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Costa DK, Yakusheva O, Khadr L, Ratliff HC, Lee KA, Sjoding M, Jimenez JV, Marriott DJ. Shift-Level Team Familiarity Is Associated with Improved Outcomes in Mechanically Ventilated Adults. Am J Respir Crit Care Med 2024; 210:311-317. [PMID: 38358858 DOI: 10.1164/rccm.202310-1971oc] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2023] [Accepted: 02/15/2024] [Indexed: 02/17/2024] Open
Abstract
Rationale: Organizing ICU interprofessional teams is a high priority because of workforce needs, but the role of interprofessional familiarity remains unexplored. Objectives: Determine if mechanically ventilated patients cared for by teams with greater familiarity have improved outcomes, such as lower mortality, shorter duration of mechanical ventilation (MV), and greater spontaneous breathing trial (SBT) implementation. Methods: We used electronic health records data of five ICUs in an academic medical center to map interprofessional teams and their ICU networks, measuring team familiarity as network coreness and mean team value. We used patient-level regression models to link team familiarity with patient outcomes, accounting for patient and unit factors. We also performed a split-sample analysis by using 2018 team familiarity data to predict 2019 outcomes. Measurements and Main Results: Team familiarity was measured as the average number of patients shared by each clinician with all other clinicians in the ICU (i.e., coreness) and the average number of patients shared by any two members of the team (i.e., mean team value). Among 4,485 encounters, unadjusted mortality was 12.9%, average duration of MV was 2.32 days, and SBT implementation was 89%; average team coreness was 467.2 (standard deviation [SD], 96.15), and average mean team value was 87.02 (SD, 42.42). A 1-SD increase in team coreness was significantly associated with a 4.5% greater probability of SBT implementation, 23% shorter MV duration, and 3.8% lower probability of dying; the mean team value was significantly associated with lower mortality. Split-sample results were attenuated but congruent in direction and interpretation. Conclusions: Interprofessional familiarity was associated with improved outcomes; assignment models that prioritize familiarity might be a novel solution.
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Affiliation(s)
- Deena Kelly Costa
- Yale School of Nursing, Orange, Connecticut
- Section of Pulmonary, Critical Care, and Sleep Medicine, Yale School of Medicine, New Haven, Connecticut
| | - Olga Yakusheva
- University of Michigan School of Nursing, Ann Arbor, Michigan
- University of Michigan School of Public Health, Ann Arbor, Michigan
| | - Lara Khadr
- University of Michigan School of Nursing, Ann Arbor, Michigan
| | | | - Kathryn A Lee
- University of Michigan School of Nursing, Ann Arbor, Michigan
| | - Michael Sjoding
- Division of Pulmonary and Critical Care Medicine, University of Michigan School of Medicine, Ann Arbor, Michigan; and
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Costa DK, Boltey E, Mosley EA, Manojlovich M, Wright NC. Knowing your team in the intensive care unit: an ethnographic study on familiarity. J Interprof Care 2024; 38:593-601. [PMID: 38517041 PMCID: PMC11141211 DOI: 10.1080/13561820.2024.2329968] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Accepted: 03/08/2024] [Indexed: 03/23/2024]
Abstract
Effective interprofessional team function is integral to high-quality care in the intensive care unit (ICU). However, little is known about how familiarity develops among teams, which may be an important antecedent to effective team function and quality care. To examine team familiarity and how it impacts ICU team function and care, we conducted an ethnographic study in four ICUs (two medical ICUs, one mixed medical-surgical ICU, and one surgical ICU) in two community hospitals and one academic medical center. We conducted 57.5 h of observation, 26 shadowing experiences, and 26 interviews across the four ICUs sequentially. We used thematic analysis to examine familiarity among the team. We found that ICU team members become familiar with their team through interpersonal, relational interactions, which involved communication, time working together, social interactions, trust, and respect. Our findings underscore the relational aspect of effective teams and demonstrate that time working together, social interactions, communication, developing trust, and respect are pathways to familiarity and optimal team function. Leveraging unique and creative ways to enhance the relational aspects of ICU teams could be an area for future research and lead to improved ICU outcomes.
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Affiliation(s)
- Deena Kelly Costa
- Yale School of Nursing, Orange CT
- Yale School of Medicine, Section on Pulmonary, Critical Care & Sleep Medicine, New Haven CT
| | | | - Elizabeth A. Mosley
- University of Pittsburgh School of Medicine, Division of General Internal Medicine, Pittsburgh, PA
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Saatchi AG, Pallotti F, Sullivan P. Network approaches and interventions in healthcare settings: A systematic scoping review. PLoS One 2023; 18:e0282050. [PMID: 36821554 PMCID: PMC9949682 DOI: 10.1371/journal.pone.0282050] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2022] [Accepted: 02/07/2023] [Indexed: 02/24/2023] Open
Abstract
INTRODUCTION The growing interest in networks of interactions is sustained by the conviction that they can be leveraged to improve the quality and efficiency of healthcare delivery systems. Evidence in support of this conviction, however, is mostly based on descriptive studies. Systematic evaluation of the outcomes of network interventions in healthcare settings is still wanting. Despite the proliferation of studies based on Social Network Analysis (SNA) tools and techniques, we still know little about how intervention programs aimed at altering existing patterns of social interaction among healthcare providers affect the quality of service delivery. We update and extend prior reviews by providing a comprehensive assessment of available evidence. METHODS AND FINDINGS We searched eight databases to identify papers using SNA in healthcare settings published between 1st January 2010 and 1st May 2022. We followed Chambers et al.'s (2012) approach, using a Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) checklist. We distinguished between studies relying on SNA as part of an intervention program, and studies using SNA for descriptive purposes only. We further distinguished studies recommending a possible SNA-based intervention. We restricted our focus on SNA performed on networks among healthcare professionals (e.g., doctors, nurses, etc.) in any healthcare setting (e.g., hospitals, primary care, etc.). Our final review included 102 papers. The majority of the papers used SNA for descriptive purposes only. Only four studies adopted SNA as an intervention tool, and measured outcome variables. CONCLUSIONS We found little evidence for SNA-based intervention programs in healthcare settings. We discuss the reasons and challenges, and identify the main component elements of a network intervention plan. Future research should seek to evaluate the long-term role of SNA in changing practices, policies and behaviors, and provide evidence of how these changes affect patients and the quality of service delivery.
