Hennus MP, Young JQ, Hennessy M, et al. ATS Sch. 2021;2:397-414.
The surge of patients during the COVID-19 pandemic forced the redeployment of non-intensive care certified staff into intensive care units (ICU). This study surveyed both intensive care (IC)-certified and non-IC-certified healthcare providers who were working in ICUs at the beginning of the pandemic. Qualitative synthesis identified five themes related to supervision; quality and safety of care; collaboration, communication, and climate; recruitment, scheduling and team composition, and; organization and facilities. The authors provide recommendations for future deployments.
This review explores the evidence on integrating teamwork, simulation, and unit-based programs to improve safety in obstetrics settings. The authors highlight the need for more data regarding the impact of these approaches on patient outcomes.
Kjaergaard-Andersen G, Ibsgaard P, Paltved C, et al. Int J Health Care Qual. 2021;33:mzaa148.
Simulation training is used by hospitals to improve patient care. This study describes the experience of one Danish hospital shifting from simulation training at external centers to in situ training. The shift to in situ training identified several latent safety threats (e.g., equipment access, lack of closed-loop communication, out-of-date checklists) and these findings led to practice changes.
Wright B, Faulkner N, Bragge P, et al. Diagnosis (Berl). 2019;6:325-334.
The hectic pace of emergency care detracts from reliability. This review examined the literature on evidence, practice, and patient perspectives regarding diagnostic error in the emergency room. A WebM&M commentary discussed an incident involving a diagnostic delay in the emergency department.
Casali G, Cullen W, Lock G. J Thorac Dis. 2019;11:S998-S1008.
Nontechnical skills, such as teamwork, communication, and leadership, are essential human-centered components of safe surgical practice. This commentary discusses contextual characteristics needed to support nontechnical skill development to improve health care outcomes. The authors recommend a cultural shift away from focusing on technical performance to one that incorporates training in nontechnical skills.
Pattni N, Arzola C, Malavade A, et al. Br J Anaesth. 2019;122:233-244.
Effective teamwork and communication are critical to ensuring patient safety in the busy environment of the operating room. This review examined the evidence on preparing staff to challenge authority in the perioperative environment. Common themes that affect speaking up included hierarchy, organizational culture, and education. Teaching that promotes open communication in the postgraduate environment and utilizing tactics such as simulation training can help address barriers to challenging authority.
According to this qualitative study at a single academic institution, staff surgeons and intensivists frequently exclude resident physicians from patient care conversations. Reasons included lack of trust, need for timely communication, and a perception that residents cannot adequately contribute to decision making. This finding has important implications for the integration of communication training during medical education.
Improving teamwork and communication is a continued focus in the hospital setting. This systematic review revealed that although studies of teamwork in the intensive care unit abound, the field lacks common definitions and constructs. Teamwork usually entailed joint strategy and shared goals, and quality improvement approaches to enhance teamwork typically involve team training and development of structured protocols. Many interventions target rounds, during which interdisciplinary providers discuss each patient, or handoffs between clinicians. The authors suggest that communication is the most prominent aspect of teamwork and propose further study in conceptualizing teamwork to design effective interventions. The heterogeneity in defining and measuring teamwork may account for mixed results in improving safety outcomes. An AHRQ WebM&M perspective describes the Veterans Health Administration's medical team training program.
Spence J, Goodwin B, Enns C, et al. BMJ Qual Saf. 2011;20:580-6.
This study employed student volunteers to observe and audit adherence to the WHO surgical safety checklist. Based on observed adherence rates, the authors recommend adopting a checklist-based preoperative briefing to foster improvements.
Coverdill JE, Carbonell AM, Fryer J, et al. Acad Med. 2010;85:S72-5.
This survey of general surgery residents found that most are struggling with balancing duty hour requirements and responsibility for their patients. In particular, residents reported difficulty adhering to shift length restrictions, and little to no education on handoffs and signouts.
Bost N, Crilly J, Wallis M, et al. Int Emerg Nurs. 2010;18:210-20.
This review found that handoff errors are common between ambulance personnel and the emergency department, and there is a need for standardization of handoff responsibilities and development of structured handoff protocols.
Siassakos D, Draycott TJ, Crofts JF, et al. BJOG. 2010;117:1262-9.
This study found that unidentified characteristics played a critical role in team effectiveness during simulated emergencies. The authors suggest traditional teamwork training programs may fail to account for these characteristics while focusing simply on specific knowledge or skills.
McMahon GT, Katz JT, Thorndike ME, et al. N Engl J Med. 2010;362:1304-1311.
Reducing housestaff workload and increasing attending physician involvement resulted in higher educational satisfaction in this internal medicine residency program. However, quality measures and patient outcomes were essentially unchanged when compared with a traditional inpatient teaching service.
This survey of rural hospitals in the southern United States found that hospitals with fewer than 125 deliveries per year were relatively less prepared to administer neonatal resuscitation. As well, one-third of hospitals did not have an established method for transferring patients to tertiary care hospitals.
This study used simulation activities to foster greater collaborative relationships and stimulate positive changes in tasks, processes, and overall team function. The author suggests that simulation can offer opportunities for individual and team reflection, innovation, and building a culture of safety.
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