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Kennedy-Metz LR, Barbeito A, Dias RD, Zenati MA. Importance of high-performing teams in the cardiovascular intensive care unit. J Thorac Cardiovasc Surg 2022; 163:1096-1104. [PMID: 33931232 PMCID: PMC8481338 DOI: 10.1016/j.jtcvs.2021.02.098] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Revised: 02/22/2021] [Accepted: 02/23/2021] [Indexed: 12/14/2022]
Affiliation(s)
- Lauren R. Kennedy-Metz
- Department of Surgery, Harvard Medical School, Boston, Mass,Division of Cardiac Surgery, VA Boston Healthcare System, Boston, Mass
| | - Atilio Barbeito
- Anesthesiology Service, Durham VA Health Care System, Durham, NC,Department of Anesthesiology, Duke University, Durham, NC
| | - Roger D. Dias
- Department of Emergency Medicine, Harvard Medical School, Boston, Mass
| | - Marco A. Zenati
- Department of Surgery, Harvard Medical School, Boston, Mass,Division of Cardiac Surgery, VA Boston Healthcare System, Boston, Mass
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Dynamo et COVID-19 : comment l’hôpital peut contribuer au flux sortant des patients ? MÉDECINE DE CATASTROPHE - URGENCES COLLECTIVES 2022. [PMCID: PMC8433039 DOI: 10.1016/j.pxur.2021.09.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/04/2022]
Abstract
La pandémie COVID-19 a inscrit l’hôpital au cœur d’une crise sanitaire de cinétique longue. Un des enjeux majeurs est d’éviter la saturation du système, notamment l’accessibilité à la réanimation. À la demande de la cellule de crise du groupe hospitalier AP–HP Sorbonne Université, une cellule spécifique nommée « Dynamo » s’est montée au cours de la 1re vague et a apporté des solutions innovantes pour libérer des places en réanimation. La cellule avec l’accord du directeur médical de crise, a ouvert un flux entre les réanimations expertes et des unités nouvelles de réanimation. Initialement la cellule « Dynamo » a géré complètement les transferts des réanimations demandeuses vers les sites d’accueil en Île-de-France en médicalisant et armant des ambulances privées avec les moyens humains et matériels d’AP–HP Sorbonne Université. Dans un second temps, la cellule s’est mise à disposition du Samu zonal afin de trouver des patients éligibles aux transferts inter-régionaux (train, avion, hélicoptère). Au cours de la 1re vague, « Dynamo » a reçu 149 demandes de transferts des réanimations de AP–HP Sorbonne Université entre le 27 mars et le 20 avril 2020. Cent cinq demandes ont été honorées, dont 91 de manière totalement autonome. Concernant les transferts en autonomie les équipes médicales étaient composées d’un MIR (médecin intensif réanimateur), d’un MAR (médecin anesthésiste-réanimateur) ou d’un réanimateur pédiatrique associé à un aide le plus souvent chirurgien. Le matériel de transport était fourni par la réanimation de départ. L’équipe constituée était accompagnée de deux ambulanciers privés. La cellule « Dynamo » a été réactivée pour la 3e vague. La typologie de patients modifiés, une épidémie différente dans ses caractéristiques et décisions politiques, le choix des proches n’ont pas permis de montrer autant d’efficacité.
