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Heesters V, van Zanten HA, den Boer MC, Te Pas AB, Witlox RS. Using the providers' perspective on video review of neonatal procedures to create a roadmap: a qualitative study. Arch Dis Child Fetal Neonatal Ed 2024; 109:550-556. [PMID: 38326027 DOI: 10.1136/archdischild-2023-326528] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2023] [Accepted: 01/29/2024] [Indexed: 02/09/2024]
Abstract
OBJECTIVE To examine the providers' perceptions and experiences on implementation of video review (VR) of procedures in the neonatal intensive care unit (NICU). DESIGN Qualitative study using semi-structured interviews with neonatal care providers about their experiences with VR. Interviews were audio-recorded, transcribed and thematically analysed using the data analysis software Atlas.ti V.22.2. SETTING Providers working in the NICU of the Leiden University Medical Center were interviewed during implementation of VR. RESULTS In total, 28 NICU staff members were interviewed. The interviewed providers appreciated VR and valued the focus on a safe learning environment. Five overarching themes were identified: (1) added value: providers reported that VR is a powerful tool for reflection on daily practice and serves as a magnifying glass on practice, provides a helicopter view and VR with nursing and medical staff together led to new insights and was seen as highly valuable; (2) preconditions and considerations: the existing culture of trust on the NICU positively influenced providers' perception; (3) adjustment: it was recommended to first let providers attend a VR session, before being recorded; (4) experiences with VR: suggestions were made by the providers regarding the preparation and organisation of VR and the role of the chair; (5) embedding VR: providers considered how to embed VR on the long-term while maintaining a safe learning environment and provided suggestions for expanding. CONCLUSION Neonatal care providers appreciated the use of VR and provided viewpoints on how to implement VR successfully, which were used to develop a roadmap with recommendations.
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Affiliation(s)
- Veerle Heesters
- Willem-Alexander Children's Hospital, Division of Neonatology, Leiden University Medical Center, Leiden, The Netherlands
| | - Henriëtte A van Zanten
- Willem-Alexander Children's Hospital, Division of Neonatology, Leiden University Medical Center, Leiden, The Netherlands
| | | | - Arjan B Te Pas
- Willem-Alexander Children's Hospital, Division of Neonatology, Leiden University Medical Center, Leiden, The Netherlands
| | - Ruben Sgm Witlox
- Willem-Alexander Children's Hospital, Division of Neonatology, Leiden University Medical Center, Leiden, The Netherlands
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Schenarts PJ, Scarborough AJ, Abraham RJ, Philip G. Teaching Before, During, and After a Surgical Resuscitation. Surg Clin North Am 2024; 104:451-471. [PMID: 38453313 DOI: 10.1016/j.suc.2023.10.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/09/2024]
Abstract
Teaching during a surgical resuscitation can be difficult due to the infrequency of these events. Furthermore, when these events do occur, the trainee can experience cognitive overload and an overwhelming amount of stress, thereby impairing the learning process. The emergent nature of these scenarios can make it difficult for the surgical educator to adequately teach. Repeated exposure through simulation, role play, and "war games" are great adjuncts to teaching and preparation before crisis. However, surgical educators can further enhance the knowledge of their trainees during these scenarios by using tactics such as talking out loud, targeted teaching, and debriefing.
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Affiliation(s)
- Paul J Schenarts
- Department of Surgery, School of Medicine, Creighton University, Omaha, NE, USA.
| | - Alec J Scarborough
- Department of Surgery, School of Medicine, Creighton University, Omaha, NE, USA
| | - Ren J Abraham
- Department of Surgery, School of Medicine, Creighton University, Omaha, NE, USA
| | - George Philip
- Department of Surgery, School of Medicine, Creighton University, Omaha, NE, USA
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Alexander EG, Denny F, Gordon MW, McKiernan C, Lowe DJ. Evaluation of video review tools for assessing non-technical skills in emergency department resuscitation teams: a systematic review. BMC Emerg Med 2023; 23:141. [PMID: 38030981 PMCID: PMC10687788 DOI: 10.1186/s12873-023-00895-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Accepted: 10/17/2023] [Indexed: 12/01/2023] Open
Abstract
BACKGROUND AND IMPORTANCE Use of video review in medicine is established in contexts such as surgery. Although not widely used in the emergency department (ED), some centres use it to evaluate non-technical skills (NTS) to support teaching and quality improvement. OBJECTIVE There is no consensus on assessment of NTS using video review in the ED and the purpose of this review was to identify tools used in this context. DESIGN, SETTING AND PARTICIPANTS Studies were identified using Embase, Medline, CINAHL and Google Scholar. Inclusion criterion for the review was NTS of resuscitation teams working within the ED were assessed using video review. A systematic search method was used, and results were synthesised after search criteria was checked by two independent reviewers. Authors settled on the same 9 studies eligible for inclusion. OUTCOME MEASURES AND ANALYSIS Reliability and validity of tools identified for use in this context. Due to the heterogeneity of studies, no meta-analysis occurred. MAIN RESULTS There are 9 studies included in the review. The review was registered with PROSPERO (Ref No: CRD42022306129). Four unique tools were identified - 6 studies used T-NOTECHS, 1 used TTCA-24, 1 used CALM and 1 used the Communication tool. T-NOTECHS is validated in the literature for use in this context. CONCLUSION T-NOTECHS is the tool of choice for assessing ED teams in this context.
