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Marsteller JA, Rosen MA, Wyskiel R, Chang BH, Hsu YJ, Thompson DA, Kim G, Speck K, Ijagbemi M, Huang S, Gurses AP. Multi-Team Shared Expectations Tool (MT-SET): An Exercise to Improve Teamwork Across Health Care Teams. Jt Comm J Qual Patient Saf 2024:S1553-7250(24)00174-0. [PMID: 39033060 DOI: 10.1016/j.jcjq.2024.05.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2023] [Revised: 05/28/2024] [Accepted: 05/29/2024] [Indexed: 07/23/2024]
Abstract
Care transitions among high-intensity units caring for patients with complex needs are a critical yet undeveloped area of patient safety research. In addition, effective communication and coordination across disciplines remain elusive. This study introduces and tests the Multi-Team Shared Expectations Tool (MT-SET), an exercise that aims to engage health care teams in eliciting needs and establishing agreed-upon expectations teams and individuals within a multi-team system have of one another. We piloted the exercise within hospital-based workflows for oncology inpatients and later adopted it to elicit data on mutual needs and expectations of teams across units involved in patient transitions in two patient safety projects. Our studies demonstrated that the exercise identified common cross-unit coordination problems of delays in care, unwanted variations in care, and lack of standardized communication among units. It also revealed mismatched prioritization of each of these problems between specific unit types. The participants reported that the MT-SET helped establish positive relationships for building better cross-unit and cross-disciplinary teamwork and coordination. There is a need for systematic approaches to understand and facilitate cross-unit communication and coordination in care delivery and transitions. Future studies should broaden the application of the exercise to additional types of multi-unit and multidisciplinary teams and observe intervention ideas generated from the exercise, as well as their implementation.
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Schwartze JT, Das S, Suggitt D, Baxter J, Tunstall S, Ronan N, Stannard H, Rezgui A, Jafar W, Baxter DN. Ward-based in situ simulation: lessons learnt from a UK District General Hospital. BMJ Open Qual 2024; 13:e002571. [PMID: 38749539 PMCID: PMC11097843 DOI: 10.1136/bmjoq-2023-002571] [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: 08/20/2023] [Accepted: 03/02/2024] [Indexed: 05/18/2024] Open
Abstract
INTRODUCTION In situ simulation (ISS) enables multiprofessional healthcare teams to train for real emergencies in their own working environment and identify latent patient safety threats. This study aimed to determine ISS impact on teamwork, technical skill performance, healthcare staff perception and latent error identification during simulated medical emergencies. MATERIALS AND METHODS Unannounced ISS sessions (n=14, n=75 staff members) using a high-fidelity mannequin were conducted in medical, paediatric and rehabilitation wards at Stepping Hill Hospital (Stockport National Health Service Foundation Trust, UK). Each session encompassed a 15 min simulation followed by a 15 min faculty-led debrief. RESULTS The clinical team score revealed low overall teamwork performances during simulated medical emergencies (mean±SEM: 4.3±0.5). Linear regression analysis revealed that overall communication (r=0.9, p<0.001), decision-making (r=0.77, p<0.001) and overall situational awareness (r=0.73, p=0.003) were the strongest statistically significant predictors of overall teamwork performance. Neither the number of attending healthcare professionals, their professional background, age, gender, degree of clinical experience, level of resuscitation training or previous simulation experience statistically significantly impacted on overall teamwork performance. ISS positively impacted on healthcare staff confidence and clinical training. Identified safety threats included unknown location of intraosseous kits, poor/absent airway management, incomplete A-E assessments, inability to activate the major haemorrhage protocol, unknown location/dose of epinephrine for anaphylaxis management, delayed administration of epinephrine and delayed/absence of attachment of pads to the defibrillator as well as absence of accessing ALS algorithms, poor chest compressions and passive behaviour during simulated cardiac arrests. CONCLUSION Poor demonstration of technical/non-technical skills mandate regular ISS interventions for healthcare professionals of all levels. ISS positively impacts on staff confidence and training and drives identification of latent errors enabling improvements in workplace systems and resources.
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Affiliation(s)
- Julian Tristan Schwartze
- Stroke Medicine, National Hospital for Neurology and Neurosurgery, London, UK
- Medical Education, Stepping Hill Hospital, Stockport, UK
| | - Souvik Das
- Emergency Department, Stepping Hill Hospital, Stockport, UK
| | | | | | - Simon Tunstall
- Department of Anaesthetics, Stepping Hill Hospital, Stockport, UK
| | - Nicholas Ronan
- Royal Stoke University Hospital Acute Medical Unit, Stoke-on-Trent, UK
| | | | - Amina Rezgui
- Acute Medicine, Stepping Hill Hospital, Stockport, UK
| | - Wisam Jafar
- Gastroenterology, Stepping Hill Hospital, Stockport, UK
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Sorensen D, Cristancho S, Soh M, Varpio L. Team Stress and Its Impact on Interprofessional Teams: A Narrative Review. TEACHING AND LEARNING IN MEDICINE 2024; 36:163-173. [PMID: 36625564 DOI: 10.1080/10401334.2022.2163400] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/08/2022] [Revised: 11/18/2022] [Accepted: 12/15/2022] [Indexed: 06/17/2023]
Abstract
Phenomenon: Interprofessional healthcare team (IHT) collaboration can produce powerful clinical benefits for patients; however, these benefits are difficult to harness when IHTs work in stressful contexts. Research about stress in healthcare typically examines stress as an individual psychological phenomenon, but stress is not only a person-centered experience. Team stress also affects the team's performance. Unfortunately, research into team stress is limited and scattered across many disciplines. We cannot prepare future healthcare professionals to work as part of IHTs in high-stress environments (e.g., emergency medicine, disaster response) unless we review how this dispersed literature is relevant to medical education. Approach: The authors conducted a narrative review of the literature on team stress experienced by interprofessional teams. The team searched five databases between 1 Jan 1990 and 16 August 2021 using the search terms: teams AND stress AND performance. Guided by four research questions, the authors reviewed and abstracted data from the 22 relevant manuscripts. Findings: Challenging problems, time pressure, life threats, environmental distractors, and communication issues are the stressors that the literature reports that teams faced. Teams reacted to team stress with engagement/cohesion and communication/coordination. Stressors impact team stress by either hindering or improving team performance. Critical thinking/decision-making, team behaviors, and time for task completion were the areas of performance affected by team stress. High-quality communication, non-technical skills training, and shared mental models were identified as performance safeguards for teams experiencing team stress. Insights: The review findings adjust current models explaining drivers of efficient and effective teams within the context of interprofessional teams. By understanding how team stress impacts teams, we can better prepare healthcare professionals to work in IHTs to meet the demands placed on them by the ever-increasing rate of high-stress medical situations.
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Affiliation(s)
- Derek Sorensen
- Center for Health Professions Education & Department of Medicine, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA
| | - Sayra Cristancho
- Department of Surgery and Faculty Education, Western University, London, Ontario, Canada
| | - Michael Soh
- Center for Health Professions Education & Department of Medicine, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA
| | - Lara Varpio
- Center for Health Professions Education & Department of Medicine, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA
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Bochatay N, Ju M, O'Brien BC, van Schaik SM. A Scoping Review of Interprofessional Simulation-Based Team Training Programs. Simul Healthc 2024:01266021-990000000-00117. [PMID: 38526045 DOI: 10.1097/sih.0000000000000792] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/26/2024]
Abstract
SUMMARY STATEMENT Interprofessional simulation-based team training (ISBTT) is promoted as a strategy to improve collaboration in healthcare, and the literature documents benefits on teamwork and patient safety. Teamwork training in healthcare is traditionally grounded in crisis resource management (CRM), but it is less clear whether ISBTT programs explicitly take the interprofessional context into account, with complex team dynamics related to hierarchy and power. This scoping review examined key aspects of published ISBTT programs including (1) underlying theoretical frameworks, (2) design features that support interprofessional learning, and (3) reported behavioral outcomes. Of 4854 titles identified, 58 articles met inclusion criteria. Most programs were based on CRM and related frameworks and measured CRM outcomes. Only 12 articles framed ISBTT as interprofessional education and none measured all interprofessional competencies. The ISBTT programs may be augmented by integrating theoretical concepts related to power and intergroup relations in their design to empower participants to navigate complex interprofessional dynamics.
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Affiliation(s)
- Naike Bochatay
- From the University of California San Francisco, San Francisco, CA
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Martinho B, Ferreira L, Koch MJ, Madeira F, Santos E, Baptista S, Alexandrino H. Observational Study About the Impact of Simulation Training of Non-Technical Skills on Teamwork: Towards a Paradigm Shift in Undergraduate Medical Training. ACTA MEDICA PORT 2024; 37:83-89. [PMID: 36972551 DOI: 10.20344/amp.19021] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2022] [Accepted: 02/02/2023] [Indexed: 03/29/2023]
Abstract
INTRODUCTION Recently, simulation as an educational method has gained increasing importance in Medicine. However, medical education has favored the acquisition of individual knowledge and skills, while overlooking the development of teamwork skills. Since most errors in clinical practice are due to human factors, i.e., non-technical skills, the aim of this study was to assess the impact that training in a simulation environment has on teamwork in an undergraduate setting. MATERIAL AND METHODS This study took place in a simulation center, with a study population of 23 participants, fifth year undergraduate students, randomly divided into teams of four elements. Twenty simulated scenarios of teamwork in the initial assessment and resuscitation of critically ill trauma patients were recorded. Video recordings were made at three distinct learning moments (before training, end of the semester, and six months after the last training), and a blinded evaluation was performed by two independent observers, who applied the Trauma Team Performance Observation Tool (TPOT). Additionally, the Team STEPPS Teamwork Attitudes Questionnaire (T-TAQ) was applied to the study population before and after the training to assess any change in individual attitudes towards non-technical skills. A 5% (or 0.05) significance level was considered for statistical analysis. RESULTS With a moderate level of inter-observer agreement (Kappa = 0.52, p = 0.002), there was a statistically significant improvement in the team's overall approach, evidenced by the TPOT scores (median of 4.23, 4.35 and 4.50, in the three time-points assessed, respectively, p = 0.003). In the T-TAQ, there was an improvement in non-technical skills, that was statistically significant for "Mutual Support" (median from 2.50 to 3.00, p = 0.010). CONCLUSION In this study, incorporating non-technical skills education and training in undergraduate medical education was associated with sustained improvement in team performance in the approach to the simulated trauma patient. Consideration should be given to introducing non-technical skills training and teamwork in the emergency setting during undergraduate training.
