Formative evaluation of the video reflexive ethnography method, as applied to the physician–nurse dyad

BackgroundDespite decades of research and interventions, poor communication between physicians and nurses continues to be a primary contributor to adverse events in the hospital setting and a major challenge to improving patient safety. The lack of progress suggests that it is time to consider alternative approaches with greater potential to identify and improve communication than those used to date. We conducted a formative evaluation to assess the feasibility, acceptability and utility of using video reflexive ethnography (VRE) to examine, and potentially improve, communication between nurses and physicians.MethodsWe begin with a brief description of the institutional review boardapproval process and recruitment activities, then explain how we conducted the formative evaluation by describing (1) the VRE process itself; (2) our assessment of the exposure to the VRE process; and (3) challenges encountered and lessons learnt as a result of the process, along with suggestions for change.ResultsOur formative evaluation demonstrates that it is feasible and acceptable to video-record communication between physicians and nurses during patient care rounds across many units at a large, academic medical centre. The lessons that we learnt helped to identify procedural changes for future projects. We also discuss the broader application of this methodology as a possible strategy for improving other important quality and safety practices in healthcare settings.ConclusionsThe VRE process did generate increased reflection in both nurse and physician participants. Moreover, VRE has utility in assessing communication and, based on the comments of our participants, can serve as an intervention to possibly improve communication, with implications for patient safety.

Download Full-text

Pilot Testing a Patient Safety Display in the Hospital Setting

Case Medical Research ◽

10.31525/ct1-nct03950921 ◽

2019 ◽

Author(s):

Keyword(s):

Patient Safety ◽

Hospital Setting ◽

Pilot Testing

Download Full-text

Exploring patient safety outcomes for people with learning disabilities in acute hospital settings: a scoping review

BMJ Open ◽

10.1136/bmjopen-2020-047102 ◽

2021 ◽

Vol 11 (5) ◽

pp. e047102

Author(s):

Gemma Louch ◽

Abigail Albutt ◽

Joanna Harlow-Trigg ◽

Sally Moore ◽

Kate Smyth ◽

...

Keyword(s):

Learning Disabilities ◽

Patient Safety ◽

Adverse Events ◽

Grey Literature ◽

Good Practice ◽

Hospital Setting ◽

Eligibility Criteria ◽

Infant Outcomes ◽

Safety Outcomes

ObjectivesTo produce a narrative synthesis of published academic and grey literature focusing on patient safety outcomes for people with learning disabilities in an acute hospital setting.DesignScoping review with narrative synthesis.MethodsThe review followed the six stages of the Arksey and O’Malley framework. We searched four research databases from January 2000 to March 2021, in addition to handsearching and backwards searching using terms relating to our eligibility criteria—patient safety and adverse events, learning disability and hospital setting. Following stakeholder input, we searched grey literature databases and specific websites of known organisations until March 2020. Potentially relevant articles and grey literature materials were screened against the eligibility criteria. Findings were extracted and collated in data charting forms.Results45 academic articles and 33 grey literature materials were included, and we organised the findings around six concepts: (1) adverse events, patient safety and quality of care; (2) maternal and infant outcomes; (3) postoperative outcomes; (4) role of family and carers; (5) understanding needs in hospital and (6) supporting initiatives, recommendations and good practice examples. The findings suggest inequalities and inequities for a range of specific patient safety outcomes including adverse events, quality of care, maternal and infant outcomes and postoperative outcomes, in addition to potential protective factors, such as the roles of family and carers and the extent to which health professionals are able to understand the needs of people with learning disabilities.ConclusionPeople with learning disabilities appear to experience poorer patient safety outcomes in hospital. The involvement of family and carers, and understanding and effectively meeting the needs of people with learning disabilities may play a protective role. Promising interventions and examples of good practice exist, however many of these have not been implemented consistently and warrant further robust evaluation.

Download Full-text

Impact of the COVID-19 pandemic on neuroimaging scan volumes at a teaching hospital

The Neuroradiology Journal ◽

10.1177/1971400920988664 ◽

2021 ◽

pp. 197140092098866

Author(s):

Daniel Thomas Ginat ◽

James Kenniff

Keyword(s):

Magnetic Resonance Imaging ◽

Computed Tomography ◽

Magnetic Resonance ◽

The United States ◽

Radiology Department ◽

Magnetic Resonance Imaging Scan ◽

Resonance Imaging ◽

Academic Medical Centre ◽

Academic Medical ◽

The Impact

Background The COVID-19 pandemic led to a widespread socioeconomic shutdown, including medical facilities in many parts of the world. The purpose of this study was to assess the impact on neuroimaging utilisation at an academic medical centre in the United States caused by this shutdown. Methods Exam volumes from 1 February 2020 to 11 August 2020 were calculated based on patient location, including outpatient, inpatient and emergency, as well as modality type, including computed tomography and magnetic resonance imaging. 13 March 2020 was designated as the beginning of the shutdown period for the radiology department and 1 May 2020 was designated as the reopening date. The scan volumes during the pre-shutdown, shutdown and post-shutdown periods were compared using t-tests. Results Overall, neuroimaging scan volumes declined significantly by 41% during the shutdown period and returned to 98% of the pre-shutdown period levels after the shutdown, with an estimated 3231 missed scans. Outpatient scan volumes were more greatly affected than inpatient scan volumes, while emergency scan volumes declined the least during the shutdown. In addition, the magnetic resonance imaging scan volumes declined to a greater degree than the computed tomography scan volumes during the shutdown. Conclusion The shutdown from the COVID-19 pandemic had a substantial but transient impact on neuroimaging utilisation overall, with variable magnitude depending on patient location and modality type.