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Affiliation(s)
| | - Francesca Pallotti
- Department of Business, Operations and Strategy, University of Greenwich, London, United Kingdom
| | - Paul Sullivan
- NIHR ARC Northwest London, Imperial College London, London, United Kingdom
- University Sussex Hospitals NHS Foundation Trust, Sussex, United Kingdom
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Han S, Park HJ, Jeong WJ, Kim GW, Choi HJ, Moon HJ, Lee K, Choi HJ, Park YJ, Cho JS, Lee CA. Application of the Team Emergency Assessment Measure for Prehospital Cardiopulmonary Resuscitation. J Clin Med 2022; 11:jcm11185390. [PMID: 36143045 PMCID: PMC9502771 DOI: 10.3390/jcm11185390] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2022] [Revised: 09/10/2022] [Accepted: 09/11/2022] [Indexed: 11/16/2022] Open
Abstract
Introduction: Communication and teamwork are critical for ensuring patient safety, particularly during prehospital cardiopulmonary resuscitation (CPR). The Team Emergency Assessment Measure (TEAM) is a tool applicable to such situations. This study aimed to validate the TEAM efficiency as a suitable tool even in prehospital CPR. Methods: A multi-centric observational study was conducted using the data of all non-traumatic out-of-hospital cardiac arrest patients aged over 18 years who were treated using video communication-based medical direction in 2018. From the extracted data of 1494 eligible patients, 67 sample cases were randomly selected. Two experienced raters were assigned to each case. Each rater reviewed 13 or 14 videos and scored the TEAM items for each field cardiopulmonary resuscitation performance. The internal consistency, concurrent validity, and inter-rater reliability were measured. Results: The TEAM showed high reliability with a Cronbach’s alpha value of 0.939, with a mean interitem correlation of 0.584. The mean item–total correlation was 0.789, indicating significant associations. The mean correlation coefficient between each item and the global score range was 0.682, indicating good concurrent validity. The mean intra-class correlation coefficient was 0.804, indicating excellent agreement. Discussion: The TEAM can be a valid and reliable tool to evaluate the non-technical skills of a team of paramedics performing CPR.
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Affiliation(s)
- Sangsoo Han
- Department of Emergency Medicine, Soonchunhyang University Bucheon Hospital, Bucheon 14584, Korea
| | - Hye Ji Park
- Department of Emergency Medicine, Hallym University, Dongtan Sacred Heart Hospital, Hwaseong 18450, Korea
| | - Won Jung Jeong
- Department of Emergency Medicine, Catholic University of Korea, St. Vincent’s Hospital, Seoul 06591, Korea
| | - Gi Woon Kim
- Department of Emergency Medicine, Soonchunhyang University Bucheon Hospital, Bucheon 14584, Korea
| | - Han Joo Choi
- Department of Emergency Medicine, Dankook University Hospital, Cheonan 31116, Korea
| | - Hyung Jun Moon
- Department of Emergency Medicine, College of Medicine, Soonchunhyang University, Cheonan 31151, Korea
| | - Kyoungmi Lee
- Department of Emergency Medicine, Myongji Hospital, Goyang 10475, Korea
| | - Hyuk Joong Choi
- Department of Emergency Medicine, Hanyang University Guri Hospital, Guri 11923, Korea
| | - Yong Jin Park
- Department of Emergency Medicine, Chosun University Hospital, Gwangju 61453, Korea
| | - Jin Seong Cho
- Department of Emergency Medicine, Gil Medical Center, Gachon University College of Medicine, Incheon 21565, Korea
| | - Choung Ah Lee
- Department of Emergency Medicine, Hallym University, Dongtan Sacred Heart Hospital, Hwaseong 18450, Korea
- Correspondence: ; Tel.: +82-31-8086-2611
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Crowe RP, Cash RE, Christgen A, Hilmas T, Varner L, Vogelsmeier A, Gilmore WS, Panchal AR. Psychometric Analysis of a Survey on Patient Safety Culture-Based Tool for Emergency Medical Services. J Patient Saf 2021; 17:e1320-e1326. [PMID: 29894440 DOI: 10.1097/pts.0000000000000504] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Evaluating organizational safety culture is critical for high-stress, high-risk professions such as prehospital emergency medical services (EMS). The aim of the study was to evaluate the psychometric properties of a safety culture instrument for EMS, based on the Agency for Healthcare Research and Quality's widely used Surveys on Patient Safety Culture (SOPS). METHODS The final EMS-adapted instrument consisted of 37 items covering 11 safety culture domains including 10 domains from existing SOPS instruments and one new domain for communication while en route to an emergency call. The analysis sample included 23,029 nationally certified EMS providers. Domain structure was evaluated on two separate halves of the data set through confirmatory factor analysis using a polychoric correlation matrix for ordinal data. The reliability and validity of each domain were evaluated using Cronbach α and Pearson correlation coefficients. RESULTS The confirmatory factor analysis supported the 11-domain model. All items loaded above the 0.4 threshold (range = 0.508-0.984). Three composite domains exhibited factor variance below the 0.5 threshold: staffing (0.32), communication about incidents (0.26), and handoffs (0.26). Floor and ceiling effects were not detected. Inter-item consistency exceeded 0.6 for all subscales (α = 0.65-0.88). Predictive validity was supported as all domain composites were correlated with the outcome variables of overall safety rating (r = 0.44-0.72) and frequency of event reporting (r = 0.31-0.48). CONCLUSIONS Overall, the EMS-adapted tool demonstrated adequate psychometric properties consistent with those of existing SOPS instruments. Additional research is needed to evaluate the instrument's performance at the agency level and its correlation with safety outcomes in the prehospital setting.
