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Shetty SR, Burke S, Timmons D, Kennedy HG, Tuohy M, Terkildsen MD. Patient perspective on observation methods used in seclusion room in an Irish forensic mental health setting: A qualitative study. J Psychiatr Ment Health Nurs 2023. [PMID: 37929765 DOI: 10.1111/jpm.12979] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Revised: 08/17/2023] [Accepted: 08/30/2023] [Indexed: 11/07/2023]
Abstract
WHAT IS KNOWN ON THE SUBJECT?: Nurses' observation of patients in seclusion is essential to ensure patient safety. Patient observation in seclusion assists nurses in adhering to the requirements of mental health legislation and hospital policy. Direct observation and video monitoring are widely used in observing patients in seclusion. Coercive practices may cause distress to patient-staff relations. WHAT THE PAPER ADDS TO EXISTING KNOWLEDGE?: We add detailed information on specific observation methods in seclusion and compare them from the perspective of patients. Nurses communicating with patients ensures relational contact and that quality care is provided to patients even in the most distressed phase of their illness. Providing prior information to patients on observation methods in seclusion and the need for engaging patients in meaningful activities, while in seclusion are emphasized. Observation via camera and nurses' presence near the seclusion room made patients feel safe and gave a sense of being cared for in seclusion. Pixellating the video camera would give a sense of privacy and dignity. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: The overarching goal is to prevent seclusion. However, when seclusion is used as a last resort to manage risk to others, it should be done in ways that recognize the human rights of the patient, in ways that are least harmful, and in ways that recognize and cater to patients' unique needs. A consistent approach to relational contact and communication is essential. A care plan must include patient's preferred approach for interacting while in seclusion to support individualized care provision. Viewing panels (small window on the seclusion door) are important in establishing two-way communication with the patient. Educating nurses to utilize them correctly helps stimulate relational contact and communication during seclusion to benefit patients. Engaging patients in meaningful activities when in seclusion is essential to keep them connected to the outside world. Depending on the patient's presentation in the seclusion room and their preferences for interactions, reading newspapers, poems, stories, or a book chapter aloud to patients, via the viewing panel could help ensure such connectedness. More focus should be placed on providing communication training to nurses to strengthen their communication skills in caring for individuals in challenging care situations. Patient education is paramount. Providing prior information to patients using a co-produced information leaflet might reduce their anxiety and make them feel safe in the room. When using cameras in the seclusion room, these should be pixelated to maintain patients' privacy. ABSTRACT: Introduction A lack of research investigating the specific role that various observational techniques may have in shaping the therapeutic relations in mental health care during seclusion warranted this study. Aim The aim of the study was to explore patients' experience of different methods of observation used while the patient was in seclusion. Method A retrospective phenomenological approach, using semi-structured interviews, ten patients' experiences of being observed in the seclusion room was investigated. Colaizzi's descriptive phenomenological method was followed to analyse the data. Results Communicating and engaging patients in meaningful activities can be achieved via the viewing panel. The camera was considered essential in monitoring behaviour and promoting a sense of safety. Pixelating the camera may transform patient view on privacy in seclusion. Discussion The mental health services must strive to prevent seclusion and every effort should be made to recognise the human rights of the patient. The study reveals numerous advantages when nurses actively engage in patient communication during the process of observation. Implications for Practice Different observation methods yield different benefits; therefore, staff education in using these methods is paramount. Empowering the patient with prior information on seclusion, engaging them in meaningful activities and proper documentation on patient engagement, supports the provision of individualised care in seclusion.
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Affiliation(s)
- Shobha Rani Shetty
- National Forensic Mental Health Service, Central Mental Hospital, Dublin, Ireland
- School of Nursing Midwifery and Health Systems, University College Dublin (UCD), Dublin, Ireland
| | - Shauna Burke
- National Forensic Mental Health Service, Central Mental Hospital, Dublin, Ireland
| | - David Timmons
- National Forensic Mental Health Service, Central Mental Hospital, Dublin, Ireland
| | - Harry G Kennedy
- Forensic Psychiatry, Trinity College Dublin, Dublin, Ireland
- Forensic Psychiatry, Aarhus University, Dublin, Ireland
- Forensic Psychiatry, University of Bari 'Aldo Moro', Dublin, Ireland
| | - Mary Tuohy
- National Forensic Mental Health Service, Central Mental Hospital, Dublin, Ireland
| | - Morten Deleuran Terkildsen
- Department of Forensic Psychiatry, Centre for Forensic Psychiatric Research and Development (CerF), Aarhus University Hospital Psychiatry, Aarhus N, Denmark
- DEFACTUM, Central Denmark Region, Aarhus N, Denmark
- Department of Clinical Medicine, Faculty of Health, Aarhus University, Aarhus N, Denmark
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van Oosterhout SPC, van der Niet AG, Abdo WF, Boenink M, Cherpanath TGV, Epker JL, Kotsopoulos AM, van Mook WNKA, Sonneveld HPC, Volbeda M, Olthuis G, van Gurp JLP. How clinicians discuss patients' donor registrations of consent and presumed consent in donor conversations in an opt-out system: a qualitative embedded multiple-case study. Crit Care 2023; 27:299. [PMID: 37507800 PMCID: PMC10375668 DOI: 10.1186/s13054-023-04581-9] [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: 05/26/2023] [Accepted: 07/13/2023] [Indexed: 07/30/2023] Open
Abstract
BACKGROUND The Netherlands introduced an opt-out donor system in 2020. While the default in (presumed) consent cases is donation, family involvement adds a crucial layer of influence when applying this default in clinical practice. We explored how clinicians discuss patients' donor registrations of (presumed) consent in donor conversations in the first years of the opt-out system. METHODS A qualitative embedded multiple-case study in eight Dutch hospitals. We performed a thematic analysis based on audio recordings and direct observations of donor conversations (n = 15, 7 consent and 8 presumed consent) and interviews with the clinicians involved (n = 16). RESULTS Clinicians' personal considerations, their prior experiences with the family and contextual factors in the clinicians' profession defined their points of departure for the conversations. Four routes to discuss patients' donor registrations were constructed. In the Consent route (A), clinicians followed patients' explicit donation wishes. With presumed consent, increased uncertainty in interpreting the donation wish appeared and prompted clinicians to refer to "the law" as a conversation starter and verify patients' wishes multiple times with the family. In the Presumed consent route (B), clinicians followed the law intending to effectuate donation, which was more easily achieved when families recognised and agreed with the registration. In the Consensus route (C), clinicians provided families some participation in decision-making, while in the Family consent route (D), families were given full decisional capacity to pursue optimal grief processing. CONCLUSION Donor conversations in an opt-out system are a complex interplay between seemingly straightforward donor registrations and clinician-family interactions. When clinicians are left with concerns regarding patients' consent or families' coping, families are given a larger role in the decision. A strict uniform application of the opt-out system is unfeasible. We suggest incorporating the four previously described routes in clinical training, stimulating discussions across cases, and encouraging public conversations about donation.
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Affiliation(s)
- Sanne P C van Oosterhout
- Department of IQ Healthcare, Radboud Institute for Health Sciences, Radboud University Medical Center, Kapittelweg 54, 6525 EP, Nijmegen, The Netherlands.
| | - Anneke G van der Niet
- Department of IQ Healthcare, Radboud Institute for Health Sciences, Radboud University Medical Center, Kapittelweg 54, 6525 EP, Nijmegen, The Netherlands
| | - W Farid Abdo
- Department of Intensive Care Medicine, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Marianne Boenink
- Department of IQ Healthcare, Radboud Institute for Health Sciences, Radboud University Medical Center, Kapittelweg 54, 6525 EP, Nijmegen, The Netherlands
| | - Thomas G V Cherpanath
- Department of Intensive Care Medicine, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Jelle L Epker
- Department of Intensive Care Medicine, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Angela M Kotsopoulos
- Department of Intensive Care, Elisabeth Tweesteden Hospital, Tilburg, The Netherlands
| | - Walther N K A van Mook
- Department of Intensive Care Medicine, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Hans P C Sonneveld
- Department of Intensive Care Medicine, Isala Hospital, Zwolle, The Netherlands
| | - Meint Volbeda
- Department of Critical Care, University of Groningen, University Medical Center, Groningen, The Netherlands
| | - Gert Olthuis
- Department of IQ Healthcare, Radboud Institute for Health Sciences, Radboud University Medical Center, Kapittelweg 54, 6525 EP, Nijmegen, The Netherlands
| | - Jelle L P van Gurp
- Department of IQ Healthcare, Radboud Institute for Health Sciences, Radboud University Medical Center, Kapittelweg 54, 6525 EP, Nijmegen, The Netherlands
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3
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Davies KM, Coombes ID, Keogh S, Hay K, Whitfield KM. Medication administration evaluation and feedback tool: Longitudinal cohort observational intervention. Collegian 2023. [DOI: 10.1016/j.colegn.2022.12.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/05/2023]
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4
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Møller KE, Sørensen JL, Topperzer MK, Koerner C, Ottesen B, Rosendahl M, Grantcharov T, Strandbygaard J. Implementation of an Innovative Technology Called the OR Black Box: A Feasibility Study. Surg Innov 2023; 30:64-72. [PMID: 36112770 PMCID: PMC9925891 DOI: 10.1177/15533506221106258] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Introduction. The operating room (OR) Black Box is an innovative technology that captures and compiles extensive real-time data from the OR, allowing identification and analysis of factors that influence intraoperative procedures and performances - ultimately improving patient safety. Implementation of this kind of technology is still an emerging research area and prone to face challenges. Methods. Observational study running from May 2017 to May 2021 conducted at Copenhagen University Hospital - Rigshospitalet, Denmark, involving 152 OR staff and 306 patients. Feasibility of the OR Black Box was assessed in accordance with Bowen's framework with 8 focus areas. Results. The OR Black Box had a high level of acceptability among stakeholders with 100% participation from management, 93% from OR staff, and 98% from patients. The implementation process improved over time, and an average of 80% of the surgeries conducted were captured. The practical aspects such as numerous formal and informal meetings, ethical and legal approval, recruitment of patients were acceptable, albeit time-consuming. The OR Black Box was adopted without any changes in scheduled surgery program, but capturing hours were adjusted to match the surgery program and relocation of OR staff declining to provide consent was possible. Conclusions. Implementation of the OR Black Box was feasible yet challenging. Management, nearly all staff, and patients embraced the initiative; however, ongoing evaluation, information meetings, and commitment from stakeholders are required and crucial to sustain momentum, continue implementation and expansion. Ideas from this study can be useful in the implementation of similar initiatives.