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Dryver E, Knutsson J, Ekelund U, Bergenfelz A. Impediments to and impact of checklists on performance of emergency interventions in primary care: an in situ simulation-based randomized controlled trial. Scand J Prim Health Care 2021; 39:438-447. [PMID: 34515607 PMCID: PMC8725847 DOI: 10.1080/02813432.2021.1973250] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
OBJECTIVE Medical crises occur rather seldom in the primary care setting, but when they do, initial management impacts on morbidity and mortality. Factors that impede the performance of emergency interventions in primary care have not been studied through in-situ simulation. Checklists reportedly improve crisis management. DESIGN This randomized controlled trial evaluated emergency intervention performance during two scenarios (hypoglycemia-coma and anaphylaxis-cardiac arrest) simulated at primary care centers, and whether checklist access improved performance. SETTING Twenty-two primary care centers in Southern Sweden participated in the study. SUBJECTS A total of 347 personnel performed 100 simulations, 45 with and 55 without checklist access. MAIN OUTCOME MEASURES Time and impediments to performance of five emergency interventions in each scenario. RESULTS On 28 of the 37 occasions when the adrenalin auto-injector was employed, the administration technique was incorrect. In 9 of 49 scenarios, teams had trouble locating the 30% glucose solution. Median time to supplemental oxygen administration during the first scenario was 186 s compared with 96 s during the second scenario (p < 0.001). Checklist access had no significant impact on time to performance of emergency interventions, aside from shorter time to adequate glucose or glucagon administration (median times 632 s with, 756 s without checklist access; p = 0.03). CONCLUSION Unfamiliarity with local emergency equipment impedes the performance of emergency interventions during crises simulated in the primary care setting. Simply providing checklist access does not improve the performance of emergency interventions.KEY POINTSLittle is known about the factors that affect the performance of emergency interventions in the primary care setting.Unfamiliarity with local emergency equipment impedes the performance of emergency interventions during crises simulated in the primary care setting.Simply providing crisis checklist access does not improve the performance of emergency interventions in the primary care setting.
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Affiliation(s)
- Eric Dryver
- Department of Emergency and Internal Medicine, Skåne University Hospital at Lund, Lund, Sweden
- Department of Clinical Sciences at Lund (IKVL), Lund University, Lund, Sweden
- Practicum Clinical Skills Centre, Office for Medical Services, Region Skåne, Sweden
- CONTACT Eric Dryver Department of Emergency Medicine, Skåne's University Hospital, Lund22185, Sweden
| | - Jeanette Knutsson
- Practicum Clinical Skills Centre, Office for Medical Services, Region Skåne, Sweden
| | - Ulf Ekelund
- Department of Emergency and Internal Medicine, Skåne University Hospital at Lund, Lund, Sweden
- Department of Clinical Sciences at Lund (IKVL), Lund University, Lund, Sweden
| | - Anders Bergenfelz
- Department of Clinical Sciences at Lund (IKVL), Lund University, Lund, Sweden
- Practicum Clinical Skills Centre, Office for Medical Services, Region Skåne, Sweden
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Rosato L, Lavorini E, Balzi D, Mondini G, Panier Suffat L. Morbidity and mortality analysis in general surgery operations. Is there any room for improvement? Minerva Surg 2021; 77:229-236. [PMID: 34160169 DOI: 10.23736/s2724-5691.21.08737-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND The aim of this work is to examine the performance of surgeries, by evaluating the results. The evaluation of the results, with particular attention to complications, is the corner stone to identify the causes leading to correction of any predisposing factors and reducing risks, to improve quality of care. METHODS We performed a retrospective analysis of 952 consecutive patients who had elective or emergency surgery from November 1, 2018 to October 31, 2019. We classified surgical intervention according to their complexity. The Clavien Dindo classification was used to categorize the complications. We performed a stepwise multivariate logistic-regression analysis, with the presence of post-operative complications as dependent variable and age, gender, BMI, ASA, type of surgery procedures, complexity of surgery, operative time as covariates. RESULTS A total of 952 surgical procedures were included in this study. Abdominal procedures were the most frequent type of surgery performed (52.1%). Post-operative complications occurred in 120 surgical procedures (12.6%), these are related to the increase of the ASA score and the longer average operative time, with an increase of developing complication of 5% for each additional 10 minutes of surgery. CONCLUSIONS many factors influence postoperative morbidity and mortality. Particular attention was due to complication's evaluation, about all in abdominal surgery and high complexity procedures. We argue that key factors which influence the favourable surgical outcome are: compliance with standardized safety procedures, volume of activity of the structure, presence of interdisciplinary care groups, and ability of health professionals in recognizing and promptly treating complications.
