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Hjorth‐Hansen KR, Rosvig L, Hvidman L, Kierkegaard O, Uldbjerg N, Manser T, Brogaard L. Video analysis of real-life shoulder dystocia to assess technical and non-technical performance. Acta Obstet Gynecol Scand 2024; 103:1985-1993. [PMID: 38925557 PMCID: PMC11426221 DOI: 10.1111/aogs.14900] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2024] [Revised: 04/24/2024] [Accepted: 06/04/2024] [Indexed: 06/28/2024]
Abstract
INTRODUCTION Managing obstetric shoulder dystocia requires swift action using correct maneuvers. However, knowledge of obstetric teams' performance during management of real-life shoulder dystocia is limited, and the impact of non-technical skills has not been adequately evaluated. We aimed to analyze videos of teams managing real-life shoulder dystocia to identify clinical challenges associated with correct management and particular non-technical skills correlated with high technical performance. MATERIAL AND METHODS We included 17 videos depicting teams managing shoulder dystocia in two Danish delivery wards, where deliveries were initially handled by midwives, and consultants were available for complications. Delivery rooms contained two or three cameras activated by Bluetooth upon obstetrician entry. Videos were captured 5 min before and after activation. Two obstetricians assessed the videos; technical performances were scored as low (0-59), average (60-84), or high (85-100). Two other assessors evaluated non-technical skills using the Global Assessment of Team Performance checklist, scoring 6 (poor) to 30 (excellent). We used a spline regression model to explore associations between these two score sets. Inter-rater agreement was assessed using interclass correlation coefficients. RESULTS Interclass correlation coefficients were 0.71 (95% confidence interval 0.23-0.89) and 0.82 (95% confidence interval 0.52-0.94) for clinical and non-technical performances, respectively. Two teams had low technical performance scores; four teams achieved high scores. Teams adhered well to guidelines, demonstrating limited head traction, McRoberts maneuver, and internal rotation maneuvers. Several clinical skills posed challenges, notably recognizing shoulder impaction, applying suprapubic pressure, and discouraging women from pushing. Two non-technical skills were associated with high technical performance: effective patient communication, with teams calming the mother and guiding her collaboration during internal rotational maneuvers, and situation awareness, where teams promptly mobilized all essential personnel (senior midwife, consultant, pediatric team). Team communication, stress management, and task management skills were not associated with high technical performance. CONCLUSIONS Videos capturing teams managing real-life shoulder dystocia are an effective tool to reveal challenges with certain technical and non-technical skills. Teams with high technical performance are associated with effective patient communication and situational awareness. Future training should include technical skills and non-technical skills, patient communication, and situation awareness.
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Affiliation(s)
- Kristiane Roed Hjorth‐Hansen
- Department of OncologyAarhus University HospitalAarhusDenmark
- Obstetrics and GynecologyAarhus University HospitalAarhusDenmark
| | - Lena Rosvig
- Department of Obstetrics and GynecologyRegional Hospital RandersRandersDenmark
| | - Lone Hvidman
- Obstetrics and GynecologyAarhus University HospitalAarhusDenmark
| | - Ole Kierkegaard
- Department of Obstetrics and GynecologyRegional Hospital HorsensHorsensDenmark
| | - Niels Uldbjerg
- Obstetrics and GynecologyAarhus University HospitalAarhusDenmark
- Department of Clinical MedicineAarhus UniversityAarhusDenmark
| | - Tanja Manser
- FHNW School of Applied PsychologyUniversity of Applied Sciences and Arts Northwestern SwitzerlandOltenSwitzerland
| | - Lise Brogaard
- Obstetrics and GynecologyAarhus University HospitalAarhusDenmark
- Department of Clinical MedicineAarhus UniversityAarhusDenmark
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Herrick HM, Wild KT, Hill M. Video recording in neonatology: the need for objective measures and collaboration. Pediatr Res 2024; 96:295-296. [PMID: 38627590 PMCID: PMC11343693 DOI: 10.1038/s41390-024-03185-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2024] [Accepted: 03/25/2024] [Indexed: 05/03/2024]
Affiliation(s)
- Heidi M Herrick
- Division of Neonatology, Department of Pediatrics, The Children's Hospital of Philadelphia, Philadelphia, PA, USA.