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Affiliation(s)
- Kjestine Emilie Møller
- Department of Gynecology and
Obstetrics, Copenhagen University Hospital –
Rigshospitalet, Copenhagen, Denmark,Kjestine Emilie Møller, Department of
Gynecology and Obstetrics, Juliane Marie Centre, Copenhagen University Hospital
– Rigshospitalet, Copenhagen, Blegdamsvej 9, 2100 Copenhagen, Denmark.
| | - Jette Led Sørensen
- Juliane Marie Centre, Children’s
Hospital Copenhagen, Copenhagen University Hospital –
Rigshospitalet and University of Copenhagen, Copenhagen, Denmark,Department of Clinical Medicine,
Faculty of Health and Medical Sciences, University of
Copenhagen, Copenhagen, Denmark
| | - Martha Krogh Topperzer
- Juliane Marie Centre, Children’s
Hospital Copenhagen, Copenhagen University Hospital –
Rigshospitalet and University of Copenhagen, Copenhagen, Denmark
| | - Christian Koerner
- Department of Improvement and
Digitalization, Copenhagen University Hospital –
Rigshospitalet, Copenhagen, Denmark
| | - Bent Ottesen
- Juliane Marie Centre, Children’s
Hospital Copenhagen, Copenhagen University Hospital –
Rigshospitalet and University of Copenhagen, Copenhagen, Denmark,Department of Clinical Medicine,
Faculty of Health and Medical Sciences, University of
Copenhagen, Copenhagen, Denmark
| | - Mikkel Rosendahl
- Department of Gynecology and
Obstetrics, Copenhagen University Hospital –
Rigshospitalet, Copenhagen, Denmark
| | - Teodor Grantcharov
- Department of General Surgery, University of Toronto, Toronto, ON, Canada,Li Ka Shing Knowledge Institute, St Michael’s Hospital, Toronto, ON, Canada
| | - Jeanett Strandbygaard
- Department of Gynecology and
Obstetrics, Copenhagen University Hospital –
Rigshospitalet, Copenhagen, Denmark,Department of Clinical Medicine,
Faculty of Health and Medical Sciences, University of
Copenhagen, Copenhagen, Denmark
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Peberdy L, Young J, Massey D, Kearney L. Integrated review of the knowledge, attitudes, and practices of maternity health care professionals concerning umbilical cord clamping. Birth 2022; 49:595-615. [PMID: 35582849 PMCID: PMC9790596 DOI: 10.1111/birt.12647] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Revised: 04/17/2022] [Accepted: 04/19/2022] [Indexed: 12/30/2022]
Abstract
BACKGROUND Umbilical cord clamp timing has implications for newborn health, which include increased iron stores up to 6 months of age. National and International cord clamping guidelines differ as do health professionals' practices. The rationale for differences in cord clamping practice is unclear. AIMS AND OBJECTIVE Studies on the knowledge, attitudes, and practices of maternity health care professionals about cord clamp timing were synthesized. Similarities and differences between professional groups and understanding of the optimal timing of cord clamp timing for term newborns were compared. METHODS An integrative review was undertaken. PubMed, Scopus, MIDIRS, CINAHL, and Google Scholar were searched. Publication date limits were set between January 2007 and December 2020. Quality appraisal was undertaken using the Critical Appraisal Skills Program (CASP) tools. RESULTS Eighteen studies met inclusion criteria, as they included primary research studies that investigated maternity health care professionals' knowledge, attitudes, and practices about umbilical cord clamping, and were written in English. Four main subject areas were identified: a) knowledge of optimal cord clamp timing; b) attitudes and perceptions of early vs deferred cord clamping; c) cord clamping practice; and d) rationale for cord clamping practice. CONCLUSIONS Different attitudes and practices were identified between midwifery and medical professionals in relation to cord clamp timing together with health professional knowledge and practice gaps pertaining to optimal cord clamp timing. Contemporary evidence should inform guidelines for clinical practice and be embedded into maternity health professional curricula and professional development programs.
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Affiliation(s)
- Lisa Peberdy
- University of the Sunshine CoastSunshine CoastQueenslandAustralia
| | - Jeanine Young
- University of the Sunshine CoastSunshine CoastQueenslandAustralia
| | - Debbie Massey
- Southern Cross UniversityLismoreNew South WalesAustralia
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Balvardi S, Kammili A, Hanson M, Mueller C, Vassiliou M, Lee L, Schwartzman K, Fiore JF, Feldman LS. The association between video-based assessment of intraoperative technical performance and patient outcomes: a systematic review. Surg Endosc 2022; 36:7938-7948. [PMID: 35556166 DOI: 10.1007/s00464-022-09296-6] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Accepted: 04/18/2022] [Indexed: 01/06/2023]
Abstract
BACKGROUND Efforts to improve surgical safety and outcomes have traditionally placed little emphasis on intraoperative performance, partly due to difficulties in measurement. Video-based assessment (VBA) provides an opportunity for blinded and unbiased appraisal of surgeon performance. Therefore, we aimed to systematically review the existing literature on the association between intraoperative technical performance, measured using VBA, and patient outcomes. METHODS Major databases (Medline, Embase, Cochrane Database, and Web of Science) were systematically searched for studies assessing the association of intraoperative technical performance measured by tools supported by validity evidence with short-term (≤ 30 days) and/or long-term postoperative outcomes. Study quality was assessed using the Newcastle-Ottawa Scale. Results were appraised descriptively as study heterogeneity precluded meta-analysis. RESULTS A total of 11 observational studies were identified involving 8 different procedures in foregut/bariatric (n = 4), colorectal (n = 4), urologic (n = 2), and hepatobiliary surgery (n = 1). The number of surgeons assessed ranged from 1 to 34; patient sample size ranged from 47 to 10,242. High risk of bias was present in 5 of 8 studies assessing short-term outcomes and 2 of 6 studies assessing long-term outcomes. Short-term outcomes were reported in 8 studies (i.e., morbidity, mortality, and readmission), while 6 reported long-term outcomes (i.e., cancer outcomes, weight loss, and urinary continence). Better intraoperative performance was associated with fewer postoperative complications (6 of 7 studies), reoperations (3 of 4 studies), and readmissions (1 of 4 studies). Long-term outcomes were less commonly investigated, with mixed results. CONCLUSION Current evidence supports an association between superior intraoperative technical performance measured using surgical videos and improved short-term postoperative outcomes. Intraoperative performance analysis using video-based assessment represents a promising approach to surgical quality-improvement.
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Affiliation(s)
- Saba Balvardi
- Department of Surgery, McGill University, 1650 Cedar Ave, D6-136, Montreal, QC, H3G 1A4, Canada
- Steinberg-Bernstein Centre for Minimally Invasive Surgery and Innovation, McGill University Health Centre, Montreal, QC, Canada
| | - Anitha Kammili
- Department of Surgery, McGill University, 1650 Cedar Ave, D6-136, Montreal, QC, H3G 1A4, Canada
- Steinberg-Bernstein Centre for Minimally Invasive Surgery and Innovation, McGill University Health Centre, Montreal, QC, Canada
| | - Melissa Hanson
- Department of Surgery, McGill University, 1650 Cedar Ave, D6-136, Montreal, QC, H3G 1A4, Canada
- Steinberg-Bernstein Centre for Minimally Invasive Surgery and Innovation, McGill University Health Centre, Montreal, QC, Canada
| | - Carmen Mueller
- Department of Surgery, McGill University, 1650 Cedar Ave, D6-136, Montreal, QC, H3G 1A4, Canada
- Steinberg-Bernstein Centre for Minimally Invasive Surgery and Innovation, McGill University Health Centre, Montreal, QC, Canada
| | - Melina Vassiliou
- Department of Surgery, McGill University, 1650 Cedar Ave, D6-136, Montreal, QC, H3G 1A4, Canada
- Steinberg-Bernstein Centre for Minimally Invasive Surgery and Innovation, McGill University Health Centre, Montreal, QC, Canada
| | - Lawrence Lee
- Department of Surgery, McGill University, 1650 Cedar Ave, D6-136, Montreal, QC, H3G 1A4, Canada
- Steinberg-Bernstein Centre for Minimally Invasive Surgery and Innovation, McGill University Health Centre, Montreal, QC, Canada
| | - Kevin Schwartzman
- Respiratory Division, Department of Medicine, McGill University, Montreal, QC, Canada
- McGill International Tuberculosis Centre, Research Institute of the McGill University Health Centre, Montreal, QC, Canada
| | - Julio F Fiore
- Department of Surgery, McGill University, 1650 Cedar Ave, D6-136, Montreal, QC, H3G 1A4, Canada
- Steinberg-Bernstein Centre for Minimally Invasive Surgery and Innovation, McGill University Health Centre, Montreal, QC, Canada
| | - Liane S Feldman
- Department of Surgery, McGill University, 1650 Cedar Ave, D6-136, Montreal, QC, H3G 1A4, Canada.
- Steinberg-Bernstein Centre for Minimally Invasive Surgery and Innovation, McGill University Health Centre, Montreal, QC, Canada.
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De Mol L, Desender L, Van Herzeele I, Van de Voorde P, Konge L, Willaert W. Assessing competence in Chest Tube Insertion with the ACTION-tool: A Delphi study. Int J Surg 2022; 104:106791. [DOI: 10.1016/j.ijsu.2022.106791] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2022] [Revised: 07/06/2022] [Accepted: 07/08/2022] [Indexed: 10/16/2022]
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Varpula J, Välimäki M, Lantta T, Berg J, Soininen P, Lahti M. Safety hazards in patient seclusion events in psychiatric care: A video observation study. J Psychiatr Ment Health Nurs 2022; 29:359-373. [PMID: 34536315 DOI: 10.1111/jpm.12799] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2020] [Revised: 08/25/2021] [Accepted: 09/07/2021] [Indexed: 02/06/2023]
Abstract
WHAT IS KNOWN ON THE SUBJECT?: Coercive measures such as seclusion are used to maintain the safety of patients and others in psychiatric care. The use of coercive measures can lead to harm among patients and staff. WHAT THE PAPER ADDS TO EXISTING KNOWLEDGE?: This study is the first of its kind to rely on video observation to expose safety hazards in seclusion events that have not been reported previously in the literature. The actions that both patients and staff take during seclusion events can result in various safety hazards. IMPLICATIONS FOR PRACTICE?: Constant monitoring of patients during seclusion is important for identifying safety hazards and intervening to prevent harm. Nursing staff who use seclusion need to be aware of how their actions can contribute to safety hazards and how they can minimize their potential for harm ABSTRACT: Introduction Seclusion is used to maintain safety in psychiatric care. There is still a lack of knowledge on potential safety hazards related to seclusion practices. Aim To identify safety hazards that might jeopardize the safety of patients and staff in seclusion events in psychiatric hospital care. Method A descriptive design with non-participant video observation was used. The data consisted of 36 video recordings, analysed with inductive thematic analysis. Results Safety hazards were related to patient and staff actions. Patient actions included aggressive behaviour, precarious movements, escaping, falling, contamination and preventing visibility. Staff actions included leaving hazardous items in a seclusion room, unsafe administration of medication, unsecured use of restraints and precarious movements and postures. Discussion This is the first observational study to identify safety hazards in seclusion, which may jeopardize the safety of patients and staff. These hazards were related to the actions of patients and staff. Implications for Practice Being better aware of possible safety hazards could help prevent adverse events during patient seclusion events. It is therefore necessary that nursing staff are aware of how their actions might impact their safety and the safety of the patients. Video observation is a useful method for identifying safety hazards. However, its use requires effort to safeguard the privacy and confidentiality of those included in the videos.
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Affiliation(s)
- Jaakko Varpula
- Department of Nursing Science, University of Turku, Turku, Finland
| | - Maritta Välimäki
- Department of Nursing Science, University of Turku, Turku, Finland.,Xiangya School of Nursing, Central South University, Hunan, China
| | - Tella Lantta
- Department of Nursing Science, University of Turku, Turku, Finland
| | - Johanna Berg
- Department of Nursing Science, University of Turku, Turku, Finland.,Turku University of Applied Sciences, Turku, Finland
| | | | - Mari Lahti
- Department of Nursing Science, University of Turku, Turku, Finland.,Turku University of Applied Sciences, Turku, Finland
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Borg S. Video-based observation in impact evaluation. EVALUATION AND PROGRAM PLANNING 2021; 89:102007. [PMID: 34547597 DOI: 10.1016/j.evalprogplan.2021.102007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Revised: 09/13/2021] [Accepted: 09/14/2021] [Indexed: 06/13/2023]
Abstract
This paper reviews the literature on the use of video-based observation (VBO) with particular attention to monitoring and evaluation (M&E) on development projects. While the use of video both as a research tool and as a strategy for supporting professional development is well-documented across several disciplines, the extent to which VBO has been utilized in M&E contexts is less clearly defined. In order to provide theoretically-grounded recommendations for the development and implementation of one organisation's innovative VBO impact evaluation scheme, this review examines recent evidence of VBO in M&E contexts and draws on VBO literature more generally to identify its advantages and challenges together with advice for enhancing its effectiveness. Based on this analysis, the paper highlights a number of practical issues that should be considered when VBO is being developed for M&E in development contexts, particularly where videos are being made by participants themselves. The value of VBO in responding to COVID-19 and reducing carbon emissions is also noted.
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Affiliation(s)
- Simon Borg
- Department of Language, Literature, Mathematics and Interpretation, Western Norway University of Applied Sciences, Bergen, Norway.
