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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]

Should they stay or should they go now? Exploring the impact of team familiarity on interprofessional team training outcomes.

tor, 16/11/2017 - 00:07
Related Articles

Should they stay or should they go now? Exploring the impact of team familiarity on interprofessional team training outcomes.

Am J Surg. 2017 Nov 04;:

Authors: Joshi K, Hernandez J, Martinez J, AbdelFattah K, Gardner AK

Abstract
INTRODUCTION: Although simulation is an effective method for enhancing team competencies, it is unclear how team familiarity impacts this process. We examined how team familiarity impacted team competencies.
METHODS: Trainees were assigned to stable or dynamic teams to participate in three simulated cases. Situation awareness (SA) data was collected through in-scenario freezes. The recorded performances were assessed for clinical effectiveness (ClinEff) and teamwork. All data are reported on a 1-100% (100% = perfect performance) scale.
RESULTS: Forty-six trainees (23 General Surgery; 23 Emergency Medicine) were randomized by specialty into stable (N = 8) or dynamic (N = 7) groups. Overall changes from Sim 1 to Sim3 were 12.2% (p < 0.01), -1.1% (ns), and 7.1% (p < 0.01) for SA, ClinEff, and Teamwork, respectively. However, improvements differed by condition, with stable teams reflecting improvements in ClinEff (15.2%; p < 0.05), whereas dynamic team ClinEff improvement (8.7%) was not significant. Both groups demonstrated improvements in teamwork (stable = 9%, p < 0.05; dynamic = 4.9%, p < 0.05).
CONCLUSIONS: Teams who continued to work together demonstrated increased improvements in clinical effectiveness and teamwork, while dynamic teams only demonstrated improvements in teamwork.

PMID: 29132646 [PubMed - as supplied by publisher]

Integration of in-hospital cardiac arrest contextual curriculum into a basic life support course: a randomized, controlled simulation study.

fre, 10/11/2017 - 21:26
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Integration of in-hospital cardiac arrest contextual curriculum into a basic life support course: a randomized, controlled simulation study.

Resuscitation. 2017 May;114:127-132

Authors: Hunt EA, Duval-Arnould JM, Chime NO, Jones K, Rosen M, Hollingsworth M, Aksamit D, Twilley M, Camacho C, Nogee DP, Jung J, Nelson-McMillan K, Shilkofski N, Perretta JS

Abstract
OBJECTIVE: The objective was to compare resuscitation performance on simulated in-hospital cardiac arrests after traditional American Heart Association (AHA) Healthcare Provider Basic Life Support course (TradBLS) versus revised course including in-hospital skills (HospBLS).
DESIGN: This study is a prospective, randomized, controlled curriculum evaluation.
SETTING: Johns Hopkins Medicine Simulation Center.
SUBJECTS: One hundred twenty-two first year medical students were divided into fifty-nine teams.
INTERVENTION: HospBLS course of identical length, containing additional content contextual to hospital environments, taught utilizing Rapid Cycle Deliberate Practice (RCDP).
MEASUREMENTS: The primary outcome measure during simulated cardiac arrest scenarios was chest compression fraction (CCF) and secondary outcome measures included metrics of high quality resuscitation.
MAIN RESULTS: Out-of-hospital cardiac arrest HospBLS teams had larger CCF: [69% (65-74) vs. 58% (53-62), p<0.001] and were faster than TradBLS at initiating compressions: [median (IQR): 9s (7-12) vs. 22s (17.5-30.5), p<0.001]. In-hospital cardiac arrest HospBLS teams had larger CCF: [73% (68-75) vs. 50% (43-54), p<0.001] and were faster to initiate compressions: [10s (6-11) vs. 36s (27-63), p<0.001]. All teams utilized the hospital AED to defibrillate within 180s per AHA guidelines [HospBLS: 122s (103-149) vs. TradBLS: 139s (117-172), p=0.09]. HospBLS teams performed more hospital-specific maneuvers to optimize compressions, i.e. utilized: CPR button to flatten bed: [7/30 (23%) vs. 0/29 (0%), p=0.006], backboard: [21/30 (70%) vs. 5/29 (17%), p<0.001], stepstool: [28/30 (93%) vs. 8/29 (28%), p<0.001], lowered bedrails: [28/30 (93%) vs. 10/29 (34%), p<0.001], connected oxygen appropriately: [26/30 (87%) vs. 1/29 (3%), p<0.001] and used oral airway and/or two-person bagging when traditional bag-mask-ventilation unsuccessful: [30/30 (100%) vs. 0/29 (0%), p<0.001].
CONCLUSION: A hospital focused BLS course utilizing RCDP was associated with improved performance on hospital-specific quality measures compared with the traditional AHA course.