| | - Katherine T Wild
- Division of Neonatology, Department of Pediatrics, The Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Morgan Hill
- Division of Neonatology, Department of Pediatrics, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, OH, USA
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Heesters V, van Zanten HA, Heijstek V, Te Pas AB, Witlox RSGM. Record, reflect and refine: using video review as an initiative to improve neonatal care. Pediatr Res 2024; 96:299-308. [PMID: 38356026 DOI: 10.1038/s41390-024-03083-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Revised: 12/21/2023] [Accepted: 01/27/2024] [Indexed: 02/16/2024]
Abstract
BACKGROUND The goal of every medical team is to provide optimal care for their patients. We aimed to use video review (VR) sessions to identify and address areas for improvement in neonatal care. METHODS For nine months, neonatal procedures (stabilization at birth, intubations and sterile line insertions) were video recorded and reviewed with the neonatal care providers. Action research was used to identify and address areas for improvement which were categorized as (1) protocol/equipment adjustments, (2) input for research, (3) aspects of variety, or (4) development of educational material or training programs. RESULTS Eighteen VR sessions were organized with a mean(SD) of 17(5) staff members participating. In total, 120 areas for improvement were identified and addressed, of which 84/120 (70%) were categorized as aspects of variety, 20/120 (17%) as development of educational material or training programs, 10/120 (8%) as protocol/equipment adjustments, and 6/120 (5%) as input for research. The areas for improvement were grouped in themes per category, including sterility, technique, equipment, communication, teamwork, parents' perspective and ventilation. CONCLUSION Our study showed that regularly organized VR empowered healthcare providers to identify and address a large variety of areas for improvement, contributing to continuous learning and improvement processes. IMPACT Video review empowered healthcare providers to identify areas for improvement in neonatal care Video review gave providers the opportunity to address identified areas for improvement, either by enhancing the application of external evidence (i.e. guidelines), learning from individual clinical expertise or strengthening resilience and teamwork Embedding regularly organized video review sessions allowed for continuous monitoring of care by providers, which can be beneficial for creating ongoing learning and improvement processes The structured pathways, supporting implementation of changes that were proposed based on the video review sessions, could help other centers make use of the potential video review has to offer.
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Affiliation(s)
- Veerle Heesters
- Division of Neonatology, Department of Paediatrics, Willem-Alexander Children's Hospital, Leiden University Medical Center, Leiden, the Netherlands.
| | - Henriette A van Zanten
- Division of Neonatology, Department of Paediatrics, Willem-Alexander Children's Hospital, Leiden University Medical Center, Leiden, the Netherlands
| | - Veerle Heijstek
- Division of Neonatology, Department of Paediatrics, Willem-Alexander Children's Hospital, Leiden University Medical Center, Leiden, the Netherlands
| | - Arjan B Te Pas
- Division of Neonatology, Department of Paediatrics, Willem-Alexander Children's Hospital, Leiden University Medical Center, Leiden, the Netherlands
| | - Ruben S G M Witlox
- Division of Neonatology, Department of Paediatrics, Willem-Alexander Children's Hospital, Leiden University Medical Center, Leiden, the Netherlands
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Heesters V, van Zanten HA, de Boer LC, Visser R, Heijstek V, Te Pas AB, Witlox RS. Quality improvement initiative: implementing and redefining video review of real-time neonatal procedures using action research. BMJ Open Qual 2024; 13:e002588. [PMID: 38749540 PMCID: PMC11097868 DOI: 10.1136/bmjoq-2023-002588] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Accepted: 04/24/2024] [Indexed: 05/18/2024] Open
Abstract
Video review (VR) of procedures in the medical environment can be used to drive quality improvement. However, first it has to be implemented in a safe and effective way. Our primary objective was to (re)define a guideline for implementing interprofessional VR in a neonatal intensive care unit (NICU). Our secondary objective was to determine the rate of acceptance by providers attending VR. For 9 months, VR sessions were evaluated with a study group, consisting of different stakeholders. A questionnaire was embedded at the end of each session to obtain feedback from providers on the session and on the safe learning environment. In consensus meetings, success factors and preconditions were identified and divided into different factors that influenced the rate of adoption of VR. The number of providers who recorded procedures and attended VR sessions was determined. A total of 18 VR sessions could be organised, with an equal distribution of medical and nursing staff. After the 9-month period, 101/125 (81%) of all providers working on the NICU attended at least 1 session and 80/125 (64%) of all providers recorded their performance of a procedure at least 1 time. In total, 179/297 (61%) providers completed the questionnaire. Almost all providers (99%) reported to have a positive opinion about the review sessions. Preconditions and success factors related to implementation were identified and addressed, including improving the pathway for obtaining consent, preparation of VR, defining the role of the chair during the session and building a safe learning environment. Different strategies were developed to ensure findings from sessions were used for quality improvement. VR was successfully implemented on our NICU and we redefined our guideline with various preconditions and success factors. The adjusted guideline can be helpful for implementation of VR in emergency care settings.
