
Helen HighamUniversity of Oxford | OX · Nuffield Department of Clinical Neurosciences
Helen Higham
Doctor of Philosophy
About
80
Publications
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Introduction
The OxSTaR research programme aims to improve the safety and quality of care in clinical settings. We are a group of researchers from diverse backgrounds including anaesthetics, intensive care medicine, psychology, ergonomics and education. Our work is mainly in healthcare systems research and the use of technology to enhance learning in multidisciplinary teams. We are based in the John Radcliffe hospital but are also integrated into the broader research community in Oxford.
Publications
Publications (80)
Objectives
Ultrasound-guided regional anesthesia (UGRA) relies on acquiring and interpreting an appropriate view of sonoanatomy. Artificial intelligence (AI) has the potential to aid this by applying a color overlay to key sonoanatomical structures.
The primary aim was to determine whether an AI-generated color overlay was associated with a differe...
Endotracheal intubation is a defining novice anaesthetic skill. Historical data suggests a 90% success rate requires a mean of 57 attempts 1. Studies of intubation learning are often small, single centre trials. Recent clinical practice has changed dramatically with the proliferation of video laryngoscopy during the COVID19 pandemic. Our prospectiv...
There is extensive evidence of diagnostic error in most healthcare specialities. It has been suggested that cognitive biases, such as overconfidence, are causally linked with these errors. This study aims to synthesise past work on diagnostic confidence to understand the factors that contribute to clinicians’ confidence in their diagnoses, as well...
Background: Postgraduate surgical training has evolved significantly, transitioning from traditional apprenticeship models to more structured competency-based programs. Despite these changes, concerns persist regarding the adequacy of technical skills (TS) training, exacerbated by modern challenges such as working time restrictions and the impact o...
Background
Healthcare systems are operating under substantial pressures. Clinicians and managers are constantly having to make adaptations, which are typically improvised, highly variable and not coordinated across teams. This study aimed to identify and describe the types of everyday pressures in intensive care and the adaptive strategies staff us...
Background
Obstetric training requires competence in both technical and non-technical skills (TS and NTS). Traditionally the acquisition of these skills is dependent on experience more than formal teaching. Simulation training can be an opportunity to bridge this gap in a safe environment. This study explores the impact of merging TS and NTS simula...
Background
Artificial intelligence (AI) for ultrasound scanning in regional anaesthesia is a rapidly developing interdisciplinary field. There is a risk that work could be undertaken in parallel by different elements of the community but with a lack of knowledge transfer between disciplines, leading to repetition and diverging methodologies. This s...
Background
Healthcare systems are operating under substantial pressures, and often simply cannot provide the standard of care they aspire to within the available resources. Organisations, managers, and individual clinicians make constant adaptations in response to these pressures, which are typically improvised, highly variable and not coordinated...
Aims
The influence of human factors on safety in healthcare settings is well established, with targeted interventions reducing risk and enhancing team performance. In experimental and early phase clinical research participant safety is paramount and safeguarded by guidelines, protocolized care and staff training; however, the real‐world interaction...
The COVID-19 pandemic has undoubtedly served as a catalyst for adaptation of effective delivery of medical education, paving the way for the adoption of novel teaching methods [1]. Simulation based education (SBE) has been no exception, with increased delivery of SBE through immersive, virtual mediums such as head mounted displays (HMD) to create a...
GP teams manage a wide spectrum of acutely unwell and deteriorating patients, these are unexpected, high risk, low frequency events. Ambulance delays mean patients may need prolonged input prior to transfer. There is little best practice guidance for many emergencies seen in primary care. Evidence from secondary care shows improved non-technical sk...
BACKGROUND
Ultrasound is the most common form of guidance for regional anaesthesia. There is increasing interest in developing supporting technology, particularly in the form of artificial intelligence (AI), to aid in the acquisition and interpretation of optimal ultrasound views for these procedures. However, this is a broad field, with academia,...
Background
Non-technical skills (NTS) assessment tools are widely used to provide formative and summative assessment for healthcare professionals and there are now many of them. This study has examined three different tools designed for similar settings and gathered evidence to test their validity and usability.
Methods
Three NTS assessment tools...
