scholarly journals Massive blood loss protocol ‘Code Red’ at Papworth Hospital: A closed loop audit

2020 ◽  
pp. 175045892094336
Author(s):  
M Tennyson ◽  
J Redlaff ◽  
G Biosse-Duplan ◽  
M Lewin ◽  
N Jones ◽  
...  
Keyword(s):  
Blood Loss ◽  
Patient Care ◽  
Closed Loop ◽  
National Standards ◽  
Standards Of Care ◽  
National Guidelines ◽  
Safe Patient Care ◽  
Massive Blood Loss ◽  
Care Systems ◽  
British Committee

Aim To investigate if the massive blood loss protocol ‘Code Red’ at a specialist cardiothoracic hospital was activated according to local and national guidelines by a closed loop audit. Methods Electronic and paper patient care systems were searched in 2015 and 2018 to access records for the ‘Code Red’ activations. Activation of the massive blood loss protocol was compared against the national standards set by The British Committee for Standards in Haematology. The percentage of cases meeting each of the ten standards in the specialist cardiac unit’s Protocol for the Management of Massive Blood Loss in Adults (adapted from the national standards) were evaluated. Results ‘Code Red’ protocol was activated on 18 occasions in 2015 and nine occasions in 2018, representing just 0.83 and 0.26% of emergency surgeries, respectively. Between 2015 and 2018, there was a 6% increase of ‘Code Red’ cases being appropriately activated, a 26% increase in the prompt notification of the haematology department upon activation, alongside a 30% increase in the timely delivery of blood products, and a 25% decrease in the average amount of blood transferred prior to ‘Code Red’ activation. Conclusion There has been an improvement in the standards of care and management of massive blood loss this specialist cardiac centre despite the target timeframe being reduced from 30 to 15min between 2015 and 2018. Preparation for and anticipation of massive blood loss has likely decreased the number of incidences requiring ‘Code Red’ activation, permitting delivery of safe patient care.

An audit on the management of pelvic inflammatory disease in the West Midlands, UK

2007 ◽  
Vol 18 (10) ◽  
pp. 717-719 ◽  
Author(s):  
M Walzman ◽  
A Tariq ◽  
S Bhaduri ◽  
J D C Ross
Keyword(s):  
Data Collection ◽  
Pelvic Inflammatory Disease ◽  
Inflammatory Disease ◽  
National Standards ◽  
National Standard ◽  
Standards Of Care ◽  
National Guidelines ◽  
The West ◽  
West Midlands

The potential complications of pelvic inflammatory disease (PID) make optimizing its management a high priority. A clinical audit of PID against current national management guidelines was conducted in 14 departments of genitourinary medicine in the West Midlands for women presenting with PID between January and December 2005. There were a total of 810 diagnoses of PID made from a total of 49,390 female attendees for that year, giving an incidence of 164 cases per 10,000 attendees. Of these 810 cases, data collection and analysis for this audit were performed on 139. An ofloxacin 400 mg twice daily (b.i.d.) based regimen was prescribed in 91 (65%, 95% confidence interval [CI] 57–73%) cases. Doxycycline 100 mg b. i. d. for 14 days plus metronidazole 400 mg b. i. d. for 5–14 days was prescribed in 44 (32%, 95% CI 25–40%) cases, but a third-generation cephalosporin was only given with this regimen in three cases. Partner notification was performed in 101 (73%, 95% CI 65–79%) cases. A total of 130 male contacts were recorded on the data collection forms, and of these 58 (45%) were traced and 51 (39%), treated. A follow-up appointment was given to 133 (96%, 95% CI 91–98%) women, although in most cases this was for seven days or more, and 104 (78%, 95% CI 67–81%) women attended for follow-up. Adherence to the national guidelines in this cohort of patients did not reach the national standard for choice of treatment regimen nor did it attain the target for proportion of male partners traced. Barriers preventing adherence to the national guidelines need to be explored and appropriate assistance given to physicians to help meet national standards of care.