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Affiliation(s)
- Veerle Heesters
- Department of Paediatrics, Leiden University Medical Center, Leiden, The Netherlands
| | | | - Linsey Cc de Boer
- Department of Paediatrics, Leiden University Medical Center, Leiden, The Netherlands
| | - Remco Visser
- Department of Paediatrics, Leiden University Medical Center, Leiden, The Netherlands
| | - Veerle Heijstek
- Department of Paediatrics, Leiden University Medical Center, Leiden, The Netherlands
| | - Arjan B Te Pas
- Department of Paediatrics, Leiden University Medical Center, Leiden, The Netherlands
| | - Ruben Sgm Witlox
- Department of Paediatrics, Leiden University Medical Center, Leiden, The Netherlands
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Nazir A, Baletic N, Dumas RP, Fitzgerald C, Xu K, McGowan M, Nolan B. Reliability of the safety threats and adverse events in trauma (STAT) taxonomy using trauma video review. Eur J Trauma Emerg Surg 2024; 50:497-504. [PMID: 37979061 DOI: 10.1007/s00068-023-02381-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2023] [Accepted: 10/17/2023] [Indexed: 11/19/2023]
Abstract
PURPOSE The STAT (Safety Threats and Adverse Events in Trauma) taxonomy was developed through expert consensus, and groups 65 identified trauma resuscitation adverse events (AEs) into nine distinct categories. It provides a framework for standardized analysis of trauma resuscitations and creates a foundation for targeted quality improvement and patient safety initiatives. This study aims to evaluate the reliability of the STAT taxonomy in identifying AEs during video-recorded trauma resuscitations. METHODS High-definition audiovisual data from 30 trauma resuscitations were reviewed. Videos were assessed and scored by four independent reviewers (two trainees and two staff). The STAT taxonomy was used to identify AEs based on binary responses: yes and no. Inter-rater reliability was calculated using Gwet's AC1. The frequencies of AEs were tallied and reported as counts and percentages. RESULTS The most common AEs identified in the videos were failure to measure temperature (86.7%) and inadequate personal protective equipment (86.7%), followed by inability to use closed-loop communication (76.7%). The agreement on all AEs between reviewers was 0.94 (95% CI: 0.93-0.95). The Gwet's AC1 agreement across the 9 AE categories was paramedic handover (0.82), airway and breathing (0.99), circulation (0.95), assessment of injuries (0.91), management of injuries (0.96), procedure-related (0.97), patient monitoring and IV access (0.99), disposition (0.98), team communication and dynamics (0.87). CONCLUSION The STAT taxonomy demonstrated excellent inter-rater reliability between reviewers and can be used to identify AEs in video-recorded trauma resuscitations. These results provide a foundation for adapting video review to objectively quantify and assess AEs in the trauma bay.
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Affiliation(s)
- Anisa Nazir
- Institute of Medical Sciences, University of Toronto, Toronto, ON, Canada.
- Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, ON, Canada.
