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Patient safety culture in Norwegian nursing homes.

ons, 21/02/2018 - 17:48
Related Articles

Patient safety culture in Norwegian nursing homes.

BMC Health Serv Res. 2017 Jun 20;17(1):424

Authors: Bondevik GT, Hofoss D, Husebø BS, Deilkås ECT

Abstract
BACKGROUND: Patient safety culture concerns leader and staff interaction, attitudes, routines, awareness and practices that impinge on the risk of patient-adverse events. Due to their complex multiple diseases, nursing home patients are at particularly high risk of adverse events. Studies have found an association between patient safety culture and the risk of adverse events. This study aimed to investigate safety attitudes among healthcare providers in Norwegian nursing homes, using the Safety Attitudes Questionnaire - Ambulatory Version (SAQ-AV). We studied whether variations in safety attitudes were related to professional background, age, work experience and mother tongue.
METHODS: In February 2016, 463 healthcare providers working in five nursing homes in Tønsberg, Norway, were invited to answer the SAQ-AV, translated and adapted to the Norwegian nursing home setting. Previous validation of the Norwegian SAQ-AV for nursing homes identified five patient safety factors: teamwork climate, safety climate, job satisfaction, working conditions and stress recognition. SPSS v.22 was used for statistical analysis, which included estimations of mean values, standard deviations and multiple linear regressions. P-values <0.05 were considered to be significant.
RESULTS: Out of the 463 employees invited, 288 (62.2%) answered the questionnaire. Response rates varied between 56.9% and 72.2% across the five nursing homes. In multiple linear regression analysis, we found that increasing age and job position among the healthcare providers were associated with significantly increased mean scores for the patient safety factors teamwork climate, safety climate, job satisfaction and working conditions. Not being a Norwegian native speaker was associated with a significantly higher mean score for job satisfaction and a significantly lower mean score for stress recognition. Neither professional background nor work experience were significantly associated with mean scores for any patient safety factor.
CONCLUSIONS: Patient safety factor scores in nursing homes were poorer than previously found in Norwegian general practices, but similar to findings in out-of-hours primary care clinics. Patient safety culture assessment may help nursing home leaders to initiate targeted quality improvement interventions. Further research should investigate associations between patient safety culture and the occurrence of adverse events in nursing homes.

PMID: 28633657 [PubMed - indexed for MEDLINE]

Designing in situ simulation in the emergency department: evaluating safety attitudes amongst physicians and nurses.

lør, 17/02/2018 - 13:51
Related Articles

Designing in situ simulation in the emergency department: evaluating safety attitudes amongst physicians and nurses.

Adv Simul (Lond). 2017;2:4

Authors: Paltved C, Bjerregaard AT, Krogh K, Pedersen JJ, Musaeus P

Abstract
Background: This intervention study aimed to enhance patient safety attitudes through the design of an in situ simulation program based on a needs analysis involving thematic analysis of patient safety data and short-term ethnography. The study took place at an Emergency Department (ED) in the Central Region of Denmark. Research suggests that poor handover communication can increase the likelihood of critical incidents and adverse events in the ED. Furthermore, simulation is an effective strategy for training handover communication skills. Research is lacking, however, on how to use patient safety data and a needs analysis to the design of in situ simulation communication training.
Methods: This is a prospective pre-post study investigating the interventional effects of in situ simulation. It used a three-pronged strategy: (1) thematic analysis of patient safety data consisting of reported critical incidents and adverse events, (2) a needs analysis based on short-term ethnography in the ED, and (3) pre-post evaluation using the validated Safety Attitudes Questionnaire (SAQ) and the Trainee Reactions Score.
Results: Sixteen different healthcare teams participated composed by 9 physicians and 30 nurses. In the SAQ, participating staff scored their safety attitudes in six categories (n = 39). Two measures where significantly higher for the post-SAQ than those for the pre-SAQ: teamwork climate (p < 0.001) and safety climate (p < 0.05). The Trainee Reactions Score showed that the training was positively evaluated.
Conclusions: This study designed a feasible strategy for implementing in situ simulation based on a needs analysis of critical incidents and adverse events and short-term ethnography.

PMID: 29450005 [PubMed]

Interprofessional Teamwork Innovation Model (ITIM) to promote communication and patient-centred, coordinated care.

fre, 16/02/2018 - 12:35

Interprofessional Teamwork Innovation Model (ITIM) to promote communication and patient-centred, coordinated care.

