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The human factor: The critical importance of effective teamwork and communication in providing safe patient care
Abstract
................ ................ ................ ................ ................ ................ ................ ............... Effective communication and teamwork is essential for the delivery of high quality, safe patient care. Communication failures are an extremely common cause of inadvertent patient harm. The complexity of medical care, coupled with the inherent limitations of human performance, make it critically important that clinicians have standardised communication tools, create an environment in which individuals can speak up and express concerns, and share common ‘‘critical language’’ to alert team members to unsafe situations. All too frequently, effective communication is situation or personality dependent. Other high reliability domains, such as commercial aviation, have shown that the adoption of standardised tools and behaviours is a very effective strategy in enhancing teamwork and reducing risk. We describe our ongoing patient safety implementation using this approach within Kaiser Permanente, a non-profit American healthcare system providing care for 8.3 million patients. We describe specific clinical experience in the application of surgical briefings, properties of high reliability perinatal care, the value of critical event training and simulation, and benefits of a standardised communication process in the care of patients transferred from hospitals to skilled nursing facilities. Additionally, lessons learned as to effective techniques in achieving cultural change, evidence of improving the quality of the work environment, practice transfer strategies, critical success factors, and the evolving methods of demonstrating the benefit of such work are described.
... Communication and human errors are common sources of unfavourable clinical outcomes and management in emergency cases [1][2][3][4][5][6]. Acute arterial bleeding is associated with high mortality but can be treated effectively by interventional radiology utilizing embolization techniques [7]. ...
... Interventional radiology often is confronted with acute and life-threatening conditions requiring immediate treatment. Besides the logistical challenges to the interventionalist and the patient, as well as other supporting specialties such as technicians and anaesthesiologists, effective communication structures are crucial [4,6,9,11]. Nevertheless, publications about effective and standardized communication structures for activation algorithms in interventional radiology are unavailable. ...
Background
Research of interventional treatment success in arterial bleeding cases is almost exclusively focused on technical and procedural factors. This study investigates the effect of an improved preprocedural activation algorithm for acute arterial bleedings treated by interventional radiology.
Methods
During the three-year study period (2018–2021), the authors implemented an always-reachable, simple-to-remember emergency phone number routed to the responsible interventional radiologist on call and compared this pathway to the previous activation process. Data were acquired for all emergency cases with active arterial bleeding detected in CT scans and the diagnosis to treatment intervals before and after implementation were retrospectively analysed. Time signatures in CT and angiography were used to determine the interval.
Results
1322 calls or contacts occurred during the study period. In general, 625 emergency procedures were conducted; 120 bleeding interventions met the study requirements. In the study 44 patients were treated via the conventional pathway and 76 via the emergency phone activation. The activation algorithm utilizing the emergency phone led to a slight decrease in radiation doses and fluoroscopy time and a significant reduction (15min) in diagnosis to treatment intervals (p = 0.019). After implementing the emergency phone, the technical success rate increased significantly from 68% to 94% (p<0.001).
Conclusions
This study shows that effective communication structures, such as implementing a standardized activation pathway via an emergency phone, can significantly reduce diagnosis to treatment intervals and increase technical success rates. Effective communication is crucial for interventional radiology to deal with acute and life-threatening conditions requiring immediate treatment. This study presents a possible improvement and provides valuable insight for interventional radiology clinics seeking to optimize their communication and management strategies for emergency cases.
... Thus, the training of health professionals must focus mainly on improving quality of care by integrating scientific and technical advances in both initial and ongoing programs. 1,2 Therefore, as the goal of health sciences education programs is to impart the knowledge, skills, and attitudes necessary for students to become competent healthcare professionals, they must necessarily benefit from high-quality training, helping them to harmoniously structure their acquired knowledge and guarantee professionalism. 3 Advances in Medical Education and Practice 2024: 15 1093-1102 In this respect, as recommended by the World Health Organization (WHO), nurse educators have responded by incorporating simulation-based learning experiences. ...
Purpose
Clinical simulation is a recent and now most used educational approach in health training programs. Its use for educational purposes in nursing education has gradually become widespread throughout the world. The aim of this study was to assess students’ satisfaction and self-confidence with simulation-based learning and to identify the association of simulation design characteristics and educational practices with those outcomes.
Subjects and methods
This study utilized a correlational cross-sectional research design. Using a convenience sample, 110 nursing students were selected. Data were collected based on a questionnaire involving three instruments: the Simulation Design Scale, Educational Practices in Simulation Scale, and Student Satisfaction and Self-Confidence in Learning Scale. Data were analysed using SPSS software, version 26.0. Pearson’s correlation coefficients was determined to describe and test the relationships between the different variables.
Results
Nursing students were mostly satisfied with their simulation-based learning activity and felt self-confident: M=21/25 and M=33.8/40, respectively. For simulation design characteristics, only “Support“was correlated with student satisfaction (r = 0.468, p = 0.000) and it was the factor most correlated with students’ self-confidence levels (r = 0.477, p = 0.000). Furthermore, there were significant correlations between all educational practices and student satisfaction/self-confidence in learning, at a level of p < 0.01. “Diverse ways of learning” was the factor most correlated with student satisfaction (r = 0.858, p = 0.000) and student self-confidence levels (r = 0.738, p = 0.000).
Conclusion
The current study’s findings show that consideration of simulation design elements and the features of all educational practices is necessary for the development of a successful simulation experience and the improvement of student satisfaction and self‐confidence.
... Effective communication is crucial in healthcare, with numerous studies demonstrating its positive impact on professional responsibility (Amon, 2002;Leonard et al., 2004), healthcare outcomes (Ong et al., 1995;Stewart, 1995), and doctor-patient interactions (Jiang et al., 2020;Miller & DiMatteo, 2020). One of the primary challenges to effective communication in healthcare is the growing influx of international students enrolling in medical schools around the world. ...
Background
The present study aims to investigate the impact of open and closed tasks on the intrinsic motivation and language learning competence of international students enrolled at UM, following the medical Dutch course. The students look forward to improving their academic-Dutch second language in the field of Medicine. We hypothesize that the students learning with open learning tasks will outperform students learning with the closed learning task on both intrinsic motivation and Medical Dutch competence.
Methods
A mixed-methods pre-post quasi experimental study was conducted with 15 Dutch medical students in two intact groups (open task: n = 7; closed task: n = 8). To measure the main constructs, we combined intrinsic motivation to experience stimulation scale (IMES), need for competence scale (NCS) with self- & peer-assessed rubrics or checklists and individual semi-structured interviews. We subsequently subjected the quantitative data to a normalized gain score analysis and applied Mann-Whitney U test. The qualitative data thematic analysis was conducted to compare the groups.
Results
IMES for second language learning was found higher in the open-task group. The open-task group demonstrated a higher level of competence based on the results of both NCS and self- and peer assessments. The interviews uncovered three themes in learning medical L2 that supported the quantitative findings: learning expectations, contentment with learning, and perceived learning improvement.
Conclusions
Compared to closed tasks, open tasks increased intrinsic motivation for learning Dutch as a second language (L2) in medical consultations. Yet, students reported higher difficulties in learning L2 as well as higher competence growth compared to the closed task. Hence, by requiring more self-reflection and creativity while positively affecting competency development, the open tasks seemed to create a desirable difficulty. Future research should incorporate more objective data on student learning and performance.
... Step 3: In the third step, an open-source network analysis software Gephi will be used to visualize the semantic networks (Leonard et al. 2004). Given the corpora's large size, the top 100 words by frequency will be included in the network visualization. ...
In the evolving landscape of digital education, the metaverse emerges as a revolutionary platform, particularly within the realm of tourism, viewed through the lens of lifelong learning. This study delves into the integration of the metaverse in the tourism and education sectors in China, aiming to uncover the intricate dynamics of public perceptions and the educational potential of this digital innovation. This research utilizes semantic network and sentiment analysis of social media discussions on China’s Weibo platform to provide a detailed understanding of sentiments toward the metaverse’s impact on tourism education. Semantic Network Analysis explores the complex dialog surrounding the metaverse in the context of lifelong learning. The findings reveal a balanced mix of enthusiasm for the immersive educational opportunities afforded by the metaverse and concerns regarding data privacy, digital addiction, and ethical considerations. It is evident from this duality that a balanced approach is necessary when the metaverse is integrated into tourism and learning while being sensitive to technological opportunities and ethical challenges. The metaverse could be an immersive, interactive learning environment endorsed by modern educational theories, supporting active learning through experience. The metaverse will provide valuable assistance to tourism education, which will help enhance this field through the simulation of real tourism for students to learn, which will foster cultural understanding and meet the demands of a globalized tourism industry. It further recommends that policies and practices should be formulated to ensure equal access, respect for the privacy of every participant, and the ethical use of the technology. This study contributes to the analysis of the potentials and challenges of the metaverse in the tourism and learning industry. It highlights the metaverse as an ‘emerging tool for lifelong learning’ and offers insights into how educators, policymakers, and industry leaders, all aiming at the integration of digital innovations in education, should exploit the metaverse.
