Multiprofessional perspectives on the identification of latent safety threats via in situ simulation: a prospective cohort pilot study

2020 ◽  
pp. bmjstel-2020-000621
Author(s):  
Daniel Rusiecki ◽  
Melanie Walker ◽  
Stuart L Douglas ◽  
Sharleen Hoffe ◽  
Timothy Chaplin
Keyword(s):  
Survey Data ◽  
Demographic Data ◽  
Tertiary Care ◽  
Years Of Experience ◽  
In Situ Simulation ◽  
Respiratory Therapists ◽  
High Acuity ◽  
The Difference ◽  
Study Participants

ObjectivesTo describe the association between participant profession and the number and type of latent safety threats (LSTs) identified during in situ simulation (ISS). Secondary objectives were to describe the association between both (a) participants’ years of experience and LST identification and (b) type of scenario and number of identified LSTs.MethodsEmergency staff physicians (MDs), registered nurses (RNs) and respiratory therapists (RTs) participated in ISS sessions in the emergency department (ED) of a tertiary care teaching hospital. Adult and paediatric scenarios were designed to be high-acuity, low-occurrence resuscitation cases. Simulations were 10 min in duration. A written survey was administered to participants immediately postsimulation, collecting demographic data and perceived LSTs. Survey data was collated and LSTs were grouped using a previously described framework.ResultsThirteen simulation sessions were completed from July to November 2018, with 59 participants (12 MDs, 41 RNs, 6 RTs). Twenty-four unique LSTs were identified from survey data. RNs identified a median of 2 (IQR 1, 2.5) LSTs, significantly more than RTs (0.5 (IQR 0, 1.25), p=0.04). Within respective professions, MDs and RTs most commonly identified equipment issues, and RNs most commonly identified medication issues. Participants with ≤10 years of experience identified a median of 2 (IQR 1, 3) LSTs versus 1 (IQR 1, 2) LST in those with >10 years of experience (p=0.06). Adult and paediatric patient scenarios were associated with the identification of a median of 4 (IQR 3.0, 4.0) and 5 LSTs (IQR 3.5, 6.5), respectively (p=0.15).ConclusionsInclusion of a multidisciplinary team is important during ISS in order to gain a breadth of perspectives for the identification of LSTs. In our study, participants with ≤10 years of experience and simulations with paediatric scenarios were associated with a higher number of identified LSTs; however, the difference was not statistically significant.

scholarly journals A comparative study of two different techniques of subcutaneous tissue closure in abdominal surgery

2017 ◽  
Vol 6 (12) ◽  
pp. 5512
Author(s):  
Jyotsna S. Dwivedi ◽  
Alka S. Gupta ◽  
Sachin H. Pardeshi
Keyword(s):  
Subcutaneous Tissue ◽  
Tertiary Care ◽  
Total Duration ◽  
Wound Complications ◽  
Control Group ◽  
Tertiary Care Centre ◽  
Surgical Access ◽  
Suction Drain ◽  
The Difference

Background: Surgical access to abdomen is required for many operative procedures. The subcutaneous tissue of the anterior abdominal wall can either be sutured or left unsutured with drain in situ. The purpose of this study was to compare the two methods of closure of the subcutaneous tissue and determine the benefit of one over the other.Methods: The study was conducted in a tertiary care centre with sample size of 30 each in study and control group. Patients fulfilling the inclusion criteria were selected and depending on the randomisation the closure of subcutaneous tissue was done either by polyglactin 910, 2-0 or left unsutured with indigenously designed syringe suction drain kept in situ. The patients were followed up till the day of suture removal and further in case of any complications.Results: Total duration taken for the procedure was significantly increased in the study group. There was a significant level of discomfort among the participants due to drain. The rate of surgical site infection, hospital readmission morbidity was significantly higher in the study group.Conclusions: The type of drain studied was indigenously designed where the closed system was not maintained during charging the drain, hence further studies need to be conducted which will compare this with the other closed suction drains to determine the difference in the risk of wound complications.

scholarly journals LO095: Developing and implementing an interprofessional in-situ simulation program in an academic, tertiary-care emergency department: barriers, successes and the Ottawa Hospital experience