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Affiliation(s)
| | - Fraser Denny
- University of Glasgow, Glasgow, UK
- Queen Elizabeth University Hospital, Glasgow, UK
| | - Malcom Wg Gordon
- University of Glasgow, Glasgow, UK
- Queen Elizabeth University Hospital, Glasgow, UK
| | - Cieran McKiernan
- University of Glasgow, Glasgow, UK
- Queen Elizabeth University Hospital, Glasgow, UK
| | - David J Lowe
- University of Glasgow, Glasgow, UK.
- Queen Elizabeth University Hospital, Glasgow, UK.
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK.
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Hill ME, Aliaga SR, Foglia EE. Learning with digital recording and video review of delivery room resuscitation. Semin Fetal Neonatal Med 2022; 27:101396. [PMID: 36457212 DOI: 10.1016/j.siny.2022.101396] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Digital recording and video review of delivery room resuscitations is a proven useful tool to evaluate neonatal resuscitation program (NRP) technical and non-technical skills. It is also valuable for research, quality improvement, and individual and group learning. Digital recording and video review programs are growing in number, and planning and implementation of digital recording requires careful thought. Consideration of technology requirements, policy implementation, and stakeholder involvement is essential to implement a successful digital recording and video review program. Video review can then be applied for individual and team-based learning. An approach to sustainability and on-going quality review of the program are key components critical to success.
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Affiliation(s)
- Morgan E Hill
- Division of Neonatology, Perinatal Institute, Department of Pediatrics, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, OH, USA.
| | - Sofia R Aliaga
- Department of Pediatrics, Division of Neonatal-Perinatal Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Elizabeth E Foglia
- Division of Neonatology, Department of Pediatrics, The Children's Hospital of Philadelphia, University of Pennsylvania School of Medicine, Philadelphia, PA, USA
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Quirion A, Nikouline A, Jung J, Nolan B. Contemporary uses of trauma video review: a scoping review. CAN J EMERG MED 2021; 23:787-796. [PMID: 34453728 DOI: 10.1007/s43678-021-00178-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2020] [Accepted: 07/19/2021] [Indexed: 12/17/2022]
Abstract
OBJECTIVES Trauma resuscitations are sporadic, high-acuity situations and conducting observation in the trauma bay for the purpose of quality improvement is challenging. We aim to review contemporary uses of trauma video review. METHODS Medline and Embase were searched from 1980 to May 2020 for studies involving trauma video review. English studies of adult and paediatric populations were included for study and analysed for uses of trauma video review, outcomes measured and any resulting quality improvement (QI) initiatives. RESULTS A total of 463 publications were identified with 21 studies meeting eligibility for final inclusion. A majority of studies (11) observed technical skills with analysis of critical procedures, including tracheal intubation and thoracotomy. The remaining studies observed team dynamics and communication. Overall, eight studies resulted in new policies being put in place for trauma resuscitations and six studies utilized trauma video review as an educational tool. CONCLUSIONS This study highlights common uses of trauma video review. The greatest benefit for this new technology is in quality improvement and education. The majority of studies focussed on critical procedures and QI initiatives, such as checklists, protocols and continued education. We recommend adoption of video review systems for ongoing improvement of team dynamics and overall trauma and emergency resuscitation.