... In such learning contexts, students are required to engage actively with one another and make use of both physical and digital resources to accomplish a collective objective (Ioannou et al., 2019). This method of learning is particularly valued within high-stakes fields such as healthcare education, where it maintains ecological validity and simultaneously mitigates the exposure of students to potential risks (Leonard et al., 2004). Drawing from the principles of embodied cognition theory, it is understood that the affective and cognitive states of students (for example, levels of stress) play a crucial role in shaping their learning experiences during ECL, as these experiences are influenced by the bodily responses to diverse stimuli (Ferreira, 2021). ...
Physiological synchrony and arousal are increasingly utilised to understand students' affective and cognitive states, such as stress, which can influence their learning performance and satisfaction in collaborative settings. However, it remains uncertain whether these physiological indicators can meaningfully reflect students' stress and learning performance during embodied collaborative learning (ECL). With advancements in sensing technologies, AI, and multimodal learning analytics (MMLA), it is now possible to model learners' affective and physiological states in such dynamic and physically active settings. This study investigates the role of physiological synchrony and arousal as indicators of stress and learning performance in ECL using a mixed-method approach. We first developed two linear mixed models using heart rate and survey data from 172 students participating in collaborative high-fidelity nursing simulations. The findings were then presented to educators to gain insights into their interpretation of the current findings on the relationship between students' physiological responses and their learning performance. Results indicate that physiological synchrony is a significant indicator of students' perceived stress and collaboration performance, while physiological arousal is a significant indicator of task performance, even after accounting for individual and group differences. Educators confirmed that these findings align with their assumptions about the relationships between students' physiological responses and their performance, validating the ecological validity of the results. They also expressed interest in using these insights to refine simulation activities and enhance reflective practices. These findings provide empirical evidence to support the development of context-aware analytic tools using AI and MMLA to enhance collaborative learning.
... TPB argues that the more favorable individuals' attitudes and subjective norms toward behavior, the greater their PBC, and the stronger their intention to act [30]. Firstly, attitudes involve an individual's evaluation of a behavior's good or bad, thus informing their decision to engage in it [36]. In the environmental domain, attitudes are conceptualized as cognitive and affective assessments of environmental protection objects [37]. ...
Pro-environmental behavior (PEB) is an essential source for solving environmental problems and implementing sustainable development. This study reveals the antecedent mechanisms of PEB from the joint perspective of environmental policy perception (EPP) and social media use (SMU). We developed a moderated mediation model based on the theory of planned behavior (TPB) and tested the hypotheses using questionnaire data from 408 residents in Tianjin, China. The results indicated that EPP positively affects PEB and that attitude and perceived behavioral control in the TPB framework mediate the relationship between EPP and PEB. SMU not only has a positive effect on PEB but also remotely mediates the effect of EPP on PEB together with perceived behavioral control. Furthermore, gender and age have a positive moderating impact on EPP. This study provides the first theoretical and empirical explanation of how EPP influences PEB within a systematic TPB framework while also introducing SMU as an innovative expansion of the explanatory model. This study also provides recommendations for policymakers on environmental management practices.
... These results underscore the need for interprofessional education, clear communication protocols, and standardized documentation practices to enhance communication and reduce the risk of errors. The importance of these factors is supported by Leonard et al.'s comprehensive examination of human factors in patient safety, which reinforces the idea that effective teamwork and communication are essential for minimizing errors and improving the quality of care [18]. ...
Background: Errors are a common occurrence in all healthcare settings, and the safety of patients is a critical concern that involves multiple factors, including the complex and demanding nature of nursing practice. Nurses, due to their continuous and direct patient care, play a pivotal role in ensuring patient safety. This cross-sectional study aimed to investigate the factors that contribute to errors from the perspectives of nurses in Greek hospitals, with a focus on understanding the challenges they face in their daily practice. Methods: Clinical nurses willingly and anonymously filled out a specific structured questionnaire, the Taxonomy of Error, Root Cause Analysis, and Practice-responsibility (TERCAP) tool that describes the conditions under which an error during clinical practice occurred. The study method included convenience sampling. After obtaining permission, questionnaires were distributed to hospital departments. To accommodate pandemic-related restrictions, an electronic version of the questionnaire was also created for distribution and collection. Analysis of data was accomplished via SPSS 26.0. Results: Five hundred and ninety-seven clinical nurses participated anonymously, reporting errors in almost seven out of ten cases, often attributing them to high workload and staff shortages. Errors were commonly reported during different shifts in this study. Factors such as assigning significant responsibilities to inexperienced staff and inadequate implementation guidelines were highlighted. Conclusions: The in-depth study of nursing errors provides a nuanced understanding of their causes by categorizing them based on various factors. It emphasizes the complexity of challenges and the need to integrate systemic, clinical, and individual factors into intervention strategies, including medication protocols, ongoing training, clear communication, administrative support, and fostering an open communication culture.
... Medical personnel can be trained to use the clear information provided in our acronym. The use of standardized tools can balance communication styles among different healthcare professionals and minimize critical intervention response times, such as ECPR [33][34][35]. ...
The acronym CALL TO ECLS has been proposed as a potential tool to support decision-making in critical communication moments when qualifying a patient for the ECPR procedure. The aim of this study is to assess the accuracy of the acronym and validate its content. Validation is crucial to ensure that the acronym is theoretically correct and includes the necessary information that must be conveyed by EMS during the qualification of a patient with out-of-hospital cardiac arrest for ECMO. A survey was conducted using the LimeSurvey platform through the Survey Research System of the Jagiellonian University Medical College over a 6-month period (from December 2022 to May 2023). Usefulness, importance, clarity, and unambiguity were rated on a 4-point Likert scale, from 1 (not useful, not important, unclear, ambiguous) to 4 (useful, important, clear, unambiguous). On the 4-point scale, the Content Validity Index (I-CVI) was calculated as the percentage of subject matter experts who rated the criterion as having a level of importance/clarity/validity/uniqueness of 3 or 4. The Scale-level Content Validity Index (S-CVI) based on the average method was computed as the average of I-CVI scores (S-CVI-AVE) for all considered criteria (protocol). The number of fully completed surveys by experts was 35, and partial completion was obtained in 63 cases. All criteria were deemed significant/useful, with I-CVI coefficients ranging from 0.87 to 0.97. Similarly, the importance of all criteria was confirmed, as all I-CVI coefficients were greater than 0.78 (ranging from 0.83 to 0.97). The average I-CVI score for the ten considered criteria in terms of usefulness/significance and importance exceeded 0.9, indicating high validity of the tool/protocol/acronym. Based on the survey results and analysis of responses provided by experts, a second version was created, incorporating additional explanations. In Criterion 10, an explanation was added—“Signs of life”—during conventional cardiopulmonary resuscitation (ROSC, motor response during CPR). It has been shown that the acronym CALL TO ECLS, according to experts, is accurate and contains the necessary content, and can serve as a system to facilitate communication between the pre-hospital environment and specialized units responsible for qualifying patients for the ECPR.
... A descriptive strategy was employed in this conversation (Leonard et al., 2004). The descriptive approach will clarify how improving patient safety through the application of health and safety at work will lower the likelihood of nursing interventions (Kirwan et al., 2013). ...
Background: Ensuring occupational safety and health in nursing procedures is essential to mitigate risks for both nurses and patients. Adhering to protocols and implementing patient safety targets are crucial for error prevention.Method: This descriptive study correlates occupational safety measures with error reduction in nursing procedures. Patient safety targets are analyzed for their impact on nurse performance and patient outcomes.Result Innovation: Implementation of six patient safety targets enhances nurse adherence to procedures, reducing errors and promoting patient safety. Effective communication and oversight of medication administration are highlighted as key factors.Conclusion: Prioritizing nurse safety through occupational safety measures improves patient care quality by minimizing errors. Professionalism and positive attitudes among nurses contribute significantly to error prevention and overall safety.Implications and Theory: Effective implementation of occupational safety measures not only safeguards nurses' well-being but also enhances patient care outcomes. The findings underscore the importance of proactive safety measures and positive attitudes in nursing practice.