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Affiliation(s)
| | - Luís Ferreira
- Faculty of Medicine. Universidade de Coimbra; Department of Surgery. Centro Hospitalar e Universitário de Coimbra. Coimbra. Portugal
| | - Maria João Koch
- Department of Anesthesiology. Centro Hospitalar e Universitário de Coimbra. Coimbra. Portugal. Portugal
| | - Filipa Madeira
- Department of Surgery. Centro Hospitalar e Universitário de Coimbra. Coimbra. Portugal. Portugal
| | - Eva Santos
- Department of Surgery. Centro Hospitalar e Universitário de Coimbra. Coimbra. Portugal. Portugal
| | - Sérgio Baptista
- Department of Anesthesiology. Centro Hospitalar Médio Tejo. Tomar. Portugal. Portugal
| | - Henrique Alexandrino
- Faculty of Medicine. Universidade de Coimbra; Department of Surgery. Centro Hospitalar e Universitário de Coimbra. Coimbra. Portugal
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Eid J, Brattebø G, Jacobsen JK, Espevik R, Johnsen BH. Distributed team processes in healthcare services: a scoping review. Front Med (Lausanne) 2023; 10:1291877. [PMID: 38162887 PMCID: PMC10756666 DOI: 10.3389/fmed.2023.1291877] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Accepted: 11/27/2023] [Indexed: 01/03/2024] Open
Abstract
Objective High-quality healthcare services is delivered by teams rather than individuals and depends heavily on multidisciplinary cooperation between dispersed healthcare professionals. The aim of this scoping review is to identify common barriers and innovative applications of technology supporting team processes and patient safety, in geographically dispersed healthcare services. Methods Studies were identified from searches in APA PsychINFO, Epistemonikos and Medline databases, from 2010 to 2023. A detailed search strategy was performed, and studies were included, based on prior established criteria. Results Among the 19 studies that fulfilled our inclusion criteria, the majority (85%) were from Europe or North America, and most studies (53%) were quantitative, with a cross-sectional study design. Several reported observed distributed team processes in training and education. Most studies described barriers and detailed how innovative approaches and technological solutions were introduced to improve communication, coordination, and shared mental models in distributed healthcare settings. A small proportion of studies (16%) used health services data to examine interpersonal exchange and team processes. Conclusion The scoping review offer recommendations to enhance future research on distributed team processes in healthcare services.
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Affiliation(s)
- Jarle Eid
- Centre for Crisis Psychology, University of Bergen, Bergen, Norway
| | - Guttorm Brattebø
- Department of Anaesthesia and Intensive Care, Norwegian National Advisory Unit on Emergency Medical Communication, Haukeland University Hospital, Bergen, Norway
- Department of Clinical Medicine, University of Bergen, Bergen, Norway
| | | | - Roar Espevik
- Department of Leadership, Command and Control, Swedish Defence University, Stockholm, Sweden
| | - Bjørn Helge Johnsen
- Department of Leadership, Command and Control, Swedish Defence University, Stockholm, Sweden
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Zhang T, Yang J, Liang N, Pitts BJ, Prakah-Asante K, Curry R, Duerstock B, Wachs JP, Yu D. Physiological Measurements of Situation Awareness: A Systematic Review. HUMAN FACTORS 2023; 65:737-758. [PMID: 33241945 DOI: 10.1177/0018720820969071] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
OBJECTIVE The goal of this systematic literature review is to investigate the relationship between indirect physiological measurements and direct measures of situation awareness (SA). BACKGROUND Across different environments and tasks, assessments of SA are often performed using techniques designed specifically to directly measure SA, such as SAGAT, SPAM, and/or SART. However, research suggests that indirect physiological sensing methods may also be capable of predicting SA. Currently, it is unclear which particular physiological approaches are sensitive to changes in SA. METHOD Seven databases were searched using the PRISMA reporting guidelines. Eligibility criteria included human-subject experiments that used at least one direct SA assessment technique, as well as at least one physiological measurement. Information extracted from each article was the physiological metric(s), the direct SA measurement(s), the correlation between these two metrics, and the experimental task(s). All studies underwent a quality assessment. RESULTS Twenty-five articles were included in this review. Eye tracking techniques were the most commonly used physiological measures, and correlations between conscious aspects of eye movement measures and direct SA scores were observed. Evidence for cardiovascular predictors of SA were mixed. EEG studies were too few to form strong conclusions, but were consistently positive. CONCLUSION Further investigation is needed to methodically collect more relevant data and comprehensively model the relationships between a wider range of physiological measurements and direct assessments of SA. APPLICATION This review will guide researchers and practitioners in methods to indirectly assess SA with sensors and highlight opportunities for future research on wearables and SA.
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Affiliation(s)
- Ting Zhang
- Purdue University, Industrial Engineering, West Lafayette, United States
| | - Jing Yang
- Purdue University, Industrial Engineering, West Lafayette, United States
| | - Nade Liang
- Purdue University, Industrial Engineering, West Lafayette, United States
| | - Brandon J Pitts
- Purdue University, School of Industrial Engineering, West Lafayette, United States
| | | | | | - Bradley Duerstock
- Purdue University, Industrial Engineering, West Lafayette, United States
| | - Juan P Wachs
- Purdue University, Industrial Engineering, West Lafayette, United States
| | - Denny Yu
- Purdue University, Industrial Engineering, West Lafayette, United States
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Ibrahim H, Lowenstern A, Goldsweig AM, Rao SV. Integrating Structural Heart Disease Trainees within the Dynamics of the Heart Team: The Case for Multimodality Training. STRUCTURAL HEART : THE JOURNAL OF THE HEART TEAM 2023; 7:100167. [PMID: 37273858 PMCID: PMC10236781 DOI: 10.1016/j.shj.2023.100167] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/09/2023] [Accepted: 02/02/2023] [Indexed: 06/06/2023]
Abstract
Structural heart disease is a rapidly evolving field. However, training in structural heart disease is still widely variable and has not been standardized. Furthermore, integration of trainees within the heart team has not been fully defined. In this review, we discuss the components and function of the heart team, the challenges of current structural heart disease models, and possible solutions and suggestions for integrating trainees within the heart team.
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Affiliation(s)
- Homam Ibrahim
- NYU Grossman School of Medicine, NYU Langone Health, New York, New York, USA
| | - Angela Lowenstern
- Division of Cardiology, Department of Internal Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Andrew M. Goldsweig
- Baystate Medical Center and University of Massachusetts-Baystate, Springfield, Massachusetts, USA
| | - Sunil V. Rao
- NYU Grossman School of Medicine, NYU Langone Health, New York, New York, USA
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9
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McCrory K, Jowsey T, Chen Y. Essential Elements of Preregistration Nursing Interprofessional Simulation Training. J Nurs Educ 2023; 62:28-35. [PMID: 36652581 DOI: 10.3928/01484834-20221109-02] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
BACKGROUND Internationally, interprofessional simulation (IPS) training increasingly is being included in nursing curricula. This systematic review examined the elements of IPS training that prepare nursing students for clinical practice. METHOD Five databases (Cumulative Index to Nursing and Allied Health Literature [CINAHL], ProQuest, PubMed, Scopus, and Google Scholar) were searched for articles published from 2000 through 2020. Search terms included interprofessional, interdisciplinary, collaboration, collaborative care, teamwork, undergraduate nursing, and simulation. Thematic analysis of included studies was conducted using Braun and Clarke's (2006) six-phase approach. RESULTS Twenty-one studies were included. Five key themes emerged: (1) foster safe learning spaces, (2) realism matters, (3) effective debriefing is essential, (4) communication and teamwork increase patient safety, and (5) learning about scopes of practice and roles enables better care. CONCLUSION IPS training provides nursing students with learning opportunities that can fundamentally shape their capacity to work effectively in interprofessional and multi-disciplinary settings. [J Nurs Educ. 2023;62(1):28-35.].
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Wilson D. Interdisciplinary collaboration: Data scientists and radiologists. Vet Radiol Ultrasound 2022; 63 Suppl 1:916-919. [PMID: 36514229 DOI: 10.1111/vru.13170] [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: 04/08/2022] [Revised: 08/06/2022] [Accepted: 08/25/2022] [Indexed: 12/15/2022] Open
Abstract
Interdisciplinary collaboration has become sought after by most institutions and corporations over the past few decades. This type of collaboration has grown exponentially since the advent of the internet and the information age. With the wave of interest to develop machine learning for the interpretation of diagnostic images it has become necessary for data scientists and radiologists to communicate through interdisciplinary research and collaboration. Such communication requires careful navigation for productive and meaningful outcomes. This article seeks to offer an overview of some previous literature discussing the best practices when forming interdisciplinary collaborative teams, explore some of the communication similarities and differences between the radiologist and data scientist disciplines, share some examples where pitfalls have caused confusion or frustration and re-work, and also to convey that, through trust, listening skills and knowing one's limitations, much can be learned and accomplished when working together.
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Affiliation(s)
- Diane Wilson
- Antech Imaging Services, Fountain Valley, California, USA
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Scott AL, Howe WT, Bisel R. Reviewing High Reliability Team (HRT) Scholarship: A 21st Century Approach to Safety. SMALL GROUP RESEARCH 2022. [DOI: 10.1177/10464964221116349] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
High reliability team (HRT) theorizing emerged from high reliability organization (HRO) theory and now represents a distinct subset of HRO literature. Seeking to capture the development and range of HRT research, a comprehensive literature review was conducted. This systematic review of HRT scholarship, the first of its kind, provides a foundation from which small group and team scholars across disciplines may reflect on key lessons and chart future research. This review includes 71 articles across 21 disciplines and incorporates historical reflection on HRT theory foundations, existing empirical support, critiques and rivals, theory extensions, and ideas for future scholarship efforts.
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Herrmann TA, Gray N, Petrova O. Staff perceptions of interdisciplinary team training and its effectiveness in reducing medical errors. INTERNATIONAL JOURNAL OF HEALTHCARE MANAGEMENT 2022. [DOI: 10.1080/20479700.2022.2097762] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
Affiliation(s)
- T. Arien Herrmann
- Department of Management, Harrison College of Business and Computing, Southeast Missouri State University, Cape Girardeau, MO, USA
| | - Natallia Gray
- Department of Management and Entrepreneurship, Ivy College of Business, Iowa State University, Ames, IA, USA
| | - Olga Petrova
- Department of Economics, Sykes College of Business, The University of Tampa, Tampa, FL, USA
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Etherington C, Lê M, Proulx L, Boet S. Bringing the patient voice into the operating room: engaging patients in surgical safety research with the Operating Room Black Box ®. RESEARCH INVOLVEMENT AND ENGAGEMENT 2022; 8:32. [PMID: 35871038 PMCID: PMC9308267 DOI: 10.1186/s40900-022-00367-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/21/2021] [Accepted: 07/12/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND Surgery is one of the most common patient experiences in the health care system. Yet, efforts to engage patients in surgical safety research have not matched those of other health care fields. This is a critical issue given the nature of surgery inhibits patients' abilities to advocate for themselves as they are typically under anesthetic when the procedure is performed. We partnered with patients throughout our research program, which uses the Operating Room Black Box® to enhance surgical patient safety through transparent and proactive analysis of human factors to detect and prevent avoidable errors. MAIN BODY In this article, we outline the need for, and our approach to, patient engagement in surgical safety research. Our approach included a series of planned activities and skill development opportunities designed to build capacity and bring together patients, clinicians, and researchers to inform research and practice. We also conducted evaluation surveys during the first year of our program, which have indicated a positive experience by both patient partners and the research team. CONCLUSION We believe our approach can serve as an important first step toward building a model for patient engagement in the surgical safety field and could significantly contribute to improved quality of care and outcomes for surgical patients.
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Affiliation(s)
- Cole Etherington
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Canada
- Department of Anesthesiology and Pain Medicine, University of Ottawa, Ottawa, Canada
| | | | - Laurie Proulx
- The Ottawa Hospital, Ottawa, Canada
- Canadian Arthritis Patient Alliance, Ottawa, Canada
| | - Sylvain Boet
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Canada.
- Department of Anesthesiology and Pain Medicine, University of Ottawa, Ottawa, Canada.