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Affiliation(s)
- Andrew Quirion
- Division of Emergency Medicine, Department of Medicine, University of Toronto, S517-112 George Street, Toronto, ON, M5A 2M5, Canada.
| | - Anton Nikouline
- Division of Emergency Medicine, Department of Medicine, University of Toronto, S517-112 George Street, Toronto, ON, M5A 2M5, Canada
| | - James Jung
- Department of Surgery, Massachusetts General Hospital, Boston, MA, USA.,International Centre for Surgical Safety, St. Michael's Hospital, Toronto, ON, Canada
| | - Brodie Nolan
- Division of Emergency Medicine, Department of Medicine, University of Toronto, S517-112 George Street, Toronto, ON, M5A 2M5, Canada.,International Centre for Surgical Safety, St. Michael's Hospital, Toronto, ON, Canada.,Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, ON, Canada.,Department of Emergency Medicine, St. Michael's Hospital, Toronto, ON, Canada
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Schulthess P, Bohnen J, Grantcharov T, Palter V. The OR Black Box Nursing Education Curriculum: Using Video Review to Optimize Patient Safety. AORN J 2020; 112:536-544. [DOI: 10.1002/aorn.13218] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2020] [Accepted: 06/04/2020] [Indexed: 11/06/2022]
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Yamane D, McCarville P, Sullivan N, Kuhl E, Lanam CR, Payette C, Rahimi-Saber A, Rabjohns J, Sparks AD, Boniface K, Drake A. Minimizing Pulse Check Duration Through Educational Video Review. West J Emerg Med 2020; 21:276-283. [PMID: 33207177 PMCID: PMC7673890 DOI: 10.5811/westjem.2020.8.47876] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Accepted: 08/09/2020] [Indexed: 12/26/2022] Open
Abstract
Introduction The American Heart Association Guidelines for Cardiopulmonary Resuscitation (CPR) recommend pulse checks of less than 10 seconds. We assessed the effect of video review-based educational feedback on pulse check duration with and without point-of-care ultrasound (POCUS). Methods Cameras recorded cases of CPR in the emergency department (ED). Investigators reviewed resuscitation videos for ultrasound use during pulse check, pulse check duration, and compression-fraction ratio. Investigators reviewed health records for patient outcomes. Providers received written feedback regarding pulse check duration and compression-fraction ratio. Researchers reviewed selected videos in multidisciplinary grand round presentations, with research team members facilitating discussion. These presentations highlighted strategies that include the following: limit on pulse check duration; emphasis on compressions; and use of “record, then review” method for pulse checks with POCUS. The primary endpoint was pulse check duration with and without POCUS. Results Over 19 months, investigators reviewed 70 resuscitations with a total of 325 pulse checks. The mean pulse check duration was 11.5 ± 8.8 seconds (n = 224) and 13.8 ± 8.6 seconds (n = 101) without and with POCUS, respectively. POCUS pulse checks were significantly longer than those without POCUS (P = 0.001). Mean pulse check duration per three-month block decreased statistically significantly from study onset to the final study period (from 17.2 to 10 seconds [P<0.0001]) overall; decreased from 16.6 to 10.5 seconds (P<0.0001) without POCUS; and with POCUS from 19.8 to 9.88 seconds (P<0.0001) with POCUS. Pulse check times decreased significantly over the study period of educational interventions. The strongest effect size was found in POCUS pulse check duration (P = −0.3640, P = 0.002). Conclusion Consistent with previous studies, POCUS prolonged pulse checks. Educational interventions were associated with significantly decreased overall pulse-check duration, with an enhanced effect on pulse checks involving POCUS. Performance feedback and video review-based education can improve CPR by increasing chest compression-fraction ratio.