... Previous research has also shown that individual silence can lead to adverse performance-related outcomes. For instance, in healthcare, silence and communication breakdowns have been associated with increased medical errors and negative patient outcomes (Greenberg et al., 2007;Kohn et al., 2000;Leonard et al., 2004). In aviation, the failure to share vital information among crew members has been identified as a significant factor in poor decision-making, adversely affecting safety and causing accidents (Bienefeld & Grote, 2012;Helmreich, 1994). ...
Team performance can be eroded or undermined when team members intentionally withhold information, such as suggestions for improvements, or concerns about issues that matter for the team. Yet, we know very little about whether silence in teams (team silence) in fact reduces team performance, and if it does, how team silence might be ameliorated. Grounded in social information processing (SIP) theory, we hypothesize and investigate the role of leaders as a potent social informational source to reduce team silence and in turn, enhance team performance. We further posit the role of team commitment to the organization as an important amplifier of humble leadership in reducing team silence. Across a programmatic series of five empirical studies involving experimental, multisource, and multiwave field data, we found support for the negative relationship between leader humility and team silence. Team silence also mediated the relationship between leader humility and team performance in a variety of work contexts. Findings supported that the benefits of leader humility were amplified in teams with higher levels of organizational commitment. Overall, this paper contributes new theoretical and practical insights by identifying leader humility as a preventative antecedent to team silence, with team commitment to the organization as an important qualifier of the impact of humble leadership on teams.
... Final year nursing students took part in four medical-surgical virtual simulation cases and the 3D Model of Debriefing ( Zigmont, Kappus, & Sudikoff, 2011 ) over two days ( Fung et al., 2021 ). Stuart et al. (2021) developed their own virtual simulation scenario as a prerecorded video delivered online to senior-level nursing students in an advanced medical-surgical course to practice the SBAR (situation, background, assessment, recommendation) communication technique ( Leonard, Graham, & Bonacum, 2004 ). All four of the above studies used avatarbased simulation experiences. ...
Background: The COVID-19 pandemic forced nursing education institutions to abruptly shift away from traditional in-person learning and find alternative approaches to fulfill program requirements. This integrative review explores the various innovative and restructured simulation strategies used by undergraduate nursing programs for lab and clinical courses in response to the pandemic. Methods: Whittemore and Knafl's (2005) five-step framework guided this review. A systematic search of six academic databases and quality appraisal using the Mixed Methods Appraisal Tool yielded 10 studies for the review. Results: Strategies identified primarily employed virtual simulation methods using avatars or real people. Additional approaches included flipcharts and simulation-based flipped classrooms. Key themes pertaining to language and culture, immersion, facilitation and skills emerged. Conclusion: Virtual simulation was a valuable tool during the pandemic, though not without challenges. Future implications are discussed. This review highlights the need for standardized terminology and considerations for cultural diversity in simulation. Additionally, further research into the effectiveness of virtual simulation as a replacement for in-person nursing clinical and lab experiences is warranted.
... Participants identified as either female (80%) or male (20%) TA B L E 1 Cue categories and timings for surgical and medical scenarios. All participants were fully familiar with the simulation centre and manikin, the INEWSV2 (Department of Health, 2020), ABCDE assessment algorithm and ISBAR (Identify, Situation, Background, Assessment, Recommendation) communication tool (Leonard et al., 2004). ...
Aim
The aim of this study was to: (1) use cognitive task analysis to describe final year nursing students situation awareness in recognising, responding and escalating care of deteriorating patients in ward settings; and (2) make recommendations for training and practice.
Design
A mixed methods cognitive task analysis with a convergent triangulation design.
Method
Data collection involved observations of 33 final year nursing students in simulated deteriorating patient scenarios and retrospective cognitive interviews. A process tracing technique was applied to identify the cues to deterioration participants perceived; how cue perception altered as situational demands increased; the extent that participants made connections between perceived cues and reached a situational understanding; and the factors that influenced and constrained participants situation awareness. Qualitative and quantitative findings are woven together and presented using descriptive statistics, illustrative quotations and timeline extractions.
Results
The median cue perception was 65.4% and 57.6% in the medical and surgical scenarios, respectively. Perception was negatively influenced by incomplete vital sign monitoring as situations escalated; limited physical assessments; passive scanning behaviours; poor task automaticity; and excessive cognitive demands. Incomplete perception, poor cue integration and underdeveloped mental models influenced situational understanding. Escalation calls did not always accurately reflect situations and a reporting mindset was evident. Clinical exposure to deteriorating patients was described as variable and opportunistic.
Reporting Method
The study is reported in accordance with the Good Reporting of a Mixed Methods Study (GRAMMS) checklist.
Patient or Public Contribution
Patients and public were not involved in this research.
... De ce fait, puisqu'il est difficile de standardiser la prise en charge d'un patient en salle de réanimation, l'équipe soignante doit s'adapter à chaque situation et harmoniser ses interventions afin d'assurer un travail d'équipe optimal, garant de la qualité des soins (1, 2, 7). En effet, le travail d'équipe et la communication sont deux facteurs essentiels à une prise en charge optimale (9). Dans le but de rapidement stabiliser l'état critique du patient, l'équipe soignante doit évaluer, intervenir et déterminer le problème rapidement, et ce, de façon concomitante (1). ...
Prenant ses origines dans le domaine de l’aviation, le Crisis Resource Management (CRM) est désormais un incontournable relativementaux principes de travail d’équipe et de communication. Le CRM englobe des habiletés non techniques permettant d’optimiser laprise en charge d’un patient en situation de soins critiques, comme vécu en salle de réanimation. Lors de ces situations, un travaild’équipe non efficient est responsable de la majorité des erreurs commises. De plus, bien souvent, il ne s’agit pas d’un problèmede connaissances, mais bien de la mise en oeuvre de celles-ci. Cet article propose une explication de deux éléments du CRM, soit letravail d’équipe et la communication, et aborde la simulation comme intervention éducative relative à ces éléments.
Objective The research for this paper was conducted to unveil the effect of comprehensive nursing combined with the Identification-Situation-Background-Assessment-Recommendation (ISBAR) handover approach in the nursing of patients with placental abruption.
Methods The 40 cases of placental abruption patients admitted to the Women’s Hospital School of Medicine Zhejiang University from May 2021 to May 2022 were subjected to conventional basic nursing combined with traditional handover tool intervention, which was recorded as the control group; the 40 cases of placental abruption patients admitted to the Women’s Hospital School of Medicine Zhejiang University from June 2022 to June 2023 were subjected to comprehensive nursing combined with ISBAR handover tool intervention, which was recorded as the observation group. Maternal and infant outcomes, the quality of nurse handover, and the psychological burden [State Anxiety Inventory (S-AI), Trait Anxiety Inventory (T-AI), Distress Thermometer (DT), and General Self-Efficacy Scale (GSES)] were observed in the two groups, and the satisfaction with nursing was also assessed by using a self-administered satisfaction scale in the two groups.
Results The rate of normal delivery of patients in the observation group was higher and the rate of cesarean section and the total incidence of complications were lower than that of the control group. The 1- and 5-min Apgar scores of the newborns in the observation group were higher and the total complication rate was lower than that in the control group. Nurses in the observation group had higher scores for nursesʼ shift handover quality. S-AI, T-AI, and DT scores were lower in both groups after the intervention and were lowest in the observation group; GSES scores were higher and were highest in the observation group. Satisfaction with nursing was higher in the observation group than in the control group.
Conclusion Comprehensive nursing combined with the ISBAR handover approach applied to the clinical care of patients with placenta abruption can effectively improve the outcomes of mothers and infants, enhance the quality of nursesʼ shift handovers, reduce the psychological burden of patients and increase nursing satisfaction.
Aim
To evaluate the impact of using ‘Situation‐Background‐Assessment‐Recommendation’ method (‘SBAR’) in a palliative care setting.
Background
Effective handover communication is crucial for patient safety. Standardised communication tools, such as the SBAR method, are recommended to reduce errors and improve care coordination, but their use in palliative care is not investigated.
Design
Mixed method study design, adhering to the GRAMMS guideline.
Methods
From January to October 2021, a SBAR guide tailored for palliative care was developed using the Delphi method and implemented in a Hospice setting. Data on 150 nurse handovers were collected before and after implementation to assess changes in nursing outcomes, including medication errors, adverse events and the identification of psychological and spiritual needs. Nurses' perceptions on the handover process were gathered through a qualitative survey.