Clinical emergencies can be defined as unpredictable events that necessitate immediate intervention. Safety critical industries have acknowledged the difficulties of responding to such crises. Strategies to improve human performance and mitigate its limitations include the provision and use of cognitive aids, a family of tools that includes algorit...
Doctors joining Emergency Departments (ED) have individual training needs based on their experience and background of working in different countries or hospitals, and a large proportion of junior doctors work for less than a year in a single ED. We designed the AWARE project to analyse the challenges associated with familiarity with the physical wo...
Background
Ultrasound-guided regional anaesthesia relies on the visualisation of key landmark, target, and safety structures on ultrasound. However, this can be challenging, particularly for inexperienced practitioners. Artificial intelligence (AI) is increasingly being applied to medical image interpretation, including ultrasound. In this explorat...
Background
Non-technical skills (NTS) assessment tools are widely used to provide formative and summative assessment for healthcare professionals and there are now many of them. This study has examined three different tools designed for similar settings and gathered evidence to test their validity and usability.
Methods
Three NTS assessment tools...
Background
Ultrasonound is used to identify anatomical structures during regional anaesthesia and to guide needle insertion and injection of local anaesthetic. ScanNav Anatomy Peripheral Nerve Block (Intelligent Ultrasound, Cardiff, UK) is an artificial intelligence-based device that produces a colour overlay on real-time B-mode ultrasound to highl...
The Medical Students’ Non-Technical Skills (Medi-StuNTS) is a behavioural marker scheme (BMS) designed to assess non-technical skills (NTS) in medical students in emergency simulations. This study aimed to assess the evidence for validity and usability of Medi-StuNTS by naive, near-peer educators. Nine doctors assessed four students in simulations...
Ultrasound-guided regional anaesthesia (UGRA) involves the targeted deposition of local anaesthesia to inhibit the function of peripheral nerves. Ultrasound allows the visualisation of nerves and the surrounding structures, to guide needle insertion to a perineural or fascial plane end point for injection. However, it is challenging to develop the...
Introduction:
Ultrasound-guided regional anesthesia (UGRA) involves the acquisition and interpretation of ultrasound images to delineate sonoanatomy. This study explores the utility of a novel artificial intelligence (AI) device designed to assist in this task (ScanNav Anatomy Peripheral Nerve Block; ScanNav), which applies a color overlay on real...
William Osler was the first to be credited with taking medical students out of the lecture theatre and to the bedside
Could VRS provide a meaningful learning opportunity during the first wave? Could we elicit the strengths and weaknesses of virtual simulation in medical learning?
We used the Oxford Medical Simulation (oxfordmedicalsimulation.com) V...
Immersive virtual reality (VR) has exciting potential as a training tool, providing opportunities for more independent learning, easier access and repeatability, and fewer cost implications
Use mixed methods to analyse the differences in confidence and competence in clinical decision-making between medical students trained using either VR or SimS s...
The COVID-19 pandemic presented healthcare workers with a challenge to provide safe clinical care while protecting staff and coping with an evolving situation. The use of simulation to devise and test emergency pathways is well recognized in the literature
Recognizing the need to develop a safe pathway, with a limited evidence base, we sought to te...
Integrating virtual reality simulation into a paediatric medical undergraduate curriculum
Background and Aims
Ultrasound-guided regional anaesthesia (UGRA) involves the acquisition and interpretation of ultrasound images. This pilot study explores the utility of an artificial intelligence (AI) device, which highlights key sono-anatomical structures with a real-time colour overlay.
Methods
With ethical approval, 30 anaesthetists collect...
This chapter introduces the topic of error as an essential foundation for an understanding of patient safety. We introduce psychological classifications of error and then, using clinical examples, show how we can use these ideas to understand how errors occur and how chains of small errors can combine to cause harm to patients. We outline a practic...
There is no universally agreed set of anatomical structures
that must be identified on ultrasound for the performance of
ultrasound-guided regional anesthesia (UGRA) techniques.
This study aimed to produce standardized recommendations
for core (minimum) structures to identify during seven basic
blocks. An international consensus was sought thr...