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Affiliation(s)
- Lodovico Rosato
- General Surgical Unit, Oncology and Surgery Departments ASL TO4 Piedmont Region, Ivrea Hospital, School of Medicine, University of Turin, Ivrea, Turin, Italy
| | - Eugenia Lavorini
- General Surgical Unit, Oncology and Surgery Departments ASL TO4 Piedmont Region, Ivrea Hospital, School of Medicine, University of Turin, Ivrea, Turin, Italy
| | - Daniela Balzi
- Epidemiology Unit, AUSL Tuscany Center, Florence, Italy
| | - Guido Mondini
- General Surgical Unit, Oncology and Surgery Departments ASL TO4 Piedmont Region, Ivrea Hospital, Ivrea, Turin, Italy -
| | - Luca Panier Suffat
- General Surgical Unit, Oncology and Surgery Departments ASL TO4 Piedmont Region, Ivrea Hospital, Ivrea, Turin, Italy
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Dryver E, Lundager Forberg J, Hård Af Segerstad C, Dupont WD, Bergenfelz A, Ekelund U. Medical crisis checklists in the emergency department: a simulation-based multi-institutional randomised controlled trial. BMJ Qual Saf 2021; 30:697-705. [PMID: 33597283 DOI: 10.1136/bmjqs-2020-012740] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2020] [Revised: 01/14/2021] [Accepted: 02/10/2021] [Indexed: 12/14/2022]
Abstract
BACKGROUND Studies carried out in simulated environments suggest that checklists improve the management of surgical and intensive care crises. Whether checklists improve the management of medical crises simulated in actual emergency departments (EDs) is unknown. METHODS Eight crises (anaphylactic shock, life-threatening asthma exacerbation, haemorrhagic shock from upper gastrointestinal bleeding, septic shock, calcium channel blocker poisoning, tricyclic antidepressant poisoning, status epilepticus, increased intracranial pressure) were simulated twice (once with and once without checklist access) in each of four EDs-of which two belong to an academic centre-and managed by resuscitation teams during their clinical shifts. A checklist for each crisis listing emergency interventions was derived from current authoritative sources. Checklists were displayed on a screen visible to all team members. Crisis and checklist access were allocated according to permuted block randomisation. No team member managed the same crisis more than once. The primary outcome measure was the percentage of indicated emergency interventions performed. RESULTS A total of 138 participants composing 41 resuscitation teams performed 76 simulations (38 with and 38 without checklist access) including 631 interventions. Median percentage of interventions performed was 38.8% (95% CI 35% to 46%) without checklist access and 85.7% (95% CI 80% to 88%) with checklist access (p=7.5×10-8). The benefit of checklist access was similar in the four EDs and independent of senior physician and senior nurse experience, type of crisis and use of usual cognitive aids. On a Likert scale of 1-6, most participants agreed (gave a score of 5 or 6) with the statement 'I would use the checklist if I got a similar case in reality'. CONCLUSION In this multi-institution study, checklists markedly improved local resuscitation teams' management of medical crises simulated in situ, and most personnel reported that they would use the checklists if they had a similar case in reality.
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Affiliation(s)
- Eric Dryver
- Department of Emergency and Internal Medicine, Skåne University Hospital Lund, Lund, Sweden .,Department of Clinical Sciences, Lund University, Lund, Sweden.,Practicum Clinical Skills Centre, Office for Medical Services, Region Skåne, Sweden
| | | | | | - William D Dupont
- Department of Biostatistics, Vanderbilt University, Nashville, Tennessee, USA
| | - Anders Bergenfelz
- Department of Clinical Sciences, Lund University, Lund, Sweden.,Practicum Clinical Skills Centre, Office for Medical Services, Region Skåne, Sweden
| | - Ulf Ekelund
- Department of Emergency and Internal Medicine, Skåne University Hospital Lund, Lund, Sweden.,Department of Clinical Sciences, Lund University, Lund, Sweden
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Hansel J, Ármannsson GS. Cardiac arrest due to accidental overdose with norepinephrine dissolved in crystalloid. BMJ Case Rep 2020; 13:13/12/e237643. [PMID: 33298492 PMCID: PMC7733087 DOI: 10.1136/bcr-2020-237643] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Vasoactive agents should be administered through a controlled well-marked infusor pump, ideally via a central venous catheter if given over longer periods of time. During transfer of haemodynamically unstable patients with limited staffing and resources on site, a peripheral vasopressor infusion is sometimes resorted to as a temporary measure of optimising haemodynamic parameters. We report a case of accidental norepinephrine overdose after such practice, resulting in cardiac arrest. It illustrates the importance of careful use and labelling of vasoactive agents during the transport and handover of critically ill patients. Finally, we explore human factor issues associated with transfer from the pre-hospital to the in-hospital environment when such preparations are used.