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Affiliation(s)
- David Yamane
- George Washington University, Department of Emergency Medicine, Washington DC.,George Washington University, Department of Anesthesiology and Critical Care Medicine, Washington DC
| | - Patrick McCarville
- George Washington University, Department of Emergency Medicine, Washington DC
| | - Natalie Sullivan
- George Washington University, Department of Emergency Medicine, Washington DC
| | - Evan Kuhl
- George Washington University, Department of Emergency Medicine, Washington DC
| | - Carolyn Robin Lanam
- George Washington University, Department of Emergency Medicine, Washington DC
| | - Christopher Payette
- George Washington University, Department of Emergency Medicine, Washington DC
| | | | - Jennifer Rabjohns
- George Washington University, Department of Emergency Medicine, Washington DC
| | - Andrew D Sparks
- George Washington University, Department of Emergency Medicine, Washington DC
| | - Keith Boniface
- George Washington University, Department of Emergency Medicine, Washington DC
| | - Aaran Drake
- George Washington University, Department of Emergency Medicine, Washington DC
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Binkhorst M, van de Wiel I, Draaisma JMT, van Heijst AFJ, Antonius T, Hogeveen M. Neonatal resuscitation guideline adherence: simulation study and framework for improvement. Eur J Pediatr 2020; 179:1813-1822. [PMID: 32472265 PMCID: PMC7547969 DOI: 10.1007/s00431-020-03693-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2020] [Revised: 04/17/2020] [Accepted: 05/16/2020] [Indexed: 11/25/2022]
Abstract
We wanted to assess newborn life support (NLS) knowledge and guideline adherence, and provide strategies to improve (neonatal) resuscitation guideline adherence. Pediatricians completed 17 multiple-choice questions (MCQ). They performed a simulated NLS scenario, using a high-fidelity manikin. The literature was systematically searched for publications regarding guideline adherence. Forty-six pediatricians participated: 45 completed the MCQ, 34 performed the scenario. Seventy-one percent (median, IQR 56-82) of the MCQ were answered correctly. Fifty-six percent performed inflation breaths ≤ 60 s, 24% delivered inflation breaths of 2-3 s, and 85% used adequate inspiratory pressures. Airway patency was ensured 83% (IQR 76-92) of the time. Median events/min, compression rate, and percentage of effective compressions were 138/min (IQR 130-145), 120/min (IQR 114-120), and 38% (IQR 24-48), respectively. Other adherence percentages were temperature management 50%, auscultation of initial heart rate 100%, pulse oximeter use 94%, oxygen increase 74%, and correct epinephrine dose 82%. Ten publications were identified and used for our framework. The framework may inspire clinicians, educators, researchers, and guideline developers in their attempt to improve resuscitation guideline adherence. It contains many feasible strategies to enhance professionals' knowledge, skills, self-efficacy, and team performance, as well as recommendations regarding equipment, environment, and guideline development/dissemination.Conclusion: NLS guideline adherence among pediatricians needs improvement. Our framework is meant to promote resuscitation guideline adherence. What is Known: • Inadequate newborn life support (NLS) may contribute to (long-term) pulmonary and cerebral damage. • Video-based assessment of neonatal resuscitations has shown that deviations from the NLS guideline occur frequently; this assessment method has its audiovisual shortcomings. What is New: • The resuscitation quality metrics provided by our high-fidelity manikin suggest that the adherence of Dutch general pediatricians to the NLS guideline is suboptimal. • We constructed a comprehensive framework, containing multiple strategies to improve (neonatal) resuscitation guideline adherence.
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Affiliation(s)
- Mathijs Binkhorst
- Department of Neonatology, Amalia Children's Hospital, Radboud Institute for Health Sciences (RIHS), Radboud University Medical Center, P.O. Box 9101, 6500 HB, Nijmegen, the Netherlands.
| | - Irene van de Wiel
- Radboudumc Health Academy, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Jos M. T. Draaisma
- Department of Pediatrics, Amalia Children’s Hospital, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Arno F. J. van Heijst
- Department of Neonatology, Amalia Children’s Hospital, Radboud Institute for Health Sciences (RIHS), Radboud University Medical Center, P.O. Box 9101, 6500 HB Nijmegen, the Netherlands
| | - Tim Antonius
- Department of Neonatology, Amalia Children’s Hospital, Radboud Institute for Health Sciences (RIHS), Radboud University Medical Center, P.O. Box 9101, 6500 HB Nijmegen, the Netherlands
| | - Marije Hogeveen
- Department of Neonatology, Amalia Children’s Hospital, Radboud Institute for Health Sciences (RIHS), Radboud University Medical Center, P.O. Box 9101, 6500 HB Nijmegen, the Netherlands
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Cambron JC, Wyatt KD, Lohse CM, Underwood PY, Hellmich TR. Medical Videography Using a Mobile App: Retrospective Analysis. JMIR Mhealth Uhealth 2019; 7:e14919. [PMID: 31793894 PMCID: PMC6918202 DOI: 10.2196/14919] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2019] [Revised: 09/06/2019] [Accepted: 09/24/2019] [Indexed: 12/04/2022] Open