BMJ Qual Saf. 2018 Feb 14;:

Authors: Li J, Talari P, Kelly A, Latham B, Dotson S, Manning K, Thornsberry L, Swartz C, Williams MV

Abstract
BACKGROUND: Despite recommendations and the need to accelerate redesign of delivery models to be team-based and patient-centred, professional silos and cultural and structural barriers that inhibit working together and communicating effectively still predominate in the hospital setting. Aiming to improve team-based rounding, we developed, implemented and evaluated the Interprofessional Teamwork Innovation Model (ITIM).
METHODS: This quality improvement (QI) study was conducted at an academic medical centre. We followed the system's QI framework, FOCUS-PDSA, with Lean as guiding principles. Primary outcomes included 30-day all-cause same-hospital readmissions and 30-day emergency department (ED) visits. The intervention group consisted of patients receiving care on two hospitalist ITIM teams, and patients receiving care from other hospitalist teams were matched with a control group. Outcomes were assessed using difference-in-difference analysis.
RESULTS: Team members reported enhanced communication and overall time savings. In multivariate modelling, patients discharged from hospitalist teams using the ITIM approach were associated with reduced 30-day same-hospital readmissions with an estimated point OR of 0.56 (95% CI 0.34 to 0.92), but there was no impact on 30-day same-hospital ED visits. Difference-in-difference analysis showed that ITIM was not associated with changes in average total direct costs nor average cost per patient day, after adjusting for all other covariates in the models, despite the addition of staff resources in the ITIM model.
CONCLUSION: The ITIM approach facilitates a collaborative environment in which patients and their family caregivers, physicians, nurses, pharmacists, case managers and others work and share in the process of care.

PMID: 29444853 [PubMed - as supplied by publisher]

Performance Under Stress Conditions During Multidisciplinary Team Immersive Pediatric Simulations.

tir, 13/02/2018 - 22:17

Performance Under Stress Conditions During Multidisciplinary Team Immersive Pediatric Simulations.

Pediatr Crit Care Med. 2018 Feb 09;:

Authors: Ghazali DA, Darmian-Rafei I, Ragot S, Oriot D

Abstract
OBJECTIVES: The primary objective was to determine whether technical and nontechnical performances were in some way correlated during immersive simulation. Performance was measured among French Emergency Medical Service workers at an individual and a team level. Secondary objectives were to assess stress response through collection of physiologic markers (salivary cortisol, heart rate, the proportion derived by dividing the number of interval differences of successive normal-to-normal intervals > 50 ms by the total number of normal-to-normal intervals [pNN50], low- and high-frequency ratio) and affective data (self-reported stress, confidence, and dissatisfaction), and to correlate them to performance scores.
DESIGN: Prospective observational study performed as part of a larger randomized controlled trial.
SETTING: Medical simulation laboratory.
SUBJECTS: Forty-eight participants distributed among 12 Emergency Medical System teams.
INTERVENTIONS: Individual and team performance measures and individual stress response were assessed during a high-fidelity simulation. Technical performance was assessed by the intraosseous access performance scale and the Team Average Performance Assessment Scale; nontechnical performance by the Behavioral Assessment Tool for leaders, and the Clinical Teamwork Scale. Stress markers (salivary cortisol, heart rate, pNN50, low- and high-frequency ratio) were measured both before (T1) and after the session (T2). Participants self-reported stress before and during the simulation, self-confidence, and perception of dissatisfaction with team performance, rated on a scale from 0 to 10.
MEASUREMENTS AND MAIN RESULTS: Scores (out of 100 total points, mean ± SD) were intraosseous equals to 65.6 ± 14.4, Team Average Performance Assessment Scale equals to 44.6 ± 18.1, Behavioral Assessment Tool equals to 49.5 ± 22.0, Clinical Teamwork Scale equals to 50.3 ± 18.5. There was a strong correlation between Behavioral Assessment Tool and Clinical Teamwork Scale (Rho = 0.97; p = 0.001), and Behavioral Assessment Tool and Team Average Performance Assessment Scale (Rho = 0.73; p = 0.02). From T1 to T2, all stress markers (salivary cortisol, heart rate, pNN50, and low- and high-frequency ratio) displayed an increase in stress level (p < 0.001 for all). Self-confidence was positively correlated with performance (Clinical Teamwork Scale: Rho = 0.47; p = 0.001, Team Average Performance Assessment Scale: Rho = 0.46; p = 0.001). Dissatisfaction was negatively correlated with performance (Rho = -0.49; p = 0.0008 with Behavioral Assessment Tool, Rho = -0.47; p = 0.001 with Clinical Teamwork Scale, Rho = -0.51; p = 0.0004 with Team Average Performance Assessment Scale). No correlation between stress response and performance was found.
CONCLUSIONS: There was a positive correlation between leader (Behavioral Assessment Tool) and team (Clinical Teamwork Scale and Team Average Performance Assessment Scale) performances. These performance scores were positively correlated with self-confidence and negatively correlated with dissatisfaction.