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Villalona S. Insights from the shadows: exploring deservingness of care in the emergency department and language as a social determinant of health. MEDICAL HUMANITIES 2021; 47:e5. [PMID: 33127616 DOI: 10.1136/medhum-2019-011669] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 08/25/2020] [Indexed: 06/11/2023]
Abstract
This study addresses the existing gap in literature that ethnographically examines the experiences of Spanish-speaking patients with limited English proficiency in clinical spaces. All of the participants in this study presented to the emergency department (ED) for evaluation of non-urgent health conditions. Patient shadowing was employed to explore the challenges that this population face in unique clinical settings like the ED. This relatively new methodology facilitates obtaining nuanced understandings of clinical contexts under study in ways that quantitative approaches and survey research do not. Drawing from the field of medical anthropology and approach of narrative medicine, the collected data are presented through the use of clinical ethnographic vignettes and thick description. The conceptual framework of health-related deservingness guided the analysis undertaken in this study. Structural stigma was used as a complementary framework in analysing the emergent themes in the data collected. The results and analysis from this study were used to develop an argument for the consideration of language as a distinct social determinant of health.
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Affiliation(s)
- Seiichi Villalona
- Rutgers Robert Wood Johnson Medical School, Piscataway, New Jersey, USA
- Anthropology, University of South Florida College of Arts and Sciences, Tampa, Florida, USA
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Gidlow CJ, Ellis NJ, Cowap L, Riley V, Crone D, Cottrell E, Grogan S, Chambers R, Clark-Carter D. Cardiovascular disease risk communication in NHS Health Checks using QRISK®2 and JBS3 risk calculators: the RICO qualitative and quantitative study. Health Technol Assess 2021; 25:1-124. [PMID: 34427556 DOI: 10.3310/hta25500] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023] Open
Abstract
BACKGROUND The NHS Health Check is a national cardiovascular disease prevention programme. There is a lack of evidence on how health checks are conducted, how cardiovascular disease risk is communicated to foster risk-reducing intentions or behaviour, and the impact on communication of using different cardiovascular disease risk calculators. OBJECTIVES RIsk COmmunication in Health Check (RICO) study aimed to explore practitioner and patient understanding of cardiovascular disease risk, the associated advice or treatment offered by the practitioner, and the response of the patients in health checks supported by either the QRISK®2 or the JBS3 lifetime risk calculator. DESIGN This was a qualitative study with quantitative process evaluation. SETTING Twelve general practices in the West Midlands of England, stratified on deprivation of the local area (bottom 50% vs. top 50%), and with matched pairs randomly allocated to use QRISK2 or JBS3 during health checks. PARTICIPANTS A total of 173 patients eligible for NHS Health Check and 15 practitioners. INTERVENTIONS The health check was delivered using either the QRISK2 10-year risk calculator (usual practice) or the JBS3 lifetime risk calculator, with heart age, event-free survival age and risk score manipulation (intervention). RESULTS Video-recorded health checks were analysed quantitatively (n = 173; JBS3, n = 100; QRISK2, n = 73) and qualitatively (n = 128; n = 64 per group), and video-stimulated recall interviews were undertaken with 40 patients and 15 practitioners, with 10 in-depth case studies. The duration of the health check varied (6.8-38 minutes), but most health checks were short (60% lasting < 20 minutes), with little cardiovascular disease risk discussion (average < 2 minutes). The use of JBS3 was associated with more cardiovascular disease risk discussion and fewer practitioner-dominated consultations than the use of QRISK2. Heart age and visual representations of risk, as used in JBS3, appeared to be better understood by patients than 10-year risk (QRISK2) and, as a result, the use of JBS3 was more likely to lead to discussion of risk factors and their management. Event-free survival age was not well understood by practitioners or patients. However, a lack of effective cardiovascular disease risk discussion in both groups increased the likelihood of a maladaptive coping response (i.e. no risk-reducing behaviour change). In both groups, practitioners often missed opportunities to check patient understanding and to tailor information on cardiovascular disease risk and its management during health checks, confirming apparent practitioner verbal dominance. LIMITATIONS The main limitations were under-recruitment in some general practices and the resulting imbalance between groups. CONCLUSIONS Communication of cardiovascular disease risk during health checks was brief, particularly when using QRISK2. Patient understanding of and responses to cardiovascular disease risk information were limited. Practitioners need to better engage patients in discussion of and action-planning for their cardiovascular disease risk to reduce misunderstandings. The use of heart age, visual representation of risk and risk score manipulation was generally seen to be a useful way of doing this. Future work could focus on more fundamental issues of practitioner training and time allocation within health check consultations. TRIAL REGISTRATION Current Controlled Trials ISRCTN10443908. FUNDING This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 25, No. 50. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Christopher J Gidlow
- Centre for Health and Development, School of Life Sciences and Education, Staffordshire University, Stoke-on-Trent, UK
| | - Naomi J Ellis
- Centre for Health and Development, School of Life Sciences and Education, Staffordshire University, Stoke-on-Trent, UK
| | - Lisa Cowap
- Centre for Psychological Research, School of Life Sciences and Education, Staffordshire University, Stoke-on-Trent, UK
| | - Victoria Riley
- Centre for Health and Development, School of Life Sciences and Education, Staffordshire University, Stoke-on-Trent, UK
| | - Diane Crone
- Cardiff School of Sport and Health Sciences, Cardiff Metropolitan University, Cardiff, UK
| | - Elizabeth Cottrell
- School of Primary, Community and Social Care, Keele University, Keele, Newcastle-under-Lyme, UK
| | - Sarah Grogan
- Department of Psychology, Manchester Metropolitan University, Manchester, UK
| | - Ruth Chambers
- Stoke-on-Trent Clinical Commissioning Group, Stoke-on-Trent, UK
| | - David Clark-Carter
- Centre for Psychological Research, School of Life Sciences and Education, Staffordshire University, Stoke-on-Trent, UK
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12
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Cooney CM, Aravind P, Hultman CS, Broderick KP, Weber RA, Brooke S, Cooney DS, Lifchez SD. An Analysis of Gender Bias in Plastic Surgery Resident Assessment. J Grad Med Educ 2021; 13:500-506. [PMID: 34434510 PMCID: PMC8370376 DOI: 10.4300/jgme-d-20-01394.1] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2020] [Revised: 03/24/2021] [Accepted: 03/30/2021] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND Previous studies have shown men and women attending physicians rate or provide operating room (OR) autonomy differently to men and women residents, with men attendings providing higher ratings and more OR autonomy to men residents. Particularly with the advent of competency-based training in plastic surgery, differential advancement of trainees influenced by gender bias could have detrimental effects on resident advancement and time to graduation. OBJECTIVE We determined if plastic surgery residents are assessed differently according to gender. METHODS Three institutions' Operative Entrustability Assessment (OEA) data were abstracted from inception through November 2018 from MileMarker, a web-based program that stores trainee operative skill assessments of CPT-coded procedures. Ratings are based on a 5-point scale. Linear regression with postgraduate year adjustment was applied to all completed OEAs to compare men and women attendings' assessments of men and women residents. RESULTS We included 8377 OEAs completed on 64 unique residents (25% women) by 51 unique attendings (29% women): men attendings completed 83% (n = 6972; 5859 assessments of men residents; 1113 of women residents) and women attendings completed 17% (n = 1405; 1025 assessments of men residents; 380 of women residents). Adjusted analysis showed men attendings rated women residents lower than men residents (P < .001); scores by women attendings demonstrated no significant difference (P = .067). CONCLUSIONS Our dataset including 4.5 years of data from 3 training programs showed men attendings scored women plastic surgery residents lower than their men counterparts.
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Affiliation(s)
- Carisa M. Cooney
- Carisa M. Cooney, MPH, CCRP, is Associate Professor, Director of Education Innovation, and Clinical Research Manager, Department of Plastic and Reconstructive Surgery, Johns Hopkins University School of Medicine
| | - Pathik Aravind
- Pathik Aravind, MBBS, is Research Fellow, Department of Plastic and Reconstructive Surgery, Johns Hopkins University School of Medicine
| | - C. Scott Hultman
- C. Scott Hultman, MD, MBA, FACS, is Professor, Department of Plastic and Reconstructive Surgery, Johns Hopkins University School of Medicine, and Professor and Program Director, Division of Plastic and Reconstructive Surgery, University of North Carolina School of Medicine
| | - Kristen P. Broderick
- Kristen P. Broderick, MD, is Assistant Professor, Department of Plastic and Reconstructive Surgery, Johns Hopkins University School of Medicine
| | - Robert A. Weber
- Robert A. Weber, MD, is Professor and Program Director, Division of Plastic Surgery, Baylor Scott and White Medical Center
| | - Sebastian Brooke
- Sebastian Brooke, MD, is Clinical Assistant Professor, Division of Plastic Surgery, Baylor Scott and White Medical Center
| | - Damon S. Cooney
- Damon S. Cooney, MD, PhD, is Assistant Professor and Associate Program Director, Department of Plastic and Reconstructive Surgery, Johns Hopkins University School of Medicine
| | - Scott D. Lifchez
- Scott D. Lifchez, MD, is Associate Professor and Program Director, Department of Plastic and Reconstructive Surgery, Johns Hopkins University School of Medicine
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Looi J, Velakoulis D. Visiting and observing: reflections on clinical observer visits to Neuropsychiatry, Royal Melbourne Hospital. Australas Psychiatry 2021; 29:465-468. [PMID: 32806942 DOI: 10.1177/1039856220946598] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVES To describe and provide experiential reflections on a model of continuing professional development in psychiatry for development and maintenance of specialised skills. CONCLUSIONS For clinical psychiatrists working in smaller population centres, clinical observer visits with peers may be a useful method to develop, improve and calibrate knowledge and skills. Such potential benefits may be even more marked for specialised fields of psychiatry, such as neuropsychiatry.
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Affiliation(s)
- Jeffrey Looi
- Academic Unit of Psychiatry and Addiction Medicine, Australian National University Medical School, Canberra Hospital, Canberra, ACT, Australia
| | - Dennis Velakoulis
- Neuropsychiatry, Royal Melbourne Hospital, Melbourne Neuropsychiatry Centre, University of Melbourne and Melbourne Health, Melbourne, VIC, Australia
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14
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Valiveru RC, Cherian A, Srinivasan K, Maroju NK. Use of a Clinical Audit System in Implementing Surviving Sepsis Campaign Guidelines in Patients With Peritonitis. Cureus 2021; 13:e15961. [PMID: 34211817 PMCID: PMC8236269 DOI: 10.7759/cureus.15961] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Background Sepsis is the predominant cause of morbidity and mortality in patients with peritonitis. "Surviving Sepsis Campaign" (SSC) is an international effort in reducing mortality based on evidence-based guidelines. This study aims to assess the impact of audit-based feedback in a Plan-Do-Study-Act (PDSA) format on improving the implementation of the SSC guidelines in patients with generalized peritonitis at our center. Methods This prospective observational study was conducted in four audit cycles in PDSA format. Multi-departmental inputs were taken to suggest modifications in practice. A questionnaire-based analysis of reasons for non-compliance was performed to find out the opinions and reasons for non-compliance. Morbidity, mortality, and the length of ICU and hospital stay among these patients were also analyzed. Results Baseline compliance with intravenous (IV) bolus administration, central venous pressure (CVP)-guided fluids, and inotropes support when indicated were 100%. Over the course of the three audit cycles, statistically significant improvement in compliance was noted for obtaining blood cultures before antibiotics, antibiotic administration within three hours of presentation, and serum lactate measurement. Overall bundle compliance improved from 9.2% to 64.7% by the end of audit cycle III. Conclusions This study demonstrates that audit-based feedback is a dependable means of improving compliance with SSC guidelines. It brings about improvement by educating users, modifying their behavior through feedback, and enhances process improvement by identifying and correcting systemic deficiencies in the organization.
