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Reynaud D, Decormeille G, Tisseaux A, Bun R. Evaluation of a training program using the SBAR communication tool for caregivers managing acute respiratory distress in lung cancer patients: A pilot randomized controlled trial protocol. Internet Interv 2024; 37:100752. [PMID: 38974112 PMCID: PMC11225351 DOI: 10.1016/j.invent.2024.100752] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2024] [Revised: 05/18/2024] [Accepted: 06/09/2024] [Indexed: 07/09/2024] Open
Abstract
Background Family-based caregivers are increasingly important in the management of non-hospitalized lung cancer patients. However, lack of training can negatively impact care including diagnostic errors that can lead to delays in providing appropriate medical treatment. Acute respiratory failure (ARF) is common symptom of lung cancer and requires urgent intervention as well as adequate communication with healthcare professionals (HCPs) to enable appropriate decision-making and improve patient outcomes. Standardized tools such as the Situation, Background, Assessment, Recommendation (SBAR) tool and its French adaptation SAED, standing for Situation, Antécédent, Évaluation et Demande, are designed to facilitate communication among (HCPs).Additionally, digital interventions, such as serious games, are increasingly used to train HCPs though its use for caregivers has not been studied. This pilot study aims to assess an innovative serious game training using the SAED tool combined with standard instructions on self-efficacy for family-based caregivers of lung cancer patients when facing a simulated situation of ARF. The study also aims to examine caregivers' emotional state, quality of life, satisfaction and knowledge about the SBAR tool. Methods A monocentric, randomized, controlled, open-label, superiority, parallel-arm trial will be conducted for 18 months with 3 mid-study assessments (NCT05839353). Family caregivers of lung cancer patients will be recruited at the University Hospital Center of Saint Pierre, Reunion Island, France. Participants will be randomized (1:1) into two groups: the experimental group receiving training using the SBAR/SAED tool and standard instructions for managing respiratory distress/dyspnea, and the control group, receiving standard instructions only. The primary outcome will be to determine perceived self-efficacy as measured by the Generalized Self-Efficacy Scale. Discussion This study will present a preliminary assessment of training family caregivers in using the SBAR/SAED tool in simulated episodes of ARF in lung cancer patients. Our findings may provide valuable insights into effective training methods for caregivers in critical home care situations and could be widely used for lung cancer management.
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Affiliation(s)
- Danielle Reynaud
- Department of Nursing, Rehabilitation and Medical Techniques (South Site), University Hospital Center, Saint-Pierre, La Réunion, France
- National Institute of Health and Medical Research (INSERM) Clinical Investigation Center (CIC) 1410 Clinical Epidemiology, University Hospital Center, Saint Pierre, La Réunion, France
| | - Guillaume Decormeille
- CLLE UMR 5263 CNRS, UT2J Laboratory and Institut de Formation en Soins Infirmiers Fondation Leonie Chaptal, Sarcelles, Paris, France
| | - Antoine Tisseaux
- National Institute of Health and Medical Research (INSERM) Clinical Investigation Center (CIC) 1410 Clinical Epidemiology, University Hospital Center, Saint Pierre, La Réunion, France
- Department of Public Health and Research Support, Methodological and Biostatistics Support Unit, University Hospital Center, Saint-Denis, La Réunion, France
| | - René Bun
- National Institute of Health and Medical Research (INSERM) Clinical Investigation Center (CIC) 1410 Clinical Epidemiology, University Hospital Center, Saint Pierre, La Réunion, France
- Department of Public Health and Research Support, Methodological and Biostatistics Support Unit, University Hospital Center, Saint-Denis, La Réunion, France
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Tjan TE, Wong LY, Rixon A. Conflict in emergency medicine: A systematic review. Acad Emerg Med 2024; 31:538-546. [PMID: 38415363 DOI: 10.1111/acem.14874] [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: 11/13/2023] [Revised: 01/04/2024] [Accepted: 01/07/2024] [Indexed: 02/29/2024]
Abstract
BACKGROUND The emergency department (ED) is a demanding and time-pressured environment where doctors must navigate numerous team interactions. Conflicts between health care professionals frequently arise in these settings. We aim to synthesize the individual-, team-, and systemic-level factors that contribute to conflict between clinicians within the ED and explore strategies and opportunities for future research. METHODS Online databases PubMed and Web of Science were systematically searched for relevant peer-reviewed journal articles in English with keywords relating to "conflict" and "emergency department," yielding a total of 29 articles. RESULTS Narrative analysis showed that conflict often occurred during referrals or admissions from ED to inpatient or admitting units. Individual-level contributors to conflict include a lack of trust in ED workup and staff inexperience. Team-level contributors include perceptions of bias between groups, patient complexity, communication errors, and difference in practice. Systems-level contributors include high workload/time pressures, ambiguities around patient responsibility, power imbalances, and workplace culture. Among identified solutions to mitigate conflict are better communication training, standardizing admission guidelines, and improving interdepartmental relationships. CONCLUSIONS In emergency medicine, conflict is common and occurs at multiple levels, reflecting the complex interface of tasks and relationships within ED.
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Affiliation(s)
- Timothy Edward Tjan
- Melbourne Medical School, The University of Melbourne, Melbourne, Victoria, Australia
| | - Lee Yung Wong
- Emergency Department, Austin Health, Melbourne, Victoria, Australia
- School of Business, Law and Entrepreneurship, Swinburne University of Technology, Melbourne, Victoria, Australia
| | - Andrew Rixon
- Department of Business, Strategy and Innovation, Griffith Business School, Griffith University, Brisbane, Queensland, Australia
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Chaica V, Marques R, Pontífice-Sousa P. ISBAR: A Handover Nursing Strategy in Emergency Departments, Scoping Review. Healthcare (Basel) 2024; 12:399. [PMID: 38338283 PMCID: PMC10855820 DOI: 10.3390/healthcare12030399] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2023] [Revised: 02/01/2024] [Accepted: 02/01/2024] [Indexed: 02/12/2024] Open
Abstract
The present work aims to map the available scientific evidence on the benefits of using the ISBAR tool in the nursing care of acutely ill adult patients' handover in an emergency department context. To this end, a scoping review was conducted, according to the guidelines proposed by the Joanna Briggs Institute (JBI), to answer the following research question: "What are the benefits of using the ISBAR tool in the nursing care of acutely ill adult patients' handover in an emergency department context?" The bibliographic search was carried out during August and September 2023 in the following electronic databases: CINAHL Complete; MEDLINE Complete; Cochrane Central Register of Controlled Trials; Cochrane Database of Systematic Reviews; and Cochrane Methodology Register. Only works published between 2013 and 2023 were deemed fit for inclusion. All the included studies (9) show that ISBAR methodology, as a standardized tool for transferring nursing care in the emergency service, allows for a safe, clear, and concise transition of nursing care. The benefits relate to patient and professional safety, continuity, and quality of care, as well as patient and professional comfort, with health gains.