Cognitive Load Theory and Patient Safety

2016 ◽  
Author(s):  
Elizabeth Harry ◽  
John Sweller
Keyword(s):  
Working Memory ◽  
Cognitive Load ◽  
Patient Care ◽  
Cognitive Load Theory ◽  
De Novo ◽  
Medical Knowledge ◽  
Safe Patient Care ◽  
Load Theory ◽  
Cognitive Overload ◽  
Care Systems

Effective patient care depends on the ability to store and retrieve patient information and medical knowledge. All knowledge is either acquired from the environment or created de novo through trial and error. In either case, cues from the environment are filtered through working memory to attempt to guide action. Psychological principles such as resource theory and cognitive load theory suggest that humans have a limited amount of working memory that can be used to assimilate new information. When working memory is overloaded (i.e., cognitive overload), one’s attention is limited to fewer salient patient data pieces and one will naturally begin to ignore potentially crucial information. Cognitive overload can occur as a result of highly complex information, poorly organized information, distracting environments, or provider physiology. Attention to factors that lead to cognitive overload are critical in designing safe patient care systems.

Closed-Loop Strategies for Patient Care Systems

2008 ◽  
Vol 64 (Supplement) ◽  
pp. S289-S294 ◽  
Author(s):  
Ronald Pauldine ◽  
George Beck ◽  
Jose Salinas ◽  
David W. Kaczka
Keyword(s):  
Patient Care ◽  
Closed Loop ◽  
Care Systems

scholarly journals P6 A proforma to improve the acute management of traumatic anterior shoulder dislocations to meet published national standards for treatment

BJS Open ◽  
2021 ◽  
Vol 5 (Supplement_1) ◽  
Author(s):  
Richard L Donovan ◽  
Amir Abdelmalek ◽  
Mark A A Crowther ◽  
Iain Packham ◽  
Richard Donovan
Keyword(s):  
Patient Care ◽  
Care Pathway ◽  
Improve Patient Care ◽  
National Standards ◽  
Acute Management ◽  
National Guidelines ◽  
Documentation Quality ◽  
Imaging Utilization

Abstract Background BESS/BOA Patient Care Pathways provide national guidelines for the acute management of traumatic anterior shoulder dislocations with respect to emergency reduction and follow-up assessment. COVID-19 posed increased challenges in terms of analgesia choice and altered follow-up arrangements. This study aimed to assess adherence to the care pathway and improve patient care. Methodology We retrospectively analysed all acute traumatic anterior shoulder dislocations at the MTC in Bristol. We collected data during 01/04/2019-31/05/2019 and 01/04/2020-31/05/2020 to analyse the quality of their management. Data parameters collated included examinations and imaging performance, choice of analgesia, follow-up rates, and physiotherapy referrals. Results We identified 32 patients in 2019, and 24 in 2020. Full neurovascular examinations pre- and post-reduction were poorly documented. Peri-reduction imaging utilization was near 100%. Referral to follow-up was 88% in 2019 but 38% in 2020. Of those assessed in clinic during COVID-19, fewer were mobilised early or referred to outpatient physiotherapy. Conclusions We have created a proforma/prompt to improve the quality of the management of these injuries, and successfully liaised with the Emergency Department for this to be included in their documentation. This proforma improves documentation quality, access to follow up and physiotherapy. During a ‘second wave’ we encourage patient access to BESS online resources.

scholarly journals Use of alternative consultation forms in Danish general practice in the initial phase of the COVID-19 pandemic – a qualitative study

2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Tina Drud Due ◽  
Thorkil Thorsen ◽  
Julie Høgsgaard Andersen
Keyword(s):  
Patient Care ◽  
Initial Phase ◽  
Health Care Systems ◽  
Qualitative Interviews ◽  
Clinical Work ◽  
Health Issues ◽  
Short Term ◽  
Diagnostic Uncertainty ◽  
Face To Face ◽  
Care Systems

Abstract Background Attempts to manage the COVID-19 pandemic have led to radical reorganisations of health care systems worldwide. General practitioners (GPs) provide the vast majority of patient care, and knowledge of their experiences with providing care for regular health issues during a pandemic is scarce. Hence, in a Danish context we explored how GPs experienced reorganising their work in an attempt to uphold sufficient patient care while contributing to minimizing the spread of COVID-19. Further, in relation to this, we examined what guided GPs’ choices between telephone, video and face-to-face consultations. Methods This study consisted of qualitative interviews with 13 GPs. They were interviewed twice, approximately three months apart in the initial phase of the pandemic, and they took daily notes for 20 days. All interviews were audio recorded, transcribed, and inductively analysed. Results The GPs re-organised their clinical work profoundly. Most consultations were converted to video or telephone, postponed or cancelled. The use of video first rose, but soon declined, once again replaced by an increased use of face-to-face consultations. When choosing between consultation forms, the GPs took into account the need to minimise the risk of COVID-19, the central guidelines, and their own preference for face-to-face consultations. There were variations over time and between the GPs regarding which health issues were dealt with by using video and/or the telephone. For some health issues, the GPs generally deemed it acceptable to use video or telephone, postpone or cancel appointments for a short term, and in a crisis situation. They experienced relational and technical limitations with video consultation, while diagnostic uncertainty was not regarded as a prominent issue Conclusion This study demonstrates how the GPs experienced telephone and video consultations as being useful in a pandemic situation when face-to-face consultations had to be severely restricted. The GPs did, however, identify several limitations similar to those known in non-pandemic times. The weighing of pros and cons and their willingness to use these alternatives shifted and generally diminished when face-to-face consultations were once again deemed viable. In case of future pandemics, such alternatives seem valuable, at least for a short term.