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Affiliation(s)
- Ramya C Valiveru
- Surgery, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, IND
| | - Anusha Cherian
- Anaesthesiology and Critical Care, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, IND
| | | | - Nanda K Maroju
- Surgery, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, IND
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15
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Snow AL, Loup J, Morgan RO, Richards K, Parmelee PA, Baier RR, McCreedy E, Frank B, Brady C, Fry L, McCullough M, Hartmann CW. Enhancing sleep quality for nursing home residents with dementia: a pragmatic randomized controlled trial of an evidence-based frontline huddling program. BMC Geriatr 2021; 21:281. [PMID: 33906631 PMCID: PMC8076882 DOI: 10.1186/s12877-021-02189-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2021] [Accepted: 04/02/2021] [Indexed: 11/19/2022] Open
Abstract
Background Disturbed sleep places older adults at higher risk for frailty, morbidity, and even mortality. Yet, nursing home routines frequently disturb residents’ sleep through use of noise, light, or efforts to reduce incontinence. Nursing home residents with Alzheimer’s disease and or related dementias—almost two-thirds of long-stay nursing home residents—are likely to be particularly affected by sleep disturbance. Addressing these issues, this study protocol implements an evidence-based intervention to improve sleep: a nursing home frontline staff huddling program known as LOCK. The LOCK program is derived from evidence supporting strengths-based learning, systematic observation, relationship-based teamwork, and efficiency. Methods This study protocol outlines a NIH Stage III, real-world hybrid efficacy-effectiveness pragmatic trial of the LOCK sleep intervention. Over two phases, in a total of 27 non-VA nursing homes from 3 corporations, the study will (1) refine the LOCK program to focus on sleep for residents with dementia, (2) test the impact of the LOCK sleep intervention for nursing home residents with dementia, and (3) evaluate the intervention’s sustainability. Phase 1 (1 year; n = 3 nursing homes; 1 per corporation) will refine the intervention and train-the-trainer protocol and pilot-tests all study methods. Phase 2 (4 years; n = 24 nursing homes; 8 per corporation) will use the refined intervention to conduct a wedge-design randomized, controlled, clinical trial. Phase 2 results will measure the LOCK sleep intervention’s impact on sleep (primary outcome) and on psychotropic medication use, pain and analgesic medication use, and activities of daily living decline (secondary outcomes). Findings will point to inter-facility variation in the program’s implementation and sustainability. Discussion This is the first study to our knowledge that applies a dementia sleep intervention to systematically address known barriers to nursing home quality improvement efforts. This innovative study has future potential to address clinical issues beyond sleep (safety, infection control) and expand to other settings (assisted living, inpatient mental health). The study’s strong team, careful consideration of design challenges, and resulting rigorous, pragmatic approach will ensure success of this promising intervention for nursing home residents with dementia. Trial registration NCT04533815, ClinicalTrials.gov, August 20, 2020. Supplementary Information The online version contains supplementary material available at 10.1186/s12877-021-02189-8.
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Affiliation(s)
- A Lynn Snow
- Alabama Research Institute on Aging and the Department of Psychology, The University of Alabama, Gordon Palmer Hall, Tuscaloosa, AL, 35487, USA. .,Tuscaloosa Veterans Affairs Medical Center, Tuscaloosa, AL, 35404, USA.
| | - Julia Loup
- Alabama Research Institute on Aging and the Department of Psychology, The University of Alabama, Gordon Palmer Hall, Tuscaloosa, AL, 35487, USA.,Tuscaloosa Veterans Affairs Medical Center, Tuscaloosa, AL, 35404, USA
| | - Robert O Morgan
- Department of Management, Policy and Community Health, School of Public Health, The University of Texas Health Science Center at Houston, Houston, USA
| | - Kathy Richards
- School of Nursing, The University of Texas at Austin, Austin, TX, 78701-1412, USA
| | - Patricia A Parmelee
- Alabama Research Institute on Aging and the Department of Psychology, The University of Alabama, Gordon Palmer Hall, Tuscaloosa, AL, 35487, USA
| | - Rosa R Baier
- Brown University School of Public Health, Providence, RI, 02912, USA
| | - Ellen McCreedy
- Brown University School of Public Health, Providence, RI, 02912, USA
| | | | | | - Liam Fry
- Department of Internal Medicine, Dell Medical School, The University of Texas at Austin, Austin, TX, 78712, USA
| | - Megan McCullough
- Department of Public Health, Zuckerberg College of Health Sciences, University of Massachusetts Lowell, Lowell, MA, 01854, USA.,Center for Healthcare Organization and Implementation Research, VA Bedford Healthcare System, Bedford, MA, 01730, USA
| | - Christine W Hartmann
- Department of Public Health, Zuckerberg College of Health Sciences, University of Massachusetts Lowell, Lowell, MA, 01854, USA.,Center for Healthcare Organization and Implementation Research, VA Bedford Healthcare System, Bedford, MA, 01730, USA
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16
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Nursing Students' Knowledge of Patient Safety and Development of Competences Over their Academic Years: Findings from a Longitudinal Study. Zdr Varst 2021; 60:114-123. [PMID: 33822834 PMCID: PMC8015659 DOI: 10.2478/sjph-2021-0017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Accepted: 02/03/2021] [Indexed: 11/20/2022] Open
Abstract
Introduction Future nurses should possess the knowledge and competences necessary to ensure patient safety. However, little evidence is available on the way in which students learn patient safety-related principles over time. This study explored the progress of a cohort of Italian undergraduate nursing students as they acquired patient safety knowledge and competences from time of enrolment to graduation. Methods A longitudinal study carried out between 2015 and 2018 enrolled a cohort of 90 nursing students from two Italian Bachelor of Nursing Science Degree Courses at the Udine University, Italy. The students were followed-up on an annual basis and data collection was performed three times: at the end of the 1st, 2nd and 3rd years. The validated Italian version of the Professional Education in Patient Safety Survey tool was used to collect data. Results At the end of the 1st year, students reported an average 4.19 out of 5 patient safety knowledge acquired in classrooms (CI 95%, 4.11-4.28), which was stable at the end of the 2nd (4.16; CI 95%, 4.06-4.26) and 3rd years (4.26; CI 95%, 4.16-4.32) and no statistical differences emerged over the years. With regard to the competences acquired in clinical settings, at the end of the 1st year the students reported an average 4.28 out of 5 (CI 95%, 4.20-4.37), which decreased significantly at the end of the 2nd year (4.15; CI 95%, 4.07-4.23; p=0.02) and increased at the end of the 3rd year (4.37; CI 95%, 4.27-4.47; p<0.01). Conclusions Nursing students' competences in patient safety issues increases over time, while their knowledge remains stable. Students are more vulnerable at the end of the 1st year, when they seem to be overconfident about patient-safety issues.
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Hasegawa S, Tagashira Y, Murakami S, Urayama Y, Takamatsu A, Nakajima Y, Honda H. Antimicrobial Time-Out for Vancomycin by Infectious Disease Physicians Versus Clinical Pharmacists: A Before-After Crossover Trial. Open Forum Infect Dis 2021; 8:ofab125. [PMID: 34189155 PMCID: PMC8232390 DOI: 10.1093/ofid/ofab125] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2020] [Accepted: 03/10/2021] [Indexed: 11/13/2022] Open
Abstract
Background The present study assessed the impact of time-out on vancomycin use and compared the strategy's efficacy when led by pharmacists versus infectious disease (ID) physicians at a tertiary care center. Methods Time-out, consisting of a telephone call to inpatient providers and documentation of vancomycin use >72 hours, was performed by ID physicians and clinical pharmacists in the Departments of Medicine and Surgery/Critical Care. Patients in the Department of Medicine were assigned to the clinical pharmacist-led arm, and patients in the Department of Surgery/Critical Care were assigned to the ID physician-led arm in the initial, 6-month phase and were switched in the second, 6-month phase. The primary outcome was the change in weekly days of therapy (DOT) per 1000 patient-days (PD), and vancomycin use was compared using interrupted time-series analysis. Results Of 587 patients receiving vancomycin, 132 participated, with 79 and 53 enrolled in the first and second phases, respectively. Overall, vancomycin use decreased, although the difference was statistically nonsignificant (change in slope, -0.25 weekly DOT per 1000 PD; 95% confidence interval [CI], -0.68 to 0.18; P = .24). The weekly vancomycin DOT per 1000 PD remained unchanged during phase 1 but decreased significantly in phase 2 (change in slope, -0.49; 95% CI, -0.84 to -0.14; P = .007). Antimicrobial use decreased significantly in the surgery/critical care patients in the pharmacist-led arm (change in slope, -0.77; 95% CI, -1.33 to -0.22; P = .007). Conclusions Vancomycin time-out was moderately effective, and clinical pharmacist-led time-out with surgery/critical care patients substantially reduced vancomycin use.
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Affiliation(s)
- Shinya Hasegawa
- Division of Infectious Diseases, Fuchu, Tokyo, Japan.,Department of Infection Control Tokyo Metropolitan Tama Medical Center, Fuchu, Tokyo, Japan
| | - Yasuaki Tagashira
- Division of Infectious Diseases, Fuchu, Tokyo, Japan.,Department of Infection Control Tokyo Metropolitan Tama Medical Center, Fuchu, Tokyo, Japan.,Department of Microbiology, Juntendo University Graduate School of Medicine, Bunkyo-ku, Tokyo, Japan
| | - Shutaro Murakami
- Department of Infection Control Tokyo Metropolitan Tama Medical Center, Fuchu, Tokyo, Japan.,Department of Pharmacy, Tokyo Metropolitan Tama Medical Center, Fuchu, Tokyo, Japan
| | - Yasunori Urayama
- Department of Pharmacy, Tokyo Metropolitan Tama Medical Center, Fuchu, Tokyo, Japan
| | - Akane Takamatsu
- Division of Infectious Diseases, Fuchu, Tokyo, Japan.,Department of Infection Control Tokyo Metropolitan Tama Medical Center, Fuchu, Tokyo, Japan
| | - Yuki Nakajima
- Division of Infectious Diseases, Fuchu, Tokyo, Japan
| | - Hitoshi Honda
- Division of Infectious Diseases, Fuchu, Tokyo, Japan.,Department of Infection Control Tokyo Metropolitan Tama Medical Center, Fuchu, Tokyo, Japan
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Inglis JM, Caughey GE, Smith W, Shakib S. Documentation of adverse drug reactions to opioids in an electronic health record. Intern Med J 2021; 51:1490-1496. [PMID: 33465262 DOI: 10.1111/imj.15209] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2020] [Revised: 12/29/2020] [Accepted: 01/04/2021] [Indexed: 01/12/2023]
Abstract
BACKGROUND Allergy to opioids is the second most common drug allergy label in electronic health records (EHR). Adverse drug reactions (ADR) to opioids cause significant morbidity and contribute to healthcare costs, while incorrect opioid allergy labels may unnecessarily complicate patient management. AIMS To examine the documentation of opioid ADR in a large-scale hospital-based EHR. METHODS A cross-sectional retrospective review of EHR documentation of opioid ADR at four public hospitals in South Australia was conducted. Data were extracted from all ADR entries including the reported allergen, ADR category (allergy or intolerance) and reaction details. Expert criteria were used to determine consistency of ADR categorisation as allergy or intolerance. RESULTS Of 86 727 unique ADR reports, there were 13 781 ADR to opioids with most being entered as allergy (n = 8913, 64.7%) rather than intolerance (n = 4868, 35.3%). The most commonly documented reactions were nausea/vomiting (n = 3912, 28%), rash (n = 647, 5%), itch (n = 642, 5%) and hallucinations (n = 527, 4%). There were 362 (3%) ADR labels of anaphylaxis. Of those ADR containing a reaction description (n = 11 868), 89% of reports entered as allergy had a reaction description that was consistent with intolerance and 8% of the entered intolerances had descriptions consistent with allergy when assessed using predefined criteria. CONCLUSIONS This large EHR-based study demonstrates the high rate of opioid ADR labels in EHR. The majority of these labels were for symptoms suggestive of pharmacological intolerance. Reactions consistent with true allergy were uncommon. Systematic review of ADR by a dedicated clinical service would improve the accuracy of documentation.