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Affiliation(s)
- Jan Hansel
- Department of Anaesthetics, Blackpool Teaching Hospitals NHS Foundation Trust, Blackpool, UK
| | - Gunnar Skúli Ármannsson
- Department of Anaesthesia and Intensive Care, Landspítali University Hospital, Reykjavík, Iceland
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Langlois M, Borel M, Clovet O, Justice V, Spuccia C, Raux M. Cellule de coordination des flux sortants des réanimations en période de Covid-19. ANNALES FRANCAISES DE MEDECINE D URGENCE 2020. [DOI: 10.3166/afmu-2020-0259] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
La pandémie de Covid-19 a inscrit l’hôpital au coeur d’une crise sanitaire de cinétique longue. Le système de santé a dû dans un premier temps accepter cette notion de crise déstructurante et piloter dans l’incertitude. Un des enjeux majeurs était d’éviter la saturation du système, notamment l’accessibilité à la réanimation. À la demande de la cellule de crise du groupe hospitalier AP–HPSorbonne Université, l’équipe Dynamo a dû apporter des propositions permettant de libérer des places en réanimation. C’était la stratégie retenue pour éviter une mise en tension de l’hôpital. La cellule Dynamo, avec l’accord du directeur médical de crise, a ouvert un flux entre les réanimations expertes et des unités créées de novo (publiques et privées). Cette équipe est le fruit d’une préparation conjointe entre le département médico-universitaire DREAM et le service médical du RAID. Elle a permis d’organiser et d’effectuer dans de bonnes conditions sanitaires et sécuritaires le transfert d’une centaine de patients entre les réanimations d’Îlede- France. L’objectif était une répartition cohérente pour maintenir une capacité d’accueil dans les réanimations les plus spécialisées et impactées par l’intensité des soins. Pour cela, la cellule Dynamo a défini des critères médicaux de patients éligibles au transfert. La méthodologie utilisait quatre boucles indépendantes : le service demandeur, l’équipe de transfert, le vecteur de transfert et le service receveur. Cette organisation a offert agilité et autonomie. Nous publions ce retour d’expérience pour partager les bases méthodologiques et humaines de notre organisation afin d’inspirer d’autres cellules innovantes en cas de situations sanitaires exceptionnelles.