PMID: 28323084 [PubMed - indexed for MEDLINE]

Simulation in Interprofessional Clinical Education: Exploring Validated Nontechnical Skills Measurement Tools.

tor, 09/11/2017 - 18:59
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Simulation in Interprofessional Clinical Education: Exploring Validated Nontechnical Skills Measurement Tools.

Simul Healthc. 2017 Nov 08;:

Authors: von Wendt CEA, Niemi-Murola L

Abstract
The research literature regarding interprofessional simulation-based medical education has grown substantially and continues to explore new aspects of this educational modality. The aim of this study was to explore the validation evidence of tools used to assess teamwork and nontechnical skills in interprofessional simulation-based clinical education. This systematic review included original studies that assessed participants' teamwork and nontechnical skills, using a measurement tool, in an interprofessional simulated setting. We assessed the validity of each assessment tool using Kane's framework. Medical Education Research Study Quality Instrument scores for the studies ranged from 8.5 to 17.0. Across the 22 different studies, there were 20 different assessment strategies, in which Team Emergency Assessment Measure, Anesthetist's Nontechnical Skills, and Nontechnical Skills for Surgeons were used more than once. Most assessment tools have been validated for scoring and generalization inference. Fewer tools have been validated for extrapolation inference, such as expert-novice analysis or factor analysis.

PMID: 29117089 [PubMed - as supplied by publisher]

Association Between Physician Teamwork and Health System Outcomes After Coronary Artery Bypass Grafting.

ons, 08/11/2017 - 17:47
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Association Between Physician Teamwork and Health System Outcomes After Coronary Artery Bypass Grafting.

Circ Cardiovasc Qual Outcomes. 2016 Nov;9(6):641-648

Authors: Hollingsworth JM, Funk RJ, Garrison SA, Owen-Smith J, Kaufman SA, Pagani FD, Nallamothu BK

Abstract
BACKGROUND: Patients undergoing coronary artery bypass grafting (CABG) must often see multiple providers dispersed across many care locations. To test whether teamwork (assessed with the bipartite clustering coefficient) among these physicians is a determinant of surgical outcomes, we examined national Medicare data from patients undergoing CABG.
METHODS AND RESULTS: Among Medicare beneficiaries who underwent CABG between 2008 and 2011, we mapped relationships between all physicians who treated them during their surgical episodes, including both surgeons and nonsurgeons. After aggregating across CABG episodes in a year to construct the physician social networks serving each health system, we then assessed the level of physician teamwork in these networks with the bipartite clustering coefficient. Finally, we fit a series of multivariable regression models to evaluate associations between a health system's teamwork level and its 60-day surgical outcomes. We observed substantial variation in the level of teamwork between health systems performing CABG (SD for the bipartite clustering coefficient was 0.09). Although health systems with high and low teamwork levels treated beneficiaries with comparable comorbidity scores, these health systems differed over several sociocultural and healthcare capacity factors (eg, physician staff size and surgical caseload). After controlling for these differences, health systems with higher teamwork levels had significantly lower 60-day rates of emergency department visit, readmission, and mortality.
CONCLUSIONS: Health systems with physicians who tend to work together in tightly-knit groups during CABG episodes realize better surgical outcomes. As such, delivery system reforms focused on building teamwork may have positive effects on surgical care.

PMID: 28263939 [PubMed - indexed for MEDLINE]

Characterizing Teamwork in Cardiovascular Care Outcomes: A Network Analytics Approach.

ons, 08/11/2017 - 17:47
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Characterizing Teamwork in Cardiovascular Care Outcomes: A Network Analytics Approach.