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Affiliation(s)
- Joshua M Inglis
- Department of Clinical Pharmacology, Royal Adelaide Hospital, Adelaide, South Australia, Australia.,Adelaide Medical School, Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, South Australia, Australia
| | - Gillian E Caughey
- Department of Clinical Pharmacology, Royal Adelaide Hospital, Adelaide, South Australia, Australia.,Discipline of Clinical Pharmacology, Adelaide Medical School, Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, South Australia, Australia.,Registry of Senior Australians, South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia
| | - William Smith
- Clinical Immunology and Allergy, Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - Sepehr Shakib
- Department of Clinical Pharmacology, Royal Adelaide Hospital, Adelaide, South Australia, Australia.,Discipline of Clinical Pharmacology, Adelaide Medical School, Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, South Australia, Australia
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Nachtigall I, Tafelski S, Heucke E, Witzke O, Staack A, Recknagel-Friese S, Geffers C, Bonsignore M. Time and personnel requirements for antimicrobial stewardship in small hospitals in a rural area in Germany. J Infect Public Health 2020; 13:1946-1950. [PMID: 33121907 DOI: 10.1016/j.jiph.2020.10.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Revised: 09/02/2020] [Accepted: 10/05/2020] [Indexed: 10/23/2022] Open
Abstract
BACKGROUND In order to control their anti-infectives consumption, hospitals are required to provide multidisciplinary teams comprising among others an infectiologist, a microbiologist and a pharmacist. Small hospitals though often do not dispose of the defaulted personnel. This study illustrates a solution for an antimicrobial stewardship program (ASP) in small community hospitals in a rural area in Germany. METHODS Four hospitals of ca. 200 beds each, jointly hired an antimicrobial stewardship expert to start a common ASP. This expert did rounds on every ward once a week, mostly as chard reviews with the physician in charge. Outside the rounds, he could be consulted by mail. Working time and number of visited patients were documented. Anti-infectives consumption, incidence of Clostridioides difficile infections (CDI) and mortality rates were retrieved from routinely collected data. The intervention period (01/2018-12/2018) was compared to the preintervention period (01/2017-12/2017). RESULTS 3321 patients were visited in the intervention period. In average, 20 patients were seen per day and 20 min were needed per patient/ chard. About 65% of the expert's working time was needed for rounds, 15% for driving between the hospitals. The anti-infectives consumption of the 4 hospitals in the preintervention period amounted to 50 defined daily doses per 100 occupied bed days. The total consumption was reduced by 10% and of quinolones by 36%. The incidence of hospital-acquired CDI receded from 0.14 to 0.07 cases per 100 patient days (-50%, p = 0.001). The overall in-hospital mortality did not change. CONCLUSIONS A single expert was able to implement a successfull ASP in 4 hospitals. While multidisciplinary antimicrobial stewardship teams are ideal for tertiary care hospitals, small hospitals need a more practical solution. This survey shows that one expert can be sufficient for several small hospitals even with the distances in a rural setting.
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Affiliation(s)
- Irit Nachtigall
- Department for Hygiene, Helios Kliniken Ost and Bad Saarow, Pieskower Str. 33, 15526 Bad Saarow, Germany; Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Klinik für Anästhesiologie mit Schwerpunkt Operative Intensivmedizin, Campus Charité Mitte, Charitéplatz 1, 10115 Berlin, Germany.
| | - Sascha Tafelski
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Klinik für Anästhesiologie mit Schwerpunkt Operative Intensivmedizin, Campus Charité Mitte, Charitéplatz 1, 10115 Berlin, Germany
| | - Edwin Heucke
- Helios Cluster Saxony-Anhalt, Helios Bördeklinik, Kreiskrankenhaus 4, 39387 Oschersleben, Germany
| | - Oliver Witzke
- Universitätsmedizin Essen, Department of Infectious Diseases, West German Centre of Infectious Diseases, University Duisburg-Essen, Hufelandstraße 55, 45147 Essen, Germany
| | - Annedore Staack
- Helios Klinik Jerichower Land, August-Bebel-Str. 55a, 39288 Burg, Germany
| | | | - Christine Geffers
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Institut für Hygiene und Umweltmedizin, Hindenburgdamm 27, 12203 Berlin, Germany
| | - Marzia Bonsignore
- Zentrum für Hygiene, Evangelische Kliniken Gelsenkirchen, Munckelstr. 27, 45879 Gelsenkirchen, Germany.
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20
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Gidlow CJ, Ellis NJ, Cowap L, Riley VA, Crone D, Cottrell E, Grogan S, Chambers R, Clark-Carter D. Quantitative examination of video-recorded NHS Health Checks: comparison of the use of QRISK2 versus JBS3 cardiovascular risk calculators. BMJ Open 2020; 10:e037790. [PMID: 32978197 PMCID: PMC7520846 DOI: 10.1136/bmjopen-2020-037790] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVES Quantitatively examine the content of National Health Service Health Check (NHSHC), patient-practitioner communication balance and differences when using QRISK2 versus JBS3 cardiovascular disease (CVD) risk calculators. DESIGN RIsk COmmunication in NHSHC was a qualitative study with quantitative process evaluation, comparing NHSHC using QRISK2 or JBS3. We present data from the quantitative process evaluation. SETTING AND PARTICIPANTS Twelve general practices in the West Midlands (England) conducted NHSHC using JBS3 or QRISK2 (6/group). Patients were eligible for NHSHC based on national criteria (aged 40-74, no existing cardiovascular-related diagnoses, not taking statins). Recruitment was stratified by patients' age, gender and ethnicity. METHODS Video recordings of NHSHC were coded, second-by-second, to quantify who was speaking and what was being discussed. Outcomes included consultation duration, practitioner verbal dominance (ratio of practitioner:patient speaking time (pr:pt ratio)) and proportion of time discussing CVD risk, risk factors and risk management. RESULTS 173 video-recorded NHSHC were analysed (73 QRISK, 100 JBS3). The sample was 51% women, 83% white British, with approximately equal proportions across age groups. NHSHC duration varied greatly (6.8-38.0 min). Most (60%) lasted less than 20 min. On average, CVD risk was discussed for less than 2 min (9.06%±4.30% of consultation time). There were indications that, compared with NHSHC using JBS3, those with QRISK2 involved less CVD risk discussion (JBS3 M=10.24%, CI: 8.01-12.48 vs QRISK2 M=7.44%, CI: 5.29-9.58) and were more verbally dominated by practitioners (pr:pt ratio JBS3 M=3.21%, CI: 2.44-3.97 vs QRISK2=2.35%, CI: 1.89-2.81). The largest proportion of NHSHC time was spent discussing causal risk factors (M=37.54%, CI: 32.92-42.17). CONCLUSIONS There was wide variation in NHSHC duration. Many were short and practitioner-dominated, with little time discussing CVD risk. JBS3 appears to extend CVD risk discussion and patient contribution. Qualitative examination of how it is used is necessary to fully understand the potential benefits of these differences. TRIAL REGISTRATION NUMBER ISRCTN10443908.
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Affiliation(s)
| | - Naomi J Ellis
- Centre for Health and Development, Staffordshire University, Stoke-on-Trent, UK
| | - Lisa Cowap
- Department of Psychology, Staffordshire University, Stoke on Trent, UK
| | - Victoria A Riley
- Centre for Health and Development, Staffordshire University, Stoke-on-Trent, UK
| | - Diane Crone
- Cardiff School of Sport and Health Sciences, Cardiff Metropolitan University, Cardiff, UK
| | - Elizabeth Cottrell
- School of Primary, Community and Social Care, Keele University, Staffordshire, UK
| | - Sarah Grogan
- Department of Psychology, Manchester Metropolitan University, Manchester, UK
| | - Ruth Chambers
- Stoke-on-Trent Clinical Commissioning Group, Stoke on Trent, UK
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Abstract
BACKGROUND A nonroutine event is any aspect of clinical care perceived by clinicians or trained observers as a deviation from optimal care based on the context of the clinical situation. The authors sought to delineate the incidence and nature of intraoperative nonroutine events during anesthesia care. METHODS The authors prospectively collected audio, video, and relevant clinical information on 556 cases at three academic hospitals from 1998 to 2004. In addition to direct observation, anesthesia providers were surveyed for nonroutine event occurrence and details at the end of each study case. For the 511 cases with reviewable video, 400 cases had no reported nonroutine events and 111 cases had at least one nonroutine event reported. Each nonroutine event was analyzed by trained anesthesiologists. Rater reliability assessment, comparisons (nonroutine event vs. no event) of patient and case variables were performed. RESULTS Of 511 cases, 111 (21.7%) contained 173 nonroutine events; 35.1% of event-containing cases had more than one nonroutine event. Of the 173 events, 69.4% were rated as having patient impact and 12.7% involved patient injury. Longer case duration (25th vs. 75th percentile; odds ratio, 1.83; 95% CI, 1.15 to 2.93; P = 0.032) and presence of a comorbid diagnosis (odds ratio, 2.14; 95% CI, 1.35 to 3.40; P = 0.001) were associated with nonroutine events. Common contributory factors were related to the patient (63.6% [110 of 173]) and anesthesia provider (59.0% [102 of 173]) categories. The most common patient impact events involved the cardiovascular system (37.4% [64 of 171]), airway (33.3% [57 of 171]), and human factors, drugs, or equipment (31.0% [53 of 171]). CONCLUSIONS This study describes characteristics of intraoperative nonroutine events in a cohort of cases at three academic hospitals. Nonroutine event-containing cases were commonly associated with patient impact and injury. Thus, nonroutine event monitoring in conjunction with traditional error reporting may enhance our understanding of potential intraoperative failure modes to guide prospective safety interventions.
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Gilljam BM, Nygren JM, Svedberg P, Arvidsson S. Impact of an Electronic Health Service on Child Participation in Pediatric Oncology Care: Quasiexperimental Study. J Med Internet Res 2020; 22:e17673. [PMID: 32720907 PMCID: PMC7420525 DOI: 10.2196/17673] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2020] [Revised: 05/04/2020] [Accepted: 05/13/2020] [Indexed: 01/16/2023] Open
Abstract
Background For children 6-12 years old, there is a shortage of electronic Health (eHealth) services that promote their participation in health care. Therefore, a digital communication tool, called Sisom, was developed to give children a voice in their health care. Children with long-term diseases want to be more involved in their health care and have the right to receive information, be listened to, express their opinions, and participate in decision making in health care. However, the outcomes of using Sisom in practice at pediatric oncology clinics have not been investigated. Objective The aim of this study was to investigate children’s participation during appointments with pediatricians at pediatric oncology clinics, with or without the use of the eHealth service Sisom. Methods A quasiexperimental design with mixed methods was used. We analyzed 27 filmed appointments with pediatricians for 14 children (8 girls and 6 boys) aged 6-12 years (mean 8.3 years) with a cancer diagnosis. The intervention group consisted of children who used Sisom prior to their appointments with pediatricians at a pediatric oncology clinic, and the control group consisted of children who had appointments with pediatricians at 4 pediatric oncology clinics. Data from observations from the videos were quantitatively and qualitatively analyzed. The quantitative analysis included manual calculations of how many times the pediatricians spoke directly to the children, the proportion of the appointment time that the children were talking, and levels of participation by the children. For the qualitative analysis, we used directed content analysis to analyze the children’s levels of participation guided by a framework based on Shier’s model of participation. Results Pediatricians directed a greater proportion of their discussion toward the child in the intervention group (731 occasions) than in the control group (624 occasions), but the proportion of the appointment time the children talked was almost the same for both the intervention and control groups (mean 17.0 minutes vs 17.6 minutes). The levels of participation corresponded to the first three levels of Shier’s participation model: children were listened to, children were supported to express their views, and children’s views were taken into account. The results showed an increased level of participation by the children in the intervention group. Several codes that were found did not fit into any of the existing categories, and a new category was thus formed: children received information. Conclusions This study shows that the eHealth service Sisom can increase children’s participation during appointments with health care professionals. Further studies employing a randomized control design focusing on the effects of eHealth services on children’s health outcomes, perceived participation, and cost-effectiveness could make a significant contribution to guiding the implementation of eHealth services in pediatric care.
