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Search results for "General Hospitals"

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Journal Article > Study

Association of a surgical task during training with team skill acquisition among surgical residents: the missing piece in multidisciplinary team training.

Sparks JL, Crouch DL, Sobba K, et al. JAMA Surg. 2017 May 24; [Epub ahead of print].

Multiple studies have linked poor teamwork and communication to adverse events in the operating room. There is a growing recognition that surgeons must learn these nontechnical skills during training in addition to the traditional focus on technical ability. In this controlled study, surgical residents participated in an educational intervention (a simulated surgical emergency) that simultaneously targeted technical and nontechnical skill development. The study used two different types of simulation—high fidelity (a cadaver) and medium fidelity (an anatomically correct mannequin)—compared to a control group, which used a nonanatomic simulator. Investigators found that nontechnical skills improved in both intervention groups compared to the control group, measured using validated teamwork assessments. As the accompanying editorial notes, the study findings indicate that technical and nontechnical skills may be best taught together, as teamwork skills improved when residents also had to perform a simulated surgical task simultaneously.

Tools/Toolkit > Government Resource

Toolkit To Improve Safety in Ambulatory Surgery Centers.

Agency for Healthcare Research and Quality: Rockville, MD.

Ambulatory surgery centers provide care to growing numbers of patients. This toolkit draws from AHRQ's Comprehensive Unit-based Safety Program to help ambulatory surgical center teams develop communication and teamwork skills to reduce infections and other iatrogenic harms.

Journal Article > Study

We are going to name names and call you out! Improving the team in the academic operating room environment.

Bodor R, Nguyen BJ, Broder K. Ann Plast Surg. 2017;78(suppl 4):S222-S224.

This study of operating room teams found that nursing staff, attending surgeons, and anesthesiologists did not always know the name or postgraduate year rank of trainees participating in surgery with them. The authors describe this lack of familiarity with team members as a knowledge gap that has the potential to affect surgical safety.

Journal Article > Review

Monitoring teamwork: a narrative review.

Rutherford JS. Anaesthesia. 2017;72(suppl 1):84-94.

Anesthesiology was an early adopter of teamwork as a safety improvement strategy. This review explored models of assessing teamwork behaviors in anesthesiology. The authors found both implicit and explicit methods in place to monitor teamwork and determined that team training improves patient safety.

Journal Article > Commentary

Implementation of the safety huddle.

Kylor C, Napier T, Rephann A, Spence SJ. Crit Care Nurse. 2016;36:80-82.

The safety huddle is becoming common within health care practice as a way to inform clinicians about what is happening during their shift. This commentary describes how huddles can help improve communication and teamwork in the acute care setting.

Book/Report

Safer delivery of surgical services: a programme of controlled before-and-after intervention studies with pre-planned pooled data analysis.

McCulloch P, Morgan L, Flynn L, et al. Health Services and Delivery Research. Southampton, UK: NIHR Journals Library; 2016.

This publication reports five British hospitals' experiences with teamwork interventions in surgical teams. Although teamwork training alone improved how teams functioned, it did not always enhance clinical performance. The investigators found that integrated training that combines technical and social improvements, such as Lean, resulted in more effective improvements.

Journal Article > Study

Development and preliminary testing of the Coordination Process Error Reporting Tool (CPERT), a prospective clinical surveillance mechanism for teamwork errors in the pediatric cardiac ICU.

Bates KE, Shea JA, Bird GL, et al. Jt Comm J Qual Patient Saf. 2016;42:562-571.

Hospitals rely on incident reporting systems to detect safety issues, but these systems are voluntary and do not capture all adverse events or near misses. Researchers developed and tested a prospective surveillance tool to identify teamwork errors in the pediatric intensive care unit. They found that this tool helped uncover safety issues not captured by the hospital's patient safety reporting system.

Journal Article > Study

Integrated approach to reduce perinatal adverse events: standardized processes, interdisciplinary teamwork training, and performance feedback.

Riley W, Begun JW, Meredith L, et al. Health Serv Res. 2016;51(suppl 3):2431-2452.

Prior research has shown that reducing preventable perinatal harm leads to a decrease in malpractice claims. In this prospective study involving the perinatal units across 14 hospitals from 12 states and accounting for almost 350,000 deliveries, researchers found that successful implementation of 3 standard care processes resulted in a 14% decrease in harm in perinatal care from the baseline period.

Journal Article > Study

Investigating teamwork in the operating room: engaging stakeholders and setting the agenda.

Frasier LL, Pavuluri Quamme SR, Becker A, et al. JAMA Surg. 2017;152:109-111.

Teamwork training can improve communication and prevention of adverse events in the operating room. In this study, focus groups with clinicians and operating room staff found that team members perceived the concept of the "team" and their roles in ensuring optimal handoff communication differently. This exploratory work has implications for the design of effective teamwork training programs.

Journal Article > Commentary

S-TEAMS: a truly multiprofessional course focusing on nontechnical skills to improve patient safety in the operating theater.

Stewart-Parker E, Galloway R, Vig S. J Surg Educ. 2017;74:137-144.

Before teamwork behaviors became a key component of medical error reduction, little research focused on nontechnical skill development in surgery. This commentary discusses a program designed to teach multidisciplinary teams nontechnical skills and enable participants to practice them in simulations. The authors found that teams continued to apply what they learned long after completing the training.

Journal Article > Study

Cluster randomized trial to evaluate the impact of team training on surgical outcomes.