CJEM ◽  
2016 ◽  
Vol 18 (S1) ◽  
pp. S63-S63
Author(s):  
C. Poulin ◽  
B. Weitzman ◽  
G. Mastoras ◽  
L. Norman ◽  
A. Pozgay ◽  
...  
Keyword(s):  
Emergency Department ◽  
Emergency Medicine ◽  
Patient Care ◽  
Financial Support ◽  
Tertiary Care ◽  
Simulation Program ◽  
In Situ Simulation ◽  
Simulation Center ◽  
The Impact

Introduction / Innovation Concept: During Emergency Department (ED) resuscitation of critically ill patients, effective teamwork and communication among various healthcare professionals is essential to ensure favorable patient outcomes and to minimize threats to patient safety. However, numerous individual and system factors create barriers to effective team functioning. Simulation center- based training has been used to improve Crisis Resource Management skills among physician and nursing trainees, but in-situ simulation is a relatively new concept in adult Emergency Medicine in North America. Methods: To enhance patient care and team effectiveness, an ED nursing and physician group was created to develop and implement a novel interprofessional in-situ simulation program in two Canadian, academic tertiary-care emergency departments. Departmental approval and financial support was obtained and sessions commenced in January 2015. Curriculum, Tool, or Material: Monthly high-fidelity simulation sessions are held in the ED resuscitation rooms at both campuses of our hospital. Each session is facilitated and debriefed by simulation-trained Emergency Medicine faculty and senior residents, a nurse educator and a research assistant. Technical support is provided by our simulation center staff. Participants are recruited from the physicians, residents, nurses, respiratory therapists and other support staff working in the ED. To minimize the impact on patient care, two additional nurses are scheduled to cover nursing assignments on “sim days”. Simulations are limited to fifteen minutes, followed by a twenty minute debriefing. Conclusion: We have successfully developed and implemented an interprofessional in-situ simulation program in our ED. Participant feedback has been overwhelmingly positive. Lack of financial support, reluctance of staff to participate, and overwhelmed resources are some of the challenges to running a program like this in a busy ED environment. However, there are clear benefits: empowering team members, culture change, identification of latent safety threats, and a perception of improved teamwork and communication.

scholarly journals LO81: The use of in situ simulation to improve emergency department staff comfort with the management of high acuity, low occurrence cases

CJEM ◽  
2020 ◽  
Vol 22 (S1) ◽  
pp. S36-S37 ◽  
Author(s):  
M. Bilic ◽  
K. Hassall ◽  
M. Hastings ◽  
C. Fraser ◽  
G. Rutledge ◽  
...  
Keyword(s):  
Emergency Department ◽  
Interprofessional Education ◽  
Low Frequency ◽  
High Volume ◽  
Simulation Design ◽  
Low Frequencies ◽  
In Situ Simulation ◽  
High Acuity ◽  
Quasi Experimental

Introduction: In the emergency department (ED), high-acuity presentations encountered at low frequencies are associated with reduced staff comfort. Previous studies have shown that simulation can improve provider confidence with practical skills and management of presentations in various fields of medicine. The present study examined the effect of in situ simulation on interprofessional provider comfort with the identification and management of high-acuity low-frequency events in the ED. It further assessed the feasibility of implementing weekly simulation as an interprofessional education initiative in a high-volume ED. Methods: This was a retrospective pre-test post-test quasi-experimental design. Weekly in situ simulation events were facilitated by an interdisciplinary team in a high-volume ED in Hamilton, Ontario that sees an average of 185 patients per day. To date, 34 simulation events were held between January 18, 2019 and November 22, 2019, and included neonatal, paediatric and obstetric emergencies, and adult codes. There was an average of 20 patients presenting to the ED during these events. Events included a debrief, and typically lasted 60 minutes in total. Participants included individuals from various disciplines working on shift at the time of the event. Questionnaires were administered via email following the event, in which participants were asked to rank their comfort with emergency codes before and after the simulation using two 5-point Likert scales. The data from 39 questionnaires was analyzed. T-tests were used to analyze differences in self-reported comfort scores. Results: Questionnaire responders included nurses (41%), respiratory therapists (26%), resident physicians (10%), paramedics (3%), attending physicians (3%), students of various disciplines (10%) and other (7%). 38% of participants reported increases in comfort following simulation when compared to prior. Using the 5-point scale, the average reported score for comfort pre-simulation was 3.59 (95% CI 3.30–3.88), and the average post-simulation score was 3.97 (95% CI 3.76–4.19, p = 0.03). Conclusion: Our results demonstrate that weekly interprofessional in situ simulation is feasible in a high-volume ED, and significantly improves self-reported provider comfort with the identification and management of high-acuity, low-frequency events. This warrants the implementation of this simulation design to improve staff confidence and has implications for its potential role in improving team dynamics and patient safety.

