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Wootton SH, Rysavy M, Davis P, Thio M, Romero-Lopez M, Holzapfel LF, Thrasher T, Wade JD, Owen L. Practical approaches for supporting informed consent in neonatal clinical trials. Acta Paediatr 2024; 113:923-930. [PMID: 38389165 PMCID: PMC11006570 DOI: 10.1111/apa.17165] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2023] [Revised: 01/23/2024] [Accepted: 02/13/2024] [Indexed: 02/24/2024]
Abstract
The survival and health of preterm and critically ill infants have markedly improved over the past 50 years, supported by well-conducted neonatal research. However, newborn research is difficult to undertake for many reasons, and obtaining informed consent for research in this population presents several unique ethical and logistical challenges. In this article, we explore methods to facilitate the consent process, including the role of checklists to support meaningful informed consent for neonatal clinical trials. CONCLUSION: The authors provide practical guidance on the design and implementation of an effective consent checklist tailored for use in neonatal clinical research.
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Affiliation(s)
- Susan H. Wootton
- Division of Infectious Diseases, Department of Pediatrics, McGovern Medical School at UTHealth Houston, Houston, Texas, USA
- Institute for Clinical Research and Learning Health Care, McGovern Medical School at UTHealth Houston, Houston, Texas, USA
- Children's Memorial Hermann Hospital, Houston, Texas, USA
| | - Matthew Rysavy
- Institute for Clinical Research and Learning Health Care, McGovern Medical School at UTHealth Houston, Houston, Texas, USA
- Children's Memorial Hermann Hospital, Houston, Texas, USA
- Division of Neonatology, Department of Pediatrics, McGovern Medical School at UTHealth, Houston, Texas, USA
| | - Peter Davis
- Newborn Research, Neonatal Services, Royal Women's Hospital, Melbourne, Australia
- Department of Obstetrics, Gynaecology and Newborn Health, University of Melbourne, Melbourne, Australia
- Clinical Sciences, Murdoch Children's Research Institute, Melbourne, Australia
| | - Marta Thio
- Newborn Research, Neonatal Services, Royal Women's Hospital, Melbourne, Australia
- Department of Obstetrics, Gynaecology and Newborn Health, University of Melbourne, Melbourne, Australia
- Clinical Sciences, Murdoch Children's Research Institute, Melbourne, Australia
- Gandel Simulation Service, Royal Women's Hospital, Melbourne, Australia
| | - Mar Romero-Lopez
- Institute for Clinical Research and Learning Health Care, McGovern Medical School at UTHealth Houston, Houston, Texas, USA
- Children's Memorial Hermann Hospital, Houston, Texas, USA
- Division of Neonatology, Department of Pediatrics, McGovern Medical School at UTHealth, Houston, Texas, USA
| | - Lindsay F. Holzapfel
- Children's Memorial Hermann Hospital, Houston, Texas, USA
- Division of Neonatology, Department of Pediatrics, McGovern Medical School at UTHealth, Houston, Texas, USA
| | - Tamara Thrasher
- Children's Memorial Hermann Hospital, Houston, Texas, USA
- March of Dimes NICU Family Support Program, Houston, Texas, USA
| | - Jaleesa D. Wade
- Division of Neonatology, Department of Pediatrics, McGovern Medical School at UTHealth, Houston, Texas, USA
| | - Louise Owen
- Newborn Research, Neonatal Services, Royal Women's Hospital, Melbourne, Australia
- Department of Obstetrics, Gynaecology and Newborn Health, University of Melbourne, Melbourne, Australia
- Clinical Sciences, Murdoch Children's Research Institute, Melbourne, Australia
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Hejrati N, Srikandarajah N, Alvi MA, Quddusi A, Tetreault LA, Guest JD, Marco RAW, Kirshblum S, Martin AR, Strantzas S, Arnold PM, Basu S, Evaniew N, Kwon BK, Skelly AC, Fehlings MG. The Management of Intraoperative Spinal Cord Injury - A Scoping Review. Global Spine J 2024; 14:150S-165S. [PMID: 38526924 DOI: 10.1177/21925682231196505] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/27/2024] Open
Abstract
STUDY DESIGN Scoping Review. OBJECTIVE To review the literature and summarize information on checklists and algorithms for responding to intraoperative neuromonitoring (IONM) alerts and management of intraoperative spinal cord injuries (ISCIs). METHODS MEDLINE® was searched from inception through January 26, 2022 as were sources of grey literature. We attempted to obtain guidelines and/or consensus statements from the following sources: American Association of Neuromuscular & Electrodiagnostic Medicine (AANEM), American Academy of Neurology (AAN), American Clinical Neurophysiology Society, NASS (North American Spine Society), and other spine surgery organizations. RESULTS Of 16 studies reporting on management strategies for ISCIs, two were publications of consensus meetings which were conducted according to the Delphi method and eight were retrospective cohort studies. The remaining six studies were narrative reviews that proposed intraoperative checklists and management strategies for IONM alerts. Of note, 56% of included studies focused only on patients undergoing spinal deformity surgery. Intraoperative considerations and measures taken in the event of an ISCI are divided and reported in three categories of i) Anesthesiologic, ii) Neurophysiological/Technical, and iii) Surgical management strategies. CONCLUSION There is a paucity of literature on comparative effectiveness and harms of management strategies in response to an IONM alert and possible ISCI. There is a pressing need to develop a standardized checklist and care pathway to avoid and minimize the risk of postoperative neurologic sequelae.
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Affiliation(s)
- Nader Hejrati
- Division of Neurosurgery, Krembil Neuroscience Centre, Toronto Western Hospital, University Health Network, Toronto, ON, Canada
- Department of Neurosurgery & Spine Center of Eastern Switzerland, Cantonal Hospital St.Gallen, St.Gallen, Switzerland
| | - Nisaharan Srikandarajah
- Division of Neurosurgery, Krembil Neuroscience Centre, Toronto Western Hospital, University Health Network, Toronto, ON, Canada
| | - Mohammed Ali Alvi
- Institute of Medical Science, University of Toronto, Toronto, ON, Canada
| | - Ayesha Quddusi
- Institute of Medical Science, University of Toronto, Toronto, ON, Canada
| | | | - James D Guest
- Department of Neurosurgery and The Miami Project to Cure Paralysis, The Miller School of Medicine, University of Miami, Miami, FL, USA
| | - Rex A W Marco
- Department of Orthopedic Surgery, Houston Methodist Hospital, Houston, TX, USA
| | - Steven Kirshblum
- Kessler Institute for Rehabilitation, Rutgers New Jersey Medical School, Newark, NJ, USA
| | - Allan R Martin
- Department of Neurological Surgery, University of California Davis, Davis, CA, USA
| | - Samuel Strantzas
- Division of Neurosurgery, Department of Surgery, The Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
| | - Paul M Arnold
- Department of Neurosurgery, University of Illinois Champaign-Urbana, Urbana, IL, USA
| | | | - Nathan Evaniew
- McCaig Institute for Bone and Joint Health, Department of Surgery, Orthopaedic Surgery, Cumming School of Medicine, University of Calgary, AB, Canada
| | - Brian K Kwon
- Department of Orthopaedics, University of British Columbia, Vancouver, BC, Canada
- International Collaboration on Repair Discoveries (ICORD), University of British Columbia, Vancouver, BC, Canada
| | | | - Michael G Fehlings
- Division of Neurosurgery, Krembil Neuroscience Centre, Toronto Western Hospital, University Health Network, Toronto, ON, Canada
- Institute of Medical Science, University of Toronto, Toronto, ON, Canada
- Division of Neurosurgery and Spine Program, Department of Surgery, University of Toronto, Toronto, ON, Canada
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Tietschert M, Higgins S, Haynes A, Sadun R, Singer SJ. Safe Surgery Checklist Implementation: Associations of Management Practice and Safety Culture Change. Adv Health Care Manag 2024; 22:117-140. [PMID: 38262013 DOI: 10.1108/s1474-823120240000022006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2024]
Abstract
Designing and developing safe systems has been a persistent challenge in health care, and in surgical settings in particular. In efforts to promote safety, safety culture, i.e., shared values regarding safety management, is considered a key driver of high-quality, safe healthcare delivery. However, changing organizational culture so that it emphasizes and promotes safety is often an elusive goal. The Safe Surgery Checklist is an innovative tool for improving safety culture and surgical care safety, but evidence about Safe Surgery Checklist effectiveness is mixed. We examined the relationship between changes in management practices and changes in perceived safety culture during implementation of safe surgery checklists. Using a pre-posttest design and survey methods, we evaluated Safe Surgery Checklist implementation in a national sample of 42 general acute care hospitals in a leading hospital network. We measured perceived management practices among managers (n = 99) using the World Management Survey. We measured perceived preoperative safety and safety culture among clinical operating room personnel (N = 2,380 (2016); N = 1,433 (2017)) using the Safe Surgical Practice Survey. We collected data in two consecutive years. Multivariable linear regression analysis demonstrated a significant relationship between changes in management practices and overall safety culture and perceived teamwork following Safe Surgery Checklist implementation.
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Khan KS, Fawzy M, Chien PFW. Integrity of randomized clinical trials: Performance of integrity tests and checklists requires assessment. Int J Gynaecol Obstet 2023; 163:733-743. [PMID: 37184087 DOI: 10.1002/ijgo.14837] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2022] [Revised: 04/06/2023] [Accepted: 04/16/2023] [Indexed: 05/16/2023]
Abstract
The integrity of randomized clinical trials (RCT) has become a concern owing to a recent rise in the number of retractions and the repercussions this has for evidence-based patient care. However, there is little research on the subject of RCT integrity assessment. Recent literature reviews have revealed that journals' authors' instructions concerning integrity and their investigation policies concerning allegations of misconduct are heterogeneous. The judicious use of integrity tests applied to RCT manuscripts is hampered by an absence of data concerning misconduct prevalence (pre-test probability), a failure to evaluate test performance (validity) and a lack of consensus over a gold standard (against which test accuracy can be evaluated). These deficiencies hinder the post-publication correction of RCT records, the integrity evaluations in systematic reviews of RCTs and the prospective application of preventive solutions in RCT peer-review and preprint assessment. Dealing with the current controversy about trustworthiness of RCT evidence requires a strong investment in research, reform and education concerning research integrity. The purpose of this review article is to highlight the current limitations in dealing with trial integrity-related concerns and to propose solutions to some of these issues.
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Affiliation(s)
- Khalid S Khan
- Department of Preventive Medicine and Public Health, Faculty of Medicine, University of Granada, Granada, Spain
- CIBER Epidemiology and Public Health, Madrid, Spain
| | - Mohamed Fawzy
- IbnSina (Sohag), Banon (Assiut), Qena (Qena), Amshag (Sohag) IVF Facilities, Cairo, Egypt
| | - Patrick F W Chien
- Department of Obstetrics & Gynecology, RCSI & UCD Malaysia Campus, Penang, Malaysia
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Jelacic S, Bowdle A, Nair BG, Nair AA, Edwards M, Boorman DJ. Lessons from aviation safety: pilot monitoring, the sterile flight deck rule, and aviation-style computerised checklists in the operating room. Br J Anaesth 2023; 131:796-801. [PMID: 37879776 DOI: 10.1016/j.bja.2023.08.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2023] [Revised: 07/26/2023] [Accepted: 08/01/2023] [Indexed: 10/27/2023] Open
Abstract
Commercial aviation practices including the role of the pilot monitoring, the sterile flight deck rule, and computerised checklists have direct applicability to anaesthesia care. The pilot monitoring performs specific tasks that complement the pilot flying who is directly controlling the aircraft flight path. The anaesthesia care team, with two providers, can be organised in a manner that is analogous to the two-pilot flight deck. However, solo providers, such as solo pilots, can emulate the pilot monitoring role by reading checklists aloud, and utilise non-anaesthesia providers to fulfil some of the functions of pilot monitoring. The sterile flight deck rule states that flight crew members should not engage in any non-essential or distracting activity during critical phases of flight. The application of the sterile flight deck rule in anaesthesia practice entails deliberately minimising distractions during critical phases of anaesthesia care. Checklists are commonly used in the operating room, especially the World Health Organization surgical safety checklist. However, the use of aviation-style computerised checklists offers additional benefits. Here we discuss how these commercial aviation practices may be applied in the operating room.
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Affiliation(s)
- Srdjan Jelacic
- Department of Anesthesiology and Pain Medicine, University of Washington, Seattle, WA, USA.
| | - Andrew Bowdle
- Department of Anesthesiology and Pain Medicine, University of Washington, Seattle, WA, USA
| | | | - Akira A Nair
- Department of Computer Science, Brown University, Providence, RI, USA
| | - Mark Edwards
- Department of Cardiothoracic and ORL Anaesthesia, Auckland City Hospital, Auckland, New Zealand
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Kapira S, Aron MB, Mphande I, Chonongera G, Khongo BD, Zaniku HR, Mkandawire S, Nkhoma W, Tengatenga L, Munyaneza F, Kachimanga C. Evaluating the uptake and effect of Surgical Safety Checklist implementation in a rural hospital, Neno District, Malawi. BMJ Open Qual 2023; 12:e002426. [PMID: 37989354 PMCID: PMC10661078 DOI: 10.1136/bmjoq-2023-002426] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Accepted: 11/03/2023] [Indexed: 11/23/2023] Open
Abstract
BACKGROUND The WHO introduced the Surgical Safety Checklist (SSC) in 2008, which has been proven to enhance collaboration and patient safety before, during and after surgical procedures. However, the impact of using SSC has not been assessed in a rural setting in Malawi. We aimed to evaluate the uptake of SSC in Neno District, Malawi. METHODS We conducted a cross-sectional hospital-based retrospective chart review of 468 surgical cases from July 2021 to March 2022 in two hospitals in Neno District. We collected data using Excel and used R software for analysis. We used descriptive statistics to characterise the surgeries. We used χ2 test and Wilcoxon signed-rank test to test the association between SSC use and independent variables. We fitted logistic regression to assess predictors of SSC use and complications. RESULTS Of 468 surgical cases, 92% (n=431) were done as emergency procedures. The median age was 23 years (IQR: 19-29) and 94% (n=439) were female. Overall, 38% of surgeries (n=176) used the SSC and of these, 98% were in emergency procedures. We found an association between the use of SSC and the age of the client (p=0.018), type of procedure, name of the procedure, healthcare worker cadre, time procedure performed and complications (p<0.001). However, no association was observed between SSC use and outcome (p>0.05). The odds of using SSC were higher in emergency surgeries, surgeries performed at night; however, they were lower among temporary employees and anaesthetists with a diploma (p<0.001). The odds of experiencing complications were 1.71 times greater when using SSC compared with surgeries without SSC (p=0.029). CONCLUSIONS The use of an SSC in a rural area was promising, despite its fluctuating use and this needs programme improvement. Further studies are highly recommended to understand the fluctuation in the use of the SSC.