Duclos A, Peix JL, Piriou V, et al; IDILIC Study Group. Br J Surg. 2016;103:1804-1814.

Teamwork training programs have been implemented in a large variety of health care settings, and growing evidence suggests a positive impact. However, the effect of teamwork training programs in the context of surgical safety checklists is less clear. In this randomized study, researchers examined whether adding a team training program to surgical safety checklist utilization affected major surgical complications. All 31 hospitals in the study had implemented a surgical safety checklist a median of 19 months prior to the study. Team training was introduced across operating room teams in 16 hospitals randomized to the intervention arm. Investigators found a significant reduction in major adverse events in both the intervention and control arms. These results suggest that team training may not provide additional benefit when combined with a checklist. A past PSNet interview discussed challenges associated with implementing surgical safety checklists.

Journal Article > Commentary

How communication among members of the health care team affects maternal morbidity and mortality.

Brennan RA, Keohane CA. J Obstet Gynecol Neonatal Nurs. 2016;45:878-884.

Communication failures in obstetric care can increase risk of harm for the mother and the infant. This commentary highlights how nurses can incorporate teamwork principles and structured communication to reduce risks of maternal injury.

Journal Article > Commentary

Patient safety in the emergency department.

Farmer BM. Emerg Med. 2016;48:396-404.

Emergency departments are high-risk environments due to the urgency of care needs and complexity of communication. This commentary explores challenges associated with medication administration, handoffs, discharge processes, and electronic health records in emergency medicine and recommends strategies to reduce risks.

Journal Article > Commentary

Use of a surgical safety checklist to improve team communication.

Cabral RA, Eggenberger T, Keller K, Gallison BS, Newman D. AORN J. 2016;104:206-216.

Surgical team communication is an important element of safe care. This project report describes how one hospital implemented a checklist program that utilized time outs and debriefings to support transparency and improve surgical teamwork behaviors.

Journal Article > Study

Relationship between operating room teamwork, contextual factors, and safety checklist performance.

Singer SJ, Molina G, Li Z, et al. J Am Coll Surg. 2016;223:568-580.e2.

Although checklists have been shown to improve safety and surgical mortality, they can be difficult to implement, which limits their effectiveness in clinical practice. This study examined whether perceptions of teamwork predicted checklist performance. Trained observers used standardized tools to rate the extent of checklist completion and quality of teamwork. They found that checklists were implemented as intended in only 3% of cases. Surgical teams with better surgeon buy-in to checklists, clinical leadership, communication, and overall teamwork completed more checklist components. Clinical factors, including older patient age and longer duration of surgery, were also associated with performing more of the checklist. The authors suggest that teamwork is critical to checklist implementation. A PSNet interview discussed the challenges of implementing checklists in health care.

Journal Article > Review

Leading article: how can I optimise my role as a leader within the surgical team?

Green B, Mitchell DA, Stevenson P, Kane T, Reynard J, Brennan PA. Br J Oral Maxillofac Surg. 2016;54:847-850.

Although leadership at the team and organizational level is considered crucial for safety, training to support this role is needed. Discussing how to improve leadership skills in maxillofacial surgery, this review describes key attributes that surgeons in leadership roles should develop—including professionalism, motivation, and innovation—to enhance quality of care.

Cases & Commentaries

Cognitive Overload in the ICU

  • Spotlight Case
  • CME/CEU
  • Web M&M

Vimla L. Patel, PhD, and Timothy G. Buchman, PhD, MD; July/August 2016

Admitted to the intensive care unit (ICU) with acute respiratory distress syndrome due to severe pancreatitis, an older woman had a central line placed. Despite maximal treatment, the patient experienced a cardiac arrest and was resuscitated. The intensivist was also actively managing numerous other ICU patients and lacked time to consider why the patient's condition had worsened.

Journal Article > Study

The 'go-between' study: a simulation study comparing the 'Traffic Lights' and 'SBAR' tools as a means of communication between anaesthetic staff.

MacDougall-Davis SR, Kettley L, Cook TM. Anaesthesia. 2016;71:764-772.

SBAR has been widely implemented to improve communication in health care settings. This simulation study compared the use of SBAR with a newly developed Traffic Lights tool to assess the communication between anesthesia teams in different operating rooms in 12 validated clinical scenarios. The authors found that the new tool yielded more accurate information transfer, took less time to use, and was preferred by the majority of study participants.

Journal Article > Study

Exclusion of residents from surgery-intensive care team communication: a qualitative study.

Gotlib Conn L, Haas B, Rubenfeld GD, et al. J Surg Educ. 2016;73:639-647.

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.

Tools/Toolkit > Multi-use Website

TeamSTEPPS: Strategies and Tools to Enhance Performance and Patient Safety.

  • Classic

Washington, DC: Department of Defense. Rockville, MD: Agency for Healthcare Research and Quality; 2016.

Effective teamwork plays an essential role in providing safe patient care. The Team Strategies and Tools to Enhance Performance and Patient Safety (TeamSTEPPS) program was developed in collaboration by the United States Department of Defense and AHRQ in order to support effective communication and teamwork in health care. This updated version of the widely implemented program provides new tools to measure its impact, supports increased emphasis on the role of effective communication in team training, and includes a new course management guide. Teamwork training programs have been shown to improve knowledge and attitudes, but have received mixed reviews on their effectiveness in changing behaviors. An AHRQ WebM&M commentary discussed how improved teamwork and shared decision-making might have prevented the unnecessary placement of a peripherally inserted central catheter that led to significant complications.

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