| | - Nemanja Baletic
- Emergency Medicine, USF/HCA Oak Hill Hospital, Brooksville, Florida, USA
| | - Ryan P Dumas
- Department of Surgery, Division of Burn, Trauma, Acute and Critical Care Surgery, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Caitlin Fitzgerald
- Department of Surgery, Division of Burn, Trauma, Acute and Critical Care Surgery, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Keying Xu
- Applied Health Research Centre (AHRC), Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Canada
| | - Melissa McGowan
- Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, ON, Canada
| | - Brodie Nolan
- Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, ON, Canada
- Division of Emergency Medicine, Department of Medicine, University of Toronto, Toronto, ON, Canada
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Brogaard L, Rosvig L, Hjorth-Hansen KR, Hvidman L, Hinshaw K, Kierkegaard O, Uldbjerg N, Manser T. Team performance during vacuum-assisted vaginal delivery: video review of obstetric multidisciplinary teams. Front Med (Lausanne) 2024; 11:1330457. [PMID: 38572162 PMCID: PMC10987771 DOI: 10.3389/fmed.2024.1330457] [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: 10/30/2023] [Accepted: 02/12/2024] [Indexed: 04/05/2024] Open
Abstract
Introduction Vacuum extraction is generally considered an operator-dependent task, with most attention directed toward the obstetrician's technical abilities (1-3). Little is known about the effect of the team and non-technical skills on clinical outcomes in vacuum-assisted delivery. This study aimed to investigate whether the non-technical skills of obstetricians were correlated with their level of clinical performance via the analysis of video recordings of teams conducting actual vacuum extractions. Methods We installed between two or three video cameras in each delivery room at Aarhus University Hospital and Horsens Regional Hospital and obtained 60 videos of teams managing vacuum extraction. Appropriate consent was obtained. Two raters carefully reviewed the videos and assessed the teams' non-technical skills using the Assessment of Obstetric Team Performance (AOTP) checklist, rating all items on a Likert scale score from 1 to 5 (1 = poor; 3 = average; and 5 = excellent). This resulted in a total score ranging from 18 to 90. Two different raters independently assessed the teams' clinical performance (adherence to clinical guidelines) using the TeamOBS-Vacuum-Assisted Delivery (VAD) checklist, rating each item (0 = not done, 1 = done incorrectly; and 2 = done correctly). This resulted in a total score with the following ranges (low clinical performance: 0-59; average: 60-84; and high: 85-100). Interrater agreement was analyzed using intraclass correlation (ICC), and the risk of high or low clinical performance was analyzed on a logit scale to meet the assumption of normality. Results Teams that received excellent non-technical scores had an 81% probability of achieving high clinical performance, whereas this probability was only 12% among teams with average non-technical scores (p < 0.001). Teams with a high clinical performance often had excellent behavior in the non-technical items of "team interaction," "anticipation," "avoidance fixation," and "focused communication." Teams with a low or average clinical performance often neglected to consider analgesia, had delayed abandonment of the attempted vaginal delivery and insufficient use of appropriate fetal monitoring. Interrater reliability was high for both rater-teams, with an ICC for the non-technical skills of 0.83 (95% confidence interval [CI]: 0.71-0.88) and 0.84 for the clinical performance (95% CI: 0.74-0.90). Conclusion Although assisted vaginal delivery by vacuum extraction is generally considered to be an operator-dependent task, our findings suggest that teamwork and effective team interaction play crucial roles in achieving high clinical performance. Teamwork helped the consultant anticipate the next step, avoid fixation, ensure adequate analgesia, and maintain thorough fetal monitoring during delivery.
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Affiliation(s)
- L. Brogaard
- Department of Obstetrics and Gynecology, Aarhus University Hospital, Aarhus, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - L. Rosvig
- Department of Obstetrics and Gynecology, Randers Hospital, Randers, Denmark
| | | | - L. Hvidman
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - K. Hinshaw
- Department of Obstetrics and Gynecology, Sunderland Royal Hospital, Sunderland, United Kingdom
| | - O. Kierkegaard
- Department of Obstetrics and Gynecology, Horsens Regional Hospital, Horsens, Denmark
| | - N. Uldbjerg
- Department of Obstetrics and Gynecology, Aarhus University Hospital, Aarhus, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - T. Manser
- FHNW School of Applied Psychology, University of Applied Sciences and Arts Northwestern Switzerland, Olten, Switzerland
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Bay ET, Breindahl N, Nielsen MM, Roehr CC, Szczapa T, Gagliardi L, Vento M, Visser DH, Stoen R, Klotz D, Rakow A, Breindahl M, Tolsgaard MG, Aunsholt L. Technical Skills Curriculum in Neonatology: A Modified European Delphi Study. Neonatology 2024; 121:314-326. [PMID: 38408441 DOI: 10.1159/000536286] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Accepted: 01/12/2024] [Indexed: 02/28/2024]
Abstract
INTRODUCTION Simulation-based training (SBT) aids healthcare providers in acquiring the technical skills necessary to improve patient outcomes and safety. However, since SBT may require significant resources, training all skills to a comparable extent is impractical. Hence, a strategic prioritization of technical skills is necessary. While the European Training Requirements in Neonatology provide guidance on necessary skills, they lack prioritization. We aimed to identify and prioritize technical skills for a SBT curriculum in neonatology. METHODS A three-round modified Delphi process of expert neonatologists and neonatal trainees was performed. In round one, the participants listed all the technical skills newly trained neonatologists should master. The content analysis excluded duplicates and non-technical skills. In round two, the Copenhagen Academy for Medical Education and Simulation Needs Assessment Formula (CAMES-NAF) was used to preliminarily prioritize the technical skills according to frequency, importance of competency, SBT impact on patient safety, and feasibility for SBT. In round three, the participants further refined and reprioritized the technical skills. Items achieving consensus (agreement of ≥75%) were included. RESULTS We included 168 participants from 10 European countries. The response rates in rounds two and three were 80% (135/168) and 87% (117/135), respectively. In round one, the participants suggested 1964 different items. Content analysis revealed 81 unique technical skills prioritized in round two. In round three, 39 technical skills achieved consensus and were included. CONCLUSION We reached a European consensus on a prioritized list of 39 technical skills to be included in a SBT curriculum in neonatology.