- Department of Innovation in Medical Education, University of Ottawa, Ottawa, Canada.
- Francophone Affairs, Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada.
- Institute du Savoir Monfort, Ottawa, ON, Canada.
- Faculty of Education, University of Ottawa, Ottawa, ON, Canada.
- Department of Anesthesiology and Pain Medicine, The Ottawa Hospital, University of Ottawa, 501 Smyth Road, Ottawa, ON, K1H 8L6, Canada.
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Andresen ÅEL, Kramer-Johansen J, Kristiansen T. Emergency cricothyroidotomy in difficult airway simulation – a national observational study of Air Ambulance crew performance. BMC Emerg Med 2022; 22:64. [PMID: 35397493 PMCID: PMC8994306 DOI: 10.1186/s12873-022-00624-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2022] [Accepted: 04/05/2022] [Indexed: 11/27/2022] Open
Abstract
Background Advanced prehospital airway management includes complex procedures carried out in challenging environments, necessitating a high level of technical and non-technical skills. We aimed to describe Norwegian Air Ambulance-crews’ performance in a difficult airway scenario simulation, ending with a “cannot intubate, cannot oxygenate”-situation. Methods The study describes Air Ambulance crews’ management of a simulated difficult airway scenario. We used video-observation to assess time expenditure according to pre-defined time intervals and technical and non-technical performance was evaluated according to a structured evaluation-form. Results Thirty-six crews successfully completed the emergency cricothyroidotomy with mean procedural time 118 (SD: ±70) seconds. There was variation among the crews in terms of completed procedural steps, including preparation of equipment, patient- monitoring and management. The participants demonstrated uniform and appropriate situational awareness, and effective communication and resource utilization within the crews was evident. Conclusions We found that Norwegian Air Ambulance crews managed a prehospital “cannot intubate, cannot oxygenate”-situation with an emergency cricothyroidotomy under stressful conditions with effective communication and resource utilization, and within a reasonable timeframe. Some discrepancies between standard operating procedures and performance are observed. Further studies to assess the impact of check lists on procedural aspects of airway management in the prehospital environment are warranted.
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Hughes V, Sistrunk K, Hughes H. Nurse Leader Breaks Through Glass Ceiling: Making History as First Air Force Nurse Major General (1999-2005). Mil Med 2021; 188:e1178-e1185. [PMID: 34865091 DOI: 10.1093/milmed/usab449] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2021] [Revised: 09/15/2021] [Accepted: 11/18/2021] [Indexed: 11/12/2022] Open
Abstract
INTRODUCTION There is a gap in the nursing literature about the significant contributions of executive military nurse leaders to the advancement of nursing as a profession and into interprofessional leadership roles. Many executive military nurse leaders have demonstrated the value of nursing leadership in non-traditional roles and paved the way to expand the leadership opportunities for nurses who would follow. The purpose of this study is to explore the personal stories, experiences, leadership strategies, and lessons learned through the eyes of the first nurse to achieve the rank of Major General in the U.S. Air Force. MATERIALS AND METHODS The oral history method guided the exploration of participant memories and experiences. In compliance with the Oral History Association guidelines, the investigator obtained Institution Review Board permission, informed consent, and audiotaped interviews. An expert panel provided feedback on the appropriate language use in semi-structured interview questions with Air Force nurse executives. The oral history method provided a framework for the semi-structured interview and analysis. Active listening techniques such as exploration, clarifying, and paraphrasing helped foster deep listening. A graduate research assistant transcribed the 4-hour interview verbatim. The primary investigator emailed a copy of the transcript to the participant to verify accuracy and clarify content. Analysis involved examination and interpretation of the professional, military, nursing, and participant's personal perspective to enhance historical understanding. Three independent coders extracted prevalent themes and subthemes during analysis. RESULTS Repetitive major themes of courage, figuring it out, and winning others over emerged during data analysis. The major theme of courage has corresponding subthemes of tenacity, risk-taking, and re-writing the narrative. The major theme of figuring it out has subthemes of optimism, creativity, connectedness, learning, and managing change. Lastly, the winning others over theme has subthemes of emotional intelligence, teamwork, role-model/mentor, and moving from outsider to insider. The leadership strategies of taking calculated risks while remaining calm, being open to opportunities that she had never considered, and spending time learning new skills contributed to repeated advancement into higher leadership positions not previously held by a nurse within the U.S. Air Force. CONCLUSION The interview is packed full of leadership lessons that are just as relative today as 20 years ago. This presentation will conclude with a discussion of the most effective leadership strategies, the lasting impact of the leadership accomplishments, and current implications for nurse leaders today.
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Affiliation(s)
- Vickie Hughes
- Johns Hopkins School of Nursing, 525 N. Wolfe Street, Baltimore, MD 21205-2110, USA
| | - Katherine Sistrunk
- Johns Hopkins School of Nursing, 525 N. Wolfe Street, Baltimore, MD 21205-2110, USA
| | - Hallmon Hughes
- Johns Hopkins School of Public Health, 615 N. Wolfe Street, Baltimore, MD 21205, USA
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16
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What is evidence as evidence is used? A case of dualism? SOCIAL THEORY & HEALTH 2021; 20:291-305. [PMID: 34803522 PMCID: PMC8594643 DOI: 10.1057/s41285-021-00170-4] [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] [Accepted: 10/26/2021] [Indexed: 11/21/2022]
Abstract
How ‘evidence’ is conceptualised, generated and deployed in meso-level policy implementation on the ground is critical to health delivery. Using the case of a large-scale health service reconfiguration in northwest England, this study began as a narrative investigation into how different data types and sources are prioritised as NHS administrative structures change over time. During the research, one unpopular reconfiguration decision, the downgrading of a hospital, was challenged using judicial review. Suddenly, a key decision was being based not upon ‘facts and data’ type evidence but upon evidence of adherence to administrative procedure. This transferred focus away from the ever-shifting categories and hierarchies of data ‘types’ towards an emphasis on process. By comparing two deliberative contexts—committee and judicial review—this article proposes that evidence can be understood as simultaneously entity and process. As health service reconfigurations continue in response to austerity, integration agendas, evolving organisational landscapes, and demographic and political change, it is increasingly important to recognise the different meanings and uses of evidence.
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17
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Hitz F, Ribi K, Grote G, Kolbe M, Schmitz C, Lamb BW, Ruhstaller T, Berchtold P, Sevdalis N. Team functioning across different tumour types: Insights from a Swiss cancer center using qualitative and quantitative methods. Cancer Rep (Hoboken) 2021; 5:e1541. [PMID: 34582132 PMCID: PMC9351662 DOI: 10.1002/cnr2.1541] [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: 05/02/2021] [Revised: 07/18/2021] [Accepted: 08/14/2021] [Indexed: 11/23/2022] Open
Abstract
Background Multidisciplinary care is pivotal in cancer centres and the interaction of all cancer disease specialists in decision making processes is state‐of‐the‐art. Aim To describe differences of MDTMs by tumour type. Methods Twelve multidisciplinary team meetings (MDTMs) with participation of different cancer disease specialists at a tertiary hospital were assessed by an exploratory sequential mixed method approach with interviews, observations and a survey to address the following five topics: organisational structure and supporting technology; leadership; teamwork; decision‐making, perceived value and motivation. Thirteen persons with different tumour specialities and levels of seniority were interviewed. The 12 MDTMs were observed twice by uninvolved persons and evaluated by the participating physicians with a survey. Results There were no systematic differences between MDTMs for different tumour types with the exception of the non‐disease specific type MDTM, which was the only one for which the organisational structure was not driven by an electronic tool. However, several factors could be identified that generally influenced the functioning of the MDTMs. In particular, the quality of decision‐making was highly dependent on the availability of case‐based information and the presence of relevant cancer disease specialists. Leadership and teamwork were rated as important and were comparable across the MDTM. Team participants' motivation and perceived value of MDTMs was high across all meetings. Conclusion MDTM at a single institution did not demonstrate disease specific characteristics. An effective MDTM, irrespective of the tumour type, can be successfully structured by technical means and a chairperson coordinating the interaction of cancer disease specialists to improve the decision‐making process.
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Affiliation(s)
- Felicitas Hitz
- Oncology Haemtology, Kantonsspital St.Gallen, St.Gallen, Switzerland
| | - Karin Ribi
- International Breast Cancer Study Group, Coordinating Center, Bern, Switzerland
| | - Gudela Grote
- Department of Management, Technology and Economics, ETH Zürich, Zürich, Switzerland
| | - Michaela Kolbe
- Department "Simulationszentrum", University Hospital Zürich, Zürich, Switzerland
| | | | - Benjamin W Lamb
- Department of Urology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK.,Faculty of Health, Education, Medicine and Social Care, Anglia Ruskin University, Cambridge, UK
| | - Thomas Ruhstaller
- Brustzentrum Ostschweiz and University of Basel, St.Gallen, Switzerland
| | | | - Nick Sevdalis
- Centre for Implementation Science, Health Service and Population Research Department, King's College, London, UK
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18
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Lin YP, Tang CJ, Tamin VA, Tan LYC, Chan EY. The hand-brain-heart connection: ICU nurses' experience of managing patient safety during COVID-19. Nurs Crit Care 2021; 27:689-697. [PMID: 34472664 PMCID: PMC8661676 DOI: 10.1111/nicc.12710] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2021] [Revised: 06/29/2021] [Accepted: 08/18/2021] [Indexed: 12/15/2022]
Abstract
Background COVID‐19 has challenged critical care nursing through increased critical care service utilization. This may have a profound impact on intensive care unit (ICU) nurses' ability to maintain patient safety. However, the experiences of ICU nurses in managing patient safety during an infectious disease outbreak remains unexplored. Aims and objectives To explore ICU nurses' narratives in managing patient safety in the outbreak ICUs during the COVID‐19 pandemic. Design A narrative inquiry design. Methods A purposive sample of 18 registered nurses who practiced in the outbreak ICUs during the COVID‐19 pandemic were recruited between June and August 2020. Individual semi‐structured interviews were conducted, transcribed verbatim, and narratively analysed. Results Findings reviewed an overarching anatomy‐specific storyline of a ‘hand‐brain‐heart’ connection that describes nurses' experience with managing patient safety during the COVID‐19 pandemic. Firstly, stories on ‘the hands of clinical practice’ revealed how critical care nursing is practiced and adapted by ICU nurses during the pandemic. In particular, ICU nurses banded together to safeguard patient safety by practicing critical care nursing with mastery. Secondly, stories on ‘the brain of psychosocial wellness’ highlights the tumultuous impact of COVID‐19 on the nurses' psychosocial well‐being and how nurses demonstrated resilience to continually uphold patient safety during the pandemic. Lastly, stories on ‘the heart of nursing’ drew upon the nurses' intrinsic professional nursing identity and values to safeguard patient safety. Specific patient tales further boosted the nurses' commitment to render safe nursing care during the pandemic. Conclusions Through their stories, ICU nurses reported how they continually seek to uphold patient safety through clinical competence, resilience, and heightened nursing identity. Relevance to clinical practice ICU nurses require sustainable clinical resources and references such as clinical instructors, as well as visible psychosocial support channels, for ICU nurses to continue to uphold patient safety during COVID‐19.
