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Regev S, Mitchnik IY. Mastering multicasualty trauma care with the Trauma Non-technical Skills Scale. J Trauma Acute Care Surg 2024; 97:S60-S66. [PMID: 38996423 DOI: 10.1097/ta.0000000000004417] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/14/2024]
Abstract
BACKGROUND Multicasualty events present complex medical challenges. This is the first study to investigate the role of nontechnical skills in prehospital multicasualty trauma care. We assessed the feasibility of using the Trauma Nontechnical Skills Scale (T-NOTECHS) instrument, which has not yet been investigated to evaluate these scenarios. METHODS We conducted an observational study involving military medical teams with Israel Defense Forces Military Trauma Life Support training to assess the T-NOTECHS' utility in predicting prehospital medical team performance during multicasualty event simulations. These teams were selected from a pool of qualified military Advanced Life Support providers. Simulations were conducted in a dedicated facility resembling a field setting, with video recordings to ensure data accuracy. Teams faced a single multicasualty scenario, assessed by two instructors, and were evaluated using a 37-item checklist. The T-NOTECHS scores were analyzed using regression models to predict simulation performance. RESULTS We included 27 teams for analysis, led by 28% physicians and 72% paramedics. Interrater reliability for simulation performance and T-NOTECHS scores showed good agreement. Overall T-NOTECHS scores were positively correlated with simulation performance scores ( R = 0.546, p < 0.001). Each T-NOTECHS domain correlated with simulation performance. The Communication and Interaction domain explained a unique part of the variance ( β = 0.406, p = 0.047). Assessment and Decision Making had the highest correlation ( R = 0.535, p < 0.001). These domains significantly predicted specific items on the simulation performance checklist. Cooperation and Resource Management showed the least correlation with checklist items. CONCLUSION This study confirms the T-NOTECHS' reliability in predicting prehospital trauma team performance during multicasualty scenarios. Key nontechnical skills, especially Communication and Interaction, and Assessment and Decision Making, play vital roles. These findings underscore the importance of training in these skills to enhance trauma care in such scenarios, offering valuable insights for medical team preparation. LEVEL OF EVIDENCE Diagnostic Tests or Criteria; Level III.
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Affiliation(s)
- Stav Regev
- From the Faculty of Medicine (S.R., I.Y.M.), Tel Aviv University, Tel Aviv; Military Medical Academy (I.Y.M.), Israel Defense Force, Ha'Negev; and Department of Orthopaedic Surgery (I.Y.M.), Shamir Medical Center, Zrifin, Israel
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Landry V, Sedillot-Daniel È, Ayad T, Leclerc AA. Strategies for CO 2 Laser Use in Laryngeal Microsurgery: A Systematic Review. Otolaryngol Head Neck Surg 2024; 171:353-367. [PMID: 38529664 DOI: 10.1002/ohn.734] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2023] [Revised: 02/21/2024] [Accepted: 02/29/2024] [Indexed: 03/27/2024]
Abstract
OBJECTIVE We aim to systematically review the literature addressing perioperative practices for optimal use of the CO2 laser in laryngeal transoral laser microsurgery (TOLMS), with a focus on safety. DATA SOURCES A systematic review of publications indexed in Medline, Embase, and EBM reviews-Cochrane Central Register of Controlled Trials which evaluated perioperative strategies for the use of CO2 laser in laryngeal TOLMS was conducted. REVIEW METHODS Records obtained from the search strategy were assessed for eligibility in a 2-step process by 2 independent researchers using the Covidence software. RESULTS Among 2143 identified records, 103 were included in this study. The majority of studies (n = 25) focused on the use of the CO2 laser in oncologic resection, while 20 addressed the treatment of vocal cord paralysis, 16 discussed the treatment of pediatric or congenital pathologies, 11 detailed the management of benign lesions, and 31 studies tackled other surgical indications. Strategies for safe CO2 TOLMS were highly heterogeneous across studies and included preoperative measures (ie, related to the environment, staff preparation, patient protection, and ventilation), intraoperative precautions (ie, protection of nontarget structures, technical considerations, topical and systemic medications), and postoperative strategies (ie, related to airway protection, oral intake, vocal rest, hospitalization duration, drug regimen, and consultant follow-up). CONCLUSION The results provided in this study can be used as a framework to guide the creation of laser safety protocols across institutions, guide quality improvement initiatives, the development of simulation training activities, and as a tool to facilitate resident teaching and skill assessment.
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Affiliation(s)
- Vivianne Landry
- Faculty of Medicine, University of Montreal, Montréal, Quebec, Canada
- Division of Otolaryngology-Head and Neck Surgery, University of Montreal Hospital Center (CHUM), Montréal, Quebec, Canada
- Division of Otolaryngology-Head and Neck Surgery, Maisonneuve-Rosemont Hospital, Montréal, Quebec, Canada
| | - Ève Sedillot-Daniel
- Faculty of Medicine, University of Montreal, Montréal, Quebec, Canada
- Division of Otolaryngology-Head and Neck Surgery, University of Montreal Hospital Center (CHUM), Montréal, Quebec, Canada
- Division of Otolaryngology-Head and Neck Surgery, Maisonneuve-Rosemont Hospital, Montréal, Quebec, Canada
| | - Tareck Ayad
- Division of Otolaryngology-Head and Neck Surgery, University of Montreal Hospital Center (CHUM), Montréal, Quebec, Canada
- Division of Otolaryngology-Head and Neck Surgery, Maisonneuve-Rosemont Hospital, Montréal, Quebec, Canada
| | - Andrée-Anne Leclerc
- Division of Otolaryngology-Head and Neck Surgery, Maisonneuve-Rosemont Hospital, Montréal, Quebec, Canada
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Garcia SI, Finch AS, Ridgeway JL, Beckman TJ, Montori VM, Rivera M, Gajic O, Kennedy CC, Kelm DJ. Understanding Team Dynamics and Culture of Safety Using Video Reflexive Ethnography during Real-Time Emergent Intubation. Ann Am Thorac Soc 2024; 21:1065-1073. [PMID: 38470228 DOI: 10.1513/annalsats.202310-901oc] [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: 10/23/2023] [Accepted: 03/08/2024] [Indexed: 03/13/2024] Open
Abstract
Rationale: Endotracheal intubation is the third most common bedside procedure in U.S. hospitals. In over 40% of intubations, preventable complications attributable to human factors occur. A better understanding of team dynamics during intubation may improve patient safety. Objectives: To explore team dynamics and safety-related actions during emergent endotracheal intubations in the emergency department and intensive care unit and to engage members of the care team in reflection for process improvement through a novel video-based team debriefing technique. Methods: Video-reflexive ethnography involves in situ video recording and reflexive discussions with practitioners to scrutinize behaviors and to identify opportunities for improvement. In this study, real-time intubations were recorded in the emergency department and intensive care unit at Mayo Clinic Rochester, and facilitated video-reflexive sessions were conducted with the multidisciplinary procedural teams. Themes about team dynamics and safety-related action were identified inductively from transcriptions of recorded sessions. Results: Between December 2022 and January 2023, eight video-reflexive sessions were conducted with a total of 78 participants. Multidisciplinary members included nurses (n = 23), respiratory therapists (n = 16), pharmacists (n = 7), advanced practitioners (n = 5), and physicians (n = 26). In video-reflexive discussions, major safety gaps were identified and several solutions were proposed related to the use of a multidisciplinary intubation checklist, standardized communication and team positioning, developing a culture of safety, and routinely debriefing after the procedure. Conclusions: The findings of this study may inform the development of a team supervision model for emergent endotracheal intubations. This approach could integrate key components such as a multidisciplinary intubation checklist, standardized communication and team positioning, a culture of safety, and debriefing as part of the procedure itself.
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Affiliation(s)
| | | | - Jennifer L Ridgeway
- Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, Minnesota
| | | | | | | | - Ognjen Gajic
- Division of Pulmonary, Critical Care, and Sleep Medicine
| | - Cassie C Kennedy
- Division of Pulmonary, Critical Care, and Sleep Medicine
- Division of Healthcare Delivery Research, Mayo Clinic College of Medicine and Science, Rochester, Minnesota; and
| | - Diana J Kelm
- Division of Pulmonary, Critical Care, and Sleep Medicine
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White SJ, Condon B, Ditton-Phare P, Dodd N, Gilroy J, Hersh D, Kerr D, Lambert K, McPherson ZE, Mullan J, Saad S, Stubbe M, Warren-James M, Weir KR, Gilligan C. Enhancing effective healthcare communication in Australia and Aotearoa New Zealand: Considerations for research, teaching, policy, and practice. PEC INNOVATION 2023; 3:100221. [PMID: 37822775 PMCID: PMC10562187 DOI: 10.1016/j.pecinn.2023.100221] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/20/2023] [Revised: 09/08/2023] [Accepted: 09/25/2023] [Indexed: 10/13/2023]
Abstract
Objective In this article we present a conceptual framework for enhancing effective healthcare communication in Australia and Aotearoa New Zealand. Methods Through an iterative, deliberative dialogue approach, we, as experts from a variety of health professions and academic disciplines, worked together to identify core values and considerations for healthcare communication across numerous health professions and disciplines and within research, teaching, policy, and practice contexts. Results The framework developed includes five core values at its centre: equitable, inclusive, evidence-based, collaborative, reflective. Around this are concentric circles showing key elements of collaborators, modality, context, and purpose. Each of these is explored. Conclusion This work may support benchmarking for healthcare providers, researchers, policymakers, and educators across a breadth of professions to help improve communication in clinical practice. The framework will also help to identify areas across disciplines that are shared and potentially idiosyncratic for various professions to promote interprofessional recognition, education, and collaboration. Innovation This framework is designed to start conversations, to form the foundation of a dialogue about the priorities and key considerations for developing teaching curricula, professional development, and research programs related to healthcare communication, providing a set of values specifically for the unique contexts of Australia and Aotearoa New Zealand. It can also be used to guide interdisciplinary healthcare professionals in advancing research, teaching, policy, and practice related to healthcare communication.
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Affiliation(s)
- Sarah J. White
- Centre for Social Impact, University of New South Wales, Sydney, Australia
| | - Brendan Condon
- Warrnambool Clinical School, Deakin University, Warrnambool, Australia
| | - Philippa Ditton-Phare
- School of Medicine & Public Health, The University of Newcastle, Newcastle, Australia
| | - Natalie Dodd
- School of Nursing, Midwifery and Paramedicine, University of Sunshine Coast, Sippy Downs, Australia
| | - John Gilroy
- Faculty of Medicine and Health, University of Sydney, Sydney, Australia
| | - Deborah Hersh
- Curtin School of Allied Health, Curtin University, Perth, Australia
| | - Debra Kerr
- Institute for Healthcare Transformation, Centre for Quality and Patient Safety, School of Nursing and Midwifery, Deakin University, Geelong, Australia
| | - Kelly Lambert
- School of Medical, Indigenous and Health Sciences, University of Wollongong, Wollongong, Australia
| | | | - Judy Mullan
- Graduate School of Medicine, University of Wollongong, Wollongong, Australia
| | - Shannon Saad
- RPA Virtual Hospital, Sydney Local Health District, Sydney, Australia
| | - Maria Stubbe
- Department of Primary Health Care and General Practice, University of Otago, Wellington, New Zealand
| | - Matthew Warren-James
- School of Nursing, Midwifery and Paramedicine, University of Sunshine Coast, Sippy Downs, Australia
| | - Kristie R. Weir
- Sydney School of Public Health, University of Sydney, Sydney, Australia and Institute of Primary Health Care BIHAM, University of Bern, Bern, Switzerland
| | - Conor Gilligan
- School of Medicine & Public Health, The University of Newcastle, Newcastle, Australia
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DE Bernardo G, Riccitelli M, Giordano M, Toni AL, Sordino D, Trevisanuto D, Buonocore G, Perrone S. Does high fidelity neonatal resuscitation simulation increase salivary cortisol levels of health care providers? Minerva Pediatr (Torino) 2023; 75:884-889. [PMID: 34152109 DOI: 10.23736/s2724-5276.21.05873-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND The use of simulation-based medical education is strongly recommended to insure neonatal resuscitation skills for health caregivers. High fidelity simulation was executed to allow the evaluation of technical and non-technical skills. Salivary cortisol level was considered reliable biomarkers of adrenocortical activity and useful tool to learning assessment and stress response. METHODS Our primary aim was to test changes in salivary cortisol levels before and after the simulation for neonatal resuscitation between high and low fidelity setting. Secondary aim was to evaluate salivary cortisol level in the participants, leader and not leader. Fifty-two health care providers were divided in ratio 1:1 into low-fidelity (LF group) and high-fidelity scenario (HF group) of neonatal resuscitation. In each group the participants assumed the role of team leader or not team leader. Salivary samples were collected from all participants 5 minutes before and after each simulation scenario by using oral swab. Analysis of difference was analyzed by Kruskal Wallis Test. RESULTS Salivary cortisol levels were significantly higher in HF group (N.=26) than LF group (N.=26) before the performance (5.407 mmol/L vs. 3.090 mmol/L; P=0.018). In the HF group, salivary cortisol levels were significantly lower after simulation than before (P=0.007), moreover not team leader showed higher salivary cortisol levels before of the simulation than after (P=0.003). Team leaders showed higher salivary cortisol levels than not team leader after high-fidelity scenario (P=0.039). CONCLUSIONS High-fidelity simulation scenario had a great impact on stress level, furthermore leaders showed higher salivary cortisol levels than not team leaders.