scholarly journals Adherence to COVID-19 Appropriate Behavior Among Respiratory Therapists: A Cross-Sectional Study in the Kingdom of Saudi Arabia

2021 ◽  
Vol 9 ◽  
Author(s):  
Noor Al Khathlan ◽  
Bijaya Kumar Padhi
Keyword(s):  
Saudi Arabia ◽  
Risk Perception ◽  
High Risk ◽  
Years Of Experience ◽  
Adherence Level ◽  
Appropriate Behavior ◽  
Respiratory Therapists ◽  
Healthcare Settings ◽  
Study Participants ◽  
At Home

Background: Adherence to novel coronavirus disease 2019 (COVID-19) appropriate behavior plays a crucial element in the management of the infections of COVID-19. Despite the importance of transmission-reducing behaviors among healthcare professionals, there is a lack of literature in this area of research explicitly relating to respiratory therapists (RTs). Therefore, it is essential to assess the adherence level to COVID-19 transmission-reducing behaviors among the RTs in Saudi Arabia.Methods: A web-based online survey was conducted using questions based on the risk assessment guidelines of WHO. A random representative sample of RTs (N = 215) residing in Saudi Arabia was recruited for the study. Descriptive and inferential statistics were computed using STATA software. Logistic regression analysis was used to identify key factors that are associated with adherence to COVID-19 appropriate behavior among the study participants.Results: Of the 215 participants, 59.5% were aged between 26 and 35 years, and 40.9% were women. Most (85.5%) participants had a bachelor's degree while 12.0% had a master's degree. About 56.2% of RTs provided direct care to a confirmed patient of COVID-19 during the study periods. The study showed 80.9% of RTs in Saudi Arabia adhered to personal protective equipment (PPE) at the workplace and 65.0% at home. Moreover, the findings of the study indicated that senior RTs (with >5 years of experience) demonstrated a higher adherence level to the guidelines than RTs with <5 years of experience. High-risk perception [aOR:2.32; 95% CI: 1.09–3.27], and work history of <5 years [aOR:2.00; 95% CI: 1.14–3.15], were found to be the strongest predictors in explaining the adherence to appropriate behavior among the RTs at the workplace. Whereas the high-risk perception [aOR:2.32; 95% CI: 1.09–3.27] and being married [aOR:1.85; 95% CI: 1.08–3.82] were found to be the strongest predictors at home.Conclusion: Adherence (“Always” or “Most times”) to COVID-19 appropriate behavior was found to be high at hospital settings among the study participants. However, the same practice was found to be inconsistence in non-healthcare settings among the RTs. Considering the paramount role of COVID-19 appropriate behavior in reducing the transmissions the policy focus, therefore, needs to be on creating a well-spread behavior change communication that is curtailing the adoption of appropriate behavior in the non-healthcare settings.

Occupational Hazards Awareness and Preventive Practices Among Dental Interns Versus Dental Postgraduate at Riyadh Elm University Hospital

2019 ◽  
Vol 4 (04) ◽  
Author(s):  
Dr. Ahmed Sayed Khashaba M.B.B. Ch. MD. PhD. ◽  
Abdulmohsen Mamdouh AlAnazi ◽  
Omar Mufi AlDawsari ◽  
Meshal Mohammed AlQahtani
Keyword(s):  
Demographic Data ◽  
Dental Materials ◽  
Assessment Tools ◽  
University Hospital ◽  
Occupational Hazards ◽  
Preventive Practices ◽  
Occupational Risks ◽  
Eye Problems ◽  
The Difference ◽  
Study Participants