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Affiliation(s)
- Emma Therese Bay
- Department of Neonatal and Pediatric Intensive Care, Copenhagen University Hospital, Copenhagen, Denmark
- Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Niklas Breindahl
- Department of Neonatal and Pediatric Intensive Care, Copenhagen University Hospital, Copenhagen, Denmark
- Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
- Copenhagen Academy for Medical Education and Simulation (CAMES), Copenhagen University Hospital, Copenhagen, Denmark
| | - Mathilde M Nielsen
- Department of Neonatal and Pediatric Intensive Care, Copenhagen University Hospital, Copenhagen, Denmark
| | - Charles C Roehr
- National Perinatal Epidemiology Unit, Nuffield Department of Population Health Medical Sciences Division, University of Oxford, Oxford, UK
- Faculty of Health Sciences, University of Bristol, Bristol, UK
- Newborn Services, Southmead Hospital, North Bristol NHS Trust Bristol, Bristol, UK
- European Society for Paediatric Research, Satigny, Switzerland
- European Board of Neonatology, Satigny, Switzerland
| | - Tomasz Szczapa
- European Society for Paediatric Research, Satigny, Switzerland
- European Board of Neonatology, Satigny, Switzerland
- 2nd Department of Neonatology, Neonatal Biophysical Monitoring and Cardiopulmonary Therapies Research Unit, Poznan University of Medical Sciences, Poznan, Poland
| | - Luigi Gagliardi
- Division of Neonatology and Pediatrics, Ospedale Versilia, Viareggio, Azienda USL Toscana Nord Ovest, Pisa, Italy
| | - Maximo Vento
- European Society for Paediatric Research, Satigny, Switzerland
- European Board of Neonatology, Satigny, Switzerland
- Division of Neonatology, University and Polytechnic Hospital La Fe (HULAFE) and Health Research Institute (IISLAFE), Valencia, Spain
| | - Douwe H Visser
- Department of Neonatology, Emma Children's Hospital, Amsterdam University Medical Centers, Academic Medical Center, Amsterdam, The Netherlands
| | - Ragnhild Stoen
- Department of Neonatology, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
- Department of Clinical and Molecular Medicine, Norwegian University of Science and Technology, Trondheim, Norway
| | - Daniel Klotz
- Center for Pediatrics, Division of Neonatology and Pediatric Intensive Care Medicine, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Alexander Rakow
- Department of Women´s and Children´s Health, Karolinska Institutet, Stockholm, Sweden
| | - Morten Breindahl
- Department of Neonatal and Pediatric Intensive Care, Copenhagen University Hospital, Copenhagen, Denmark
| | - Martin G Tolsgaard
- Copenhagen Academy for Medical Education and Simulation (CAMES), Copenhagen University Hospital, Copenhagen, Denmark
- Department of Obstetrics, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
- Faculty of Health and Medical Sciences, Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Lise Aunsholt
- Department of Neonatal and Pediatric Intensive Care, Copenhagen University Hospital, Copenhagen, Denmark
- Department of Obstetrics, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
- Faculty of Health and Medical Sciences, Department of Comparative Pediatrics and Nutrition, University of Copenhagen, Copenhagen, Denmark
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Silva Gomes V, Cardoso Júnior MM. The effect of sleepiness in situation awareness: A scoping review. Work 2024; 78:641-655. [PMID: 38277325 DOI: 10.3233/wor-230115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2024] Open
Abstract
BACKGROUND Situational awareness is the acquisition of information from elements present in the work environment, the perception of the meaning of this information, and the prediction of future working conditions. Sleepiness and fatigue can influence an individual's ability to reach situation awareness, decision-making, and performance on a task. OBJECTIVE This scoping review examines methods used to assess situational awareness, fatigue, sleepiness, and their interrelationships. METHODS A systematic search of online databases was conducted to identify experimental, peer-reviewed articles published in English between 2017 and 2022. A total of 29 publications were selected for analysis. RESULTS The selected studies originated from various countries, primarily in the northern hemisphere. Health and automotive engineering were the academic categories with the highest publications. The studies employed objective and subjective methods to assess situational awareness, fatigue, and sleepiness. CONCLUSIONS Most studies reported a decline in situational awareness during fatigue and sleepiness conditions, although one study did not find this association. Future research should focus on employing objective methods to analyze cognitive factors, increasing sample sizes, and conducting testing in real-world situations.