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Affiliation(s)
- Veronica Chaica
- Institute of Health Sciences, Universidade Católica Portuguesa, 1649-023 Lisbon, Portugal;
- Hospital Garcia de Orta, 2805-267 Almada, Portugal
- CIIS-Center for Interdisciplinary Health Research, Universidade Católica Portuguesa, 1649-023 Lisbon, Portugal;
| | - Rita Marques
- CIIS-Center for Interdisciplinary Health Research, Universidade Católica Portuguesa, 1649-023 Lisbon, Portugal;
- Portuguese Red Cross Health School, 1300-125 Lisbon, Portugal
| | - Patrícia Pontífice-Sousa
- Institute of Health Sciences, Universidade Católica Portuguesa, 1649-023 Lisbon, Portugal;
- CIIS-Center for Interdisciplinary Health Research, Universidade Católica Portuguesa, 1649-023 Lisbon, Portugal;
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Burnett SJ, Stemerman R, Innes JC, Kaisler MC, Crowe RP, Clemency BM. Social Determinants of Health in EMS Records: A Mixed-methods Analysis Using Natural Language Processing and Qualitative Content Analysis. West J Emerg Med 2023; 24:878-887. [PMID: 37788028 PMCID: PMC10527846 DOI: 10.5811/westjem.59070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Revised: 04/17/2023] [Accepted: 04/10/2023] [Indexed: 10/04/2023] Open
Abstract
Introduction: Social determinants of health (SDoH) are known to impact the health and well-being of patients. However, information regarding them is not always collected in healthcare interactions, and healthcare professionals are not always well-trained or equipped to address them. Emergency medical services (EMS) professionals are uniquely positioned to observe and attend to SDoH because of their presence in patients' environments; however, the transmission of that information may be lost during transitions of care. Documentation of SDoH in EMS records may be helpful in identifying and addressing patients' insecurities and improving their health outcomes. Our objective in this study was to determine the presence of SDoH information in adult EMS records and understand how such information is referenced, appraised, and linked to other determinants by EMS personnel. Methods: Using EMS records for adult patients in the 2019 ESO Data Collaborative public-use research dataset using a natural language processing (NLP) algorithm, we identified free-text narratives containing documentation of at least one SDoH from categories associated with food, housing, employment, insurance, financial, and social support insecurities. From the NLP corpus, we randomly selected 100 records from each of the SDoH categories for qualitative content analysis using grounded theory. Results: Of the 5,665,229 records analyzed by the NLP algorithm, 175,378 (3.1%) were identified as containing at least one reference to SDoH. References to those SDoH were centered around the social topics of accessibility, mental health, physical health, and substance use. There were infrequent explicit references to other SDoH in the EMS records, but some relationships between categories could be inferred from contexts. Appraisals of patients' employment, food, and housing insecurities were mostly negative. Narratives including social support and financial insecurities were less negatively appraised, while those regarding insurance insecurities were mostly neutral and related to EMS operations and procedures. Conclusion: The social determinants of health are infrequently documented in EMS records. When they are included, they are infrequently explicitly linked to other SDoH categories and are often negatively appraised by EMS professionals. Given their unique position to observe and share patients' SDoH information, EMS professionals should be trained to understand, document, and address SDoH in their practice.
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Affiliation(s)
- Susan J. Burnett
- Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, The State University of New York, Department of Emergency Medicine, Buffalo, New York
| | | | - Johanna C. Innes
- Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, The State University of New York, Department of Emergency Medicine, Buffalo, New York
| | - Maria C. Kaisler
- Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, The State University of New York, Department of Emergency Medicine, Buffalo, New York
| | | | - Brian M. Clemency
- Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, The State University of New York, Department of Emergency Medicine, Buffalo, New York
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Yun J, Lee YJ, Kang K, Park J. Effectiveness of SBAR-based simulation programs for nursing students: a systematic review. BMC MEDICAL EDUCATION 2023; 23:507. [PMID: 37452348 PMCID: PMC10347853 DOI: 10.1186/s12909-023-04495-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/25/2022] [Accepted: 07/05/2023] [Indexed: 07/18/2023]
Abstract
BACKGROUND Situation, background, assessment, and recommendation (SBAR) has been extensively used in clinical and nursing education. A structured communication program increases effective communication, positivity, and education satisfaction during inter-professional collaboration among nursing students. This systematic review aimed to identify and synthesize evidence on the effectiveness of SBAR-based simulation training for nursing students. METHODS A research protocol was developed according to the Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols guidelines. The protocol for this study was registered in PROSPERO (CRD42021234068). Eight bibliographical databases were searched for studies published between 2001 and 2021, using relevant search terms. Searches were conducted in PubMed, Embase, Cumulative Index to Nursing and Allied Health, and Cochrane Central Register of Controlled Trials for literature in English, and DBpia, Research Information Sharing Service, Korean Studies Information Service System, and Korea Institute of Science and Technology Information for literature in Korean. After screening titles, abstracts, and full-text papers, pertinent data were extracted, and critical appraisals of the retrieved studies were performed. Data were analyzed using the framework approach, and the findings were presented in a narrative summary. The Effective Public Health Practice Project "Quality Assessment Tool for Quantitative Studies" was used to assess the quality of the included studies. RESULTS Twelve studies were included: 3 randomized controlled trials and 9 quasi-experimental studies. Two overarching themes were noted, namely communication clarity and critical thinking. The results of six out of 12 studies produced significant results in favor of SBAR-based simulation in terms of communication clarity. Divergent results were obtained regarding communication ability, critical thinking, confidence, learning self-efficacy, and attitude toward patient safety. The results of these studies highlight that communication clarity ultimately leads to positive results in terms of nursing students' behaviors related to patient safety. CONCLUSIONS This review provides a comprehensive update of the literature on the effectiveness of SBAR-based nursing simulation programs for nursing students. These programs were found to have positive learning outcomes because of clear and concise communication. Further studies on the effectiveness of various learning outcomes derived from SBAR-based programs are required.
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Affiliation(s)
- Jungmi Yun
- College of Nursing, Research Institute of Nursing Science, Pusan National University, Yangsan, 50612, Republic of Korea
| | - Yun Ji Lee
- College of Nursing, Research Institute of Nursing Science, Pusan National University, Yangsan, 50612, Republic of Korea
| | - Kyoungrim Kang
- College of Nursing, Research Institute of Nursing Science, Pusan National University, Yangsan, 50612, Republic of Korea
| | - Jongmin Park
- College of Nursing, Research Institute of Nursing Science, Pusan National University, Yangsan, 50612, Republic of Korea.