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Affiliation(s)
| | - Moses Banda Aron
- Monitoring and Evaluation, Partners In Health, Neno, Malawi
- Research Group Snakebite Envenoming, Bernhard Nocht Institute for Tropical Medicine, Hamburg, Germany
| | | | | | | | - Haules Robbins Zaniku
- Neno District Health Office, Ministry of Health, Neno, Malawi
- Kamuzu University of Health Sciences, School of Global and Public Health, Blantyre, Malawi
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7
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Kasunuran-Cruz MT, Tan DKY, Yeo CY, Hooi BMY, Soong JTY. Sustainability and impact of the implementation of a frailty checklist for the acute medical unit: experience from a tertiary public hospital in Singapore. BMJ Open Qual 2023; 12:e002203. [PMID: 37463783 PMCID: PMC10357726 DOI: 10.1136/bmjoq-2022-002203] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2022] [Accepted: 07/07/2023] [Indexed: 07/20/2023] Open
Abstract
BACKGROUND Accelerated population ageing is associated with an increasing prevalence of frailty. International guidelines call for systematic assessment and timely interventions for older persons requiring acute care. Checklists have been applied successfully in healthcare settings. OBJECTIVE This study describes the implementation of a safety checklist for frailty in the acute medical unit (AMU) of a tertiary public hospital in Singapore. We explored the sustainability of processes up to 6 months after initial implementation. Additionally, we investigated process and system outcome benefits following the implementation of the checklist. METHODS This retrospective observational study used case notes review of patients admitted to the AMU of a tertiary public hospital in Singapore from February to August 2019. Process outcomes measured to include compliance with AMU frailty checklist assessments and interventions at 24 hours of hospital admission. System and patient outcomes studied to include the length of hospital stay; 30-day emergency department reattendance rate; 30-day hospital readmission rate and inpatient mortality. Propensity scores were used to create balanced cohorts for comparison between those with complete and incomplete compliance with the checklist. Logistic regression was used to adjust for known confounders. RESULTS Average weekly (all-or-nothing) compliance with the frailty checklist (14.7%) was sustained for 6 months. Where assessments detected high risk, appropriate interventions were appropriately triggered (44%-97.4%). While trends to benefit systems and patient outcomes were present, these were not statistically significant. Contextual patterns are discussed. CONCLUSION A safety checklist for frailty was feasibly implemented in the AMU. The checklist was a complex intervention. Full compliance with the checklist was challenging to achieve. Further research assessing optimal patient selection criteria and how checklists may shift team behaviour is a priority.
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Affiliation(s)
| | - Drusilla Kai Yan Tan
- Medicine, National University of Singapore Yong Loo Lin School of Medicine, Singapore
| | - Charmaine Yan Yeo
- Medicine, National University of Singapore Yong Loo Lin School of Medicine, Singapore
| | | | - John Tshon Yit Soong
- Medicine, National University Hospital, Singapore
- Medicine, National University of Singapore Yong Loo Lin School of Medicine, Singapore
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Renouard F, Renouard E, Rendón A, Pinsky HM. Increasing the margin of patient safety for periodontal and implant treatments: The role of human factors. Periodontol 2000 2023; 92:382-398. [PMID: 37183608 DOI: 10.1111/prd.12488] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2022] [Revised: 02/06/2023] [Accepted: 04/02/2023] [Indexed: 05/16/2023]
Abstract
Early complications following periodontal and dental implant surgeries are typically attributed to technique or poor biological response, ignoring the possibility of the human element. Interestingly, significant experience is not correlated with increased success, whereas evidence supports the impact of clinical behavior on patient outcome. This is the result of errors, much like those scrutinized in other high-risk technical fields, such as aviation. What can be surprising is that those who make these errors are very well acquainted with best practices. Given this, how is it possible for the conscientious practitioner to fail to apply protocols that are nonetheless very well known? Recently, the concepts of human and organizational factors have been translated to medicine, though dentistry has been slow to recognize their potential benefit. This review lists specific human factor behaviors, such as use of checklists and crew resource management, which might improve postsurgical outcome.
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Affiliation(s)
| | - Erell Renouard
- Intercampus Affairs, Assistant Dean, Sciences Po, Paris, France
| | - Alexandra Rendón
- Periodontology Unit, Department of Biomedical and Neuromotor Sciences, Bologna University, Bologna, Italy
| | - Harold M Pinsky
- DDS Private Practice, Airline Transport Pilot, Lead Line Check Pilot Airbus A-330, Michigan, Ann Arbor, USA
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9
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Biringer E, Helgeland J, Hellesen HB, Aβmus J, Hartveit M. Development and testing of the QDis-MH checklist for discharge letters from specialised mental healthcare: a stakeholder-centred study. BMJ Open Qual 2023; 12:bmjoq-2022-002036. [PMID: 37019467 PMCID: PMC10083855 DOI: 10.1136/bmjoq-2022-002036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2022] [Accepted: 03/21/2023] [Indexed: 04/07/2023] Open
Abstract
BACKGROUND The 'discharge letter' is the mandatory written report sent from specialists in the specialist services to general practitioners (GPs) on patient discharge. Clear recommendations from relevant stakeholders for contents of discharge letters and instruments to measure the quality of discharge letters in mental healthcare are needed. The objectives were to (1) detect which information relevant stakeholders defined as important to include in discharge letters from mental health specialist services, (2) develop a checklist to measure the quality of discharge letters and (3) test the psychometric properties of the checklist. METHODS We used a stepwise multimethod stakeholder-centred approach. Group interviews with GPs, mental health specialists and patient representatives defined 68 information items with 10 consensus-based thematic headings relevant to include in high-quality discharge letters. Information items rated as highly important by GPs (n=50) were included in the Quality of Discharge information-Mental Health (QDis-MH) checklist. The 26-item checklist was tested by GPs (n=18) and experts in healthcare improvement or health services research (n=15). Psychometric properties were assessed using estimates of intrascale consistency and linear mixed effects models. Inter-rater and test-retest reliability were assessed using Gwet's agreement coefficient (Gwet's AC1) and intraclass correlation coefficients. RESULTS The QDis-MH checklist had satisfactory intrascale consistency. Inter-rater reliability was poor to moderate, and test-retest reliability was moderate. In descriptive analyses, mean checklist scores were higher in the category of discharge letters defined as 'good' than in 'medium' or 'poor' letters, but differences did not reach statistical significance. CONCLUSIONS GPs, mental health specialists and patient representatives defined 26 information items relevant to include in discharge letters in mental healthcare. The QDis-MH checklist is valid and feasible. However, when using the checklist, raters should be trained and the number of raters kept to a minimum due to questionable inter-rater reliability.
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Affiliation(s)
- Eva Biringer
- Department of Research and Innovation, Helse Fonna HF, Haugesund/Valen/Stord, Norway
| | | | | | - Jörg Aβmus
- Centre for Clinical Research, Helse Bergen HF, Bergen, Norway
| | - M Hartveit
- Department of Research and Innovation, Helse Fonna HF, Haugesund/Valen/Stord, Norway
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
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Manzo BF, Silva DCZ, Fonseca MP, Tavares IVR, de Oliveira Marcatto J, da Mata LRF, Parker LA. Content validity of a Safe Nursing Care Checklist for a neonatal unit. Nurs Crit Care 2023; 28:307-321. [PMID: 35920678 DOI: 10.1111/nicc.12831] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Revised: 07/12/2022] [Accepted: 07/14/2022] [Indexed: 12/01/2022]
Abstract
BACKGROUND Nursing checklists have been shown to improve communication, reduce the occurrence of adverse events, and promote safe, quality care in different care settings. However, to date, there is no validated patient care safety checklist for nurses caring for infants in Neonatal Intensive Care Units (NICU). AIM To describe development and content validation of the "Safe Nursing Care Checklist for Infants Hospitalized in the Neonatal Intensive Care Unit". STUDY DESIGN Online Survey. METHODS Based upon an integrative literature review, we developed a checklist focused on safe nursing care for infants in the NICU. Nursing experts participated in three rounds of a content validation process where they rated the items online. An agreement level ≥0.90 was required for inclusion in the checklist. Forty- three expert nurses with experience working in the NICU and who were certified in neonatal nursing or had a master's or doctoratal degree in child health provided content validation of the patient care checklist. RESULTS The final checklist contained 45 items with content validation index scores greater than 90%. The instrument was structured into six dimensions including patient identification, effective communication, medication safety, infection prevention, fall prevention, and pressure injuries/skin injuries prevention. CONCLUSION Content validity was established for the "Safe Nursing Care Checklist for Infants Hospitalized in the Neonatal Intensive Care Unit" which can identify strengths and weaknesses in safe nursing care for infants in the NICU as well as direct educational interventions to promote nursing care based on scientific evidence. RELEVANCE TO CLINICAL PRACTICE This checklist can potentially be used by bedside nurses to promote provision of safe care to infants in the NICU and to guide corrective strategies and encourage evidence-based decision-making. Validation in the clinical setting is needed.
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Affiliation(s)
- Bruna Figueiredo Manzo
- Department of Maternal Child Nursing and Public Health, Federal University of Minas Gerais, Belo Horizonte, Brazil
| | | | | | | | - Juliana de Oliveira Marcatto
- Department of Maternal Child Nursing and Public Health, Federal University of Minas Gerais, Belo Horizonte, Brazil
| | | | - Leslie A Parker
- Department of Biobehavioval Nursing Science, University of Florida College of Nursing, Gainesville, Florida, USA
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Boyle MH, Duncan L, Wang L, Georgiades K. Problem checklists and standardized diagnostic interviews: evidence of psychometric equivalence for classifying psychiatric disorder among children and youth in epidemiological studies. J Child Psychol Psychiatry 2022; 64:779-786. [PMID: 36504296 DOI: 10.1111/jcpp.13735] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/25/2022] [Indexed: 12/14/2022]
Abstract
BACKGROUND The standard approach for classifying child/youth psychiatric disorder as present or absent in epidemiological studies is lay-administered structured, standardized diagnostic interviews (interviews) based on categorical taxonomies such as the DSM and ICD. Converting problem checklist scale scores (checklists) to binary classifications provides a simple, inexpensive alternative. METHODS Using assessments obtained from 737 parents, we determine if child/youth behavioral, attentional, and emotional disorder classifications based on checklists are equivalent psychometrically to interview classifications. We test this hypothesis by (1) comparing their test-retest reliabilities based on kappa (κ), (2) estimating their observed agreement at times 1 and 2, and (3) in structural equation models, comparing their strength of association with clinical status and reported use of prescription medication to treat disorder. A confidence interval approach is used to determine if parameter differences lie within the smallest effect size of interest set at ±0.125. RESULTS The test-retest reliabilities (κ) for interviews compared with checklists met criteria for statistical equivalence: behavioral, .67 and .70; attentional, .64 and .66; and emotional, .61 and .65. Observed agreement between the checklist and interviews on classifications of disorder at times 1 and 2 was, on average, κ = .61. On average, the β coefficients estimating associations with clinical status were .59 (interviews) and .63 (checklists); and with prescription medication use, .69 (interviews) and .71 (checklists). Behavioral and attentional disorders met criteria for statistical equivalence. Emotional disorder did not, although the coefficients were stronger numerically for the checklist. CONCLUSIONS Classifications of child/youth psychiatric disorder from parent-reported checklists and interviews are equivalent psychometrically. The practical advantages of checklists over interviews for classifying disorder (lower administration cost and respondent burden) are enhanced by their ability to measure disorder dimensionally. Checklists provide an option to interviews in epidemiological studies of common child/youth psychiatric disorders.
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Affiliation(s)
- Michael H Boyle
- Department of Psychiatry and Behavioural Neurosciences, Offord Centre for Child Studies, McMaster University, Hamilton, ON, Canada
| | - Laura Duncan
- Department of Psychiatry and Behavioural Neurosciences, Offord Centre for Child Studies, McMaster University, Hamilton, ON, Canada
| | - Li Wang
- Department of Psychiatry and Behavioural Neurosciences, Offord Centre for Child Studies, McMaster University, Hamilton, ON, Canada
| | - Katholiki Georgiades
- Department of Psychiatry and Behavioural Neurosciences, Offord Centre for Child Studies, McMaster University, Hamilton, ON, Canada
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Escamilla-Ocañas CE, Torrealba-Acosta G, Mandava P, Qasim MS, Gutiérrez-Flores B, Bershad E, Hirzallah M, Venkatasubba Rao CP, Damani R. Implementation of systematic safety checklists in a neurocritical care unit: a quality improvement study. BMJ Open Qual 2022; 11:bmjoq-2022-001824. [PMID: 36588320 PMCID: PMC9743379 DOI: 10.1136/bmjoq-2022-001824] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2022] [Accepted: 09/16/2022] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Structured and systematised checklists have been shown to prevent complications and improve patient care. We evaluated the implementation of systematic safety checklists in our neurocritical care unit (NCCU) and assessed its effect on patient outcomes. DESIGN/METHODS This quality improvement project followed a Plan-Do-Study-Act (PDSA) methodology. A checklist for medication reconciliation, thromboembolic prophylaxis, glycaemic control, daily spontaneous awakening, breathing trial, diet, catheter/lines duration monitoring and antibiotics de-escalation was implemented during daily patient rounds. Main outcomes included the rate of new infections, mortality and NCCU-length of stay (LOS). Intervened patients were compared with historical controls after propensity score and Euclidean distance matching to balance baseline covariates. RESULTS After several PDSA iterations, we applied checklists to 411 patients; the overall average age was 61.34 (17.39). The main reason for admission included tumour resection (31.39%), ischaemic stroke (26.76%) and intracerebral haemorrhage (10.95%); the mean Sequential Organ Failure Assessment (SOFA) score was 2.58 (2.68). At the end of the study, the checklist compliance rate throughout the full NCCU stays reached 97.11%. After controlling for SOFA score, age, sex and primary admitting diagnosis, the implementation of systematic checklists significantly correlated with a reduced LOS (ß=-0.15, 95% CI -0.24 to -0.06), reduced rate of any new infections (OR 0.59, 95% CI 0.40 to 0.87) and reduced urinary tract infections (UTIs) (OR 0.23, 95% CI 0.09 to 0.55). Propensity score and Euclidean distance matching yielded 382 and 338 pairs with excellent covariate balance. After matching, outcomes remained significant. DISCUSSION The implementation of safety checklists in the NCCU proved feasible, easy to incorporate into the NCCU workflow, and a helpful tool to improve adherence to practice guidelines and quality of care measurements. Furthermore, our intervention resulted in a reduced NCCU-LOS, rate of new infections and rate of UTIs compared with propensity score and Euclidean distance matched historical controls.