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Affiliation(s)
- Yongxing Patrick Lin
- Nursing Research Unit, Nursing Service, Tan Tock Seng Hospital, Singapore, Singapore
| | - Charmaine Jinxiu Tang
- Nursing Research Unit, Nursing Service, Tan Tock Seng Hospital, Singapore, Singapore
| | - Vincent Aditya Tamin
- Nursing Research Unit, Nursing Service, Tan Tock Seng Hospital, Singapore, Singapore
| | - Lorraine Yee Ching Tan
- High Level Isolation Unit, National Centre for Infectious Diseases, Singapore, Singapore
| | - Ee-Yuee Chan
- Nursing Research Unit, Nursing Service, Tan Tock Seng Hospital, Singapore, Singapore.,Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
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19
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Communication failures contributing to patient injury in anaesthesia malpractice claims☆. Br J Anaesth 2021; 127:470-478. [PMID: 34238547 DOI: 10.1016/j.bja.2021.05.030] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Revised: 05/18/2021] [Accepted: 05/27/2021] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Communication amongst team members is critical to providing safe, effective medical care. We investigated the role of communication failures in patient injury using the Anesthesia Closed Claims Project database. METHODS Claims associated with surgical/procedural and obstetric anaesthesia and postoperative pain management for adverse events from 2004 or later were included. Communication was defined as transfer of information between two or more parties. Failure was defined as communication that was incomplete, inaccurate, absent, or not timely. We classified root causes of failures as content, audience, purpose, or occasion with inter-rater reliability assessed by kappa. Claims with communication failures contributing to injury (injury-related communication failures; n=389) were compared with claims without any communication failures (n=521) using Fisher's exact test, t-test, or Mann-Whitney U-tests. RESULTS At least one communication failure contributing to patient injury occurred in 43% (n=389) out of 910 claims (κ=0.885). Patients in claims with injury-related communication failures were similar to patients in claims without failures, except that failures were more common in outpatient settings (34% vs 26%; P=0.004). Fifty-two claims had multiple communication failures for a total of 446 injury-related failures, and 47% of failures occurred during surgery, 28% preoperatively, and 23% postoperatively. Content failures (insufficient, inaccurate, or no information transmitted) accounted for 60% of the 446 communication failures. CONCLUSIONS Communication failure contributed to patient injury in 43% of anaesthesia malpractice claims. Patient/case characteristics in claims with communication failures were similar to those without failures, except that failures were more common in outpatient settings.
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20
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Ito-Masui A, Kawamoto E, Esumi R, Imai H, Shimaoka M. Sociometric wearable devices for studying human behavior in corporate and healthcare workplaces. Biotechniques 2021; 71:392-399. [PMID: 34164992 DOI: 10.2144/btn-2020-0160] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Wearable sensor technology enables objective data collection of direct human interactions. The authors review sociometric wearable devices (SWD) and their application in healthcare. Human interactions captured by wearable sensors have been shown to correlate with social constructs such as teamwork and productivity in the office. Application of SWD in the field of healthcare requires special considerations: validation studies have shown technological disadvantages in acute medical settings. Application of SWD in healthcare should be considered based on the strengths and weaknesses of the methodology. SWD can also play an important role in investigation of human interaction and epidemic spread. When study designs and methodologies are carefully considered, incorporation of SWD in healthcare research has promising potential for new insights.
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Affiliation(s)
- Asami Ito-Masui
- Emergency & Critical Care Center, Mie University Hospital, Mie, 5148507, Japan.,Department of Emergency & Disaster Medicine, Mie University Graduate School of Medicine, Mie, 5148507, Japan.,Department of Molecular Pathobiology & Cell Adhesion Biology, Mie University Graduate School of Medicine, Mie, 5148507, Japan
| | - Eiji Kawamoto
- Emergency & Critical Care Center, Mie University Hospital, Mie, 5148507, Japan.,Department of Emergency & Disaster Medicine, Mie University Graduate School of Medicine, Mie, 5148507, Japan.,Department of Molecular Pathobiology & Cell Adhesion Biology, Mie University Graduate School of Medicine, Mie, 5148507, Japan
| | - Ryo Esumi
- Emergency & Critical Care Center, Mie University Hospital, Mie, 5148507, Japan.,Department of Emergency & Disaster Medicine, Mie University Graduate School of Medicine, Mie, 5148507, Japan.,Department of Molecular Pathobiology & Cell Adhesion Biology, Mie University Graduate School of Medicine, Mie, 5148507, Japan
| | - Hiroshi Imai
- Emergency & Critical Care Center, Mie University Hospital, Mie, 5148507, Japan.,Department of Emergency & Disaster Medicine, Mie University Graduate School of Medicine, Mie, 5148507, Japan
| | - Motomu Shimaoka
- Department of Molecular Pathobiology & Cell Adhesion Biology, Mie University Graduate School of Medicine, Mie, 5148507, Japan
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21
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Baynouna Al Ketbi LM. Meta-Decision in Healthcare. Front Public Health 2021; 9:694689. [PMID: 34211958 PMCID: PMC8239282 DOI: 10.3389/fpubh.2021.694689] [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: 04/13/2021] [Accepted: 05/24/2021] [Indexed: 11/13/2022] Open
Abstract
Meta-decision as a junction between evidence and its rightful implementation is suggested in this review as a structured framework applied in healthcare, valuable to clinicians and healthcare decision-makers. The process of meta-decision requires optimum measurements to provide data necessary for identifying and developing decision alternatives and explicitly reflect on its value and choose the optimum decision. The location of value in the meta-decision framework is core component. Of equal importance are prerequisites for decision-makers' abilities to make meta-decisions and focus on optimum team environments. As well as improving their decision-making process through reflection and learning.
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22
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Leung WI, Emery C, Egan R. Improving interprofessional handover on labor and delivery: A needs assessment study. J Interprof Care 2021:1-7. [PMID: 34126849 DOI: 10.1080/13561820.2021.1888901] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2020] [Revised: 02/03/2021] [Accepted: 02/04/2021] [Indexed: 10/21/2022]
Abstract
Handover is the transfer of important clinical information between health providers. The current report describes a needs assessment of interprofessional labor and delivery handover at an urban hospital in Canada. The goal of this study was to explore the perceptions of the current handover meeting and opportunities for improvement. Using a constructivist paradigm, we conducted 28 semi-structured inter- views with handover participants. We used a recruitment grid to ensure we included the voices of participants representing each profession involved in interprofessional handover meetings. An inductive process was used to code the interview transcripts and theme the data. Major themes identified were: (1) Interprofessional handover contributes positively to team situational awareness, interprofessional relationships, and team communication; (2) Handover could be better if it had a more defined process; (3) Interprofessional handover can lead to feelings of intimidation; and (4) Interprofessional handovers on the labor and delivery unit in our setting need increased inclusivity of midwives. From these themes, continued development of interprofessional handover meetings on labor and delivery should be aimed at a formal definition of the scope and process for these meetings reducing feelings of intimidation, increased integration of Midwifery providers, and continued improvement of relationships between different professions and practitioners on labor and delivery.
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Affiliation(s)
- Wynne I Leung
- Faculty of Medicine, Department of Obstetrics and Gynecology, University of Calgary, Calgary, AB, Canada
| | - Crystal Emery
- Faculty of Nursing, Department of Health Quality, Queens University, Kingston, ON, Canada
| | - Rylan Egan
- Faculty of Nursing, Department of Health Quality, Queens University, Kingston, ON, Canada
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23
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Sinha R, Stothard C. Power asymmetry, egalitarianism and team learning – part II: empirical examination of the moderating role of environmental hardship. LEARNING ORGANIZATION 2021. [DOI: 10.1108/tlo-06-2020-0115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose
This paper aims to clarify under which conditions, and via what mechanisms, power asymmetry is likely to affect team learning. This work is part of a two-paper series. Part I presents the theoretical arguments linking power asymmetry to team learning via egalitarianism and the moderating role of environmental hardship. In Part II, the authors provide an empirical evaluation of the conceptual model presented in Part I.
Design/methodology/approach
Data was gathered on 4,637 military personnel nested in 143 ongoing teams. Multiple regression analysis was used to analyze the proposed moderated mediation model. The results show that under higher levels of environmental hardship, teams with higher power asymmetry (greater hierarchy) show greater team egalitarianism and higher team learning.
Findings
The results show that under higher levels of environmental hardship, teams with higher power asymmetry (greater hierarchy) show greater team egalitarianism and higher team learning.
Research limitations/implications
The empirical examination of the proposed relationships is based on a large sample of military teams in the real world. Future research would benefit from testing the model on different samples across industries and adopting different operationalizations for environmental hardship relevant to each industry.
Originality/value
This work provides insights to help practitioners to preserve the coordination benefits of hierarchy, while still promoting more egalitarianism and team learning in hierarchical teams.
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24
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Burns J, Ciccarelli S, Mardakhaev E, Erdfarb A, Goldberg-Stein S, Bello JA. Handoffs in Radiology: Minimizing Communication Errors and Improving Care Transitions. J Am Coll Radiol 2021; 18:1297-1309. [PMID: 33989534 DOI: 10.1016/j.jacr.2021.04.007] [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: 01/01/2021] [Revised: 03/13/2021] [Accepted: 04/06/2021] [Indexed: 11/30/2022]
Abstract
Handoffs are essential to achieving safe care transitions. In radiology practice, frequent transitions of care responsibility among clinicians, radiologists, and patients occur between moments of care such as determining protocol, imaging, interpreting, and consulting. Continuity of care is maintained across these transitions with handoffs, which are the process of communicating patient information and transferring decision-making responsibility. As a leading cause of medical error, handoffs are a major communication challenge that is exceedingly common in both diagnostic and interventional radiology practice. The frequency of handoffs in radiology underscores the importance of using evidence-based strategies to improve patient safety in the radiology department. In this article, reliability science principles and handoff improvement tools are adapted to provide radiology-focused strategies at individual, team, and organizational levels with the goal of minimizing handoff errors and improving care transitions.
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Affiliation(s)
- Judah Burns
- Chair, Montefiore Medical Center Peer Review Board; Program Director, Montefiore Medical Center Diagnostic Radiology Residency Program; Department of Radiology, Montefiore Medical Center, Bronx, New York.
| | | | | | - Amichai Erdfarb
- Director of Quality and Safety, Department of Radiology, Montefiore Medical Center, Bronx, New York
| | - Shlomit Goldberg-Stein
- Director of Operational Improvement, Department of Radiology, Montefiore Medical Center, Bronx, New York
| | - Jacqueline A Bello
- Vice Chair, Board of Chancellors, American College of Radiology; Section Chief of Neuroradiology, Montefiore Medical Center; Department of Radiology, Montefiore Medical Center, Bronx, New York
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25
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Generic Crew Resource Management Training to Improve Non-technical Skills in Acute Care—Phase 1: An Interdisciplinary Needs Assessment Survey. Clin Simul Nurs 2021. [DOI: 10.1016/j.ecns.2020.12.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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26
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Barnes T, Rennie SC. Leadership and surgical training part 1: preparing to lead the way? ANZ J Surg 2021; 91:1068-1074. [PMID: 33825315 DOI: 10.1111/ans.16685] [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: 08/13/2020] [Revised: 02/05/2021] [Accepted: 02/07/2021] [Indexed: 11/29/2022]
Abstract
Every day surgeons lead teams on the wards, in clinics and operating theatres, but most trainees and some surgeons do not consider themselves as leaders. Leadership skills are increasingly important for surgeons, who need knowledge of organizational structure and policy, management strategy and team dynamics to deliver and improve health care in resource-constrained environments. The Royal Australasian College of Surgeons recognizes leadership as one of 10 core surgical competencies but leadership curricula within surgical training programmes are not well defined. There is limited opportunity for formal leadership training and development prior to becoming a consultant.