PMID: 29432402 [PubMed - as supplied by publisher]

Emergency Manuals: How Quality Improvement and Implementation Science Can Enable Better Perioperative Management During Crises.

lør, 10/02/2018 - 19:41

Emergency Manuals: How Quality Improvement and Implementation Science Can Enable Better Perioperative Management During Crises.

Anesthesiol Clin. 2018 Mar;36(1):45-62

Authors: Goldhaber-Fiebert SN, Macrae C

Abstract
How can teams manage critical events more effectively? There are commonly gaps in performance during perioperative crises, and emergency manuals are recently available tools that can improve team performance under stress, via multiple mechanisms. This article examines how the principles of implementation science and quality improvement were applied by multiple teams in the development, testing, and systematic implementations of emergency manuals in perioperative care. The core principles of implementation have relevance for future patient safety innovations perioperatively and beyond, and the concepts of emergency manuals and interprofessional teamwork are applicable for diverse fields throughout health care.

PMID: 29425598 [PubMed - in process]

[Miscommunication as a risk focus in patient safety : Work process analysis in prehospital emergency care].

ons, 07/02/2018 - 17:50

[Miscommunication as a risk focus in patient safety : Work process analysis in prehospital emergency care].

Anaesthesist. 2018 Feb 05;:

Authors: Wilk S, Siegl L, Siegl K, Hohenstein C

Abstract
BACKGROUND: In an analysis of a critical incident reporting system (CIRS) in out-of-hospital emergency medicine, it was demonstrated that in 30% of cases deficient communication led to a threat to patients; however, the analysis did not show what exactly the most dangerous work processes are. Current research shows the impact of poor communication on patient safety.
OBJECTIVES: An out-of-hospital workflow analysis collects data about key work processes and risk areas. The analysis points out confounding factors for a sufficient communication. Almost 70% of critical incidents are based on human factors. Factors, such as communication and teamwork have an impact but fatigue, noise levels and illness also have a major influence.
MATERIAL AND METHODS: (I) CIRS database analysis The workflow analysis was based on 247 CIRS cases. This was completed by participant observation and interviews with emergency doctors and paramedics. The 247 CIRS cases displayed 282 communication incidents, which are categorized into 6 subcategories of miscommunication. One CIRS case can be classified into different categories if more communication incidents were validated by the reviewers and four experienced emergency physicians sorted these cases into six subcategories. (II) Workflow analysis The workflow analysis was carried out between 2015 and 2016 in Jena and Berlin, Germany. The focal point of research was to find accumulation of communication risks in different parts of prehospital patient care. During 30 h driving with emergency ambulances, the author interviewed 12 members of the emergency medical service of which 5 were emergency physicians and 7 paramedics. A total of 11 internal medicine cases and one automobile accident were monitored. After patient care the author asked in a 15-min interview if miscommunication or communication incidents occurred.
RESULTS: (I) CIRS analysis Between 2005 and 2015, 845 reports were reported to the database. The experts identified 247 incident reports with communication failure. All communication aspects were analyzed and classified. We identified 282 communication incidents. (II) Workflow analysis The analysis showed three phases of prehospital patient care: 1. incoming emergency call and dispatch of ambulance service, 2. prehospital treatment, 3. transportation to a hospital. Overall, the number of incidences is increasing as a consequence of parallel workflows. Category 1 was particularly significant and predominantly, paramedics criticized that emergency physicians did not acknowledge their advice (n = 73 vs. n = 9). Category 3 with n = 63, category 4 with n = 20 and category 2 with n = 13 were the major reasons for incidents.
CONCLUSION: A better interface communication helps to coordinate patient transfer and is an option for optimizing resources. Frequent training in communication is an option to avoid incidents.

PMID: 29404658 [PubMed - as supplied by publisher]

Education and training for nonanesthesia providers performing deep sedation.

ons, 07/02/2018 - 17:50
Related Articles

Education and training for nonanesthesia providers performing deep sedation.