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Mileder LP, Schwaberger B, Baik-Schneditz N, Ribitsch M, Pansy J, Raith W, Rohrleitner A, Mesaric G, Urlesberger B. Sustained decrease in latent safety threats through regular interprofessional in situ simulation training of neonatal emergencies. BMJ Open Qual 2023; 12:e002567. [PMID: 38154819 PMCID: PMC10759052 DOI: 10.1136/bmjoq-2023-002567] [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: 08/19/2023] [Accepted: 12/17/2023] [Indexed: 12/30/2023] Open
Abstract
Simulation training at trainees' actual workplace offers benefits over traditional simulation-based team training. We prospectively investigated whether regular in situ simulation training of neonatal emergencies in an interprofessional and interdisciplinary team could be used to identify and rectify latent safety threats (LSTs).For this purpose, we conducted 1-day in situ simulation trainings at the Department of Gynaecology and Obstetrics, Feldbach, Austria, targeting anaesthesiologists, obstetricians, midwives, nurses and consultant paediatricians. Using published criteria for categorising LSTs, we collected LSTs, either recognised by trainers or training participants, categorised them qualitatively (medication, equipment, resource/system) and based on their potential for harm, discussed them with training participants, and reported them to hospital leadership.We conducted 13 trainings between June 2015 and April 2023, identifying 67 LSTs, most in the category of equipment (42/67, 62.7%), followed by resource/system (14/67, 20.9%) and medication (11/67, 16.4%). Sixty-one (91.0%) of the LSTs could be rectified by the next training. We observed a significant negative correlation between the number of delivered trainings and the frequency of identified LSTs (Pearson correlation coefficient r= -0,684, p=0.01).While we identified a higher number of LSTs in comparison to previously published studies, regular in situ simulation training of neonatal emergencies over a period of almost 8 years positively impacted patient safety, as the majority of LSTs was rectified by the next training. Even more important, the decrease in LSTs with the increasing number of delivered in situ simulation trainings underlines the sustained effect of this educational intervention.
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Affiliation(s)
- Lukas Peter Mileder
- Division of Neonatology, Department of Paediatrics and Adolescent Medicine, Medical University of Graz, Graz, Styria, Austria
| | - Bernhard Schwaberger
- Division of Neonatology, Department of Paediatrics and Adolescent Medicine, Medical University of Graz, Graz, Styria, Austria
| | - Nariae Baik-Schneditz
- Division of Neonatology, Department of Paediatrics and Adolescent Medicine, Medical University of Graz, Graz, Styria, Austria
| | - Mirjam Ribitsch
- Department of Paediatrics and Adolescent Medicine, Medical University of Graz, Graz, Styria, Austria
| | - Jasmin Pansy
- Division of Neonatology, Department of Paediatrics and Adolescent Medicine, Medical University of Graz, Graz, Styria, Austria
| | - Wolfgang Raith
- Division of Neonatology, Department of Paediatrics and Adolescent Medicine, Medical University of Graz, Graz, Styria, Austria
| | - Angelika Rohrleitner
- Department of Anaesthesiology and Intensive Care Medicine, State Hospital Feldbach-Fürstenfeld, Feldbach, Styria, Austria
| | - Günter Mesaric
- Department of Anaesthesiology and Intensive Care Medicine, State Hospital Feldbach-Fürstenfeld, Feldbach, Styria, Austria
| | - Berndt Urlesberger
- Division of Neonatology, Department of Paediatrics and Adolescent Medicine, Medical University of Graz, Graz, Styria, Austria
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Zeng Q, Wang K, Liu WX, Zeng JZ, Li XL, Zhang QF, Ren SQ, Xu WM. Efficacy of high-fidelity simulation in advanced life support training: a systematic review and meta-analysis of randomized controlled trials. BMC MEDICAL EDUCATION 2023; 23:664. [PMID: 37710261 PMCID: PMC10500810 DOI: 10.1186/s12909-023-04654-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Accepted: 09/05/2023] [Indexed: 09/16/2023]