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Affiliation(s)
| | | | - Pitchaiah Mandava
- Neurology, Baylor College of Medicine, Houston, Texas, USA,Analytical Software and Engineering Research Laboratory, Michael E DeBakey VA Medical Center, Houston, Texas, USA
| | | | | | - Eric Bershad
- Neurology, Baylor College of Medicine, Houston, Texas, USA
| | | | | | - Rahul Damani
- Neurology, Baylor College of Medicine, Houston, Texas, USA
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Nascimbene J, Gheza G, Bilovitz PO, Francesconi L, Hafellner J, Mayrhofer H, Salvadori M, Vallese C, Nimis PL. A hotspot of lichen diversity and lichenological research in the Alps: the Paneveggio-Pale di San Martino Natural Park (Italy). MycoKeys 2022; 94:37-50. [PMID: 36760543 PMCID: PMC9836431 DOI: 10.3897/mycokeys.94.95858] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Accepted: 11/10/2022] [Indexed: 12/12/2022] Open
Abstract
A checklist of 916 lichenised taxa is reported from the Paneveggio-Pale di San Martino Natural Park and its surroundings (Trentino-Alto Adige, N Italy), based on 7351 records from: (a) 72 literature sources, (b) eight public and private herbaria and (c) field observations by some of the authors. The study area appears as a hotspot of lichen diversity, hosting 30.1% of the lichen biota of the Alps in a territory that has 0.064% of their total surface area. This is mainly due to its high climatical, geological and orographic heterogeneity, but also to the long history of lichenological exploration, that started in the 19th century with Ferdinand Arnold and is still ongoing. The present work highlights the importance of detailed species inventories to support knowledge of biodiversity patterns, taxonomy and ecology and to properly address conservation issues. Fuscideamollisvar.caesioalbescens, Hydropunctariascabra, Protoparmeliabadiavar.cinereobadia and Variosporapaulii are new to Italy, 18 other taxa are new to Trentino-Alto Adige.
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Affiliation(s)
- Juri Nascimbene
- BIOME Lab, Department of Biological, Geological and Environmental Sciences, Alma Mater Studiorum University of Bologna, Via Irnerio 42, 40126 Bologna, ItalyAlma Mater Studiorum University of BolognaBolognaItaly
| | - Gabriele Gheza
- BIOME Lab, Department of Biological, Geological and Environmental Sciences, Alma Mater Studiorum University of Bologna, Via Irnerio 42, 40126 Bologna, ItalyAlma Mater Studiorum University of BolognaBolognaItaly
| | - Peter O. Bilovitz
- Division of Plant Sciences, Institute of Biology, NAWI Graz, University of Graz, Holteigasse 6, 8010 Graz, AustriaUniversity of GrazGrazAustria
| | - Luana Francesconi
- BIOME Lab, Department of Biological, Geological and Environmental Sciences, Alma Mater Studiorum University of Bologna, Via Irnerio 42, 40126 Bologna, ItalyAlma Mater Studiorum University of BolognaBolognaItaly
| | - Josef Hafellner
- Division of Plant Sciences, Institute of Biology, NAWI Graz, University of Graz, Holteigasse 6, 8010 Graz, AustriaUniversity of GrazGrazAustria
| | - Helmut Mayrhofer
- Division of Plant Sciences, Institute of Biology, NAWI Graz, University of Graz, Holteigasse 6, 8010 Graz, AustriaUniversity of GrazGrazAustria
| | - Maurizio Salvadori
- Paneveggio-Pale di San Martino Natural Park, Villa Welsperg, località Castelpietra 2, 38054 Primiero San Martino di Castrozza (Trento), ItalyPaneveggio-Pale di San Martino Natural ParkPrimiero San Martino di CastrozzaItaly
| | - Chiara Vallese
- BIOME Lab, Department of Biological, Geological and Environmental Sciences, Alma Mater Studiorum University of Bologna, Via Irnerio 42, 40126 Bologna, ItalyAlma Mater Studiorum University of BolognaBolognaItaly
| | - Pier Luigi Nimis
- Department of Life Sciences, University of Trieste, Via L. Giorgieri 10, 34127 Trieste, ItalyUniversity of TriesteTriesteItaly
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Galloway GK, Choudhury SN. New take on the post-take ward round: a quality improvement project undertaken in a district general hospital. BMJ Open Qual 2022; 11:bmjoq-2022-001923. [PMID: 36192036 PMCID: PMC9535189 DOI: 10.1136/bmjoq-2022-001923] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Accepted: 08/27/2022] [Indexed: 11/03/2022] Open
Abstract
A patient's first encounter with a consultant clinician, known as the post-take ward round (PTWR), is a pivotal encounter at the start of their hospital journey. It is a chance for a review of history, examination and investigations, formulation of preliminary diagnosis and management plan. High-quality patient care is reliant on effective communication of clinical information between teams, and the PTWR record is an integral part of this handover of information across different clinicians, medical teams and wards.Consensus of consultant opinion allowed for the formation of a standard against which the quality of PTWR documentation could be measured. This project aimed to assess and improve compliance with the devised standard.Following a survey of referrals made to the medical team after the move to electronic record keeping, it was found that important information was being missed from PTWR records. For example, of the 446 records analysed, only 34% had a documented potential discharge date (PDD) and 20% had a documented escalation plan. Analysis showed overall compliance to core criteria was 63%.Several changes within the department of acute medicine were trialled, including the introduction of a checklist, prompt cards for clinical staff to carry and finally the implementation of an electronic form for PTWR records.Over the course of several cycles of data collection, compliance with core criteria improved from 63% to 86%. Most notably, improvement was seen in documentation of social history (42%-87%), frailty score (0%-63%), PDD (41%-81%) and escalation plan (21%-66%).This work demonstrates the value of development of a standard for PTWR documentation, and of a proforma. The actions taken in this hospital may be of benefit to other medical departments.
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Hung CH, Wang YM, Huang CY, Lin CH. Developing of Multidimensional Perspectives Checklist of Professionalism for Undergraduate Occupational Therapy Students in Assistive Technology Service: Delphi Study. Int J Environ Res Public Health 2022; 19:7028. [PMID: 35742274 PMCID: PMC9222639 DOI: 10.3390/ijerph19127028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/26/2022] [Revised: 06/06/2022] [Accepted: 06/07/2022] [Indexed: 02/04/2023]
Abstract
Professionalism is a critical attribute that occupational therapy students must establish throughout education, especially in the context of assistive technology (AT). This study aimed to construct a multidimensional perspectives checklist (MPC) from the stakeholders to reflect professionalism development in the AT service courses. Fifteen experts in AT clinical practice and educators (N = 15) consented to and completed three rounds of the Delphi survey. Data were qualitatively analyzed to form a preliminary checklist in the first round. In rounds two and three, participants rated their level of agreement with the MPC items. A descriptive analysis of consensus was performed. Thirty items were classified into five subscales (teachers, therapists, patients, peers, learners) and fit into a framework with three dimensions and seven categories. After the Delphi survey, the MPC achieved high consensus, convergence, and stability. Two additional categories of professionalism emerged in the study, namely aesthetic and personal characteristics and reflection. The MPC developed in this study reflects the perspectives of various stakeholders in occupational therapy practice, providing helpful information for students to prepare themselves. Therefore, the MPC could contribute to expanding and developing the scope of professionalism in occupational therapy, especially in AT service.
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Affiliation(s)
- Chia-Hui Hung
- Department of Occupational Therapy, Chung Shan Medical University, Taichung 40201, Taiwan;
- Department of Occupational Therapy, Chung Shan Medical University Hospital, Taichung 40201, Taiwan
| | - Yu-Ming Wang
- Department of Psychology, Chung Shan Medical University, Taichung 40201, Taiwan;
- Clinical Psychological Room, Chung Shan Medical University Hospital, Taichung 40201, Taiwan
| | - Cheng-Yi Huang
- Department of Nursing, Chung Shan Medical University, Taichung 40201, Taiwan;
- Department of Nursing, Chung Shan Medical University Hospital, Taichung 40201, Taiwan
| | - Chung-Hui Lin
- Department of Occupational Therapy, Chung Shan Medical University, Taichung 40201, Taiwan;
- Department of Occupational Therapy, Chung Shan Medical University Hospital, Taichung 40201, Taiwan
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Armstrong BA, Dutescu IA, Nemoy L, Bhavsar E, Carter DN, Ng KD, Boet S, Trbovich P, Palter V. Effect of the surgical safety checklist on provider and patient outcomes: a systematic review. BMJ Qual Saf 2022; 31:463-478. [PMID: 35393355 DOI: 10.1136/bmjqs-2021-014361] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Accepted: 03/28/2022] [Indexed: 01/10/2023]
Abstract
BACKGROUND Despite being implemented for over a decade, literature describing how the surgical safety checklist (SSC) is completed by operating room (OR) teams and how this relates to its effectiveness is scarce. This systematic review aimed to: (1) quantify how many studies reported SSC completion versus described how the SSC was completed; (2) evaluate the impact of the SSC on provider outcomes (Communication, case Understanding, Safety Culture, CUSC), patient outcomes (complications, mortality rates) and moderators of these relationships. METHODS A systematic literature search was conducted using Medline, CINAHL, Embase, PsycINFO, PubMed, Scopus and Web of Science on 10 January 2020. We included providers who treat human patients and completed any type of SSC in any OR or simulation centre. Statistical directional findings were extracted for provider and patient outcomes and key factors (eg, attentiveness) were used to determine moderating effects. RESULTS 300 studies were included in the analysis comprising over 7 302 674 operations and 2 480 748 providers and patients. Thirty-eight per cent of studies provided at least some description of how the SSC was completed. Of the studies that described SSC completion, a clearer positive relationship was observed concerning the SSC's influence on provider outcomes (CUSC) compared with patient outcomes (complications and mortality), as well as related moderators. CONCLUSION There is a scarcity of research that examines how the SSC is completed and how this influences safety outcomes. Examining how a checklist is completed is critical for understanding why the checklist is successful in some instances and not others.
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Affiliation(s)
- Bonnie A Armstrong
- Surgery, International Centre for Surgical Safety, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, ON, Canada
| | - Ilinca A Dutescu
- Surgery, International Centre for Surgical Safety, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, ON, Canada
| | - Lori Nemoy
- Surgery, International Centre for Surgical Safety, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, ON, Canada
| | - Ekta Bhavsar
- Surgery, International Centre for Surgical Safety, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, ON, Canada
| | - Diana N Carter
- General Surgery, Milton District Hospital, Milton, Ontario, Canada
| | | | - Sylvain Boet
- Department of Anesthesiology and Pain Medicine, The Ottawa Hospital, University of Ottawa, Ottawa, ON, Canada.,Department of Innovation in Medical Education, University of Ottawa, Ottawa, ON, Canada.,Francophone Affairs, Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada.,Ottawa Hospital Research Institute, Clinical Epidemiology Program, Ottawa, ON, Canada.,Institut du Savoir Montfort, Ottawa, ON, Canada.,Faculty of Education, University of Ottawa, Ottawa, ON, Canada
| | - Patricia Trbovich
- Surgery, North York General Hospital, Toronto, ON, Canada.,Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada.,Institute of Biomedical Engineering, University of Toronto, Toronto, ON, Canada
| | - Vanessa Palter
- Surgery, International Centre for Surgical Safety, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, ON, Canada
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Ortiz La Banca R, Rebustini F, Alvarenga WA, de Carvalho EC, Lopes M, Milaszewski K, Nascimento LC. Checklists for Assessing Skills of Children With Type 1 Diabetes on Insulin Injection Technique. J Diabetes Sci Technol 2022; 16:742-750. [PMID: 33423543 PMCID: PMC9294572 DOI: 10.1177/1932296820984771] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND School-aged children often participate in type 1 diabetes (T1D) self-care tasks. Despite widespread discussion about the importance of developing self-care skills in childhood, few explain how the health care team should assess the skills of children with T1D when performing insulin injections. OBJECTIVE We sought to assess content validity evidence in two checklists regarding injection technique performed by children. METHODS Two checklists were designed based on a systematic review of the insulin injection technique. Experts in pediatric diabetes, health literacy, and diabetes education assessed the checklists regarding their clarity, objectivity, and relevance. Content validity was assessed using the content validity ratio (CVR). RESULTS Eleven providers (72% nurses or physicians, professional experience 19.4 ± 10.1 years, 45% of specialists in endocrinology, and 18% in pediatrics) participated in the assessment. Experts considered items containing the word homogeneity inappropriate. Items related to the needle insertion angle and the skin fold did not reach the CVR critical value. The final version of the checklist for syringe injection comprised 22 items with CVR = 0.91, and the checklist for pen injection comprised 18 items with CVR = 0.87. CONCLUSIONS The checklists presented clear, objective, and relevant content that assesses the skills of children with T1D for insulin injection. The checklists formally present the order of the technique and all the steps for insulin injection and allow a quantitative assessment of the operational skills of children. The developed instruments offer providers the possibility of continuous assessment of the progress of the pediatric clientele until they reach independence in diabetes self-care.
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Affiliation(s)
- Rebecca Ortiz La Banca
- Section on Clinical, Behavioral and
Outcomes Research, Joslin Diabetes Center, Harvard Medical School, Boston, MA,
USA
- Rebecca Ortiz La Banca, RN, MSN, PhD,
Section on Clinical, Behavioral and Outcomes Research, Joslin Diabetes Center,
Harvard Medical School, One Joslin Place, Boston, MA, 02215, USA.
| | - Flávio Rebustini
- Department of Gerontology, College of
Arts, Science and Humanities, University of Sao Paulo, São Paulo, SP, Brazil
| | | | - Emilia C. de Carvalho
- Ribeirao Preto College of Nursing,
University of Sao Paulo, Ribeirão Preto, SP, Brazil
| | - Mayara Lopes
- Paulista School of Nursing, Federal
University of Sao Paulo, São Paulo, SP, Brazil
| | - Kerry Milaszewski
- Section on Clinical, Behavioral and
Outcomes Research, Joslin Diabetes Center, Harvard Medical School, Boston, MA,
USA
| | - Lucila C. Nascimento
- Ribeirao Preto College of Nursing,
University of Sao Paulo, Ribeirão Preto, SP, Brazil
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Al-Khafaji J, Townsend RF, Townsend W, Chopra V, Gupta A. Checklists to reduce diagnostic error: a systematic review of the literature using a human factors framework. BMJ Open 2022; 12:e058219. [PMID: 35487728 PMCID: PMC9058772 DOI: 10.1136/bmjopen-2021-058219] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVES To apply a human factors framework to understand whether checklists reduce clinical diagnostic error have (1) gaps in composition; and (2) components that may be more likely to reduce errors. DESIGN Systematic review. DATA SOURCES PubMed, EMBASE, Scopus and Web of Science were searched through 15 February 2022. ELIGIBILITY CRITERIA Any article that included a clinical checklist aimed at improving the diagnostic process. Checklists were defined as any structured guide intended to elicit additional thinking regarding diagnosis. DATA EXTRACTION AND SYNTHESIS Two authors independently reviewed and selected articles based on eligibility criteria. Each extracted unique checklist was independently characterised according to the well-established human factors framework: Systems Engineering Initiative for Patient Safety 2.0 (SEIPS 2.0). If reported, checklist efficacy in reducing diagnostic error (eg, diagnostic accuracy, number of errors or any patient-related outcomes) was outlined. Risk of study bias was independently evaluated using standardised quality assessment tools in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses. RESULTS A total of 30 articles containing 25 unique checklists were included. Checklists were characterised within the SEIPS 2.0 framework as follows: Work Systems subcomponents of Tasks (n=13), Persons (n=2) and Internal Environment (n=3); Processes subcomponents of Cognitive (n=20) and Social and Behavioural (n=2); and Outcomes subcomponents of Professional (n=2). Other subcomponents, such as External Environment or Patient outcomes, were not addressed. Fourteen checklists examined effect on diagnostic outcomes: seven demonstrated improvement, six were without improvement and one demonstrated mixed results. Importantly, Tasks-oriented studies more often demonstrated error reduction (n=5/7) than those addressing the Cognitive process (n=4/10). CONCLUSIONS Most diagnostic checklists incorporated few human factors components. Checklists addressing the SEIPS 2.0 Tasks subcomponent were more often associated with a reduction in diagnostic errors. Studies examining less explored subcomponents and emphasis on Tasks, rather than the Cognitive subcomponents, may be warranted to prevent diagnostic errors.