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De Bie Dekker AJR, Dijkmans JJ, Todorovac N, Hibbs R, Boe Krarup K, Bouwman AR, Barach P, Fløjstrup M, Cooksley T, Kellett J, Bindels AJGH, Korsten HHM, Brabrand M, Subbe CP. Testing the effects of checklists on team behaviour during emergencies on general wards: An observational study using high-fidelity simulation. Resuscitation 2020; 157:3-12. [PMID: 33027620 DOI: 10.1016/j.resuscitation.2020.09.031] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2020] [Revised: 09/11/2020] [Accepted: 09/23/2020] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Clinical teams struggle on general wards with acute management of deteriorating patients. We hypothesized that the Crisis Checklist App, a mobile application containing checklists tailored to crisis-management, can improve teamwork and acute care management. METHODS A before-and-after study was undertaken in high-fidelity simulation centres in the Netherlands, Denmark and United Kingdom. Clinical teams completed three scenarios with a deteriorating patient without checklists followed by three scenarios using the Crisis Checklist App. Teamwork performance as the primary outcome was assessed by the Mayo High Performance Teamwork scale. The secondary outcomes were the time required to complete all predefined safety-critical steps, percentage of omitted safety-critical steps, effects on other non-technical skills, and users' self-assessments. Linear mixed models and a non-parametric survival test were conducted to assess these outcomes. RESULTS 32 teams completed 188 scenarios. The Mayo High Performance Teamwork scale mean scores improved to 23.4 out of 32 (95% CI: 22.4-24.3) with the Crisis Checklist App compared to 21.4 (20.4-22.3) with local standard of care. The mean difference was 1.97 (1.34-2.6; p < 0.001). Teams that used the checklists were able to complete all safety-critical steps of a scenario in more simulations (40/95 vs 21/93 scenarios) and these steps were completed faster (stratified log-rank test χ2 = 8.0; p = 0.005). The self-assessments of the observers and users showed favourable effects after checklist usage for other non-technical skills including situational awareness, decision making, task management and communication. CONCLUSIONS Implementation of a novel mobile crisis checklist application among clinical teams was associated in a simulated general ward setting with improved teamwork performance, and a higher and faster completion rate of predetermined safety-critical steps.
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Affiliation(s)
- A J R De Bie Dekker
- Department of Intensive Care Unit, Catharina Hospital Eindhoven, Eindhoven, The Netherlands.
| | - J J Dijkmans
- Department of Intensive Care Unit, Catharina Hospital Eindhoven, Eindhoven, The Netherlands
| | - N Todorovac
- Department of Emergency Medicine, Odense University Hospital, Odense, Denmark; Department of Emergency Medicine, Hospital of South West Jutland, Esbjerg, Denmark
| | - R Hibbs
- Integral Business Support Ltd, Wrexham, United Kingdom
| | - K Boe Krarup
- Department of Anesthesiology, Odense University Hospital, Odense, Denmark
| | - A R Bouwman
- Department of Anesthesiology, Catharina Hospital Eindhoven, Eindhoven, The Netherlands
| | - P Barach
- Department of Anesthesiology and Critical care, Wayne State University School of Medicine, Detroit; Jefferson College of Population Health, PA, USA
| | - M Fløjstrup
- Institute of Regional Health Research, University of Southern Denmark, Esbjerg, Denmark
| | - T Cooksley
- Department of Acute and Internal Medicine, The Christie Hospital, Manchester, United Kingdom
| | - J Kellett
- Department of Emergency Medicine, Hospital of South West Jutland, Esbjerg, Denmark
| | - A J G H Bindels
- Department of Intensive Care Unit, Catharina Hospital Eindhoven, Eindhoven, The Netherlands
| | - H H M Korsten
- Department of Intensive Care Unit, Catharina Hospital Eindhoven, Eindhoven, The Netherlands; Department of Anesthesiology, Catharina Hospital Eindhoven, Eindhoven, The Netherlands
| | - M Brabrand
- Department of Emergency Medicine, Odense University Hospital, Odense, Denmark; Department of Emergency Medicine, Hospital of South West Jutland, Esbjerg, Denmark; Institute of Regional Health Research, University of Southern Denmark, Esbjerg, Denmark
| | - C P Subbe
- Department of Acute Medicine, Ysbyty Gwynedd and Bangor University, Bangor, United Kingdom
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9
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Jones HV, Smith H, Cooksley T, Jones P, Woolley T, Gwyn Murdoch D, Thomas D, Foster B, Wakefield V, Innominato P, Mullard A, Ghosal N, Subbe C. Checklists for Complications During Systemic Cancer Treatment Shared by Patients, Friends, and Health Care Professionals: Prospective Interventional Cohort Study. JMIR Mhealth Uhealth 2020; 8:e19225. [PMID: 32975526 PMCID: PMC7540918 DOI: 10.2196/19225] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Revised: 08/09/2020] [Accepted: 08/18/2020] [Indexed: 01/18/2023] Open
Abstract