Download Full-text

The Role and Activities of Board-Certified Chaplains in Advance Care Planning

American Journal of Hospice and Palliative Medicine® ◽

10.1177/1049909121989996 ◽

2021 ◽

pp. 104990912198999

Author(s):

Jung Kwak ◽

Soyeon Cho ◽

George Handzo ◽

Brian P. Hughes ◽

Sami S. Hasan ◽

...

Keyword(s):

Advance Care Planning ◽

Self Report ◽

Healthcare Team ◽

Care Planning ◽

Cross Sectional ◽

Team Members ◽

Roles And Responsibilities ◽

Healthcare Settings ◽

Academic Medical ◽

Advance Care

Background: Healthcare chaplains have key roles in providing palliative support to patients and families, and they are well-suited to facilitate advance care planning (ACP). However, empirical data on the roles and responsibilities of chaplains in facilitating ACP are limited. Objectives: To examine the roles of board-certified healthcare chaplains in ACP in various healthcare settings. Methods: A cross-sectional, web-based self-report survey was conducted with 585 board-certified chaplains recruited from 3 major professional chaplains’ organizations in the U.S. The survey data included chaplains’ demographic and professional characteristics, their roles and responsibilities, and responses regarding communication and participation with other healthcare team members in facilitating ACP, including experienced barriers. Results: More participants worked in community hospital settings (42%) and academic medical centers (19.6%) than in any other setting. Over 90% viewed ACP as an important part of their work, 70% helped patients complete advance directives, and 90% helped patients discuss their preferences about end-of-life treatments. Many chaplains were not consistently included in team discussions regarding decision-making, although most chaplains reported that they could always find ways to communicate with their teams. Conclusion: Professional board-certified chaplains regularly engage in facilitating ACP discussions with patients and families in various healthcare settings. There is a need to recognize and provide systematic support for the role of chaplains in facilitating ACP conversations and to integrate chaplains into routine interdisciplinary team and family meetings.

Download Full-text

Zero cost approach to fostering multidisciplinary engagement and innovation in an academic medical centre during COVID-19: experience from the Jugaar Innovation Challenge

BMJ Innovations ◽

10.1136/bmjinnov-2020-000542 ◽

2020 ◽

pp. bmjinnov-2020-000542

Author(s):

Rafeh Ahmed ◽

Komal Dayani ◽

Haider Ali Amir ◽

Asad Mian

Keyword(s):

Medical Centre ◽

Academic Medical Centre ◽

Cost Approach ◽

Academic Medical ◽

Innovation Challenge

Download Full-text

Antiepileptic Drug Management in Hospitalized Epilepsy Patients With Nil Per Os Diets: A Retrospective Review

The Neurohospitalist ◽

10.1177/1941874418802513 ◽

2018 ◽

Vol 9 (2) ◽

pp. 65-70

Author(s):

Anna M. Bank ◽

Jong Woo Lee ◽

Alexa N. Ehlert ◽

Aaron L. Berkowitz

Keyword(s):

Antiepileptic Drug ◽

Medical Center ◽

Academic Medical Center ◽

Management Strategies ◽

Hospital Setting ◽

Drug Selection ◽

Drug Management ◽

Oral Medications ◽

Academic Medical ◽

Patients With Epilepsy

Background and Purpose: Antiepileptic drug (AED) management in patients with epilepsy who cannot take their usual oral medications is a common neurologic dilemma in the hospital setting. Strategies to maintain seizure control in patients with nil per os (NPO, nothing by mouth) diet orders include continuation of oral AEDs despite NPO nutrition orders, administration of intravenous AED(s), or temporary administration of benzodiazepines. The frequency with which these strategies are used and their effectiveness in preventing in-hospital seizures is unknown. Methods: We conducted a retrospective cohort study to determine AED management strategies and seizure frequency in hospitalized epilepsy patients with NPO diet status admitted to an academic medical center between 2001 and 2016. Clinical documentation was reviewed. Antiepileptic drug selection (medication and route of administration) and presence or absence of seizures were recorded. Results: We identified 199 admissions during which epilepsy patients had NPO diet orders. Antiepileptic drug management strategies included continuation of oral medications (50.3% of admissions), intravenous AED monotherapy (22.1%), intravenous AED polytherapy (12.6%), benzodiazepines (1.0%), holding AEDs (4.5%), or a combination (9.5%). Seizures occurred during 14 admissions. Treatment with AED polytherapy prior to admission and changing the patient’s AED regimen during admission were associated with increased odds of seizures during admission ( P = .0028; P = .0114). Conclusions: These results suggest that patients’ home oral AED regimens should be continued when possible in order to minimize the frequency of seizures during hospitalizations.

Download Full-text