Background: Dental interns and postgraduates were predisposed to a number of occupational hazards, these includes exposure to infections, percutaneous exposure events, dental materials, radiation, and noise, musculoskeletal disorders, psychological problems and dermatitis, respiratory disorders, and eye problems. Aim of work: To assess the level of occupational hazards awareness and preventive practices among dental interns versus dental postgraduates in Riyadh Elm University. Subject and methods: 100 participants were subjected to a questionnaire that included demographic data, awareness of occupational hazards and safety measures practiced by the study participants. Assessment tools were conducted through calculation of the three rates (accident incidence rate, accident frequency rate and accident severity rate), in addition to, calculation of frequency of each question, scoring degree and grading from weak, moderate to excellent. Results: Out of the 100 participants, 85% were males and 15% were females; 87% of participants were excellent in applying the term preventive practices and the rest of participants were moderate but the difference between the two groups was statistically insignificant (P= 0.103) and nearly equal to each other. However, the majority of participants awareness about occupational hazards and preventive practices were weak and the difference between the two groups was statistically significant (P=0.000). Conclusion: Dentists were exposed to many occupational risks hazarded during work and need more education programs to overcome these occupational hazards.

scholarly journals LO90: The clock is ticking: using in situ simulation to improve time to blood delivery in bleeding trauma patients

CJEM ◽  
2019 ◽  
Vol 21 (S1) ◽  
pp. S40-S41 ◽  
Author(s):  
A. Petrosoniak ◽  
A. Gray ◽  
K. Pavenski ◽  
M. McGowan ◽  
L. Chartier
Keyword(s):  
Injury Severity ◽  
Blood Product ◽  
Clinical Care ◽  
Demographic Data ◽  
Clinical Work ◽  
Relative Reduction ◽  
Trauma Patients ◽  
In Situ Simulation ◽  
Stakeholder Satisfaction

Background: Massive transfusion protocols (MTP) are widely used to rapidly deliver blood products to bleeding trauma patients. Every minute delay in blood product administration in bleeding trauma patients is associated with a 5% increased odds of death. In-situ simulation (ISS) is simulation that takes place in the actual clinical work environment. We used ISS as a novel, prospective and iterative quality improvement (QI) approach to identify and improve MTP steps that impact time to blood delivery (TTBD) during actual trauma resuscitations. Aim Statement: To reduce the TTBD for bleeding trauma patients by 20% over a 12-month ISS-based QI initiative. Measures & Design: We conducted twelve high-fidelity, interprofessional ISS sessions at a Level-1 trauma center in Toronto, Canada. We used clinician video review as well as extensive stakeholder involvement, including with nurses, porters, blood bank and human factors experts, to develop Plan-Do-Study-Act (PDSA) cycles for MTP improvement. Our three major PDSA cycles revolved around: 1) decreasing MTP activation time; 2) reducing the unpredictable and inefficient transport times for the blood itself; and 3) improving the notification of blood product arrival in the trauma bay. Each PDSA cycle was iteratively tested with ISS prior to implementation into clinical care. Outcome measure was the mean TTBD for trauma patients requiring MTP (in minutes, standard deviation [SD]). Process measures included time to MTP activation and porter transport times. Balancing measures included stakeholder satisfaction. Evaluation/Results: Our baseline TTBD for MTP patients was 11.58min (n = 41, SD 6.8). There were 54 trauma patients that had MTP during the ISS-based QI initiative, and their mean TTBD was 10.44min (SD 6.1). The TTBD after the QI initiative was 9.12min, sustained over 1 year (n = 50, SD 5.3; 21.2% relative reduction, p < 0.05). A run chart did not show special cause variation chronologically related to our interventions. Patients in each group were similar in demographic data, trauma characteristics and injury severity score. Discussion/Impact: We achieved a 21.2% reduction in TTBD for trauma patients requiring MTP with an ISS-based QI initiative. ISS represents a novel approach to the identification and iterative testing of process improvements within trauma care. This methodology can and should be included in QI projects in order to safely test and improve processes of care before they impact real patients.

scholarly journals Assessment on awareness of rational prescribing practices among medical interns in a tertiary care hospital: a questionnaire based study