Background:
The Partners at Care Transitions Measure (PACT-M) is a patient-reported questionnaire for evaluation of the quality and safety of care transitions from hospital to home, as experienced by older adults. PACT-M has two components; PACT-M 1 to capture the immediate post discharge period and PACT-M 2 to assess the experience of managing ca...
Background
GP practices have limited access to medical emergency training and basic life support is often taught out of context as a skills-based event.
Aim
To develop and evaluate a whole team integrated simulation-based education, to enhance learning, change behaviours and provide safer care.
Method
Phase 1: 10 practices piloted a 3-hour progra...
This review will present developments in simulation-based education (SBE) over the past decade with a focus on activity in the UK’s National Health Service and the role of the national society (the Association for Simulation Practice in Healthcare). The article covers the evolution of strategic changes for the use of SBE in the UK and the operation...
Background
At any moment approximately one in ten doctors in training are taking approved time out of their programme. Returning to training after a break from clinical work can be daunting, with many trainees expressing anxiety about readjusting to the workplace. Recognising this, the Department of Health allocated £10 million nationally to Health...
Background
Simulation is a well-established and effective tool for medical education¹. It provides sophisticated representations of real-world clinical scenarios, for immersive learning. At the technological frontier is virtual reality simulation (VRS), which involves an interactive, three-dimensional, computer-generated space. Whilst the medical c...
Background
Evidence suggests that GPs are managing more acutely unwell patients in their practices.¹ The RCGP curriculum for the care of acutely ill people includes:
• Recognising the signs of illness that require urgent intervention
• acting calmly in emergency situations and following agreed protocols
• working effectively in teams
Simulation b...
Introduction
Over the years, teaching methodology in clinical medicine has attempted to keep pace with rapidly changing technological advances. The next wave of technology is virtual reality simulation (VRS). VRS is a three-dimensional, computer-generated environment where users interact with virtual surroundings offering the opportunity for real-l...
Background
Simulation training is an increasingly utilised tool in medical and nursing student education, leading to demand for skilled faculty to assist in scenarios and run debriefs. At our centre, a large pool of junior doctors are enthusiastic contributors to the faculty of regular training sessions. However, this group frequently has limited e...
Background:
The transition of older patients (over 65 years of age) from hospital to their own home is a time when patients are at high risk. No measure currently exists to assess the experience, quality and safety of care transitions relevant to UK population. We aim to describe the development and initial testing of the Partners at Care Transiti...
Background
Over the past three decades multiple tools have been developed for the assessment of non-technical skills (NTS) in healthcare. This study was designed primarily to analyse how they have been designed and tested but also to consider guidance on how to select them.
Objectives
To analyse the context of use, method of development, evidence...
We discuss the deficiencies of current NHS patient safety investigation and specifically the need for independence and Human Factors training. We describe the theory behind a regional network approach to improving the quality of investigations, and the development of a pilot study. We report outcomes from the first three investigations and the lear...
We discuss the deficiencies of current NHS patient safety investigation and specifically the need for independence and Human Factors training. We describe the theory behind a regional network approach to improving the quality of investigations, and the development of a pilot study. We report outcomes from the first three investigations and the lear...
Background
Situation Awareness (SA) is an essential cognitive skill for the safe management of patients in rapidly changing environments such as the Intensive Care Unit (ICU).The Situation Awareness Global Assessment Tool (SAGAT) was designed for the objective measurement of SA in military pilots and requires a Goal Directed Task Analysis (GDTA) to...
Introduction:
Methods to improve clinical systems safety suffer from significant difficulties in implementation and scaling up. We used an upscaling implementation strategy entitled Supported Champions in a quality and safety improvement programme for emergency surgery at regional level, focusing on patients with right iliac fossa pain.
Methods:...
Human beings who work in complex, dynamic, and stressful situations make mistakes. This is as true for anaesthetists as for any other health-care professional, but we face unique challenges in the many roles and responsibilities we have in diverse clinical contexts. As a profession, we are well versed in the development and utilization of improveme...
Background. The variability in risk tolerance in medicine is not well understood. Parallels are often drawn between aviation and anaesthesia. The aviation industry is perceived as culturally risk averse, and part of preflight checks involves a decision on whether the flight can operate. This is sometimes termed a go/no-go decision. This questionnai...