Abstract
Background As mobile devices and apps grow in popularity, they are increasingly being used by health care providers to aid clinical care. At our institution, we developed and implemented a point-of-care clinical photography app that also permitted the capture of video recordings; however, the clinical findings it was used to capture and the outcomes that resulted following video recording were unclear. Objective The study aimed to assess the use of a mobile clinical video recording app at our institution and its impact on clinical care. Methods A single reviewer retrospectively reviewed video recordings captured between April 2016 and July 2017, associated metadata, and patient records. Results We identified 362 video recordings that were eligible for inclusion. Most video recordings (54.1%; 190/351) were captured by attending physicians. Specialties recording a high number of video recordings included orthopedic surgery (33.7%; 122/362), neurology (21.3%; 77/362), and ophthalmology (15.2%; 55/362). Consent was clearly documented in the medical record in less than one-third (31.8%; 115/362) of the records. People other than the patient were incidentally captured in 29.6% (107/362) of video recordings. Although video recordings were infrequently referenced in notes corresponding to the clinical encounter (12.2%; 44/362), 7.7% (22/286) of patients were video recorded in subsequent clinical encounters, with 82% (18/22) of these corresponding to the same finding seen in the index video. Store-and-forward telemedicine was documented in clinical notes in only 2 cases (0.5%; 2/362). Videos appeared to be of acceptable quality for clinical purposes. Conclusions Video recordings were captured in a variety of clinical settings. Documentation of consent was inconsistent, and other individuals were incidentally included in videos. Although clinical impact was not always clearly evident through retrospective review because of limited documentation, potential uses include documentation for future reference and store-and-forward telemedicine. Repeat video recordings of the same finding provide evidence of use to track the findings over time. Clinical video recordings have the potential to support clinical care; however, documentation of consent requires standardization.
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Affiliation(s)
- Julia C Cambron
- Mayo Clinic Alix School of Medicine, Mayo Clinic, Rochester, MN, United States
| | - Kirk D Wyatt
- Division of Pediatric Hematology/Oncology, Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, MN, United States
| | - Christine M Lohse
- Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, MN, United States
| | | | - Thomas R Hellmich
- Department of Emergency Medicine, Mayo Clinic, Rochester, MN, United States
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Dumas RP, Vella MA, Chreiman KC, Smith BP, Subramanian M, Maher Z, Seamon MJ, Holena DN. Team Assessment and Decision Making Is Associated With Outcomes: A Trauma Video Review Analysis. J Surg Res 2019; 246:544-549. [PMID: 31635832 DOI: 10.1016/j.jss.2019.09.033] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2019] [Revised: 07/24/2019] [Accepted: 09/18/2019] [Indexed: 10/25/2022]
Abstract
BACKGROUND Teamwork is a critical element of trauma resuscitation. Assessment tools such as T-NOTECHS (Trauma NOn-TECHnical Skills) exist, but correlation with patient outcomes is unclear. Using emergency department thoracotomy (EDT), we sought to describe T-NOTECHS scores during resuscitations. We hypothesized that patients undergoing EDT whose resuscitations had better scores would be more likely to have return of spontaneous circulation (ROSC). METHODS Continuously recording video was used to review all captured EDTs over a 24-mo period. We used a modification of the validated T-NOTECHS instrument to measure five domains on a 3-point scale (1 = best, 2 = average, 3 = worst). A total T-NOTECHS score was calculated by one of three reviewers. The primary outcome was ROSC. ROSC was defined as an organized rhythm no longer requiring internal cardiac compressions. Associations between variables and ROSC were examined using univariate regression. RESULTS Sixty-one EDTs were captured. Nineteen patients had ROSC (31%) and 42 (69%) did not. The median T-NOTECHS score for all resuscitations was 8 [IQR 6-10]. As demographic and injury data (age, gender, mechanism, signs of life) were not associated with ROSC in univariate analysis, they were not considered for inclusion in a multivariable regression model. The association between overall T-NOTECHS score and ROSC did not reach statistical significance, but examination of the individual components of the T-NOTECHS score demonstrated that, compared to resuscitations that had "average" (2) or "worst" (3) scores on "Assessment and Decision Making," resuscitations with a "best" score were 5 times more likely to lead to ROSC. CONCLUSIONS Although the association between overall T-NOTECHS scores and ROSC did not reach statistical significance, better scores in the domain of assessment and decision making are associated with improved rates of ROSC in patients arriving in cardiac arrest who undergo EDT. LEVEL OF EVIDENCE Level IV Therapeutic/Care Management.
