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McGuier EA, Feldman J, Bay M, Ascione S, Tatum M, Salas E, Kolko DJ. Improving teamwork in multidisciplinary cross-sector teams: Adaption and pilot testing of a team training for Child Advocacy Center teams. CHILDREN AND YOUTH SERVICES REVIEW 2023; 153:107096. [PMID: 37601235 PMCID: PMC10437145 DOI: 10.1016/j.childyouth.2023.107096] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/22/2023]
Abstract
Background Effective teamwork is critical to the mission of Child Advocacy Center (CAC) multidisciplinary teams. Team interventions designed to fit the unique cross-organizational context of CAC teams may improve teamwork in CACs. Methods A collaborative, community-engaged approach was used to adapt TeamSTEPPS, an evidence-based team training for healthcare, for CAC multidisciplinary teams. The adapted training was piloted with one team and evaluated using mixed methods. Team members completed pre-training (n = 26) and follow-up surveys (n = 22) and participated in qualitative interviews (n = 9). Results The adaptation process resulted in the creation of TeamTRACS (Team Training in Roles, Awareness, Communication, and Support). Participants rated TeamTRACS as highly acceptable, appropriate, feasible, relevant, and useful for CAC teams. They identified positive and negative aspects of the training, ideas for improvement, and future uses for TeamTRACS. Conclusions TeamTRACS is a feasible approach to team training in CACs, and team members find the content and skills relevant and useful. Additional research is needed to test the effectiveness of TeamTRACS and identify appropriate implementation strategies to support its use.
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Affiliation(s)
| | - Jamie Feldman
- Western Psychiatric Hospital, University of Pittsburgh Medical Center
| | - Mikele Bay
- Children’s Advocacy Center of McKean County
| | - Sue Ascione
- Northeast Regional Children’s Advocacy Center
| | - Mary Tatum
- Child Advocacy Center of Clearfield County
| | | | - David J. Kolko
- Department of Psychiatry, University of Pittsburgh School of Medicine
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Svensson J. Patient Safety Strategies in Psychiatry and How They Construct the Notion of Preventable Harm: A Scoping Review. J Patient Saf 2022; 18:245-252. [PMID: 34347739 PMCID: PMC9359776 DOI: 10.1097/pts.0000000000000885] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES The literature on patient safety in psychiatry has not been explored systematically in terms of what interventions are used, how they are used, and what type of (preventable) harm is targeted. The aims of this scoping review are to explore patient safety strategies used in psychiatry and determine how they construct the notion of preventable harm. METHOD A scoping review of literature on patient safety in psychiatry published in English between 2000 and 2019 was conducted using Scopus, MEDLINE, PsycInfo, and CINAHL. Keywords of patient safety strategies and possible outcomes were coded from the results, discussion, or conclusion. Patient safety strategies were inductively categorized into themes according to the focus of the strategy. RESULTS The review introduces 7 focus areas of patient safety strategies identified within the psychiatric literature: "risk management," "healthcare practitioners," "patient observation," "patient involvement," "computerized methods," "admission and discharge," and "security." The result shows that patient safety strategies mainly aim to reduce suicide, self-harm, violence, and falls and present a large diversity of measures, often aimed at reducing variability while increasing standardization. CONCLUSIONS The strategies that are supported in the literature to achieve safer psychiatry mainly arise from linear cause-effect models and rely on staff performance, competence, and compliance. Contemporary safety science acknowledges the performance variability of everyday normal work and sees risk as the dynamic migration of these daily activities. The field of psychiatry has not yet included this view of safety in the strategic actions to reduce preventable harm.