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Affiliation(s)
| | - Jens M Nygren
- School of Health and Welfare, Halmstad University, Halmstad, Sweden
| | - Petra Svedberg
- School of Health and Welfare, Halmstad University, Halmstad, Sweden
| | - Susann Arvidsson
- School of Health and Welfare, Halmstad University, Halmstad, Sweden
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O'Logbon J. What can surgery learn from other high-performance disciplines? Ann Med Surg (Lond) 2020; 55:334-337. [PMID: 32577226 PMCID: PMC7305423 DOI: 10.1016/j.amsu.2020.04.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2020] [Revised: 03/28/2020] [Accepted: 04/08/2020] [Indexed: 11/21/2022] Open
Abstract
High-performance disciplines have always been concerned with safety and exceptional performance. They have established a culture of vigilance and accepted that human error is both inevitable and ubiquitous. These disciplines, therefore, have all implemented a 'systems approach' to error by focusing on predicting, preventing, rescuing and reporting errors that occur so that they can constantly adapt and improve. Given the complexity of surgery, and the error-prone environment within which it takes place, extracting positive behaviours from other high-performance disciplines will serve to improve performance and enhance patient safety. Surgery is being practiced in an ever-changing environment. Currently, there is less available operative experience for surgical trainees; multi-morbidity in patients is growing and rapidly evolving technology means that more high-tech equipment is being used in procedures. This article evaluates the effectiveness of current surgical protocol in reducing errors and possible modifications that can be made to fit the new environment that surgery is now being practiced in. It will then describe how three different high-performance disciplines: aviation, professional sport and Formula 1, have developed in their approaches to safety and excellence, which will serve as the basis for a discussion about what more can be learnt from these disciplines so that the surgical profession can continue to excel in the face of change.
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Affiliation(s)
- Jessica O'Logbon
- GKT School of Medical Education, King's College London, Hodgkin Building, Newcomen St., London SE1 1UL, UK
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Resilience in the Surgical Scheduling to Support Adaptive Scheduling System. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17103511. [PMID: 32443414 PMCID: PMC7277516 DOI: 10.3390/ijerph17103511] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Revised: 05/14/2020] [Accepted: 05/15/2020] [Indexed: 12/17/2022]
Abstract
Operating Room (OR) managers frequently encounter uncertainties related to real-time scheduling, especially on the day of surgery. It is necessary to enable earlier identification of uncertainties occurring in the perioperative environment. This study aims to propose a framework for resilient surgical scheduling by identifying uncertainty factors affecting the real-time surgical scheduling through a mixed-methods study. We collected the pre- and post-surgical scheduling data for twenty days and a one-day observation data in a top-tier general university hospital in South Korea. Data were compared and analyzed for any changes related to the dimensions of uncertainty. The observations in situ of surgical scheduling were performed to confirm our findings from the quantitative data. Analysis was divided into two phases of fundamental uncertainties categorization (conceptual, technical and personal) and uncertainties leveling for effective decision-making strategies. Pre- and post-surgical scheduling data analysis showed that unconfirmed patient medical conditions and emergency cases are the main causes of frequent same-day surgery schedule changes, with derived factors that affect the scheduling pattern (time of surgery, overtime surgery, surgical procedure changes and surgery duration). The observation revealed how the OR manager controlled the unexpected events to prevent overtime surgeries. In conclusion, integrating resilience approach to identifying uncertainties and managing event changes can minimize potential risks that may compromise the surgical personnel and patients' safety, thereby promoting higher resilience in the current system. Furthermore, this strategy may improve coordination among personnel and increase surgical scheduling efficiency.
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Hultstrand C, Coe AB, Lilja M, Hajdarevic S. Negotiating bodily sensations between patients and GPs in the context of standardized cancer patient pathways - an observational study in primary care. BMC Health Serv Res 2020; 20:46. [PMID: 31952534 PMCID: PMC6969453 DOI: 10.1186/s12913-020-4893-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2019] [Accepted: 01/06/2020] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND How interactions during patient-provider encounters in Swedish primary care construct access to further care is rarely explored. This is especially relevant nowadays since Standardized Cancer Patient Pathways have been implemented as an organizational tool for standardizing the diagnostic process and increase equity in access. Most patients with symptoms indicating serious illness as cancer initially start their diagnostic trajectory in primary care. Furthermore, cancer symptoms are diverse and puts high demands on general practitioners (GPs). Hence, we aim to explore how presentation of bodily sensations were constructed and legitimized in primary care encounters within the context of Standardized Cancer Patient Pathways (CPPs). METHODS Participant observations of patient-provider encounters (n = 18, on 18 unique patients and 13 GPs) were carried out at primary healthcare centres in one county in northern Sweden. Participants were consecutively sampled and inclusion criteria were i) patients (≥18 years) seeking care for sensations/symptoms that could indicate cancer, or had worries about cancer, Swedish speaking and with no cognitive disabilities, and ii) GPs who met with these patients during the encounter. A constructivist approach of grounded theory method guided the data collection and was used as a method for analysis, and the COREQ-checklist for qualitative studies (Equator guidelines) were employed. RESULTS One conceptual model emerged from the analysis, consisting of one core category Negotiating bodily sensations to legitimize access, and four categories i) Justifying care-seeking, ii) Transmitting credibility, iii) Seeking and giving recognition, and iv) Balancing expectations with needs. We interpret the four categories as social processes that the patient and GP constructed interactively using different strategies to negotiate. Combined, these four processes illuminate how access was legitimized by negotiating bodily sensations. CONCLUSIONS Patients and GPs seem to be mutually dependent on each other and both patients' expertise and GPs' medical expertise need to be reconciled during the encounter. The four social processes reported in this study acknowledge the challenging task which both patients and primary healthcare face. Namely, negotiating sensations signaling possible cancer and further identifying and matching them with the best pathway for investigations corresponding as well to patients' needs as to standardized routines as CPPs.
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Affiliation(s)
- Cecilia Hultstrand
- Department of Nursing, Umeå University, SE-901 87, Umeå, Sweden.
- Department of Public Health and Clinical Medicine, Family Medicine, Umeå University, SE-901 87, Umeå, Sweden.
| | - Anna-Britt Coe
- Department of Sociology, Umeå University, SE-901 87, Umeå, Sweden
| | - Mikael Lilja
- Department of Public Health and Clinical Medicine, Unit of Research, Education, and Development, Östersund Hospital, Umeå University, SE-901 87, Umeå, Sweden
| | - Senada Hajdarevic
- Department of Nursing, Umeå University, SE-901 87, Umeå, Sweden
- Department of Public Health and Clinical Medicine, Family Medicine, Umeå University, SE-901 87, Umeå, Sweden
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Etherington N, Larrigan S, Liu H, Wu M, Sullivan KJ, Jung J, Boet S. Measuring the teamwork performance of operating room teams: a systematic review of assessment tools and their measurement properties. J Interprof Care 2019; 35:37-45. [PMID: 31865827 DOI: 10.1080/13561820.2019.1702931] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Teamwork is fundamental to surgical patient safety but is inconsistently measured. While many tools have been developed for elective intraoperative situations, it is unclear which is the most robust. This systematic review aimed to identify tools to measure the teamwork of operating room teams. Studies were included if they examined the measurement properties of these tools. PsycINFO, Embase (via OVID), CINAHL, ERIC, Medline and Medline in Process (via OVID) were searched through to May 3, 2019, as were reference lists of included studies and previously published relevant reviews. Retrieved articles were screened and data extracted in duplicate by two independent reviewers. Quality was assessed using the COSMIN checklist. Of the 2121 references identified, 14 studies of six assessment tools were included. Tools were validated across various specialties, mostly in clinical rather than simulated settings. The Observational Teamwork Assessment for Surgery (OTAS) and Operating Theater Team Non-Technical Skills Assessment Tool (NOTECHS) were the most frequently investigated tools. Though acceptable for assessing teamwork, both NOTECHS and OTAS rely on the questionable assumption that the teamwork of a team is equivalent to the sum of individual performances. Future studies may investigate other assessment tools that assess the whole team as the unit of analysis along with the potential of these tools to provide healthcare providers with meaningful feedback in clinical practice.
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Affiliation(s)
| | - Sarah Larrigan
- Faculty of Medicine, University of Ottawa , Ottawa, Canada
| | - Henry Liu
- Faculty of Medicine, University of Ottawa , Ottawa, Canada
| | - Michael Wu
- Faculty of Medicine, University of Ottawa , Ottawa, Canada
| | | | - James Jung
- La Ki Shing Knowledge Institute, St. Michael' Hospital , Toronto, Ontario
| | - Sylvain Boet
- Clinical Epidemiology Program, The Ottawa Hospital Research Institute.,Department of Anesthesiology and Pain Medicine, The Ottawa Hospital , Ottawa, Ontario
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Gualandi R, Masella C, Viglione D, Tartaglini D. Exploring the hospital patient journey: What does the patient experience? PLoS One 2019; 14:e0224899. [PMID: 31805061 PMCID: PMC6894823 DOI: 10.1371/journal.pone.0224899] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2019] [Accepted: 10/23/2019] [Indexed: 01/24/2023] Open
Abstract
PURPOSE To understand how different methodologies of qualitative research are able to capture patient experience of the hospital journey. METHODS A qualitative study of orthopaedic patients admitted for hip and knee replacement surgery in a 250-bed university hospital was performed. Eight patients were shadowed from the time they entered the hospital to the time of transfer to rehabilitation. Four patients and sixteen professionals, including orthopaedists, head nurses, nurses and administrative staff, were interviewed. RESULTS Through analysis of the data collected four main themes emerged: the information gap; the covering patient-professionals relationship; the effectiveness of family closeness; and the micro-integration of hospital services. The three different standpoints (patient shadowing, health professionals' interviews and patients' interviews) allowed different issues to be captured in the various phases of the journey. CONCLUSIONS Hospitals can significantly improve the quality of the service provided by exploring and understanding the individual patient journey. When dealing with a key cross-functional business process, the time-space dynamics of the activities performed have to be considered. Further research in the academic field can explore practical, methodological and ethical challenges more deeply in capturing the whole patient journey experience by using multiple methods and integrated tools.
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Affiliation(s)
- Raffaella Gualandi
- Department of Nursing, Università Campus Bio-Medico di Roma, Rome, Italy
- * E-mail:
| | - Cristina Masella
- Department of Management Economics and Industrial Engineering, Politecnico di Milano, Milan, Italy
| | - Daniela Viglione
- Department of Nursing, Università Campus Bio-Medico di Roma, Rome, Italy
| | - Daniela Tartaglini
- Department of Nursing, Università Campus Bio-Medico di Roma, Rome, Italy
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Martin DR, Moskop JC, Bookman K, Basford JB, Geiderman JM. Compensation models in emergency medicine: An ethical perspective. Am J Emerg Med 2019; 38:138-142. [PMID: 31378410 DOI: 10.1016/j.ajem.2019.158372] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2019] [Revised: 07/16/2019] [Accepted: 07/26/2019] [Indexed: 10/26/2022] Open
Abstract
There is considerable diversity in compensation models in the specialty of Emergency Medicine (EM). We review different compensation models and examine moral consequences possibly associated with the use of various models. The article will consider how different models may promote or undermine health care's quadruple aim of providing quality care, improving population health, reducing health care costs, and improving the work-life balance of health care professionals. It will also assess how different models may promote or undermine the basic bioethical principles of beneficence, non-maleficence, respect for autonomy, and justice.
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Affiliation(s)
- Daniel R Martin
- Department of Emergency Medicine, Ohio State University, 760 Prior Hall, 376 West 10th Avenue, Columbus, OH 43210, United States of America.
| | - John C Moskop
- Wake Forest School of Medicine, Medical Center Blvd, Winston-Salem, NC 27157-0001, United States of America.
| | - Kelly Bookman
- University of Colorado School of Medicine, Department of Emergency Medicine, 12401 E. 17th Ave, B125, Aurora, CO 80045-2548, United States of America.
| | - Jesse B Basford
- Alabama College of Osteopathic Medicine, 445 Health Sciences Blvd, Dothan, AL 36303, United States of America.
| | - Joel Martin Geiderman
- Department of Emergency Medicine, Ruth and Harry Roman Emergency Department, Cedars Sinai Medical Center ED, 8700 Beverly Blvd, Los Angeles, CA 90048-1804, United States of America.