Curr Opin Anaesthesiol. 2016 Aug;29(4):499-505

Authors: Pisansky AJ, Beutler SS, Urman RD

Abstract
PURPOSE OF REVIEW: There has been a significant increase in the number and types of procedures performed outside of the operating room with nonanesthesia providers administering sedation. This review describes current recommendations for training nonanesthesiologists involved in administering deep sedation, summarizes best practices and highlights select patient outcomes.
RECENT FINDINGS: There are numerous guidelines and standards related to the administration of deep sedation. However, there are no universally accepted guidelines regarding the necessary educational and skill competencies needed for nonanesthesiologists to provide deep sedation. The American Society of Anesthesiologists has published a position statement and guidelines on these educational requirements, yet the extent to which these are adhered to remains unknown. As evidence-based guidelines continue to evolve, more research is needed to describe how current practices affect patient outcomes.
SUMMARY: The American Society of Anesthesiologists publishes recommendations regarding the essential educational components for nonanesthesiologist providers who administer deep sedation. The available data support the need for formal educational programmes to prevent adverse events associated with deep sedation. Competencies should include preprocedural evaluation, understanding sedation levels, airway management, documentation, emergency life support skills, teamwork and quality improvement.

PMID: 27054416 [PubMed - indexed for MEDLINE]

Filling the Gap: Simulation-based Crisis Resource Management Training for Emergency Medicine Residents.

tor, 01/02/2018 - 22:04
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Filling the Gap: Simulation-based Crisis Resource Management Training for Emergency Medicine Residents.

West J Emerg Med. 2018 Jan;19(1):205-210

Authors: Parsons JR, Crichlow A, Ponnuru S, Shewokis PA, Goswami V, Griswold S

Abstract
Introduction: In today's team-oriented healthcare environment, high-quality patient care requires physicians to possess not only medical knowledge and technical skills but also crisis resource management (CRM) skills. In emergency medicine (EM), the high acuity and dynamic environment makes CRM skills of physicians particularly critical to healthcare team success. The Accreditation Council of Graduate Medicine Education Core Competencies that guide residency program curriculums include CRM skills; however, EM residency programs are not given specific instructions as to how to teach these skills to their trainees. This article describes a simulation-based CRM course designed specifically for novice EM residents.
Methods: The CRM course includes an introductory didactic presentation followed by a series of simulation scenarios and structured debriefs. The course is designed to use observational learning within simulation education to decrease the time and resources required for implementation. To assess the effectiveness in improving team CRM skills, two independent raters use a validated CRM global rating scale to measure the CRM skills displayed by teams of EM interns in a pretest and posttest during the course.
Results: The CRM course improved leadership, problem solving, communication, situational awareness, teamwork, resource utilization and overall CRM skills displayed by teams of EM interns. While the improvement from pretest to posttest did not reach statistical significance for this pilot study, the large effect sizes suggest that statistical significance may be achieved with a larger sample size.
Conclusion: This course can feasibly be incorporated into existing EM residency curriculums to provide EM trainees with basic CRM skills required of successful emergency physicians. We believe integrating CRM training early into existing EM education encourages continued deliberate practice, discussion, and improvement of essential CRM skills.

PMID: 29383082 [PubMed - in process]

Interprofessional Emergency Training Leads to Changes in the Workplace.

tor, 01/02/2018 - 22:04
Related Articles

Interprofessional Emergency Training Leads to Changes in the Workplace.

West J Emerg Med. 2018 Jan;19(1):185-192

Authors: Eisenmann D, Stroben F, Gerken JD, Exadaktylos AK, Machner M, Hautz WE

Abstract
Introduction: Preventable mistakes occur frequently and can lead to patient harm and death. The emergency department (ED) is notoriously prone to such errors, and evidence suggests that improving teamwork is a key aspect to reduce the rate of error in acute care settings. Only a few strategies are in place to train team skills and communication in interprofessional situations. Our goal was to conceptualize, implement, and evaluate a training module for students of three professions involved in emergency care. The objective was to sensitize participants to barriers for their team skills and communication across professional borders.
Methods: We developed a longitudinal simulation-enhanced training format for interprofessional teams, consisting of final-year medical students, advanced trainees of emergency nursing and student paramedics. The training format consisted of several one-day training modules, which took place twice in 2016 and 2017. Each training module started with an introduction to share one's roles, professional self-concepts, common misconceptions, and communication barriers. Next, we conducted different simulated cases. Each case consisted of a prehospital section (for paramedics and medical students), a handover (everyone), and an ED section (medical students and emergency nurses). After each training module, we assessed participants' "Commitment to Change." In this questionnaire, students were anonymously asked to state up to three changes that they wished to implement as a result of the course, as well as the strength of their commitment to these changes.
Results: In total, 64 of 80 participants (80.0%) made at least one commitment to change after participating in the training modules. The total of 123 commitments was evenly distributed over four emerging categories: communication, behavior, knowledge and attitude. Roughly one third of behavior- and attitude-related commitments were directly related to interprofessional topics (e.g., "acknowledge other professions' work"), and these were equally distributed among professions. At the two-month follow-up, 32 participants (50%) provided written feedback on their original commitments: 57 of 62 (91.9%) commitments were at least partly realized at the follow-up, and only five (8.1%) commitments lacked realization entirely.
Conclusion: A structured simulation-enhanced intervention was successful in promoting change to the practice of emergency care, while training teamwork and communication skills jointly.