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Affiliation(s)
- Giuseppe DE Bernardo
- Department of Woman and Child, Buon Consiglio Fatebenefratelli Hospital, Naples, Italy -
| | - Marina Riccitelli
- Department of Molecular and Developmental Medicine, University of Siena, Siena, Italy
| | - Maurizio Giordano
- Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples, Italy
| | - Anna L Toni
- Department of Molecular and Developmental Medicine, University of Siena, Siena, Italy
| | - Desiree Sordino
- Department of Emergency, NICU, A.O.R.N. Santobono-Pausilipon, Naples, Italy
| | | | - Giuseppe Buonocore
- Department of Molecular and Developmental Medicine, University of Siena, Siena, Italy
| | - Serafina Perrone
- Department of Medicine and Surgery, University of Parma, Parma, Italy
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Risavi BL, Carlson J, Reese EM, Raleigh A, Wallis J. Prehospital Surgical Airway Management Skills in a Rural Emergency Medical Service System. Cureus 2023; 15:e41864. [PMID: 37581144 PMCID: PMC10423438 DOI: 10.7759/cureus.41864] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Accepted: 07/14/2023] [Indexed: 08/16/2023] Open
Abstract
BACKGROUND The objective of this study is to describe the education, training, and use of prehospital surgical airways in a rural Emergency Medical Service (EMS) system. MATERIALS AND METHODS We conducted an internet-based survey instrument of all advanced life support (ALS) EMS agencies in a seven-county rural EMS system in Pennsylvania. ALS agencies were queried regarding basic demographic information as well as the number of surgical airways performed in the previous 10 years as well as the education and training of EMS providers in surgical airways. RESULTS The survey was completed by 11 of 20 ALS EMS agencies in our region (55% rate of return). The content and frequency of training varied considerably among EMS agencies. Only four prehospital surgical airways were performed during the study period. One patient survived to hospital discharge to home. CONCLUSION Surgical airways are an infrequently performed procedure in the rural prehospital setting. There is no universally accepted standard for teaching or evaluating the competency of this potentially life-saving procedure. Further efforts to establish a core educational curriculum appear warranted.
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Affiliation(s)
- Brian L Risavi
- Emergency Medicine, Lake Erie College of Osteopathic Medicine, Erie, USA
| | | | - Erin M Reese
- Emergency Medicine, UPMC (University of Pittsburgh Medical Center) Hamot, Erie, USA
| | - Aaron Raleigh
- Emergency Medicine, Lake Erie College of Osteopathic Medicine, Erie, USA
| | - Jordan Wallis
- Emergency Medicine, Lake Erie College of Osteopathic Medicine, Erie, USA
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Dietl JE, Derksen C, Keller FM, Lippke S. Interdisciplinary and interprofessional communication intervention: How psychological safety fosters communication and increases patient safety. Front Psychol 2023; 14:1164288. [PMID: 37397302 PMCID: PMC10310961 DOI: 10.3389/fpsyg.2023.1164288] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2023] [Accepted: 05/16/2023] [Indexed: 07/04/2023] Open
Abstract
Background Effective teamwork and communication are imperative for patient safety and quality care. Communication errors and human failures are considered the main source of patient harm. Thus, team trainings focusing on communication and creating psychologically safe environments are required. This can facilitate challenging communication and teamwork scenarios, prevent patient safety risks, and increase team performance perception. The sparse research concerning communication interventions calls for an understanding of psychological mechanisms. Therefore, this study investigated mechanisms of an interpersonal team intervention targeting communication and the relation of psychological safety to patient safety and team performance perception based on the applied input-process-output model of team effectiveness. Methods Before and after a 4-h communication intervention for multidisciplinary teams, a paper-pencil survey with N = 137 healthcare workers from obstetric units of two university hospitals was conducted. Changes after the intervention in perceived communication, patient safety risks, and team performance perception were analyzed via t-tests. To examine psychological mechanisms regarding psychological safety and communication behavior, mediation analyses were conducted. Results On average, perceived patient safety risks were lower after the intervention than before the intervention (MT1 = 3.220, SDT1 = 0.735; MT2 = 2.887, SDT2 = 0.902). This change was statistically significant (t (67) = 2.760, p =.007). However, no such effect was found for interpersonal communication and team performance perception. The results illustrate the mediating role of interpersonal communication between psychological safety and safety performances operationalized as perceived patient safety risks (α1∗β1 = -0.163, 95% CI [-0.310, -0.046]) and team performance perception (α1∗β1 = 0.189, 95% CI [0.044, 0.370]). Discussion This study demonstrates the psychological mechanisms of communication team training to foster safety performances and psychological safety as an important predecessor for interpersonal communication. Our results highlight the importance of teamwork for patient safety. Interpersonal and interprofessional team training represents a novel approach as it empirically brings together interpersonal communication and collaboration in the context of patient safety. Future research should work on follow-up measures in randomized-controlled trials to broaden an understanding of changes over time.
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Affiliation(s)
- Johanna Elisa Dietl
- Health Psychology and Behavioral Medicine, School of Business, Social and Decision Science, Constructor University, Bremen, Germany
| | - Christina Derksen
- Health Psychology and Behavioral Medicine, School of Business, Social and Decision Science, Constructor University, Bremen, Germany
| | - Franziska Maria Keller
- Health Psychology and Behavioral Medicine, School of Business, Social and Decision Science, Constructor University, Bremen, Germany
- Klinikum Bremerhaven Reinkenheide gGmbH, Treatment Center for Psychiatry, Psychotherapy and Psychosomatic, Bremerhaven, Germany
| | - Sonia Lippke
- Health Psychology and Behavioral Medicine, School of Business, Social and Decision Science, Constructor University, Bremen, Germany
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Bergauer L, Akbas S, Braun J, Ganter MT, Meybohm P, Hottenrott S, Zacharowski K, Raimann FJ, Rivas E, López-Baamonde M, Spahn DR, Noethiger CB, Tscholl DW, Roche TR. Visual Blood, Visualisation of Blood Gas Analysis in Virtual Reality, Leads to More Correct Diagnoses: A Computer-Based, Multicentre, Simulation Study. Bioengineering (Basel) 2023; 10:bioengineering10030340. [PMID: 36978731 PMCID: PMC10044755 DOI: 10.3390/bioengineering10030340] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Revised: 03/03/2023] [Accepted: 03/06/2023] [Indexed: 03/11/2023] Open
Abstract
Interpreting blood gas analysis results can be challenging for the clinician, especially in stressful situations under time pressure. To foster fast and correct interpretation of blood gas results, we developed Visual Blood. This computer-based, multicentre, noninferiority study compared Visual Blood and conventional arterial blood gas (ABG) printouts. We presented six scenarios to anaesthesiologists, once with Visual Blood and once with the conventional ABG printout. The primary outcome was ABG parameter perception. The secondary outcomes included correct clinical diagnoses, perceived diagnostic confidence, and perceived workload. To analyse the results, we used mixed models and matched odds ratios. Analysing 300 within-subject cases, we showed noninferiority of Visual Blood compared to ABG printouts concerning the rate of correctly perceived ABG parameters (rate ratio, 0.96; 95% CI, 0.92–1.00; p = 0.06). Additionally, the study revealed two times higher odds of making the correct clinical diagnosis using Visual Blood (OR, 2.16; 95% CI, 1.42–3.29; p < 0.001) than using ABG printouts. There was no or, respectively, weak evidence for a difference in diagnostic confidence (OR, 0.84; 95% CI, 0.58–1.21; p = 0.34) and perceived workload (Coefficient, 2.44; 95% CI, −0.09–4.98; p = 0.06). This study showed that participants did not perceive the ABG parameters better, but using Visual Blood resulted in more correct clinical diagnoses than using conventional ABG printouts. This suggests that Visual Blood allows for a higher level of situation awareness beyond individual parameters’ perception. However, the study also highlighted the limitations of today’s virtual reality headsets and Visual Blood.
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Affiliation(s)
- Lisa Bergauer
- Institute of Anaesthesiology, University Hospital Zurich, 8091 Zurich, Switzerland
| | - Samira Akbas
- Institute of Anaesthesiology, University Hospital Zurich, 8091 Zurich, Switzerland
- Correspondence: ; Tel.: +41-43-253-2242
| | - Julia Braun
- Departments of Epidemiology and Biostatistics, Epidemiology, Biostatistics and Prevention Institute, University of Zurich, 8001 Zurich, Switzerland
| | - Michael T. Ganter
- Institute of Anaesthesiology and Intensive Care Medicine, Clinic Hirslanden Zurich, 8032 Zurich, Switzerland
| | - Patrick Meybohm
- Department of Anaesthesiology, Intensive Care, Emergency, and Pain Medicine, University Hospital Wuerzburg, University of Wuerzburg, 97080 Wuerzburg, Germany
| | - Sebastian Hottenrott
- Department of Anaesthesiology, Intensive Care, Emergency, and Pain Medicine, University Hospital Wuerzburg, University of Wuerzburg, 97080 Wuerzburg, Germany
| | - Kai Zacharowski
- Department of Anaesthesiology, Intensive Care Medicine, and Pain Therapy, University Hospital Frankfurt, Goethe University Frankfurt, 60323 Frankfurt, Germany
| | - Florian J. Raimann
- Department of Anaesthesiology, Intensive Care Medicine, and Pain Therapy, University Hospital Frankfurt, Goethe University Frankfurt, 60323 Frankfurt, Germany
| | - Eva Rivas
- Department of Anaesthesiology, Intensive Care Medicine, and Pain Therapy, Hospital Clinic of Barcelona, University of Barcelona, 08036 Barcelona, Spain
| | - Manuel López-Baamonde
- Department of Anaesthesiology, Intensive Care Medicine, and Pain Therapy, Hospital Clinic of Barcelona, University of Barcelona, 08036 Barcelona, Spain
| | - Donat R. Spahn
- Institute of Anaesthesiology, University Hospital Zurich, 8091 Zurich, Switzerland
| | | | - David W. Tscholl
- Institute of Anaesthesiology, University Hospital Zurich, 8091 Zurich, Switzerland
| | - Tadzio R. Roche
- Institute of Anaesthesiology, University Hospital Zurich, 8091 Zurich, Switzerland
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Zhang C. A Literature Study of Medical Simulations for Non-Technical Skills Training in Emergency Medicine: Twenty Years of Progress, an Integrated Research Framework, and Future Research Avenues. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:4487. [PMID: 36901496 PMCID: PMC10002261 DOI: 10.3390/ijerph20054487] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/09/2022] [Revised: 02/26/2023] [Accepted: 03/01/2023] [Indexed: 06/18/2023]
Abstract
Medical simulations have led to extensive developments in emergency medicine. Apart from the growing number of applications and research efforts in patient safety, few studies have focused on modalities, research methods, and professions via a synthesis of simulation studies with a focus on non-technical skills training. Intersections between medical simulation, non-technical skills training, and emergency medicine merit a synthesis of progress over the first two decades of the 21st century. Drawing on research from the Web of Science Core Collection's Science Citation Index Expanded and Social Science Citation Index editions, results showed that medical simulations were found to be effective, practical, and highly motivating. More importantly, simulation-based education should be a teaching approach, and many simulations are utilised to substitute high-risk, rare, and complex circumstances in technical or situational simulations. (1) Publications were grouped by specific categories of non-technical skills, teamwork, communication, diagnosis, resuscitation, airway management, anaesthesia, simulation, and medical education. (2) Although mixed-method and quantitative approaches were prominent during the time period, further exploration of qualitative data would greatly contribute to the interpretation of experience. (3) High-fidelity dummy was the most suitable instrument, but the tendency of simulators without explicitly stating the vendor selection calls for a standardised training process. The literature study concludes with a ring model as the integrated framework of presently known best practices and a broad range of underexplored research areas to be investigated in detail.