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Affiliation(s)
- Ryan P Dumas
- Division of General and Acute Care Surgery, University of Texas Southwestern Medical Center, Dallas, Texas.
| | - Michael A Vella
- Division of Traumatology, Surgical Critical Care and Emergency Surgery, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Kristen C Chreiman
- Division of Traumatology, Surgical Critical Care and Emergency Surgery, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Brian P Smith
- Division of Traumatology, Surgical Critical Care and Emergency Surgery, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Madhu Subramanian
- Division of Traumatology, Surgical Critical Care and Emergency Surgery, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Zoe Maher
- Division of Trauma and Surgical Critical Care, Temple University, Philadelphia, Pennsylvania
| | - Mark J Seamon
- Division of Traumatology, Surgical Critical Care and Emergency Surgery, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Daniel N Holena
- Division of Traumatology, Surgical Critical Care and Emergency Surgery, University of Pennsylvania, Philadelphia, Pennsylvania; Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania, Philadelphia, Pennsylvania
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11
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Dumas RP, Vella MA, Hatchimonji JS, Ma L, Maher Z, Holena DN. Trauma video review utilization: A survey of practice in the United States. Am J Surg 2019; 219:49-53. [PMID: 31537325 DOI: 10.1016/j.amjsurg.2019.08.025] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2019] [Revised: 08/08/2019] [Accepted: 08/26/2019] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Trauma video review (TVR) for quality improvement and education in the United States has been described for nearly three decades. The most recent information on this practice indicated a declining prevalence. We hypothesized that TVR utilization has increased since most recent estimates. METHODS We conducted a survey of TVR practices at level I and level II US trauma centers. We distributed an electronic survey covering past, current, and future TVR utilization to the Eastern Association for the Surgery of Trauma membership. RESULTS 45.0% of US level I and level II trauma centers completed surveys. 71/249 centers (28.5%) had active TVR programs. The use of TVR did not differ between level I and level II centers (28.8% vs. 27.8%, p = 0.87). Respondents using TVR were overwhelmingly positive about its perception (median score 8, [IQR 6-9]; 10 = 'best') at their institutions. CONCLUSIONS TVR use at Level I centers has increased over the past decade. Increased TVR utilization may form the basis for multicenter studies comparing processes of care during trauma resuscitation.
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Affiliation(s)
- R P Dumas
- Division of General and Acute Care Surgery, University of Texas Southwestern Medical Center, Dallas, TX, USA.
| | - M A Vella
- Division of Acute Care Surgery and Trauma, University of Rochester School of Medicine and Dentistry, Rochester NY, USA.
| | - J S Hatchimonji
- Division of Traumatology, Surgical Critical Care and Emergency Surgery, University of Pennsylvania, Philadelphia, PA, USA.
| | - L Ma
- Division of Traumatology, Surgical Critical Care and Emergency Surgery, University of Pennsylvania, Philadelphia, PA, USA.
| | - Z Maher
- Division of Trauma and Surgical Critical Care, Temple University, Philadelphia, PA, USA.
| | - D N Holena
- Division of Traumatology, Surgical Critical Care and Emergency Surgery, University of Pennsylvania, Philadelphia, PA, USA; Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania, Philadelphia, PA, USA.
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Jun Rong VP, Au B, Arundhati A, Long QB. Impact of extracapsular cataract extraction surgical instructional video on self-directed learning of surgical skills in a tertiary eye care centre. BMJ SIMULATION & TECHNOLOGY ENHANCED LEARNING 2019; 5:114-115. [DOI: 10.1136/bmjstel-2017-000256] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 10/13/2017] [Indexed: 11/04/2022]
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13
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Huang MY, Kung LC, Hou SW, Lee YK, Su YC. Comparison of the validity of checklist assessment in cardiac arrest simulations with an app in an academic hospital in Taiwan: a retrospective observational study. BMJ Open 2018; 8:e024309. [PMID: 30552278 PMCID: PMC6303606 DOI: 10.1136/bmjopen-2018-024309] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
INTRODUCTION Robust assessment is a crucial component in Advanced Cardiac Life Support (ACLS) training to determine whether participants have achieved learning objectives with little or no variation in their overall outcomes. This study aimed to evaluate resuscitation performance by real-time logs. We hypothesised that instructors may not be able to evaluate time-sensitive parameters, namely, chest compression fraction, time to initiating chest compression and time to initiating defibrillation accurately in a subjective manner. METHODS Video records and formal checklist-based test results of Megacode scenarios for the ACLS certification examination at several hospitals in Taipei were examined. For the study interest, three time-sensitive parameters were measured via video review assisted by a mobile phone application, and were used for evaluation. We evaluated if the pass/fail results made by instructors via checklists were correlated with these parameters. RESULTS A total of 185 Megacode scenarios were eligible for the final analysis. Among the three parameters, good chest compression fraction was statistically significant with a higher OR of passing (OR=3.65; 95% CI 1.36 to 9.91; p=0.01). In 112 participants with one parameter that did not meet the criteria, 25 were graded as fail, making the specificity 22.3% (95% CI 15.0% to 31.2%). CONCLUSIONS Visual observation of cardiopulmonary resuscitation performance is not accurate when evaluating time-sensitive parameters. Objective results should be offered for training outcome evaluation, and also for feedback to participants.