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Affiliation(s)
- Jakob Svensson
- From the Division of Risk Management and Societal Safety, Lund University, Sweden
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Gardner L, Campbell JM, Gilchrest C, McClain MB, Shahidullah JD. Identification of autism spectrum disorder and interprofessional collaboration between school and clinical settings. PSYCHOLOGY IN THE SCHOOLS 2022. [DOI: 10.1002/pits.22673] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Lauren Gardner
- Psychology and Neuropsychology Division Johns Hopkins All Children's Hospital St Petersburg Florida USA
| | - Jonathan M. Campbell
- Department of Psychology Western Carolina University Cullowhee North Carolina USA
| | - Callie Gilchrest
- Psychology and Neuropsychology Division Johns Hopkins All Children's Hospital St Petersburg Florida USA
| | | | - Jeffrey D. Shahidullah
- Department of Psychiatry and Behavioral Sciences The University of Texas at Austin Austin Texas USA
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Hamm B, Pozuelo L, Brendel R. General Hospital Agitation Management Under the Lens of Leadership Theory and Health Care Team Best Practices Using TeamSTEPPS. J Acad Consult Liaison Psychiatry 2021; 63:213-224. [PMID: 34793998 DOI: 10.1016/j.jaclp.2021.10.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2021] [Revised: 10/17/2021] [Accepted: 10/30/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND Acute agitation management is an emergency clinical intervention, often presenting acute danger to patients and medical staff. Unlike many other emergency clinical interventions, acute agitation management lacks a substantial evidence base regarding leadership and teamwork best practices. The Team Strategies and Tools to Enhance Performance and Patient Safety (TeamSTEPPS) framework is a comprehensive strategy for improving health care outcomes in acute clinical situations. OBJECTIVE Practical application of TeamSTEPPS frameworks in team-based acute agitation management in the medical setting. METHODS A literature review was performed from January 1990 to March 2021 for verbal de-escalation in acute agitation management, leadership and teamwork in psychiatry and medicine, and TeamSTEPPS. RESULTS No literature was found that applied TeamSTEPPS for acute agitation management in the general medical unit context although limited application has been trialed in the inpatient psychiatric context. The verbal de-escalation literature describes applicable content including conflict management approaches, communication strategies, security presence management, modeling therapeutic behavior, and debriefing strategies. Several articles were found regarding a rapid response team model for acute agitation management and describing handoff tools in psychiatric care contexts. Translation of the TeamSTEPPS approach provided many additional approaches for operation of a rapid response team in acute agitation management. CONCLUSIONS The leadership and teamwork best practices in TeamSTEPPS provide a clear and actionable framework for team-based acute agitation management as an emergency clinical intervention.
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Affiliation(s)
- Brandon Hamm
- Department of Psychiatry & Behavioral Neuroscience, Northwestern University, Chicago, IL.
| | | | - Rebecca Brendel
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA
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Improving Team Performance and Patient Safety on the Job Through Team Training and Performance Support Tools: A Systematic Review. J Patient Saf 2021; 16:S48-S56. [PMID: 32810001 PMCID: PMC7447186 DOI: 10.1097/pts.0000000000000746] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Introduction Efforts to improve teamwork in health care have received considerable attention. The current systematic review was conducted to identify recent studies that implemented practices to improve teamwork and were associated with positive improvements on the job. Methods Electronic searches of 2 databases (i.e., CINAHL and MEDLINE) were conducted to identify relevant articles published between 2008 and 2018. Results Twenty articles were selected for inclusion in this review. The studies most often used quasiexperimental designs and interventions were applied in a variety of hospital settings including labor and delivery, operating rooms, and emergency departments. Across studies, measures assessing teamwork skills on the job were most often collected and showed sustained improvements up to 12 months. Moreover, evidence of improved clinical processes (e.g., compliance with guidelines and efficiency) and increased patient safety (e.g., reduction in adverse events) was found in both studies of team training interventions, as well as in those that introduced performance support tools (e.g., checklist). Conclusions The results of the current review are consistent with previous research and add to the evidence base on the practices to improve teamwork within hospital settings. Although efforts to improve teamwork have spread to other health care settings such as office-based care, published studies are lagging behind.