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Affiliation(s)
- Cevin Zhang
- School of Media and Design, Beijing Technology and Business University, Sunlight South Road 1, Beijing 102488, China
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Lockertsen Ø, Løvhaug L, Davik NK, Bølgen BR, Færden A, Skarstein S. Second-year undergraduate nursing students' experiences with clinical simulation training in mental health clinical practice: A focus group study. Nurse Educ Pract 2023; 66:103534. [PMID: 36563598 DOI: 10.1016/j.nepr.2022.103534] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Revised: 11/30/2022] [Accepted: 12/02/2022] [Indexed: 12/14/2022]
Abstract
AIM The aim of this focus group study was to investigate second-year undergraduate nursing students' experiences with clinical simulation training as part of their clinical practice in acute mental health care. BACKGROUND The quality of bachelor programmes in nursing has been criticised for lacking theoretical and experiential learning in the mental health modules. Novice nurses feel unprepared to care for patients with mental health challenges and graduate nurses are reported to lack the necessary knowledge and skills to manage patients with mental health issues confidently and competently. Clinical simulation training can facilitate the teaching of clinical and non-clinical skills simultaneously and is a highly suitable method within mental health care for addressing gaps in knowledge and skills in communicating with patients. Clinical simulation training may enhance nursing students' competence and thereby reduce the risk of adverse events and increase safety. However, we know little about undergraduate nursing students' experiences with clinical simulation training as an integrated part of nursing students' clinical practice in acute mental health wards. DESIGN Explorative qualitative focus group study. METHOD Three focus group interviews were conducted using a semi-structured interview guide with second-year undergraduate nursing students from a university in Norway during spring 2020. In total, 14 students who had experienced clinical simulation training as part of their mental health clinical practice participated in the study. The collected data were analysed using systematic text condensation. RESULTS Clinical simulation training as part of the clinical practice increased the students' preparedness, coping and self-awareness. Most of the participants had positive perceptions of the use of high-fidelity simulation-based learning. Furthermore, they highlighted three elements that increased the value of the training. First, the simulation felt authentic and increased their professional skills. Second, the standardised patient had clinical qualifications, which made the simulation feel authentic and close to realistic situations. Third, not having a former relationship with the person acting as the standardised patient enhanced authenticity. CONCLUSION Clinical simulation training as part of clinical practice contributed to increasing the students' self-awareness and in-depth reflection and to broadening their nursing competence. The present study lays the groundwork for future studies on clinical simulation training in mental health clinical practice for nursing students.
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Affiliation(s)
- Øyvind Lockertsen
- OsloMet - Oslo Metropolitan University, Faculty of Health Sciences, Department of Nursing and Health Promotion, Oslo, Norway; Oslo University Hospital, Division of Mental Health and Addiction, Regional Centre for Research and Education in Forensic Psychiatry, Oslo, Norway.
| | - Lars Løvhaug
- Oslo University Hospital, Division of Mental Health and Addiction, Acute Psychiatric Department, Oslo, Norway
| | - Nils Kristian Davik
- Oslo University Hospital, Division of Mental Health and Addiction, Acute Psychiatric Department, Oslo, Norway
| | - Brita Rønbeck Bølgen
- Oslo University Hospital, Division of Mental Health and Addiction, Acute Psychiatric Department, Oslo, Norway
| | - Ann Færden
- Oslo University Hospital, Division of Mental Health and Addiction, Acute Psychiatric Department, Oslo, Norway
| | - Siv Skarstein
- OsloMet - Oslo Metropolitan University, Faculty of Health Sciences, Department of Nursing and Health Promotion, Oslo, Norway
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Mallows JL. Qualitative study using grounded theory examining collegiality among emergency physicians. Emerg Med Australas 2022; 35:398-405. [PMID: 36372444 DOI: 10.1111/1742-6723.14128] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2022] [Revised: 10/11/2022] [Accepted: 10/18/2022] [Indexed: 11/15/2022]
Abstract
OBJECTIVES Collegiality is considered to be any extra-role behaviour that is discretionary, not recognised by a formal reward system and that promotes the effective functioning of the organisation. Although there is much literature on the concept of collegiality, there are few studies examining collegiality in the medical profession and none looking at collegiality among emergency physicians (EPs). The aim of the present study is to explore the perceptions of different ED healthcare professionals on the meaning of collegiality among EPs, the benefits of collegiality and behaviours they identify as indicative of collegiality. METHODS This was a qualitative study using grounded theory. Data collection was via focus group interviews of three to four participants per group. Participants included EPs, emergency medicine trainees, senior emergency nurses and nurse practitioners. Three questions were explored: 'what does collegiality mean to you?'; 'what are the benefits of collegiality?'; and 'what specific behaviours do you see as part of collegiality?' RESULTS Ten focus group interviews involving a total of 33 participants were conducted. Several themes were identified for both the meaning of collegiality and the benefits of collegiality among EPs. Eight themes regarding collegial behaviour were identified: (i) mutual respect and trust; (ii) mutual support; (iii) attitude; (iv) work ethic; (v) staff welfare; (vi) patient management; (vii) handover; and (viii) education. CONCLUSION The present study identified distinct themes and behaviours indicative of collegiality among EPs. Promoting these behaviours could improve staff well-being, ED efficiency, patient safety and productivity.
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Affiliation(s)
- James L Mallows
- Emergency Department Nepean Hospital Sydney New South Wales Australia
- Discipline of Emergency Medicine The University of Sydney Nepean Clinical School Sydney New South Wales Australia
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12
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Farooq M, Ahmad S, Hanjra FK, Zafar O, Bashir K. Interprofessional On-floor Education on Oxygen Therapy in COVID-19 Patients, Cardiac Arrest, and Procedural Sedation: Perception of Health-care Workers in Emergency Setting. OPEN ACCESS EMERGENCY MEDICINE 2022; 14:535-543. [PMID: 36204721 PMCID: PMC9531615 DOI: 10.2147/oaem.s349656] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2021] [Accepted: 09/13/2022] [Indexed: 11/23/2022] Open
Affiliation(s)
- Munawar Farooq
- Emergency Department, Hamad General Hospital, Doha, Qatar
| | - Shabbir Ahmad
- Emergency Department, Hamad General Hospital, Doha, Qatar
| | | | | | - Khalid Bashir
- Emergency Department, Hamad General Hospital, Doha, Qatar
- Correspondence: Khalid Bashir, Tel +974 33766596, Email
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Rowland M, Adefuye AO. An Evaluation of Pre-Hospital Emergency Care Personnel Knowledge About Crisis Resource Management and Perspectives of Educators About Inclusion of Crisis Resource Management in the Pre-Hospital Emergency Care Curriculum. ADVANCES IN MEDICAL EDUCATION AND PRACTICE 2022; 13:849-864. [PMID: 35982855 PMCID: PMC9379110 DOI: 10.2147/amep.s365436] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Accepted: 06/20/2022] [Indexed: 06/15/2023]
Abstract
PURPOSE To evaluate the knowledge of pre-hospital emergency care personnel (PECP) in South Africa on the principles, practice of crisis resource management (CRM), and obtain emergency medical care (EMC) educators' views on the teaching and learning of CRM skills in the pre-hospital EMC curriculum. METHODS This research was designed as an exploratory study that used a semi-structured questionnaire administered to 2000 PECP and focus group discussion (FGD) with 19 emergency care educators. Chi-squared test and Cramér's V were used to examine the existence and the strength of an association between cross-tabulated variables. Responses to open-ended questions, as well as the data generated by the FGD, were analysed qualitatively using iterative inductive coding to identify themes. RESULTS A response rate of 76% was obtained for the survey. Findings are that the majority (64.5%) of the PECP were not familiar with CRM, though familiarity varied significantly across cadres of PECP (p <0.001). EMC educators reported that the concept of CRM must be thoroughly researched and developed in the emergency medical service (EMS) context before it is included in the EMC curriculum. The educators reported that early introduction of CRM in the EMC curriculum will have a positive effect on students' professional development. Difficulties with assessment, knowing what to teach, and lack of universally accepted guidelines or teaching modalities are some of the challenges identified by EMC educators in relation to teaching CRM in the EMC curriculum. CONCLUSION The findings of this study provide new insights into PECP's knowledge and EMC educators' views on the teaching and learning of CRM in the EMC curriculum. This study highlights that more research is needed to develop an EMS CRM curriculum. Investigation into the development of a teaching and learning framework for CRM in EMC education could be the focus of future studies.
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Affiliation(s)
- Mugsien Rowland
- Department of Emergency Medical Care, Boitekanelo College, Gaborone, Botswana
| | - Anthonio Oladele Adefuye
- Division of Health Sciences Education, Faculty of Health Sciences, University of the Free State, Bloemfontein, Free State, 9301, South Africa
- Western Atlantic University School of Medicine, Freeport, Bahamas
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14
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Innocenti F, Tassinari I, Ralli ML, Bona A, Stefanone VT, Audisio R, Meo F, Grifoni C, Pini R. Improving technical and non-technical skills of emergency medicine residents through a program based on high-fidelity simulation. Intern Emerg Med 2022; 17:1471-1480. [PMID: 35181840 DOI: 10.1007/s11739-022-02940-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2021] [Accepted: 01/29/2022] [Indexed: 11/28/2022]
Abstract
We evaluated the effectiveness of a training program with high-fidelity simulation (HFS) to improve technical (TS) and non-technical skills (NTS) of residents in Emergency Medicine. We conducted a 2-year training program for the management of a critical patient based on HFS (6 sessions for every year, four teams who performed 4 scenarios per session). At the beginning of the training program, all participants received a presentation of Crisis Resource Management (CRM) principles. Each session covered a different topic in Emergency Medicine Curriculum. TSs were measured as the proportion of completed tasks in the following areas: airway, breathing, circulation, disability and exposure (ABCDE) assessment and management, completion of anamnesis based on AMPLE (allergy, medications, previous illness, last meal and event) scheme, diagnostic and therapeutic assessment. NTSs were rated by the Clinical Teamwork Scale (CTS). Scores' values and the percentage of correctly performed actions were presented as median with interquartile range. Friedmann non-parametric test was employed to evaluate the trend of TS and NTS over the following sessions. Among the TS, the assessment and management of ABCDE and completion of therapeutic tasks improved (all p < 0.05). The completion of diagnostic tasks (p = 0.050) tended toward significant improvement. The overall CTS score (first session 61 ± 17, last session 84 ± 16, p < 0.001) as well as Communication (first 13.7 ± 3.6, last 18.7 ± 3.5, p < 0.001), Situational Awareness (first 5.3 ± 1.8, last 6.4 ± 1.4, p = 0.012) and Role Responsibility subscores (first 9.7 ± 2.8, last 12.1 ± 3.7, p < 0.001) increased through the following sessions. Therefore, HFS has proven to be an effective instrument to improve TS and NTS among Emergency Medicine residents.
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Affiliation(s)
- Francesca Innocenti
- High-Dependency Unit, Department of Clinical and Experimental Medicine, Careggi University Hospital, Largo Brambilla 3, 50134, Florence, Italy.
| | - Irene Tassinari
- High-Dependency Unit, Department of Clinical and Experimental Medicine, Careggi University Hospital, Largo Brambilla 3, 50134, Florence, Italy
| | - Maria Luisa Ralli
- High-Dependency Unit, Department of Clinical and Experimental Medicine, Careggi University Hospital, Largo Brambilla 3, 50134, Florence, Italy
| | - Andrea Bona
- High-Dependency Unit, Department of Clinical and Experimental Medicine, Careggi University Hospital, Largo Brambilla 3, 50134, Florence, Italy
| | - Valerio Teodoro Stefanone
- High-Dependency Unit, Department of Clinical and Experimental Medicine, Careggi University Hospital, Largo Brambilla 3, 50134, Florence, Italy
| | - Rita Audisio
- High-Dependency Unit, Department of Clinical and Experimental Medicine, Careggi University Hospital, Largo Brambilla 3, 50134, Florence, Italy
| | - Federico Meo
- High-Dependency Unit, Department of Clinical and Experimental Medicine, Careggi University Hospital, Largo Brambilla 3, 50134, Florence, Italy
| | - Caterina Grifoni
- High-Dependency Unit, Department of Clinical and Experimental Medicine, Careggi University Hospital, Largo Brambilla 3, 50134, Florence, Italy
| | - Riccardo Pini
- High-Dependency Unit, Department of Clinical and Experimental Medicine, Careggi University Hospital, Largo Brambilla 3, 50134, Florence, Italy
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15
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Developing a conceptual framework for flexible surge capacity based on complexity and collaborative theoretical frameworks. Public Health 2022; 208:46-51. [DOI: 10.1016/j.puhe.2022.04.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Revised: 04/21/2022] [Accepted: 04/27/2022] [Indexed: 11/21/2022]
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16
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An Undergraduate Interprofessional Experience with Self-Learning Methodology in Simulation Environment (MAES©): A Qualitative Study. NURSING REPORTS 2022; 12:446-463. [PMID: 35894033 PMCID: PMC9326708 DOI: 10.3390/nursrep12030043] [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: 05/16/2022] [Revised: 06/15/2022] [Accepted: 06/20/2022] [Indexed: 11/17/2022] Open
Abstract
This article describes the impact that a Self-learning Methodology in Simulated Environments can have on Interprofessional Education within a Crisis Resource Management simulated scenario. We used a qualitative approach. It is divided into three phases: study and design, plan of action, and analysis and evaluation. During the first phase of the study, there emerged a poor use of Interprofessional Education in the nursing and medical degrees, and it became apparent that there was a need for an implementation. Due to the possibility for better training for both technical and non-technical skills within Crisis Resource Management, a simulation scenario within this setting has been established as a learning baseline objective. The technique used to develop the scenario in the second phase of the study was the Self-learning Methodology in Simulated Environments. Its structure, comprising six items, was previously demonstrated in the literature as appropriate for healthcare degree students. The main result of the third phase shows an overall acceptance of an Interprofessional Education within Self-learning Methodology in Simulated Environments during the practice of a Crisis Resource Management scenario. The integrated application of a Self-learning Methodology in Simulated Environments, Interprofessional Education, and Crisis Resource Management result in a synergistic combination that allows students to share knowledge, technical, and non-technical skills using an innovative learning method.