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Affiliation(s)
- Jawad Al-Khafaji
- Department of Medicine, University of Michigan Medical School, Ann Arbor, Michigan, USA
- Department of Medicine, Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, Michigan, USA
| | - Ryan F Townsend
- University of Michigan Medical School, Ann Arbor, Michigan, USA
| | - Whitney Townsend
- Taubman Health Sciences Library, University of Michigan, Ann Arbor, Michigan, USA
| | - Vineet Chopra
- Department of Medicine, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Ashwin Gupta
- Department of Medicine, University of Michigan Medical School, Ann Arbor, Michigan, USA
- Department of Medicine, Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, Michigan, USA
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19
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Kronen RJ, Haff M, Patwardhan V, LaSalvia M. Improving hepatitis A vaccination rates in hospitalised patients with cirrhosis: insights and lessons learnt. BMJ Open Qual 2022; 11:bmjoq-2021-001723. [PMID: 35440438 PMCID: PMC9020302 DOI: 10.1136/bmjoq-2021-001723] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2021] [Accepted: 03/27/2022] [Indexed: 11/16/2022] Open
Affiliation(s)
- Ryan Jean Kronen
- Department of Medicine, University of Washington, Seattle, Washington, USA
| | - Madeleine Haff
- Division of Gastroenterology, Internal Medicine, Boston University, Boston, Massachusetts, USA
| | - Vilas Patwardhan
- Division of Gastroenterology and Hepatology, Internal Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | - Mary LaSalvia
- Division of Infectious Diseases, Internal Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
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Wagner FL, Feller S, Schmitz FM, Zimmermann PG, Krings R, Guttormsen S, Huwendiek S. Usability and preference of electronic vs. paper and pencil OSCE checklists by examiners and influence of checklist type on missed ratings in the Swiss Federal Licensing Exam. GMS J Med Educ 2022; 39:Doc24. [PMID: 35692359 PMCID: PMC9174065 DOI: 10.3205/zma001545] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Figures] [Subscribe] [Scholar Register] [Received: 01/13/2021] [Revised: 01/28/2022] [Accepted: 02/09/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND Only a few studies with small sample sizes have compared electronic Objective Structured Clinical Examination (OSCE) rating checklists with traditional paper-based OSCE rating checklists. In this study, the examiner-perceived usability and preference for type of OSCE checklist (electronic vs. paper based) were compared, and the influence of OSCE checklist type on missed ratings was determined, for the Swiss Federal Licensing Examination in clinical skills for human medicine. METHODS All examiners in the Swiss Federal Licensing Examination in clinical skills for human medicine were invited over two subsequent years to evaluate the OSCE checklist type they had worked with during the examination. This was based on a questionnaire with 14 closed questions (i.e., demographic, checklist-type experience, perceived usability, checklist type preference). Furthermore, the numbers of missed ratings for the paper-based checklist were recorded. RESULTS The data from these examiners (n=377) with experience of both OSCE checklist types were analyzed. The electronic OSCE checklist was rated significantly higher on all usability aspects (i.e., ease of use, candidate rating and error correction, clarity, distraction using the checklist, overall satisfaction), except for the speed of registering comments (no significant difference). The majority of the examiners in both years (2014: 54.5%, n=60, 2015: 89.8%, n=230) reported preference for working with the electronic OSCE checklist in the future. Missed ratings were seen for 14.2% of the paper-based OSCE checklists, which were prevented with the electronic OSCE checklists. CONCLUSIONS Electronic OSCE checklists were rated significantly more user-friendly and were preferred over paper-based OSCE checklists by a broad national sample of examiners, supporting previous results from faculty-level examinations. Furthermore, missed ratings were prevented with the electronic OSCE checklists. Overall, the use of electronic OSCE checklists is therefore advisable.
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Affiliation(s)
- Felicitas L. Wagner
- University of Bern, Institute for Medical Education, Department for Assessment and Evaluation, Bern, Switzerland
| | - Sabine Feller
- University of Bern, Institute for Medical Education, Department for Assessment and Evaluation, Bern, Switzerland
| | - Felix M. Schmitz
- University of Bern, Institute for Medical Education, Department for Software Development, Usability Consulting and IT Infrastructure, Bern, Switzerland
| | - Philippe G. Zimmermann
- University of Bern, Institute for Medical Education, Department for Software Development, Usability Consulting and IT Infrastructure, Bern, Switzerland
| | - Rabea Krings
- University of Bern, Institute for Medical Education, Department for Assessment and Evaluation, Bern, Switzerland
| | - Sissel Guttormsen
- University of Bern, Institute for Medical Education, Bern, Switzerland
| | - Sören Huwendiek
- University of Bern, Institute for Medical Education, Department for Assessment and Evaluation, Bern, Switzerland
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21
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Nenad MW. Effects of a Radiography Checklist on Reducing Retake Exposures. J Dent Hyg 2022; 96:18-24. [PMID: 35418492] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 12/19/2020] [Accepted: 09/21/2021] [Indexed: 06/14/2023]
Abstract
Purpose: Typically implemented as a safety measure, checklists can reduce risks and improve patient outcomes. Checklists have been widely used in medicine, but rarely applied to dentistry. The purpose of this replication study was to evaluate the effectiveness of a dental radiography checklist intervention for improving the diagnostic value of bitewing images and reducing retake exposures.Methods: Two cohorts of dental hygiene students from programs in the same community college district participated in the mixed methods study; one as intervention group (n=22), the other as control group (n=23). The intervention group used a checklist each time bitewing images were acquired on manikins and live patients while the control group followed the usual protocol for image acquisition. Calibrated faculty evaluated all images and recorded whether images passed, failed, or required retakes. All participants completed a demographic survey at the study conclusion while the experimental group completed two additional surveys regarding perceived value of the checklist and intention to continue its use outside the educational setting. Descriptive and inferential statistics were used to analyze the data.Results: Image failure and retake rates were significantly lower in the experimental group on both manikins and live patients (p<0.001). The control group experienced a lower failure rate on patients versus manikins; however, overall retake rates were higher than the experimental group. While the retake rate improved among both groups from manikin to human exposures, the magnitude of change across groups did not differ (p=0.992). Sensor placement was the most common cause for a failing image. Participants generally considered the checklist thorough and easy to use, however there was less agreement that it improved image quality or that they would continue its use outside the educational setting.Conclusion: A radiography checklist used in an educational setting was successful in reducing bitewing image failure and retake rates, thus benefiting patient safety with reduced radiation exposure.
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Affiliation(s)
- Monica Williamson Nenad
- Chair of Dental Programs, Rio Salado College, Tempe, AZ and the former Director of Faculty Development, Accreditation, and Continuing Dental Education, A.T. Still University, Arizona School of Dentistry & Oral Health, Mesa, AZ, USA.
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22
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Arbizo JC, Dalal K, Lao V, Rosinia F, Adejuyigbe T. Safe preoperative regional nerve blocks. BMJ Open Qual 2022; 11:bmjoq-2021-001370. [PMID: 35012932 PMCID: PMC8753394 DOI: 10.1136/bmjoq-2021-001370] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2021] [Accepted: 12/14/2021] [Indexed: 11/21/2022] Open
Abstract
Background Procedural time-outs and checklists are proven to be an effective means of improving teamwork and preventing wrong-sided procedures. The main objective of this study was to ensure that all regional nerve blocks being performed in the preoperative area at our hospital were executed with a proper time-out. The goal of this project was to increase integration of a safe preoperative block process including a time-out checklist to ensure; complete consents, correct patient and laterality were marked prior to each procedure. We focused on recognising events that took place before, during and after the nerve block including non-compliance with the checklist and deviations from protocol. Methods A safe preoperative block process current and future state flowchart, revised time-out checklist and action/implementation plan as part of our Plan–Do–Study–Act model was constructed using a multidisciplinary approach. Pre-implementation and post- implementation data were collected by medical students acting anonymously via direct observation noting the presence of an anaesthesiologist, resident, nurse, time-out for procedure, checklist completed and procedure start and sedation time representing a complete time-out. Results The direct observations in the pre-implementation group showed a 20% (3/15) compliance with a correct time-out. The direct observations in the post implementation group showed 85% (12/14) compliance. This revealed a 65% increase in all portions of the time-out checklist completed. Comparative analysis confirmed decrease in non-compliance and deviations from protocol as displayed by 65% increase in all portions of time-out checklist completed. Conclusion We aimed to improve safety, communication and compliance for preoperative nerve blocks through development and implementation of a safe preoperative block process using a multidisciplinary model. We conclude that creation of a safe nerve block was achieved by integration of a preoperative nerve block process which included increased compliance to the time-out checklist, verifying patients and laterality with marking of patient prior to each procedure, identifying proper consents were completed and ensuring each regional nerve block was executed with a proper time-out.
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Affiliation(s)
| | - Kajal Dalal
- Anesthesiology, UTHSCSA, San Antonio, Texas, USA
| | - Veronia Lao
- Anesthesiology, UTHSCSA, San Antonio, Texas, USA
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Abstract
Endotracheal intubation (ETI) is a high-risk procedure often performed in the emergency department (ED) in critically unwell patients. The fourth National Audit Project by The Royal College of Anaesthetists found the risk of adverse events is much higher when performing the intervention in this setting compared with a theatre suite, and therefore use of a safety checklist is recommended. This quality improvement project was set in a large teaching hospital in the North West of the UK, where anaesthesia and intensive care clinicians are responsible for performing this procedure. A retrospective baseline audit indicated checklist use was 16.7% of applicable cases. The project aim was to increase the incidence of checklist use in the ED to 90% within a 6-month period. The model for improvement was used as a methodological approach to the problem along with other quality improvement tools, including a driver diagram to generate change ideas. The interventions were targeted at three broad areas: awareness of the checklist and expectation of use, building a favourable view of the benefits of the checklist and increasing the likelihood it would be remembered to use the checklist in the correct moment. After implementation checklist use increased to 84%. In addition, run chart analysis indicated a pattern of nonrandom variation in the form of a shift. This coincided with the period shortly after the beginning of the interventions. The changes were viewed favourably by junior and senior anaesthetists, as well as operating department practitioners and ED staff. Limitations of the project were that some suitable cases were likely missed due to the method of capture and lack of anonymous qualitative feedback on the changes made. Overall, however, it was shown the combination of low-cost interventions made was effective in increasing checklist use when performing emergency ETI in the ED.
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Brown B, Bermingham S, Vermeulen M, Jennings B, Adamek K, Markou M, Bassham JE, Hibbert P. Surgical safety checklist audits may be misleading! Improving the implementation and adherence of the surgical safety checklist: a quality improvement project. BMJ Open Qual 2021; 10:bmjoq-2021-001593. [PMID: 34732540 PMCID: PMC8572456 DOI: 10.1136/bmjoq-2021-001593] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Accepted: 09/30/2021] [Indexed: 11/06/2022] Open
Abstract
Despite good quality evidence for benefits with its use, challenges have been encountered in the correct and consistent implementation of the surgical safety checklist (SSC). Previous studies of the SSC have reported a discrepancy between what is documented and what is observed in real time. A baseline observational audit at our institution demonstrated compliance of only 3.5% despite a documented compliance of 100%. This project used quality improvement principles of identifying the problem and designing strategies to improve staff compliance with the SSC. These included changing the SSC from paper-based to a reusable laminated form, a broad multidisciplinary education and marketing campaign, targeted coaching and modifying the implementation in response to ongoing staff feedback. Five direct observational audits were undertaken over four Plan–Do–Study–Act cycles to capture real-time information on staff compliance. Two staff surveys were also undertaken. Compliance with the SSC improved from 3.5% to 63% during this study. Staff reported they felt the new process improved patient safety and that the new SSC was easily incorporated into their workflow. Improving compliance with the SSC requires deep engagement with and cooperation of surgical, anaesthesia and nursing teams and understanding of their work practices and culture. The prospective observational audit highlighted an initial 3.5% compliance rate compared with 100% based on an audit of the patient notes. Relying solely on a retrospective paper-based model can lead to hospitals being unaware of significant safety and quality issues. While in-person prospective observations are more time-consuming and resource-consuming than retrospective audits, this study highlights their potential utility to gain a clear picture of actual events. The significant variation between documented and observed data may have considerable implications for other retrospective studies which rely on human-entered data for their results.