PMID: 29383079 [PubMed - in process]

Self-assessment of team performance using T-NOTECHS in simulated pediatric trauma resuscitation is not consistent with expert assessment.

fre, 26/01/2018 - 15:44
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Self-assessment of team performance using T-NOTECHS in simulated pediatric trauma resuscitation is not consistent with expert assessment.

Am J Surg. 2018 Jan 20;:

Authors: Wieck MM, McLaughlin C, Chang TP, Rake A, Park C, Lane C, Burke RV, Young LC, Cleek EA, Morton I, Goodhue CJ, Burd RS, Ford HR, Upperman JS, Jensen AR

Abstract
BACKGROUND: The Trauma NOn-TECHnical Skills (T-NOTECHS) tool has been used to assess teamwork in trauma resuscitation, but its reliability and validity for self-assessment is unknown. Our purpose was to determine the reliability and validity of self-administered T-NOTECHS in pediatric trauma resuscitation.
METHODS: Simulated in situ resuscitations were evaluated using T-NOTECHS in real time by experts and immediately afterwards by team members. Reliability was analyzed with linear-weighted kappa and intra-class correlation. T-NOTECHS scores were compared between expert (gold-standard) and self-assessment.
RESULTS: Fifteen simulations were examined. T-NOTECHS scores were similar between self- and expert assessment for leadership. Self-assessment scores were higher than expert for the other domains and total composite score. Inter-rater reliability for total score was similar between the two groups, but differences were observed in the domains.
CONCLUSIONS: Self-assessment is not interchangeable with expert rating when using T-NOTECHS. Future studies need to determine how self-assessment can be best utilized.
LEVEL OF EVIDENCE: Studies of diagnostic accuracy - Level 2.

PMID: 29366483 [PubMed - as supplied by publisher]

Developing a model for effective leadership in healthcare: a concept mapping approach.

tir, 23/01/2018 - 23:33
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Developing a model for effective leadership in healthcare: a concept mapping approach.

J Healthc Leadersh. 2017;9:69-78

Authors: Hargett CW, Doty JP, Hauck JN, Webb AM, Cook SH, Tsipis NE, Neumann JA, Andolsek KM, Taylor DC

Abstract
Purpose: Despite increasing awareness of the importance of leadership in healthcare, our understanding of the competencies of effective leadership remains limited. We used a concept mapping approach (a blend of qualitative and quantitative analysis of group processes to produce a visual composite of the group's ideas) to identify stakeholders' mental model of effective healthcare leadership, clarifying the underlying structure and importance of leadership competencies.
Methods: Literature review, focus groups, and consensus meetings were used to derive a representative set of healthcare leadership competency statements. Study participants subsequently sorted and rank-ordered these statements based on their perceived importance in contributing to effective healthcare leadership in real-world settings. Hierarchical cluster analysis of individual sortings was used to develop a coherent model of effective leadership in healthcare.
Results: A diverse group of 92 faculty and trainees individually rank-sorted 33 leadership competency statements. The highest rated statements were "Acting with Personal Integrity", "Communicating Effectively", "Acting with Professional Ethical Values", "Pursuing Excellence", "Building and Maintaining Relationships", and "Thinking Critically". Combining the results from hierarchical cluster analysis with our qualitative data led to a healthcare leadership model based on the core principle of Patient Centeredness and the core competencies of Integrity, Teamwork, Critical Thinking, Emotional Intelligence, and Selfless Service.
Conclusion: Using a mixed qualitative-quantitative approach, we developed a graphical representation of a shared leadership model derived in the healthcare setting. This model may enhance learning, teaching, and patient care in this important area, as well as guide future research.