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Training with High Fidelity Simulation in the Care of Patients with Coronavirus-A Learning Experience in Native Health Care Multi-Professional Teams. Healthcare (Basel) 2021; 9:healthcare9101260. [PMID: 34682940 PMCID: PMC8535904 DOI: 10.3390/healthcare9101260] [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: 07/13/2021] [Revised: 09/13/2021] [Accepted: 09/20/2021] [Indexed: 11/25/2022] Open
Abstract
The training of emergency and intensive care teams in technical and non-technical skills is fundamental. The general aim of this study was to evaluate the training of various professional teams with simulations based on the care of COVID-19 patients using Zone 3 simulations (native emergency medical services and intensive care units-ICU teams) in the Region of Murcia (Spain). A mixed pilot study was designed (qualitative/quantitative) comprised of three phases: Phase 1: detection of needs (focus groups), Phase 2: design of simulation scenarios, and Phase 3: training with high-fidelity simulation and evaluation of competences. The results were used to determine the real training needs of these health professionals, which were used to design four simulation scenarios in line with these needs. The team competences were evaluated before and after the training session, with increases observed after the training sessions, especially in non-technical skills such as communication. Training with zone 3 simulation, with multi-professional native emergency and intensive care teams who provided care to patients with coronavirus was shown to be an effective method, especially for training in non-technical skills. We should consider the training needs of the professionals before the start of any training program to stay one-step ahead of crisis situations.
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18
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Dijkstra FS, Renden PG, Meeter M, Schoonmade LJ, Krage R, van Schuppen H, de la Croix A. Learning about stress from building, drilling and flying: a scoping review on team performance and stress in non-medical fields. Scand J Trauma Resusc Emerg Med 2021; 29:52. [PMID: 33766092 PMCID: PMC7993475 DOI: 10.1186/s13049-021-00865-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2020] [Accepted: 03/09/2021] [Indexed: 11/10/2022] Open
Abstract
Background Teamwork is essential in healthcare, but team performance tends to deteriorate in stressful situations. Further development of training and education for healthcare teams requires a more complete understanding of team performance in stressful situations. We wanted to learn from others, by looking beyond the field of medicine, aiming to learn about a) sources of stress, b) effects of stress on team performance and c) concepts on dealing with stress. Methods A scoping literature review was undertaken. The three largest interdisciplinary databases outside of healthcare, Scopus, Web of Science and PsycINFO, were searched for articles published in English between 2008 and 2020. Eligible articles focused on team performance in stressful situations with outcome measures at a team level. Studies were selected, and data were extracted and analysed by at least two researchers. Results In total, 15 articles were included in the review (4 non-comparative, 6 multi- or mixed methods, 5 experimental studies). Three sources of stress were identified: performance pressure, role pressure and time pressure. Potential effects of stress on the team were: a narrow focus on task execution, unclear responsibilities within the team and diminished understanding of the situation. Communication, shared knowledge and situational awareness were identified as potentially helpful team processes. Cross training was suggested as a promising intervention to develop a shared mental model within a team. Conclusion Stress can have a significant impact on team performance. Developing strategies to prevent and manage stress and its impact has the potential to significantly increase performance of teams in stressful situations. Further research into the development and use of team cognition in stress in healthcare teams is needed, in order to be able to integrate this ‘team brain’ in training and education with the specific goal of preparing professionals for team performance in stressful situations. Supplementary Information The online version contains supplementary material available at 10.1186/s13049-021-00865-7.
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Affiliation(s)
- Femke S Dijkstra
- Department of Educational Sciences, Vrije Universiteit Amsterdam, Van der Boechorststraat 7, Amsterdam, the Netherlands. .,Academy of Health Sciences, Saxion University of Applied Sciences, Handelskade 75, Deventer, the Netherlands.
| | - Peter G Renden
- Faculty of Health, Nutritrion and Sport, The Hague University of Applied Sciences, Johanna Westerdijkplein 75, The Hague, the Netherlands.,Department of Human Movement Sciences, Vrije Universiteit Amsterdam, Van der Boechorststraat 7, Amsterdam, the Netherlands
| | - Martijn Meeter
- Department of Educational Sciences, Vrije Universiteit Amsterdam, Van der Boechorststraat 7, Amsterdam, the Netherlands
| | - Linda J Schoonmade
- Medical library, Vrije Universiteit Amsterdam, De Boelelaan 1117, Amsterdam, the Netherlands
| | - Ralf Krage
- Department of Anesthesiology, KJF Klinik St. Elisabeth, Müller-Gnadenegg-Weg 4, Neuburg an der Donau, Germany
| | - Hans van Schuppen
- Department of Anesthesiology, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, Amsterdam, the Netherlands
| | - Anne de la Croix
- Research in Education, Amsterdam UMC, Vrije Universiteit Amsterdam, De Boelelaan 1117, Amsterdam, the Netherlands
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19
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Hayes P, Bearman C, Butler P, Owen C. Non‐technical skills for emergency incident management teams: A literature review. JOURNAL OF CONTINGENCIES AND CRISIS MANAGEMENT 2020. [DOI: 10.1111/1468-5973.12341] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Peter Hayes
- Appleton Institute Central Queensland University Adelaide SA Australia
- Bushfire and Natural Hazards Cooperative Research Centre Melbourne Vic. Australia
| | - Chris Bearman
- Appleton Institute Central Queensland University Adelaide SA Australia
- Bushfire and Natural Hazards Cooperative Research Centre Melbourne Vic. Australia
| | | | - Christine Owen
- Bushfire and Natural Hazards Cooperative Research Centre Melbourne Vic. Australia
- Tasmanian Institute of Law Enforcement Studies University of Tasmania Hobart Tas. Australia
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20
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Williams KL, Renouf TS, Dubrowski A. Pitfalls in Emergency Medicine: Survey-Based Identification of Learning Objectives for Targeted Simulation Curricula by Emergency Department Staff. Cureus 2020; 12:e11965. [PMID: 33425541 PMCID: PMC7790324 DOI: 10.7759/cureus.11965] [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] [Indexed: 11/05/2022] Open
Abstract
INTRODUCTION The emergency department is a complex practice environment into which numerous factors may introduce both human and system error. Emergency physicians have to assemble and manage multidisciplinary teams with a moment's notice to manage critically ill patients. The EM training programs across Canada are diverse with considerable variation among programs. Acquisition of both high acuity low occurrence (HALO) and crisis resource management (CRM) skills are crucial to the development of proficient emergency room physicians. Physicians and allied health workers were surveyed to identify potential causes of error in local emergency departments and to find simulation-driven solutions. METHODS An anonymous survey was prepared to evaluate potential pitfalls of emergency care in St. John's, NL, Canada. It was distributed electronically to 108 medical staff, including physicians, nurses, and postgraduate year three (PGY3) residents. Respondents were asked about their experience with simulation education, and whether or not they feel that there is an opportunity for it in postgraduate emergency medicine training. RESULTS The response rate was 30%. Communication - with the emergency department team, consulting services, and patients - was identified as a potential topic for simulation, along with interruptions. Burnout, busy department, departmental crowding, end of shift handover, and incomplete/missing patient medical history were identified as topics that should be included in the emergency medicine curriculum. Following a review with the simulation expert panel, it was determined that end of shift handover could also be incorporated as a simulation in the existing curriculum. DISCUSSION This survey looked at pitfalls in emergency medicine through a CRM lens. Six pitfalls were identified as important for patient safety, but not best addressed with simulation. These could be incorporated into the half-day curriculum as didactic lectures. Four important patient safety pitfalls were identified that could potentially be addressed with simulation and incorporated in the existing emergency medicine simulation curriculum.
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Affiliation(s)
- Kerry-Lynn Williams
- Family Medicine, Memorial University of Newfoundland, Happy Valley-Goose Bay, CAN
| | - Tia S Renouf
- Emergency Medicine, Memorial University of Newfoundland, St. John's, CAN
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21
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Freeman WD, Karnatovskaia LV, Dredla BK. How to Prepare and Protect Health-Care Teams During COVID-19: Know Thyself. Neurocrit Care 2020; 34:10-12. [PMID: 33108628 PMCID: PMC7590558 DOI: 10.1007/s12028-020-01135-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2020] [Accepted: 10/14/2020] [Indexed: 11/23/2022]
Affiliation(s)
- W David Freeman
- Department of Critical Care Medicine, Mayo Clinic, 4500 San Pablo Rd, Jacksonville, FL, 32224, USA. .,Department of Neurology, Mayo Clinic, Jacksonville, FL, USA. .,Department of Neurologic Surgery, Mayo Clinic, Jacksonville, FL, USA.
| | | | - Brynn K Dredla
- Department of Neurology, Mayo Clinic, Jacksonville, FL, USA.,Division of Pulmonary, Allergy and Sleep Medicine, Mayo Clinic, Jacksonville, FL, USA
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22
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Psychophysiologic measures of cognitive load in physician team leaders during trauma resuscitation. COMPUTERS IN HUMAN BEHAVIOR 2020. [DOI: 10.1016/j.chb.2020.106393] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
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23
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Gavin N, Romney MLS, Lema PC, Babineau J, Chang B, Egan DJ, Tedeschi C, Mills AM, Kessler DO. Organisational crisis resource management: leading an academic department of emergency medicine through the COVID-19 pandemic. BMJ LEADER 2020. [DOI: 10.1136/leader-2020-000310] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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24
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Carey S, Hogan S. Failure in Systems and Culture: Barriers That Prevent Implementation of Evidence-Based Fasting Times for Patients in the Acute Care Setting. JPEN J Parenter Enteral Nutr 2020; 45:933-940. [PMID: 32654214 DOI: 10.1002/jpen.1961] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2020] [Revised: 06/23/2020] [Accepted: 06/28/2020] [Indexed: 01/22/2023]
Abstract
BACKGROUND There is strong evidence supporting fasting guidelines of 6 hours' fast from solids and 2 hours' fast from fluids prior to surgery. Despite this, patients spend prolonged periods of time fasting for surgery with a lack of research to support translating this evidence into practice, particularly for emergency surgical theater lists. This study aims to explore barriers and enablers to reduce prolonged fasting for patients on emergency surgical lists in the acute care setting. METHODS Qualitative interviews were undertaken with 22 health professionals on acute surgical wards within a quaternary referral hospital in Sydney, Australia. Semistructured interviews explored barriers and enablers to implementing evidence-based fasting practices for patients on emergency surgical lists, using a theoretical domains framework. Interviews were transcribed verbatim and analyzed using an inductive thematic approach. RESULTS Key barriers to implementing reduced fasting included unpredictable, inflexible systems; cultural concerns; and gaps in knowledge. Major enablers to reducing fasting times are the recognition of patient distress caused by excessive fasting and desire by all 22 interviewees to address the problem. CONCLUSIONS This research is the first to explore barriers and enablers to implementing interventions to address excessive fasting. This research highlights the complexity of the issue and the need for a multifaceted translational intervention addressing limitations in systems and cultural barriers.