Abstract
BACKGROUND Simulation is an increasingly used novel method for the education of medical professionals. This study aimed to systematically review the efficacy of high-fidelity (HF) simulation compared with low-fidelity (LF) simulation or no simulation in advanced life support (ALS) training. METHODS A comprehensive search of the PubMed, Chinese Biomedicine Database, Embase, CENTRAL, ISI, and China Knowledge Resource Integrated Database was performed to identify randomized controlled trials (RCTs) that evaluated the use of HF simulation in ALS training. Quality assessment was based on the Cochrane Handbook for Systematic Reviews of Interventions version 5.0.1. The primary outcome was the improvement of knowledge and skill performance. The secondary outcomes included the participants' confidence and satisfaction at the course conclusion, skill performance at one year, skill performance in actual resuscitation, and patient outcomes. Data were synthesized using the RevMan 5.4 software. RESULTS Altogether, 25 RCTs with a total of 1,987 trainees were included in the meta-analysis. In the intervention group, 998 participants used HF manikins, whereas 989 participants received LF simulation-based or traditional training (classical training without simulation). Pooled data from the RCTs demonstrated a benefit in improvement of knowledge [standardized mean difference (SMD) = 0.38; 95% confidence interval (CI): 0.18-0.59, P = 0.0003, I2 = 70%] and skill performance (SMD = 0.63; 95% CI: 0.21-1.04, P = 0.003, I2 = 92%) for HF simulation when compared with LF simulation and traditional training. The subgroup analysis revealed a greater benefit in knowledge with HF simulation compared with traditional training at the course conclusion (SMD = 0.51; 95% CI: 0.20-0.83, P = 0.003, I2 = 61%). Studies measuring knowledge at three months, skill performance at one year, teamwork behaviors, participants' satisfaction and confidence demonstrated no significant benefit for HF simulation. CONCLUSIONS Learners using HF simulation more significantly benefited from the ALS training in terms of knowledge and skill performance at the course conclusion. However, further research is necessary to enhance long-term retention of knowledge and skill in actual resuscitation and patient's outcomes.
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Affiliation(s)
- Qin Zeng
- Joint Laboratory of Reproductive Medicine, Key Laboratory of Obstetric, Gynecologic and Pediatric Diseases and Birth Defects of Ministry of Education, West China Second University Hospital, SCU-CUHK, Sichuan University, Chengdu, 610041, P. R. China
- Key Laboratory of Reproductive Medicine, Sichuan Provincial Maternity and Child Health Care Hospital, The Affiliated Women's and children's Hospital of Chengdu Medical College, Chengdu, 610045, China
| | - Kai Wang
- Department of Acute Care Surgery, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu, 610072, China
| | - Wei-Xin Liu
- Key Laboratory of Reproductive Medicine, Sichuan Provincial Maternity and Child Health Care Hospital, The Affiliated Women's and children's Hospital of Chengdu Medical College, Chengdu, 610045, China
| | - Jiu-Zhi Zeng
- Key Laboratory of Reproductive Medicine, Sichuan Provincial Maternity and Child Health Care Hospital, The Affiliated Women's and children's Hospital of Chengdu Medical College, Chengdu, 610045, China
| | - Xing-Lan Li
- Department of pathology, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu, 610072, China
| | - Qing-Feng Zhang
- Ultrasound in Cardiac Electrophysiology and Biomechanics Key Laboratory of Sichuan Province, Sichuan Provincial People's Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, 610072, China
| | - Shang-Qing Ren
- Robotic Minimally Invasive Surgery Center, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu, 610072, China.
| | - Wen-Ming Xu
- Joint Laboratory of Reproductive Medicine, Key Laboratory of Obstetric, Gynecologic and Pediatric Diseases and Birth Defects of Ministry of Education, West China Second University Hospital, SCU-CUHK, Sichuan University, Chengdu, 610041, P. R. China.