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Kuriyan A, Kinkler G, Cidav Z, Kang-Yi C, Eiraldi R, Salas E, Wolk CB. Team Strategies and Tools to Enhance Performance and Patient Safety (TeamSTEPPS) to Improve Collaboration in School Mental Health: Protocol for a Mixed Methods Hybrid Effectiveness-Implementation Study. JMIR Res Protoc 2021; 10:e26567. [PMID: 33555258 PMCID: PMC7899798 DOI: 10.2196/26567] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Accepted: 01/04/2021] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Public schools in the United States are the main providers of mental health services to children but are often ill equipped to provide quality mental health care, especially in low-income urban communities. Schools often rely on partnerships with community organizations to provide mental health services to students. However, collaboration and communication challenges often hinder implementation of evidence-based mental health strategies. Interventions informed by team science, such as Team Strategies and Tools to Enhance Performance and Patient Safety (TeamSTEPPS), have the potential to improve treatment implementation and collaboration within schools. OBJECTIVE The objective of this study is to improve communication and collaboration strategies among mental health and school staff by adapting an evidence-based team science intervention for school settings. We present a protocol for a hybrid effectiveness-implementation study to adapt TeamSTEPPS using stakeholder feedback, develop a tailored implementation plan, and pilot the adapted content in eight schools. METHODS Study participants will be recruited from public and charter schools and agencies overseeing school mental health services in the local metro area. We will characterize current services by conducting a needs assessment including stakeholder interviews, observations, and review of administrative data. Thereafter, we will establish an advisory board to understand challenges and develop possible solutions to guide additional TeamSTEPPS adaptations along with a complementary implementation plan. In aim 3, we will implement the adapted TeamSTEPPS plus tailored implementation strategies in eight schools using a pre-post design. The primary outcome measures include the feasibility and acceptability of the adapted TeamSTEPPS. In addition, self-report measures of interprofessional collaboration and teamwork will be collected from 80 participating mental health and school personnel. School observations will be conducted prior to and at three time points following the intervention along with stakeholder interviews. The analysis plan includes qualitative, quantitative, and mixed methods analysis of feasibility and acceptability, school observations, stakeholder interviews, and administrative data of behavioral health and school outcomes for students receiving mental health services. RESULTS Recruitment for the study has begun. Goals for aim 1 are expected to be completed in Spring 2021. CONCLUSIONS This study utilizes team science to improve interprofessional collaboration among school and mental health staff and contributes broadly to the team science literature by developing and specifying implementation strategies to promote sustainability. Results from this study will provide knowledge about whether interventions to improve school culture and climate can ready both mental health and school systems for implementation of evidence-based mental health practices. TRIAL REGISTRATION ClinicalTrials.gov NCT04440228; https://clinicaltrials.gov/ct2/show/NCT04440228. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/26567.
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Affiliation(s)
- Aparajita Kuriyan
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States
| | - Grace Kinkler
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States
| | - Zuleyha Cidav
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States
- Leonard Davis Institute for Health Economics, University of Pennsylvania, Philadelphia, PA, United States
| | - Christina Kang-Yi
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States
- Leonard Davis Institute for Health Economics, University of Pennsylvania, Philadelphia, PA, United States
| | - Ricardo Eiraldi
- Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States
- Department of Child and Adolescent Psychiatry and Behavioral Sciences, Children's Hospital of Philadelphia, Philadelphia, PA, United States
| | - Eduardo Salas
- Department of Psychological Sciences, Rice University, Houston, TX, United States
| | - Courtney Benjamin Wolk
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States
- Leonard Davis Institute for Health Economics, University of Pennsylvania, Philadelphia, PA, United States
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Haefner J, Dunn I, McFarland M. A Quality Improvement Project Using Verbal De-Escalation to Reduce Seclusion and Patient Aggression in an Inpatient Psychiatric Unit. Issues Ment Health Nurs 2021; 42:138-144. [PMID: 32749904 DOI: 10.1080/01612840.2020.1789784] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
The use of seclusion is controversial and has been deemed an encroachment on human rights and dignity which can cause psychological trauma and physical injury to patients in the psychiatric setting. This quality improvement project used a quasi-experimental design to implement the TeamSTEPPS educational program, an evidenced-based program to inform nurses about verbal de-escalation to reduce patient aggressive behavior that can lead to patient seclusion. The targeted patient population included all patients admitted 2 months prior to initiation of Team STEPPS (n = 388) and 2 months following completion of the education modules (n = 342). After the implementation of the educational program there was a statistically significant difference in the rate of charting aggressive behavior (p = 0.024). The pre rate was 17.3%, and the post rate was 11.4%. While there was not a statistically significant difference in the rate of seclusion events, (p = 0.349) there was a clinically significant reduction. The pre rate was 5.9%, and the post rate was 4.4%. The results of this study support the importance of educating psychiatric nurses on verbal-de-escalation to reduce patients placed in seclusion and decrease patients' aggressive behavior in the psychiatric settings.