Once considered to confer cardiac protection, perioperative betablockade is now regarded as potentially harmful as reduction of cardiac complications is associated with increased all-cause mortality and increased risk of strokes. Over the past decades relatively small studies were not powered enough to detect relatively rare complications, thus all...
The surgical training program in the Kingdom of Saudi Arabia (KSA) is still evolving. In order to improve future programs, we conducted a study of trainees' perspectives to explore their views on the value of simulation and the perception of non-technical skills developed during the current training program.
The structural survey was distributed am...
It is well recognised that a significant proportion of errors involving trainee doctors result from failures of non-technical skills (NTS),1 which occur at least as frequently as knowledge and technical errors.2 Regardless of background, all trainees need generic skills of leadership, decision-making, team-working and resource management.3 It might...
Background The clinical environment has been described as an ‘ergonomic nightmare’,1 in part because equipment is poorly standardised across institutions. A survey conducted locally found in excess of 40 different display layouts in anaesthetic and critical-care monitors alone. Monitor layouts were not even standardised within individual theatre su...
Background Situational awareness is a ‘safety-critical’ skill in medicine,1 but attentional focus narrows as individuals concentrate on tasks. Missing an event that would otherwise appear obvious is termed a perceptual error. Individuals greatly overestimate their perceptual reliability.2
These forms of perceptual failure are well recognised in psy...
Background The increasing ubiquity of ‘smart’ devices opens up new possibilities for presenting data. Technology-enhanced learning is a rapidly evolving field, and much progress is made by finding new use for audio-visual technology. Some of these innovations can be difficult to communicate adequately in the traditional paper-based format required...
Introduction
Attentional focus narrows as individuals concentrate on tasks. Missing an event that would otherwise appear obvious is termed a perceptual error. These forms of perceptual failure are well-recognised in psychological literature, but little attention has been paid to them in medicine. Cognitive workload and expertise modulate risk, alth...
Simulation training involves reproducing the management of real patients in a risk-free environment. This study aims to assess the use of simulation training in the management of acutely ill patients for those in second year oral and maxillofacial surgery dental foundation training (DF2s). DF2s attended four full day courses on the recognition and...
In recent years our understanding of molecular mechanisms of drug action and interindividual variability in drug response has grown enormously. Meanwhile, the practice of anesthesiology has expanded to the preoperative environment and numerous locations outside the OR. Anesthetic Pharmacology: Basic Principles and Clinical Practice, 2nd edition, is...
BACKGROUND:The effect of carotid endarterectomy in lowering the risk of stroke ipsilateral to severe atherosclerotic carotid-artery stenosis is offset by complications during or soon after surgery. We compared surgery under general anaesthesia with that under local anaesthesia because prediction and avoidance of perioperative strokes might be easie...
We have previously demonstrated that the peri-operative measurement of increased serum concentrations of the cardiac markers troponins I and T and creatine kinase-MB can be predictors of major cardiovascular outcomes (including cardiac death) at 3 months after surgery. In the present study, we have followed the postoperative course of 157 patients...
The elderly patient may show normal physiological changes of the cardiovascular and respiratory systems that accompany aging, as well as features of intrinsic cardiac disease. The latter include: a past history of myocardial infarction or ischaemic heart disease; history of congestive cardiac failure; angina; arterial hypertension (BP >140/90mm Hg)...
Two hundred and seventy-five non-cardiac surgical patients were recruited to determine risk factors associated with the development of postoperative cardiovascular complications during the first year after surgery. Patients underwent ambulatory electrocardiography pre- and postoperatively. There were 34 adverse events over the whole study period. T...
Editor—Rodgers et al report a meta-analysis of 141 trials comparing general anaesthesia with neuraxial blocks.1 They conclude that their data should result in more widespread use of spinal or epidural anaesthesia. The challenge for clinicians is deciding which of their patients (if any) these results apply to, but Rodgers et al provided little info...
Although hypothermia is widely used to protect the brain during cardiac and neurologic surgery, the optimal level of cooling has not been established. This study examined the protective effect of graded levels of surface cooling on cerebral function in rats after complete global cerebral ischemia.
Groups of ketamine-anesthetized rats (13 animals in...