BACKGROUND Advances in cancer management have been associated with an increased incidence of emergency presentations with disease- or treatment-related complications. OBJECTIVE This study aimed to measure the ability of patients and members of their social network to complete checklists for complications of systemic treatment for cancer and examine the impact on patient-centered and health-economic outcomes. METHODS A prospective interventional cohort study was performed to assess the impact of a smartphone app used by patients undergoing systemic cancer therapy and members of their network to monitor for common complications. The app was used by patients, a nominated "safety buddy," and acute oncology services. The control group was made up of patients from the same institution. Measures were based on process (completion of checklists over 60 days), patient experience outcomes (Hospital Anxiety and Depression Scale and the General version of the Functional Assessment of Cancer Therapy at baseline, 1 month, and 2 months) and health-economic outcomes (usage of appointments in primary care and elective and unscheduled hospital admissions). RESULTS At the conclusion of the study, 50 patients had completed 2882 checklists, and their 50 "safety buddies" had completed 318 checklists. Near daily usage was maintained over the 60-day study period. When compared to a cohort of 50 patients with matching disease profiles from the same institution, patients in the intervention group had comparable changes in Hospital Anxiety and Depression Scale and General version of the Functional Assessment of Cancer Therapy. Patients in the Intervention Group required a third (32 vs 97 nights) of the hospital days with overnight stay compared to patients in the Control Group, though the difference was not significant. The question, "I feel safer with the checklist," received a mean score of 4.27 (SD 0.87) on a Likert scale (1-5) for patients and 4.55 (SD 0.65) for family and friends. CONCLUSIONS Patients undergoing treatment for cancer and their close contacts can complete checklists for common complications of systemic treatments and take an active role in systems supporting their own safety. A larger sample size will be needed to assess the impact on clinical outcomes and health economics.
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Affiliation(s)
- Helen V Jones
- Ysbyty Gwynedd, Penrhosgarnedd, Bangor, United Kingdom
| | - Harry Smith
- School of Medicine, Cardiff Univeristy, Cardiff, United Kingdom
| | | | | | - Toby Woolley
- Ysbyty Gwynedd, Penrhosgarnedd, Bangor, United Kingdom
| | | | | | - Betty Foster
- North Wales Cancer Forum, Bangor, United Kingdom
| | | | - Pasquale Innominato
- Ysbyty Gwynedd, Penrhosgarnedd, Bangor, United Kingdom.,Cancer Chronotherapy Team, Warwick Medical School, Coventry, United Kingdom.,European Laboratory U935, Institut National de la Santé et de la Recherche Médicale (INSERM), Paris-Saclay University, Villejuif, France
| | - Anna Mullard
- Ysbyty Gwynedd, Penrhosgarnedd, Bangor, United Kingdom
| | | | - Christian Subbe
- School of Medical Sciences, Bangor University, Bangor, United Kingdom
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Barach P, Lipshultz SE. Rethinking COVID-19 in children: Lessons learned from pediatric viral and inflammatory cardiovascular diseases. PROGRESS IN PEDIATRIC CARDIOLOGY 2020; 57:101233. [PMID: 32837143 PMCID: PMC7243773 DOI: 10.1016/j.ppedcard.2020.101233] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Affiliation(s)
- Paul Barach
- Department of Pediatrics, Wayne State University School of Medicine, Detroit, MI, United States of America
- Jefferson College of Population Health, Philadelphia, PA, United States of America
| | - Steven E Lipshultz
- Department of Pediatrics, University at Buffalo Jacobs School of Medicine and Biomedical Sciences, Buffalo, NY, United States of America
- Oishei Children's Hospital, Buffalo, NY, United States of America
- Roswell Park Comprehensive Cancer Center, Buffalo, NY, United States of America
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Kulp L, Sarcevic A, Cheng M, Zheng Y, Burd RS. Comparing the Effects of Paper and Digital Checklists on Team Performance in Time-Critical Work. PROCEEDINGS OF THE SIGCHI CONFERENCE ON HUMAN FACTORS IN COMPUTING SYSTEMS. CHI CONFERENCE 2019; 2019. [PMID: 31633126 DOI: 10.1145/3290605.3300777] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
This mixed-methods study examines the effects of a tablet-based checklist system on team performance during a dynamic and safety-critical process of trauma resuscitation. We compared team performance from 47 resuscitations that used a paper checklist to that from 47 cases with a digital checklist to determine if digitizing a checklist led to improvements in task completion rates and in how fast the tasks were initiated for 18 most critical assessment and treatment tasks. We also compared if the checklist compliance increased with the digital design. We found that using the digital checklist led to more frequent completions of the initial airway assessment task but fewer completions of ear and lower extremities exams. We did not observe any significant differences in time to task performance, but found increased compliance with the checklist. Although improvements in team performance with the digital checklist were minor, our findings are important because they showed no adverse effects as a result of the digital checklist introduction. We conclude by discussing the takeaways and implications of these results for effective digitization of medical work.