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Affiliation(s)
- Brigid Brown
- Anaesthesia, Flinders Medical Centre, Bedford Park, South Australia, Australia
| | - Sophia Bermingham
- Anaesthesia, Flinders Medical Centre, Bedford Park, South Australia, Australia
| | - Marthinus Vermeulen
- Anaesthesia, Flinders Medical Centre, Bedford Park, South Australia, Australia
| | - Beth Jennings
- Anaesthesia, Flinders Medical Centre, Bedford Park, South Australia, Australia
| | - Kirsty Adamek
- Anaesthesia, Flinders Medical Centre, Bedford Park, South Australia, Australia
| | - Mark Markou
- Anaesthesia, Flinders Medical Centre, Bedford Park, South Australia, Australia
| | - Jane E Bassham
- Continuous Improvement Unit, Southern Adelaide Local Health Network, Bedford Park, South Australia, Australia.,College of Business, Government and Law, Flinders University, Adelaide, South Australia, Australia
| | - Peter Hibbert
- Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia.,IIMPACT in Health, Allied Health and Human Performance, University of South Australia, Adelaide, South Australia, Australia
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Zhu H, Yang Y, Xu Y, Deng X, Yan J, Li T, Sang H, Li X, Hu R, Gu W. Effect of a quality improvement intervention with safety-based checklists for perinatal health of hypertension disorders in pregnancy. Int J Gynaecol Obstet 2021; 157:375-382. [PMID: 34368966 DOI: 10.1002/ijgo.13862] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2021] [Accepted: 08/06/2021] [Indexed: 11/10/2022]
Abstract
OBJECTIVE To improve perinatal management for hypertensive disorders in pregnancy (HDP) using checklists. METHODS A pre-post evaluation of the implementation of checklists was performed. The checklist for HDP was adapted for the local context through expert consultations and had been used within peripartum since September 2017. Data of 763 women with singleton pregnancies diagnosed with HDP were collected between April 2016 and March 2019 at the Obstetrics & Gynecology Hospital of Fudan University. The monitoring and control groups consisted of 394 and 369 cases, respectively. Analysis was carried out by intention-to-treat with respect to maternal and fetal complications and delivery outcomes. RESULTS After the implementation of the checklists, patients had a significant reduction in anti-hypertensive treatment both orally (P = 0.028) and intravenously (P = 0.003), and increased utilization rate of MgSO4 management (P < 0.001). Gestation was prolonged in the expectant treatment (P = 0.012) and the rate of elective and intrapartum cesarean delivery decreased (P < 0.001 and P = 0.001, respectively). The neonates of these patients had a low rate of admission to the neonatal intensive care unit (P < 0.001). CONCLUSION National clinical guidelines complied critically after the implementation of the checklists. These checklists could be used for improving the quality of the clinical strategy and treatment, which benefitted perinatal management.
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Affiliation(s)
- Hao Zhu
- Department of Obstetrics, Obstetrics & Gynecology Hospital of Fudan University, Shanghai, China
| | - Yijia Yang
- Department of Obstetrics, Shanghai Changning Maternity & Infant Health Hospital, Shanghai, China
| | - Yi Xu
- Department of Obstetrics, Zhengzhou Maternity & Infant Health Hospital, Henan, China
| | - Xia Deng
- Department of Obstetrics, Cixi Maternity & Infant Health Hospital, Zhejiang, China
| | - Jie Yan
- Department of Obstetrics, The Second Affiliated Hospital of Sichuan University, Sichuan, China
| | - Tao Li
- Department of Obstetrics, The Second Affiliated Hospital of Sichuan University, Sichuan, China
| | - Huige Sang
- Department of Obstetrics, The Second People's Hospital of Pingdingshan, Henan, China
| | - Xiaotian Li
- Department of Obstetrics, Obstetrics & Gynecology Hospital of Fudan University, Shanghai, China
| | - Rong Hu
- Department of Obstetrics, Obstetrics & Gynecology Hospital of Fudan University, Shanghai, China
| | - Weirong Gu
- Department of Obstetrics, Obstetrics & Gynecology Hospital of Fudan University, Shanghai, China
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Puntambekar V, Sharma AK, Yadav K, Kumar R. Checklist to aid young physicians managing obstetric emergencies in rural India: a quality improvement initiative. BMJ Open Qual 2021; 10:bmjoq-2021-001435. [PMID: 34344735 PMCID: PMC8336185 DOI: 10.1136/bmjoq-2021-001435] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2021] [Accepted: 05/10/2021] [Indexed: 11/10/2022] Open
Abstract
Background The decision to admit or refer a patient presenting with an obstetric emergency is extremely crucial. In rural India, such decisions are usually made by young physicians who are less experienced and often miss relevant data points required for appropriate decision making. In our setting, before the quality improvement (QI) initiative, this information was recorded on loose blank sheets (first information sheets (FIS)) where an initial clinical history, physical examination and investigations were recorded. The mean FIS completeness, at baseline, was 73.95% (1–5 January 2020) with none of the FIS being fully complete. Our objective was to increase the FIS completeness to >90% and to increase the number of FIS that were fully complete over a 9-month period. Methods With the help of a prioritisation matrix, the QI team decided to tackle the problem of incomplete FIS. The team then used fishbone analysis and identified that the main causes of incomplete FIS were that the interns did not know what to document and would often forget some data points. Change ideas to improve FIS completeness were implemented using Plan-Do-Study-Act (PDSA) cycles, and ultimately, a checklist (referred to as antenatal care (ANC) checklist) was implemented. The study was divided into six phases, and after every phase, a few FIS were conveniently sampled for completeness. Results FIS completeness improved to 86.34% (p<0.001) in the post implementation phase (1 Feb to 31 August 2020), and in this phase, 69.72% of the FIS were documented using the ANC checklist. The data points that saw the maximum improvement were relating to the physical examination. Conclusion The use of ANC checklist increased FIS completeness. Interns with no prior clinical and QI experience can effectively lead and participate in QI initiatives. The ANC checklist is a scalable concept across similar healthcare settings in rural India.
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Affiliation(s)
- Varad Puntambekar
- Academic, All India Institute of Medical Sciences, New Delhi, Delhi, India
| | - Aparna K Sharma
- Obstetrics and Gynecology, All India Institute of Medical Sciences Cardio-Thoracic Sciences Centre, New Delhi, India
| | - Kapil Yadav
- Centre for Community Medicine, All India Institute of Medical Sciences, New Delhi, Delhi, India
| | - Rakesh Kumar
- Centre for Community Medicine, All India Institute of Medical Sciences, New Delhi, Delhi, India
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Giscombe SR, Baptiste DL, Koirala B, Asano R, Commodore-Mensah Y. The use of clinical decision support in reducing readmissions for patients with heart failure: a quasi-experimental study. Contemp Nurse 2021; 57:39-50. [PMID: 33863268 DOI: 10.1080/10376178.2021.1919161] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
BACKGROUND Heart failure is a chronic, progressive condition which affects over six million Americans and 26 million people worldwide. Evidence-based guidelines, protocols, and decision-support tools are available to enhance the quality of care delivery but are not implemented consistently. AIMS To examine the effect of clinical decision-making support during patient discharge on 30-day hospital readmission among patients admitted with heart failure and evaluate provider utilization and satisfaction of clinical decision support tool. DESIGN A quasi-experimental study. METHODS An intervention group of hospitalized patients (N = 55) with heart failure were provided the intervention over a 3-month period and compared to the pre-intervention comparison group (N = 109) of patients who did not receive the intervention. An evidence-based discharge checklist and a pocket guide was implemented by an advanced practice nurse to assist health providers with clinical decision making. Descriptive statistics among samples, 30-day readmission rates, and provider utilization and satisfaction were examined. RESULTS Readmission rates slightly decreased (N = 109, 9.2% vs. N = 55, 9.1%) in the post-intervention period, but no significant difference. Heterogeneity between the two groups were minimal related to use of specific medications, age, length-of-stay and comorbidities. Descriptively, there was a significant difference the use of diuretics among each group (p = .002).The discharge checklist was used regularly by 67% of (N = 15) providers, and 93% expressed satisfaction with use. CONCLUSION There was no significant reduction in 30-day readmission rates between both groups. However, a slight reduction was noted which indicates the need for further examination into how the use of checklists for clinical decision support can reduce readmissions. A well-designed evidence-based discharge plan remains a critical component of the patient discharge process. Advance practice nurses are uniquely qualified to implement evidence-based interventions that promote practice change among health care providers and improve health outcomes.
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Affiliation(s)
- Susan R Giscombe
- Department of Nursing, Johns Hopkins University School of Nursing, 525 N. Wolfe Street, Baltimore, MD 21205, USA
| | | | - Binu Koirala
- Department of Nursing, Johns Hopkins University School of Nursing, 525 N. Wolfe Street, Baltimore, MD 21205, USA
| | - Reiko Asano
- Department of Nursing, Johns Hopkins University School of Nursing, 525 N. Wolfe Street, Baltimore, MD 21205, USA
| | - Yvonne Commodore-Mensah
- Department of Nursing, Johns Hopkins University School of Nursing, 525 N. Wolfe Street, Baltimore, MD 21205, USA
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Rege S, Malik AM, Ward M, Hong J. Checklists in community care: reducing differences in care delivery between regular and relief staff to improve consistency and client experience. BMJ Open Qual 2021; 9:bmjoq-2019-000809. [PMID: 32518200 PMCID: PMC7282392 DOI: 10.1136/bmjoq-2019-000809] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2019] [Revised: 05/07/2020] [Accepted: 05/16/2020] [Indexed: 11/13/2022] Open
Abstract
Background Today, healthcare is more complex than just ensuring clients receive quality care; it also involves consistently delivering excellent client experience. A non-profit community support services agency conducted an extensive diagnostic journey to determine root causes of inconsistent care delivery between regular and relief frontline staff. Local problem Clients and family caregivers noted lower satisfaction in care delivery when a relief staff (ie, internal staff or an external agency that is covering a shift) provided service in comparison with their regular staff. The diagnostic journey discovered that the shift exchange process—when outgoing staff transfers critical knowledge to incoming staff for continuing care—varied significantly between the 11 service locations, leading to a lack of consistent service delivery, thereby impacting client experience. Methods A working group consisting of Supervisors of Client Services, Personal Support Workers (PSW) and management were tasked with process mapping the current state, highlighting gaps and outlining the ideal state of the shift exchange process. Interventions Using best practices from the aviation industry, a checklist was developed that encapsulated all the critical steps needed to be undertaken for a successful, consistent shift exchange. The theory was that the utilisation of the checklist would enable consistency and improve client satisfaction with care delivery, especially when care is delivered by a staff unfamiliar with clients. Results Prior to the checklist implementation, 74% of clients were satisfied or very satisfied with their relief staff, and post checklist implementation client satisfaction improved to 90%. Staff self-assessments also indicated that PSWs agreed that the checklist helped provide consistent care. Conclusion The use of checklists can transform the way care is delivered in the community support sector and other service delivery agencies alike to bring greater standardisation of care between providers, thus significantly improving client experience across the healthcare sector.
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Affiliation(s)
| | | | | | - Jing Hong
- Peel Senior Link, Mississauga, Ontario, Canada
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Verholen N, Vogt L, Klasen M, Schmidt M, Beckers S, Marx G, Sopka S. Do Digital Handover Checklists Influence the Clinical Outcome Parameters of Intensive Care Unit Patients? A Randomized Controlled Pilot Study. Front Med (Lausanne) 2021; 8:661343. [PMID: 33959627 PMCID: PMC8093756 DOI: 10.3389/fmed.2021.661343] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2021] [Accepted: 03/23/2021] [Indexed: 12/02/2022] Open
Abstract
Background: Clinical handovers have been identified as high-risk situations for medical treatment errors. It has been shown that handover checklists lead to a reduced rate of medical errors and mortality. However, the influence of handover checklists on essential patient outcomes such as prevalence of sepsis, mortality, and length of hospitalization has not yet been investigated in a randomized controlled trial (RCT). Objectives: The aim of the present pilot study was to estimate the effect of two different handover checklists on the 48 h sepsis-related organ failure assessment (SOFA) score and the feasibility of a respective clinical RCT. Methods: Outcome parameters and feasibility were investigated implementing and comparing an intervention with a control checklist. Design: Single center two-armed cluster randomized prospective crossover pilot study. Setting: The study took place over three 1-month periods in an intensive care unit (ICU) setting at the University Hospital Aachen. Patients/Participants: Data from 1,882 patients on seven ICU wards were assessed, of which 1,038 were included in the analysis. Intervention: A digital standardized handover checklist (ISBAR3) was compared to a control checklist (VICUR). Main Outcome Measures: Primary outcome was the 2nd 24 h time window sepsis-related organ failure assessment (SOFA) score. Secondary outcomes were SOFA scores on the 3rd and 5th 24 h time window, mortality, reuptake, and length of stay; handover duration, degree of satisfaction, and compliance as feasibility-related outcomes. Results: Different sepsis scores were observed only for the 1st 24 h time window after admission to the ICU, with higher values for ISBAR3. With respect to the patient-centered outcomes, both checklists achieved similar results. Average handover duration was shorter for VICUR, whereas satisfaction and compliance were higher for ISBAR3. However, overall compliance was low (25.4% for ISBAR3 and 15.8% for VICUR). Conclusions: Based on the results, a stratified randomization procedure is recommended for following RCTs, in which medical treatment errors should also be investigated as an additional variable. The use of control checklists is discouraged due to lower acceptance and compliance among healthcare practitioners. Measures should be undertaken to increase compliance with the use of checklists. Clinical outcome parameters should be carefully selected. Trial Registration:ClinicalTrials.gov, Identifier [NCT03117088]. Registered April 14, 2017.
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Affiliation(s)
- Nina Verholen
- Department of Anaesthesiology, Medical Faculty, University Hospital Rheinisch-Westfälische Technische Hochschule Aachen, Aachen, Germany.,AIXTRA-Competence Center for Training and Patient Safety, Medical Faculty, Rheinisch-Westfälische Technische Hochschule Aachen, Aachen, Germany
| | - Lina Vogt
- Department of Anaesthesiology, Medical Faculty, University Hospital Rheinisch-Westfälische Technische Hochschule Aachen, Aachen, Germany.,AIXTRA-Competence Center for Training and Patient Safety, Medical Faculty, Rheinisch-Westfälische Technische Hochschule Aachen, Aachen, Germany
| | - Martin Klasen
- Department of Anaesthesiology, Medical Faculty, University Hospital Rheinisch-Westfälische Technische Hochschule Aachen, Aachen, Germany.,AIXTRA-Competence Center for Training and Patient Safety, Medical Faculty, Rheinisch-Westfälische Technische Hochschule Aachen, Aachen, Germany
| | - Michelle Schmidt
- Department of Anaesthesiology, Medical Faculty, University Hospital Rheinisch-Westfälische Technische Hochschule Aachen, Aachen, Germany.,AIXTRA-Competence Center for Training and Patient Safety, Medical Faculty, Rheinisch-Westfälische Technische Hochschule Aachen, Aachen, Germany
| | - Stefan Beckers
- Department of Anaesthesiology, Medical Faculty, University Hospital Rheinisch-Westfälische Technische Hochschule Aachen, Aachen, Germany
| | - Gernot Marx
- Department of Intensive Care Medicine and Intermediate Care, Medical Faculty, University Hospital Rheinisch-Westfälische Technische Hochschule Aachen, Aachen, Germany
| | - Saša Sopka
- Department of Anaesthesiology, Medical Faculty, University Hospital Rheinisch-Westfälische Technische Hochschule Aachen, Aachen, Germany.,AIXTRA-Competence Center for Training and Patient Safety, Medical Faculty, Rheinisch-Westfälische Technische Hochschule Aachen, Aachen, Germany
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Kovacevic P, Jandric M, Kovacevic T, Momcicevic D, Zlojutro B, Baric G, Dragic S. Impact of Checklist for Early Recognition and Treatment of Acute Illness on Treatment of Critically Ill Septic Patients in a Low-Resource Medical Intensive Care Unit. Microb Drug Resist 2021; 27:1203-1206. [PMID: 33739869 DOI: 10.1089/mdr.2020.0454] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Introduction: Treatment of sepsis and septic shock can be a challenge even for intensive care units (ICUs) in high income countries, but it is especially difficult for ICUs with limited resources. Aim: To evaluate the impact of CERTAIN on treatment of critically ill septic patients in low-resource medical ICU. Materials and Methods: In a before-and-after study design, we compared clinical outcomes, processes, and complications (hospital acquired infections) 1 year before and 2 years after (2016 and 2017) introduction of CERTAIN. Results: A total of 125 patients with sepsis were prospectively identified for a 3-year period. Mean patient age, gender distribution, number of patients on mechanical ventilation (33 [76.7%] vs. 42 [84%] vs. 24 [75%]) and vasopressor use (23 [53.5%] vs. 34 [68%] vs. 24 [75%]) were similar before (2015) and 2 years after (2016 and 2017) the implementation of CERTAIN. Severity of illness (Simplified Acute Physiology Score II [SAPS II score]) was higher after the implementation. The checklist was incorporated in the daily practice with 100% adherence to its use. The duration of mechanical ventilation (5.3 ± 5.3 vs. 4.2 ± 3.6 vs. 3.7 ± 5.5), antibiotic treatment (8.2 ± 5.4 vs. 6.9 ± 4.1 vs. 5.8 ± 5.6), central venous catheter use (6.2 ± 5.7 vs. 5.7 ± 4.6 vs. 4.2 ± 6.1), ICU stay (8.4 ± 5.4 vs. 7.1 ± 4.1 vs. 5.8 ± 5.6), and the incidence of nosocomial infection (33.3% vs. 30% vs. 12.5%) decreased in the period after the onset of the intervention, but the results did not reach statistical significance. When adjusted for baseline characteristics, CERTAIN was not associated with hospital mortality (odds ratio 0.88, 0.38-2.04). Conclusion: CERTAIN was readily adopted in the ICU workflow and was associated with improvement in treatment of critically ill patients with sepsis.