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Affiliation(s)
- Judy Haefner
- School of Nursing, University of Michigan Flint, Flint, Michigan, USA
| | | | - Marilyn McFarland
- School of Nursing, University of Michigan Flint, Flint, Michigan, USA
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Wolk CB, Locke J, Salas E, Eiraldi R, Cronholm PF, Mandell D. An examination of the factor structure of TeamSTEPPS measures in school mental health teams. JOURNAL OF PSYCHOLOGISTS AND COUNSELLORS IN SCHOOLS 2020; 30:172-184. [PMID: 33777407 PMCID: PMC7995600 DOI: 10.1017/jgc.2019.18] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/14/2023]
Abstract
Team Strategies and Tools to Enhance Performance and Patient Safety (TeamSTEPPS™) is a tested strategy for improving communication and climate in hospitals. It is a promising but untested tool among school-based mental health teams. We examined the psychometric properties of the TeamSTEPPS Teamwork Perceptions Questionnaire (T-TPQ) and Teamwork Attitudes Questionnaire (T-TAQ) among 167 school mental health team members. Team members worked for one of five agencies in 33 K-8 urban public schools. Exploratory factor analyses and descriptive data are presented. For both the T-TPQ and T-TAQ, a unitary factor structure best fit the data for this sample. The T-TPQ and T-TAQ were not significantly correlated with one another and total scores did not significantly differ by staff role. Agencies differed in T-TAQ results, and one agency had lower T-TAQ total scores relative to other agencies. Results suggest that the factor structures are different among school mental health teams than among other healthcare providers.
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Affiliation(s)
- Courtney Benjamin Wolk
- Center for Mental Health Policy and Services Research, Perelman School of Medicine, University of Pennsylvania. 3535 Market Street, Floor 3, Philadelphia, PA 19104
- Corresponding author Phone: 215-746-6099; Fax: 215-349-8715
| | - Jill Locke
- Department of Speech and Hearing Sciences, University of Washington. 1701 NE Columbia Road, Seattle, WA 98195
| | - Eduardo Salas
- Department of Psychology, Rice University. P.O. Box 1892, Houston, TX 77251
| | - Ricardo Eiraldi
- Division of Developmental and Behavioral Pediatrics, Perelman School of Medicine, University of Pennsylvania, 2716 South Street, 8th floor, Philadelphia, PA 19146
| | - Peter F. Cronholm
- Department of Family Medicine and Community Health, University of Pennsylvania, 51 North 39th Street, 6th Floor Mutch Bld, Philadelphia, PA 19104
| | - David Mandell
- Center for Mental Health Policy and Services Research, Perelman School of Medicine, University of Pennsylvania. 3535 Market Street, Floor 3, Philadelphia, PA 19104
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Buljac-Samardzic M, Doekhie KD, van Wijngaarden JDH. Interventions to improve team effectiveness within health care: a systematic review of the past decade. HUMAN RESOURCES FOR HEALTH 2020; 18:2. [PMID: 31915007 PMCID: PMC6950792 DOI: 10.1186/s12960-019-0411-3] [Citation(s) in RCA: 161] [Impact Index Per Article: 40.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/14/2019] [Accepted: 09/05/2019] [Indexed: 05/19/2023]
Abstract
BACKGROUND A high variety of team interventions aims to improve team performance outcomes. In 2008, we conducted a systematic review to provide an overview of the scientific studies focused on these interventions. However, over the past decade, the literature on team interventions has rapidly evolved. An updated overview is therefore required, and it will focus on all possible team interventions without restrictions to a type of intervention, setting, or research design. OBJECTIVES To review the literature from the past decade on interventions with the goal of improving team effectiveness within healthcare organizations and identify the "evidence base" levels of the research. METHODS Seven major databases were systematically searched for relevant articles published between 2008 and July 2018. Of the original search yield of 6025 studies, 297 studies met the inclusion criteria according to three independent authors and were subsequently included for analysis. The Grading of Recommendations, Assessment, Development, and Evaluation Scale was used to assess the level of empirical evidence. RESULTS Three types of interventions were distinguished: (1) Training, which is sub-divided into training that is based on predefined principles (i.e. CRM: crew resource management and TeamSTEPPS: Team Strategies and Tools to Enhance Performance and Patient Safety), on a specific method (i.e. simulation), or on general team training. (2) Tools covers tools that structure (i.e. SBAR: Situation, Background, Assessment, and Recommendation, (de)briefing checklists, and rounds), facilitate (through communication technology), or trigger (through monitoring and feedback) teamwork. (3) Organizational (re)design is about (re)designing structures to stimulate team processes and team functioning. (4) A programme is a combination of the previous types. The majority of studies evaluated a training focused on the (acute) hospital care setting. Most of the evaluated interventions focused on improving non-technical skills and provided evidence of improvements. CONCLUSION Over the last decade, the number of studies on team interventions has increased exponentially. At the same time, research tends to focus on certain interventions, settings, and/or outcomes. Principle-based training (i.e. CRM and TeamSTEPPS) and simulation-based training seem to provide the greatest opportunities for reaching the improvement goals in team functioning.