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Affiliation(s)
- Ming-Yuan Huang
- Department of Emergency Medicine, Mackay Memorial Hospital, Taipei, Taiwan
- Department of Medicine, MacKay Medical College, Taipei, Taiwan
| | - Lu-Chih Kung
- Department of Emergency Medicine, Mackay Memorial Hospital, Taipei, Taiwan
- Department of Medicine, MacKay Medical College, Taipei, Taiwan
| | - Sheng-Wen Hou
- Department of Emergency Medicine, Shin-Kong Wu Ho-Su Memorial Hospital, Taipei, Taiwan
| | - Yi-Kung Lee
- Emergency Department, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Chiayi, Taiwan
- School of Medicine, Tzu Chi University, Hualien, Taiwan
| | - Yung-Cheng Su
- Emergency Department, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Chiayi, Taiwan
- School of Medicine, Tzu Chi University, Hualien, Taiwan
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Iedema R. Research paradigm that tackles the complexity of in situ care: video reflexivity. BMJ Qual Saf 2018; 28:89-90. [DOI: 10.1136/bmjqs-2018-008778] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/31/2018] [Indexed: 11/04/2022]
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Lau Y, Nyoe RSS, Wong SN, Ab Hamid ZB, Leong BSH, Lau ST. Effectiveness of digital resuscitation training in improving knowledge and skills: A systematic review and meta-analysis of randomised controlled trials. Resuscitation 2018; 131:14-23. [PMID: 30071263 DOI: 10.1016/j.resuscitation.2018.07.033] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2018] [Revised: 07/11/2018] [Accepted: 07/26/2018] [Indexed: 11/29/2022]
Abstract
AIM This review aims to evaluate the effectiveness of digital resuscitation training in improving knowledge and skill compared with standard resuscitation training. METHODS We searched through the CINAHL, Cochrane Library, EMBASE, ERIC, ProQuest Dissertations and Thesis, PsycINFO, PubMed and Scopus from inception of our review until 5 March 2018. The quality of individual and overall evidence was evaluated according to the risk of bias, Medical Education Research Study Quality Instrument (MERSQI) and Grade of Recommendation, Assessment, Development and Evaluation (GRADE) system, respectively. Meta-analyses were performed with the Review Manger software. Z-statistics were used to evaluate the overall effect of training, and I2 test was used to assess heterogeneity. Sensitivity and subgroup analyses were used for additional meta-analyses. RESULTS Amongst the 15,528 studies retrieved, 20 randomised controlled trials (RCTs) were selected from 13 countries across different ethnicities. More than half (52%) of the trials had a low risk of bias, and MERSQI scores ranged from 13.5 to 15.5. The overall quality of evidence was very low according to GRADE criteria. Meta-analyses revealed that trainees in digital resuscitation training had better knowledge scores but poorer chest compression rates than that of trainees in standard resuscitation training. Digital resuscitation trainings were non-inferior to standard resuscitation trainings in skill performance scores. Subgroup analyses suggested that digital resuscitation training might consider using blended learning approach with virtual patient, computer-screen based, learning theories and video-recorded assessment, especially for basic life support trainings amongst health professionals. CONCLUSION Despite the wide variation in digital resuscitation trainings, evidence suggesting the use of digital resuscitation training for improving knowledge and skills is inadequate. Well-designed non-inferiority RCTs in multiple settings with follow-up data and large sample size are needed to ensure the robustness of the evidence.
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Affiliation(s)
- Ying Lau
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Singapore.
| | | | - Suei Nee Wong
- Medical Resource Team, National University of Singapore Libraries, National University of Singapore, Singapore.
| | | | | | - Siew Tiang Lau
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Singapore.