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Jo HB, Ham SY, Jung J, Moon SM, Kim NH, Song KH, Park JS, Park KU, Kim ES, Kim HB. Prevalence of and factors associated with inappropriate Clostridioides difficile testing in a teaching hospital in Korea. Antimicrob Resist Infect Control 2022; 11:70. [PMID: 35562785 PMCID: PMC9107266 DOI: 10.1186/s13756-022-01111-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2021] [Accepted: 04/29/2022] [Indexed: 11/15/2022] Open
Abstract
Background Given the increasing incidence of Clostridioides difficile infections in Korea, there has been an increase in inappropriate testing for C. difficile, which has rendered overdiagnosis of asymptomatic colonisers common. We aimed to investigate the appropriateness of C. difficile testing and the related factors. Methods We retrospectively reviewed the medical records of patients who were admitted to a 1300-bed tertiary-care teaching hospital in Korea and were tested for C. difficile infection from September 2019 to November 2019. We performed logistic regression analysis to investigate factors related to inappropriate testing. Further, a survey was conducted on physicians to assess the knowledge and ordering patterns of C. difficile testing. Results We included 715 tests from 520 patients in the analysis. Testing was classified as hospital-onset and community-onset and subclassified as appropriate and inappropriate following an algorithmic method. Among the 715 tests, 576 (80.6%) and 139 (19.6%) tests were classified as hospital-onset and community-onset, respectively. Among the hospital-onset tests, 297 (52%) were considered inappropriate. The risk of inappropriate testing increased when C. difficile tests were conducted in the emergency room (OR 24.96; 95% CI 3.12–199.98) but decreased in intensive care units (OR 0.36, 95% CI 0.19–0.67). The survey was conducted on 61 physicians. Internal medicine physicians had significantly higher scores than non-internal medicine physicians (7.1 vs. 5.7, p = 0.001). The most frequently ordered combination of tests was toxin + glutamate dehydrogenase (47.5%), which was consistent with the ordered tests. Conclusion Almost half of the C. difficile tests were performed inappropriately. The patient being located in the emergency room and intensive care unit increased and decreased the risk of inappropriate testing, respectively. In a questionnaire survey, we showed that internal medicine physicians were more knowledgeable about C. difficile testing than non-internal medicine physicians. There is a need to implement the diagnostic stewardship for C. difficile, especially through educational interventions for emergency room and non-internal medicine physicians. Supplementary Information The online version contains supplementary material available at 10.1186/s13756-022-01111-0.
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Braam A, Buljac-Samardzic M, Hilders CGJM, van Wijngaarden JDH. Collaboration Between Physicians from Different Medical Specialties in Hospital Settings: A Systematic Review. J Multidiscip Healthc 2022; 15:2277-2300. [PMID: 36237842 PMCID: PMC9552793 DOI: 10.2147/jmdh.s376927] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2022] [Accepted: 09/02/2022] [Indexed: 11/06/2022] Open
Abstract
Health care today is characterized by an increasing number of patients with comorbidities for whom interphysician collaboration seems very important. We reviewed the literature to understand what factors affect interphysician collaboration, determine how interphysician collaboration is measured, and determine its effects. We systematically searched six major databases. Based on 63 articles, we identified five categories that influence interphysician collaboration: personal factors, professional factors, preconditions and tools, organizational elements, and contextual characteristics. We identified a diverse set of mostly unvalidated tools for measuring interphysician collaboration that focus on information being transferred and understood, frequency of interaction and tone of the relationship, and value judgements about quality or satisfaction. We found that interphysician collaboration increased clinical outcomes as well as patient and staff satisfaction, while error rates and length of stay were reduced. The results should, however, be interpreted with caution, as most of the studies provide a low level of evidence.
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Affiliation(s)
- Anoek Braam
- Health Services Management & Organisation, Erasmus School of Health Policy & Management, Erasmus University Rotterdam, Rotterdam, the Netherlands,Correspondence: Anoek Braam, Health Services Management & Organisation, Erasmus School of Health Policy & Management, Erasmus University Rotterdam, Bayle Building, P.O. Box 1738, Rotterdam, DR 3000, the Netherlands, Email
| | - Martina Buljac-Samardzic
- Health Services Management & Organisation, Erasmus School of Health Policy & Management, Erasmus University Rotterdam, Rotterdam, the Netherlands
| | - Carina G J M Hilders
- Health Services Management & Organisation, Erasmus School of Health Policy & Management, Erasmus University Rotterdam, Rotterdam, the Netherlands
| | - Jeroen D H van Wijngaarden
- Health Services Management & Organisation, Erasmus School of Health Policy & Management, Erasmus University Rotterdam, Rotterdam, the Netherlands
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Schrepel C, Amick AE, Bann M, Watsjold B, Jauregui J, Ilgen JS, Sebok-Syer SS. Who's on your team? Specialty identity and inter-physician conflict during admissions. MEDICAL EDUCATION 2022; 56:625-633. [PMID: 34942027 DOI: 10.1111/medu.14715] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/13/2021] [Revised: 12/01/2021] [Accepted: 12/11/2021] [Indexed: 06/14/2023]
Abstract
PURPOSE Despite the implementation of professionalism curricula and standardised communication tools, inter-physician conflict persists. In particular, the interface between emergency medicine (EM) and internal medicine (IM) has long been recognised as a source of conflict. The social nuances of this conflict remain underexplored, limiting educators' ability to comprehensively address these issues in the clinical learning environment. Thus, the authors explored EM and IM physicians' experiences with negotiating hospital admissions to better understand the social dynamics that contribute to inter-physician conflict and provide foundational guidance for communication best practices. METHODS Using a constructivist grounded theory (CGT) approach, the authors conducted 18 semi-structured interviews between June and October 2020 with EM and IM physicians involved in conversations regarding admissions (CRAs). They asked participants to describe the social exchanges that influenced these conversations and to reflect on their experiences with inter-physician conflict. Data collection and analysis occurred iteratively. The relationships between the codes were discussed by the research team with the goal of developing conceptual connections between the emergent themes. RESULTS Participants described how their approaches to CRAs were shaped by their specialty identity, and how allegiance to members of their group contributed to interpersonal conflict. This conflict was further promoted by a mutual sense of disempowerment within the organisation, misaligned expectations, and a desire to promote their group's prerogatives. Conflict was mitigated when patient care experiences fostered cross-specialty team formation and collaboration that dissolved traditional group boundaries. CONCLUSIONS Conflict between EM and IM physicians during CRAs was primed by participants' specialty identities, their power struggles within the broader organisation, and their sense of duty to their own specialty. However, formation of collaborative inter-specialty physician teams and expansion of identity to include colleagues from other specialties can mitigate inter-physician conflict.
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Affiliation(s)
- Caitlin Schrepel
- Department of Emergency Medicine, University of Washington, Seattle, Washington, USA
| | - Ashley E Amick
- Department of Emergency Medicine, University of Washington, Seattle, Washington, USA
- Department of Medicine, University of Washington, Seattle, Washington, USA
| | - Maralyssa Bann
- Department of Medicine, University of Washington, Seattle, Washington, USA
| | - Bjorn Watsjold
- Department of Emergency Medicine, University of Washington, Seattle, Washington, USA
| | - Joshua Jauregui
- Department of Emergency Medicine, University of Washington, Seattle, Washington, USA
| | - Jonathan S Ilgen
- Department of Emergency Medicine, University of Washington, Seattle, Washington, USA
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Development of Nurse-Sensitive, Emergency Department-Specific Quality Indicators Using a Modified Delphi Technique. J Nurs Care Qual 2022; 37:E59-E66. [PMID: 35404876 DOI: 10.1097/ncq.0000000000000627] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND There is no identified set of nursing-sensitive, emergency department (ED)-specific quality indicators. PURPOSE The purpose of this study was to address the gap in quality indicators specific to the emergency care environment and identify a list of nursing-sensitive, ED-specific quality indicators across ED populations and phases of the ED visit for further development and testing. METHODS A modified Delphi technique was used to reach initial consensus. RESULTS Four thematic groups were identified, and quality indicators within each were rank ordered. Of the 4 groups, 21 quality indicators were identified: triage (6) was ranked highest, followed by special populations (4), transitions of care (4), and medical/surgical (7). CONCLUSIONS Many of the recommended metrics were questionable because they are nonspecific to the ED setting or subject to influences in the emergency care environment. Some identified priorities for quality indicator development were unsupported; we recommend that alternate methodologies be used to identify critical areas of quality measurement.