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Etherington N, Wu M, Cheng-Boivin O, Larrigan S, Boet S. Interprofessional communication in the operating room: a narrative review to advance research and practice. Can J Anaesth 2019; 66:1251-1260. [DOI: 10.1007/s12630-019-01413-9] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2019] [Revised: 04/04/2019] [Accepted: 04/05/2019] [Indexed: 10/26/2022] Open
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Krug B, Colliers A, Matthys J, Anthierens S, Philips H, Damen J, Coenen S, Remmen R. Video-recording consultations for educational purposes in out-of-hours primary care: patients and physicians are willing to participate. Acta Clin Belg 2019; 74:65-69. [PMID: 29609529 DOI: 10.1080/17843286.2018.1459231] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
Background Video-recordings of consultations are used by general practitioner (GP) trainees to enable reflection on aspects of knowledge, skills and attitudes. Typically, these recordings are made during office hours in general practice, but little is known about using video-recording during out of hours (OOH) care, which is an important and distinct part of a GP's work. To be able to record consultations during OOH care (i.e. at the emergency department (ED) and at the General Practitioner Cooperative (GPC)), patients must be willing to cooperate and give informed consent. Therefore, it was of interest to investigate potential barriers in these OOH settings. Methods A questionnaire on demographics and attitudes regarding consent was administered to patients and physicians at the ED and at the GPC in Sint-Niklaas, Belgium. Results A total of 346 questionnaires were completed, 23 by physicians and 323 by patients. A majority of the patients (225/286 (79%)) would consent to video-recording the consultation, without physical examination. Almost all physicians (21/23) would agree to participate. Overall, 85% (260/323) of the patients agree when only the doctor was being recorded. Patients were neutral in recording in 79% (88/224) at the GPC and 57% (56/99) at the ED. Shyness or embarrassment was present in 32% (71/224), and 28% (28/99) at the GPC and ED, respectively. We did not find any significant differences in giving consent or feelings between patients at the GPC and ED. Conclusion A vast majority of both patients and physicians would consent to video-recording their consultation in OOH primary care settings (GPC and ED), with possible concerns about privacy, shame and discomfort.
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Affiliation(s)
- Bertwin Krug
- Faculty of Medicine and Health Sciences, Department of Primary and Interdisciplinary Care (ELIZA) – Centre for General Practice (CHA), University of Antwerp – Campus Drie Eiken, Antwerp, Belgium
| | - Annelies Colliers
- Faculty of Medicine and Health Sciences, Department of Primary and Interdisciplinary Care (ELIZA) – Centre for General Practice (CHA), University of Antwerp – Campus Drie Eiken, Antwerp, Belgium
| | - Jan Matthys
- Department of Family Medicine and Primary Healthcare, University of Ghent – UZ Gent, Ghent, Belgium
| | - Sibyl Anthierens
- Faculty of Medicine and Health Sciences, Department of Primary and Interdisciplinary Care (ELIZA) – Centre for General Practice (CHA), University of Antwerp – Campus Drie Eiken, Antwerp, Belgium
| | - Hilde Philips
- Faculty of Medicine and Health Sciences, Department of Primary and Interdisciplinary Care (ELIZA) – Centre for General Practice (CHA), University of Antwerp – Campus Drie Eiken, Antwerp, Belgium
| | - Jorn Damen
- Emergency Department, AZ Nikolaas, Sint-Niklaas, Belgium
| | - Samuel Coenen
- Faculty of Medicine and Health Sciences, Department of Primary and Interdisciplinary Care (ELIZA) – Centre for General Practice (CHA), University of Antwerp – Campus Drie Eiken, Antwerp, Belgium
- Faculty of Medicine and Health Sciences, Department of Epidemiology and Social Medicine (ESOC), University of Antwerp – Campus Drie Eiken, Antwerp, Belgium
- Faculty of Medicine and Health Sciences, Vaccine & Infectious Disease Institute (VAXINFECTIO), University of Antwerp – Campus Drie Eiken, Antwerp, Belgium
| | - Roy Remmen
- Faculty of Medicine and Health Sciences, Department of Primary and Interdisciplinary Care (ELIZA) – Centre for General Practice (CHA), University of Antwerp – Campus Drie Eiken, Antwerp, Belgium
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Gidlow CJ, Ellis NJ, Cowap L, Riley V, Crone D, Cottrell E, Grogan S, Chambers R, Clark-Carter D. A qualitative study of cardiovascular disease risk communication in NHS Health Check using different risk calculators: protocol for the RIsk COmmunication in NHS Health Check (RICO) study. BMC FAMILY PRACTICE 2019; 20:11. [PMID: 30642267 PMCID: PMC6332912 DOI: 10.1186/s12875-018-0897-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/17/2018] [Accepted: 12/26/2018] [Indexed: 11/16/2022]
Abstract
BACKGROUND NHS Health Check is a national cardiovascular disease (CVD) risk assessment programme for 40-74 year olds in England, in which practitioners should assess and communicate CVD risk, supported by appropriate risk-management advice and goal-setting. This requires effective communication, to equip patients with knowledge and intention to act. Currently, the QRISK®2 10-year CVD risk score is most common way in which CVD risk is estimated. Newer tools, such as JBS3, allow manipulation of risk factors and can demonstrate the impact of positive actions. However, the use, and relative value, of these tools within CVD risk communication is unknown. We will explore practitioner and patient CVD risk perceptions when using QRISK®2 or JBS3, the associated advice or treatment offered by the practitioner, and patients' responses. METHODS RIsk COmmunication in NHS Health Check (RICO) is a qualitative study with quantitative process evaluation. Twelve general practices in the West Midlands of England will be randomised to one of two groups: usual practice, in which practitioners use QRISK®2 to assess and communicate CVD risk; intervention, in which practitioners use JBS3. Twenty Health Checks per practice will be video-recorded (n = 240, 120 per group), with patients stratified by age, gender and ethnicity. Post-Health Check, video-stimulated recall (VSR) interviews will be conducted with 48 patients (n = 24 per group) and all practitioners (n = 12-18), using video excerpts to enhance participant recall/reflection. Patient medical record reviews will detect health-protective actions in the first 12-weeks following a Health Check (e.g., lifestyle referrals, statin prescription). Risk communication, patient response and intentions for health-protective behaviours in each group will be explored through thematic analysis of video-recorded Health Checks (using Protection Motivation Theory as a framework) and VSR interviews. Process evaluation will include between-group comparisons of quantitatively coded Health Check content and post-Health Check patient outcomes. Finally, 10 patients with the most positive intentions or behaviours will be selected for case study analysis (using all data sources). DISCUSSION This study will produce novel insights about the utility of QRISK®2 and JBS3 to promote patient and practitioner understanding and perception of CVD risk and associated implications for patient intentions with respect to health-protective behaviours (and underlying mechanisms). Recommendations for practice will be developed. TRIAL REGISTRATION ISRCTN ISRCTN10443908 . Registered 7th February 2017.
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Affiliation(s)
| | - Naomi J. Ellis
- Staffordshire University, Brindley Building, Leek Road, Stoke-on-Trent, ST4 2DF UK
| | - Lisa Cowap
- Staffordshire University, Brindley Building, Leek Road, Stoke-on-Trent, ST4 2DF UK
| | - Victoria Riley
- Staffordshire University, Brindley Building, Leek Road, Stoke-on-Trent, ST4 2DF UK
| | - Diane Crone
- Cardiff Metropolitan University, Cyncoed Campus, Cyncoed Road, Cardiff, CF23 6XD UK
| | | | - Sarah Grogan
- Manchester Metropolitan University, Manchester Campus, Bonsall Street, Manchester, M15 6GX UK
| | - Ruth Chambers
- Stoke-on-Trent Clinical Commissioning Group, Smithfield One Building, Stoke-on-Trent, ST1 4FA UK
| | - David Clark-Carter
- Staffordshire University, The Science Centre, Leek Road, Stoke-on-Trent, ST4 2DF UK
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de Lind van Wijngaarden RAF, Siregar S, Legué J, Fraaije A, Abbas A, Dankelman J, Klautz RJM. Developing a Quality Standard for Verbal Communication During CABG Procedures. Semin Thorac Cardiovasc Surg 2018; 31:383-391. [PMID: 30537534 DOI: 10.1053/j.semtcvs.2018.12.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2018] [Accepted: 12/03/2018] [Indexed: 11/11/2022]
Abstract
Verbal communication during coronary artery bypass graft (CABG) procedures is essential for safe and efficient cardiac surgery, yet sensitive to failure due to a current lack of standardization. The goal of this study was to improve communication during CABG by identifying critical items in verbal interaction between surgeons, anesthetists, and perfusionists. Based on 6 video recordings, a list was assembled containing items of communication in CABG procedures. Personal interviews and a consecutive focus group meeting with surgeons, anesthetists, and perfusionists revealed which of these items were considered critical. Afterward, the recordings were systematically analyzed on the communication of these critical items. Practitioners considered 64 items to be critical to verbally communicate for safe CABG surgery. On average, these critical items were verbalized in 4.4 out of 6 recorded CABGs. Observations also show that the surgical subteam is the most verbally active subteam and the initiator of the majority of all exchanges. The exchange type involved was mainly "direction" and "status." The majority of communication during critical events is between 2 subteams and occurs in the form of call-back loops. Over half of the call-backs are substantive and communication is rarely directed at a specific team member by name. In this study, a list was developed containing 64 items that practitioners unanimously considered critical to verbalize during a CABG procedure. It forms the foundation of a quality standard for verbal communication during cardiopulmonary bypass (CPB) and can increase safety and efficiency of cardiac surgery.
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Affiliation(s)
| | - Sabrina Siregar
- Department of Cardio-Thoracic Surgery, Leiden University Medical Center, Leiden, the Netherlands
| | - Juno Legué
- Department of Cardio-Thoracic Surgery, Leiden University Medical Center, Leiden, the Netherlands
| | - Aafke Fraaije
- Department of Cardio-Thoracic Surgery, Leiden University Medical Center, Leiden, the Netherlands; Department of Biomedical Engineering, Technical University Delft, Delft, the Netherlands
| | - Araz Abbas
- Department of Cardio-Thoracic Surgery, Leiden University Medical Center, Leiden, the Netherlands
| | - Jenny Dankelman
- Department of Biomedical Engineering, Technical University Delft, Delft, the Netherlands
| | - Robert J M Klautz
- Department of Cardio-Thoracic Surgery, Leiden University Medical Center, Leiden, the Netherlands
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Mills WL, Pimentel CB, Palmer JA, Snow AL, Wewiorski NJ, Allen RS, Hartmann CW. Applying a Theory-Driven Framework to Guide Quality Improvement Efforts in Nursing Homes: The LOCK Model. THE GERONTOLOGIST 2018; 58:598-605. [PMID: 28651351 PMCID: PMC6281338 DOI: 10.1093/geront/gnx023] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2016] [Accepted: 06/13/2017] [Indexed: 11/14/2022] Open
Abstract
Purpose of the Study Implementing quality improvement (QI) programs in nursing homes continues to encounter significant challenges, despite recognized need. QI approaches provide nursing home staff with opportunities to collaborate on developing and testing strategies for improving care delivery. We present a theory-driven and user-friendly adaptable framework and facilitation package to overcome existing challenges and guide QI efforts in nursing homes. Design and development The framework is grounded in the foundational concepts of strengths-based learning, observation, relationship-based teams, efficiency, and organizational learning. We adapted these concepts to QI in the nursing home setting, creating the "LOCK" framework. The LOCK framework is currently being disseminated across the Veterans Health Administration. Results The LOCK framework has five tenets: (a) Look for the bright spots, (b) Observe, (c) Collaborate in huddles, (d) Keep it bite-sized, and (e) facilitation. Each tenet is described. We also present a case study documenting how a fictional nursing home can implement the LOCK framework as part of a QI effort to improve engagement between staff and residents. The case study describes sample observations, processes, and outcomes. We also discuss practical applications for nursing home staff, the adaptability of LOCK for different QI projects, the specific role of facilitation, and lessons learned. Implications The proposed framework complements national efforts to improve quality of care and quality of life for nursing home residents and may be valuable across long-term care settings and QI project types.
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Affiliation(s)
- Whitney L Mills
- Center for Innovation in Quality, Effectiveness and Safety, Michael E.