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Affiliation(s)
- Pedja Kovacevic
- Medical Intensive Care Unit, University Clinical Centre of Republic of Srpska and Medical School of Banja Luka, Banja Luka, Bosnia and Herzegovina
| | - Milka Jandric
- Medical Intensive Care Unit, University Clinical Centre of Republic of Srpska and Medical School of Banja Luka, Banja Luka, Bosnia and Herzegovina
| | - Tijana Kovacevic
- Clinical Pharmacy, University Clinical Centre of Republic of Srpska, Banja Luka, Bosnia and Herzegovina
| | - Danica Momcicevic
- Medical Intensive Care Unit, University Clinical Centre of Republic of Srpska and Medical School of Banja Luka, Banja Luka, Bosnia and Herzegovina
| | - Biljana Zlojutro
- Medical Intensive Care Unit, University Clinical Centre of Republic of Srpska and Medical School of Banja Luka, Banja Luka, Bosnia and Herzegovina
| | - Goran Baric
- Medical Intensive Care Unit, University Clinical Centre of Republic of Srpska and Medical School of Banja Luka, Banja Luka, Bosnia and Herzegovina
| | - Sasa Dragic
- Medical Intensive Care Unit, University Clinical Centre of Republic of Srpska and Medical School of Banja Luka, Banja Luka, Bosnia and Herzegovina
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Abstract
Integrating sex as an important biological variable is imperative to enhance the accuracy and reproducibility of cell-based studies, which provide basic information for subsequent preclinical and clinical study designs. Recently, international funding agencies and renowned journals have been attempting to integrate sex as a variable in every research step. To understand what progress has been made in reporting of cell sex in the articles published in AJP-Cell Physiology since the analysis in 2013, we examined the sex notation of the cells in relevant articles published in the same journal in 2018. Of the 107 articles reporting cell experiments, 53 reported the sex of the cells, 18 used both male and female cells, 23 used male cells only, and 12 used female cells only. Sex omission was more frequent when cell lines were used than when primary cells were used. In the articles describing experiments performed using rodent primary cells, more than half of the studies used only male cells. Our results showed an overall improvement in sex reporting for cells in AJP-Cell Physiology articles from 2013 (25%) to 2018 (50%). However, sex omission and male bias were often found still. Furthermore, the obtained results were rarely analyzed by sex even when both male and female cells were used in the experiments. To boost sex-considerate research implementation in basic biomedical studies, cooperative efforts of the research community, funders, and publishers are urged.
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Affiliation(s)
- Jun Yeob Kim
- Department of Medical Life Sciences, College of Medicine, The Catholic University of Korea, Seoul, Korea.,Department of Biomedicine & Health Sciences, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Kyoungmi Min
- Department of Medical Life Sciences, College of Medicine, The Catholic University of Korea, Seoul, Korea.,Department of Biomedicine & Health Sciences, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Hee Young Paik
- Department of Food and Nutrition, Seoul National University, Seoul, Republic of Korea
| | - Suk Kyeong Lee
- Department of Medical Life Sciences, College of Medicine, The Catholic University of Korea, Seoul, Korea.,Department of Biomedicine & Health Sciences, College of Medicine, The Catholic University of Korea, Seoul, Korea
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Dryver E, Lundager Forberg J, Hård Af Segerstad C, Dupont WD, Bergenfelz A, Ekelund U. Medical crisis checklists in the emergency department: a simulation-based multi-institutional randomised controlled trial. BMJ Qual Saf 2021; 30:697-705. [PMID: 33597283 DOI: 10.1136/bmjqs-2020-012740] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2020] [Revised: 01/14/2021] [Accepted: 02/10/2021] [Indexed: 12/14/2022]
Abstract
BACKGROUND Studies carried out in simulated environments suggest that checklists improve the management of surgical and intensive care crises. Whether checklists improve the management of medical crises simulated in actual emergency departments (EDs) is unknown. METHODS Eight crises (anaphylactic shock, life-threatening asthma exacerbation, haemorrhagic shock from upper gastrointestinal bleeding, septic shock, calcium channel blocker poisoning, tricyclic antidepressant poisoning, status epilepticus, increased intracranial pressure) were simulated twice (once with and once without checklist access) in each of four EDs-of which two belong to an academic centre-and managed by resuscitation teams during their clinical shifts. A checklist for each crisis listing emergency interventions was derived from current authoritative sources. Checklists were displayed on a screen visible to all team members. Crisis and checklist access were allocated according to permuted block randomisation. No team member managed the same crisis more than once. The primary outcome measure was the percentage of indicated emergency interventions performed. RESULTS A total of 138 participants composing 41 resuscitation teams performed 76 simulations (38 with and 38 without checklist access) including 631 interventions. Median percentage of interventions performed was 38.8% (95% CI 35% to 46%) without checklist access and 85.7% (95% CI 80% to 88%) with checklist access (p=7.5×10-8). The benefit of checklist access was similar in the four EDs and independent of senior physician and senior nurse experience, type of crisis and use of usual cognitive aids. On a Likert scale of 1-6, most participants agreed (gave a score of 5 or 6) with the statement 'I would use the checklist if I got a similar case in reality'. CONCLUSION In this multi-institution study, checklists markedly improved local resuscitation teams' management of medical crises simulated in situ, and most personnel reported that they would use the checklists if they had a similar case in reality.
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Affiliation(s)
- Eric Dryver
- Department of Emergency and Internal Medicine, Skåne University Hospital Lund, Lund, Sweden .,Department of Clinical Sciences, Lund University, Lund, Sweden.,Practicum Clinical Skills Centre, Office for Medical Services, Region Skåne, Sweden
| | | | | | - William D Dupont
- Department of Biostatistics, Vanderbilt University, Nashville, Tennessee, USA
| | - Anders Bergenfelz
- Department of Clinical Sciences, Lund University, Lund, Sweden.,Practicum Clinical Skills Centre, Office for Medical Services, Region Skåne, Sweden
| | - Ulf Ekelund
- Department of Emergency and Internal Medicine, Skåne University Hospital Lund, Lund, Sweden.,Department of Clinical Sciences, Lund University, Lund, Sweden
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Abraham J, Meng A, Tripathy S, Avidan MS, Kannampallil T. Systematic review and meta-analysis of interventions for operating room to intensive care unit handoffs. BMJ Qual Saf 2021; 30:513-524. [PMID: 33563791 DOI: 10.1136/bmjqs-2020-012474] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2020] [Revised: 01/23/2021] [Accepted: 01/26/2021] [Indexed: 12/12/2022]
Abstract
OBJECTIVE To conduct a systematic review and meta-analysis to ascertain the impact of operating room (OR) to intensive care unit (ICU) handoff interventions on process-based and clinical outcomes. METHOD We included all English language, prospective evaluation studies of OR to ICU handoff interventions published as original research articles in peer-reviewed journals. The search was conducted on 11 November 2019 on MEDLINE, CINAHL, EMBASE, Scopus and the Cochrane Central Register of Controlled Trials databases, with no prespecified criteria for the type of comparison or outcome. A meta-analysis of similar outcomes was conducted using a random effects model. Quality was assessed using a modified Downs and Black (D&B) checklist. RESULTS 32 studies were included for review. 31 studies were conducted at a single site and 28 studies used an observational study design with a control. Most studies (n=28) evaluated bundled interventions which comprised information transfer/communication checklists and protocols. Meta-analysis showed that the handoff intervention group had statistically significant improvements in time to analgesia dosing (mean difference (MD)=-42.51 min, 95% CI -60.39 to -24.64), fewer information omissions (MD=-2.22, 95% CI -3.68 to -0.77), fewer technical errors (MD=-2.38, 95% CI -4.10 to -0.66) and greater information sharing scores (MD=30.03%, 95% CI 19.67% to 40.40%). Only 15 of the 32 studies scored above 9 points on the modified D&B checklist, indicating a lack of high-quality studies. DISCUSSION Bundled interventions were commonly used to support OR to ICU handoff standardisation. Although the meta-analysis showed significant improvements for a number of clinical and process outcomes, the statistical and clinical heterogeneity must be accounted for when interpreting these findings. Implications for OR to ICU handoff practice and future research are discussed.
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Affiliation(s)
- Joanna Abraham
- Department of Anesthesiology, Washington University School of Medicine in St Louis, St Louis, Missouri, USA
| | - Alicia Meng
- Department of Anesthesiology, Washington University School of Medicine in St Louis, St Louis, Missouri, USA
| | | | - Michael S Avidan
- Department of Anesthesiology, Washington University School of Medicine in St Louis, St Louis, Missouri, USA
| | - Thomas Kannampallil
- Department of Anesthesiology, Washington University School of Medicine in St Louis, St Louis, Missouri, USA
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Cushley C, Knight T, Murray H, Kidd L. Writing's on the wall: improving the WHO Surgical Safety Checklist. BMJ Open Qual 2021; 10:bmjoq-2020-001086. [PMID: 33452183 PMCID: PMC7813408 DOI: 10.1136/bmjoq-2020-001086] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Revised: 12/02/2020] [Accepted: 12/10/2020] [Indexed: 11/24/2022] Open
Abstract
Background and problem The WHO Surgical Safety Checklist has been shown to improve patient safety as well as improving teamwork and communication in theatres. In 2009, it was made a mandatory requirement for all NHS hospitals in England and Wales. The WHO checklist is intended to be adapted to suit local settings and was modified for use in Gloucestershire Hospitals NHS Foundation Trust. In 2018, it was decided to review the use of the adapted WHO checklist and determine whether improvements in compliance and engagement could be achieved. Aim The aim was to achieve 90% compliance and engagement with the WHO Surgical Safety Checklist by April 2019. Methods In April 2018, a prospective observational audit and online survey took place. The results showed compliance for the ‘Sign In’ section of the checklist was 55% and for the ‘Time Out’ section was 91%. Engagement by the entire theatre team was measured at 58%. It was proposed to move from a paper checklist to a wall-mounted checklist, to review and refine the items in the checklist and to change the timing of ‘Time Out’ to ensure it was done immediately prior to knife-to-skin. Results Following its introduction in September 2018, the new wall-mounted checklist was reaudited. Compliance improved to 91% for ‘Sign In’ and to 94% for ‘Time Out’. Engagement by the entire theatre team was achieved 100% of the time. Feedback was collected, adjustments made and the new checklist was rolled out in stages across all theatres. A reaudit in December 2018 showed compliance improved further, to 99% with ‘Sign In’ and to 100% with ‘Time Out’. Engagement was maintained at 100%. Conclusions The aim of the project was met and exceeded. Since April 2019, the new checklist is being used across all theatres in the Trust.
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Affiliation(s)
- Claire Cushley
- Anaesthesia, Royal United Hospital Bath NHS Trust, Bath, UK
| | - Tom Knight
- Anaesthesia, Gloucestershire Hospitals NHS Foundation Trust, Cheltenham, UK
| | - Helen Murray
- Anaesthesia, Gloucestershire Hospitals NHS Foundation Trust, Cheltenham, UK
| | - Lawrence Kidd
- Anaesthesia, Gloucestershire Hospitals NHS Foundation Trust, Cheltenham, UK
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Affiliation(s)
| | - Mian-Mian Kao
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
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Power J, Jungmann E, Rayan A, Battison T, Edwards S. Quality improvement project to eliminate the occurrence of never events during insertion of intrauterine contraception. BMJ Open Qual 2020; 9:bmjoq-2019-000819. [PMID: 33328316 PMCID: PMC7745678 DOI: 10.1136/bmjoq-2019-000819] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2019] [Revised: 10/13/2020] [Accepted: 11/23/2020] [Indexed: 11/24/2022] Open
Abstract
Aim This project aimed to reduce the occurrence of never events during insertion of intrauterine contraception (IUC), within Central North West London NHS Foundation Trust (CNWL) clinics, to zero within 6 weeks. Background CNWL provides sexual health services in seven London boroughs and Surrey. Approximately 5500 IUC are inserted annually. Over a period of 67 days between 7 December 2017 and 12 February 2018, three incidents were identified within CNWL involving the insertion of an intrauterine contraceptive that was different to that agreed with the patient. Several different types of IUCs are available, avoiding insertion of an incorrect IUC device is important as it could lead to unwanted side effects and swapping to the chosen device could lead to a repeat procedure with potential increased risks of infection and uterine perforation. Insertion of an incorrect IUC has been classified as a never event since January 2018 when NHS Improvement updated their never events list to include ‘insertion of an IUC different from the one in the procedural plan’. Never events are serious incidents that are preventable if appropriate systems are in place. There is currently no national guidance on how to reduce the risk of IUC never events but since inclusion of IUC events in the never event list the Faculty of Sexual and Reproductive Health has been working to produce national guidance for safety standards for IUC insertion. In the interim, CNWL undertook a review of their local policies. Investigation and recommendations Following the CNWL IUC never events, a root cause analysis investigation was conducted. A multidisciplinary team was convened to identify potential contributory factors. The main cause was identified as the lack of a standard process for confirming, documenting and double-checking the chosen IUC immediately prior to insertion. Other contributory factors included storage of similar IUC devices alongside each other and delayed access to a trained assistant in IUC clinics. Quality improvement (QI) methodology was used to help implement local system changes to reduce the risk of future errors. These included changes to IUC storage and the introduction of an IUC checklist to confirm the chosen device type during IUC insertions. Results and conclusion Since implementation of these changes 30 months ago there have been no further IUC never events within CNWL. QI methods have facilitated the successful introduction of local system changes that have reduced the occurrence of errors during IUC insertion.