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Affiliation(s)
| | | | | | - Tina Hilmas
- Center for Patient Safety, Jefferson City, Missouri
| | - Lee Varner
- Center for Patient Safety, Jefferson City, Missouri
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Leonardsen ACL, Helgesen AK, Ulvøy L, Grøndahl VA. Prehospital assessment and management of postpartum haemorrhage- healthcare personnel's experiences and perspectives. BMC Emerg Med 2021; 21:98. [PMID: 34454430 PMCID: PMC8403351 DOI: 10.1186/s12873-021-00490-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2021] [Accepted: 08/10/2021] [Indexed: 01/18/2023] Open
Abstract
BACKGROUND Postpartum hemorrhage (PPH) is a serious obstetric emergency, and one of the top five causes of maternal mortality globally. The most common causes of PPH include uterine atony, placental disorders, birth trauma and coagulation defects. Timely diagnosis and early management are critical to reduce morbidity, the need for blood transfusion or even mortality. External, manual aortic compression (AC) has been suggested as an intervention that reduce PPH and extend time for control of bleeding or resuscitation. This procedure is not commonly utilized by healthcare personnel. The incidence of home-births is increasing, and competence in PPH assessment and management is essential in prehospital personnel. The objective was to explore prehospital personnel's competence in PPH and AC, utilizing different tools. METHODS The study was conducted in a county in South-eastern Norway, including five ambulance stations. All prehospital personnel (n = 250) were invited to participate in a questionnaire study. The questionnaire included the PPH self-efficacy (PPHSE) and PPH collective efficacy (PPHCE) tools, as well as tool developed utilizing the Delphi technique. Descriptive statistics were used to analyze the quantitative data, while quantitative content analysis was used to analyse free-text responses. RESULTS A total of 87 prehospital personnel responded to the questionnaire, 57.5% male, mean age 37.9 years. In total, 80.4% were ambulance workers and/or paramedics, and 96.6 and 97.7% respectively reported to need more education or training in PPH. Moreover, 82.8% reported having managed patient(s) with PPH, but only 2.9% had performed AC. Prehospital personnels' responses varied extensively regarding knowledge about what PPH is, how to estimate and handle PPH, and how to perform AC. Mean self-efficacy varied from 3.3 to 5.6, while collective efficacy varied from 1.9 to 3.8. CONCLUSIONS This study indicates that prehospital personnel lack knowledge about PPH and AC, due to various responses to the developed questionnaire. Even though AC is an acknowledged intervention in PPH, few participants reported that this was utilized. Our findings emphasize the need for education and training in PPH and PPH handling generally, and in AC specifically.
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Affiliation(s)
- Ann-Chatrin Linqvist Leonardsen
- Department of Health and Welfare/Ostfold Hospital Trust, Ostfold University College, Postal box code (PB) 700, NO-1757 Halden, Norway
- Ostfold Hospital Trust, Department of Anesthesia, 300 NO-1714 Grålum, PB Norway
| | - Ann Karin Helgesen
- Department of Health and Welfare/Ostfold Hospital Trust, Ostfold University College, Postal box code (PB) 700, NO-1757 Halden, Norway
| | - Linn Ulvøy
- Department of Health and Welfare/Ostfold Hospital Trust, Ostfold University College, Postal box code (PB) 700, NO-1757 Halden, Norway
- Ostfold Hospital Trust, Prehospital Department, 300 NO-1714 Grålum, PB Norway
| | - Vigdis Abrahamsen Grøndahl
- Department of Health and Welfare/Ostfold Hospital Trust, Ostfold University College, Postal box code (PB) 700, NO-1757 Halden, Norway
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Carnesten H, Asp M, Holmberg M. Caring approach for patients with chest pain - Swedish registered nurses' lived experiences in Emergency Medical Services. Int J Qual Stud Health Well-being 2021; 16:1901449. [PMID: 33779530 PMCID: PMC8009108 DOI: 10.1080/17482631.2021.1901449] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
Purpose: Encountering patients with chest pain iscommon for Registered Nurses (RNs) in Emergency Medical Services (EMS) who are responsible for the patient’s medical and nursing care . From a lifeworld perspective, bodily illness is related to existential suffering, requiring knowledge to asses the situation from a holistic perspective . The aim of this study is to describe the caring approach when RNs encounter patients with chest pain. Methods: A phenomenological methodology to capture RNs’ lived experiences was chosen. Seven qualitative in-depth interviews were conducted at three ambulance stations in Sweden. Results: The essence of the caring approach while encountering patients with chest pain comprises two constituents; “trust based on confidence and competence” and “the collegial striving towards the best possible care”. Trust is two-parted; trust in oneself, and striving towards gaining the patient’s trust . Competence and experience when combined, develop into confidence especially in stressful situations. The caring approach is nurtured in a well-functioning collegial team. Conclusions: This study contributes to understanding the caring approach based on the specific patient’s lifeworld in holistic EMS care. By trusting oneself, the patient, and one’s colleague, RNs in EMS shift focus from medical-orientated care to a holistic lifeworld caring approach. . More research is needed on trust as a phenomenon in EMS, both from caregivers’ and patients’ perspectives.
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Affiliation(s)
- Hillewi Carnesten
- School of Health, Care and Social Welfare, Mälardalen University, Eskilstuna, Sweden
| | - Margareta Asp
- School of Health, Care and Social Welfare, Mälardalen University, Eskilstuna, Sweden
| | - Mats Holmberg
- School of Health, Care and Social Welfare, Mälardalen University, Eskilstuna, Sweden.,Department of Ambulance Service, Region of Sörmland, Eskilstuna, Sweden.,Centre for Clinical Research Sörmland, Uppsala University, Eskilstuna, Sweden
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Ozkaynak M, Dolen C, Dollin Y, Rappaport K, Adelgais K. Simulating Teamwork for Better Decision Making in Pediatric Emergency Medical Services. AMIA ... ANNUAL SYMPOSIUM PROCEEDINGS. AMIA SYMPOSIUM 2021; 2020:993-1002. [PMID: 33936475 PMCID: PMC8075524] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Emergency Medical Services (EMS) are an essential component of health systems and are critical to the provision of pediatric emergency care. Challenges in this setting include fast pace, need for advanced teamwork, situational awareness and limited resources. The purpose of this study was to identify human factors-related obstacles during care delivery by EMS teams that could lead to inefficiencies and patient safety issues. We examined video recordings of 24 simulations of EMS teams (paramedics and EMTs) who were providing care to pediatric patients. Two reviewers documented a total of 262 efficiency and patient safety issues in 4.25 hours of videos. These issues were grouped into 28 categories. Reviewers also documented 19 decision support opportunities. These issues and decision support opportunities can inform the design of clinical decision support systems that can improve EMS related patient outcomes.