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Affiliation(s)
- Tracey Barnes
- Department of General Surgery, Dunedin Hospital, Dunedin, New Zealand.,Department of Surgical Sciences, Dunedin School of Medicine, The University of Otago, Dunedin, New Zealand
| | - Sarah C Rennie
- Education Unit, The University of Otago, Wellington, New Zealand
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27
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Nawathe P, Wong R, Pollock G, Green J, Kissen M, Ng P, Cohen S, Barron J, Robert S, Slingwine C, Frank P, Navab K, Kim D, Yang M, Gouvea T, Johnson C, Pedraza I, Zahn E. Creation of a dedicated line team for critically ill patients with COVID-19: A multidisciplinary approach to maximize resource utilization during the COVID-19 pandemic. J Vasc Access 2021; 23:348-352. [PMID: 33541202 DOI: 10.1177/1129729821991754] [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] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Pandemics create challenges for medical centers, which call for innovative adaptations to care for patients during the unusually high census, to distribute stress and work hours among providers, to reduce the likelihood of transmission to health care workers, and to maximize resource utilization. METHODS We describe a multidisciplinary vascular access team's development to improve frontline providers' workflow by placing central venous and arterial catheters. Herein we describe the development, organization, and processes resulting in the rapid formation and deployment of this team, reporting on notable clinical issues encountered, which might serve as a basis for future quality improvement and investigation. We describe a retrospective, single-center descriptive study in a large, quaternary academic medical center in a major city. The COVID-19 vascular access team included physicians with specialized experience in placing invasive catheters and whose usual clinical schedule had been lessened through deferment of elective cases. The target population included patients with confirmed or suspected COVID-19 in the medical ICU (MICU) needing invasive catheter placement. The line team placed all invasive catheters on patients in the MICU with suspected or confirmed COVID-19. RESULTS AND CONCLUSIONS Primary data collected were the number and type of catheters placed, time of team member exposure to potentially infected patients, and any complications over the first three weeks. Secondary outcomes pertained to workflow enhancement and quality improvement. 145 invasive catheters were placed on 67 patients. Of these 67 patients, 90% received arterial catheters, 64% central venous catheters, and 25% hemodialysis catheters. None of the central venous catheterizations or hemodialysis catheters were associated with early complications. Arterial line malfunction due to thrombosis was the most frequent complication. Division of labor through specialized expert procedural teams is feasible during a pandemic and offloads frontline providers while potentially conferring safety benefits.
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Affiliation(s)
- Pooja Nawathe
- Department of Pediatrics, Cedars-Sinai Medical Center, Los Angeles, CA, USA.,Department of Cardiology, Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Robert Wong
- Department of Anesthesiology, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Gabriel Pollock
- Department of Anesthesiology, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Jack Green
- Department of Pediatrics, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Michael Kissen
- Department of Anesthesiology, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Phillip Ng
- Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Samuel Cohen
- Department of Anesthesiology, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Joel Barron
- Department of Pediatrics, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Stephen Robert
- Department of Pediatrics, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Christy Slingwine
- Department of Anesthesiology, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Paul Frank
- Department of Anesthesiology, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Kaveh Navab
- Department of Anesthesiology, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Doran Kim
- Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Michael Yang
- Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Tyler Gouvea
- Department of Anesthesiology, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Calvin Johnson
- Department of Anesthesiology, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Isabel Pedraza
- Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Evan Zahn
- Department of Pediatrics, Cedars-Sinai Medical Center, Los Angeles, CA, USA.,Department of Cardiology, Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA
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28
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Alberto EC, Harvey AR, Amberson MJ, Zheng Y, Thenappan AA, Oluigbo C, Marsic I, Sarcevic A, O'Connell KJ, Burd RS. Assessment of Non-Routine Events and Significant Physiological Disturbances during Emergency Department Evaluation after Pediatric Head Trauma. Neurotrauma Rep 2021; 2:39-47. [PMID: 33748812 PMCID: PMC7962792 DOI: 10.1089/neur.2020.0043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Outcomes following pediatric traumatic brain injury (TBI) are dependent on initial injury severity and prevention of secondary injury. Hypoxia, hypotension, and hyperventilation following TBI are associated with increased mortality. The purpose of this study was to determine the association of non-routine events (NREs) during the initial resuscitation phase with these physiological disturbances. We conducted a video review of pediatric trauma resuscitations of patients with suspected TBI and Glasgow Coma Scale (GCS) scores <13. NREs were rated as "momentary" if task progression was delayed by <1 min and "moderate" if delayed by >1 min. Vital sign monitor data were used to identify periods of significant physiological disturbances. We calculated the association between the rate of overall and moderate NREs per case and the proportion of cases with abnormal vital signs using multi-variate linear regression, controlling for GCS score and need for intubation. Among 26 resuscitations, 604 NREs were identified with a median of 23 (interquartile range [IQR] 17-27.8, range 5-44) per case. Moderate delay NREs occurred in 19 resuscitations (n = 32, median 1 NRE/resuscitation, IQR 0.3-1, range 0-5). Oxygen desaturation and respiratory depression were associated with a greater rate of moderate NREs (p = 0.008, p < 0.001, respectively). We observed no association between duration of hypotension, desaturation, and respiratory depression and overall NRE rate. NREs are common in the initial resuscitation of children with moderate to severe TBI. Episodes of hypoxia and respiratory depression are associated with NREs that cause a moderate delay in task progression. Conformance with resuscitation guidelines is needed to prevent physiological events associated with adverse outcomes following pediatric TBI.
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Affiliation(s)
- Emily C. Alberto
- Division of Trauma and Burn Surgery, Children's National Hospital, Washington DC, USA
| | - Allison R. Harvey
- Division of Trauma and Burn Surgery, Children's National Hospital, Washington DC, USA
| | | | - Yinan Zheng
- Division of Trauma and Burn Surgery, Children's National Hospital, Washington DC, USA
| | | | - Chima Oluigbo
- Division of Neurosurgery, Children's National Hospital, Washington DC, USA
| | - Ivan Marsic
- Department of Electrical and Computer Engineering, Rutgers University, Piscataway, New Jersey, USA
| | - Aleksandra Sarcevic
- College of Computing and Informatics, Drexel University, Philadelphia, Pennsylvania, USA
| | - Karen J. O'Connell
- Division of Emergency Medicine, Children's National Hospital, Washington DC, USA
| | - Randall S. Burd
- Division of Trauma and Burn Surgery, Children's National Hospital, Washington DC, USA
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29
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Design, build, train, excel: using simulation to create elite trauma systems. Int Anesthesiol Clin 2021; 59:58-66. [DOI: 10.1097/aia.0000000000000312] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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30
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Katz NT, Sacks BH, Hynson JL, Heywood M, Williams M, Sokol J. Improving paediatric advance care planning: Results of a learning needs analysis and simulation-based education programme. J Paediatr Child Health 2020; 56:1898-1905. [PMID: 32812306 DOI: 10.1111/jpc.15074] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Revised: 06/16/2020] [Accepted: 06/17/2020] [Indexed: 11/28/2022]
Abstract
AIM To assess clinicians' experience, attitudes and confidence with advance care planning (ACP) at a quaternary paediatric referral centre using a learning-needs survey, and then apply this information to develop and examine the feasibility of simulation-based education for this topic. METHODS An electronic learning-needs survey was distributed to medical, nursing and allied health clinicians from departments who provide primary care for children with life-limiting conditions. Results were incorporated into the design of a simulation-based education session which was piloted with the Royal Children's Hospital Oncology Department. RESULTS A total of 157 learning-needs surveys were included in analysis, and included quantitative and qualitative responses from nursing, allied health, senior and junior medical staff from intensive care, general and subspecialty medical teams. Most (75.0%) participants had participated in ACP discussions previously. Only 40.1% of participants felt confident to assess appropriate timing of, and 45.2% felt adequately prepared to participate in ACP discussions. Barriers identified were both clinician and patient/parent related, including clinicians not knowing when to address issues (43.9%) or what to say (21.0%). Participants indicated that ACP discussions are most frequently initiated when death is clearly imminent. Following a pilot of simulation-based education with the oncology department, 90% of participants expressed confidence to participate in ACP discussions. CONCLUSIONS Barriers to paediatric ACP, including lack of clinician training, continue to contribute to delayed conversations. Simulation-based education is a valuable and feasible educational tool that can increase clinicians' understanding and confidence in this area.
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Affiliation(s)
- Naomi T Katz
- Victorian Paediatric Palliative Care Program, Royal Children's Hospital, Melbourne, Victoria, Australia.,Simulation Program, Royal Children's Hospital, Melbourne, Victoria, Australia.,Department of Paediatrics, University of Melbourne, Melbourne, Victoria, Australia.,Clinical Paediatrics Group, Murdoch Children's Research Group, Melbourne, Victoria, Australia
| | - Bronwyn H Sacks
- Victorian Paediatric Palliative Care Program, Royal Children's Hospital, Melbourne, Victoria, Australia
| | - Jenny L Hynson
- Victorian Paediatric Palliative Care Program, Royal Children's Hospital, Melbourne, Victoria, Australia.,Department of Paediatrics, University of Melbourne, Melbourne, Victoria, Australia.,Clinical Paediatrics Group, Murdoch Children's Research Group, Melbourne, Victoria, Australia
| | - Melissa Heywood
- Victorian Paediatric Palliative Care Program, Royal Children's Hospital, Melbourne, Victoria, Australia.,Simulation Program, Royal Children's Hospital, Melbourne, Victoria, Australia
| | - Molly Williams
- Victorian Paediatric Palliative Care Program, Royal Children's Hospital, Melbourne, Victoria, Australia
| | - Jenni Sokol
- Simulation Program, Royal Children's Hospital, Melbourne, Victoria, Australia.,Department of Paediatrics, University of Melbourne, Melbourne, Victoria, Australia
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Schumm MA, Ohev-Shalom R, Nguyen DT, Kim J, Tseng CH, Zanocco KA. Measuring patient perceptions of surgeon communication performance in the treatment of thyroid nodules and thyroid cancer using the communication assessment tool. Surgery 2020; 169:282-288. [PMID: 32980166 DOI: 10.1016/j.surg.2020.08.019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Revised: 08/03/2020] [Accepted: 08/11/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND Thyroid surgeons are offering their patients less aggressive diagnostic and therapeutic management strategies for thyroid nodules and low-risk thyroid cancer in an effort to decrease overdiagnosis and overtreatment of indolent disease. Explaining the rationale for less aggressive management plans requires physicians to be effective communicators. We aimed to assess the communication skills of thyroid surgeons with the Makoul Communication Assessment Tool and to identify risk factors for poor communication. METHODS New adult patients with thyroid nodules or thyroid cancer presenting to a single tertiary-referral endocrine surgery clinic were enrolled from July 2018 through December 2019. Patients were administered the Communication Assessment Tool immediately after their clinical encounter. Outlier communication scores were identified, and clinical characteristics were compared between outlier and nonoutlier groups. RESULTS A total of 107 patients completed the Communication Assessment Tool. Mean (standard deviation) total and top box scores were 67 (6) and 86% (29%), respectively. Twenty-five patients (23%) were in the low-outlier group, defined by a total score below 67.5/70 or top box score below 82.25%. Other race and non-Hispanic patients (versus white race) were more likely low outliers (odds ratio 3.58, P = .048). The lowest scoring Communication Assessment Tool item overall was "the doctor encouraged me to ask questions" (78.5% top box). CONCLUSION We found communication to be perceived as excellent in the majority of patients; however, an opportunity for improvement was identified in 29% of participants. Significant differences in race and ethnicity between low outlier and nonoutlier communication score patients were observed, which warrants additional investigation. These findings support the utility of the Communication Assessment Tool in studying the effectiveness of communication improvement initiatives.