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Fitzpatrick D, McKenna M, Duncan EAS, Laird C, Lyon R, Corfield A. Critcomms: a national cross-sectional questionnaire based study to investigate prehospital handover practices between ambulance clinicians and specialist prehospital teams in Scotland. Scand J Trauma Resusc Emerg Med 2018; 26:45. [PMID: 29859121 PMCID: PMC5984735 DOI: 10.1186/s13049-018-0512-3] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2018] [Accepted: 05/14/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Poor communication during patient handover is recognised internationally as a root cause of a significant proportion of preventable deaths. Improving the accuracy and quality of handover may reduce associated mortality and morbidity. Although the practice of handover between Ambulance and Emergency Department clinicians has received some attention over recent years there is little evidence to support handover best practice within the prehospital domain. Further research is therefore urgently required to understand the most appropriate way to deliver clinical information exchange in the pre-hospital environment. We aimed to investigate current clinical information exchange practices, perceived challenges and the preferred handover mnemonic for use during transfer of high acuity patients between ambulance clinicians and specialist prehospital teams. METHODS A national, cross-sectional questionnaire study. Participants were road based ambulance clinicians (RBAC) or active members of specialist prehospital teams (SPHT) based in Scotland. RESULTS Over a three month study period there were 247 prehospital incidents involving specialist teams. One hundred ninety individuals completed the questionnaire; 61% [n = 116] RBAC and 39% [n = 74] SPHT. Median length of prehospital experience was 10 years (IQR 5-18). Overall current prehospital handover practices were perceived as being effective (Mdn 4.00; IQR 3-4 [1 = very ineffective - 5 = very effective]) although SPHT clinicians rated handover effectiveness slightly lower than RBAC's (Mdn 3.00 vs 4.00, U = 1842.5, p = .03). 'ATMIST' (Age, Time of onset, Medical complaint/injury, Investigation, Signs and Treatment) was deemed the mnemonic of choice. The clinical variables perceived as essential for handover are not explicitly identified within the SBAR mnemonic. The most frequently reported method of recording and transferring information during handover was via memory (n = 112 and n = 120 respectively) and 'interruptions' were perceived as the most significant barrier to effective handover. CONCLUSION While, overall, current prehospital handover practice is perceived as effective this study has identified a number of areas for improvement. These include the development of a shared mental model through system standardisation, innovations to support information recording and delivery, and the clear identification at incidents of a handover lead. Mnemonics must be carefully selected to ensure they explicitly contain the perceived essential clinical variables required for prehospital handover; the mnemonic ATMIST meets these requirements. New theoretically informed, evidence-based interventions, must be developed and tested within existing systems of care to minimise information loss and risk to patients.
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Affiliation(s)
- David Fitzpatrick
- Faculty of Health Sciences and Sport, University of Stirling, FK9 4LA Stirling, Scotland
| | - Michael McKenna
- Scottish Ambulance Service, Glebe Cottage, Strath, Gairloch, Ross-shire IV212BT Scotland
| | - Edward A. S. Duncan
- Nursing, Midwifery & Allied Health Professions Research Unit, University of Stirling, FK9 4NF Scion House, Scotland, UK
| | - Colville Laird
- Basics Scotland, Aberuthven Enterpise Park, Sandpiper House, Aberuthven, Auchterarder Scotland
| | - Richard Lyon
- Pre-Hospital Emergency Care, School of Health Sciences, University of Surrey, Guildford, UK
| | - Alasdair Corfield
- Emergency Medical Retrieval Service, School of Medicine, Dentistry and Nursing, University of Glasgow, Wolfson Medical School Building, G12 8QQ Glasgow, Scotland
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Brown C, Thomas I. Twelve tips for conducting successful multiple patient encounter simulations (simultaneous simulations). MEDICAL TEACHER 2017; 39:660-664. [PMID: 28598737 DOI: 10.1080/0142159x.2017.1288864] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Multiple patient encounter simulations (MPES), whereby learners are exposed to a number of simulated patients simultaneously, are gaining popularity as a method to address curricular gaps. Whilst this approach offers a host of benefits to educators and learners in ways single patient encounter simulations cannot, it also has significant challenges with regards to its implementation. We describe twelve tips for conducting successful MPES, divided into pre-, intra- and post-simulation considerations. By adhering to these twelve tips, educators can plan successful, fiscally responsible, well-organized, structured sessions for all learners (active and observing) that will achieve the learning outcomes desired using this advanced method of simulation.
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Affiliation(s)
- Craig Brown
- a Institute of Education for Medical and Dental Sciences, School of Medicine, Medical Sciences and Nutrition, University of Aberdeen , Aberdeen , UK
| | - Ian Thomas
- a Institute of Education for Medical and Dental Sciences, School of Medicine, Medical Sciences and Nutrition, University of Aberdeen , Aberdeen , UK
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