Circ Cardiovasc Qual Outcomes. 2016 Nov;9(6):670-678

Authors: Carson MB, Scholtens DM, Frailey CN, Gravenor SJ, Powell ES, Wang AY, Kricke GS, Ahmad FS, Mutharasan RK, Soulakis ND

Abstract
BACKGROUND: The nature of teamwork in healthcare is complex and interdisciplinary, and provider collaboration based on shared patient encounters is crucial to its success. Characterizing the intensity of working relationships with risk-adjusted patient outcomes supplies insight into provider interactions in a hospital environment.
METHODS AND RESULTS: We extracted 4 years of patient, provider, and activity data for encounters in an inpatient cardiology unit from Northwestern Medicine's Enterprise Data Warehouse. We then created a provider-patient network to identify healthcare providers who jointly participated in patient encounters and calculated satisfaction rates for provider-provider pairs. We demonstrated the application of a novel parameter, the shared positive outcome ratio, a measure that assesses the strength of a patient-sharing relationship between 2 providers based on risk-adjusted encounter outcomes. We compared an observed collaboration network of 334 providers and 3453 relationships to 1000 networks with shared positive outcome ratio scores based on randomized outcomes and found 188 collaborative relationships between pairs of providers that showed significantly higher than expected patient satisfaction ratings. A group of 22 providers performed exceptionally in terms of patient satisfaction. Our results indicate high variability in collaboration scores across the network and highlight our ability to identify relationships with both higher and lower than expected scores across a set of shared patient encounters.
CONCLUSIONS: Satisfaction rates seem to vary across different teams of providers. Team collaboration can be quantified using a composite measure of collaboration across provider pairs. Tracking provider pair outcomes over a sufficient set of shared encounters may inform quality improvement strategies such as optimizing team staffing, identifying characteristics and practices of high-performing teams, developing evidence-based team guidelines, and redesigning inpatient care processes.

PMID: 28051772 [PubMed - indexed for MEDLINE]

What Every Graduating Resident Needs to Know About Quality Improvement and Patient Safety: A Content Analysis of 26 Sets of ACGME Milestones.

fre, 03/11/2017 - 13:31

What Every Graduating Resident Needs to Know About Quality Improvement and Patient Safety: A Content Analysis of 26 Sets of ACGME Milestones.

Acad Med. 2017 Oct 31;:

Authors: Lane-Fall M, Davis JJ, Clapp J, Myers JS, Riesenberg LA

Abstract
PURPOSE: Quality improvement (QI) and patient safety (PS) are broadly relevant to the practice of medicine, but specialty-specific milestones demonstrate variable expectations for trainee competency in QI/PS. The purpose of this study was to develop a unifying portrait of QI/ PS expectations for graduating residents irrespective of specialty.
METHOD: Milestones from 26 residency programs representing the 24 member boards of the American Board of Medical specialties were downloaded from the Accreditation Council for Graduate Medical Education (ACGME) website in 2015. A codebook was generated by in-depth reading of all milestone sets by two authors. Using a content analytic approach, milestones were then coded by a single author, with a 10% sample double-coded by another author. Descriptive statistics were used to characterize frequency counts.
RESULTS: Of 612 total milestones, 249 (40.7%) made mention of QI/PS. A median 10 milestones per specialty (interquartile range, 5.25-11.75) mentioned QI/PS. There were 446 individual references to QI, 423 references to PS, and another 1,065 references to QI/PS-related concepts, including patient-centered care, cost-effective practice, documentation, equity, handoffs and care transitions, and teamwork. QI/PS references reflected expectations about both individual-level practice (531/869, 61.1%) and practice within a healthcare system (338/869, 38.9%). QI and PS references were linked to all six ACGME core competencies.
CONCLUSIONS: Although there is variability in the emphasis placed on QI/PS across specialties, overall, QI/PS is reflected in more than 40% of residency milestones. Graduating residents in all specialties are expected to demonstrate competence in QI, PS, and multiple related concepts.

PMID: 29095169 [PubMed - as supplied by publisher]

Promoting Learning and Patient Care Through Shared Reflection: A Conceptual Framework for Team Reflexivity in Health Care.

tir, 31/10/2017 - 23:00
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Promoting Learning and Patient Care Through Shared Reflection: A Conceptual Framework for Team Reflexivity in Health Care.