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Toren O, Lipschuetz M, Lehmann A, Regev G, Arad D. Improving Patient Safety in General Hospitals Using Structured Handoffs: Outcomes From a National Project. Front Public Health 2022; 10:777678. [PMID: 35372215 PMCID: PMC8965813 DOI: 10.3389/fpubh.2022.777678] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Accepted: 02/16/2022] [Indexed: 11/21/2022] Open
Abstract
Background Promoting quality and patient safety is one of the health policy pillars of Israel's Ministry of Health. Communication among healthcare professionals is of utmost importance and can be improved using a standardized, well-known handoff tool such as the Introduction, Situation, Background, Assessment, and Recommendations (ISBAR). This study aims to present implementation process and participants' satisfaction of a national project that used a standardized tool for team communication. Methods This national intervention project included process implementation teams from 17 Israeli general hospitals evaluating the ISBAR implementation process for transferring patients from intensive care units to medical/surgical wards. The project, conducted between January 2017 and March 2018, used Fischer's test and logistic regression. The project evaluation was based on the participants' assessment of and satisfaction with the handoff process. Results Eighty-seven process implementers completed the questionnaire. A statistically significant increase in satisfaction scores in terms of four variables (p < 0.001) was observed following the implementation of the project. Nurses reported higher satisfaction at the end of the process (0.036). Participants who perceived less missing information during handoffs were more satisfied with the process of information flow between wards (84.9%) than those who perceived more missing information (15.6%). Participants who responded that there was no need to improve information flow were more satisfied with the project information flow (95.6%) compared to the group which responded that it was necessary to improve information flow (58.2%). Three out of four variables predicted satisfaction with the process. Being a nurse also predicted satisfaction with information flow with a point estimate of 2.4. The C value of the total model was 0.87. Conclusions Implementation of a safety project at a national level requires careful planning and the close involvement of the participating teams. A standardized instrument, a well-defined process, and external controls to monitor and manage the project are essential for success. Disparities found in the responses of nurses vs. physicians suggest the need for a different approach for each profession in planning and executing a similar project in the future.
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Affiliation(s)
- Orly Toren
- Patient Safety and Risk Management, Hadassah-Hebrew University Medical Center, Jerusalem, Israel.,Nursing Department, Ono Academic College, Kiryat Ono, Israel
| | - Michal Lipschuetz
- Patient Safety and Risk Management, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | | | - Gil Regev
- Psyfas, Teamwork and Healthcare, Herzliya, Israel
| | - Dana Arad
- Patient Safety Division, The Israeli Ministry of Health, Jerusalem, Israel
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Gross E, Bunke C, Schellpfeffer N. Improving Verbal Handoff for Patients Admitted From the Pediatric Emergency Department to Medical Inpatient Services: A Trainee-Led Quality Improvement Intervention. Pediatr Emerg Care 2022; 38:e1229-e1232. [PMID: 35358151 DOI: 10.1097/pec.0000000000002684] [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] [Indexed: 11/25/2022]
Abstract
OBJECTIVE Transitions of care are a well-identified source of adverse events. At our academic tertiary children's hospital, no standardized verbal handoff is used in the emergency department with a lack of education provided to clinicians on handoff. We aimed to increase the percent of handoffs from the pediatric emergency department to inpatient medical services including 7 critical elements and increase clinician score of individual handoffs and overall clinician satisfaction with handoff key components. METHODS Study occurred from Fall 2017 through Winter 2019. After collecting baseline data, a modified I-PASS tool was visually integrated into work areas. Tool education was performed by brief lecture, with iterative education occurring cyclically. Handoff assessment and clinician satisfaction surveys were then recollected. Outcome measures included clinician scores of individual handoffs and overall satisfaction with handoff. Process measure was percent handoffs including 7 critical elements. Balancing measure was handoff length in minutes. RESULTS Clinician satisfaction scores improved from baseline (response rate, 38%) to postintervention (response rate, 30%) in efficiency (57%-69%), detail (57%-66%), and safety (55%-64%). Clinician scores of individual handoffs improved from 66% rating very good or excellent at baseline to 77% postintervention. Handoff time did not increase. Percent handoffs with all 7 critical elements did not show improvement. CONCLUSIONS Trainee-led implementation of handoff standardization increased clinician satisfaction and clinician score of individual handoffs without compromising handoff length. Although feasibility can be a challenge, trainee-led quality improvement is meaningful and should be promoted and valued in graduate medical education, despite limitations.
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Lafontaine J, Casacalenda N, Perreault M, Laliberté V, Milton D. Improving Transfer of Care Between Psychiatrists and Residents: Participants' Perspective on the Implementation of a Handover Protocol in a Psychiatric Emergency. ACADEMIC PSYCHIATRY : THE JOURNAL OF THE AMERICAN ASSOCIATION OF DIRECTORS OF PSYCHIATRIC RESIDENCY TRAINING AND THE ASSOCIATION FOR ACADEMIC PSYCHIATRY 2022; 46:114-119. [PMID: 33973167 DOI: 10.1007/s40596-021-01472-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/22/2020] [Accepted: 04/27/2021] [Indexed: 06/12/2023]
Abstract
OBJECTIVES Handover refers to the transfer of information from one professional to another during transitions of care. I-PASS is a mnemonic tool which stands for Illness severity; Patient summary; Action list; Situation awareness and contingency planning; and Synthesis by receiver. It was developed to standardize the handover process. Psychiatrists, nurses, and residents at the Montreal Jewish General Hospital psychiatric emergency were trained and the I-PASS handover model was implemented. METHODS Thirty-one psychiatrists, nurses, and residents participated in this quality improvement project. Participants filled a pre-training questionnaire to examine the baseline status of handovers before attending a training session on I-PASS. Participants then filled a second questionnaire assessing the perceived quality of the handover training session, as well as anticipated benefits and challenges of I-PASS prior to its implementation. Finally, following implementation, two focus groups were held to collect feedback from participants. RESULTS Pre-training, most participants reported that information provided during handovers was incomplete. Training was overall much appreciated. The most significant anticipated obstacle for implementing I-PASS was lack of time to properly fill out the form. Post-implementation, participants unanimously reported an improvement in the handover process. Handovers were perceived as faster, providing all key information about patients, and the perceived quality of the information was better. CONCLUSION Overall, the implementation of the I-PASS handover model was much appreciated by participants, who perceived that handovers were more comprehensive, efficient, and of better quality.
