysis, we outlined a new framework of EMS teamwork processes to describe the procedures that EMS operators employ to convert individual inputs into team performance outputs. The revised framework may be useful in both EMS education and research to empirically evaluate the key planning, action, reflection, and interpersonal processes that are critical to teamwork effectiveness in EMS.
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Affiliation(s)
| | - Justin K Benzer
- The University of Texas at Austin, Department of Psychiatry, Austin, Texas
| | - Martin P Charns
- Boston University School of Public Health, Department of Health Law, Boston, Massachusetts
| | - James F Burgess
- Boston University School of Public Health, Department of Health Law, Boston, Massachusetts
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Allen JA, Taylor J, Murray RM, Kilcullen M, Cushenbery L, Gevers J, Larson L, Ioku T, Maupin C, Perry S, Park S, Rosen M, Fry T, McLeod P, Harris A, Fosler K. Mitigating Violence Against First Responder Teams: Results and Ideas From the Hackmanathon. SMALL GROUP RESEARCH 2019. [DOI: 10.1177/1046496419876342] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
First responders are on the front line of patient care and service, but research has shown that they are also on the front line of exposure to violence. Currently, there is a lack of evidence-based interventions that prepare first responders to handle violence on the job. With the increase in emergency medical services (EMS) call volume and reports of at least 57% of the EMS responders having experienced workplace violence, there is a need to develop scientifically systematic solutions to improve emergency responder safety. Using an adapted version of the hackathon method, academic scholars and practitioner conference attendees at the Interdisciplinary Network for Group Research (INGRoup) Conference were deployed into three multidisciplinary teams to analyze the issue and develop specific solutions. These solutions offer unique interventions to improve first responder safety.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | - Trevor Fry
- Florida Institute of Technology, Melbourne, USA
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Lee SJC, Clark MA, Cox JV, Needles BM, Seigel C, Balasubramanian BA. Achieving Coordinated Care for Patients With Complex Cases of Cancer: A Multiteam System Approach. J Oncol Pract 2016; 12:1029-1038. [PMID: 27577621 PMCID: PMC5356468 DOI: 10.1200/jop.2016.013664] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Patients with cancer with multiple chronic conditions pose a unique challenge to how primary care and specialty care teams provide well-coordinated, patient-centered care. Effectiveness of these care teams in providing optimal health care depends on the extent to which they coordinate their goals and knowledge as components of a multiteam system (MTS). This article outlines challenges of care coordination in the context of an MTS, illustrated through the care experience of "Mr Fuentes," a patient in the Dallas County integrated safety-net system, Parkland. As a continuing patient with chronic illnesses, the patient being discussed is managed through one of the Parkland community-oriented primary care clinics. However, a cancer diagnosis triggered an additional need for augmented coordination between his different provider teams. Further research and practice should investigate the relationships of MTS coordination for shared care management, transfer to and from specialty care, treatment compliance, barriers to care, and health outcomes of chronic comorbid conditions, as well as cancer control and surveillance.
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Affiliation(s)
- Simon J. Craddock Lee
- University of Texas Southwestern Medical Center; Harold C. Simmons Comprehensive Cancer Center; Parkland Health and Hospital System; University of Texas School of Public Health, Dallas, TX; Kogod School of Business, American University, Washington, DC; Mercy Hospital, St Louis, MO; and Massachusetts General Hospital Cancer Center, Boston, MA
| | - Mark A. Clark
- University of Texas Southwestern Medical Center; Harold C. Simmons Comprehensive Cancer Center; Parkland Health and Hospital System; University of Texas School of Public Health, Dallas, TX; Kogod School of Business, American University, Washington, DC; Mercy Hospital, St Louis, MO; and Massachusetts General Hospital Cancer Center, Boston, MA
| | - John V. Cox
- University of Texas Southwestern Medical Center; Harold C. Simmons Comprehensive Cancer Center; Parkland Health and Hospital System; University of Texas School of Public Health, Dallas, TX; Kogod School of Business, American University, Washington, DC; Mercy Hospital, St Louis, MO; and Massachusetts General Hospital Cancer Center, Boston, MA
| | - Burton M. Needles
- University of Texas Southwestern Medical Center; Harold C. Simmons Comprehensive Cancer Center; Parkland Health and Hospital System; University of Texas School of Public Health, Dallas, TX; Kogod School of Business, American University, Washington, DC; Mercy Hospital, St Louis, MO; and Massachusetts General Hospital Cancer Center, Boston, MA
| | - Carole Seigel
- University of Texas Southwestern Medical Center; Harold C. Simmons Comprehensive Cancer Center; Parkland Health and Hospital System; University of Texas School of Public Health, Dallas, TX; Kogod School of Business, American University, Washington, DC; Mercy Hospital, St Louis, MO; and Massachusetts General Hospital Cancer Center, Boston, MA
| | - Bijal A. Balasubramanian
- University of Texas Southwestern Medical Center; Harold C. Simmons Comprehensive Cancer Center; Parkland Health and Hospital System; University of Texas School of Public Health, Dallas, TX; Kogod School of Business, American University, Washington, DC; Mercy Hospital, St Louis, MO; and Massachusetts General Hospital Cancer Center, Boston, MA
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