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Affiliation(s)
- Jo Power
- Sexual Health, Central North West London NHS Foundation Trust, London, UK
| | - Eva Jungmann
- Sexual Health, Central North West London NHS Foundation Trust, London, UK
| | - Anshu Rayan
- Sexual Health, Central North West London NHS Foundation Trust, London, UK
| | - Teresa Battison
- Sexual Health, Central North West London NHS Foundation Trust, London, UK
| | - Simon Edwards
- Sexual Health, Central North West London NHS Foundation Trust, London, UK
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Bowie P, de Wet C, Crickett T, McCulloch J, Young P, Freestone J, Watson P, Houston N, Gillies J, McNab D. User redesign, testing and evaluation of the Monitoring Risk and Improving System Safety (MoRISS) checklist for the general practice work environment. BMJ Open Qual 2020; 9:bmjoq-2020-000977. [PMID: 33184042 PMCID: PMC7662415 DOI: 10.1136/bmjoq-2020-000977] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2020] [Revised: 08/11/2020] [Accepted: 10/03/2020] [Indexed: 11/21/2022] Open
Abstract
Background Inadequate checking of safety-critical issues can compromise care quality in general practice (GP) work settings. Adopting a systemic, methodical approach may lead to improved standardisation of processes and reliability of task performance, strengthening the safety systems concerned. This study aimed to revise, modify and test the content and relevance of a previously validated safety checklist to the current GP context. Methods A multimethod study was undertaken in Scottish GP involving: consensus building workshops with users and ‘experts’ to revise checklist content; regional testing of the modified checklist and follow-up usability evaluation survey of users. Quantitative data underwent descriptive statistical analyses and selected survey free-text comments are presented. Results A redesigned checklist tool consisting of eight themes (eg, medication safety) and 61 items (eg, out-of-date stock is appropriately disposed) was agreed by 53 users/experts with items reclassified as: mandatory (n=25), essential (n=24) and advisory (n=12). Totally 42/55 GPs tested the tool and submitted checklist data (76.4%). The mean aggregated results demonstrated 92.0% compliance with all 61 checklist items (range: 83.0%–98.0%) and 25/42 GP managers responded to the survey (59.5%) and reported high mean levels of agreement on the usefulness of the checklist (77.0%), ease of use (89.0%), learnability (94.0%) and satisfaction (78.4%). Conclusions The checklist was comprehensively redesigned as a practical safety monitoring and improvement tool for potential implementation in Scottish GP. Testing and evaluation demonstrated high levels of checklist content compliance and strong usability feedback, but some variation was evident indicating room for improvement in current safety-critical checking processes. The checklist should be of interest in similar GP settings internationally and to other areas of primary care practice.
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Affiliation(s)
- Paul Bowie
- Medical Directorate, NHS Education for Scotland West Region, Glasgow, UK .,Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Carl de Wet
- Healthcare Improvement Unit, Queensland Health, Brisbane, Queensland, Australia.,School of Medicine, Griffith University, Nathan, Queensland, Australia
| | - Tracey Crickett
- Medical Directorate, NHS Education for Scotland West Region, Glasgow, UK
| | | | | | | | - Paul Watson
- Medical Directorate, NHS Education for Scotland West Region, Glasgow, UK
| | | | | | - Duncan McNab
- Medical Directorate, NHS Education for Scotland West Region, Glasgow, UK
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Katsevman GA, Sedney CL, Braca Iii JA, Hatchett L. Interdisciplinary differences in needlestick injuries among healthcare professionals in training: Improving situational awareness to prevent high-risk injuries. Work 2020; 65:635-645. [PMID: 32116282 DOI: 10.3233/wor-203118] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Needlestick injuries among healthcare professionals continue to be an occupational hazard, frequently and incorrectly regarded as low-risk, and exacerbated by underreporting. We aimed to investigate rates of needlestick injury, reasons for underreporting, and how explicit announcements that patients are "high-risk" (i.e., human immunodeficiency virus, hepatitis, or intravenous drug abuse history) might affect the actions of those at risk of sustaining an injury. METHODS A cross-sectional survey was administered to medical students (MS), nursing students (NS), and residents. RESULTS 30/224 (13%) of MS, 6/65 (9%) of NS, and 67/126 (53%) of residents experienced needlestick injuries. 37% of MS, 33% of NS, and 46% of residents attributed "lack of concentration" as cause of injury. Residents had the lowest percentage of underreporting (33%), with rates of 40% and 83% among MS and NS, respectively. Top reasons for non-reporting included the injury being perceived as "trivial" (22%) and patient being "low-risk" (18%). A majority stated pre-operative "high-risk" announcements should be required (91%), and would promote "culture of safety" (82%), reporting of injuries (85%), and increased concentration during procedures (70%). CONCLUSIONS We recommend routine announcements during pre-operative time-out and nursing/resident hand-offs that state a patient is "high-risk" if applicable. We hypothesize such policy will promote a "culture of safety," situational awareness, and incident reporting.
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Affiliation(s)
- Gennadiy A Katsevman
- Department of Neurological Surgery, West Virginia University, Morgantown, WV, USA
| | - Cara L Sedney
- Department of Neurological Surgery, Indiana University, Indianapolis, IN, USA
| | - John A Braca Iii
- Department of Neurological Surgery, Indiana University, Indianapolis, IN, USA
| | - Lena Hatchett
- Neiswanger Institute for Bioethics and Health Policy, Loyola University Medical Center, Maywood, IL, USA
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Wundavalli L, Singh S, Singh AR, Satpathy S. How to rapidly design and operationalise PPE donning and doffing areas for a COVID-19 care facility: quality improvement initiative. BMJ Open Qual 2020; 9:bmjoq-2020-001022. [PMID: 32978176 PMCID: PMC7520810 DOI: 10.1136/bmjoq-2020-001022] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2020] [Revised: 07/27/2020] [Accepted: 09/03/2020] [Indexed: 12/11/2022] Open
Abstract
Introduction Effective implementation of standard precautions specific to COVID-19 is a challenge for hospitals within the existing constraints of time and resources. Aim To rapidly design and operationalise personal protective equipment (PPE) donning and doffing areas required for a COVID-19 care facility. Methods Literature review was done to identify all issues pertaining to donning and doffing in terms of Donabedian’s structure, process and outcome. Training on donning and doffing was given to hospital staff. Donning and doffing mock drills were held. 5S was used as a tool to set up donning and doffing areas. Instances of donning and doffing were observed for protocol deviations and errors. Plan–do–study–act cycles were conducted every alternate day for 4 weeks. The initiative was reported using Standards for QUality Improvement Reporting Excellence (SQUIRE) guidelines. Results Best practices in donning and doffing were described. Our study recommends a minimum area of 16 m2 each for donning and doffing rooms. Verbally assisted doffing was found most useful than visual prompts. Discussion Challenges included sustaining the structure and process of donning and doffing, varied supplies of PPE which altered sequencing of donning and/or doffing, and training non-healthcare workers such as plumbers, electricians and drivers who were required during emergencies in the facility. Conclusion Our study used evidence-based literature and quality improvement (QI) tools to design and operationalise donning and doffing areas with focus on people, task and environment. Our QI will enable healthcare facilities to rapidly prototype donning and doffing areas in a systematic way.
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Affiliation(s)
- LaxmiTej Wundavalli
- Hospital Administration, All India Institute of Medical Sciences, New Delhi, India
| | - Sheetal Singh
- Hospital Administration, All India Institute of Medical Sciences, New Delhi, India
| | - Angel Rajan Singh
- Hospital Administration, All India Institute of Medical Sciences, New Delhi, India
| | - Sidhartha Satpathy
- Hospital Administration, All India Institute of Medical Sciences, New Delhi, India
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Daniels B, Pearson SA, Buckley NA, Bruno C, Schaffer A, Zoega H. Coming to grips with seemingly conflicting results in programme evaluation: the devil's in the detail. BMJ Qual Saf 2020; 30:70-71. [PMID: 32900853 DOI: 10.1136/bmjqs-2020-012118] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2020] [Accepted: 07/30/2020] [Indexed: 12/22/2022]
Affiliation(s)
- Benjamin Daniels
- Medicine Policy Research Unit, Centre for Big Data Research in Health, Sydney, New South Wales, Australia
| | - Sallie-Anne Pearson
- Medicine Policy Research Unit, Centre for Big Data Research in Health, Sydney, New South Wales, Australia
| | - Nicholas A Buckley
- Clinical Pharmacology and Toxicology Research Group, The University of Sydney Discipline of Pharmacology, Sydney, New South Wales, Australia
| | - Claudia Bruno
- Medicine Policy Research Unit, Centre for Big Data Research in Health, Sydney, New South Wales, Australia
| | - Andrea Schaffer
- Medicine Policy Research Unit, Centre for Big Data Research in Health, Sydney, New South Wales, Australia
| | - Helga Zoega
- Medicine Policy Research Unit, Centre for Big Data Research in Health, Sydney, New South Wales, Australia.,Centre of Public Health Sciences, Faculty of Medicine, University of Iceland, Reykjavik, Iceland
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Abstract
OBJECTIVE This study aimed to organize the literature on cognitive aids to allow comparison of findings across studies and link the applied work of aid development to psychological constructs and theories of cognition. BACKGROUND Numerous taxonomies have been developed, all of which label cognitive aids via their surface characteristics. This complicates integration of the literature, as a type of aid, such as a checklist, can provide many different forms of support (cf. prospective memory for steps and decision support for alternative diagnoses). METHOD In this synthesis of the literature, we address the disparate findings and organize them at their most basic level: Which cognitive processes does the aid need to support? Which processes do they support? Such processes include attention, perception, decision making, memory, and declarative knowledge. RESULTS Cognitive aids can be classified into the processes they support. Some studies focused on how an aid supports the cognitive processes demanded by the task (aid function). Other studies focused on supporting the processes needed to utilize the aid (aid usability). CONCLUSION Classifying cognitive aids according to the processes they support allows comparison across studies in the literature and a formalized way of planning the design of new cognitive aids. Once the literature is organized, theory-based guidelines and applied examples can be used by cognitive aid researchers and designers. APPLICATION Aids can be designed according to the cognitive processes they need to support. Designers can be clear about their focus, either examining how to support specific cognitive processes or improving the usability of the aid.
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Kashyap R, Murthy S, Arteaga GM, Dong Y, Cooper L, Kovacevic T, Basavaraja C, Ren H, Qiao L, Zhang G, Sridharan K, Jin P, Wang T, Tuibeqa I, Kang A, Ravi MD, Ongun E, Gajic O, Tripathi S. Effectiveness of a Daily Rounding Checklist on Processes of Care and Outcomes in Diverse Pediatric Intensive Care Units Across the World. J Trop Pediatr 2020; 67:5897681. [PMID: 32853362 PMCID: PMC8488874 DOI: 10.1093/tropej/fmaa058] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
BACKGROUND Implementation of checklists has been shown to be effective in improving patient safety. This study aims to evaluate the effectiveness of implementation of a checklist for daily care processes into clinical practice of pediatric intensive care units (PICUs) with limited resources. METHODS Prospective before-after study in eight PICUs from China, Congo, Croatia, Fiji, and India after implementation of a daily checklist into the ICU rounds. RESULTS Seven hundred and thirty-five patients from eight centers were enrolled between 2015 and 2017. Baseline stage had 292 patients and post-implementation 443. The ICU length of stay post-implementation decreased significantly [9.4 (4-15.5) vs. 7.3 (3.4-13.4) days, p = 0.01], with a nominal improvement in the hospital length of stay [15.4 (8.4-25) vs. 12.6 (7.5-24.4) days, p = 0.055]. The hospital mortality and ICU mortality between baseline group and post-implementation group did not show a significant difference, 14.4% vs. 11.3%; p = 0.22 for each. There was a variable impact of checklist implementation on adherence to various processes of care recommendations. A decreased exposure in days was noticed for; mechanical ventilation from 42.6% to 33.8%, p < 0.01; central line from 31.3% to 25.3%, p < 0.01; and urinary catheter from 30.6% to 24.4%, p < 0.01. Although there was an increased utilization of antimicrobials (89.9-93.2%, p < 0.01). CONCLUSIONS Checklists for the treatment of acute illness and injury in the PICU setting marginally impacted the outcome and processes of care. The intervention led to increasing adherence with guidelines in multiple ICU processes and led to decreased length of stay.