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Affiliation(s)
- Mustafa Ozkaynak
- College of Nursing, University of Colorado | Anschutz Medical Campus, Aurora, CO, USA
| | - Casey Dolen
- School of Medicine, University of Colorado | Anschutz Medical Campus, Aurora, CO, USA
| | - Yeshai Dollin
- School of Medicine, University of Colorado | Anschutz Medical Campus, Aurora, CO, USA
| | - Kathryn Rappaport
- Section of Pediatric Emergency Medicine, University of Colorado | Anschutz Medical Campus, Aurora, CO, USA
| | - Kathleen Adelgais
- Section of Pediatric Emergency Medicine, University of Colorado | Anschutz Medical Campus, Aurora, CO, USA
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Jeppesen E, Wiig S. Resilience in a prehospital setting - a new focus for future research? Scand J Trauma Resusc Emerg Med 2020; 28:104. [PMID: 33087167 PMCID: PMC7579966 DOI: 10.1186/s13049-020-00803-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2020] [Accepted: 10/15/2020] [Indexed: 12/18/2022] Open
Abstract
Background Handling and initiating of treatment in a prehospital setting are complex processes that involve many treatment options and include several parts of the chain of survival. Capacity to adapt to unexpected changes in the patients’ conditions or in the surroundings is a prerequisite for patient safety. Outside the healthcare sector, safety science is moving from an approach focused on the analysis and management of error (Safety I) to instead understanding the inherent properties of safety systems (Safety II). In healthcare the attention to why service providers are able to succeed under challenging conditions remains sparse. The aim of this commentary is to give a better understanding of how the concept and inclusion of resilience can inspire a new approach for future research in prehospital settings. So far, most resilience studies have been conducted in emergency departments while the role of contextual factors and adaptations in a prehospital setting has remained unexplored. Main body In contrast to traditional research on healthcare quality and safety, which tends to focus on failures, resilience research is interested in examining the overwhelming majority of healthcare processes with successful outcomes, to determine how high-quality patient care is generated. Resilience is conceptualized as a proactive ability to adjust to potentially harmful influences and challenges rather than to resist them. To better understand and promote resilience, there is a need to explore the underlying mechanisms of adaptation, trade-offs and improvisation that occur in the emergency chain. Attention to how people respond to disruptions, challenges and opportunities is vital. There are factors, recognized and unidentified, influencing adaptation, trade-offs and improvisation. Influencing factors at different levels could be of particular value to increase knowledge to better understand resilience in a practical perspective. As prehospital work conditions are highly unpredictable and diverse, learning through everyday work could be of great value if the experiences are transferred and integrated in training and simulation. Conclusions Empirical research is of crucial importance to build and support resilient systems and processes in a prehospital setting. We need a new framework and a new approach to how research on this topic is conducted and to support resilient performance. This should involve identifying factors that promote resilience, both on individual-, team- and system- levels.
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Affiliation(s)
- Elisabeth Jeppesen
- Department of Research and Development, Norwegian Air Ambulance Foundation, NO-0103, Oslo, Norway. .,SHARE Center for Resilience in Healthcare, Faculty of Health Science, University of Stavanger, Stavanger, Norway.
| | - Siri Wiig
- SHARE Center for Resilience in Healthcare, Faculty of Health Science, University of Stavanger, Stavanger, Norway
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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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Investigating the Relationship between Teamwork and Professional and Demographic Factors of Emergency Medical Technicians (EMTs) in Zanjan Province in 2019. PREVENTIVE CARE IN NURSING AND MIDWIFERY JOURNAL 2020. [DOI: 10.52547/pcnm.9.4.31] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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Relationships Between Expertise, Crew Familiarity and Surgical Workflow Disruptions: An Observational Study. World J Surg 2019; 43:431-438. [PMID: 30280222 DOI: 10.1007/s00268-018-4805-5] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
BACKGROUND Teamwork is an essential factor in reducing workflow disruption (WD) in the operating room. Team familiarity (TF) has been recognized as an antecedent to surgical quality and safety. To date, no study has examined the link between team members' role and expertise, TF and WD in surgical setting. This study aimed to examine the relationships between expertise, surgeon-scrub nurse familiarity and WD. METHODS We observed a convenience sample of 12 elective neurosurgical procedures carried out by 4 surgeons and 11 SN with different levels of expertise and different degrees of familiarity between surgeons and SN. We calculated the number of WD per unit of coding time to control for the duration of operation. We explored the type and frequency of WD, and the differences between the surgeons and SN. We examined the relationships between duration of WD, staff expertise and surgeon-scrub nurse familiarity. RESULTS 9.91% of the coded surgical time concerned WD. The most frequent causes of WD were distractions (29.7%) and colleagues' interruptions (25.2%). This proportion was seen for SN, whereas teaching moments and colleagues' interruptions were the most frequent WD for surgeons. The WD was less high among expert surgeons and less frequent when surgeon was familiar with SN. CONCLUSIONS The frequency of WD during surgical time can compromise surgical quality and patient safety. WD seems to decrease in teams with high levels of surgeon-scrub nurse familiarity and with development of surgical expertise. Favoring TF and giving feedback to the team about WD issues could be interesting ways to improve teamwork.