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Affiliation(s)
- Max A Schumm
- Department of Surgery, University of California, Los Angeles, David Geffen School of Medicine, Los Angeles, CA.
| | - Roben Ohev-Shalom
- Section of Endocrine Surgery, Department of Surgery, University of California, Los Angeles, David Geffen School of Medicine, Los Angeles, CA
| | - Dalena T Nguyen
- Section of Endocrine Surgery, Department of Surgery, University of California, Los Angeles, David Geffen School of Medicine, Los Angeles, CA
| | - Jiyoon Kim
- Department of Biostatistics, University of California, Los Angeles, Fielding School of Public Health, Los Angeles, CA
| | - Chi-Hong Tseng
- Department of Medicine, University of California, Los Angeles, David Geffen School of Medicine, Los Angeles, CA
| | - Kyle A Zanocco
- Section of Endocrine Surgery, Department of Surgery, University of California, Los Angeles, David Geffen School of Medicine, Los Angeles, CA
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Sinha R, Stothard C. Power asymmetry, egalitarianism and team learning – Part 1: conceptualizing the moderating role of environmental hardship. LEARNING ORGANIZATION 2020. [DOI: 10.1108/tlo-01-2020-0018] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose
This paper aims to understand the effects of team power asymmetry (hierarchy) on team learning.
Design/methodology/approach
Literature suggests that power asymmetry can hurt team learning due to unequal interactions. The authors integrate the situated focus theory of power and the theory of adversarial growth to propose that environmental hardship can moderate this relationship. Such that, under environmental hardship there is a shift in power relations within hierarchical teams, such that power asymmetry positively relates to team learning via increased team egalitarianism (interactional equality).
Findings
The study is presented in two parts. Part 1 reviews the literature and builds the theoretical arguments for the conceptual model, while Part 2 empirically examines the model on a sample of military teams. In Part 1, the authors propose a theoretically derived model and directions for future research in team power, dynamics and learning.
Research limitations/implications
It provides directions to empirically validate a contingency-based model to resolve the dilemma of creating equality and high levels of team learning in hierarchical teams.
Originality/value
The conceptual model and hypotheses contribute to the team learning literature by theoretically clarifying the conditions under which power asymmetry is likely to improve team learning.
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Simulation-Based Team Leadership Training Improves Team Leadership During Actual Trauma Resuscitations: A Randomized Controlled Trial. Crit Care Med 2020; 48:73-82. [PMID: 31725441 DOI: 10.1097/ccm.0000000000004077] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES Trauma resuscitations are complex critical care events that present patient safety-related risk. Simulation-based leadership training is thought to improve trauma care; however, there is no robust evidence supporting the impact of leadership training on clinical performance. The objective of this study was to assess the clinical impact of simulation-based leadership training on team leadership and patient care during actual trauma resuscitations. DESIGN Randomized controlled trial. SETTING Harborview Medical Center (level 1 trauma center). SUBJECTS Seventy-nine second- and third-year residents were randomized and 360 resuscitations were analyzed. INTERVENTIONS Subjects were randomized to a 4-hour simulation-based leadership training (intervention) or standard orientation (control) condition. MEASUREMENTS AND MAIN RESULTS Participant-led actual trauma resuscitations were video recorded and coded for leadership behaviors and patient care. We used random coefficient modeling to account for the nesting effect of multiple observations within residents and to test for post-training group differences in leadership behaviors while controlling for pre-training behaviors, Injury Severity Score, postgraduate training year, and days since training occurred. Sixty participants completed the study. There was a significant difference in post-training leadership behaviors between the intervention and control conditions (b1 = 4.06, t (55) = 6.11, p < 0.001; intervention M = 11.29, SE = 0.66, 95% CI, 9.99-12.59 vs control M = 7.23, SE = 0.46, 95% CI, 6.33-8.13, d = 0.92). Although patient care was similar between conditions (b = 2.00, t (55) = 0.99, p = 0.325; predicted means intervention M = 62.38, SE = 2.01, 95% CI, 58.43-66.33 vs control M = 60.38, SE = 1.37, 95% CI, 57.69-63.07, d = 0.15), a test of the mediation effect between training and patient care suggests leadership behaviors mediate an effect of training on patient care with a significant indirect effect (b = 3.44, 95% CI, 1.43-5.80). Across all trauma resuscitations leadership was significantly related to patient care (b1 = 0.61, SE = 0.15, t (273) = 3.64, p < 0.001). CONCLUSIONS Leadership training resulted in the transfer of complex skills to the clinical environment and may have an indirect effect on patient care through better team leadership.
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Ivarsson J, Åberg M. Role of requests and communication breakdowns in the coordination of teamwork: a video-based observational study of hybrid operating rooms. BMJ Open 2020; 10:e035194. [PMID: 32461294 PMCID: PMC7259866 DOI: 10.1136/bmjopen-2019-035194] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVES This study investigated the functional role of 'requests' in the coordination of surgical activities in the operating room (OR). A secondary aim was to describe, closely, instances of potential miscommunication to scrutinise how so-called conversational repairs were used to address and prevent mistakes. DESIGN Non-participant video-based observations. SETTING Team coordination around image acquisitions (digital subtraction angiography) done during endovascular aortic repair (EVAR) procedures in a hybrid OR. METHODS The study followed and documented a total of 72 EVAR procedures, out of which 12 were video-recorded (58 hours). The results were based on 12 teams operating during these recorded surgeries and specifically targeted all sequences involving controlled apnoea. In total, 115 sequences were analysed within the theoretical framework of conversation analysis. RESULTS The results indicated a simple structure of communication that can enable the successful coordination of work between different team members. Central to this analysis was the distinction between immediate requests and pre-requests. The results also showed how conversational repairs became key in establishing joint understanding and, therefore, how they can function as crucial resources in safety management operations. CONCLUSION The results suggest the possibility of devising an interactional framework to minimise problems with communication, thereby enabling the advancement of patient safety. By making the distinction between different types of requests explicit, certain ambiguities can be mitigated and some misunderstandings avoided. One way to accomplish this practically would be to tie various actions to clearer and more distinct forms of expression.
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Affiliation(s)
- Jonas Ivarsson
- Department of Applied Information Technology, University of Gothenburg, Goteborg, Sweden
| | - Mikaela Åberg
- Department of Education, Communication and Learning, University of Gothenburg, Goteborg, Sweden
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Boet S, Etherington N, Crnic A, Kenna J, Jung J, Cairns M, Posner G, Grantcharov T. La définition des moments critiques et non critiques en salle d'opération : une étude de consensus Delphi modifiée. Can J Anaesth 2020; 67:949-958. [PMID: 32377936 DOI: 10.1007/s12630-020-01688-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2019] [Revised: 01/17/2020] [Accepted: 03/02/2020] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND While the operating room (OR) has significantly benefited from aviation strategies to improve safety, the rate of avoidable human errors remains relatively high. One key aviation strategy that has yet to be formally established in the OR is the "sterile cockpit" rule, which prohibits all non-essential behaviours during critical moments of a flight. Applying this rule to the OR may enhance patient safety, but the critical moments of surgery need to be defined first. METHODS This study used a modified Delphi methodology to determine critical moments during surgery according to OR team members across institutions, professions, and specialties. Analysis occurred after each round. The stopping criterion was consensus on 80% of survey items or no change in the mean score for any individual item between two consecutive rounds. RESULTS The first round included 304 respondents. Of these, 115 completed the second-round survey, and 75 completed all three rounds (27 nurses, 29 anesthesiologists, 19 surgeons). Critical moments obtained by consensus were: induction of anesthesia; emergence from anesthesia; preoperative briefing; final counts at the end of the procedure; anesthesiologist- or surgeon-relevant intraoperative event; handovers; procedure-specific high-risk surgical moments; crisis resource management situations; medication and equipment preparation; and key medication administration. CONCLUSIONS By defining the most critical moments of surgery, future research can determine the relative importance of behaviour and actions at each stage and target interventions to these stages.
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Affiliation(s)
- Sylvain Boet
- Department of Anesthesiology and Pain Medicine, University of Ottawa, Ottawa, ON, Canada.,Clinical Epidemiology Program, Ottawa Hospital Research Institute - Centre for Practice Changing Research, 501 Smyth Rd, Ottawa, ON, K1H 8L6, Canada.,Department of Innovation in Medical Education, University of Ottawa, Ottawa, ON, Canada
| | - Nicole Etherington
- Department of Anesthesiology and Pain Medicine, University of Ottawa, Ottawa, ON, Canada. .,Clinical Epidemiology Program, Ottawa Hospital Research Institute - Centre for Practice Changing Research, 501 Smyth Rd, Ottawa, ON, K1H 8L6, Canada.
| | - Agnes Crnic
- Department of Anesthesiology and Pain Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Julie Kenna
- The Ottawa Hospital, Main Operating Room, Ottawa, ON, Canada
| | - James Jung
- Department of Surgery, University of Toronto, Toronto, ON, Canada.,International Centre for Surgical Safety, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, ON, Canada
| | - Martin Cairns
- Department of Anesthesiology and Pain Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Glen Posner
- Department of Obstetrics, Gynecology and Newborn Care, University of Ottawa, Ottawa, ON, Canada
| | - Teodor Grantcharov
- Department of Surgery, University of Toronto, Toronto, ON, Canada.,International Centre for Surgical Safety, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, ON, Canada
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Uttley E, Suggitt D, Baxter D, Jafar W. Multiprofessional in situ simulation is an effective method of identifying latent patient safety threats on the gastroenterology ward. Frontline Gastroenterol 2020; 11:351-357. [PMID: 32879718 PMCID: PMC7447278 DOI: 10.1136/flgastro-2019-101307] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2019] [Revised: 12/11/2019] [Accepted: 12/24/2019] [Indexed: 02/04/2023] Open
Abstract
OBJECTIVE In situ simulation (ISS) is an effective training method for multiprofessional teams dealing with emergencies in high pressured environments. A regular ISS programme was organised for the multiprofessional gastroenterology team with a primary objective of identifying, classifying and addressing latent patient safety threats and secondary objectives of improving team confidence and individual role recognition. METHOD 22 unannounced ISS sessions (averaging approximately one session every 6 weeks and four participants per session) were conducted between February 2017 and August 2019 involving multiprofessional team members. The sessions centred around the following four common gastrointestinal emergency scenarios: massive upper gastrointestinal haemorrhage; biliary sepsis (cholangitis) and shock; postendoscopic retrograde cholangiopancreatography complications including perforation and cardiac arrest. Following the simulation, the faculty, which included nurses and doctors, facilitated a structured debrief session and action plan to identify and address latent errors. RESULTS 96 participants from nursing, medical, physician associate and pharmacy backgrounds took part in the simulation programme. Analysis of collected latent safety threats identified the following four themes: education and training; equipment; medication and team working. Analysis of anonymously completed questionnaires identified that 95% of participants had a perceived better understanding of their role and 86% felt more confident in assessing an unwell patient. 96% of participants felt comfortable during the debrief. CONCLUSION ISS provides a unique opportunity to train the multiprofessional gastroenterology team in their own high-pressured environment, helping identify and address latent patient safety threats and improve perceived participant confidence and role recognition.