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Affiliation(s)
- Rahul Kashyap
- Department of Anesthesiology and Peri-operative Medicine, Mayo Clinic, Rochester, MN, USA,METRIC-Multidisciplinary and Translational Research in Intensive Care Medicine, Mayo Clinic, Rochester, MN, USA
| | - Srinivas Murthy
- Division of Critical Care, Department of Pediatrics, University of British Columbia, Vancouver, British Columbia, Canada
| | - Grace M Arteaga
- METRIC-Multidisciplinary and Translational Research in Intensive Care Medicine, Mayo Clinic, Rochester, MN, USA,Pediatric Critical Care Medicine, Mayo Clinic, Rochester, MN, USA
| | - Yue Dong
- Department of Anesthesiology and Peri-operative Medicine, Mayo Clinic, Rochester, MN, USA,METRIC-Multidisciplinary and Translational Research in Intensive Care Medicine, Mayo Clinic, Rochester, MN, USA
| | - Lindsey Cooper
- Department of Pediatrics/Intensive Care, Centre Medicale Evangelique-Nyankunde, Nyankunde, Democratic Republic of the Congo
| | - Tanja Kovacevic
- School of Medicine and University Hospital of Split, Split, Croatia
| | - Chetak Basavaraja
- JSS Academy of Higher Education and Research (JSSAHER), JSS Hospital, Mysuru, KA, India
| | - Hong Ren
- Pediatric Intensive Care Unit, Shanghai Children’s Medical Center, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Lina Qiao
- Sichuan University West China Second Hospital, Chengdu, China
| | - Guoying Zhang
- Chengdu Women and Children's central Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
| | - Kannan Sridharan
- Department of Pharmacology, College of Medicine, Nursing and Health Sciences, Fiji national University, Suva, Fiji
| | - Ping Jin
- Bao'an Maternity & Child Health Hospital, Shenzhen, China
| | - Tao Wang
- Chengdu Women and Children's central Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
| | - Ilisapeci Tuibeqa
- Department of Pediatrics, Colonial war memorial Hospital, Suva, Fiji
| | - An Kang
- Pediatric Intensive Care Unit, Shanghai Children’s Medical Center, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Mandyam Dhanti Ravi
- JSS Academy of Higher Education and Research (JSSAHER), JSS Hospital, Mysuru, KA, India
| | - Ebru Ongun
- Akdeniz University Hospital, Antalya, Turkey
| | - Ognjen Gajic
- METRIC-Multidisciplinary and Translational Research in Intensive Care Medicine, Mayo Clinic, Rochester, MN, USA,Divison of Pulmonary and Care Medicine, Mayo Clinic, Rochester, MN, USA
| | - Sandeep Tripathi
- METRIC-Multidisciplinary and Translational Research in Intensive Care Medicine, Mayo Clinic, Rochester, MN, USA,Pediatric Critical Care Medicine, Mayo Clinic, Rochester, MN, USA,Pediatric Critical Care Medicine, University of Illinois College of Medicine at Peoria, Peoria, IL, USA,Correspondence: Sandeep Tripathi, Pediatrics Critical Care Medicine, OSF Children's Hospital of Illinois, University of Illinois College of Medicine, Peoria, IL, USA. E-mail <>
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Barr J, Ghaferi AA, Costa DK, Hedlin HK, Ding VY, Ross C, Pun BT, Watson SR, Asch SM. Organizational Characteristics Associated With ICU Liberation (ABCDEF) Bundle Implementation by Adult ICUs in Michigan. Crit Care Explor 2020; 2:e0169. [PMID: 32885171 DOI: 10.1097/CCE.0000000000000169] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
The ICU Liberation (ABCDEF) Bundle can help to improve care and outcomes for ICU patients, but bundle implementation is far from universal. Understanding how ICU organizational characteristics influence bundle implementation could inform quality improvement efforts. We surveyed all hospitals in Michigan with adult ICUs to determine whether organizational characteristics were associated with bundle implementation and to determine the level of agreement between ICU physician and nurse leaders around ICU organizational characteristics and bundle implementation. Design We surveyed ICU physician and nurse leaders, assessing their safety culture, ICU team collaboration, and work environment. Using logistic and linear regression models, we compared these organizational characteristics to bundle element implementation, and also compared physician and nurse leaders' perceptions about organizational characteristics and bundle implementation. Setting All (n = 72) acute care hospitals with adult ICUs in Michigan. Subjects ICU physician and nurse leader pairs from each hospital's main ICU. Interventions We developed, pilot-tested, and deployed an electronic survey to all subjects over a 3 month period in 2016. Results Results from 73 surveys (28 physicians, 45 nurses, 60% hospital response rate) demonstrated significant variation in hospital and ICU size and type, organizational characteristics, and physician/nurse perceptions of ICU organization and bundle implementation. We found that a robust safety culture and collaborative work environment that uses checklists to facilitate team communication are strongly associated with bundle implementation. There is also a significant dose-response effect between safety culture, a collaborative work environment, and overall bundle implementation. Conclusions We identified several specific ICU practices that can facilitate ABCDEF Bundle implementation. Our results can be used to develop effective bundle implementation strategies that leverage safety culture, interprofessional collaboration, and routine checklist use in ICUs to improve bundle implementation and performance.
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Huang J, Liu X, Wu Z, Zhang L, Yang X. Improving staff safety with checklists during novel coronavirus disease (COVID-19) pandemic: A quasi-experiment study in vascular surgical department. Medicine (Baltimore) 2020; 99:e21548. [PMID: 32769893 PMCID: PMC7593007 DOI: 10.1097/md.0000000000021548] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
Novel coronavirus disease (COVID-19) emerged in Wuhan in December 2019, has spread in many countries affected people globally. In response to the economic requirement of the nation and meet the need of patient's, a momentous event was going back to work step by step as fighting against COVID-19. Safety in clinical work is of priority as elective surgery in the department of surgery progressing. We used checklists based on our experiences on COVID-19 control and reality of clinical work from February to March in the West China Hospital, involving events of screening patient, chaperonage, and healthcare workers. Checklist summarized the actual clinical nursing work and management practices, hope to provide a reference for the order of surgery during the epidemic prevention and control, and standardize the clinical nursing work of surgery during pandemic.
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Dwivedi AK, Shukla R. Evidence-based statistical analysis and methods in biomedical research (SAMBR) checklists according to design features. Cancer Rep (Hoboken) 2020; 3:e1211. [PMID: 32794640 PMCID: PMC7941456 DOI: 10.1002/cnr2.1211] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2019] [Revised: 06/11/2019] [Accepted: 07/16/2019] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Statistical analysis according to design features and objectives is essential to ensure the validity and reliability of the study findings and conclusions in biomedical research. Heterogeneity in reporting study design elements and conducting statistical analyses is often observed for the same study design and study objective in medical literatures. Sometimes, researchers face a lot of predicaments using appropriate statistical approaches highlighted by methodologists for a specific study design either due to lack of accessibility or understanding of statistical methods or unavailability of checklists related to design and analysis in a concise format. The purpose of this review is to provide the checklist of statistical analysis and methods in biomedical research (SAMBR) to applied researchers. RECENT FINDINGS We initially identified the important steps of reporting design features that may influence the choice of statistical analysis in biomedical research and essential steps of data analysis of common studies. We subsequently searched for statistical approaches employed for each study design/study objective available in publications and other resources. Compilation of these steps produced SAMBR guidance document, which includes three parts. Applied researchers can use part (A) and part (B) of SAMBR to describe or evaluate research design features and quality of statistical analysis, respectively, in reviewing studies or designing protocols. Part (C) of SAMBR can be used to perform essential and preferred evidence-based data analysis specific to study design and objective. CONCLUSIONS We believe that the statistical methods checklists may improve reporting of research design, standardize methodological practices, and promote consistent application of statistical approaches, thus improving the quality of research studies. The checklists do not enforce the use of suggested statistical methods but rather highlight and encourage to conduct the best statistical practices. There is a need to develop an interactive web-based application of the checklists for users for its wide applications.
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Affiliation(s)
- Alok Kumar Dwivedi
- Division of Biostatistics and Epidemiology, Department of Molecular and Translational MedicinePaul L. Foster School of Medicine, Texas Tech University Health Sciences Center El PasoEl PasoTexas
| | - Rakesh Shukla
- Division of Biostatistics and Epidemiology, Department of Environmental HealthUniversity of CincinnatiCincinnatiOhio
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George ER, Hawrusik R, Marx Delaney M, Kara N, Kalita T, Semrau KE. Who's your coach? The relationship between coach characteristics and birth attendants' adherence to the WHO Safe Childbirth Checklist. Gates Open Res 2020; 4:111. [PMID: 32803131 PMCID: PMC7417619 DOI: 10.12688/gatesopenres.13118.1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/13/2020] [Indexed: 11/24/2022] Open
Abstract
Background: Research demonstrates that coaching is an effective method for promoting behavior change, yet little is known about which attributes of a coach make them more or less effective. This post hoc, sub-analysis of the BetterBirth trial used observational data to explore whether specific coaches' and team leaders' characteristics were associated with improved adherence to essential birth practices listed on the World Health Organization Safe Childbirth Checklist. Methods: A descriptive analysis was conducted on the coach characteristics from the 50 BetterBirth coaches and team leaders. Data on adherence to essential birth practices by birth attendants who received coaching were collected by independent observers. Bivariate linear regression models were constructed, accounting for clustering by site, to examine the association between coach characteristics and attendants' adherence to practices. Results: All of the coaches were female and the majority were nurses. Team leaders were comprised of both males and females; half had clinical backgrounds. There was no association between coaches' or team leaders' characteristics, namely gender, type of degree, or years of clinical training, and attendants' adherence to essential birth practices. However, a significant inverse relationship was detected between the coach or team leader's age and years of experience and the birth attendants' adherence to the checklist. Conclusion: Younger, less experienced coaches were more successful in promoting essential birth practices adherence in this population. More data is needed to fully understand the relationship between coaches and birth attendants.
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Affiliation(s)
- Emily R. George
- Ariadne Labs | Brigham & Women's Hospital and Harvard TH Chan School of Public Health, Boston, MA, 02135, USA
| | - Rebecca Hawrusik
- Ariadne Labs | Brigham & Women's Hospital and Harvard TH Chan School of Public Health, Boston, MA, 02135, USA
| | - Megan Marx Delaney
- Ariadne Labs | Brigham & Women's Hospital and Harvard TH Chan School of Public Health, Boston, MA, 02135, USA
| | - Nabihah Kara
- Ariadne Labs | Brigham & Women's Hospital and Harvard TH Chan School of Public Health, Boston, MA, 02135, USA
| | - Tapan Kalita
- Population Services International, Lucknow, India
| | - Katherine E.A. Semrau
- Ariadne Labs | Brigham & Women's Hospital and Harvard TH Chan School of Public Health, Boston, MA, 02135, USA
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Arya DK. Are we using the right tools to manage variation, errors and omissions? Int J Qual Health Care 2020; 32:156-159. [PMID: 31993628 DOI: 10.1093/intqhc/mzz129] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2019] [Revised: 09/29/2019] [Accepted: 12/05/2019] [Indexed: 12/13/2022] Open
Abstract
In all processes, there is an inherent risk of variability to occur. In the process of delivering healthcare, variability can occur as a result of an error or omission and compromise the quality of care or affect the safety of the health care consumer. Even though incident reporting, root cause analysis, use of checklists and other quality improvement methods are in wide-spread use, we may not be using these tools appropriately and therefore we are losing an opportunity to improve the quality of care.
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Affiliation(s)
- Dinesh K Arya
- ACT Health Directorate, 2 Bowes Street, Phillip, ACT 2606, Australia
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Affiliation(s)
- Ashwin Gupta
- Medicine Service, Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, Michigan, USA .,Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, Michigan, USA
| | - Jennifer Meddings
- Medicine Service, Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, Michigan, USA.,Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, Michigan, USA.,Department of Pediatrics and Communicable Diseases, University of Michigan Medical School, Ann Arbor, Michigan, USA
| | - Nathan Houchens
- Medicine Service, Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, Michigan, USA.,Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, Michigan, USA
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Colling C, Mueller C, Perera G, Funnell N, Sauer J, Harwood D, Stewart R, Bishara D. 'Real time' monitoring of antipsychotic prescribing in patients with dementia: a study using the Clinical Record Interactive Search (CRIS) platform to enhance safer prescribing. BMJ Open Qual 2020; 9:e000778. [PMID: 32229485 PMCID: PMC7170541 DOI: 10.1136/bmjoq-2019-000778] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2019] [Revised: 02/25/2020] [Accepted: 03/10/2020] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND The use of antipsychotic drugs in dementia has been reported to be associated with increased risk of cerebrovascular events and mortality. There is an international drive to reduce the use of these agents in patients with dementia and to improve the safety of prescribing and monitoring in this area. OBJECTIVES The aim of this project was to use enhanced automated regular feedback of information from electronic health records to improve the quality of antipsychotic prescribing and monitoring in people with dementia. METHODS The South London and Maudsley NHS Foundation Trust (SLaM) incorporated antipsychotic monitoring forms into its electronic health records. The SLaM Clinical Record Interactive Search (CRIS) platform provides researcher access to de-identified health records, and natural language processing is used in CRIS to derive structured data from unstructured free text, including recorded diagnoses and medication. Algorithms were thus developed to ascertain patients with dementia receiving antipsychotic treatment and to determine whether monitoring forms had been completed. We used two improvement plan-do-study-act cycles to improve the accuracy of the algorithm for automated evaluation and provided monthly feedback on team performance. RESULTS A steady increase in antipsychotic monitoring form completion was observed across the study period. The percentage of our sample with a completed antipsychotic monitoring form more than doubled from October 2017 (22%) to January 2019 (58%). CONCLUSION 'Real time' monitoring and regular feedback to teams offer a time-effective approach, complementary to standard audit methods, to enhance the safer prescribing of high risk drugs.
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Affiliation(s)
- Craig Colling
- Biomedical Research Centre (BRC), Institute of Psychiatry, Psychology and Neuroscience, London, UK
| | - Christoph Mueller
- Biomedical Research Centre (BRC), Institute of Psychiatry, Psychology and Neuroscience, London, UK
- Mental Health of Older Adults and Dementia Clinical Academic Group (SLaM), South London and Maudsley NHS Foundation Trust, London, UK
| | - Gayan Perera
- Biomedical Research Centre (BRC), Institute of Psychiatry, Psychology and Neuroscience, London, UK
| | - Nicola Funnell
- Mental Health of Older Adults and Dementia Clinical Academic Group (SLaM), South London and Maudsley NHS Foundation Trust, London, UK
| | - Justin Sauer
- Biomedical Research Centre (BRC), Institute of Psychiatry, Psychology and Neuroscience, London, UK
- Mental Health of Older Adults and Dementia Clinical Academic Group (SLaM), South London and Maudsley NHS Foundation Trust, London, UK
| | - Daniel Harwood
- Mental Health of Older Adults and Dementia Clinical Academic Group (SLaM), South London and Maudsley NHS Foundation Trust, London, UK
| | - Robert Stewart
- Biomedical Research Centre (BRC), Institute of Psychiatry, Psychology and Neuroscience, London, UK
- Mental Health of Older Adults and Dementia Clinical Academic Group (SLaM), South London and Maudsley NHS Foundation Trust, London, UK
| | - Delia Bishara
- Biomedical Research Centre (BRC), Institute of Psychiatry, Psychology and Neuroscience, London, UK
- Mental Health of Older Adults and Dementia Clinical Academic Group (SLaM), South London and Maudsley NHS Foundation Trust, London, UK
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Reeves K, Chan S, Marsh A, Gallier S, Wigley C, Khunti K, Lilford RJ. Response to: 'Concerns about the evidence in relation to implementation of the ProFHER trial' by Handoll et al. BMJ Qual Saf 2020; 29:432-435. [PMID: 32071138 DOI: 10.1136/bmjqs-2020-010967] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2020] [Accepted: 01/31/2020] [Indexed: 11/04/2022]
Affiliation(s)
- Katharine Reeves
- Queen Elizabeth Hospital, University Hospitals Birmingham NHS Foundation Trust, Birmingham, West Midlands, UK
| | - Samuel Chan
- Queen Elizabeth Hospital, University Hospitals Birmingham NHS Foundation Trust, Birmingham, West Midlands, UK
| | - Alastair Marsh
- Queen Elizabeth Hospital, University Hospitals Birmingham NHS Foundation Trust, Birmingham, West Midlands, UK
| | - Suzy Gallier
- Queen Elizabeth Hospital, University Hospitals Birmingham NHS Foundation Trust, Birmingham, West Midlands, UK
| | - Catrin Wigley
- Bristol Medical School, University of Bristol, Bristol, UK
| | - Kamlesh Khunti
- College of Life Sciences, University of Leicester, Leicester, UK
| | - Richard J Lilford
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
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