2019 ◽  
Vol 8 (5) ◽  
pp. 1096
Author(s):  
Manasa C. R. ◽  
Kalpana L. ◽  
Veena R. M. ◽  
Lavanya S. H. ◽  
Bharath Kumar V. D.
Keyword(s):  
Tertiary Care ◽  
Future Generation ◽  
Work Place ◽  
Care Hospital ◽  
Prescribing Practices ◽  
Rational Use ◽  
Rational Use Of Medicines ◽  
Rational Drug ◽  
The Difference ◽  
Study Participants

Background: Awareness about rational use of Medicines is required to improve the quality of health care system. Attitude towards rational drug use is also an utmost importance as they constitute the future generation doctors.Methods: A set of 13 questionnaire is given to the interns through an online link to their e-mail which contains informed consent and questionnaires. Respondents has to select the best suitable option and after which the data will be compiled and statistically analyzed.Results: Age of the study participants range from 22-26yrs. Half of them have finished major postings. Almost 96.1 % of them were aware of the term essential drugs. Only 25% of them said that they have NLEMI at work place, 75% of them were aware of the term Rational use of Medicines. Only 32% of them were aware of the term P drugs. 44% of them were aware of STEP criteria for selection of drug and 47% of them were aware of the updated prescribing format. 8% knew the difference between old and new prescription format, 25% of them always prescribe. Almost 82% of them narrate regarding the disease and drug therapy, 31% of them prescribe only generic name.Conclusions: Educational intervention like CME and practical hands on training in Rational use of Medicines would help them in better understanding of the subject and its clinical implications thereby decreasing the prescribing errors.

scholarly journals Integration of In Situ Simulation Into an Emergency Department Code Orange Exercise in a Tertiary Care Trauma Referral Center

2020 ◽  
Author(s):  
Harrison Carmichael ◽  
George Mastoras ◽  
Caroline Nolan ◽  
Hung Tan ◽  
Jeffrey Tochkin ◽  
...  
Keyword(s):  
Emergency Department ◽  
Tertiary Care ◽  
In Situ Simulation ◽  
Referral Center

scholarly journals The Effect of the Nature of the Job on Job stability: Applied study on the employees of the General Directorate of Health Affairs in Assir Region: أثر طبيعة الوظيفة على الاستقرار الوظيفي: دراسة تطبيقية على العاملين بالمديرية العامة للشئون الصحية بمنطقة عسير

2020 ◽  
Vol 4 (3) ◽  
Author(s):  
FAHAD ABDULLAH MOHAMMED ALJUBAIRI
Keyword(s):  
Demographic Data ◽  
Total Degree ◽  
Functional Stability ◽  
Years Of Experience ◽  
Job Stability ◽  
Temporary Employees ◽  
Temporary Employee ◽  
Academic Qualification ◽  
The Difference ◽  
Permanent Employees

The study aimed to detect the effect of the nature of the job (temporary- permanent) on the job stability of the employees of the general directorate of Health Affairs in Assir region, as well as to identify the differences between these employees according to the variables ((Nature of the job – type/sex- age- academic qualification- years of experience- career status). The study used the descriptive analytical method in this research. The researcher prepared a questionnaire as a tool for study, which included the demographic data of the workers and two presidents. The first is the nature of the job and its paragraphs (11) and the second represents the stability of the career and paragraphs (17) paragraph. After the questionnaire was applied to the study sample, the data was obtained and processed and analyzed statistically by the Statistical Packages for Social Sciences (SPSS) program. The study found statistically significant differences between the averages of permanent and temporary employees in the total degree of career stability for permanent employees, where the average permanent employees were higher than the average of temporary employees. There were also no statistically significant differences between the averages of temporary employees in the total degree of job stability due to differences in gender (males and females). Also, there were no statistically significant differences in job stability due to job status, nor were there any differences in job stability between the general employee and managers. There were also no differences in job stability among temporary employee, depending on the difference in the academic qualification. The value of "P" was not statistically significant. There were also no differences in the functional stability of the temporary employee, depending on the difference in years of experience. The value of "P" was not statistically significant. There were also no differences in the functional stability of the temporary employee according to the difference in age, where the value of "P" was not statistically significant. The study recommended the necessity of providing the basic needs of temporary employees for the purpose of informing them of safety and job stability, while providing them with material and moral incentives in order to increase their association with the labor institution and thus ensure their job stability.

Sign in / Sign up

Export Citation Format

Share Document