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Affiliation(s)
- Jonathan Lafontaine
- Faculty of Medicine and Health Sciences, McGill University, Montreal, Quebec, Canada.
| | - Nicola Casacalenda
- Faculty of Medicine and Health Sciences, McGill University, Montreal, Quebec, Canada
- Jewish General Hospital, Montreal, Quebec, Canada
| | - Michel Perreault
- Faculty of Medicine and Health Sciences, McGill University, Montreal, Quebec, Canada
- Douglas Mental Health University Institute, Montreal, Quebec, Canada
| | - Vincent Laliberté
- Faculty of Medicine and Health Sciences, McGill University, Montreal, Quebec, Canada
- Jewish General Hospital, Montreal, Quebec, Canada
| | - Diana Milton
- Douglas Mental Health University Institute, Montreal, Quebec, Canada
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13
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Lo L, Rotteau L, Shojania K. Can SBAR be implemented with high fidelity and does it improve communication between healthcare workers? A systematic review. BMJ Open 2021; 11:e055247. [PMID: 34921087 PMCID: PMC8685965 DOI: 10.1136/bmjopen-2021-055247] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
OBJECTIVE To characterise the extent to which health professionals perform SBAR (situation, background, assessment, recommendation) as intended (ie, with high fidelity) and the extent to which its use improves communication clarity or other quality measures. DATA SOURCES Medline, Healthstar, PsycINFO, Embase and CINAHL to October 2020 and handsearching selected journals. STUDY SELECTION AND OUTCOME MEASURES Eligible studies consisted of controlled trials and time series, including simple before-after design, assessing SBAR implementation fidelity or the effects of SBAR on communication clarity or other quality measures (eg, safety climate, patient outcomes). DATA EXTRACTION AND SYNTHESIS Two reviewers independently abstracted data according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses on study features, intervention details and study outcomes. We characterised the magnitude of improvement in outcomes as small (<20% relative increase), moderate (20%-40%) or large (>40%). RESULTS Twenty-eight studies (3 randomised controlled trials, 6 controlled before-after studies, and 19 uncontrolled before-after studies) met inclusion criteria. Of the nine studies assessing fidelity of SBAR use, four occurred in classroom settings and three of these studies reported large improvements. The five studies assessing fidelity in clinical settings reported small to moderate effects. Among eight studies measuring communication clarity, only three reported large improvements and two of these occurred in classroom settings. Among the 17 studies reporting impacts on quality measures beyond communication, over half reported moderate to large improvements. These improvements tended to involve measures of teamwork and culture. Improvements in patient outcomes occurred only with intensive multifaceted interventions (eg, early warning scores and rapid response systems). CONCLUSIONS High fidelity uptake of SBAR and improvements in communication clarity occurred predominantly in classroom studies. Studies in clinical settings achieving impacts beyond communication typically involved broader, multifaceted interventions. Future efforts to improve communication using SBAR should first confirm high fidelity uptake in clinical settings rather than assuming this has occurred. PROSPERO REGISTRATION NUMBER CRD42018111377.
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Affiliation(s)
- Lisha Lo
- Centre for Quality Improvement and Patient Safety, University of Toronto, Toronto, Ontario, Canada
| | - Leahora Rotteau
- Centre for Quality Improvement and Patient Safety, University of Toronto, Toronto, Ontario, Canada
| | - Kaveh Shojania
- Centre for Quality Improvement and Patient Safety, University of Toronto, Toronto, Ontario, Canada
- Department of Medicine, University of Toronto, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
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Kanjee Z, Beltran CP, Smith CC, Lewis J, Hall MM, Tibbles CD, Sullivan AM. "Friction by Definition": Conflict at Patient Handover Between Emergency and Internal Medicine Physicians at an Academic Medical Center. West J Emerg Med 2021; 22:1227-1239. [PMID: 34787545 PMCID: PMC8597691 DOI: 10.5811/westjem.2021.7.52762] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Accepted: 07/23/2021] [Indexed: 11/11/2022] Open
Abstract
INTRODUCTION Patient handoffs from emergency physicians (EP) to internal medicine (IM) physicians may be complicated by conflict with the potential for adverse outcomes. The objective of this study was to identify the specific types of, and contributors to, conflict between EPs and IM physicians in this context. METHODS We performed a qualitative focus group study using a constructivist grounded theory approach involving emergency medicine (EM) and IM residents and faculty at a large academic medical center. Focus groups assessed perspectives and experiences of EP/IM physician interactions related to patient handoffs. We interpreted data with the matrix analytic method. RESULTS From May to December 2019, 24 residents (IM = 11, EM = 13) and 11 faculty (IM = 6, EM = 5) from the two departments participated in eight focus groups and two interviews. Two key themes emerged: 1) disagreements about disposition (ie, whether a patient needed to be admitted, should go to an intensive care unit, or required additional testing before transfer to the floor); and 2) contextual factors (ie, the request to discuss an admission being a primer for conflict; lack of knowledge of the other person and their workflow; high clinical workload and volume; and different interdepartmental perspectives on the benefits of a rapid emergency department workflow). CONCLUSIONS Causes of conflict at patient handover between EPs and IM physicians are related primarily to disposition concerns and contextual factors. Using theoretical models of task, process, and relationship conflict, we suggest recommendations to improve the EM/IM interaction to potentially reduce conflict and advance patient care.
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Affiliation(s)
- Zahir Kanjee
- Beth Israel Deaconess Medical Center, Hospital Medicine Program, Boston, Massachusetts.,Harvard Medical School, Boston, Massachusetts
| | - Christine P Beltran
- Beth Israel Deaconess Medical Center, Carl J. Shapiro Institute for Education and Research, Boston, Massachusetts
| | - C Christopher Smith
- Beth Israel Deaconess Medical Center, Hospital Medicine Program, Boston, Massachusetts.,Harvard Medical School, Boston, Massachusetts.,Beth Israel Deaconess Medical Center, Internal Medicine Residency Program, Boston, Massachusetts
| | - Jason Lewis
- Harvard Medical School, Boston, Massachusetts.,Beth Israel Deaconess Medical Center, Department of Emergency Medicine, Boston, Massachusetts
| | - Matthew M Hall
- Providence Regional Medical Center, Department of Emergency Medicine, Everett, Washington.,Washington State University, Pullman, Washington
| | - Carrie D Tibbles
- Harvard Medical School, Boston, Massachusetts.,Beth Israel Deaconess Medical Center, Carl J. Shapiro Institute for Education and Research, Boston, Massachusetts.,Beth Israel Deaconess Medical Center, Emergency Medicine Residency Program, Boston, Massachusetts.,Beth Israel Deaconess Medical Center, Office of Graduate Medical Education, Boston, Massachusetts
| | - Amy M Sullivan
- Harvard Medical School, Boston, Massachusetts.,Beth Israel Deaconess Medical Center, Carl J. Shapiro Institute for Education and Research, Boston, Massachusetts
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15
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Coifman AHM, Pedreira LC, Jesus APSD, Batista REA. Interprofessional communication in an emergency care unit: a case study. Rev Esc Enferm USP 2021; 55:e03781. [PMID: 34346972 DOI: 10.1590/s1980-220x2020047303781] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2020] [Accepted: 02/24/2021] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE To map internal and external factors in an emergency care unit that interfere with interprofessional communicative practice. METHOD This is a single case study carried out in the emergency care unit of a general hospital. Data were collected through participant observation, document analysis, and semi-structured interviews, and were triangulated and subjected to thematic analysis, out of categories defined a priori, based on the SWOT matrix. RESULTS Twenty-two health care professionals participated in the study. As for the strengths and opportunities, it was found that professionals understand the importance of communication as a safety measure, and they use the shift change and written communication to share information. However, overcrowding, work overload, the lack of behaviors standardization, the inexperience of professionals, and the deficit in the interprofessional relationship are factors that hinder effective communication. CONCLUSION The fragile interprofessional communicative process hampers interaction and information sharing for shared decisions that allow the safe continuity of care.