Results
The SBAR guide significantly improved the handovers quality, reducing medication errors and eliminating adverse events postimplementation. The identification of psychological and spiritual needs increased during postimplementation period. Nurses also reported improved clarity, accuracy and completeness of information during handover.
Conclusion
This is the first study to evaluate the impact of SBAR for handover in palliative nursing care. Findings show the added value of using communication tools.
Background
Falls remain a persistent problem in residential aged care (RAC) facilities. Fall screening and assessment tools such as the Peninsula Health Falls Risk Assessment Tool (PHFRAT) are widely used to inform falls risk and guide fall prevention interventions. However, it is unclear how it is used in practice and whether clinicians believe it supports resident care. This study aimed to measure the extent of use of PHFRAT to understand clinicians’ perceptions of its value and usefulness.
Methods
This mixed method study involved an analysis of PHFRAT assessment from 25 RAC facilities in New South Wales, Australia, and interviews with seven RAC staff about how PHFRAT information is used in practice. In the quantitative component, descriptive statistics were applied to PHFRAT data to summarise how RAC staff use the PHFRAT including the completeness and content of the three parts. In the qualitative component, thematic analysis techniques were applied to interview data.
Results
The sample included 215 RAC residents with 703 PHFRATs, of which 617 documented fall prevention interventions. Among these 617 PHFRATs, 593 (96.1%) included strategies related to staff assistance and 283 (45.9%) recorded strategies related to device provision. While nearly all residents (96.74%) received at least one PHFRAT assessment over the study period, many PHFRAT assessments were incomplete (part 1: 11.5% of information missing; part 2: 10.8%; part 3: 17.1%). There were few variations in fall interventions prescribed to individual residents by their fall risk level. Interviews with RAC staff indicated that PHFRAT assessments are the responsibility of registered nurses with limited input from other staff or residents. While the structured process was viewed positively in guiding risk assessment and intervention assessment, a lack of input from others prevented strategies from being tailored to residents’ specific needs and preferences. A shortage of resources, lack of communication, and limited staff education were identified as the main barriers to PHFRAT guideline implementation.
Conclusion
The PHFRAT provides a useful structure for clinicians to assess falls risk factors and plan falls prevention strategies. In the future, increased multidisciplinary input into fall prevention strategy development may improve the comprehensiveness of fall prevention plans.
Purpose of Review
Emergency trauma procedures are life-saving interventions that require a high level of skill and technique byemergency medicine providers and trauma surgeons. These procedures are considered high acuity, lowoccurrence (HALO) events or procedures due to the high skill level they require but infrequent clinicalpresentation.
Recent Findings
Simulation offers a unique approach to teaching HALO procedures. This article reviews educational considerationswhen utilizing simulation as a teaching modality. It also describes the different simulation methods: task trainersand models, in-situ simulation, and virtual reality trainers. Finally, we review the challenges and advantages ofsimulation as an educational approach for training providers and other clinical staff for HALO procedures andevents.
Summary
Simulation is a sound instructional design to train for HALO procedures and events. It provides hands-onexperience, psychological safety, and a wide range of equipment to allow educators to tailor training for eachindividual learner.
Effective communication of scientific knowledge plays a crucial role in the advancement of medical research and health care. Technological advancements have introduced large language models such as Chat Generative Pre-Trained Transformer (ChatGPT), powered by artificial intelligence (AI), which has already shown promise in revolutionizing medical writing. This study aimed to conduct a detailed evaluation of ChatGPT-3.5’s role in enhancing various aspects of medical writing. From May 10 to 12, 2023, the authors engaged in a series of interactions with ChatGPT-3.5 to evaluate its effectiveness in various tasks, particularly its application to medical writing, including vocabulary enhancement, text rewriting for plagiarism prevention, hypothesis generation, keyword generation, title generation, article summarization, simplification of medical jargon, transforming text from informal to scientific and data interpretation. The exploration of ChatGPT’s functionalities in medical writing revealed its potential in enhancing various aspects of the writing process, demonstrating its efficiency in improving vocabulary usage, suggesting alternative phrasing, and providing grammar enhancements. While the results indicate the effectiveness of ChatGPT (version 3.5), the presence of certain imperfections highlights the current indispensability of human intervention to refine and validate outputs, ensuring accuracy and relevance in medical settings. The integration of AI into medical writing shows significant potential for improving clarity, efficiency, and reliability. This evaluation highlights both the benefits and limitations of using ChatGPT-3.5, emphasizing its ability to enhance vocabulary, prevent plagiarism, generate hypotheses, suggest keywords, summarize articles, simplify medical jargon, and transform informal text into an academic format. However, AI tools should not replace human expertise. It is crucial for medical professionals to ensure thorough human review and validation to maintain the accuracy and relevance of the content in case they eventually use AI as a supplementary resource in medical writing. Accepting this mutually symbiotic partnership holds the promise of improving medical research and patient outcomes, and it sets the stage for the fusion of AI and human knowledge to produce a novel approach to medical assessment. Thus, while AI can streamline certain tasks, experienced medical writers and researchers must perform final reviews to uphold high standards in medical communications.
Background
Mental health symptoms among healthcare professionals (HCP) in intensive care units (ICUs) are a significant concern affecting both HCP well-being and patient care outcomes. Cross-sectional studies among members of the European Society of Intensive Care Medicine (ESICM) report up to 50% burnout rates. Determinants of burnout include communication, team cohesion, psychological support, and well-being promotion. We designed the 'Hello Bundle' intervention to mitigate burnout among ICU-HCPs by fostering positive social interactions and a supportive work environment. This justification synthesizes evidence from social psychology, positive psychology, and healthcare communication research to support the intervention. The 'Hello Bundle' aims to enhance interpersonal relationships, improve team cohesion, and reduce burnout rates. The six components include: Hello campaign posters, email reminders, integrating greetings in morning huddles, hello jars, lead-by-example initiatives, and a daily updated hello board in each ICU. This protocol describes a cluster randomized controlled trial to evaluate the effectiveness of the intervention.
Methods
This protocol describes a cluster randomized controlled trial (RCT) conducted among ESICM-affiliated ICUs, consisting of at least 73 clusters with in average of 50 respondents per cluster, totaling approximately 7300 participants. Intervention clusters will implement the 6-component Hello Bundle between October 14 and November 10, 2024, while control clusters will be wait-listed to receive the intervention in January 2025 after the RCT concludes. Clusters will be matched based on ICU size (fewer or more than 20 beds), region, and average 2023 mortality. The primary outcome is the proportion of HCPs with burnout between intervention and control clusters at the end of the intervention. Secondary outcomes include comparing the following between clusters: (1) number of HCPs with high emotional exhaustion; (2) number with high depersonalization; (3) number with loss of accomplishment; (4) perception of ethical climate (5) satisfaction at work (VAS); (6) professional conflicts; (7) intention to leave the ICU (VAS); (8) patient-centered care rating; (9) family-centered care rating. The last secondary outcome is the comparison of burnout rates before and after the intervention in the intervention cluster. Outcomes will be based on HCP reports collected within four weeks before and after the intervention.
Discussion
This is the first large trial of healthcare communication, social, and positive psychology intervention among ICU-HCPs. It holds the potential to provide valuable insights into effective strategies for addressing burnout in ICU settings, ultimately benefiting both HCPs and patients.
Trial registration : This trial was registered on ClinicalTrials.Gov on June 18, 2024. Registration: NCT06453616.
Background
Falls in hospital remain a common and costly patient safety issue internationally. There is evidence that falls in hospitals can be prevented by multifactorial programs and by education for patients and staff, but these are often not routinely or effectively implemented in practice. Perspectives of multiple key stakeholder groups could inform implementation of fall prevention strategies.
Methods
Clinicians of different disciplines, patients and their families were recruited from wards at two acute public hospitals. Semi-structured interviews and focus groups were conducted to gain a broad understanding of participants’ perspectives about implementing fall prevention programs. Data were analysed using an inductive thematic approach.
Results
Data from 50 participants revealed three key themes across the stakeholder groups shaping implementation of acute hospital fall prevention programs: (i) ‘Fall prevention is a priority, but whose?’ where participants agreed falls in hospital should be addressed but did not necessarily see themselves as responsible for this; (ii) ‘Disempowered stakeholders’ where participants expressed feeling frustrated and powerless with fall prevention in acute hospital settings; and (iii) ‘Shared responsibility may be a solution’ where participants were optimistic about the positive impact of collective action on effectively implementing fall prevention strategies.
Conclusion
Key stakeholder groups agree that hospital fall prevention is a priority, however, challenges related to role perception, competing priorities, workforce pressure and disempowerment mean fall prevention may often be neglected in practice. Improving shared responsibility for fall prevention implementation across disciplines, organisational levels and patients, family and staff may help overcome this.