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Gebru AA, Mosadeghrad AM, Sari AA. Perceptions of leadership, motivation, structure, and assurance for implementation of emergency medical services in Ethiopia: Perspectives of emergency medical services case teams based on focus group discussions. Hum Antibodies 2019; 27:53-71. [PMID: 31127761 DOI: 10.3233/hab-190383] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND The research was assessed the Ethiopian Emergency Medical Services Case teams' and officers views on Emergency Medical services in Ethiopia. The aim of study was to present the point of views, prospect and priorities of Emergency medical services case teams and its coordinator along some main dimensions of emergency medical services, such as Leadership, Motivation, Structure, and Assurance for implementation. METHODS Six focus group discussion were facilitated with EMS case teams, focal persons and FMoH emergency medical services case teams from December to August, 2017 in all regions chosen of the study. The focus group techniques were used in the study as qualitative research method for examination of viewpoints of case team members towards to the emergency medical care system and overall pre-hospital and at hospital emergency care services. The discussion was addressing the topics of: general aspects of emergency Medical Services (EMS) and which occupations included in EMS; possibilities to importance review EMS issues based on Leadership, Motivation, Structure, and Assurance for implementation of EMS in the country. Finally, thematic analysis was used to evaluate data sets which collected during the focus group discussion. RESULTS There were 6 focus groups in total: an Emergency medical services case teams, officers, Directorates, and integrated disease prevention and control program coordinators groups in each of the regional, city Administration Health Bureau and Federal Ministry of Health in Ethiopia. Findings of the thematic analysis were summarized along the following dimensions: Leadership, Motivation, Structure, and Assurance for implementation. The result shown that lack of resources, shortage of training, lack of professionals and community awareness on EMS, immaturity of EMS strategic plan and lack of revision, workload as a result of limited skilled manpower, lack of partnerships and collaboration on EMS and lack of research and community services evidence are among factors affecting the quality EMS and continuity of the program at various health care facilities at the regional and national levels. CONCLUSION The study shows views of the Ethiopian Emergency Medical Services Case teams' and officers in Emergency Medical services in Ethiopia. The participants were considered determining factors of the EMS were rather similar among the participated regional, city Administration Health Bureau and Federal Ministry of health. Nonetheless, there was some degree of difference among those participated institutes. Especially, as a national level, Ethiopian Ministry of Health is exists only one emergency medical service directorate that leading the whole national activities. Therefore, EMS program need to respond to the challenges by respondents to articulate emergency medical services policies appropriate to Ethiopia, including the pre-hospital, at hospital care system and Ambulance services with more reformed professional skills and case team work at country level including all regions, Zone, Woreda (Districts) and other related sectors.
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Affiliation(s)
- Addis Adera Gebru
- Department of Health Management and Economics, International Campus, Tehran University of Medical Sciences, Tehran, Iran.,Department of Nursing, Faculty of Health Sciences, Woldia University, Woldia, Ethiopia
| | - Ali Mohammad Mosadeghrad
- Department of Health Management and Economics, School of Public Health, Health Information Management Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Ali Akbari Sari
- Department of Health Management and Economics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
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14
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Alshyyab MA, FitzGerald G, Dingle K, Ting J, Bowman P, Kinnear FB, Borkoles E. Developing a conceptual framework for patient safety culture in emergency department: A review of the literature. Int J Health Plann Manage 2018; 34:42-55. [PMID: 30187536 DOI: 10.1002/hpm.2640] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2018] [Accepted: 08/01/2018] [Indexed: 11/08/2022] Open
Abstract
Patient safety culture is a critical component of modern health care. However, the high-paced, unpredictable nature of the emergency department (ED) environment may impact adversely on it. The aim of this paper is to explore the concept of patient safety culture as it may apply to emergency health care, and to propose a conceptual framework that could form the basis for interventions designed to improve it. This is a systematic review of the literature. A search was undertaken of common electronic bibliographic databases using key words such as safety culture, safety climate, and Emergency Department. Articles were analysed for consistent themes with the aim to construct a conceptual framework. Ten articles met the inclusion criteria that specifically examined safety culture in the ED. Synthesis of the literature resulted in the emergence of three overarching themes of ED practice found to impact on safety culture in the ED. These were the dimensions of patient safety culture, the factors influencing it, and the interventions for improving it. A conceptual framework was constructed that identifies elements that significantly impact the patient safety culture in the ED. This framework may assist managers and researchers to take a comprehensive approach to build an effective safety culture in ED setting.
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Affiliation(s)
- Muhammad Ahmed Alshyyab
- School of Public Health and Social Work and Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, QLD, Australia
| | - Gerard FitzGerald
- School of Public Health and Social Work and Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, QLD, Australia
| | - Kaeleen Dingle
- School of Public Health and Social Work and Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, QLD, Australia
| | - Joseph Ting
- School of Public Health and Social Work and Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, QLD, Australia.,Department of Emergency Medicine, Mater Health Services, Brisbane, QLD, Australia
| | - Paula Bowman
- School of Public Health and Social Work and Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, QLD, Australia
| | - Frances B Kinnear
- School of Public Health and Social Work and Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, QLD, Australia.,Department of Emergency Medicine, The Prince Charles Hospital, Brisbane, QLD, Australia
| | - Erika Borkoles
- School of Public Health and Social Work and Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, QLD, Australia
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15
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Hughes AM, Patterson PD, Weaver MD, Gregory ME, Sonesh SC, Landsittel DP, Krackhardt D, Hostler D, Lazzara EH, Wang X, Vena JE, Salas E, Yealy DM. Teammate Familiarity, Teamwork, and Risk of Workplace Injury in Emergency Medical Services Teams. J Emerg Nurs 2017; 43:339-346. [DOI: 10.1016/j.jen.2016.11.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2016] [Revised: 10/31/2016] [Accepted: 11/22/2016] [Indexed: 10/19/2022]
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16
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Crowe RP, Wagoner RL, Rodriguez SA, Bentley MA, Page D. Defining Components of Team Leadership and Membership in Prehospital Emergency Medical Services. PREHOSP EMERG CARE 2017; 21:645-651. [PMID: 28463042 DOI: 10.1080/10903127.2017.1315200] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
BACKGROUND Teamwork is critical for patient and provider safety in high-stakes environments, including the setting of prehospital emergency medical services (EMS). OBJECTIVE We sought to describe the components of team leadership and team membership on a single patient call where multiple EMS providers are present. METHODS We conducted a two-day focus group with nine subject matter experts in crew resource management (CRM) and EMS using a structured nominal group technique (NGT). The specific question posed to the group was, "What are the specific components of team leadership and team membership on a single patient call where multiple EMS providers are present?" After round-robin submission of ideas and in-depth discussion of the meaning of each component, participants voted on the most important components of team leadership and team membership. RESULTS Through the NGT process, we identified eight components of team leadership: a) creates an action plan; b) communicates; c) receives, processes, verifies, and prioritizes information; d) reconciles incongruent information; e) demonstrates confidence, compassion, maturity, command presence, and trustworthiness; f) takes charge; g) is accountable for team actions and outcomes; and h) assesses the situation and resources and modifies the plan. The eight essential components of team membership identified included: a) demonstrates followership, b) maintains situational awareness, c) demonstrates appreciative inquiry, d) does not freelance, e) is an active listener, f) accurately performs tasks in a timely manner, g) is safety conscious and advocates for safety at all times, and h) leaves ego and rank at the door. CONCLUSIONS This study used a highly structured qualitative technique and subject matter experts to identify components of teamwork essential for prehospital EMS providers. These findings and may be used to help inform the development of future EMS training and assessment initiatives.