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16
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Tasi MC, Baymon DE, Temin ES, Zheng H, Lehman KM, Baccari B, Tubridy A, Conly B, Yun BJ. Evaluation of Process Improvement Interventions on Handoff Times between the Emergency Department and Observation Unit. J Emerg Med 2020; 60:237-244. [PMID: 33223270 DOI: 10.1016/j.jemermed.2020.10.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Revised: 09/28/2020] [Accepted: 10/04/2020] [Indexed: 12/31/2022]
Abstract
BACKGROUND Mitigating hospital crowding requires judicious use of inpatient resources, making Emergency Department Observation Units (EDOUs) an increasingly vital destination for patients that are not suitable for discharge. Maximizing the utility of the EDOU hinges on efficient patient transfers and safe provider communication, which may be accomplished with asynchronous handoff and an emphasis on pull-through operations. OBJECTIVE The purpose of this study was to assess the impact of an electronic, asynchronous handoff replacing verbal handoff on transfer times from the Emergency Department (ED) to the EDOU. METHODS A retrospective observational study was performed with patients transferred to the EDOU throughout several process improvement measures focused on asynchronous handoff. Multivariable linear regression analysis was used to determine the effect that these process improvements had on the time from EDOU bed assignment to patient transfer. RESULTS There were 14,996 EDOU stays during the 20-month period included in the analysis. Time from EDOU bed assignment to patient transfer decreased significantly with all three interventions studied. An auto-page to the clinicians notifying them of a ready bed reduced the mean time to transfer by 10.1 min (p < 0.0001), asynchronous nursing handoff reduced it by 3.57 min (p = 0.0299), and asynchronous clinician handoff reduced it by 14.67 min (p < 0.0001). CONCLUSION Introducing automatic pages regarding bed status and converting the handoff process from a verbal model to an asynchronous, electronic handoff were effective ways to reduce the time from bed assignment to transfer out of the ED for patients being sent to the EDOU.
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Affiliation(s)
- Michael C Tasi
- Harvard Affiliated Emergency Medicine Residency Program, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts
| | - Da'Marcus E Baymon
- Harvard Affiliated Emergency Medicine Residency Program, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts
| | - Elizabeth S Temin
- Harvard Medical School, Boston, Massachusetts; Department of Emergency Medicine, Massachusetts General Hospital, Boston, Massachusetts
| | - Hui Zheng
- Massachusetts General Hospital, Boston, Massachusetts
| | - Kendra M Lehman
- Department of Emergency Medicine, Massachusetts General Hospital, Boston, Massachusetts
| | - Brian Baccari
- Department of Emergency Medicine, Massachusetts General Hospital, Boston, Massachusetts
| | - Aileen Tubridy
- Nursing and Patient Care Services, Massachusetts General Hospital, Boston, Massachusetts
| | - Bridget Conly
- Nursing and Patient Care Services, Massachusetts General Hospital, Boston, Massachusetts
| | - Brian J Yun
- Harvard Medical School, Boston, Massachusetts; Department of Emergency Medicine, Massachusetts General Hospital, Boston, Massachusetts
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17
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Preliminary Psychometrics of the Knowledge and Attitudes Toward SBAR Instrument (KA-SBAR). J Dr Nurs Pract 2020; 13:120-124. [PMID: 32817500 DOI: 10.1891/jdnp-d-19-00058] [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: 11/25/2022]
Abstract
BACKGROUND When measuring new practice approaches for improving patient safety in the clinical setting, researchers need instruments with evidence of reliability and validity. OBJECTIVE The purpose of this analysis was to examine the reliability and validity of an instrument to assess knowledge and attitudes toward communication using situation-background-assessment-recommendation (SBAR; KA-SBAR). METHODS This psychometric analysis was conducted with data from an interprofessional simulation-based learning experience with doctor of nursing practice students (n = 19) and physical therapy students (n = 52). Internal consistency reliability and construct validity tests including factor analysis for the KA-SBAR were conducted. RESULTS The KA-SBAR instrument had adequate internal consistency reliability and evidence of construct validity, including identification of two factors that explained 70% of the instrument's variance. However, there may be a ceiling effect of scores, making it difficult to show change. CONCLUSIONS The KA-SBAR instrument may be useful in assessing clinicians' perceptions of SBAR communication in education and practice settings. IMPLICATIONS FOR NURSING When selecting data collection measures, nurses need to carefully consider the purpose of the measure and evidence of the instrument's reliability and validity. Educators need to consider the clinical expertise of the students in designing challenging simulations to advance learning.
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18
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Zhu W, Patterson BW, Smith M, Rifleman AC, Carayon P, Li J. A Markov Chain Model for Transient Analysis of Handoff Process in Emergency Departments. IEEE Robot Autom Lett 2020; 5:4360-4367. [PMID: 32695881 DOI: 10.1109/lra.2020.2996066] [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] [Indexed: 11/08/2022]
Abstract
Transfer of care between multiple units or facilities is of significant importance for patient safety, care quality, and operation efficiency. Such transfers are often referred to as handoffs in hospitals, which need to be carried out timely, safely, and smoothly with accurate information. This paper introduces a Markov chain model to study the transients of handoff process in hospital emergency departments. The handoff process is modeled by a stochastic process with unavailability of service, which characterizes the constraints in bed capacity, staff shortage, and coordination issues, etc. For systems only allowing one transfer request waiting, the transient performance is obtained through Laplace transform and its inverse transform. Such a result is then used as a building block to study the systems allowing multiple requests waiting through an iteration process, which can reduce the computation complexity substantially. Numerical studies show that such a method can provide estimates of transient performance in the handoff process with acceptable accuracy.