Acad Med. 2017 Nov;92(11):1555-1563

Authors: Schmutz JB, Eppich WJ

Abstract
Health care teams are groups of highly skilled experts who may often form inexpert teams because of a lack of collective competence. Because teamwork and collaboration form the foundation of effective clinical practice, factors that promote collective competence demand exploration. The authors review team reflexivity (TR), a concept from the psychology and management literatures, and how it could contribute to the collective competence of health care teams. TR captures a team's ability to reflect collectively on group objectives, strategies, goals, processes, and outcomes of past, current, and future performance to process key information and adapt accordingly. As an overarching process that promotes team functioning, TR builds shared mental models as well as triggering team adaptation and learning.The authors present a conceptual framework for TR in health care, describing three phases in which TR may occur: pre-action TR (briefing before patient care), in-action TR (deliberations during active patient care), and post-action TR (debriefing after patient care). Depending on the phase, TR targets either goals, taskwork, teamwork, or resources and leads to different outcomes (e.g., optimal preparation, a shared mental model, adaptation, or learning). This novel conceptual framework incorporates various constructs related to reflection and unites them under the umbrella of TR. Viewing reflection through a team lens may guide future research about team functioning, optimize training efforts, and elucidate mechanisms for workplace learning, with better patient care as the ultimate goal.

PMID: 28445215 [PubMed - indexed for MEDLINE]

Concerns and Responses for Integrating Health Systems Science Into Medical Education.

lør, 28/10/2017 - 08:15
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Concerns and Responses for Integrating Health Systems Science Into Medical Education.

Acad Med. 2017 Oct 24;:

Authors: Gonzalo JD, Caverzagie KJ, Hawkins RE, Lawson L, Wolpaw DR, Chang A

Abstract
With the aim of improving the health of individuals and populations, medical schools are transforming curricula to ensure physician competence encompasses health systems science (HSS), which includes population health, health policy, high-value care, interprofessional teamwork, leadership, quality improvement, and patient safety. Large-scale, meaningful integration remains limited, however, and a major challenge in HSS curricular transformation efforts relates to the receptivity and engagement of students, educators, clinicians, scientists, and health system leaders. The authors identify several widely perceived challenges to integrating HSS into medical school curricula, respond to each concern, and provide potential strategies to address these concerns, based on their experiences designing and integrating HSS curricula. They identify two broad categories of concerns: the (1) relevance and importance of learning HSS-including the perception that there is inadequate urgency for change; HSS education is too complex and should occur in later years; early students would not be able to contribute, and the roles already exist; and the science is too nascent-and (2) logistics and practicality of teaching HSS-including limited curricular time, scarcity of faculty educators with expertise, lack of support from accreditation agencies and licensing boards, and unpreparedness of evolving health care systems to partner with schools with HSS curricula. The authors recommend the initiation and continuation of discussions between educators, clinicians, basic science faculty, health system leaders, and accrediting and regulatory bodies about the goals and priorities of medical education, as well as about the need to collaborate on new methods of education to reach these goals.

PMID: 29068816 [PubMed - as supplied by publisher]

Patient Safety Culture in Slovenian out-of-hours Primary Care Clinics.

ons, 25/10/2017 - 17:09
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Patient Safety Culture in Slovenian out-of-hours Primary Care Clinics.

Zdr Varst. 2017 Oct;56(4):203-210

Authors: Klemenc-Ketiš Z, Deilkås ET, Hofoss D, Bondevik GT

Abstract
INTRODUCTION: Patient safety culture is a concept which describes how leader and staff interaction, attitudes, routines and practices protect patients from adverse events in healthcare. We aimed to investigate patient safety culture in Slovenian out-of-hours health care (OOHC) clinics, and determine the possible factors that might be associated with it.
METHODS: This was a cross-sectional study, which took place in Slovenian OOHC, as part of the international study entitled Patient Safety Culture in European Out-of-Hours Services (SAFE-EUR-OOH). All the OOHC clinics in Slovenia (N=60) were invited to participate, and 37 agreed to do so; 438 employees from these clinics were invited to participate. We used the Slovenian version of the Safety Attitudes Questionnaire - an ambulatory version (SAQAV) to measure the climate of safety.
RESULTS: Out of 438 invited participants, 250 answered the questionnaire (57.1% response rate). The mean overall score ± standard deviation of the SAQ was 56.6±16.0 points, of Perceptions of Management 53.6±19.6 points, of Job Satisfaction 48.5±18.3 points, of Safety Climate 59.1±22.1 points, of Teamwork Climate 72.7±16.6, and of Communication 51.5±23.4 points. Employees working in the Ravne na Koroškem region, employees with variable work shifts, and those with full-time jobs scored significantly higher on the SAQ-AV.
CONCLUSION: The safety culture in Slovenian OOHC clinics needs improvement. The variations in the safety culture factor scores in Slovenian OOHC clinics point to the need to eliminate variations and improve working conditions in Slovenian OOHC clinics.