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17
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Hesselink G, Berben S, Beune T, Schoonhoven L. Improving the governance of patient safety in emergency care: a systematic review of interventions. BMJ Open 2016; 6:e009837. [PMID: 26826151 PMCID: PMC4735318 DOI: 10.1136/bmjopen-2015-009837] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
OBJECTIVES To systematically review interventions that aim to improve the governance of patient safety within emergency care on effectiveness, reliability, validity and feasibility. DESIGN A systematic review of the literature. METHODS PubMed, EMBASE, Cumulative Index to Nursing and Allied Health Literature, the Cochrane Database of Systematic Reviews and PsychInfo were searched for studies published between January 1990 and July 2014. We included studies evaluating interventions relevant for higher management to oversee and manage patient safety, in prehospital emergency medical service (EMS) organisations and hospital-based emergency departments (EDs). Two reviewers independently selected candidate studies, extracted data and assessed study quality. Studies were categorised according to study quality, setting, sample, intervention characteristics and findings. RESULTS Of the 18 included studies, 13 (72%) were non-experimental. Nine studies (50%) reported data on the reliability and/or validity of the intervention. Eight studies (44%) reported on the feasibility of the intervention. Only 4 studies (22%) reported statistically significant effects. The use of a simulation-based training programme and well-designed incident reporting systems led to a statistically significant improvement of safety knowledge and attitudes by ED staff and an increase of incident reports within EDs, respectively. CONCLUSIONS Characteristics of the interventions included in this review (eg, anonymous incident reporting and validation of incident reports by an independent party) could provide useful input for the design of an effective tool to govern patient safety in EMS organisations and EDs. However, executives cannot rely on a robust set of evidence-based and feasible tools to govern patient safety within their emergency care organisation and in the chain of emergency care. Established strategies from other high-risk sectors need to be evaluated in emergency care settings, using an experimental design with valid outcome measures to strengthen the evidence base.
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Affiliation(s)
- Gijs Hesselink
- Regional Emergency Healthcare Network, Radboud University Medical Center, Nijmegen, The Netherlands
- Radboud University Medical Center, Scientific Institute for Quality of Healthcare (IQ healthcare), Nijmegen, The Netherlands
| | - Sivera Berben
- Regional Emergency Healthcare Network, Radboud University Medical Center, Nijmegen, The Netherlands
- Faculty of Health and Social Studies, Department of Emergency and Critical Care, HAN University of Applied Sciences, Nijmegen, The Netherlands
| | - Thimpe Beune
- Regional Emergency Healthcare Network, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Lisette Schoonhoven
- Regional Emergency Healthcare Network, Radboud University Medical Center, Nijmegen, The Netherlands
- Radboud University Medical Center, Scientific Institute for Quality of Healthcare (IQ healthcare), Nijmegen, The Netherlands
- Faculty of Health Science, NIHR CLAHRC Wessex, University of Southampton, Southampton, UK
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18
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Weaver MD, Patterson PD, Fabio A, Moore CG, Freiberg MS, Songer TJ. The association between weekly work hours, crew familiarity, and occupational injury and illness in emergency medical services workers. Am J Ind Med 2015; 58:1270-7. [PMID: 26391202 DOI: 10.1002/ajim.22510] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/13/2015] [Indexed: 11/07/2022]
Abstract
OBJECTIVE Emergency Medical Services (EMS) workers are shift workers in a high-risk, uncontrolled occupational environment. EMS-worker fatigue has been associated with self-reported injury, but the influence of extended weekly work hours is unknown. METHODS A retrospective cohort study was designed using historical shift schedules and occupational injury and illness reports. Using multilevel models, we examined the association between weekly work hours, crew familiarity, and injury or illness. RESULTS In total, 966,082 shifts and 950 reports across 14 EMS agencies were obtained over a 1-3 year period. Weekly work hours were not associated with occupational injury or illness. Schedule characteristics that yield decreased exposure to occupational hazards, such as part-time work and night work, conferred reduced risk of injury or illness. CONCLUSIONS Extended weekly work hours were not associated with occupational injury or illness. Future work should focus on transient exposures and agency-level characteristics that may contribute to adverse work events.