DeBakey VA Medical Center, Houston, Texas
- Department of Medicine, Section of Health Services Research, Baylor College
of Medicine, Houston, Texas
| | - Camilla B Pimentel
- Department of Quantitative Health Sciences, University of Massachusetts
Medical School, Worcester
| | - Jennifer A Palmer
- Center for Healthcare Organization and Implementation Research, Edith Nourse
Rogers Memorial VA Hospital, Bedford, Massachusetts
| | - A Lynn Snow
- Alabama Research Institute on Aging, University of Alabama, Tuscaloosa
- Department of Psychology, University of Alabama, Tuscaloosa
- Tuscaloosa Veterans Affairs Medical Center, Alabama
| | - Nancy J Wewiorski
- Center for Healthcare Organization and Implementation Research, Edith Nourse
Rogers Memorial VA Hospital, Bedford, Massachusetts
| | - Rebecca S Allen
- Alabama Research Institute on Aging, University of Alabama, Tuscaloosa
- Department of Psychology, University of Alabama, Tuscaloosa
| | - Christine W Hartmann
- Center for Healthcare Organization and Implementation Research, Edith Nourse
Rogers Memorial VA Hospital, Bedford, Massachusetts
- Department of Health Law, Policy and Management, School of Public Health,
Boston University, Massachusetts
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Bui AH, Guerrier S, Feldman DL, Kischak P, Mudiraj S, Somerville D, Shebeen M, Girdusky C, Leitman IM. Is video observation as effective as live observation in improving teamwork in the operating room? Surgery 2018; 163:1191-1196. [PMID: 29625708 DOI: 10.1016/j.surg.2018.01.019] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2017] [Revised: 12/03/2017] [Accepted: 01/29/2018] [Indexed: 11/18/2022]
Abstract
BACKGROUND Teamwork in the operating room decreases the risk of preventable patient harm. Observation in the operating room allows for evaluation of compliance with best-practice surgical guidelines. This study examines the relative ability of video and live observation to promote operating room teamwork. METHODS Video and audio cameras were installed in 2014 into all operating rooms at an 875-bed, urban teaching hospital. Recordings were chosen at random for review by an internal quality improvement team. Concurrently, live observers were deployed into a random selection of operations. A customized tool was used to evaluate compliance to TeamSTEPPS skills during surgical briefs and debriefs. RESULTS A total of 1,410 briefs were evaluated: 325 (23%) through live observation and 1,085 (77%) through video; 1,398 debriefs were evaluated: 166 (12%) live and 1,232 (88%) video. For briefs, greater compliance was observed under live observation compared to video for recognition of team membership (87% vs 44%, P<.001), anticipation of complex procedural events (61% vs 45%, P<.001), and monitoring of resources (58% vs 42%, P<.001). For debriefs, greater compliance was observed under live observation for determination of team structure (90% vs 60%, P<.001), establishment of a leader (70% vs 51%, P<.001), postoperative planning (77% vs 48%, P<.001), case review and feedback (49% vs 33%, P<.001), team engagement (64% vs 41%, P<.001), and check back (61% vs 46%, P<.001) compared to video. CONCLUSION Video observations may not be as effective as evaluating live performance in promoting teamwork in the OR. Live observation enables immediate feedback, which may improve behavior and decrease barriers to compliance with surgical safety practices.
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Affiliation(s)
- Anthony H Bui
- Department of Surgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Shanice Guerrier
- Department of Surgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - David L Feldman
- Department of Surgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA; Hospitals Insurance Company, New York, NY, USA
| | | | | | | | - Minimole Shebeen
- Department of Surgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Cynthia Girdusky
- Department of Surgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - I Michael Leitman
- Department of Surgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
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Tamma PD, Avdic E, Keenan JF, Zhao Y, Anand G, Cooper J, Dezube R, Hsu S, Cosgrove SE. What Is the More Effective Antibiotic Stewardship Intervention: Preprescription Authorization or Postprescription Review With Feedback? Clin Infect Dis 2017; 64:537-543. [PMID: 27927861 DOI: 10.1093/cid/ciw780] [Citation(s) in RCA: 46] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Background The optimal approach to conducting antibiotic stewardship interventions has not been defined. We compared days of antibiotic therapy (DOT) using preprescription authorization (PPA) vs postprescription review with feedback (PPRF) strategies. Methods A quasi-experimental, crossover trial comparing PPA and PPRF for adult inpatients prescribed any antibiotic was conducted. For the first 4 months, 2 medicine teams were assigned to the PPA arm and the other 2 teams to the PPRF arm. The teams were then assigned to the alternate arm for an additional 4 months. Appropriateness of antibiotic use was adjudicated by at least 2 infectious diseases-trained clinicians and according to institutional guidelines. Results There were 2686 and 2693 patients admitted to the PPA and PPRF groups, with 29% and 27% of patients prescribed antibiotics, respectively. Initially, antibiotic DOTs remained relatively unchanged in the PPA arm. When changed to the PPRF arm, antibiotic use decreased (-2.45 DOT per 1000 patient-days [PD]). In the initial PPRF arm, antibiotic use decreased (slope of -5.73 DOT per 1000 PD) but remained constant when changed to the PPA arm. Median patient DOTs in the PPA and PPRF arms were 8 and 6 DOT per 1000 PD, respectively (P = .03). Antibiotic therapy was guideline-noncompliant in 34% and 41% of patients on days 1 and 3 in the PPA group (P < .01) and in 57% and 36% of patients on days 1 and 3 in the PPRF group (P = .03). Conclusions PPRF may have more of an impact on decreasing antibiotic DOTs compared with PPA. This information may be useful for institutions without sufficient resources to incorporate both stewardship approaches.
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Affiliation(s)
- Pranita D Tamma
- Division of Infectious Diseases, Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Edina Avdic
- Department of Pharmacy, Johns Hopkins Hospital, Baltimore, Maryland, USA
| | - John F Keenan
- Department of Family Medicine, Lynchburg General and Virginia Baptist Hospital, Lynchburg, USA
| | - Yuan Zhao
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Gobind Anand
- Division of Gastroenterology, Department of Medicine, University of California, San Diego, USA
| | - James Cooper
- Division of Hematology, Department of Medicine, National Institutes of Health, Bethesda, MD, USA
| | - Rebecca Dezube
- Pulmonary and Critical Care Medicine, Johns Hopkins Medical Institutions, Baltimore, Maryland, USA
| | - Steven Hsu
- Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Sara E Cosgrove
- Infectious Diseases, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
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Abstract
OBJECTIVE To identify, classify, and describe safety hazards during the process of intrahospital transport of critically ill patients. DESIGN A prospective observational study. Data from participant observations of the intrahospital transport process were collected over a period of 3 months. SETTING The study was undertaken at two ICUs in one university hospital. PATIENTS Critically ill patients transported within the hospital by critical care nurses, unlicensed nurses, and physicians. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS Content analysis was performed using deductive and inductive approaches. We detected a total of 365 safety hazards (median, 7; interquartile range, 4-10) during 51 intrahospital transports of critically ill patients, 80% of whom were mechanically ventilated. The majority of detected safety hazards were assessed as increasing the risk of harm, compromising patient safety (n = 204). Using the System Engineering Initiative for Patient Safety, we identified safety hazards related to the work system, as follows: team (n = 61), tasks (n = 83), tools and technologies (n = 124), environment (n = 48), and organization (n = 49). Inductive analysis provided an in-depth description of those safety hazards, contributing factors, and process-related outcomes. CONCLUSIONS Findings suggest that intrahospital transport is a hazardous process for critically ill patients. We have identified several factors that may contribute to transport-related adverse events, which will provide the opportunity for the redesign of systems to enhance patient safety.
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Skodvin B, Aase K, Brekken AL, Charani E, Lindemann PC, Smith I. Addressing the key communication barriers between microbiology laboratories and clinical units: a qualitative study. J Antimicrob Chemother 2017; 72:2666-2672. [PMID: 28633405 PMCID: PMC5890706 DOI: 10.1093/jac/dkx163] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2016] [Revised: 04/05/2017] [Accepted: 04/28/2017] [Indexed: 12/28/2022] Open
Abstract
Background Many countries are on the brink of establishing antibiotic stewardship programmes in hospitals nationwide. In a previous study we found that communication between microbiology laboratories and clinical units is a barrier to implementing efficient antibiotic stewardship programmes in Norway. We have now addressed the key communication barriers between microbiology laboratories and clinical units from a laboratory point of view. Methods Qualitative semi-structured interviews were conducted with 18 employees (managers, doctors and technicians) from six diverse Norwegian microbiological laboratories, representing all four regional health authorities. Interviews were recorded and transcribed verbatim. Thematic analysis was applied, identifying emergent themes, subthemes and corresponding descriptions. Results The main barrier to communication is disruption involving specimen logistics, information on request forms, verbal reporting of test results and information transfer between poorly integrated IT systems. Furthermore, communication is challenged by lack of insight into each other's area of expertise and limited provision of laboratory services, leading to prolonged turnaround time, limited advisory services and restricted opening hours. Conclusions Communication between microbiology laboratories and clinical units can be improved by a review of testing processes, educational programmes to increase insights into the other's area of expertise, an evaluation of work tasks and expansion of rapid and point-of-care test services. Antibiotic stewardship programmes may serve as a valuable framework to establish these measures.
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Affiliation(s)
- Brita Skodvin
- Norwegian Advisory Unit for Antibiotic Use in Hospitals, Department of Research and Development, Haukeland University Hospital, 5021 Bergen, Norway
| | - Karina Aase
- Department of Health Studies, University of Stavanger, 4036 Stavanger, Norway
| | - Anita Løvås Brekken
- Department of Microbiology, Stavanger University Hospital, 4068 Stavanger, Norway
| | - Esmita Charani
- National Institute of Health Research Health Protection Research Unit—Antimicrobial Resistance and Healthcare Associated Infection, Imperial College London, Hammersmith Hospital, London W12 OHS, UK
| | - Paul Christoffer Lindemann
- Department of Clinical Science, University of Bergen, 5020 Bergen, Norway
- Department of Microbiology, Haukeland University Hospital, 5021 Bergen, Norway
| | - Ingrid Smith
- Norwegian Advisory Unit for Antibiotic Use in Hospitals, Department of Research and Development, Haukeland University Hospital, 5021 Bergen, Norway
- Department of Clinical Science, University of Bergen, 5020 Bergen, Norway
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Borus J, Pitts S, Gooding H. Acceptability of peer clinical observation by faculty members. CLINICAL TEACHER 2017; 15:309-313. [PMID: 28612509 DOI: 10.1111/tct.12681] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND Most doctors are not observed in the actual practice of medicine after they complete training. Direct observation and feedback are seen as invaluable in learning in most other professions, at formative stages of medical training and in other aspects of academic medicine, yet are not performed at the level of the independently practicing clinician. Creating an opportunity for faculty member development based on observation of clinical practice is needed for continued growth and competence as a clinician. METHODS Independently practicing clinicians within our practice volunteered to both observe and be observed by a colleague in clinical practice, and then both give and receive feedback. Pairs of clinicians with similar experience levels were created. The person being observed set the ground rules for feedback to promote a safe environment. RESULTS Most respondents found both observing and being observed useful, comfortable experiences, which were better than most other continuing professional development (CPD) initiatives. Both observing and being observed seemed to lead to reflection on practice and a change in practice by most participants. Most respondents would like to participate again. Both observing and being observed seemed to lead to reflection on practice DISCUSSION: Next steps include expanding the programme within our group and to other departments within our institution. There is potential to use this programme as a model for CPD credit. An intradepartmental programme in which participants receive CPD credit for the observation of their practice of medicine could meet the primary goal of CPD, ensuring doctors are competent and continue to develop in an efficient, meaningful and cost-effective way.
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Affiliation(s)
- Joshua Borus
- Division of Adolescent and Young Adult Medicine, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Sarah Pitts
- Division of Adolescent and Young Adult Medicine, Boston Children's Hospital, Boston, Massachusetts, USA.,Division of Endocrinology, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Holly Gooding
- Division of Adolescent and Young Adult Medicine, Boston Children's Hospital, Boston, Massachusetts, USA
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Goldenberg MG, Grantcharov TP. Video-analysis for the assessment of practical skill. ACTA ACUST UNITED AC 2016. [DOI: 10.1007/s13629-016-0156-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Liberati EG. What is the potential of patient shadowing as a patient-centred method? BMJ Qual Saf 2016; 26:343-346. [PMID: 27164848 DOI: 10.1136/bmjqs-2016-005308] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/24/2016] [Indexed: 11/04/2022]
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