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Affiliation(s)
- Martina Buljac-Samardzic
- Erasmus School of Health Policy & Management, Erasmus University Rotterdam, Bayle building, p.o. box 1738, 3000 DR Rotterdam, The Netherlands
| | - Kirti D. Doekhie
- Erasmus School of Health Policy & Management, Erasmus University Rotterdam, Bayle building, p.o. box 1738, 3000 DR Rotterdam, The Netherlands
| | - Jeroen D. H. van Wijngaarden
- Erasmus School of Health Policy & Management, Erasmus University Rotterdam, Bayle building, p.o. box 1738, 3000 DR Rotterdam, The Netherlands
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Wolk CB, Stewart RE, Cronholm P, Eiraldi R, Salas E, Mandell DS. Adapting TeamSTEPPS for school mental health teams: a pilot study. Pilot Feasibility Stud 2020; 5:148. [PMID: 31890260 PMCID: PMC6918659 DOI: 10.1186/s40814-019-0529-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2018] [Accepted: 11/12/2019] [Indexed: 10/29/2022] Open
Abstract
Background School mental health care often is provided by teams contracted from community mental health agencies. The team members that provide this care, however, do not typically receive training in how to work effectively in a team-based context. Team Strategies and Tools to Enhance Performance and Patient Safety (TeamSTEPPS) provides a promising, evidence-based strategy for improving communication and climate in school-based teams. Methods In collaboration with stakeholders, we adapted and piloted TeamSTEPPS for use with school mental health teams. Teams in six schools were randomized to receive the adapted TeamSTEPPS approach or usual supports. The main outcomes of interest were feasibility and acceptability of the adapted TeamSTEPPS strategy. Results Results indicated that team member burnout was significantly higher at follow-up than pretreatment for both control and intervention teams. TeamSTEPPS was feasible and acceptable to implement, and leadership emerged as an important facilitator. Barriers to implementation success included staff turnover, lack of resources, and challenges in the school mental health team relationship. Additional supports to implement TeamSTEPPS were suggested, including ongoing consultation and booster training to address high staff turnover. Conclusions Results suggest that TeamSTEPPS is promising for school mental health teams but additional modifications are likely needed.
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Affiliation(s)
- Courtney Benjamin Wolk
- 1Center for Mental Health Policy and Services Research, Perelman School of Medicine, University of Pennsylvania, 3535 Market Street, Floor 3, Philadelphia, PA 19104 USA
| | - Rebecca E Stewart
- 1Center for Mental Health Policy and Services Research, Perelman School of Medicine, University of Pennsylvania, 3535 Market Street, Floor 3, Philadelphia, PA 19104 USA
| | - Peter Cronholm
- 2Department of Family Medicine and Community Health and Center for Public Health Initiatives, University of Pennsylvania, 51 North 39th Street, 6th Floor Mutch Bld, Philadelphia, PA 19104 USA
| | - Ricardo Eiraldi
- 3Division of Developmental and Behavioral Pediatrics and Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, 2716 South Street, 8th floor, Philadelphia, PA 19146 USA
| | - Eduardo Salas
- 4Department of Psychological Sciences, Rice University, P.O. Box 1892, Houston, TX 77251 USA
| | - David S Mandell
- 1Center for Mental Health Policy and Services Research, Perelman School of Medicine, University of Pennsylvania, 3535 Market Street, Floor 3, Philadelphia, PA 19104 USA
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Thibaut B, Dewa LH, Ramtale SC, D'Lima D, Adam S, Ashrafian H, Darzi A, Archer S. Patient safety in inpatient mental health settings: a systematic review. BMJ Open 2019; 9:e030230. [PMID: 31874869 PMCID: PMC7008434 DOI: 10.1136/bmjopen-2019-030230] [Citation(s) in RCA: 46] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