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Affiliation(s)
- Sharon Carey
- Nutrition and Dietetics Department, Royal Prince Alfred Hospital, Sydney, Australia.,School of Life and Environmental Sciences, University of Sydney, Sydney, Australia
| | - Sophie Hogan
- Nutrition and Dietetics Department, Royal Prince Alfred Hospital, Sydney, Australia
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Buljac-Samardzic M, Doekhie KD, van Wijngaarden JDH. Interventions to improve team effectiveness within health care: a systematic review of the past decade. HUMAN RESOURCES FOR HEALTH 2020; 18:2. [PMID: 31915007 PMCID: PMC6950792 DOI: 10.1186/s12960-019-0411-3] [Citation(s) in RCA: 163] [Impact Index Per Article: 40.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/14/2019] [Accepted: 09/05/2019] [Indexed: 05/19/2023]
Abstract
BACKGROUND A high variety of team interventions aims to improve team performance outcomes. In 2008, we conducted a systematic review to provide an overview of the scientific studies focused on these interventions. However, over the past decade, the literature on team interventions has rapidly evolved. An updated overview is therefore required, and it will focus on all possible team interventions without restrictions to a type of intervention, setting, or research design. OBJECTIVES To review the literature from the past decade on interventions with the goal of improving team effectiveness within healthcare organizations and identify the "evidence base" levels of the research. METHODS Seven major databases were systematically searched for relevant articles published between 2008 and July 2018. Of the original search yield of 6025 studies, 297 studies met the inclusion criteria according to three independent authors and were subsequently included for analysis. The Grading of Recommendations, Assessment, Development, and Evaluation Scale was used to assess the level of empirical evidence. RESULTS Three types of interventions were distinguished: (1) Training, which is sub-divided into training that is based on predefined principles (i.e. CRM: crew resource management and TeamSTEPPS: Team Strategies and Tools to Enhance Performance and Patient Safety), on a specific method (i.e. simulation), or on general team training. (2) Tools covers tools that structure (i.e. SBAR: Situation, Background, Assessment, and Recommendation, (de)briefing checklists, and rounds), facilitate (through communication technology), or trigger (through monitoring and feedback) teamwork. (3) Organizational (re)design is about (re)designing structures to stimulate team processes and team functioning. (4) A programme is a combination of the previous types. The majority of studies evaluated a training focused on the (acute) hospital care setting. Most of the evaluated interventions focused on improving non-technical skills and provided evidence of improvements. CONCLUSION Over the last decade, the number of studies on team interventions has increased exponentially. At the same time, research tends to focus on certain interventions, settings, and/or outcomes. Principle-based training (i.e. CRM and TeamSTEPPS) and simulation-based training seem to provide the greatest opportunities for reaching the improvement goals in team functioning.
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Affiliation(s)
- Martina Buljac-Samardzic
- Erasmus School of Health Policy & Management, Erasmus University Rotterdam, Bayle building, p.o. box 1738, 3000 DR Rotterdam, The Netherlands
| | - Kirti D. Doekhie
- Erasmus School of Health Policy & Management, Erasmus University Rotterdam, Bayle building, p.o. box 1738, 3000 DR Rotterdam, The Netherlands
| | - Jeroen D. H. van Wijngaarden
- Erasmus School of Health Policy & Management, Erasmus University Rotterdam, Bayle building, p.o. box 1738, 3000 DR Rotterdam, The Netherlands
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26
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Amaniyan S, Faldaas BO, Logan PA, Vaismoradi M. Learning from Patient Safety Incidents in the Emergency Department: A Systematic Review. J Emerg Med 2019; 58:234-244. [PMID: 31843322 DOI: 10.1016/j.jemermed.2019.11.015] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2019] [Revised: 11/01/2019] [Accepted: 11/10/2019] [Indexed: 12/18/2022]
Abstract
BACKGROUND Patient safety incidents are commonly observed in critical and high demanding care settings, including the emergency department. There is a need to understand what causes patient safety incidents in emergency departments and determine the implications for excellence in practice. OBJECTIVE Our aim was to systematically review the international literature on patient safety incidents in emergency departments and determine what can be learned from reported incidents to inform and improve practice. DISCUSSION Patient safety incidents in emergency departments have a number of recognized contributing factors. These can be used as groundwork for the development of effective tools to systematically identify incident risk. Participation in efforts to diminish risk and improve patient safety through appropriate incident reporting is critical for removing barriers to safe care. CONCLUSIONS This review enhances our awareness of contributing factors to patient safety incidents within emergency departments and encourages researchers from different disciplines to investigate the causes of practice errors and formulate safety improvement strategies.
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Affiliation(s)
- Sara Amaniyan
- Student Research Committe, Semnan University of Medical Sciences, Semnan, Iran
| | - Bjørn Ove Faldaas
- Faculty of Nursing and Health Sciences, Nord University, Bodø, Norway
| | - Patricia A Logan
- Faculty of Science, Charles Sturt University, Bathurst Campus, New South Wales, Australia
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Busch HJ, Schmid B, Kron J, Fink K, Busche C, Danner T, Veits O, Gottlieb D, Benk C, Trummer G, Meyer-Först S, Kopp S, Schwab W, Wengenmayer T, Biever P. [Freiburg Cardiac Arrest Receiving Team (CART) : Interdisciplinary solution for the acute management of non-traumatic out-of-hospital cardiac arrest]. Med Klin Intensivmed Notfmed 2019; 115:292-299. [PMID: 31363800 DOI: 10.1007/s00063-019-0598-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2019] [Revised: 04/18/2019] [Accepted: 05/13/2019] [Indexed: 10/26/2022]
Abstract
Standard procedures and guidelines provide specific instructions for basic and advanced cardiac life support. Recommendations for the admission of patients from preclinical into clinical structures after successful cardiopulmonary resuscitation (CPR) are available, but only a few are detailed. In the presence of ST-elevation myocardial infarction after return of spontaneous circulation (ROSC), coronary angiography must be performed as soon as possible. However, acute management and consecutive diagnostic procedures after hospital admission are up to the doctor on duty, who can rely on standard internal hospital procedures at best. Despite the enormous progress and new findings in intensive care and emergency medicine, intra-hospital mortality, as well as long-term survival, after CPR remains low and depends on a wide variety of influencing factors. To optimize in-hospital acute care of successfully resuscitated patients, an interdisciplinary admission team, a so-called cardiac arrest receiving team (CART), has been implemented at the University Hospital of Freiburg, Germany. The aim of the CART is to provide primary care to resuscitated patients as quickly and in as standardized a manner as possible with predefined diagnostic and therapeutic pathways by a team with special expertise in the field of CPR and post-resuscitation management. Accordingly, clear criteria for procedures and the location of primary care (e.g. emergency room vs. cardiac catheter laboratory), the composition of the CART and concrete treatment measures were defined.
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Affiliation(s)
- H-J Busch
- Universitäts-Notfallzentrum (UNZ), Universitätsklinikum Freiburg, Sir-Hans-A.-Krebs-Str., 79106, Freiburg im Breisgau, Deutschland.
| | - B Schmid
- Universitäts-Notfallzentrum (UNZ), Universitätsklinikum Freiburg, Sir-Hans-A.-Krebs-Str., 79106, Freiburg im Breisgau, Deutschland
| | - J Kron
- Universitäts-Notfallzentrum (UNZ), Universitätsklinikum Freiburg, Sir-Hans-A.-Krebs-Str., 79106, Freiburg im Breisgau, Deutschland
| | - K Fink
- Universitäts-Notfallzentrum (UNZ), Universitätsklinikum Freiburg, Sir-Hans-A.-Krebs-Str., 79106, Freiburg im Breisgau, Deutschland
| | - C Busche
- Universitäts-Notfallzentrum (UNZ), Universitätsklinikum Freiburg, Sir-Hans-A.-Krebs-Str., 79106, Freiburg im Breisgau, Deutschland
| | - T Danner
- Universitäts-Notfallzentrum (UNZ), Universitätsklinikum Freiburg, Sir-Hans-A.-Krebs-Str., 79106, Freiburg im Breisgau, Deutschland
| | - O Veits
- Universitäts-Notfallzentrum (UNZ), Universitätsklinikum Freiburg, Sir-Hans-A.-Krebs-Str., 79106, Freiburg im Breisgau, Deutschland
| | - D Gottlieb
- Universitäts-Notfallzentrum (UNZ), Universitätsklinikum Freiburg, Sir-Hans-A.-Krebs-Str., 79106, Freiburg im Breisgau, Deutschland
| | - C Benk
- Universitäts-Herzzentrum Freiburg Bad Krozingen GmbH, Bad Krozingen, Deutschland
| | - G Trummer
- Universitäts-Herzzentrum Freiburg Bad Krozingen GmbH, Bad Krozingen, Deutschland
| | - S Meyer-Först
- Universitäts-Herzzentrum Freiburg Bad Krozingen GmbH, Bad Krozingen, Deutschland
| | - S Kopp
- Universitäts-Herzzentrum Freiburg Bad Krozingen GmbH, Bad Krozingen, Deutschland
| | - W Schwab
- Universitäts-Herzzentrum Freiburg Bad Krozingen GmbH, Bad Krozingen, Deutschland
| | - T Wengenmayer
- Universitäts-Herzzentrum Freiburg Bad Krozingen GmbH, Bad Krozingen, Deutschland
| | - P Biever
- Universitäts-Herzzentrum Freiburg Bad Krozingen GmbH, Bad Krozingen, Deutschland
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Abstract
PURPOSE OF REVIEW The pediatric resuscitation environment is a high-stakes, environment in which a multidisciplinary team must work together with patient outcomes dependent, at least in part, on the performance of that team. Given constraints of the environment and the nature of these events, quality improvement work in pediatric resuscitation can be challenging. Ongoing collection of accurate and reliable data on team performance is necessary to inform and evaluate change. RECENT FINDINGS Despite the relative difficulty of quality improvement analysis and intervention implementation in the resuscitation environment, these efforts can have significant impact on patient outcomes. Although there are barriers to accurate data collection in real-life resuscitation, team performance of both technical and nontechnical skills can be reliably measured in video-based quality improvement programs. Training of nontechnical skills, using crisis resource management principles, can improve care delivery in resuscitation. SUMMARY Striving toward a learning healthcare system model in resuscitation care delivery can allow for efficient performance improvement. Given the possible impacts on mortality and quality of life of care delivered in the resuscitation environment, all providers who could possibly face a resuscitation event - no matter how rare - should consider how they are evaluating the quality of their care delivery in this arena.
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Szulewski A, Braund H, Egan R, Gegenfurtner A, Hall AK, Howes D, Dagnone D, van Merrienboer JJG. Starting to Think Like an Expert: An Analysis of Resident Cognitive Processes During Simulation-Based Resuscitation Examinations. Ann Emerg Med 2019; 74:647-659. [PMID: 31080034 DOI: 10.1016/j.annemergmed.2019.04.002] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2019] [Revised: 03/25/2019] [Accepted: 04/03/2019] [Indexed: 11/15/2022]
Abstract
STUDY OBJECTIVE Simulation is commonly used to teach crisis resource management skills and assess them in emergency medicine residents. However, our understanding of the cognitive processes underlying crisis resource management skills is limited because these processes are difficult to assess and describe. The objective of this study is to uncover and characterize the cognitive processes underlying crisis resource management skills and to describe how these processes vary between residents according to performance in a simulation-based examination. METHODS Twenty-two of 24 eligible emergency medicine trainees from 1 tertiary academic center completed 1 or 2 resuscitation-based examinations in the simulation laboratory. Resident performance was assessed by a blinded expert using an entrustment-based scoring tool. Participants wore eye-tracking glasses that generated first-person video that was used to augment subsequent interviews led by an emergency medicine faculty member. Interviews were audio recorded and then transcribed. An emergent thematic analysis was completed with a codebook that was developed by 4 research assistants, with subsequent analyses conducted by the lead research assistant with input from emergency medicine faculty. Themes from high- and low-performing residents were subsequently qualitatively compared. RESULTS Higher-performing residents were better able to anticipate, selectively attend to relevant information, and manage cognitive demands, and took a concurrent (as opposed to linear) approach to managing the simulated patient. CONCLUSION The results provide new insights into residents' cognitive processes while managing simulated patients in an examination environment and how these processes vary with performance. More work is needed to determine how best to apply these findings to improve crisis resource management education.