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Affiliation(s)
- Matthew D. Weaver
- Division of Sleep Medicine; Harvard Medical School; Boston Massachusetts
- Departments of Medicine and Neurology; Brigham and Women's Hospital; Boston Massachusetts
| | - P. Daniel Patterson
- Department of Emergency Medicine; Carolinas HealthCare System Medical Center; Charlotte North Carolina
| | - Anthony Fabio
- Department of Epidemiology, University of Pittsburgh; Graduate School of Public Health; Pittsburgh Pennsylvania
| | - Charity G. Moore
- Carolinas HealthCare System; Dickson Advance Analytics Group; Charlotte North Carolina
| | - Matthew S. Freiberg
- Department of Medicine, Vanderbilt University; School of Medicine; Nashville Tennessee
| | - Thomas J. Songer
- Department of Epidemiology, University of Pittsburgh; Graduate School of Public Health; Pittsburgh Pennsylvania
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19
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Patterson PD, Weaver MD, Landsittel DP, Krackhardt D, Hostler D, Vena JE, Hughes AM, Salas E, Yealy DM. Teammate familiarity and risk of injury in emergency medical services. Emerg Med J 2015; 33:280-5. [PMID: 26614096 DOI: 10.1136/emermed-2015-204964] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2015] [Accepted: 11/06/2015] [Indexed: 11/04/2022]
Abstract
OBJECTIVE We investigated the association between teammate familiarity and workplace injury in the emergency medical services (EMS) setting. METHODS From January 2011 to November 2013, we abstracted a mean of 29 months of shift records and Occupational Safety Health Administration injury logs from 14 EMS organisations with 37 total bases located in four US Census regions. Total teammate familiarity was calculated for each dyad as the total number of times a clinician dyad worked together over the study period. We used negative binomial regression to examine differences in injury incidence rate ratios (IRRs) by familiarity. RESULTS We analysed 715 826 shift records, representing 4197 EMS clinicians and 60 701 unique dyads. We determined the mean shifts per dyad was (5.9, SD 19.7), and quartiles of familiarity were 1 shift worked together over the study period, 2-3 shifts, 4-9 shifts and ≥10 shifts worked together. More than half of all dyads worked one shift together (53.9%, n=32 739), 24.8% of dyads 2-3 shifts, 11.8% worked 4-9 shifts and 9.6% worked ≥10 shifts. The overall incidence rate of injury across all organisations was 17.5 per 100 full-time equivalent (FTE), range 4.7-85.6 per 100 FTE. The raw injury rate was 33.5 per 100 FTEs for dyads with one shift of total familiarity, 14.2 for 2-3 shifts, 8.3 for 4-9 shifts and 0.3 for ≥10 shifts. Negative binomial regression confirmed that dyads with ≥10 shifts had the lowest incidence of injury (IRR 0.03; 95% CI 0.02 to 0.04). CONCLUSIONS Familiarity between teammates varies in the EMS setting, and less familiarity is associated with greater incidence of workplace injury.
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Affiliation(s)
- P Daniel Patterson
- Department of Emergency Medicine, Carolinas Medical Center, Charlotte, North Carolina, USA
| | - Matthew D Weaver
- Division of Sleep and Circadian Disorders, Departments of Medicine and Neurology, Brigham and Women's Hospital, Boston, Massachusetts, USA Division of Sleep Medicine, Harvard Medical School, Boston, Massachusetts, USA
| | - Douglas P Landsittel
- Section on Biomarkers and Prediction Modeling, Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - David Krackhardt
- Heinz School of Public Policy and Management, Tepper School of Business, Carnegie Mellon University, Pittsburgh, Pennsylvania, USA
| | - David Hostler
- Department of Exercise and Nutrition Sciences, School of Public Health and Health Professions, University at Buffalo, The State University of New York, Buffalo, New York, USA
| | - John E Vena
- Department of Public Health Sciences, College of Medicine, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Ashley M Hughes
- Institute for Simulation & Training, University of Central Florida, Orlando, Florida, USA
| | - Eduardo Salas
- Department of Psychology, Rice University, Houston, Texas, USA
| | - Donald M Yealy
- Department of Emergency Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
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20
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Weaver MD, Patterson PD, Fabio A, Moore CG, Freiberg MS, Songer TJ. An observational study of shift length, crew familiarity, and occupational injury and illness in emergency medical services workers. Occup Environ Med 2015; 72:798-804. [PMID: 26371071 DOI: 10.1136/oemed-2015-102966] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2015] [Accepted: 08/06/2015] [Indexed: 11/04/2022]
Abstract
OBJECTIVES Emergency medical services (EMS) clinicians are shift workers deployed in two-person teams. Extended shift duration, workplace fatigue, poor sleep and lack of familiarity with teammates are common in the EMS workforce and may contribute to workplace injury. We sought to examine the relationship between shift length and occupational injury while controlling for relevant shift work and teamwork factors. METHODS We obtained 3 years of shift schedules and occupational injury and illness reports were from 14 large EMS agencies. We abstracted shift length and additional scheduling and team characteristics from shift schedules. We matched occupational injury and illness reports to shift records and used hierarchical logistic regression models to test the relationship between shift length and occupational injury and illness while controlling for teammate familiarity. RESULTS The cohort contained 966,082 shifts, 4382 employees and 950 outcome reports. Risk of occupational injury and illness was lower for shifts ≤8 h in duration (RR 0.70; 95% CI 0.51 to 0.96) compared with shifts >8 and ≤12 h. Relative to shifts >8 and ≤12 h, risk of injury was 60% greater (RR 1.60; 95% CI 1.22 to 2.10) for employees that worked shifts >16 and ≤24 h. CONCLUSIONS Shift length is associated with increased risk of occupational injury and illness in this sample of EMS shift workers.