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Affiliation(s)
- Wenjun Zhu
- Department of Industrial and Systems Engineering, University of Wisconsin, Madison, WI 53706, USA
| | - Brian W Patterson
- Department of Medicine, University of Wisconsin, Madison, WI 53705 USA
| | - Maureen Smith
- Departments of Population Health Sciences and Family Medicine & Community Health, University of Wisconsin, Madison, WI 53705 USA
| | - Anne C Rifleman
- University of Wisconsin Hospital and Clinic, Madison, WI 53705 USA
| | - Pascale Carayon
- Department of Industrial and Systems Engineering, University of Wisconsin, Madison, WI 53706, USA
| | - Jingshan Li
- Department of Industrial and Systems Engineering, University of Wisconsin, Madison, WI 53706, USA
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Kwok ESH, Clapham G, White S, Austin M, Calder LA. Development and implementation of a standardised emergency department intershift handover tool to improve physician communication. BMJ Open Qual 2020; 9:e000780. [PMID: 32019750 PMCID: PMC7011887 DOI: 10.1136/bmjoq-2019-000780] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2019] [Revised: 01/03/2020] [Accepted: 01/14/2020] [Indexed: 12/04/2022] Open
Abstract
BACKGROUND Structured handover can reduce communication breakdowns and potential medical errors. In our emergency department (ED) we identified a safety risk due to variation in quality and content of overnight handovers between physicians. AIM Our goal was to develop and implement a standardised ED-specific handover tool using quality improvement (QI) methodology. We aimed to increase the proportion of patients having adequate handover information conveyed at overnight shift change from a baseline of 50%-75% in 4 months. METHODS We used published best practices, stakeholder input and local data to develop a tool customised for intershift ED handovers. Implementation methods included education, cognitive aids, policy change and plan-do-study-act cycles informed by end-user feedback. We monitored progress using direct observation convenience sampling. MEASURES Our outcome measure was proportion of adequate patient handovers (defined as >50% of handover components communicated per patient) per overnight handover session. Tool utilisation characteristics were used for process measurement, and time metrics for balancing measures. We report changes using statistical process control charts and descriptive statistics. RESULTS We observed 49 overnight handover sessions from 2017 to 2019, evaluating handovers of 850 patients. Our improvement target was met in 10 months (median=76.1%) and proportion of adequate handovers continued to improve to median=83.0% at the postimprovement audit. Written communication of handover information increased from a median of 19.2% to 68.7%. Handover time increased by median=31 s per patient. End-users subjectively reported improved communication quality and value for resident education. CONCLUSIONS We achieved sustained improvements in the amount of information communicated during physician ED handovers using established QI methodologies. Engaging stakeholders in handover tool customisation for local context was an important success factor. We believe this approach can be easily adopted by any ED.
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Affiliation(s)
- Edmund S H Kwok
- Department of Emergency Medicine, Ottawa Hospital, Ottawa, Ontario, Canada
| | - Glenda Clapham
- Department of Emergency Medicine, Ottawa Hospital, Ottawa, Ontario, Canada
| | - Shannon White
- Department of Emergency Medicine, Ottawa Hospital, Ottawa, Ontario, Canada
| | - Michael Austin
- Department of Emergency Medicine, University of Ottawa, Ottawa, Ontario, Canada
- Department of Emergency Medicine, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Lisa A Calder
- Department of Emergency Medicine, University of Ottawa, Ottawa, Ontario, Canada
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20
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Nurse-to-nurse communication about multidisciplinary care delivered in the emergency department: An observation study of nurse-to-nurse handover to transfer patient care to general medical wards. Australas Emerg Care 2020; 23:37-46. [PMID: 31948933 DOI: 10.1016/j.auec.2019.12.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2019] [Revised: 12/03/2019] [Accepted: 12/09/2019] [Indexed: 12/21/2022]
Abstract
BACKGROUND Little is known about how Australian national safety standards for communicating multidisciplinary care are operationalised during high-risk care transitions. We examined transfer of care for complex patients from the emergency department (ED) to medical wards to explore nurse-to-nurse communication about multidisciplinary care provided in the ED. METHODS Using naturalistic, mixed-methods design, observation, audit and interview data were collected from a convenience sample of 38 nurses during transfer of care for 19 complex patients from the ED to medical wards at a tertiary hospital. A focus group with 19 clinicians from multiple disciplines explored explanations for findings and recommendations. Quantitative data were analysed using frequencies and descriptive statistics; the Connect, Observe, Listen, Delegate (COLD) framework informed qualitative content analysis. RESULTS Nurses seldom communicated multidisciplinary care at patient transfer. Most handovers included Connect and Observe (63-95%) and Listen (90%); Delegate (42%) behaviours were infrequent. Behaviours consistent with good practice recommendations (90%) and known to increase communication risk (53%) were observed. Tensions between policies and clinical processes, and information quality negatively impacted transfers. CONCLUSIONS This study revealed gaps in nurse-to-nurse communication about patients' multidisciplinary care. Complex factors negatively impact nurses' handover communication necessitating workarounds, and highlighting nurses' role as patient safety advocates.
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21
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Improving perceptions of patient safety through standardizing handoffs from the emergency department to the inpatient setting: a systematic review. J Am Assoc Nurse Pract 2019; 31:354-363. [PMID: 30829973 DOI: 10.1097/jxx.0000000000000160] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND AND PURPOSE Patient handoffs have long been identified as a potentially challenging time for patients because poor communication produces numerous complications. This is especially true with regards to patient care handoffs between areas such as the emergency department (ED) and inpatient setting. The purpose of this systematic review is to analyze existing literature pertaining to standardized handoffs between the ED and inpatient setting and its effect on perceived patient safety to guide future research, clinical practice, and patient safety. METHODS A review was conducted using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Studies were selected using predetermined inclusion/exclusion criteria: primary research and patient handoff from the ED to the inpatient setting. Quality assessment of the studies was completed using The Joanna Briggs Institute critical appraisal tool. CONCLUSION Existing studies demonstrate the potential for increased perception of patient safety as well as provider satisfaction when appropriate staff education and standardized handoff tools are implemented. There is a lack of data on the standardization of handoff tools between the ED and inpatient setting and their impact on perceived patient safety. IMPLICATIONS FOR PRACTICE The combination of provider education and implementation of standardized handoff tools in the ED positively affects perceptions of patient safety and provider satisfaction. Hospital administrations should strongly consider incorporating standardized handoff tools into practice.