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Affiliation(s)
- Adam Szulewski
- Department of Emergency Medicine, Queen's University, Kingston, Ontario, Canada.
| | - Heather Braund
- Faculty of Education and Office of Professional Development and Educational Scholarship, Faculty of Health Sciences, Queen's University, Kingston, Ontario, Canada
| | - Rylan Egan
- Health Quality Programs, Queen's University, Kingston, Ontario, Canada
| | - Andreas Gegenfurtner
- Institut für Qualität und Weiterbildung, Technische Hochschule Deggendorf, Deggendorf, Germany
| | - Andrew K Hall
- Department of Emergency Medicine, Queen's University, Kingston, Ontario, Canada
| | - Daniel Howes
- Department of Emergency Medicine, Queen's University, Kingston, Ontario, Canada; Department of Critical Care Medicine, Queen's University, Kingston, Ontario, Canada
| | - Damon Dagnone
- Department of Emergency Medicine, Queen's University, Kingston, Ontario, Canada
| | - Jeroen J G van Merrienboer
- School of Health Professions Education, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, the Netherlands
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Murphy M, Curtis K, McCloughen A. Facilitators and barriers to the clinical application of teamwork skills taught in multidisciplinary simulated Trauma Team Training. Injury 2019; 50:1147-1152. [PMID: 30704778 DOI: 10.1016/j.injury.2019.01.026] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2018] [Revised: 11/29/2018] [Accepted: 01/14/2019] [Indexed: 02/02/2023]
Abstract
BACKGROUND Efforts to improve teamwork in trauma include simulation-based team training with a non-technical skills (NTS) focus. However, there is a lack of evidence to inform the development of team training programs for maximum uptake of NTS in clinical practice. This descriptive paper aims to evaluate the extent NTS were practiced by the trauma team in a Level 1 trauma hospital after NTS training and to identify facilitators and barriers to use of NTS in clinical practice. METHOD A 38-item questionnaire targeting clinicians who attended a simulation based multidisciplinary Trauma Team Training program was developed. The questionnaire was developed using the Theoretical Domains Framework, a validated tool to identify what practices need to change. It included questions on the current practice of NTS in real life trauma resuscitation. RESULTS Eighty six of 235 eligible participants (rate 37%) responded to the questionnaire. All relevant professions and clinical services were represented. There were 15 facilitators and 12 barriers identified. Barriers and facilitators were allocated to categories of factors known to influence trauma team practices. These were: (1) organisational factors that influence the trauma team, (2) team factors that influence teamwork and (3) cognitive factors that influence team decision making. CONCLUSION NTS were being used by frontline clinicians in real world trauma resuscitations to varying degrees, depending on organisational, team and cognitive facilitators and barriers. Facilitators to the implementation of NTS skills during trauma emergencies included team composition, roles and responsibilities, procedural compliance and leadership. Barriers included decision making and communication. This study described team members experience of using NTS in 'real world trauma resuscitation' to inform future team training interventions.
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Affiliation(s)
- Margaret Murphy
- Sydney Nursing School, University of Sydney, Australia; Emergency Department, Westmead Hospital, Australia.
| | - Kate Curtis
- Sydney Nursing School, University of Sydney, Australia; Emergency Department, Illawarra Shoalhaven, Australia
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Experience of emergency healthcare professionals in cardiopulmonary resuscitation and its relationship with self-efficacy: A qualitative approach. ENFERMERIA CLINICA 2018; 29:155-169. [PMID: 30529053 DOI: 10.1016/j.enfcli.2018.09.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2018] [Revised: 08/27/2018] [Accepted: 09/30/2018] [Indexed: 11/21/2022]
Abstract
AIM To gain a deeper knowledge of the phenomenon of cardiopulmonary resuscitation by capturing the meanings that professionals attach to the behaviour of reanimation and its relationship with Social Cognitive Theory. METHOD Qualitative research from a phenomenological approach focussing on field work with a focus group of professionals from Madrid (doctors, nurses and technicians), as well as a previous study. After the transcription of the data, it was coded, categories were formed and it was grouped into dimensions, interpreting the data according to the Social Cognitive Theory. Data was collected from other sources, experience of professionals and family members who had witnessed a cardiopulmonary resuscitation, until the saturation of the data. RESULTS The phenomena that affect the people involved in a cardiopulmonary resuscitation were explored holistically. The relevant aspects to feel able to perform cardiopulmonary resuscitation, as well as those that may hinder the behaviour were identified. Two dimensions were found, personal and situational factors, as well as several categories in each dimension related to Bandura's theory of self-efficacy. CONCLUSIONS Professionals' self-efficacy in a cardiopulmonary resuscitation does not always depend on the technical skills acquired. Personal and situational factors influence the professional being able to vary their behaviour cognitively and emotionally. This knowledge enables cardiopulmonary resuscitation competencies in a clinical situation to be improved and individualized training programmes to be designed in teaching practice.
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The impact of simulated multidisciplinary Trauma Team Training on team performance: A qualitative study. Australas Emerg Care 2018; 22:1-7. [PMID: 30998866 DOI: 10.1016/j.auec.2018.11.003] [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: 09/10/2018] [Revised: 11/16/2018] [Accepted: 11/20/2018] [Indexed: 11/20/2022]
Abstract
INTRODUCTION Effective teamwork is imperative in the emergency trauma setting as trauma teams work in the uncertain and complex context of resuscitating critically injured patients. Poorly performing teams have the potential to contribute to adverse events. Efforts to improve teamwork in trauma include simulation-based multidisciplinary team training with a non-technical skills (NTS) focus. However, there is a lack of evidence linking teamwork training programs with the uptake of NTS in real life trauma resuscitations. The aim of this study was to understand trauma team members' perspectives and experiences of teamwork in real world trauma resuscitations at a Level 1 Trauma Hospital, following completion of a simulated multidisciplinary Trauma Team Training (TTT) program. METHOD Semi-structured interviews were used to explore trauma team members' experiences and perspectives of the impact of TTT on the team's performance. Trauma team members who had completed TTT were invited to participate in the study. Fifteen participants from various disciplines (nursing, medical, allied health) and specialities (emergency, intensive care, trauma, anaesthetics, allied health) were interviewed. Qualitative data were thematically analysed. RESULTS The overarching finding was that teamwork was the essential component to facilitate a group of skilled experts to collectively perform at an optimum level in emergency trauma care. Four main themes were developed: Leader-follower synergy promotes trauma teamwork; Instability and inconsistency threaten trauma teamwork; Clear communication enhances trauma team decision-making and Team training improves trauma team performance. CONCLUSION A quickly constructed specialty team with unstable membership, will not transform naturally into an expert trauma team. The creation and maintenance of effective trauma teams requires training strategies such as multidisciplinary simulation that target team training and team interaction. Specifically, training should focus on developing non-technical skills for resuscitation trauma teams that have to form quickly and function effectively, often having never met before. As participants were overwhelmingly female, the data generated by this study are not necessarily generalisable to male members of trauma teams.
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Williams T. Educate students about human factors in acute care. CLINICAL TEACHER 2018; 16:533-535. [PMID: 30298985 DOI: 10.1111/tct.12957] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Improving Clinical Performance of an Interprofessional Emergency Medical Team Through a One-day Crisis Resource Management Training. ACTA ACUST UNITED AC 2018; 4:126-136. [PMID: 30574565 PMCID: PMC6296275 DOI: 10.2478/jccm-2018-0018] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2018] [Accepted: 09/08/2018] [Indexed: 11/20/2022]
Abstract
Introduction Errors are frequent in health care and Emergency Departments are one of the riskiest areas due to frequent changes of team composition, complexity and variety of the cases and difficulties encountered in managing multiple patients. As the majority of clinical errors are the results of human factors and not technical in nature or due to the lack of knowledge, a training focused on these factors appears to be necessary. Crisis resource management (CRM), a tool that was developed initially by the aviation industry and then adopted by different medical specialties as anesthesia and emergency medicine, has been associated with decreased error rates. The aim of the study To assess whether a single day CRM training, combining didactic and simulation sessions, improves the clinical performance of an interprofessional emergency medical team. Material and Methods Seventy health professionals with different qualifications, working in an emergency department, were enrolled in the study. Twenty individual interprofessional teams were created. Each team was assessed before and after the training, through two in situ simulated exercises. The exercises were videotaped and were evaluated by two assessors who were blinded as to whether it was the initial or the final exercise. Objective measurement of clinical team performance was performed using a checklist that was designed for each scenario and included essential assessment items for the diagnosis and treatment of a critical patient, with the focus on key actions and decisions. The intervention consisted of a one-day training, combining didactic and simulation sessions, followed by instructor facilitated debriefing. All participants went through this training after the initial assessment exercises. Results An improvement was seen in most of the measured clinical parameters. Conclusion Our study supports the use of combined CRM training for improving the clinical performance of an interprofessional emergency team. Empirically this may improve the patient outcome.
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Impact of a One Day Crisis Resource Management Training on the Work Satisfaction among Emergency Department Healthcare Staff. ACTA MEDICA MARISIENSIS 2018. [DOI: 10.2478/amma-2018-0019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Abstract
Objective: To evaluate the impact of a single day Crisis Resource Management (CRM) oriented team training, combining didactic and simulation sessions, on work satisfaction of the healthcare staff working in an Emergency Department. Methods: Seventy health professionals with different qualifications, working in an emergency department, were enrolled in the study. After enrollment, participants were asked to complete a work satisfaction questionnaire and to choose a day for the training session according to their availability. Each training session took place in the simulation center and consisted of several elements: didactic session and simulation session, followed by instructor facilitated debriefing. The lecture was focused on medical errors and CRM principles. Two months after, they were asked to complete again the work satisfaction questionnaire. Results: There were no significant improvements on the items evaluated through the work satisfaction questionnaire for none of the professional categories involved, except for ‘the possibility to refer the patient to a specialist whenever was considered necessary’ for the doctors. Improvements were seen for the same professional category on the following items: workload, leisure time, level of stress at work, time and energy spent on administrative tasks. Conclusions: The findings of this study do not support the effectiveness of a single day CRM training as a tool to improve the work satisfaction among medical staff in ED. Further research is necessary.
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Charco-Mora P, Urtubia R, Reviriego-Agudo L. The Vortex model: A different approach to the difficult airway. REVISTA ESPANOLA DE ANESTESIOLOGIA Y REANIMACION 2018; 65:385-393. [PMID: 30037388 DOI: 10.1016/j.redar.2018.05.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/23/2018] [Revised: 05/22/2018] [Accepted: 05/28/2018] [Indexed: 06/08/2023]
Abstract
Airway management is an essential area in anaesthesia, and anaesthesiologists are considered the most expert professionals to manage airway tasks. However, complications related to inadequate airway management remain the most frequent cause of morbidity and mortality. Algorithmic strategy to solve difficulties fails, due to several factors related to its structure and clinical application. The Vortex Approach has emerged as a response to the limitations found in the algorithmic strategy of managing the difficult airway, by using a cognitive aid strategy to reduce cognitive load and fixation error. This new strategy may represent a solution to the elusive problem of the challenging airway and reduce the complications rate.
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Affiliation(s)
- P Charco-Mora
- Servicio de Anestesiología y Cuidados Críticos, Airway Management Teaching Center (FIDIVA), Universidad de Valencia, Hospital Clínico Universitario de Valencia, Valencia, España; Vicepresidente de la Sección de Vía Aérea de la SEDAR.
| | - R Urtubia
- Servicio de Anestesiología, Clínica Vespucio, Santiago de Chile, Chile
| | - L Reviriego-Agudo
- Servicio de Anestesiología y Cuidados Críticos, Airway Management Teaching Center (FIDIVA), Universidad de Valencia, Hospital Clínico Universitario de Valencia, Valencia, España
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Performance Under Stress Conditions During Multidisciplinary Team Immersive Pediatric Simulations. Pediatr Crit Care Med 2018; 19:e270-e278. [PMID: 29432402 DOI: 10.1097/pcc.0000000000001473] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES The primary objective was to determine whether technical and nontechnical performances were in some way correlated during immersive simulation. Performance was measured among French Emergency Medical Service workers at an individual and a team level. Secondary objectives were to assess stress response through collection of physiologic markers (salivary cortisol, heart rate, the proportion derived by dividing the number of interval differences of successive normal-to-normal intervals > 50 ms by the total number of normal-to-normal intervals [pNN50], low- and high-frequency ratio) and affective data (self-reported stress, confidence, and dissatisfaction), and to correlate them to performance scores. DESIGN Prospective observational study performed as part of a larger randomized controlled trial. SETTING Medical simulation laboratory. SUBJECTS Forty-eight participants distributed among 12 Emergency Medical System teams. INTERVENTIONS Individual and team performance measures and individual stress response were assessed during a high-fidelity simulation. Technical performance was assessed by the intraosseous access performance scale and the Team Average Performance Assessment Scale; nontechnical performance by the Behavioral Assessment Tool for leaders, and the Clinical Teamwork Scale. Stress markers (salivary cortisol, heart rate, pNN50, low- and high-frequency ratio) were measured both before (T1) and after the session (T2). Participants self-reported stress before and during the simulation, self-confidence, and perception of dissatisfaction with team performance, rated on a scale from 0 to 10. MEASUREMENTS AND MAIN RESULTS Scores (out of 100 total points, mean ± SD) were intraosseous equals to 65.6 ± 14.4, Team Average Performance Assessment Scale equals to 44.6 ± 18.1, Behavioral Assessment Tool equals to 49.5 ± 22.0, Clinical Teamwork Scale equals to 50.3 ± 18.5. There was a strong correlation between Behavioral Assessment Tool and Clinical Teamwork Scale (Rho = 0.97; p = 0.001), and Behavioral Assessment Tool and Team Average Performance Assessment Scale (Rho = 0.73; p = 0.02). From T1 to T2, all stress markers (salivary cortisol, heart rate, pNN50, and low- and high-frequency ratio) displayed an increase in stress level (p < 0.001 for all). Self-confidence was positively correlated with performance (Clinical Teamwork Scale: Rho = 0.47; p = 0.001, Team Average Performance Assessment Scale: Rho = 0.46; p = 0.001). Dissatisfaction was negatively correlated with performance (Rho = -0.49; p = 0.0008 with Behavioral Assessment Tool, Rho = -0.47; p = 0.001 with Clinical Teamwork Scale, Rho = -0.51; p = 0.0004 with Team Average Performance Assessment Scale). No correlation between stress response and performance was found. CONCLUSIONS There was a positive correlation between leader (Behavioral Assessment Tool) and team (Clinical Teamwork Scale and Team Average Performance Assessment Scale) performances. These performance scores were positively correlated with self-confidence and negatively correlated with dissatisfaction.