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Affiliation(s)
- Leah Kulp
- College of Computing and Informatics, Drexel University, Philadelphia, PA, USA
| | - Aleksandra Sarcevic
- College of Computing and Informatics, Drexel University, Philadelphia, PA, USA
| | - Megan Cheng
- Trauma and Burn Surgery, Children's National Medical Center, Washington, DC, USA
| | - Yinan Zheng
- Trauma and Burn Surgery, Children's National Medical Center, Washington, DC, USA
| | - Randall S Burd
- Trauma and Burn Surgery, Children's National Medical Center, Washington, DC, USA
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Lyons PG, Edelson DP, Churpek MM. Rapid response systems. Resuscitation 2018; 128:191-197. [PMID: 29777740 DOI: 10.1016/j.resuscitation.2018.05.013] [Citation(s) in RCA: 113] [Impact Index Per Article: 18.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2018] [Revised: 04/20/2018] [Accepted: 05/09/2018] [Indexed: 12/23/2022]
Abstract
INTRODUCTION Rapid response systems are commonly employed by hospitals to identify and respond to deteriorating patients outside of the intensive care unit. Controversy exists about the benefits of rapid response systems. AIMS We aimed to review the current state of the rapid response literature, including evolving aspects of afferent (risk detection) and efferent (intervention) arms, outcome measurement, process improvement, and implementation. DATA SOURCES Articles written in English and published in PubMed. RESULTS Rapid response systems are heterogeneous, with important differences among afferent and efferent arms. Clinically meaningful outcomes may include unexpected mortality, in-hospital cardiac arrest, length of stay, cost, and processes of care at end of life. Both positive and negative interventional studies have been published, although the two largest randomized trials involving rapid response systems - the Medical Early Response and Intervention Trial (MERIT) and the Effect of a Pediatric Early Warning System on All-Cause Mortality in Hospitalized Pediatric Patients (EPOCH) trial - did not find a mortality benefit with these systems, albeit with important limitations. Advances in monitoring technologies, risk assessment strategies, and behavioral ergonomics may offer opportunities for improvement. CONCLUSIONS Rapid responses may improve some meaningful outcomes, although these findings remain controversial. These systems may also improve care for patients at the end of life. Rapid response systems are expected to continue evolving with novel developments in monitoring technologies, risk prediction informatics, and work in human factors.
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Affiliation(s)
- Patrick G Lyons
- Department of Medicine, Division of Pulmonary and Critical Care Medicine, Washington University in St. Louis, St. Louis, MO, United States
| | - Dana P Edelson
- Department of Medicine, University of Chicago, Chicago, IL, United States
| | - Matthew M Churpek
- Department of Medicine, University of Chicago, Chicago, IL, United States.
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Abstract
Unconscious patients are commonly seen by physicians. They are challenging to manage and in a time sensitive condition, a systematic, team approach is required. Early physiological stability and diagnosis are necessary to optimise outcome. This article focuses on unconscious patients where the initial cause appears to be non-traumatic and provides a practical guide for their immediate care.
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