PMID: 29355249 [PubMed]

Overall Emergency Department Rating: Identifying the Factors That Matter Most to Patient Experience.

ons, 10/01/2018 - 17:14

Overall Emergency Department Rating: Identifying the Factors That Matter Most to Patient Experience.

J Healthc Qual. 2018 Jan 08;:

Authors: Aaronson EL, Mort E, Sonis JD, Chang Y, White BA

Abstract
BACKGROUND: Patient experience is becoming an area of interest in Emergency Medicine as more is understood about its impact on outcomes and the expectation that it will soon be tied to reimbursement. No study has investigated the predictors of emergency department (ED) patient satisfaction in over a decade. As the care environment, access to information, and consumer interests change, determinants of satisfaction have likely evolved. Our objective was to examine the factors that were most predictive of ED satisfaction.
METHODS: A retrospective cohort study at an urban, university-affiliated ED. The relationship between overall satisfaction and patients' responses to individual questions was assessed using a chi-square test and a multivariable logistic regression model.
RESULTS: During the study period, 7,872 patients participated in a telephone interview. Logistic regression found 13 questions predictive of high overall ED rating and 9 questions predictive of low overall ED rating. Six questions appeared in both analyses, related to timeliness, cleanliness, the physician's ability to listen carefully, teamwork, and the perception of being helped by the care.
CONCLUSIONS: There are strong predictors of overall ED satisfaction related to communication, wait time, environment, and perception that care was helpful. Further efforts should focus on identifying interventions in each of these domains.

PMID: 29315153 [PubMed - as supplied by publisher]

A simulated emergency department for medical students.

lør, 06/01/2018 - 12:06
Related Articles

A simulated emergency department for medical students.

Clin Teach. 2017 Aug;14(4):256-262

Authors: Johnson P, Brazil V, Raymond-Dufresne É, Nielson T

Abstract
BACKGROUND: During their training, medical students often undertake a rotation in an emergency department (ED), where they are exposed to a wide variety of patient presentations. Simulation can be an effective teaching strategy to help prepare learners for the realities of the clinical environment. Simulating an ED shift can provide students with the opportunity to perform a range of clinical activities, within their scope of practice, in a supervised and supportive learning environment. Medical students often undertake a rotation in an emergency department CONTEXT: There is limited literature describing the structure, syllabus, feasibility and perceived usefulness of simulating a typical ED for medical student training.
INNOVATION: We developed a simulated ED (simED) teaching session for medical students at our university. Students were informed of the purpose and learning tasks of the session prior to attendance. At the start of their 2-hour simED shift students were allocated 'patients' by the Triage nurse. At the completion of their shift, students attended a debriefing discussion. Student feedback indicated that they felt that the simED: provided a good opportunity to practise skills and apply theory to practice; was realistic and challenging; highlighted the importance of teamwork; and enabled them to identify skills requiring further practise. Suggestions for improvements included a longer time spent in the simED and the opportunity to see more patients.
IMPLICATION: The simED approach seemed to be well received and perceived by medical students as useful preparation for the ED. An overview of the structure, materials and resources used is provided to assist educators seeking to implement similar ED clinical scenarios in their curriculum.

PMID: 27425036 [PubMed - indexed for MEDLINE]

Operating Room Team Training with Simulation: A Systematic Review.

lør, 06/01/2018 - 00:03
Related Articles

Operating Room Team Training with Simulation: A Systematic Review.

J Laparoendosc Adv Surg Tech A. 2017 May;27(5):475-480

Authors: Robertson JM, Dias RD, Yule S, Smink DS

Abstract
INTRODUCTION: Nontechnical skills (NTS) such as teamwork and communication play an important role in preventing adverse outcomes in the operating room (OR). Simulation-based OR team training focused on these skills provides an environment where team members can learn with and from one another. We sought to conduct a systematic review to identify simulation-based approaches to NTS training for surgical teams.
MATERIALS AND METHODS: We conducted a systematic search of PubMed, ERIC, and the Cochrane Database using keywords and MeSH terms for studies describing simulation-based training for OR teams, including members from surgery, anesthesia, and nursing in September 2016. Information on the simulations, participants, and NTS assessments were abstracted from the articles meeting our search criteria.
RESULTS: We identified 10 published articles describing simulation-based OR team-training programs focused on NTS. The primary focus of these programs was on communication, teamwork, leadership, and situation awareness. Only four of the programs used a validated instrument to assess the NTS of the individuals or teams participating in the simulations.
DISCUSSION: Simulation-based OR team-training programs provide opportunities for NTS development and reflection by participants. Future programs could benefit from involving the full range of disciplines and professions that compose an OR team, as well as increased use of validated assessment instruments.