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Urtubia R, Reviriego-Agudo L, Charco-Mora P. Vortex: What is the expected contribution of this novel approach to airway management? TRENDS IN ANAESTHESIA AND CRITICAL CARE 2018. [DOI: 10.1016/j.tacc.2018.03.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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White MR, Braund H, Howes D, Egan R, Gegenfurtner A, van Merrienboer JJG, Szulewski A. Getting Inside the Expert's Head: An Analysis of Physician Cognitive Processes During Trauma Resuscitations. Ann Emerg Med 2018; 72:289-298. [PMID: 29699720 DOI: 10.1016/j.annemergmed.2018.03.005] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2017] [Revised: 01/31/2018] [Accepted: 02/28/2018] [Indexed: 11/29/2022]
Abstract
STUDY OBJECTIVE Crisis resource management skills are integral to leading the resuscitation of a critically ill patient. Despite their importance, crisis resource management skills (and their associated cognitive processes) have traditionally been difficult to study in the real world. The objective of this study was to derive key cognitive processes underpinning expert performance in resuscitation medicine, using a new eye-tracking-based video capture method during clinical cases. METHODS During an 18-month period, a sample of 10 trauma resuscitations led by 4 expert trauma team leaders was analyzed. The physician team leaders were outfitted with mobile eye-tracking glasses for each case. After each resuscitation, participants were debriefed with a modified cognitive task analysis, based on a cued-recall protocol, augmented by viewing their own first-person perspective eye-tracking video from the clinical encounter. RESULTS Eye-tracking technology was successfully applied as a tool to aid in the qualitative analysis of expert performance in a clinical setting. All participants stated that using these methods helped uncover previously unconscious aspects of their cognition. Overall, 5 major themes were derived from the interviews: logistic awareness, managing uncertainty, visual fixation behaviors, selective attendance to information, and anticipatory behaviors. CONCLUSION The novel approach of cognitive task analysis augmented by eye tracking allowed the derivation of 5 unique cognitive processes underpinning expert performance in leading a resuscitation. An understanding of these cognitive processes has the potential to enhance educational methods and to create new assessment modalities of these previously tacit aspects of expertise in this field.
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Affiliation(s)
- Matthew R White
- Department of Emergency Medicine, Queen's University, Kingston, Ontario, Canada; Department of Critical Care Medicine, Queen's University, Kingston, Ontario, Canada
| | - Heather Braund
- Department of Education, Queen's University, Kingston, Ontario, Canada; Office of Professional Development and Educational Scholarship, Queen's University, Kingston, Ontario, Canada
| | - Daniel Howes
- Department of Emergency Medicine, Queen's University, Kingston, Ontario, Canada; Department of Critical Care Medicine, Queen's University, Kingston, Ontario, Canada
| | - Rylan Egan
- Office of Professional Development and Educational Scholarship, Queen's University, Kingston, Ontario, Canada
| | - Andreas Gegenfurtner
- Institut für Qualität und Weiterbildung, Technische Hochschule Deggendorf, Deggendorf, Germany
| | - Jeroen J G van Merrienboer
- School of Health Professions Education, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, the Netherlands
| | - Adam Szulewski
- Department of Emergency Medicine, Queen's University, Kingston, Ontario, Canada.
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[Simulation-based learning and internal medicine: Opportunities and current perspectives for a national harmonized program]. Rev Med Interne 2018; 39:414-420. [PMID: 29548580 DOI: 10.1016/j.revmed.2017.11.011] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2017] [Revised: 11/09/2017] [Accepted: 11/25/2017] [Indexed: 11/19/2022]
Abstract
Simulation-based learning (SBL) is developing rapidly in France and the question of its use in the teaching of internal medicine (IM) is essential. While HAS encourages its integration into medical education, French Young Internists (AJI) set up a working group to reflect on the added-value of this tool in our specialty. Different sorts of SBL exist: human, synthetic and electronic. It enables student to acquire and evaluate technical skills (strengths, invasive procedures, etc.) and non-technical skills (relational, reasoning…). The debriefing that follows the simulation session is an essential time in pedagogical terms. It enables the acquisition of knowledge by encouraging the students' reflection to reshape their reasoning patterns by self-correcting. IM interns are supportive of its use. The simulation would allow young internists to acquire skills specific to our specialty such as certain gestures, complex consulting management, the synthesis of difficult clinical cases. SBL remains confronted with human and financial cost issues. The budgets allocated to the development and maintenance of simulation centres are uneven, making the supply of training unequal on the territory. Simulation sessions are time-consuming and require teacher training. Are faculties ready to train and invest their time in simulation, even though the studies do not allow us to conclude on its pedagogical validity?
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Paquin H, Bank I, Young M, Nguyen LHP, Fisher R, Nugus P. Leadership in crisis situations: merging the interdisciplinary silos. Leadersh Health Serv (Bradf Engl) 2017; 31:110-128. [PMID: 29412098 DOI: 10.1108/lhs-02-2017-0010] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose Complex clinical situations, involving multiple medical specialists, create potential for tension or lack of clarity over leadership roles and may result in miscommunication, errors and poor patient outcomes. Even though copresence has been shown to overcome some differences among team members, the coordination literature provides little guidance on the relationship between coordination and leadership in highly specialized health settings. The purpose of this paper is to determine how different specialties involved in critical medical situations perceive the role of a leader and its contribution to effective crisis management, to better define leadership and improve interdisciplinary leadership and education. Design/methodology/approach A qualitative study was conducted featuring purposively sampled, semi-structured interviews with 27 physicians, from three different specialties involved in crisis resource management in pediatric centers across Canada: Pediatric Emergency Medicine, Otolaryngology and Anesthesia. A total of three researchers independently organized participant responses into categories. The categories were further refined into conceptual themes through iterative negotiation among the researchers. Findings Relatively "structured" (predictable) cases were amenable to concrete distributed leadership - the performance by micro-teams of specialized tasks with relative independence from each other. In contrast, relatively "unstructured" (unpredictable) cases required higher-level coordinative leadership - the overall management of the context and allocations of priorities by a designated individual. Originality/value Crisis medicine relies on designated leadership over highly differentiated personnel and unpredictable events. This challenges the notion of organic coordination and upholds the validity of a concept of leadership for crisis medicine that is not reducible to simple coordination. The intersection of predictability of cases with types of leadership can be incorporated into medical simulation training to develop non-technical skills crisis management and adaptive leaderships skills.
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Affiliation(s)
- Hugo Paquin
- Department of Pediatric Emergency Medicine, CHU Sainte-Justine, University of Montreal , Montréal, Canada
| | - Ilana Bank
- Department of Pediatric Emergency Medicine, Montreal Children's Hospital, Centre for Medical Education, McGill University , Montréal, Canada
| | - Meredith Young
- Department of Medicine, Centre for Medical Education, McGill University , Montréal, Canada
| | - Lily H P Nguyen
- Department of Otolaryngology - Head and Neck Surgery, Centre for Medical Education, Montreal Children's Hospital, McGill University , Montréal, Canada
| | - Rachel Fisher
- Department of Anesthesiology, Montreal Children's Hospital, McGill University , Montréal, Canada
| | - Peter Nugus
- Department of Family Medicine, Centre for Medical Education, McGill University , Montreal, Canada
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Buengeler C, Klonek F, Lehmann-Willenbrock N, Morency LP, Poppe R. Killer Apps: Developing Novel Applications That Enhance Team Coordination, Communication, and Effectiveness. SMALL GROUP RESEARCH 2017; 48:591-620. [PMID: 28989264 PMCID: PMC5607933 DOI: 10.1177/1046496417721745] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
As part of the Lorentz workshop, “Interdisciplinary Insights into Group and Team Dynamics,” held in Leiden, Netherlands, this article describes how Geeks and Groupies (computer and social scientists) may benefit from interdisciplinary collaboration toward the development of killer apps in team contexts that are meaningful and challenging for both. First, we discuss interaction processes during team meetings as a research topic for both Groupies and Geeks. Second, we highlight teamwork in health care settings as an interdisciplinary research challenge. Third, we discuss how an automated solution for optimal team design could benefit team effectiveness and feed into team-based interventions. Fourth, we discuss team collaboration in massive open online courses as a challenge for both Geeks and Groupies. We argue for the necessary integration of social and computational research insights and approaches. In the hope of inspiring future interdisciplinary collaborations, we develop criteria for evaluating killer apps—including the four proposed here—and discuss future research challenges and opportunities that potentially derive from these developments.
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Therrien MC, Normandin JM, Denis JL. Bridging complexity theory and resilience to develop surge capacity in health systems. J Health Organ Manag 2017; 31:96-109. [PMID: 28260411 DOI: 10.1108/jhom-04-2016-0067] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose Health systems are periodically confronted by crises - think of Severe Acute Respiratory Syndrome, H1N1, and Ebola - during which they are called upon to manage exceptional situations without interrupting essential services to the population. The ability to accomplish this dual mandate is at the heart of resilience strategies, which in healthcare systems involve developing surge capacity to manage a sudden influx of patients. The paper aims to discuss these issues. Design/methodology/approach This paper relates insights from resilience research to the four "S" of surge capacity (staff, stuff, structures and systems) and proposes a framework based on complexity theory to better understand and assess resilience factors that enable the development of surge capacity in complex health systems. Findings Detailed and dynamic complexities manifest in different challenges during a crisis. Resilience factors are classified according to these types of complexity and along their temporal dimensions: proactive factors that improve preparedness to confront both usual and exceptional requirements, and passive factors that enable response to unexpected demands as they arise during a crisis. The framework is completed by further categorizing resilience factors according to their stabilizing or destabilizing impact, drawing on feedback processes described in complexity theory. Favorable order resilience factors create consistency and act as stabilizing forces in systems, while favorable disorder factors such as diversity and complementarity act as destabilizing forces. Originality/value The framework suggests a balanced and innovative process to integrate these factors in a pragmatic approach built around the fours "S" of surge capacity to increase health system resilience.
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Affiliation(s)
| | | | - Jean-Louis Denis
- Department of Public Health, Ecole nationale d'administration publique a Montreal, Montreal, Canada
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Bouhabel S, Kay-Rivest E, Nhan C, Bank I, Nugus P, Fisher R, Nguyen LHP. Error Detection–Based Model to Assess Educational Outcomes in Crisis Resource Management Training: A Pilot Study. Otolaryngol Head Neck Surg 2017; 156:1080-1083. [DOI: 10.1177/0194599817697946] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Otolaryngology–head and neck surgery (OTL-HNS) residents face a variety of difficult, high-stress situations, which may occur early in their training. Since these events occur infrequently, simulation-based learning has become an important part of residents’ training and is already well established in fields such as anesthesia and emergency medicine. In the domain of OTL-HNS, it is gradually gaining in popularity. Crisis Resource Management (CRM), a program adapted from the aviation industry, aims to improve outcomes of crisis situations by attempting to mitigate human errors. Some examples of CRM principles include cultivating situational awareness; promoting proper use of available resources; and improving rapid decision making, particularly in high-acuity, low-frequency clinical situations. Our pilot project sought to integrate CRM principles into an airway simulation course for OTL-HNS residents, but most important, it evaluated whether learning objectives were met, through use of a novel error identification model.