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22
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Mangus CW, Mahajan P. Common Medical Errors in Pediatric Emergency Medicine. CLINICAL PEDIATRIC EMERGENCY MEDICINE 2019. [DOI: 10.1016/j.cpem.2019.100714] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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23
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Hendrickson MA, Schempf EN, Furnival RA, Marmet J, Lunos SA, Jacob AK. The Admission Conference Call: A Novel Approach to Optimizing Pediatric Emergency Department to Admitting Floor Communication. Jt Comm J Qual Patient Saf 2019; 45:431-439. [PMID: 31000353 PMCID: PMC6588502 DOI: 10.1016/j.jcjq.2019.02.008] [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: 09/07/2018] [Revised: 02/01/2019] [Accepted: 02/15/2019] [Indexed: 10/27/2022]
Abstract
Optimizing information sharing at transfer of care between teams is an important target for the improvement of patient safety. Traditional emergency department (ED)-to-floor handoffs do not support a shared mental model between physicians, residents, and nurses. This report describes and evaluates acceptance of a novel process for coordinating physician and nursing handoff calls for patients being admitted to an inpatient floor from a children's hospital ED. METHODS The Admission Conference Call (ACC) is a single conference call including attendings, residents, and nurses from the ED and inpatient teams, currently used for 29.8% of admissions from one ED. Physicians and nurses were surveyed to assess perception of its effects on patient care. RESULTS A total of 653 ACCs were conducted during 2017. The survey was completed by 43 nurses and 89 physicians. Mean Likert scale findings were in favor of the process supporting safe patient care (4.5/5; standard deviation [SD], 0.6); none said it increased risk. Ratings favored the process improving interdisciplinary alignment (4.0/5; SD, 0.8) and the benefits outweighing the inconvenience (3.9/5; SD, 0.9). Respondents were neutral on the effect of the ACC on throughput time (3.0/5; SD, 1.0). Logistical concerns were expressed; mean satisfaction was 6.8/10 (SD, 2.1). Free text comments varied widely, from pride to frustration. CONCLUSION The Admission Conference Call is a well-accepted alternative to a traditional multiple call process. Most participants believe it supports safe patient care. Further research is necessary to confirm measurable effects on patient outcomes, but this project provides encouragement to institutions considering innovative approaches.
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Affiliation(s)
- Marissa A. Hendrickson
- Department of Pediatrics, University of Minnesota, Minneapolis, Minnesota, United States
| | - Emma N. Schempf
- Department of Pediatrics, University of Minnesota, Minneapolis, Minnesota, United States
| | - Ronald A. Furnival
- Department of Pediatrics, University of Minnesota, Minneapolis, Minnesota, United States
| | - Jordan Marmet
- Department of Pediatrics, University of Minnesota, Minneapolis, Minnesota, United States
| | - Scott A. Lunos
- Clinical and Translational Science Institute/Biostatistical Design and Analysis Center, University of Minnesota, Minneapolis, Minnesota, United States
| | - Abraham K. Jacob
- Department of Pediatrics, University of Minnesota, Minneapolis, Minnesota, United States
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Wang ES, Velásquez ST, Smith CJ, Matthias TH, Schmit D, Hsu S, Leykum LK. Triaging Inpatient Admissions: an Opportunity for Resident Education. J Gen Intern Med 2019; 34:754-757. [PMID: 30993610 PMCID: PMC6502926 DOI: 10.1007/s11606-019-04882-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
In the context of internal medicine, "triage" is a newly popularized term that refers to constellation of activities related to determining the most appropriate disposition plans for patients, including assessing patients for admissions into the inpatient medicine service. The physician or "triagist" plays a critical role in the transition of care from the outpatient to the inpatient settings, yet little literature exists addressing this particular transition. The importance of this set of responsibilities has evolved over time as health systems become increasingly complex to navigate for physicians and patients. With the emphasis on hospital efficiency metrics such as emergency department throughput and appropriateness of admissions, this type of systems-based thinking is a necessary skill for practicing contemporary inpatient medicine. We believe that triaging admissions is a critical transition in the care continuum and represents an entrustable professional activity that integrates skills across multiple Accreditation Council for Graduate Medical Education (ACGME) competencies that internal medicine residents must master. Specific curricular competencies that address the domains of provider, system, and patient will deliver a solid foundation to fill a gap in skills and knowledge for the triagist role in IM residency training.
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Affiliation(s)
- Emily S Wang
- Department of Medicine, South Texas Veterans Health Care System, San Antonio, TX, USA.
- Division of General and Hospital Medicine, University of Texas Health Science Center at San Antonio, San Antonio, TX, USA.
| | - Sadie Trammell Velásquez
- Department of Medicine, South Texas Veterans Health Care System, San Antonio, TX, USA
- Division of General and Hospital Medicine, University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
| | - Christopher J Smith
- Division of Hospital Medicine, University of Nebraska Medicine Center, Omaha, NE, USA
| | - Tabatha H Matthias
- Division of Hospital Medicine, University of Nebraska Medicine Center, Omaha, NE, USA
| | - David Schmit
- Department of Medicine, South Texas Veterans Health Care System, San Antonio, TX, USA
- Division of General and Hospital Medicine, University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
| | - Sherwin Hsu
- Department of Medicine, Olive View - University of California Los Angeles Medical Center, Los Angeles, CA, USA
| | - Luci K Leykum
- Department of Medicine, South Texas Veterans Health Care System, San Antonio, TX, USA
- Division of General and Hospital Medicine, University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
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Moraes KB, Riboldi CDO, Silva KSD, Maschio J, Stefani LPC, Tavares JP, Wegner W. Transfer of the care of patients with low risk of mortality in postoperative: experience report. Rev Gaucha Enferm 2019; 40:e20180398. [PMID: 31038610 DOI: 10.1590/1983-1447.2019.2018039] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2018] [Accepted: 11/30/2018] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE Describe the implementation of care transfer flow chart in postoperative, based on a risk classification model. METHOD Experience report on the implementation of a pilot project between the post-anesthetic recovery room and the surgical hospitalization unit, developed between December/2016 and March/2017, aimed at transferring s the care of patients with low risk of postoperative mortality, in a university hospital in the South of Brazil. RESULTS The project made it possible to expedite the discharge of the patient from the Post-Anesthetic Recovery Room to the surgical hospitalization unit, to qualify the records regarding nursing care and to optimize the time of nurses in both units for care activities. CONCLUSION The implementation of a care transfer flow chart from the risk classification for postoperative patients contributed to a more effective communication, culminating in improvements in patient safety.
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Affiliation(s)
- Kátia Bottega Moraes
- Hospital de Clínicas de Porto Alegre (HCPA), Serviço de Enfermagem em Centro Cirúrgico. Porto Alegre, Rio Grande do Sul, Brasil
| | - Caren de Oliveira Riboldi
- Hospital de Clínicas de Porto Alegre (HCPA), Serviço de Enfermagem Cirúrgica. Porto Alegre, Rio Grande do Sul, Brasil
| | - Karen Schein da Silva
- Hospital de Clínicas de Porto Alegre (HCPA), Serviço de Enfermagem Cirúrgica. Porto Alegre, Rio Grande do Sul, Brasil
| | - Jéssica Maschio
- Universidade Federal do Rio Grande do Sul (UFRGS), Escola de Enfermagem. Porto Alegre, Rio Grande do Sul, Brasil
| | - Luciana Paula Cadore Stefani
- Universidade Federal do Rio Grande do Sul (UFRGS), Faculdade de Medicina, Departamento de Cirurgia. Porto Alegre, Rio Grande do Sul, Brasil
| | - Juliana Petri Tavares
- Universidade Federal do Rio Grande do Sul (UFRGS), Escola de Enfermagem, Departamento de Enfermagem Médico-Cirúrgica. Porto Alegre, Rio Grande do Sul, Brasil
| | - Wiliam Wegner
- Universidade Federal do Rio Grande do Sul (UFRGS), Escola de Enfermagem, Departamento de Enfermagem Materno-infantil. Porto Alegre, Rio Grande do Sul, Brasil
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