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Callaghan-Koru J, Farzin A, Ridout E, Curran G. Integrating Implementation Science with Quality Improvement to Improve Perinatal Outcomes. Clin Perinatol 2023; 50:343-361. [PMID: 37201985 DOI: 10.1016/j.clp.2023.01.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/20/2023]
Abstract
Implementation science is an interdisciplinary field that seeks to contribute generalizable knowledge that can improve the translation of clinical evidence in routine care. To promote the integration of implementation science approaches with health care quality improvement, the authors offer a framework that links the Model for Improvement with implementation strategies and methods. Perinatal quality improvement teams can leverage the robust frameworks of implementation science to diagnose implementation barriers, select implementation strategies, and assess the strategies' contribution to improving care. Partnerships between implementation scientists and quality improvement teams could accelerate efforts by both groups to achieve measurable improvements in care.
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Affiliation(s)
- Jennifer Callaghan-Koru
- Department of Internal Medicine, University of Arkansas for Medical Sciences, 1125 North College Avenue, Fayetteville, AR 72703, USA.
| | - Azadeh Farzin
- Pediatrix of Maryland/Adventist Healthcare, 9901 Medical Center Drive, Rockville, MD 20850, USA
| | - Erick Ridout
- American Academy of Pediatrics, 1380 East Medical Center Drive, St George, UT 84790, USA
| | - Geoffrey Curran
- Department of Pharmacy Practice, University of Arkansas for Medical Sciences, 4301 West Markham Street, Little Rock, AR 72205, USA
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KC A, Kong SYJ, Basnet O, Haaland SH, Bhattarai P, Gomo Ø, Gurung R, Ahlsson F, Meinich-Bache Ø, Axelin A, Malla H, Basula YN, Pathak OK, Pokharel SM, Subedi H, Myklebust H. Usability, acceptability and feasibility of a novel technology with visual guidance with video and audio recording during newborn resuscitation: a pilot study. BMJ Health Care Inform 2022; 29:bmjhci-2022-100667. [PMID: 36455992 PMCID: PMC9717377 DOI: 10.1136/bmjhci-2022-100667] [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: 08/20/2022] [Accepted: 10/21/2022] [Indexed: 02/18/2023] Open
Abstract
OBJECTIVE Inadequate adherence to resuscitation for non-crying infants will have poor outcome and thus rationalise a need for real-time guidance and quality improvement technology. This study assessed the usability, feasibility and acceptability of a novel technology of real-time visual guidance, with sound and video recording during resuscitation. SETTING A public hospital in Nepal. DESIGN A cross-sectional design. INTERVENTION The technology has an infant warmer with light, equipped with a tablet monitor, NeoBeat and upright bag and mask. The tablet records resuscitation activities, ventilation sound, heart rate and display time since birth. Healthcare providers (HCPs) were trained on the technology before piloting. DATA COLLECTION AND ANALYSIS HCPs who had at least 8 weeks of experience using the technology completed a questionnaire on usability, feasibility and acceptability (ranged 1-5 scale). Overall usability score was calculated (ranged 1-100 scale). RESULTS Among the 30 HCPs, 25 consented to the study. The usability score was good with the mean score (SD) of 68.4% (10.4). In terms of feasibility, the participants perceived that they did not receive adequate support from the hospital administration for use of the technology, mean score (SD) of 2.44 (1.56). In terms of acceptability, the information provided in the monitor, that is, time elapsed from birth was easy to understand with mean score (SD) of 4.60 (0.76). CONCLUSION The study demonstrates reasonable usability, feasibility and acceptability of a technological solution that records audio visual events during resuscitation and provides visual guidance to improve care.
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Affiliation(s)
- Ashish KC
- Department of Women’s and Children’s Health, Uppsala University, Uppsala, Sweden
| | - So Yeon Joyce Kong
- Department of Women’s and Children’s Health, Laerdal Medical AS, Stavanger, Norway
| | | | | | | | | | - Rejina Gurung
- Department of Women’s and Children’s Health, Uppsala University, Uppsala, Sweden,Golden Community, Lalitpur, Nepal
| | - Fredrik Ahlsson
- Department of Women’s and Children’s Health, Uppsala University, Uppsala, Sweden
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