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Affiliation(s)
- Sarah Bouhabel
- Department of Otolaryngology–Head and Neck Surgery, McGill University, Montréal, Canada
| | - Emily Kay-Rivest
- Department of Otolaryngology–Head and Neck Surgery, McGill University, Montréal, Canada
| | - Carol Nhan
- Department of Otolaryngology–Head and Neck Surgery, McGill University, Montréal, Canada
| | - Ilana Bank
- Department of Pediatrics, McGill University, Montréal, Canada
- Centre for Medical Education, McGill University, Montréal, Canada
| | - Peter Nugus
- Centre for Medical Education, McGill University, Montréal, Canada
| | - Rachel Fisher
- Department of Anesthesiology, Montreal Children’s Hospital, Montréal, Canada
| | - Lily HP Nguyen
- Department of Otolaryngology–Head and Neck Surgery, McGill University, Montréal, Canada
- Centre for Medical Education, McGill University, Montréal, Canada
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Helicopter Emergency Medical Service Simulation Training in the Extreme: Simulation-based Training in a Mountain Weather Chamber. Air Med J 2017; 36:193-194. [PMID: 28739242 DOI: 10.1016/j.amj.2017.03.004] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2017] [Accepted: 03/24/2017] [Indexed: 11/22/2022]
Abstract
Mountain rescue operations often confront crews with extreme weather conditions. Extremely cold temperatures make standard treatment sometimes difficult or even impossible. It is well-known that most manual tasks, including those involved in mountain rescue operations, are slowed by extremely cold weather. To lessen and improve the decrement in performance of emergency medical treatment caused by cold-induced manual impairment and inadequate medical equipment and supplies, simulation training in a weather chamber, which can produce wind and temperatures up to -22°C, was developed. It provides a promising tool to train the management of complex multidisciplinary settings, thus reducing the occurrence of fatal human and technical errors and increasing the safety for both the patient and the mountain emergency medical service crew.
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Teis R, Allen J, Lee N, Kildea S. So you want to conduct a randomised trial? Learnings from a 'failed' feasibility study of a Crisis Resource Management prompt during simulated paediatric resuscitation. ACTA ACUST UNITED AC 2017; 20:37-44. [PMID: 28042009 DOI: 10.1016/j.aenj.2016.12.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2016] [Revised: 12/07/2016] [Accepted: 12/08/2016] [Indexed: 11/26/2022]
Abstract
BACKGROUND No study has tested a Crisis Resource Management prompt on resuscitation performance. METHODS We conducted a feasibility, unblinded, parallel-group, randomised controlled trial at one Australian paediatric hospital (June-September 2014). Eligible participants were any doctor, nurse, or nurse manager who would normally be involved in a Medical Emergency Team simulation. The unit of block randomisation was one of six scenarios (3 control:3 intervention) with or without a verbal prompt. The primary outcomes tested the feasibility and utility of the intervention and data collection tools. The secondary outcomes measured resuscitation quality and team performance. RESULTS Data were analysed from six resuscitation scenarios (n=49 participants); three control groups (n=25) and three intervention groups (n=24). The ability to measure all data items on the data collection tools was hindered by problems with the recording devices both in the mannequins and the video camera. CONCLUSIONS For a pilot study, greater training for the prompt role and pre-briefing participants about assessment of their cardio-pulmonary resuscitation quality should be undertaken. Data could be analysed in real time with independent video analysis to validate findings. Two cameras would strengthen reliability of the methods.
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Affiliation(s)
- Rachel Teis
- Midwifery Research Unit, Mater Research Institute and University of Queensland, Mater Health, Raymond Terrace, South Brisbane, Queensland 4101, Australia; Paediatric Intensive Care Unit, Mater Children's Hospital, Mater Health, Raymond Terrace, South Brisbane, Queensland 4101, Australia; School of Nursing, Midwifery and Paramedicine, Australian Catholic University, PO Box 456, Virginia, Queensland 4101, Australia
| | - Jyai Allen
- Midwifery Research Unit, Mater Research Institute and University of Queensland, Mater Health, Raymond Terrace, South Brisbane, Queensland 4101, Australia; School of Nursing, Midwifery and Social Work, Level 3, Chamberlain Building (35), University of Queensland, St Lucia, Queensland 4165, Australia.
| | - Nigel Lee
- School of Nursing, Midwifery and Social Work, Level 3, Chamberlain Building (35), University of Queensland, St Lucia, Queensland 4165, Australia
| | - Sue Kildea
- Midwifery Research Unit, Mater Research Institute and University of Queensland, Mater Health, Raymond Terrace, South Brisbane, Queensland 4101, Australia; School of Nursing, Midwifery and Social Work, Level 3, Chamberlain Building (35), University of Queensland, St Lucia, Queensland 4165, Australia; Mothers, Babies and Women's Health, Mater Health, Raymond Terrace, South Brisbane, Queensland 4101, Australia
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Holly D, Swanson V, Cachia P, Beasant B, Laird C. Development of a behaviour rating system for rural/remote pre-hospital settings. APPLIED ERGONOMICS 2017; 58:405-413. [PMID: 27633237 DOI: 10.1016/j.apergo.2016.08.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/06/2015] [Revised: 07/22/2016] [Accepted: 08/02/2016] [Indexed: 06/06/2023]
Abstract
BACKGROUND Remote and Rural pre-hospital care practitioners manage serious illness and injury on an unplanned basis, necessitating technical and non-technical skills (NTS). However, no behaviour rating systems currently address NTS within these settings. Informed by health psychology theory, a NTS-specific behaviour rating system was developed for use within pre-hospital care training for remote and rural practitioners. METHOD The Immediate Medical Care Behaviour Rating System (IMCBRS), was informed by literature, expert advice and review and observation of an Immediate Medical Care (IMC) course. Once developed, the usability and appropriateness of the rating system was tested through observation of candidates' behaviour at IMC courses during simulated scenarios and rating their use of NTS using the IMCBRS. RESULTS AND CONCLUSION Observation of training confirmed rating system items were demonstrated in 28-62% of scenarios, depending on context. The IMCBRS may thus be a useful addition to training for rural and practitioners.
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Affiliation(s)
- Deirdre Holly
- Psychology Directorate, NHS Education for Scotland, 89 Hydepark St., 2 Central Quay, Glasgow, G3 8BW, Scotland, UK.
| | - Vivien Swanson
- Psychology Directorate, NHS Education for Scotland, 89 Hydepark St., 2 Central Quay, Glasgow, G3 8BW, Scotland, UK
| | - Philip Cachia
- NHS Education for Scotland, Ninewells Hospital, Dundee, DD1 9SY, Scotland, UK
| | - Beverley Beasant
- NHS Education for Scotland, Ninewells Hospital, Dundee, DD1 9SY, Scotland, UK
| | - Colville Laird
- BASICS Scotland, Sandpiper House, Aberuthven Enterprise Park, Main Road, Aberuthven, PH3 1EL, Scotland, UK
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De Bernardo G, Sordino D, Cavallin F, Mardegan V, Doglioni N, Tataranno ML, Trevisanuto D. Performances of low level hospital health caregivers after a neonatal resuscitation course. Ital J Pediatr 2016; 42:100. [PMID: 27863530 PMCID: PMC5116137 DOI: 10.1186/s13052-016-0313-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2016] [Accepted: 11/12/2016] [Indexed: 11/30/2022] Open
Abstract
Background High fidelity simulation has been executed to allow the evaluation of technical and non-technical skills of health caregivers. Our objective was to assess technical and non-technical performances of low level hospitals health caregivers who attended a Neonatal Resuscitation course using high fidelity simulation in a standard-setting scenario. Methods Twenty-three volunteers were asked to manage a simple scenario (infant with secondary apnea) after the course. Technical and non-technical skills were assessed by using previously published scores. Performances were assessed during the scenario and after 2 months by filmed video recordings. Results Sixteen (69.5%) participants failed to pass the minimum required technical score. Staff experience and participation in previous courses were associated to higher score in technical and non-technical skills, while working in level I or II hospitals did not affect the scores. Previous experience in neonatal resuscitation requiring positive pressure ventilation was associated to better non-technical performance. Technical and non-technical scores were significantly correlated (r = 0.67, p = 0.0005). Delayed and direct evaluation of technical skills provided the same scores. Conclusions A neonatal resuscitation course, performed by using a high fidelity simulation manikin, had a limited impact on technical and non-technical skills of participants working in low level hospitals. Training programs should be tailored to the participants’ professional background and to the more relevant sessions.
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Affiliation(s)
- Giuseppe De Bernardo
- Department of Emergency, AORN Santobono-Pausilipon, Via Mario Fiore 6, Naples, NA, 80129, Italy.
| | - Desirée Sordino
- Department of Emergency, AORN Santobono-Pausilipon, Via Mario Fiore 6, Naples, NA, 80129, Italy
| | | | - Veronica Mardegan
- Department of Women and Children Health, School of Medicine, Padua University, Azienda Ospedaliera di Padova, Padua, Italy
| | - Nicoletta Doglioni
- Department of Women and Children Health, School of Medicine, Padua University, Azienda Ospedaliera di Padova, Padua, Italy
| | - Maria Luisa Tataranno
- Department of Molecular and Developmental Medicine, University of Siena, Siena, Italy
| | - Daniele Trevisanuto
- Department of Women and Children Health, School of Medicine, Padua University, Azienda Ospedaliera di Padova, Padua, Italy
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Pietsch U, Knapp J, Ney L, Berner A, Lischke V. Simulation-Based Training in Mountain Helicopter Emergency Medical Service: A Multidisciplinary Team Training Concept. Air Med J 2016; 35:301-304. [PMID: 27637441 DOI: 10.1016/j.amj.2016.05.006] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2016] [Revised: 05/18/2016] [Accepted: 05/30/2016] [Indexed: 06/06/2023]
Abstract
OBJECTIVE Mountain helicopter rescue operations often confront crews with unique challenges in which even minor errors can result in dangerous situations. Simulation training provides a promising tool to train the management of complex multidisciplinary settings, thus reducing the occurrence of fatal errors and increasing the safety for both the patient and the helicopter emergency medical service (HEMS) crew. METHODS A simulation-based training, dedicated to mountain helicopter emergency medicine service, was developed and executed. We evaluated the impact of this training by the means of a pre- and posttraining self-assessment of 40 HEMS crewmembers. RESULTS Multidisciplinary simulation-based educational training in HEMS is feasible. There was a significant increase in self-assessed competence in safety-related items of human factors and team resource management. The highest gain of competence was demonstrated by a trend in the domain of structured decision making. CONCLUSIONS Interprofessional simulation-based team training could have the potential to impact patient outcomes and improve rescuer safety. Simulation trainings lead to a subjective increase of self-assuredness in the management of complex situations in a difficult working environment.
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Affiliation(s)
- Urs Pietsch
- Kantonsspital St Gallen Klinik für Anästhesiologie, Intensiv-, Rettungs- und Schmerzmedizin, St Gallen, Switzerland; Klinik für Anästhesiologie und Schmerztherapie, Unispital Bern, Bern, Switzerland; Air Zermatt Heliport Raron, Raron, Switzerland.
| | - Jürgen Knapp
- Klinik für Anästhesiologie und Schmerztherapie, Unispital Bern, Bern, Switzerland; Air Zermatt Heliport Raron, Raron, Switzerland
| | - Ludwig Ney
- Klinik für Anästhesiologie und Schmerztherapie, Unispital Bern, Bern, Switzerland; Bergwacht Schwarzwald, Hessen, Bayern, Germany; Klinik für Anaesthesiologie, Klinikum der Universität München, München, Germany
| | - Armin Berner
- Klinik für Anästhesiologie und Schmerztherapie, Unispital Bern, Bern, Switzerland; Bergwacht Schwarzwald, Hessen, Bayern, Germany; Abteilung für Anästhesie und operative Intensivmedizin, Klinikum Garmisch - Partenkirchen, Garmisch - Partenkirchen, Germany
| | - Volker Lischke
- Klinik für Anästhesiologie und Schmerztherapie, Unispital Bern, Bern, Switzerland; Bergwacht Schwarzwald, Hessen, Bayern, Germany; Hochtaunus-Kliniken gGmbH Krankenhaus Bad Homburg, Abteilung für Anästhesie und operative Intensivmedizin, Bad Homburg, Germany
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