OBJECTIVES Patients in inpatient mental health settings face similar risks (eg, medication errors) to those in other areas of healthcare. In addition, some unsafe behaviours associated with serious mental health problems (eg, self-harm), and the measures taken to address these (eg, restraint), may result in further risks to patient safety. The objective of this review is to identify and synthesise the literature on patient safety within inpatient mental health settings using robust systematic methodology. DESIGN Systematic review and meta-synthesis. Embase, Cumulative Index to Nursing and Allied Health Literature, Health Management Information Consortium, MEDLINE, PsycINFO and Web of Science were systematically searched from 1999 to 2019. Search terms were related to 'mental health', 'patient safety', 'inpatient setting' and 'research'. Study quality was assessed using the Hawker checklist. Data were extracted and grouped based on study focus and outcome. Safety incidents were meta-analysed where possible using a random-effects model. RESULTS Of the 57 637 article titles and abstracts, 364 met inclusion criteria. Included publications came from 31 countries and included data from over 150 000 participants. Study quality varied and statistical heterogeneity was high. Ten research categories were identified: interpersonal violence, coercive interventions, safety culture, harm to self, safety of the physical environment, medication safety, unauthorised leave, clinical decision making, falls and infection prevention and control. CONCLUSIONS Patient safety in inpatient mental health settings is under-researched in comparison to other non-mental health inpatient settings. Findings demonstrate that inpatient mental health settings pose unique challenges for patient safety, which require investment in research, policy development, and translation into clinical practice. PROSPERO REGISTRATION NUMBER CRD42016034057.
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Affiliation(s)
- Bethan Thibaut
- NIHR Imperial Patient Safety Tranlsational Research Centre, Department of Surgery and Cancer, Imperial College London, London, UK
| | - Lindsay Helen Dewa
- NIHR Imperial Patient Safety Tranlsational Research Centre, Department of Surgery and Cancer, Imperial College London, London, UK
| | - Sonny Christian Ramtale
- NIHR Imperial Patient Safety Tranlsational Research Centre, Department of Surgery and Cancer, Imperial College London, London, UK
| | - Danielle D'Lima
- Centre for Behaviour Change, Department of Clinical, Educational and Health Psychology, University College London, London, UK
| | - Sheila Adam
- NIHR Imperial Patient Safety Tranlsational Research Centre, Department of Surgery and Cancer, Imperial College London, London, UK
| | - Hutan Ashrafian
- NIHR Imperial Patient Safety Tranlsational Research Centre, Department of Surgery and Cancer, Imperial College London, London, UK
| | - Ara Darzi
- NIHR Imperial Patient Safety Tranlsational Research Centre, Department of Surgery and Cancer, Imperial College London, London, UK
| | - Stephanie Archer
- NIHR Imperial Patient Safety Tranlsational Research Centre, Department of Surgery and Cancer, Imperial College London, London, UK
- Department of Public Health and Primary Care, University of Cambridge, Cambridge, Cambridgeshire, UK
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Hoplock LB, Lobchuk MM. Are perspective-taking outcomes always positive? Challenges and mitigation strategies. Nurs Forum 2019; 55:177-181. [PMID: 31724743 DOI: 10.1111/nuf.12413] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND Engaging in perspective-taking often has positive outcomes for both healthcare providers and patients. Perspective-taking by healthcare providers has been linked to increased patient satisfaction and compliance, patients' positive perceptions of healthcare providers' interpersonal skills, and a reduction in judgmental attitudes toward individuals who engage in health-risk behaviors. The positive outcomes that are associated with perspective-taking are often highlighted in the literature. However, less discussed are the negative outcomes. AIM This paper discusses the positive and negative outcomes associated with perspective-taking and presents potential methods for mitigating negative outcomes. CONCLUSION When designing and implementing perspective-taking interventions, educators and researchers should consider potential negative intervention outcomes and strategies to attenuate these outcomes.