PMID: 28294695 [PubMed - indexed for MEDLINE]

Debriefing of the medical team after emergencies on cruise ships.

tor, 04/01/2018 - 23:25
Related Articles

Debriefing of the medical team after emergencies on cruise ships.

Int Marit Health. 2017;68(4):183-186

Authors: Dahl E

Abstract
Done to improve safety and patient outcome but not to lay blame, debriefings on cruise ships should preferably be conducted as standard practice in the medical facility immediately after all critical events aboard. The key questions to be asked are: What went well, what could have gone better and what must participants do to improve care? Post-debriefing the ship's doctor might have to deal with team members' mental stress resulting both from the event and from debriefing it. Required by most cruise companies, standardised advanced life support courses teach effective high-performance team dynamics. They provide the multinational medical staff with a clearer understanding of the rescue sequence, which again will reduce the risk of mistakes and simplify post-event debriefings. Their systematic approach to the chain of survival is also helpful for post-event debriefings if something went wrong.

PMID: 29297567 [PubMed - in process]

Neonatology faculty development using simulation.

tor, 04/01/2018 - 23:25
Related Articles

Neonatology faculty development using simulation.

Semin Perinatol. 2016 Nov;40(7):455-465

Authors: French HM, Hales RL

Abstract
The goal of faculty development activities is to supply the public with knowledgeable, skilled, and competent physicians who are prepared for high performance in the dynamic and complex healthcare environment. Current faculty development programs lack evidence-based support and are not sufficient to meet the professional needs of practicing physicians. Simulation activities for faculty development offer an alternative to traditional, teacher-centric educational offerings. Grounded in adult learning theory, simulation is a learner-centric, interactive, efficient, and effective method to train busy professionals. Many of the faculty development needs of clinical neonatologists can be met by participating in simulation-based activities that focus on technical skills, teamwork, leadership, communication, and patient safety.

PMID: 28029389 [PubMed - indexed for MEDLINE]

Choosing between staying at home or moving: A systematic review of factors influencing housing decisions among frail older adults.

tor, 04/01/2018 - 10:54
Related Articles

Choosing between staying at home or moving: A systematic review of factors influencing housing decisions among frail older adults.

PLoS One. 2018;13(1):e0189266

Authors: Roy N, Dubé R, Després C, Freitas A, Légaré F

Abstract
BACKGROUND: Most older adults wish to stay at home during their late life years, but physical disabilities and cognitive impairment may force them to face a housing decision. However, they lack relevant information to make informed value-based housing decisions. Consequently, we sought to identify the sets of factors influencing the housing decision-making of older adults.
METHODS: We performed a systematic literature search for studies evaluating any factors influencing the housing decisions among older adults over 65 years old without cognitive disabilities. Primary research from any study design reported after 1990 in a peer-reviewed journal, a book chapter or an evaluated doctoral thesis and written in English, French or Spanish were eligible. We extracted the main study characteristics, the participant characteristics and any factors reported as associated with the housing decision. We conducted a qualitative thematic analysis from the perspective of the meaning and experience of home.
RESULTS: The search resulted in 660 titles (after duplicate removal) from which 86 studies were kept for analysis. One study out of five reported exclusively on frail older adults (n = 17) and two on adults over 75 years old. Overall, a total of 88 factors were identified, of which 71 seem to have an influence on the housing decision-making of older adults, although the influence of 19 of them remains uncertain due to discrepancies between research methodologies. No conclusion was made regarding 12 additional factors due to lack of evidence.
CONCLUSION: A wealth of factors were found to influence housing decisions among older adults. However, very few of them have been studied extensively. Our results highlight the importance of interdisciplinary teamwork to study the influence of a broader range of factors as a whole. These results will help older adults make the best possible housing decision based on their unique situation and values.

PMID: 29293511 [PubMed - in process]

Impact of Interprofessional Relationships from Nurses' Perspective on the Decision-Making Capacity of Patients in a Clinical Setting.

søn, 31/12/2017 - 16:52
Related Articles

Impact of Interprofessional Relationships from Nurses' Perspective on the Decision-Making Capacity of Patients in a Clinical Setting.