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Affiliation(s)
- Elizabeth Uttley
- Medical Education, Stockport NHS Foundation Trust, Stockport, UK
| | - Deborah Suggitt
- Medical Education, Stockport NHS Foundation Trust, Stockport, UK
| | - David Baxter
- Medical Education, Stockport NHS Foundation Trust, Stockport, UK
| | - Wisam Jafar
- Medical Education, Stockport NHS Foundation Trust, Stockport, UK
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Burlacu A, Covic A, Cinteza M, Lupu PM, Deac R, Tinica G. Exploring Current Evidence on the Past, the Present, and the Future of the Heart Team: A Narrative Review. Cardiovasc Ther 2020; 2020:9241081. [PMID: 31969934 PMCID: PMC6964708 DOI: 10.1155/2020/9241081] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2019] [Accepted: 12/19/2019] [Indexed: 02/06/2023] Open
Abstract
INTRODUCTION Including healthcare professionals dealing with cardiovascular diseases, Heart Team is a concept/structure designed for selecting diagnostic strategies, facilitating therapeutic decisions, and improving cardiovascular outcomes in patients with complex heart pathologies, requiring input from different subspecialties and the necessity of a multidisciplinary approach. The aim of this narrative review is to search for and to summarize current evidence regarding Heart Team and to underline the future directions for the development of this concept. METHODS We searched the electronic database of PubMed, SCOPUS, and Cochrane CENTRAL for studies including Heart Team. Forty-eight studies were included, if reference was made to Heart Team structure and functionality. RESULTS We depicted the structure and the timeline of Heart Team, along with actual evidence-based recommendations from European Guidelines. We underlined the importance of quality of knowledge-sharing and decision-making inside the Team, analyzing bad decisions which did not reflect members' true beliefs due to "uniformity pressure, closed mindedness, and illusion of invulnerability." The observation that Guidelines' indications regarding Heart Team carry a level C indication underlines the very future of this Team: randomized controlled trials proving solid benefits in an evidence-based world. CONCLUSIONS Envisioned as a tool for optimizing the management of various complex cardiovascular pathologies, Heart Team should simplify and facilitate the activity in the cardiovascular ward. Finally, these facts should be translated into better cardiovascular outcomes and a lower psychological distress among Team participants. Despite all future changes, there must always be a constant part: the patient should remain at the very center of the Team.
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Affiliation(s)
- Alexandru Burlacu
- Department of Interventional Cardiology, Cardiovascular Diseases Institute, Iasi, Romania
- “Grigore T. Popa” University of Medicine and Pharmacy, Iasi, Romania
| | - Adrian Covic
- “Grigore T. Popa” University of Medicine and Pharmacy, Iasi, Romania
- Nephrology Clinic, Dialysis and Renal Transplant Center, “C.I. Parhon” University Hospital, Iasi, Romania
- The Academy of Romanian Scientists (AOSR), Bucharest, Romania
| | - Mircea Cinteza
- Department of Cardiology, Emergency University Hospital, Bucharest, Romania
- “Carol Davila” University of Medicine and Pharmacy, Bucharest, Romania
| | | | - Radu Deac
- The Romanian Academy of Medical Sciences, Bucharest, Romania
| | - Grigore Tinica
- “Grigore T. Popa” University of Medicine and Pharmacy, Iasi, Romania
- Department of Cardiovascular Surgery, Cardiovascular Diseases Institute, Iasi, Romania
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Keller S, Tschan F, Semmer NK, Timm-Holzer E, Zimmermann J, Candinas D, Demartines N, Hübner M, Beldi G. "Disruptive behavior" in the operating room: A prospective observational study of triggers and effects of tense communication episodes in surgical teams. PLoS One 2019; 14:e0226437. [PMID: 31830122 PMCID: PMC6907803 DOI: 10.1371/journal.pone.0226437] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2019] [Accepted: 11/26/2019] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Tense communication and disruptive behaviors during surgery have often been attributed to surgeons' personality or hierarchies, while situational triggers for tense communication were neglected. Goals of this study were to assess situational triggers of tense communication in the operating room and to assess its impact on collaboration quality within the surgical team. METHODS AND FINDINGS The prospective observational study was performed in two university hospitals in Europe. Trained external observers assessed communication in 137 elective abdominal operations led by 30 different main surgeons. Objective observations were related to perceived collaboration quality by all members of the surgical team. A total of 340 tense communication episodes were observed (= 0.57 per hour); mean tensions in surgeries with tensions was 1.21 per hour. Individual surgeons accounted for 24% of the variation in tensions, while situational aspects accounted for 76% of variation. A total of 72% of tensions were triggered by coordination problems; 21.2% by task-related problems and 9.1% by other issues. More tensions were related to lower perceived teamwork quality for all team members except main surgeons. Coordination-triggered tensions significantly lowered teamwork quality for second surgeons, scrub technicians and circulators. CONCLUSIONS Although individual surgeons differ in their tense communication, situational aspects during the operation had a much more important influence on the occurrence of tensions, mostly triggered by coordination problems. Because tensions negatively impact team collaboration, surgical teams may profit from improving collaboration, for instance through training, or through reflexivity.
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Affiliation(s)
- Sandra Keller
- Institute of Work and Organizational Psychology, University of Neuchâtel, Neuchâtel, Switzerland
- Virginia Tech, Blacksburg, VA, United States of America
| | - Franziska Tschan
- Institute of Work and Organizational Psychology, University of Neuchâtel, Neuchâtel, Switzerland
| | | | - Eliane Timm-Holzer
- Institute of Work and Organizational Psychology, University of Neuchâtel, Neuchâtel, Switzerland
| | - Jasmin Zimmermann
- Institute of Work and Organizational Psychology, University of Neuchâtel, Neuchâtel, Switzerland
| | - Daniel Candinas
- Department of Visceral Surgery and Medicine, University Hospital of Bern, Bern, Switzerland
| | - Nicolas Demartines
- Department of Visceral Surgery, Lausanne University Hospital CHUV, Lausanne, Switzerland
| | - Martin Hübner
- Department of Visceral Surgery, Lausanne University Hospital CHUV, Lausanne, Switzerland
| | - Guido Beldi
- Department of Visceral Surgery and Medicine, University Hospital of Bern, Bern, Switzerland
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The history of crises and crisis management in anesthesia: prevention, detection, and recovery. Int Anesthesiol Clin 2019; 58:2-6. [DOI: 10.1097/aia.0000000000000258] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Dinh JV, Traylor AM, Kilcullen MP, Perez JA, Schweissing EJ, Venkatesh A, Salas E. Cross-Disciplinary Care: A Systematic Review on Teamwork Processes in Health Care. SMALL GROUP RESEARCH 2019. [DOI: 10.1177/1046496419872002] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
As health care delivery moves toward more complex, team-based systems, the topic of medical teamwork has gained considerable attention and study across disciplines. This systematic review integrates empirical research on teamwork and health care to identify broad trends. We identified and coded 1,818 relevant, English, and peer-reviewed journal articles using a teamwork processes rubric. Several themes emerged. The health care teamwork literature has grown substantially over the past 20 years. Approximately half of the studies were descriptive (rather than interventional or psychometric); the majority relied on quantitative methods. Health care teamwork was also studied in thematically distinct manners. Interpersonal processes were most commonly studied across fields. Of all disciplines, medicine focused most on transition processes, whereas those from team science centered more highly on action processes. There were also finer grained disciplinary differences in content areas of communication and collaboration. Interprofessional journals represent a potential area for interdisciplinary efforts. Implications and future directions are discussed.
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Training novice anaesthesiology trainees to speak up for patient safety. Br J Anaesth 2019; 122:767-775. [DOI: 10.1016/j.bja.2019.01.017] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2018] [Revised: 01/01/2019] [Accepted: 01/11/2019] [Indexed: 11/18/2022] Open
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Kolbe M, Grande B, Marty A, Manka R, Taramasso M, Nietlispach F, Pomar JL, Maisano F, Reser D. Making Heart Team Discussions Work. STRUCTURAL HEART 2019. [DOI: 10.1080/24748706.2019.1572254] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- Michaela Kolbe
- Simulation Center, University Hospital Zurich, Switzerland
- ETH Zurich, Switzerland
| | - Bastian Grande
- Simulation Center, University Hospital Zurich, Switzerland
- Institute of Anesthesiology, University Hospital Zurich, Switzerland
| | - Adrian Marty
- Simulation Center, University Hospital Zurich, Switzerland
- Institute of Anesthesiology, University Hospital Zurich, Switzerland
| | - Robert Manka
- Department of Cardiology, Heart Center, University Hospital Zurich, Switzerland
| | - Maurizio Taramasso
- Department of Cardiovascular Surgery, Heart Center, University Hospital Zurich, Switzerland
| | - Fabian Nietlispach
- Department of Cardiology, Heart Center, University Hospital Zurich, Switzerland
| | - Jose Luis Pomar
- Hospital Clinico de Barcelona, University of Barcelona, Spain
| | - Francesco Maisano
- Department of Cardiovascular Surgery, Heart Center, University Hospital Zurich, Switzerland
| | - Diana Reser
- Department of Cardiovascular Surgery, Heart Center, University Hospital Zurich, Switzerland
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Bannister SL, Wu TF, Keegan DA. The Clinical COACH: How to Enable Your Learners to Own Their Learning. Pediatrics 2018; 142:peds.2018-2601. [PMID: 30327376 DOI: 10.1542/peds.2018-2601] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/20/2018] [Indexed: 11/24/2022] Open
Affiliation(s)
- Susan L Bannister
- Departments of Paediatrics and .,Alberta Children's Hospital, Calgary, Alberta, Canada
| | - Theresa F Wu
- Departments of Paediatrics and.,Alberta Children's Hospital, Calgary, Alberta, Canada
| | - David A Keegan
- Family Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada; and
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An International Interprofessional Study of Mental Models and Factors Delaying Neuroimaging of Critically Head-Injured Children Presenting to Emergency Departments. Pediatr Emerg Care 2018; 34:797-801. [PMID: 27753711 DOI: 10.1097/pec.0000000000000915] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
OBJECTIVES Thousands of head-injured children are cared for by interprofessional teams in emergency departments every day. Teams must balance performing time-consuming interventions with safe transport for neuroimaging. This study aims to describe and compare providers' perspectives on the transfer of head-injured children to neuroimaging and factors contributing to delays. METHODS Participants were interprofessional health care providers involved in the care of head-injured children at sites in the United Kingdom, the United States, and New Zealand. They first viewed a 3-minute video of a child with a severe head injury presenting to their resuscitation bay. Next, they were presented with 5 physiologically different simulated scenarios and asked to report whether interventions were required before transporting each patient to neuroimaging. Then, they reported team and system factors contributing to delays in neuroimaging. RESULTS Two hundred forty of 296 providers completed the intervention. The percentage of providers reporting that they would directly transport to neuroimaging without intervention was 89% for "stable," 49% for "Cushing's triad," 26% for "hypoxic," 25% for "tachycardic," and 5% for "extremis." There were differences noted in responses by profession for the hypoxia and tachycardia cases. No differences were noted between trainees and attending physicians for any cases. The most frequent factors reported as delaying neuroimaging were team decision making and waiting for equipment, medications, and scanner availability. CONCLUSIONS There is variability in providers' perspectives on the interventions required before transporting severely head-injured patients for imaging. Diverse team and system factors contribute to delays in imaging.