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Affiliation(s)
- Matthew D Weaver
- Department of Emergency Medicine, University of Pittsburgh, School of Medicine, Pittsburgh, PA, USA Division of Sleep and Circadian Disorders, Departments of Medicine and Neurology, Brigham and Women's Hospital, Boston, Massachusetts, USA Division of Sleep Medicine, Department of Medicine, Harvard Medical School, Boston, Massachusetts, USA
| | - P Daniel Patterson
- Department of Emergency Medicine, Carolinas HealthCare System Medical Center, Charlotte, North Carolina, USA
| | - Anthony Fabio
- Department of Epidemiology, University of Pittsburgh, Graduate School of Public Health, Pittsburgh, Pennsylvania, USA
| | - Charity G Moore
- Dickson Advance Analytics Group, Carolinas HealthCare System, Charlotte, North Carolina, USA
| | - Matthew S Freiberg
- Department of Medicine, Vanderbilt University, School of Medicine, Nashville, Tennessee, USA
| | - Thomas J Songer
- Department of Epidemiology, University of Pittsburgh, Graduate School of Public Health, Pittsburgh, Pennsylvania, USA
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21
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Patterson PD, Pfeiffer AJ, Lave JR, Weaver MD, Abebe K, Krackhardt D, Arnold RM, Yealy DM. How familiar are clinician teammates in the emergency department? Emerg Med J 2013; 32:258-62. [PMID: 24351519 DOI: 10.1136/emermed-2013-203199] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVES Lack of familiarity between teammates is linked to worsened safety in high risk settings. The emergency department (ED) is a high risk healthcare setting where unfamiliar teams are created by diversity in clinician shift schedules and flexibility in clinician movement across the department. We sought to characterise familiarity between clinician teammates in one urban teaching hospital ED over a 22 week study period. METHODS We used a retrospective study design of shift scheduling data to calculate the mean weekly hours of familiarity between teammates at the dyadic level, and the proportion of clinicians with a minimum of 2, 5, 10 and 20 h of familiarity at any given hour during the study period. RESULTS Mean weekly hours of familiarity between ED clinician dyads was 2 h (SD 1.5). At any given hour over the study period, the proportions of clinicians with a minimum of 2, 5, 10 and 20 h of familiarity were 80%, 51%, 27% and 0.8%, respectively. CONCLUSIONS In our study, few clinicians could be described as having a high level of familiarity with teammates. The limited familiarity between ED clinicians identified in this study may be a natural feature of ED care delivery in academic settings. We provide a template for measurement of ED team familiarity.
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Affiliation(s)
- P Daniel Patterson
- Department of Emergency Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Anthony J Pfeiffer
- Department of Emergency Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Judith R Lave
- Department of Health Policy and Management, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Matthew D Weaver
- Department of Emergency Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Kaleab Abebe
- Department of General Internal Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - David Krackhardt
- David A Tepper School of Business, Carnegie Mellon University, Pittsburgh, Pennsylvania, USA
| | - Robert M Arnold
- Division of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Donald M Yealy
- Department of Emergency Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
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22
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Disclosure of Harmful Medical Errors in Out-of-Hospital Care. Ann Emerg Med 2013; 61:215-21. [DOI: 10.1016/j.annemergmed.2012.07.004] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2012] [Revised: 07/02/2012] [Accepted: 07/09/2012] [Indexed: 12/24/2022]
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Patterson PD, Anderson MS, Zionts ND, Paris PM. The emergency medical services safety champions. Am J Med Qual 2012; 28:286-91. [PMID: 23150883 DOI: 10.1177/1062860612463727] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The overarching mission of prehospital emergency medical services (EMS) is to deliver lifesaving care for people when their needs are greatest. Fulfilling this mission is challenged by threats to patient and provider safety. The EMS setting is a high-risk one because care is delivered rapidly in the out-of-hospital setting where resources of benefit to patients are limited. There is growing evidence that safety culture varies widely across EMS agencies. A poor safety culture may manifest as error in medication, back injuries, and other poor outcomes for patient and provider. Recently, federal and national leaders of EMS (ie, the National Highway Traffic Safety Administration) have made improving EMS safety culture a national priority. Unfortunately, few initiatives can help local EMS leaders achieve that priority. The authors describe the successful EMS Champs Fellowship program, supported by the Jewish Healthcare Foundation, designed to train EMS leaders to improve safety for patients and providers.
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Affiliation(s)
- P Daniel Patterson
- Department of Emergency Medicine, University of Pittsburgh School of Medicine, 3600 Forbes Avenue, Iroquois Bldg, Pittsburgh, PA 15261, USA
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Patterson PD, Weaver MD, Weaver SJ, Rosen MA, Todorova G, Weingart LR, Krackhardt D, Lave JR, Arnold RM, Yealy DM, Salas E. Measuring teamwork and conflict among emergency medical technician personnel. PREHOSP EMERG CARE 2012; 16:98-108. [PMID: 22128909 DOI: 10.3109/10903127.2011.616260] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE We sought to develop a reliable and valid tool for measuring teamwork among emergency medical technician (EMT) partnerships. METHODS We adapted existing scales and developed new items to measure components of teamwork. After recruiting a convenience sample of 39 agencies, we tested a 122-item draft survey tool (EMT-TEAMWORK). We performed a series of exploratory factor analyses (EFAs) and confirmatory factor analysis (CFA) to test reliability and construct validity, describing variation in domain and global scores using descriptive statistics. RESULTS We received 687 completed surveys. The EFAs identified a nine-factor solution. We labeled these factors 1) Team Orientation, 2) Team Structure & Leadership, 3) Partner Communication, Team Support, & Monitoring, 4) Partner Trust and Shared Mental Models, 5) Partner Adaptability & Back-Up Behavior, 6) Process Conflict, 7) Strong Task Conflict, 8) Mild Task Conflict, and 9) Interpersonal Conflict. We tested a short-form (30-item SF) and long-form (45-item LF) version. The CFAs determined that both the SF and the LF possess positive psychometric properties of reliability and construct validity. The EMT-TEAMWORK-SF has positive internal consistency properties, with a mean Cronbach's alpha coefficient ≥0.70 across all nine factors (mean = 0.84; minimum = 0.78, maximum = 0.94). The mean Cronbach's alpha coefficient for the EMT-TEAMWORK-LF was 0.87 (minimum = 0.79, maximum = 0.94). There was wide variation in weighted scores across all nine factors and the global score for the SF and LF. Mean scores were lowest for the Team Orientation factor (48.1, standard deviation [SD] 21.5, SF; 49.3, SD 19.8, LF) and highest (more positive) for the Interpersonal Conflict factor (87.7, SD 18.1, for both SF and LF). CONCLUSIONS We developed a reliable and valid survey to evaluate teamwork between EMT partners.
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Affiliation(s)
- P Daniel Patterson
- Department of Emergency Medicine and Center for Emergency Medicine of Western Pennsylvania, Inc., Pennsylvania, USA.
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