Int J Environ Res Public Health. 2017 Dec 29;15(1):

Authors: Molina-Mula J, Gallo-Estrada J, Perelló-Campaner C

Abstract
Interprofessional relationships may impact the decision making of patients in a clinical setting. The objective of this study was to analyse the decision-making capabilities of patients from nurses' perspectives of interprofessional relationships using Foucauldian ethics. This qualitative study was based on poststructuralist Foucault references with in-depth interviews of nurses working in internal medicine and specialties in a general hospital. The patients constantly appeared in the definition of teamwork, but also as a passive element used by every professional to communicate with others. Nurses continue modelling a type of patient passivity, or what Foucault called passive subjectivity in relation to oneself, because the patient is guided and directed to take charge of a truth provided by professionals. Nurses must break the rigid design of sections or professional skills, and adopt a model of teamwork that meets the needs of the patient and increases their decision-making power. The quality of care will increase to the extent that professionals establish a relationship of equality with the patient, allowing the patient to make real decisions about their care. An egalitarian model of teamwork is beneficial to the patient, abandoning the idea of a team where the patient and family are constantly excluded from decisions about their care.

PMID: 29286342 [PubMed - in process]

The effect of the number and level of emergency medical technicians on patient outcomes following out of hospital cardiac arrest in Taipei.

søn, 26/11/2017 - 06:23

The effect of the number and level of emergency medical technicians on patient outcomes following out of hospital cardiac arrest in Taipei.

Resuscitation. 2017 Nov 20;:

Authors: Sun JT, Chiang WC, Hsieh MJ, Huang EP, Yang WS, Chien YC, Wang YC, Lee BC, Sim SS, Tsai KC, Ma MH, Chen LW

Abstract
AIM: The effect of the number and level of on-scene emergency medical technicians (EMTs) on the outcomes of patients with out-of-hospital cardiac arrest (OHCA) remains unclear. We aimed to test the association between the number and level of EMTs and the outcomes of patients with OHCA.
METHODS: We analysed Utstein-based registry data on OHCA in Taipei from 2011 to 2015. The eligible patients were adults, aged ≥20 years, with non-traumatic OHCA who underwent resuscitation attempts. The exposures were the total number of EMTs or the EMT-Paramedic (EMT-P) ratio >50%. The outcome of interest was survival to discharge.
RESULTS: During study period, total 8,262 OHCA cases were included, of which 1,085 (13.1%) were approached by crews with an EMT-P ratio >50%. While an increase in the number of EMTs on-scene was not associated with better chances of survival (adjusted odds ratio [aOR] 0.98, 95% confidence interval [CI] 0.89-1.08), an EMT-P ratio >50% was significantly associated with improved outcome (aOR 1.36, 95% CI 1.06-1.76). Subgroup analyses showed that EMT-P >50% significantly benefited survival in witnessed OHCA cases with non-shockable rhythm (aOR 1.69, 95% CI 1.01-2.58). Survival was the highest among cases seen by four EMTs with an EMT-P ratio >50% (aOR 2.54, 95% CI 1.43-4.50).
CONCLUSION: An on-scene EMT-P ratio >50% was associated with improved survival to discharge of OHCA cases, especially in those with witnessed, non-shockable rhythm. The presence of four EMTs with an EMT-P ratio >50% at the scene of OHCA was associated with the best outcome.

PMID: 29169910 [PubMed - as supplied by publisher]

Why saying what you mean matters: An analysis of trauma team communication.

tir, 21/11/2017 - 15:21

Why saying what you mean matters: An analysis of trauma team communication.

Am J Surg. 2017 Nov 08;:

Authors: Jung HS, Warner-Hillard C, Thompson R, Haines K, Moungey B, LeGare A, Shaffer DW, Pugh C, Agarwal S, Sullivan S

Abstract
BACKGROUND: We hypothesized that team communication with unmatched grammatical form and communicative intent (mixed mode communication) would correlate with worse trauma teamwork.
METHODS: Interdisciplinary trauma simulations were conducted. Team performance was rated using the TEAM tool. Team communication was coded for grammatical form and communicative intent. The rate of mixed mode communication (MMC) was calculated. MMC rates were compared to overall TEAM scores. Statements with advisement intent (attempts to guide behavior) and edification intent (objective information) were specifically examined. The rates of MMC with advisement intent (aMMC) and edification intent (eMMC) were also compared to TEAM scores.
RESULTS: TEAM scores did not correlate with MMC or eMMC. However, aMMC rates negatively correlated with total TEAM scores (r = -0.556, p = 0.025) and with the TEAM task management component scores (r = -0.513, p = 0.042).
CONCLUSIONS: Trauma teams with lower rates of mixed mode communication with advisement intent had better non-technical skills as measured by TEAM.

PMID: 29153980 [PubMed - as supplied by publisher]

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