Objective To build the Brazilian instrument for investigating adverse health events and evaluate the evidence of content validity and the response process. Methods This psychometric study was conducted according to the Standards for Education and Psychological Testing in the following stages: search for evidence of content validity and response process. In the content evidence, 46 experts from all regions of Brazil participated. In the response process, 76 professionals from 31 health institutions participated. The Statistical Package for the Social Sciences program was used for the distribution of quantitative variables and synthesis, via the calculation of descriptive statistics. In the content evidence stage, the acceptable Content Validity Ratio (CVR) greater than the expected critical CVR for N judges was used; the critical CVR of 0.35 was used in this study. The focus group has been performed for the response process. Results In total, 46 experts participated in the content validation stage, predominantly training nurses (84.8%), and nurses who graduated 11 years ago (60.7%) or more. The results obtained for each level in content validation were as follows: levels I, II, and III respectively presented the following CVR values: 0.88, 0.76, and 0.97. In the response process stage, adjustments to the nomenclature and sequence of steps were performed. Conclusion Building and validating the first Brazilian Instrument for Investigating Adverse Events in Health was possible with the necessary sources to ensure the content and response process. The best evidence articulated with national and international references was considered, making it possible to improve investigation systems in private and public health institutions.
Objetivo: Construir o instrumento brasileiro para investigação de eventos adversos em saúde e avaliar as evidências da validade de conteúdo e o processo de resposta.
Métodos: Este estudo psicométrico foi realizado conforme o Standards for Education and Psychological Testing e conduzido nas seguintes etapas: busca por evidências da validade de conteúdo e do processo de resposta. Na evidência de conteúdo participaram 46 especialistas de todas as regiões do Brasil. No processo
de resposta, participaram 76 profissionais de 31 instituições de saúde. Foi usado o programa Statistical Package for the Social Sciences para distribuição de variáveis quantitativas e síntese, via cálculo de estatísticas descritivas. Na etapa de evidência de conteúdo, foi usado o Content Validity Ratio (CVR) aceitável maior que o CVR crítico esperado para N juízes; neste estudo, foi usado o CVR crítico de 0,35. Já o grupo focal foi realizado para o processo de resposta.
Resultados: No total, 46 especialistas participaram na etapa de validação de conteúdo, predominantemente enfermeiros de formação (84,8%) formados há 11 anos (60,7%) ou mais. Os resultados obtidos na validação de conteúdo para cada nível foram: nivel I apresentou um CVR: 0,88, nível II 0,76 e nível III 0,97. Já na etapa
de processo de resposta, foram realizados ajustes na nomenclatura e encadeamento das etapas.
Conclusão: Foi possível construir e validar o primeiro Instrumento Brasileiro para Investigação de Eventos Adversos na Saúde com as fontes necessárias para assegurar o conteúdo e processo de resposta, considerando as melhores evidências articuladas com as referências nacionais e internacionais, permitindo o aprimoramento dos sistemas de investigação para instituições de saúde privadas e públicas
Hospital discharge is a pivotal point in healthcare delivery, impacting patient outcomes and resource utilisation. Ineffective discharge processes contribute to unplanned hospital readmissions. This study explored hospital discharge process from the perspectives of patients, caregivers, and healthcare staff. Qualitative data were collected through semi-structured interviews with adult patients being discharged home from a medical ward, their caregivers, and healthcare staff at an Australian hospital. Thematic analysis followed established guidelines for qualitative research. A total of 65 interviews and 21 structured observations were completed. There were three themes: i) Communication, ii) System Pressure, and iii) Continuing Care. The theme ‘Communication’ highlighted challenges and inconsistencies in notifying patients, caregivers, and staff about discharge plans, leading to patient stress and frustration. Information overload during discharge hindered patient comprehension and satisfaction. Staff identified communication gaps between teams, resulting in uncertainty regarding discharge logistics. The theme ‘System Pressure’ referred to pressure to discharge patients quickly to free hospital capacity occasionally, even in the face of inadequate service provision on weekends and out-of-hours. The ‘Continuing Care’ theme drew attention to gaps in patient understanding of follow-up appointments, underscoring the need for clearer post-discharge instructions. The lack of structured systems for tracking referrals and post-discharge care coordination was also highlighted, potentially leading to fragmented care. The findings resonate with international literature and the current emphasis in Australia on improving communication during care transitions. Furthermore, the study highlights the tension between patient-centred care and health service pressure for bed availability, resulting in perceptions of premature discharges and unplanned readmissions. It underscores the need for strengthening community-based support and systems for tracking referrals to improve care continuity. These findings have implications for patient experience and safety and suggest the need for targeted interventions to optimise the discharge process.
Background
Deficiencies in communication among healthcare professionals, recognized by medical educators and healthcare institutions, can negatively impact medical education and clinical practice. Analyzing teacher-resident communication difficulties shed light on this issue and propose practical strategies for its mitigation.
Objective
To identify common communication challenges between teacher and residents during Family Medicine residency and to analyze their impact on interactions with peers, the work team, and patients.
Design
Qualitative study, the critical incident technique was used to collect information of interest.
Participants
Seventy teachers, and fifty third-year residents from the Mexican Republic described critical incidents related to their communication experiences during Family Medicine residency.
Results
192 critical incidents were collected (several participants reported more than one incident), comprising 127 reports from teachers, and 65 from residents. Four themes were identified: 1) asymmetric communication, 2) assertive communication, 3) organizational communication, and 4) effective communication. The main challenges identified were abuse of power in communication, lack of communication skills, and the absence of institutional communication channels. These issues significantly impacted learning, work environment, interpersonal relationships, and medical care.
Conclusion
This study highlights communication issues within Family Medicine residency in Mexico. The issues detected hindered learning and effective collaboration and negatively impacted the work environment, interpersonal relationships, and the quality of medical care. These findings underscore the urgent need to reorient the medical specialty curriculum towards an approach that includes communication skills.
BACKGROUND
Optimal communication between care teams is a critical component in providing safe, timely, and appropriate patient care. Labor and delivery (L&D) units experience rapidly changing clinical scenarios often requiring escalation in care and unplanned cesarean deliveries (CDs). The University of Cincinnati Medical Center (UCMC) is a 550-bed academic level 4 maternal care center with a 13-bed L&D unit in Cincinnati, OH. There are approximately 2500 deliveries/y with a CD rate of 33%. The L&D unit is staffed with dedicated anesthesia personnel 24 hours a day. In our L&D unit, there was widespread dissatisfaction with multidisciplinary communication surrounding unscheduled CD. Near-miss safety events in our obstetric unit were attributed to preoperative communication failures. Initial surveys identified challenges in preoperative communication among nursing, anesthesiology, and obstetric teams leading to potential risk for compromised care.
METHOD
Using the UC Health Performance Improvement Way, we first sought to understand the process leading up to unscheduled CD. Change ideas were developed based on observed failures in communication. Interventions were tested and refined through iterative plan-do-study-act (PDSA) cycles. One key intervention was the introduction of a bedside, multidisciplinary, patient-centered, pre-CD huddle attended by nursing, anesthesia, and obstetrics representatives using a standard checklist for critical information. Qualitative patient feedback was elicited to inform change efforts. We compared patient and procedure characteristics from the baseline and huddle implementation phases.
MEASURES
Our primary outcome measure was the satisfaction of care team members with communication around unscheduled CD. A secondary outcome was the general anesthesia (GA) rate for unscheduled CD. Our key process measure was adherence to the preoperative huddle. We tracked decision-to-incision interval (DTI) as a balancing measure.
RESULTS
Huddle adherence reached 96% for unscheduled CD within 6 months of testing and implementation. A combined survey of anesthesia, nursing, and obstetrics showed that satisfaction scores related to unscheduled CD communication improved from 3.3/5 to 4.7/5 after huddle implementation. The rate of GA use and the median DTI remained unchanged. Patients felt more engaged and reported positive experiences by being a part of the huddle discussion.
CONCLUSIONS
In an academic obstetric unit, communication failures surrounding unscheduled CD were identified as a contributor to staff dissatisfaction and perception of safety risk. Implementation of a bedside multidisciplinary pre-CD huddle improved communication between teams and contributed to creating a culture of safety without causing significant delays in care.
Background
Allergy disorders caused by biological particles, such as the proteins in some airborne pollen grains, are currently considered one of the most common chronic diseases, and European Academy of Allergy and Clinical Immunology forecasts indicate that within 15 years 50% of Europeans will have some kind of allergy as a consequence of urbanization, industrialization, pollution, and climate change.