PMID: 29062394 [PubMed]

Can Teamwork and Situational Awareness (SA) in ED Resuscitations be Improved with a Technological Cognitive Aid? Design and a Pilot Study of a Team Situation Display.

lør, 21/10/2017 - 14:39
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Can Teamwork and Situational Awareness (SA) in ED Resuscitations be Improved with a Technological Cognitive Aid? Design and a Pilot Study of a Team Situation Display.

J Biomed Inform. 2017 Oct 16;:

Authors: Parush A, Mastoras G, Bhandari A, Momtahan K, Day K, Weitzman B, Sohmer B, Cwinn A, Hamstra SJ, Calder L

Abstract
Effective teamwork in ED resuscitations, including information sharing and situational awareness, could be degraded. Technological cognitive aids can facilitate effective teamwork.
OBJECTIVE: This study focused on the design of an ED situation display and pilot test its influence on teamwork and situational awareness during simulated resuscitation scenarios.
MATERIAL AND METHODS: The display design consisted of a central area showing the critical dynamic parameters of the interventions with an events time-line below it. Static information was placed at the sides of the display. We pilot tested whether the situation display could lead to higher scores on the Clinical Teamwork Scale (CTS), improved scores on a context-specific Situational Awareness Global Assessment Technique (SAGAT) tool, and team communication patterns that reflect teamwork and situational awareness.
RESULTS: Resuscitation teamwork, as measured by the CTS, was overall better with the presence of the situation display as compared with no situation display. Team members discussed interventions more with the situation display compared with not having the situation display. Situational awareness was better with the situation display only in the trauma scenario.
DISCUSSION: The situation display could be more effective for certain ED team members and in certain cases.
CONCLUSIONS: Overall, this pilot study implies that a situation display could facilitate better teamwork and team communication in the resuscitation event.

PMID: 29051106 [PubMed - as supplied by publisher]

Twelve tips for using applied improvisation in medical education.

søn, 15/10/2017 - 21:19
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Twelve tips for using applied improvisation in medical education.

Med Teach. 2017 Oct 12;:1-6

Authors: Hoffmann-Longtin K, Rossing JP, Weinstein E

Abstract
Future physicians will practice medicine in a more complex environment than ever, where skills of interpersonal communication, collaboration and adaptability to change are critical. Applied improvisation (or AI) is an instructional strategy which adapts the concepts of improvisational theater to teach these types of complex skills in other contexts. Unique to AI is its very active teaching approach, adapting theater games to help learners meet curricular objectives. In medical education, AI is particularly helpful when attempting to build students' comfort with and skills in complex, interpersonal behaviors such as effective listening, person-centeredness, teamwork and communication. This article draws on current evidence and the authors' experiences to present best practices for incorporating AI into teaching medicine. These practical tips help faculty new to AI get started by establishing goals, choosing appropriate games, understanding effective debriefing, considering evaluation strategies and managing resistance within the context of medical education.

PMID: 29025298 [PubMed - as supplied by publisher]

Barriers to Effective Teamwork Relating to Pediatric Resuscitations: Perceptions of Pediatric Emergency Medicine Staff.

ons, 11/10/2017 - 17:04

Barriers to Effective Teamwork Relating to Pediatric Resuscitations: Perceptions of Pediatric Emergency Medicine Staff.

Pediatr Emerg Care. 2017 Oct 09;:

Authors: Sherman JM, Chang TP, Ziv N, Nager AL

Abstract
BACKGROUND: In the pediatric emergency department (PED), resuscitations require medical teams form ad hoc, rarely communicating beforehand. Literature has shown that the medical community has deficiencies in communication and teamwork. However, we as medical providers do not know or understand the perceived barriers of our colleagues. Physicians may perceive a barrier that is different from nurses, respiratory therapists, pharmacists, or technicians. Perhaps we do not know in which area of teamwork and communication we are deficient. Only when we understand the perceptions of our fellow coworkers can we take steps toward improvement in quality resuscitations and therefore patient safety.
OBJECTIVE: The primary objectives of this study were to describe and understand the perceived barriers to effective communication and teamwork among different disciplines forming spontaneous resuscitation teams at a tertiary urban PED and to determine if providers of different disciplines perceived these barriers differently.
METHODS: This was a mixed-methods study conducted in a single, tertiary care freestanding children's hospital emergency department. Survey questions were iteratively developed to measure the construct of barriers and best practices within resuscitation teamwork, which was administered to staff among 5 selected roles: physicians, nurses, respiratory technicians, PED technicians, and PED pharmacists. It contained open-ended questions to provide statements on specific barriers or goals in effective teamwork, as well as a priority ranking on 25 different statements on teamwork extracted from the literature. From the participant data, 9 core themes related to resuscitation teamwork were coalesced using affinity diagramming by the authors. All statements from the survey were coded to the 9 core themes by 2 authors, with high reliability (κ = 0.93). Descriptive statistics were used to summarize the prevalence of themes mentioned by survey participants. A χ test was used to determine differences in prevalence of core themes by role. Rank data for the 25 statements were converted to a point system (5 points for most important, 4 points for second most important, etc), and a mixed within-between analysis of variance was used to determine the association of role and relative rank.
RESULTS: There were 125 respondents (62% response rate) who provided 893 coded statements. The core theme of communication-in particular, closed-loop communication-was the most prevalent theme, although no differences in the proportion of themes represented were seen by PED staff of different roles (P = 0.18). There was a significant effect from the core theme (P = 0.002, partial η = 0.13), with highest priority on team leader performance (mean points out of 5 = 2.5 ± 1.9), but neither effect nor interaction with role (P = 0.6, P = 0.7).
CONCLUSIONS: When answering open-ended questions regarding barriers to effective resuscitations, all disciplines perceived communication, particularly closed-loop communication, as the primary theme lacking during resuscitations. However, when choosing from a list of themes, all groups except physicians perceived deficiencies in team leader qualities to be the greatest barrier. We as physicians must work on improving our communication and leadership attributes if we want to improve the quality of our resuscitations.

PMID: 29016516 [PubMed - as supplied by publisher]

Examining participant perceptions of an interprofessional simulation-based trauma team training for medical and nursing students.

lør, 07/10/2017 - 23:47

Examining participant perceptions of an interprofessional simulation-based trauma team training for medical and nursing students.

J Interprof Care. 2017 Oct 06;:1-9

Authors: Jakobsen RB, Gran SF, Grimsmo B, Arntzen K, Fosse E, Frich JC, Hjortdahl P

Abstract
High quality care relies on interprofessional teamwork. We developed a short simulation-based course for final year medical, nursing and nursing anaesthesia students, using scenarios from emergency medicine. The aim of this paper is to describe the adaptation of an interprofessional simulation course in an undergraduate setting and to report participants' experiences with the course and students' learning outcomes. We evaluated the course collecting responses from students through questionnaires with both closed-ended and open-ended questions, supplemented by the facilitators' assessment of students' performance. Our data is based on responses from 310 students and 16 facilitators who contributed through three evaluation phases. In the analysis, we found that students reported emotional activation and learning outcomes within the domains self-insight and stress management, understanding of the leadership role, insight into teamwork, and skills in team communication. In subsequent questionnaire studies students reported having gained insights about communication, teamwork and leadership, and they believed they would be better leaders of teams and/or team members after having completed the course. Facilitators' observations suggested a progress in students' non-technical skills during the course. The facilitators observed that nursing anaesthesia students seemed to be more comfortable in finding their role in the team than the two other groups. In conclusion, we found that an interprofessional simulation-based emergency team training course with a focus on leadership, communication and teamwork, was feasible to run on a regular basis for large groups of students. The course improved the students' team skills and received a favourable evaluation from both students and faculty.

PMID: 28985089 [PubMed - as supplied by publisher]

The work is never ending: uncovering teamwork sustainability using realistic evaluation.

lør, 07/10/2017 - 23:47
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The work is never ending: uncovering teamwork sustainability using realistic evaluation.