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Affiliation(s)
- Lisa B Hoplock
- Rady Faculty of Health Sciences, College of Nursing, University of Manitoba, Winnipeg, Canada
| | - Michelle M Lobchuk
- Rady Faculty of Health Sciences, College of Nursing, University of Manitoba, Winnipeg, Canada
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Wolk CB, Stewart RE, Eiraldi R, Cronholm P, Salas E, Mandell DS. The implementation of a team training intervention for school mental health: Lessons learned. Psychotherapy (Chic) 2019; 56:83-90. [PMID: 30489095 PMCID: PMC6395502 DOI: 10.1037/pst0000179] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Children obtain more mental health services through schools than through any other system. In urban, low-resource schools, mental health care often is provided by teams of contracted community mental health workers. Implementation of intended services may struggle in the context of challenges related to team functioning. Team Strategies and Tools to Enhance Performance and Patient Safety (TeamSTEPPS) is an efficacious approach for improving team functioning in health care. In collaboration with stakeholders, we adapted TeamSTEPPS for school mental health teams and pilot-tested it in 3 schools participating in an ongoing implementation of cognitive-behavioral therapy. In total, 3 teams randomized to receive TeamSTEPPS were compared with 3 teams who did not participate in TeamSTEPPS. Feasibility and acceptability of the adapted TeamSTEPPS and the impact on team skills and behavior were assessed through qualitative interviews and field notes and quantitatively over the course of 1 school year. In this article, we describe the process of adapting and implementing TeamSTEPPS. In addition to providing the researchers' perspective, we illustrate participant perspectives using qualitative data when possible. Key challenges included leader and staff turnover, logistical barriers (e.g., difficulty securing private space for qualitative interviews in schools), and navigating the protection of participant rights and autonomy given that prospective participants were employed by an agency with a vested interest in their participation. Concrete suggestions for overcoming challenges are provided to guide future research. (PsycINFO Database Record (c) 2019 APA, all rights reserved).
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Affiliation(s)
- Courtney Benjamin Wolk
- Center for Mental Health Policy and Services Research, Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania
| | - Rebecca E Stewart
- Center for Mental Health Policy and Services Research, Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania
| | - Ricardo Eiraldi
- Division of Developmental and Behavioral Pediatrics, Perelman School of Medicine, University of Pennsylvania
| | - Peter Cronholm
- Department of Family Medicine and Community Health, University of Pennsylvania
| | | | - David S Mandell
- Center for Mental Health Policy and Services Research, Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania
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Delaney KR. How can nurses reclaim the inpatient research agenda? JOURNAL OF CHILD AND ADOLESCENT PSYCHIATRIC NURSING 2018; 31:4-5. [PMID: 30230141 DOI: 10.1111/jcap.12208] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/22/2018] [Indexed: 11/28/2022]
Affiliation(s)
- Kathleen R Delaney
- Department of Community Mental Health and Systems, Rush College of Nursing, Chicago, Illinois
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Miller CJ, Kim B, Silverman A, Bauer MS. A systematic review of team-building interventions in non-acute healthcare settings. BMC Health Serv Res 2018; 18:146. [PMID: 29490664 PMCID: PMC5831839 DOI: 10.1186/s12913-018-2961-9] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2017] [Accepted: 02/21/2018] [Indexed: 11/17/2022] Open
Abstract
Background Healthcare is increasingly delivered in a team-based format emphasizing interdisciplinary coordination. While recent reviews have investigated team-building interventions primarily in acute healthcare settings (e.g. emergency or surgery departments), we aimed to systematically review the evidence base for team-building interventions in non-acute settings (e.g. primary care or rehabilitation clinics). Methods We conducted a systematic review in PubMed and Embase to identify team-building interventions, and conducted follow-up literature searches to identify articles describing empirical studies of those interventions. This process identified 14 team-building interventions for non-acute healthcare settings, and 25 manuscripts describing empirical studies of these interventions. We evaluated outcomes in four domains: trainee evaluations, teamwork attitudes/knowledge, team functioning, and patient impact. Results Trainee evaluations for team-building interventions were generally positive, but only one study associated team-building with statistically significant improvement in teamwork attitudes/knowledge. Similarly mixed results emerged for team functioning and patient impact. Conclusions The evidence base for healthcare team-building interventions in non-acute healthcare settings is much less developed than the parallel literature for short-term team function in acute care settings. Only one intervention we identified has been tested in multiple non-acute settings by distinct research teams. Positive findings regarding the utility of team-building interventions are tempered by a lack of control conditions, inconsistency in outcome measures, and high probability of bias. Considering these results alongside the well-recognized costs of poor healthcare teamwork suggests that additional research is sorely needed to develop the evidence base for team-building in non-acute settings.