Objective
The aim of this study was to monitor and analyze the dissemination of information about pollen symptoms from December 2006 to January 2022. By conducting a comprehensive evaluation of public comments and trends on Twitter, the research sought to provide valuable insights into the impact of pollen on sensitive individuals, ultimately enhancing our understanding of how pollen-related information spreads and its implications for public health awareness.
Methods
Using a blend of large language models, dimensionality reduction, unsupervised clustering, and term frequency–inverse document frequency, alongside visual representations such as word clouds and semantic interaction graphs, our study analyzed Twitter data to uncover insights on respiratory allergies. This concise methodology enabled the extraction of significant themes and patterns, offering a deep dive into public knowledge and discussions surrounding respiratory allergies on Twitter.
Results
The months between March and August had the highest volume of messages. The percentage of patient tweets appeared to increase notably during the later years, and there was also a potential increase in the prevalence of symptoms, mainly in the morning hours, indicating a potential rise in pollen allergies and related discussions on social media. While pollen allergy is a global issue, specific sociocultural, political, and economic contexts mean that patients experience symptomatology at a localized level, needing appropriate localized responses.
Conclusions
The interpretation of tweet information represents a valuable tool to take preventive measures to mitigate the impact of pollen allergy on sensitive patients to achieve equity in living conditions and enhance access to health information and services.
Purpose
Provisions for the minimisation of human error are essential through governance structures such as recruitment, human resource allocation and education/training. As predictors of safety attitudes/behaviours, employees’ personality traits (e.g. conscientiousness, sensation-seeking, agreeableness, etc.) have been examined in relation to human error and safety education.
Design/methodology/approach
This review aimed to explore research activity on the safety attitudes of healthcare staff and their relationship with the different types of personalities, compared to other complex and highly regulated industries. A scoping review was conducted on five electronic databases on all industrial/work areas from 2001 to July 2023. A total of 60 studies were included in this review.
Findings
Studies were categorised as driving/traffic and industrial to draw useful comparisons between healthcare. Certain employees’ personality traits were matched to positive and negative relationships with safety attitudes/behaviours. Results are proposed to be used as a baseline when conducting further relevant research in healthcare.
Research limitations/implications
Only two studies were identified in the healthcare sector.
Originality/value
The necessity for additional research in healthcare and for comparisons to other complex and highly regulated industries has been established. Safety will be enhanced through healthcare governance through personality-based recruitment, human resource allocation and education/training.
Background
Respectful maternity care includes shared decision‐making (SDM). However, research on SDM is lacking from the intrapartum period and instruments to measure it have only recently been developed. TeamBirth is a quality improvement initiative that uses team huddles to improve SDM during labor and birth. Team huddles are structured meetings including the patient and full care team when the patient's preferences, care plans, and expectations for when the next huddle will occur are reviewed.
Methods
We used patient survey data (n = 1253) from a prospective observational study at four U.S. hospitals to examine the relationship between TeamBirth huddles and SDM. We measured SDM using the Mother's Autonomy in Decision‐Making (MADM) scale. Linear regression models were used to assess the association between any exposure to huddles and the MADM score and between the number of huddles and the MADM score.
Results
In our multivariable model, experiencing a huddle was significantly associated with a 3.13‐point higher MADM score. When compared with receiving one huddle, experiencing 6+ huddles yielded a 3.64‐point higher MADM score.
Discussion
Patients reporting at least one TeamBirth huddle experienced significantly higher SDM, as measured by the MADM scale. Our findings align with prior research that found actively involving the patient in their care by creating structured opportunities to discuss preferences and choices enables SDM. We also demonstrated that MADM is sensitive to hospital‐based quality improvement, suggesting that future labor and birth interventions might adopt MADM as a patient‐reported experience measure.
The subspecialty of obstetric anaesthesiology is different from other subspecialties in anaesthesiology in that, at any point of time, two lives are at stake, making drug errors particularly critical. This narrative review explores the incidence, contributing factors, and preventive strategies for medication errors in Obstetric Anaesthesia. Key contributors of medication errors include distractions, fatigue, look-alike/sound-alike drugs, lack of standardized protocols, poor communication strategies, inadequate training and education. Effective strategies for reducing errors include double-check procedures, bar-coded medication administration systems, implementing “Tall Man lettering for look-alike/sound-alike drugs, structured communication tools, continuous education and training. The review also introduces the mnemonic "SAFE-LABEL CHECK" to encapsulate best practices for minimizing drug errors. Future directions suggest integrating advanced technologies and fostering a multidisciplinary approach to enhance patient safety in obstetric anaesthesia.
Purpose
The purpose of the research is to investigate the determinants of consumer ethnocentrism (CE) and its influence on the actual purchase behaviour (APB) of domestic versus foreign products among Indians post COVID-19 pandemic using the theory of planned behaviour (TPB).
Design/methodology/approach
To obtain the results, statistical techniques such as EFA, CFA, t-test, ANOVA and regression were applied to 861 responses, conducted via a structured questionnaire in the different metropolitan cities of India in two phases.
Findings
Two major determinants of CE, i.e., patriotism and nationalism, are found. Indians have moderate to high ethnocentrism levels, and their tendency to be ethnocentric significantly differs across demographic traits; there is a significant influence of CE on attitude formation that subsequently leads to favourable intention and finally to APB.
Practical implications
The findings indicate that marketers can feel confident in targeting both genders in their promotional campaigns as there were no pertinent variations in both genders’ ethnocentric tendencies. The increasing level of ethnocentrism will surely be an opportunity for Indian manufacturers and sellers. Their promotional tools must carry a visible message that the product is domestically manufactured and its consumption will lead to value addition in the country.
Originality/value
The research provides insights to understand ethnocentrism through the lenses of TPB and social identity theory. The study will augment our understanding of the plausible reasons behind the increasing ethnocentrism among Indians, especially after the COVID-19 pandemic.
Background
Effective communication skill of physicians is an important component of high‐quality healthcare delivery and safe patient care. Communication is embedded in the social and cultural contexts where it takes place. An understanding of medical students' attitudes and learning communication skills would help to design and deliver culturally appropriate medical education. The Communication Skills Attitude Scale (CSAS) is a widely used and validated tool to measure the attitude of medical students toward learning communication skills in different populations, settings, and countries. However, there is no culturally adapted and validated scale in Bangla in the Bangladesh context. This study aims to culturally adapt the CSAS into Bangla, and validate it in a cohort of medical students in Bangladesh.
Methods
This study used a cross‐sectional survey design to collect data from purposively selected 566 undergraduate medical students from the Rajshahi division. The survey was conducted from January to December 2023. Descriptive statistics like frequency distribution and measures of central tendency were used to measure perception regarding communication skills. The sample adequacy was measured through the Kaiser–Meyer–Olkin test. The internal consistency of the items was identified using Cronbach's alpha (α) coefficients.
Result
The results of the study show that the Bangla version of the scale is feasible, valid, and internally consistent in the context of a developing country, Bangladesh. The overall internal consistency of the Bangla version is good since the value of Cronbach's alpha (α) is 0.882. For PAS, the internal consistency is 0.933. While, for NAS, the value is 0.719. The item‐wise average scores in the PAS indicate that female medical students are more willing to learn communication skills compared with male students (α = 0.933). While, the scores in the NAS indicate that the male students tend to have more negative attitude toward learning communication skills compared with female students (α = 0.719).
Conclusion
The CSAS‐Bangla is a valid and reliable tool for assessing communication skill attitudes among Bangla speaking medical students. This scale can be used in future studies to measure the attitude of students, designing and evaluating communication skills training programs in medical colleges.
Background
Diagnostic stewardship is ‘coordinated guidance and interventions to improve appropriate use of microbiological diagnostics to guide therapeutic decisions’ and a fundamental part of antimicrobial stewardship and the nursing role. The role of the nurse in diagnostic stewardship is relatively unknown and an underused resource. Lack of involvement and training in diagnostic stewardship can lead to inaction or incorrect actions, either of which may be detrimental to patient management, outcomes and care.
Aim
To determine the role of the hospital adult nurse in diagnostic stewardship to inform local engagement strategies.
Methods
The methodology was informed by Whiffin's (2020) systematic search approach. Electronic databases were searched from 2016 to 2022. The studies included were primary research papers involving adult nurses working in a hospital setting, with findings relevant to a diagnostic stewardship role. Thematic analysis was chosen to understand and compare the results, findings and recommendations of the studies.