J Health Organ Manag. 2017 Mar 20;31(1):64-81

Authors: Frykman M, von Thiele Schwarz U, Muntlin Athlin Å, Hasson H, Mazzocato P

Abstract
Purpose The purpose of this paper is to uncover the mechanisms influencing the sustainability of behavior changes following the implementation of teamwork. Design/methodology/approach Realistic evaluation was combined with a framework (DCOM®) based on applied behavior analysis to study the sustainability of behavior changes two and a half years after the initial implementation of teamwork at an emergency department. The DCOM® framework was used to categorize the mechanisms of behavior change interventions (BCIs) into the four categories of direction, competence, opportunity, and motivation. Non-participant observation and interview data were used. Findings The teamwork behaviors were not sustained. A substantial fallback in managerial activities in combination with a complex context contributed to reduced direction, opportunity, and motivation. Reduced direction made staff members unclear about how and why they should work in teams. Deterioration of opportunity was evident from the lack of problem-solving resources resulting in accumulated barriers to teamwork. Motivation in terms of management support and feedback was reduced. Practical implications The implementation of complex organizational changes in complex healthcare contexts requires continuous adaption and managerial activities well beyond the initial implementation period. Originality/value By integrating the DCOM® framework with realistic evaluation, this study responds to the call for theoretically based research on behavioral mechanisms that can explain how BCIs interact with context and how this interaction influences sustainability.

PMID: 28260412 [PubMed - indexed for MEDLINE]

The effects of interprofessional education - Self-reported professional competence among prehospital emergency care nursing students on the point of graduation - A cross-sectional study.

tir, 03/10/2017 - 17:33
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The effects of interprofessional education - Self-reported professional competence among prehospital emergency care nursing students on the point of graduation - A cross-sectional study.

Int Emerg Nurs. 2017 May;32:50-55

Authors: Castrèn M, Mäkinen M, Nilsson J, Lindström V

Abstract
The aim of the study was to investigate whether interprofessional education (IPE) and interprofessional collaboration (IPC) during the educational program had an impact on prehospital emergency care nurses' (PECN) self-reported competence towards the end of the study program. A cross-sectional study using the Nurse Professional Competence (NPC) Scale was conducted. A comparison was made between PECN students from Finland who experienced IPE and IPC in the clinical setting, and PECN students from Sweden with no IPE and a low level of IPC. Forty-one students participated (Finnish n=19, Swedish n=22). The self-reported competence was higher among the Swedish students. A statistically significant difference was found in one competence area; legislation in nursing and safety planning (p<0.01). The Finnish students scored significantly higher on items related to interprofessional teamwork. Both the Swedish and Finnish students' self-reported professional competence was relatively low according to the NPC Scale. Increasing IPC and IPE in combination with offering a higher academic degree may be an option when developing the ambulance service and the study program for PECNs.

PMID: 28325485 [PubMed - indexed for MEDLINE]

The organisation of physiotherapy for people with multiple sclerosis across Europe: a multicentre questionnaire survey.

tir, 19/09/2017 - 18:36
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The organisation of physiotherapy for people with multiple sclerosis across Europe: a multicentre questionnaire survey.

BMC Health Serv Res. 2016 Oct 06;16(1):552

Authors: Rasova K, Freeman J, Martinkova P, Pavlikova M, Cattaneo D, Jonsdottir J, Henze T, Baert I, Van Asch P, Santoyo C, Smedal T, Beiske AG, Stachowiak M, Kovalewski M, Nedeljkovic U, Bakalidou D, Guerreiro JM, Nilsagård Y, Dimitrova EN, Habek M, Armutlu K, Donzé C, Ross E, Ilie AM, Martić A, Romberg A, Feys P

Abstract
BACKGROUND: Understanding the organisational set-up of physiotherapy services across different countries is increasingly important as clinicians around the world use evidence to improve their practice. This also has to be taken into consideration when multi-centre international clinical trials are conducted. This survey aimed to systematically describe organisational aspects of physiotherapy services for people with multiple sclerosis (MS) across Europe.
METHODS: Representatives from 72 rehabilitation facilities within 23 European countries completed an online web-based questionnaire survey between 2013 and 2014. Countries were categorised according to four European regions (defined by United Nations Statistics). Similarities and differences between regions were examined.
RESULTS: Most participating centres specialized in rehabilitation (82 %) and neurology (60 %), with only 38 % specialising in MS. Of these, the Western based Specialist MS centres were predominately based on outpatient services (median MS inpatient ratio 0.14), whilst the Eastern based European services were mostly inpatient in nature (median MS inpatient ratio 0.5). In almost all participating countries, medical doctors - specialists in neurology (60 %) and in rehabilitation (64 %) - were responsible for referral to/prescription of physiotherapy. The most frequent reason for referral to/prescription of physiotherapy was the worsening of symptoms (78 % of centres). Physiotherapists were the most common members of the rehabilitation team; comprising 49 % of the team in Eastern countries compared to approximately 30 % in the rest of Europe. Teamwork was commonly adopted; 86 % of centres based in Western countries utilised the interdisciplinary model, whilst the multidisciplinary model was utilised in Eastern based countries (p = 0.046).
CONCLUSION: This survey is the first to provide data about organisational aspects of physiotherapy for people with MS across Europe. Overall, care in key organisational aspects of service provision is broadly similar across regions, although some variations, for example the models of teamwork utilised, are apparent. Organisational framework specifics should be considered anytime a multi-centre study is conducted and results from such studies are applied.