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Affiliation(s)
- Christopher J Miller
- Center for Healthcare Organization and Implementation Research (CHOIR), VA Boston Healthcare System (152M), 150 South Huntington Avenue, Boston, MA, 02130, USA. .,Harvard Medical School, Department of Psychiatry, Boston, USA.
| | - Bo Kim
- Center for Healthcare Organization and Implementation Research (CHOIR), VA Boston Healthcare System (152M), 150 South Huntington Avenue, Boston, MA, 02130, USA.,Harvard Medical School, Department of Psychiatry, Boston, USA
| | - Allie Silverman
- Center for Healthcare Organization and Implementation Research (CHOIR), VA Boston Healthcare System (152M), 150 South Huntington Avenue, Boston, MA, 02130, USA
| | - Mark S Bauer
- Center for Healthcare Organization and Implementation Research (CHOIR), VA Boston Healthcare System (152M), 150 South Huntington Avenue, Boston, MA, 02130, USA.,Harvard Medical School, Department of Psychiatry, Boston, USA
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Utility of an integrated electronic suicide alert system in a psychiatric hospital. Qual Manag Health Care 2016; 24:79-83. [PMID: 25830616 DOI: 10.1097/qmh.0000000000000053] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Management of suicide-related behaviors in a hospital is challenging. This article (1) describes integration of an electronic suicide risk notification system to improve assessment of psychiatric inpatients, (2) details the manner in which these alerts complement standard of care, and (3) provides support of using aggregate data to inform administrative decision-making. Complementing routine clinical care and under the supervision of an assessment coordinator, adult inpatients at a specialty psychiatric hospital complete a computerized battery of outcome assessments throughout the course of their hospitalization. A critical-item response notification system for suicide-related behaviors was implemented within the larger, assessment architecture, sending an alert e-mail to unit staff if patients endorsed suicidal ideation on any 1 of 6 critical items. Analysis of aggregate data over a 19-month period reveal a linear trend of increasing rate of suicide alerts from October 2012 to April 2013 (Phase A) with a stabilization at the heightened level from July 2013 to April 2014 (Phase B), R = 0.697, P = .007. Findings suggest that more nuanced training in the management of suicide-related behavior may be necessary and that traditional approaches to staffing may need to accommodate patient acuity. The communication innovation of this system is in line with the Joint Commission's emphasis on designing and implementing patient-centered systems that enhance quality of care, including improved safety.
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Verbeek-van Noord I, de Bruijne MC, Zwijnenberg NC, Jansma EP, van Dyck C, Wagner C. Does classroom-based Crew Resource Management training improve patient safety culture? A systematic review. SAGE Open Med 2014; 2:2050312114529561. [PMID: 26770720 PMCID: PMC4607184 DOI: 10.1177/2050312114529561] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2013] [Accepted: 03/05/2014] [Indexed: 12/13/2022] Open
Abstract
AIM To evaluate the evidence of the effectiveness of classroom-based Crew Resource Management training on safety culture by a systematic review of literature. METHODS Studies were identified in PubMed, Cochrane Library, PsycINFO, and Educational Resources Information Center up to 19 December 2012. The Methods Guide for Comparative Effectiveness Reviews was used to assess the risk of bias in the individual studies. RESULTS In total, 22 manuscripts were included for review. Training settings, study designs, and evaluation methods varied widely. Most studies reporting only a selection of culture dimensions found mainly positive results, whereas studies reporting all safety culture dimensions of the particular survey found mixed results. On average, studies were at moderate risk of bias. CONCLUSION Evidence of the effectiveness of Crew Resource Management training in health care on safety culture is scarce and the validity of most studies is limited. The results underline the necessity of more valid study designs, preferably using triangulation methods.
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Affiliation(s)
- Inge Verbeek-van Noord
- Department of Public and Occupational Health, EMGO Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands
| | - Martine C de Bruijne
- Department of Public and Occupational Health, EMGO Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands
| | | | - Elise P Jansma
- Medical Library, VU University Amsterdam, Amsterdam, The Netherlands
| | - Cathy van Dyck
- Department of Organization Sciences, VU University Amsterdam, Amsterdam, The Netherlands
| | - Cordula Wagner
- Department of Public and Occupational Health, EMGO Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands
- NIVEL, Netherlands Institute for Health Services Research, Utrecht, The Netherlands
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