Findings
Seven studies were included in the review. The identified themes were: (i) nursing role – to recognize infection, aid diagnosis and review results; (ii) nurse challenges – lack of knowledge and confidence to implement diagnostic stewardship; and (iii) Nurse education, empowerment and use of clinical tools.
Conclusion
Research studies do not consistently recognize the full scope of the diagnostic stewardship nursing role, signifying that nurses remain an underused resource in promoting diagnostic stewardship. Research-based clarification of the role of the nurse in diagnostic stewardship, outlined in this review, is therefore vital. Further UK-based, nurse-led research is needed to capture the impact of nurse-driven diagnostic stewardship interventions.
This topic deals with the process of transforming a group of people (healthcare workers) into a well-functioning team through a transformative leadership model. One of the biggest challenges in health systems strengthening is that healthcare workers function in silos, as defined by their individual professional disciplines. This compromises service delivery due to poor service integration, duplication of effort, weak referrals, and a toxic work environment. This chapter will focus on the journey that we embark on to implement a transformative leadership model to develop effective and efficient multidisciplinary teams among healthcare workers that in turn drive better and sustainable health outcomes.
Background: Effective communication is vital in nursing, influencing patient safety, satisfaction, and care quality. The AIDET framework is a proven tool for reducing patient anxiety and enhancing their experience. However, perceptions and experiences of Filipino nursing students with AIDET remain unexplored. Objective: This study explored Filipino nursing students’ use of AIDET, focusing on benefits, challenges, and improvements. Methods: A qualitative, interpretive phenomenological approach informed by the philosophy of Martin Heidegger was employed. This 2023 study, conducted at a university in Angeles City, Philippines, explored Filipino nursing students’ experiences with the AIDET communication framework. Thirty participants were purposefully selected to participate in facilitated discussions following a semi-structured interview guide. Thematic content analysis of the transcribed audio recording identified recurring themes in their narratives, focusing on the meanings they ascribed to their experiences using AIDET. Results: Four themes emerged: (a) Streamlined nurse-patient interaction (organizes communication, rapport building, alleviate anxiety, acknowledgment, and empowerment as sub-themes), (b) Enhances patient-centered care (empathy and compassion, improved patient experience as sub-topics), (c) Challenges with specific patient populations (patient preferences, language barrier, patient condition, acknowledgment of cultural differences as sub-themes), and (d) AIDET in nursing education strengthening application through practice, optimizing frequency and timing, promoting deeper understanding, enhancing feedback mechanism) as student nurses’ recommendations. Conclusion: Early integration of AIDET in nursing education is essential for student nurses to enhance communication, improve patient satisfaction, and deliver patient-centered care, equipping them with valuable communication skills.
Research and practice in patient safety education have garnered widespread attention; however, a comprehensive bibliometric analysis is lacking. This study aimed to provide a comprehensive understanding of the research focus and research trends in the globalization of the field of patient safety education and to describe the general characteristics of publications. Data on articles and reviews about student safety education were extracted from Web of Science. Microsoft Excel 2019, CiteSpace 6.1.R3, VOSviewer 1.6.18, SATI 3.2, Scimago Graphica, and Pajek were used for quantitative analysis. Collaboration networks of countries, institutions, journals, authors, and keywords were visualized based on publications from January 2000 to September 2022. A total of 573 papers were published between 2000 to 2022, showing an overall increasing trend. The USA, England, and Australia are the top three most prolific countries; Johns Hopkins University, the University of Technology Sydney, and the University of Toronto are the top three most productive institutions; Nurse Education Today, Journal of Nursing Education, and BMC Medical Education are the most productive journals; Based on content analysis five research hotspots focused on: (1) Quality Improvement of Patient safety Teaching and Learning; (2) Patient safety Teaching Content; (3)Specialized Teaching in Patient Safety; (4) Integrating Patient Safety and Clinical Teaching; (5)Patient Safety Teaching Assessment Content. Through keyword clustering analysis, five research hotspots and relevant contents were identified. According to this study, simulation, communication, collaboration, and medication may attract more attention from researchers and educators, and could be the major trend for future study.
Effective collaboration and teamwork skills are critical in high‐risk sectors, as deficiencies in these areas can result in injuries and risk of death. To foster the growth of these vital skills, immersive learning spaces have been created to simulate real‐world scenarios, enabling students to safely improve their teamwork abilities. In such learning environments, multiple dialogue segments can occur concurrently as students independently organise themselves to tackle tasks in parallel across diverse spatial locations. This complex situation creates challenges for educators in assessing teamwork and for students in reflecting on their performance, especially considering the importance of effective communication in embodied teamwork. To address this, we propose an automated approach for generating teamwork analytics based on spatial and speech data. We illustrate this approach within a dynamic, immersive healthcare learning environment centred on embodied teamwork. Moreover, we evaluated whether the automated approach can produce transcriptions and epistemic networks of spatially distributed dialogue segments with a quality comparable to those generated manually for research objectives. This paper makes two key contributions: (1) it proposes an approach that integrates automated speech recognition and natural language processing techniques to automate the transcription and coding of team communication and generate analytics; and (2) it provides analyses of the errors in outputs generated by those techniques, offering insights for researchers and practitioners involved in the design of similar systems.
Practitioner notes
What is currently known about this topic Immersive learning environments simulate real‐world situations, helping students improve their teamwork skills.
In these settings, students can have multiple simultaneous conversations while working together on tasks at different physical locations.
The dynamic nature of these interactions makes it hard for teachers to assess teamwork and communication and for students to reflect on their performance.
What this paper adds We propose a method that employs multimodal learning analytics for automatically generating teamwork‐related insights into the content of student conversations.
This data processing method allows for automatically transcribing and coding spatially distributed dialogue segments generated from students working in teams in an immersive learning environment and enables downstream analysis.
This approach uses spatial analytics, natural language processing and automated speech recognition techniques.
Implications for practitioners Automated coding of dialogue segments among team members can help create analytical tools to assist in evaluating and reflecting on teamwork.
By analysing spatial and speech data, it is possible to apply learning analytics advancements to support teaching and learning in fast‐paced physical learning spaces where students can freely engage with one another.
An obstacle to effective teaming between humans and AI is the agent’s "black box" design. AI explanations have proven benefits, but few studies have explored the effects that explanations can have in a teaming environment with AI agents operating at heightened levels of autonomy. We conducted two complementary studies, an experiment and participatory design sessions, investigating the effect that varying levels of AI explainability and AI autonomy have on the participants’ perceived trust and competence of an AI teammate to address this research gap. The results of the experiment were counter-intuitive, where the participants actually perceived the lower explainability agent as both more trustworthy and more competent. The participatory design sessions further revealed how a team’s need to know influences when and what teammates need explained from AI teammates. Based on these findings, several design recommendations were developed for the HCI community to guide how AI teammates should share decision information with their human counterparts considering the careful balance between trust and competence in human-AI teams.
Simulation in perioperative healthcare is an effective and powerful tool for patient safety. It is used for training in technical skills without putting patients at risk, for improving the performance of interprofessional teams via enhancement of crisis event management, communication, and other teamwork skills, as an adjunct to root cause analysis (RCA) and failure mode and effects analysis (FMEA) to identify causative factors in actual or potential safety events and generally to improve the culture of safety. Participation in team-based simulation has been shown to improve both safety culture and team performance. Because of the increasing body of evidence pointing toward these outcomes, simulation is increasingly becoming a component of accreditation across healthcare professions. We expect its use to become more tightly interwoven in the fabric of patient safety in the future.
Background
Emergency healthcare services are under intense pressure to meet increasing patient demands. Many patients presenting to emergency departments could be managed by general practitioners in general practitioner–emergency department service models.
Objectives
To evaluate the effectiveness, safety, patient experience and system implications of the different general practitioner–emergency department models.
Design
Mixed-methods realist evaluation.
Methods
Phase 1 (2017–8), to understand current practice: rapid realist literature review, national survey and follow-up key informant interviews, national stakeholder event and safety data analysis. Phase 2 (2018–21), to collect and analyse qualitative (observations, interviews) and quantitative data (time series analysis); cost–consequences analysis of routine data; and case site data for ‘marker condition’ analysis from a purposive sample of 13 case sites in England and Wales. Phase 3 (2021–2), to conduct mixed-methods analysis for programme theory and toolkit development.