PMID: 27716390 [PubMed - indexed for MEDLINE]

Outcomes of adults with in-hospital cardiac arrest after implementation of the 2010 resuscitation guidelines.

søn, 17/09/2017 - 16:58
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Outcomes of adults with in-hospital cardiac arrest after implementation of the 2010 resuscitation guidelines.

Int J Cardiol. 2017 Sep 11;:

Authors: Wang CH, Huang CH, Chang WT, Tsai MS, Yu PH, Wu YW, Chen WJ

Abstract
BACKGROUND: The 2015 guidelines for cardiopulmonary resuscitation (CPR) are based on an update of the 2010 guidelines with minor revisions. It is important to assess the 2010 guidelines to ensure their efficacy, which may help promote widespread adoption of the 2015 guidelines.
METHODS: We conducted a retrospective observational study in a single center that evaluated patients with in-hospital cardiac arrest (IHCA) between 2006 and 2014. Multivariable logistic regression analysis was used to evaluate associations between independent variables and outcomes.
RESULTS: A total of 1525 patients were included. For patients with initial non-shockable rhythms, the elapsed time to first adrenaline injection was significantly shorter for patients who received CPR according to the 2010 guidelines (2010-CPR) than for those who were treated according to the 2005 guidelines (2005-CPR). During post-cardiac arrest care, the percentage of patients with fever was significantly lower and the implementation of critical interventions was significantly higher in patients who received 2010-CPR than in those who received 2005-CPR. After adjusting for the effects of confounding factors, patients who received 2010-CPR had improved neurological outcomes (odds ratio [OR], 1.75; 95% confidence interval [CI], 1.05-2.93; p=0.03) and survival (OR, 1.50; 95% CI, 1.06-2.12; p=0.02) at hospital discharge than patients who received 2005-CPR.
CONCLUSIONS: Hospital adoption of the 2010 guidelines may improve the neurological and survival outcomes for IHCA patients. This improvement might result from an emphasis on the importance of high-quality CPR, post-cardiac arrest care, and teamwork in the 2010 guidelines.

PMID: 28916353 [PubMed - as supplied by publisher]

Anaesthesiologists' simulation training during emergencies in obstetrics.

lør, 16/09/2017 - 15:41
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Anaesthesiologists' simulation training during emergencies in obstetrics.

Rom J Anaesth Intensive Care. 2017 Apr;24(1):37-40

Authors: Artyomenko VV, Nosenko VM

Abstract
BACKGROUND AND AIMS: Methods of simulation training and quality assessment during obstetric emergencies are still ambiguous. The aim of this study was to evaluate the effectiveness of anaesthesiologists' simulation training for emergency situations in obstetrics.
METHODS: We conducted a prospective, descriptive, and comparative study to evaluate the anaesthesiologists' simulation training effectiveness during obstetrical emergencies. Data of 109 obstetrical anaesthesiologists trained over two years for invasive procedures and cardiopulmonary resuscitation, high-fidelity scenarios and medical personnel teamwork included were analyzed. We used the two-sided t-test (p < 0.05 considered significant).
RESULTS: We noted during the fifth training sessions, the anaesthesiologists had a significant manipulation time decrease for all skills compared to the ones assessed during their first training session (p < 0.01). The 100-grade scale scores for all invasive techniques significantly improved during the anaesthesiologists' training (p < 0.01). Cardiopulmonary resuscitation effectiveness and team work also improved significantly during the fifth session (p < 0.01).
CONCLUSIONS: As a result of simulation training, significant improvement of speed and quality indicators, for invasive techniques in obstetrical emergency states treatment, was noted. For the fifth training sessions, there was a decrease in the practical skills execution time. The overall effectiveness and teamwork quality for cardiopulmonary resuscitation showed significant improvement.

PMID: 28913496 [PubMed]

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