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Gisick LM, Webster KL, Keebler JR, Lazzara EH, Fouquet S, Fletcher K, Fagerlund A, Lew V, Chan R. Measuring shared mental models in healthcare. JOURNAL OF PATIENT SAFETY AND RISK MANAGEMENT 2018. [DOI: 10.1177/2516043518796442] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Objective To review common qualitative and quantitative methods of measuring shared mental models appropriate for use in the healthcare setting. Background Shared mental models are the overlap of individuals’ set of knowledge and/or assumptions that act as the basis for understanding and decision making between individuals. Within healthcare, shared mental models facilitate effective teamwork and theorized to influence clinical decision making and performance. With the current rapid growth and expansion of healthcare teams, it is critical that we understand and correctly use shared mental model measurement methods assess optimal team performance. Unfortunately, agreement on the proper measurement of shared mental models within healthcare remains diffuse. Method This paper presents methods appropriate to measure shared mental models within healthcare. Results Multiple shared mental model measurement methods are discussed with regard to their utility within this setting, ease of use, and difficulties in deploying within the healthcare operational environment. For rigorous analysis of shared mental models, it is recommended that a combination of qualitative and quantitative analyses be employed. Conclusion There are multitude of shared mental model measurement methods that can be used in the healthcare domain; although there is no perfect solution for every situation. Researchers can utilize this article to determine the best approach for their needs.
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Affiliation(s)
- Logan M Gisick
- Department of Human Factors and Systems, Embry Riddle Aeronautical University, Daytona Beach, FL, USA
| | - Kristen L Webster
- The Armstrong Institute of Patient Safety and Quality, Johns Hopkins Medicine, Baltimore, MD, USA
| | - Joseph R Keebler
- Department of Human Factors and Systems, Embry Riddle Aeronautical University, Daytona Beach, FL, USA
| | - Elizabeth H Lazzara
- Department of Human Factors and Systems, Embry Riddle Aeronautical University, Daytona Beach, FL, USA
| | | | | | | | - Victoria Lew
- Department of Human Factors and Systems, Embry Riddle Aeronautical University, Daytona Beach, FL, USA
| | - Raymond Chan
- Department of Psychology, Children’s Mercy, Kansas City, MI, USA
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Abstract
STATEMENT Simulation has had a major impact in the advancement of healthcare team training and assessment. To date, most simulation-based training and assessments focus on the teamwork behaviors that impact team performance, often ignoring critical cognitive, motivational, and affective team processes. Evidence from team science research demonstrates a strong relationship between team cognition and team performance and suggests a role for simulation in the development of this team-level construct. In this article, we synthesize research from the broader team science literature to provide foundational knowledge regarding team cognition and highlight best practices for using simulation to target team cognition.
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Henrickson Parker S, Schmutz JB, Manser T. Training Needs for Adaptive Coordination: Utilizing Task Analysis to Identify Coordination Requirements in Three Different Clinical Settings. GROUP & ORGANIZATION MANAGEMENT 2018. [DOI: 10.1177/1059601118768022] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
A team’s ability to coordinate and adapt their performance to meet situational demands is critical to excellent patient care. The goal of this article is to identify common coordination characteristics that enable health care action teams to ensure effective patient care and to discuss specific examples of adaptive coordination within the health care setting. Task analyses were conducted to identify situational demands, in three different clinical settings: cardiac anesthesia, pediatric sepsis simulation, and trauma resuscitation. Each task analysis identified specific coordination requirements for pertinent tasks. The research team compared these task analyses, identified emerging themes, and agreed on core coordination characteristics common across all three environments by consensus through iterative abductive analysis. Findings across these diverse clinical settings showed that expert action teams (a) continually appraise their dynamic environment, (b) identify and define points of coordination, and (c) respond to the demands of nonroutine events by making coordination highly explicit. Specific examples of adaptive coordination within the health care setting are discussed, and implications for training are articulated. Findings are also pertinent outside of health care and may contribute to the understanding of coordination behaviors within action teams across multiple settings.
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Affiliation(s)
| | | | - Tanja Manser
- University of Applied Sciences and Arts Northwestern Switzerland, Olten, Switzerland
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48
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Hitchins CR, Metzner M, Edworthy J, Ward C. Non-technical skills and gastrointestinal endoscopy: a review of the literature. Frontline Gastroenterol 2018; 9:129-134. [PMID: 29588841 PMCID: PMC5868447 DOI: 10.1136/flgastro-2016-100800] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2016] [Revised: 02/25/2017] [Accepted: 03/07/2017] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND Non-technical skills (NTS) have gained increasing recognition in recent years for their role in safe, effective team performance in healthcare. Gastrointestinal endoscopy is a procedure-based specialty with rapidly advancing technology, significant operational pressures and rapidly changing 'teams of experts'. However, to date there has been little focus on the effect of NTS in this field. OBJECTIVES This review aims to examine the existing literature on NTS in gastrointestinal endoscopy and identify areas for further research. METHOD A systematic search of MEDLINE, Embase, Cochrane Library, PsychINFO, CINAHL Plus and PubMed databases was performed using search terms Non-Technical Skills, Team Performance or Team Skills, and Endoscopy, Colonoscopy, OGD, Gastroscopy, Endoscopic Retrograde Cholangio-Pancreatography or Endoscopic Ultrasound. RESULTS Eighteen relevant publications were found. NTS are deemed an essential component of practice, but so far there is little evidence of their integration into training or competency assessment. Those studies examining the effects of NTS and team training in endoscopy are small and have variable outcome measures with limited evidence of improvement in skills or clinical outcomes. NTS assessment in endoscopy is in its early phases with a few tools in development. CONCLUSIONS The current literature on NTS in gastrointestinal endoscopy is limited. NTS, however, are deemed an essential component of practice, with potential positive effects on team performance and clinical outcomes. A validated reliable tool would enable evaluation of training and investigation into the effects of NTS on outcomes. There is a clear need for further research in this field.
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Affiliation(s)
- Charlotte R Hitchins
- Department of General Surgery, Plymouth Hospitals NHS Trust, Plymouth, UK,Plymouth University Peninsula Schools of Medicine and Dentistry, Plymouth, UK
| | - Magdalena Metzner
- Plymouth University Peninsula Schools of Medicine and Dentistry, Plymouth, UK,Department of Gastroenterology, Plymouth Hospitals NHS Trust, Plymouth, UK
| | - Judy Edworthy
- Cognition Institute, Plymouth University, Plymouth, UK
| | - Catherine Ward
- Plymouth University Peninsula Schools of Medicine and Dentistry, Plymouth, UK,Department of Anaesthesia, Plymouth Hospitals NHS Trust, Plymouth, UK
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49
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Salas E, Zajac S, Marlow SL. Transforming Health Care One Team at a Time: Ten Observations and the Trail Ahead. GROUP & ORGANIZATION MANAGEMENT 2018. [DOI: 10.1177/1059601118756554] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The present review synthesizes existing evidence and theory on the science of health care teams and health care team training. Ten observations are presented that capture the current state of the science, with applications to both researchers and practitioners. The observations are drawn from a variety of salient sources, including meta-analytic evidence, reviews of health care team training, primary investigations, and the authors’ collective expertise in developing and implementing medical team training. These observations provide insight into the team (e.g., psychological safety) and organizational-level (e.g., culture for teamwork) factors that drive effective health care teamwork, as well as advancements and best practices for designing and implementing team training initiatives (e.g., multilevel measurement). We highlight areas where new knowledge has emerged, and offer directions for future research that will continue to improve our understanding of health care teams in the future.
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Affiliation(s)
| | - Stephanie Zajac
- Rice University, Houston, TX, USA
- The Houston Methodist Institute for Technology, Innovation, and Education (MITIESM) and Department of Surgery, Houston, TX, USA
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50
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Da Dalt L, Parri N, Amigoni A, Nocerino A, Selmin F, Manara R, Perretta P, Vardeu MP, Bressan S. Italian guidelines on the assessment and management of pediatric head injury in the emergency department. Ital J Pediatr 2018; 44:7. [PMID: 29334996 PMCID: PMC5769508 DOI: 10.1186/s13052-017-0442-0] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2017] [Accepted: 12/18/2017] [Indexed: 02/06/2023] Open
Abstract
OBJECTIVE We aim to formulate evidence-based recommendations to assist physicians decision-making in the assessment and management of children younger than 16 years presenting to the emergency department (ED) following a blunt head trauma with no suspicion of non-accidental injury. METHODS These guidelines were commissioned by the Italian Society of Pediatric Emergency Medicine and include a systematic review and analysis of the literature published since 2005. Physicians with expertise and experience in the fields of pediatrics, pediatric emergency medicine, pediatric intensive care, neurosurgery and neuroradiology, as well as an experienced pediatric nurse and a parent representative were the components of the guidelines working group. Areas of direct interest included 1) initial assessment and stabilization in the ED, 2) diagnosis of clinically important traumatic brain injury in the ED, 3) management and disposition in the ED. The guidelines do not provide specific guidance on the identification and management of possible associated cervical spine injuries. Other exclusions are noted in the full text. CONCLUSIONS Recommendations to guide physicians practice when assessing children presenting to the ED following blunt head trauma are reported in both summary and extensive format in the guideline document.
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Affiliation(s)
- Liviana Da Dalt
- Pediatric Emergency Department-Intensive Care Unit, Department of Woman's and Child's Health, University of Padova, Via Giustiniani 2, 35128, Padova, Italy
| | - Niccolo' Parri
- Department of Pediatric Emergency Medicine and Trauma Center, Meyer University Children's Hospital, Florence, Italy
| | - Angela Amigoni
- Pediatric Emergency Department-Intensive Care Unit, Department of Woman's and Child's Health, University of Padova, Via Giustiniani 2, 35128, Padova, Italy
| | - Agostino Nocerino
- Department of Pediatrics, S. Maria della Misericordia University Hospital, University of Udine, Udine, Italy
| | - Francesca Selmin
- Pediatric Emergency Department-Intensive Care Unit, Department of Woman's and Child's Health, University of Padova, Via Giustiniani 2, 35128, Padova, Italy
| | - Renzo Manara
- Department of Radiology, Neuroradiology Unit, University of Salerno, Salerno, Italy
| | - Paola Perretta
- Neurosurgery Unit, Regina Margherita Pediatric Hospital, Torino, Italy
| | - Maria Paola Vardeu
- Pediatric Emergency Department, Regina Margherita Pediatric Hospital, Torino, Italy
| | - Silvia Bressan
- Pediatric Emergency Department-Intensive Care Unit, Department of Woman's and Child's Health, University of Padova, Via Giustiniani 2, 35128, Padova, Italy.
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