Results
General practitioners commonly work in emergency departments, but delivery models vary widely in terms of the scope of the general practitioner role and the scale of the general practitioner service. We developed a taxonomy to describe general practitioner–emergency department service models (Integrated with the emergency department service, Parallel within the emergency department, Outside the emergency department on the hospital site) and present a programme theory as principal output of the study to describe how these service models were observed to operate. Routine data were of variable quality, limiting our analysis. Time series analysis demonstrated trends across intervention sites for: increased time spent in the emergency department; increased emergency department attendances and reattendances; and mixed results for hospital admissions. Evidence on patient experience was limited but broadly supportive; we identified department-level processes to optimise the safety of general practitioner–emergency department models.
Limitations
The quality, heterogeneity and extent of routine emergency department data collection during the study period limited the conclusions. Recruitment was limited by criteria for case sites (time series requirements) and individual patients (with ‘marker conditions’). Pandemic and other pressures limited data collection for marker condition analysis. Data collected and analysed were pre pandemic; new approaches such as ‘telephone first’ and their relevance to our findings remains unexplored.
Conclusion
Findings suggest that general practitioner–emergency department service models do not meet the aim of reducing the overall emergency department waiting times and improving patient flow with limited evidence of cost savings. Qualitative data indicated that general practitioners were often valued as members of the wider emergency department team. We have developed a toolkit, based on our findings, to provide guidance for implementing and delivering general practitioner–emergency department services.
Future work
The emergency care data set has since been introduced across England to help standardise data collection to facilitate further research. We would advocate the systematic capture of patient experience measures and patient-reported outcome measures as part of routine care. More could be done to support the development of the general practitioner in emergency department role, including a core set of competencies and governance structure, to reflect the different general practitioner–emergency department models and to evaluate the effectiveness and cost effectiveness to guide future policy.
Study registration
This study is registered as PROSPERO CRD42017069741.
Funding
This award was funded by the National Institute for Health and Care Research (NIHR) Health and Social Care Delivery Research programme (NIHR award ref: 15/145/04) and is published in full in Health and Social Care Delivery Research ; Vol. 12, No. 10. See the NIHR Funding and Awards website for further award information.
Purpose of Review
Unrecognized esophageal intubation (UEI) continues to occur. This causes avoidable mortality and severe morbidity. Traditionally, operators have relied on simple manoeuvres and one-line aphorisms to teach students how to avoid it. These have not always proven successful and tragic deaths still occur.
Recent Findings
In some jurisdictions, Coroners are exerting significant pressure on anesthetic authorities to eliminate this complication. The international, multi-disciplinary group, the Project for the Universal Management of the Airway (PUMA), in conjunction with the main specialist airway societies around the world, have produced a straightforward, systematic guideline focused on avoiding UEI.
Summary
This article reviews why UEI deaths happen and how the new guideline approaches this issue which will be of interest to all airway practitioners, independent of specialty or seniority.
Background
Despite recommendations against psychotropic medication in older nursing homes residents with behavioral and psychological symptoms of dementia (BPSD), antidepressants and other psychotropic drugs are still prescribed. We performed a cluster-randomized controlled trial to evaluate the effect of a complex intervention aiming to promote the deprescribing of antidepressants in institutionalized older persons with dementia. To understand the underlying mechanisms of trial outcomes, we conducted a process evaluation exploring the interventions implementation, areas of impact, and contextual factors. The aim of this study was to explore the implementation process and the key factors that promoted and inhibited intervention implementation in the care home setting (Clinicaltrials.gov: NCT04985305. Registered 30 July 2021).
Methods
Qualitative interviews were conducted between August 2022 and February 2023 with four general practitioners and eight nursing home staff from four associated nursing homes in the Capital Region of Denmark. We coded the interview data according to the four constructs of the Normalization Process Theory (coherence, cognitive participation, collective action, and reflexive monitoring).
Results
There was a common understanding of the intervention aim. We observed a raised awareness concerning the deprescription of antidepressants among healthcare professionals with good collaboration (coherence). An overall buy-in to a deprescribing mentality was seen (cognitive participation). There were barriers to the GPs and nursing home staff’s use of the intervention elements and how they implemented it, but to some, a common language was created (collective action). Professionals overall valued the idea of deprescribing, but lack of time, high staff turnover, and low education level among nursing home staff hampered the integration (reflexive monitoring).
Conclusion
Successful implementation seemed to be dependent on the quality of the relationship between the single GP and the single nursing home professional. A common deprescribing mentality promoted the uptake of the intervention. However, several barriers related to lack of resources hindered implementation. It is imperative to adapt complex interventions to the available resources and context.
Background
Emergency medical service (EMS) workers face challenging working conditions that are characterized by high stress and a susceptibility to making errors. The objectives of the present study were (a) to characterize the psychosocial working conditions of EMS workers, (b) to describe the perceived quality of patient care they provide and patient safety, and (c) to investigate for the first time among EMS workers associations of psychosocial working conditions with the quality of patient care and patient safety.
Methods
For this cross-sectional study, we carried out an online survey among 393 EMS workers who were members of a professional organization. Working conditions were measured by the Demand-Control-SupportQuestionnaire (DCSQ) and seven self-devised items covering key stressors. Participants reported how often they perceived work stress to affect the patient care they provided and we inquired to what extent they are concerned to have made a major medical error in the last three months. Additionally, we used parts of the Emergency Medical Services – Safety Inventory (EMS-SI) to assess various specific errors and adverse events. We ran descriptive analyses (objective a and b) and multivariable logistic regression (objective c).
Results
The most common stressors identified were communication problems (reported by 76.3%), legal insecurity (69.5%), and switching of colleagues (48.9%) or workplaces (44.5%). Overall, 74.0% reported at least one negative safety outcome based on the EMS-SI. Concerns to have made an important error and the perception that patient care is impaired by work stress and were also frequent (17.8% and 12.7%, respectively). Most psychosocial working conditions were associated with the perception that patient care is impaired due to work stress.
Conclusions
Work stress in EMS staff is pronounced and negative safety outcomes or potential errors are perceived to occur frequently. Poor psychosocial working conditions were only consistently associated with perceived impairment of patient care due to work stress. It seems necessary to reduce communication problems and to optimize working processes especially at interfaces between emergency services and other institutions. Legal insecurity could be reduced by clarifying and defining responsibilities. Communication and familiarity between team colleagues could be fostered by more consistent composition of squads.
Perinatal units differ in their ability to prevent patient injury and medical malpractice litigation. Obstetrical units with favorable performance are distinguished by common organizational and clinical features. Organizationally, they resemble what behavioral scientists define as “high-reliability organizations” (i.e., the ability to operate technologically complex systems essentially without error over long periods). Clinically, practices are based on nationally recognized guidelines and/or an operational philosophy of “safety first.” These organizational and clinical features are described so that physicians, nurses, and administrators might view their own clinical environments in the context of this perspective.
Sumario: The challenge of team management these days is not simply to execute existing processes efficiently. It's to implement new processes as quickly as possible. But adopting new technologies or new business processes is highly disruptive, regardless of the industry. The authors studied how surgical teams at 16 major medical centers implemented a difficult new procedure for performing cardiac surgery. The authors found that the most successful teams had leaders who actively managed the groups' learning efforts. Teams that most successfully implemented the new technology shared three essential characteristics. They were designed for learning; their leaders framed the challenge so that team members were highly motivated to learn; and an environment of psychological safety fostered communication and innovation
Effective intrapartum fetal heart rate (FHR) monitoring requires ongoing collaboration among health care providers. Nurses, midwives, and physicians must have a shared understanding of 1) how FHR tracings are interpreted, 2) which FHR patterns are associated with actual or impending fetal acidemia, 3) when and within what time frame the physician or the midwife should be notified of variant FHR patterns, 4) how quickly physicians and midwives should respond when notified of variant patterns, and 5) the indications for and optimal timing of interventions such as operative delivery. This article reviews the literature on FHR monitoring and includes a discussion of the advantages and limitations of different monitoring modalities. An overview of those FHR patterns are associated with presumed fetal acidemia is presented, as well as sample multidisciplinary FHR monitoring guidelines and an exercise in intrapartum FHR pattern evaluation that can be used to initiate development of local FHR monitoring patterns.
In this review, we discuss human factors research in cardiac surgery and other medical domains. We describe a systems approach to understanding human factors in cardiac surgery and summarize the lessons that have been learned about critical incident and near-miss reporting in other high technology industries that are pertinent to this field.
Available at: www.qualityhealthcare.org
- B Sexton
Sexton B. Safety Attitude Questionnaire (SAQ), Available at:
www.qualityhealthcare.org.
High reliability perinatal units: an approach to the prevention of patient injury and medical malpractice claims
- G E Knox
- K R Simpson
- T J Garite