Predictors of massive blood loss from placenta accreta: Wright et al

2011 ◽  
Vol 205 (1) ◽  
pp. 85-86
Author(s):  
Anthony Shanks ◽  
Jennifer McNamara ◽  
Meiling Hua ◽  
Jessica McPherson
Keyword(s):  
Blood Loss ◽  
Placenta Accreta ◽  
Massive Blood Loss

scholarly journals Payment Reforms for Prehospital Care Services in a Middle Income Country: Assessing Implementation and Patient Outcomes Using a Mixed-Methods Approach

2018 ◽  
Vol 2018 ◽  
pp. 1-10
Author(s):  
Paibul Suriyawongpaisal ◽  
Samrit Srithamrongsawad ◽  
Pongsakorn Atiksawedparit ◽  
Khanisthar Phooseemungkun ◽  
Krongkan Bunchaiyai ◽  
...  
Keyword(s):  
Mixed Methods ◽  
Patient Care ◽  
Patient Outcomes ◽  
Prehospital Care ◽  
Clinical Care ◽  
Mixed Methods Approach ◽  
Time Flow ◽  
Care Systems ◽  
Pay System ◽  
Made In

Introduction. Financing health systems constitutes a key element of well-functioning healthcare system. Prior to 2015, two new financial arrangements (direct-pay and E-claim systems) were introduced on a voluntary basis which aimed to pool more financial resources and improve cash flow of prehospital care systems. The aims of this study were to (1) assess the effects of direct-pay system in terms of (a) timeliness of reimbursement to EMS agencies, (b) changes in clinical care processes, and (c) the outcomes of patient care as compared to previous system; (2) identify the reasons for or against EMS agencies to participate in direct-pay system mechanisms; (3) identify the emerging issues with potential to significantly further the advancement of EMS systems. Using a mixed-methods approach, retrospective datasets of 3,769,399 individual records of call responses from 2015 to 2017 were analyzed which compared EMS units with the direct-pay system against those without in terms of time flow of claim data and patient outcomes. For qualitative data, in-depth interviews were conducted. Results. EMS units participating in both systems had the highest percentages of financial claim being made in time as compared to those not participating in any (p=0.012). However, there were not any practically meaningful differences between EMS units participating and not participating in either of the payment systems in terms of patient care such as appropriateness of response time, airway management, and outcome of treatment. Analysis of data from focus-group and individual interviews ended up with a causal loop diagram demonstrating potential explanatory mechanisms for those findings. Conclusion. It is evident that progress has been made in terms of mobilising more financial inputs and improving financial information flow. However, there is no evidence of any changes in patient outcomes and quality of care. Furthermore, whether the progress is meaningful in filling the gaps of financial demands of the prehospital care systems is still questionable. Room for future improvement of prehospital care systems was discussed with implications for other countries.

Fire in operating theatres: DaSH-ing to the rescue

2018 ◽  
Vol 28 (7-8) ◽  
pp. 188-193
Author(s):  
Liam Wilson ◽  
Omer Farooq
Keyword(s):  
Patient Care ◽  
Fire Safety ◽  
Training Session ◽  
Operating Theatre ◽  
In Situ Simulation ◽  
Safe Patient Care ◽  
Team Interactions ◽  
Operating Theatres ◽  
Theatre Staff ◽  
Safety Officer

Operating theatres are dynamic environments that require multi professional team interactions. Effective team working is essential for efficient delivery of safe patient care. A fire in the operating theatre is a rare but potentially life threatening event for both patients and staff. A rapid and cohesive response from theatre and allied staff including porters, fire safety officer etc is paramount. We delivered a training session that utilised in situ simulation (simulation in workplace). After conducting needs analysis, learning objectives were agreed. After thorough planning, the date and location of the training session were identified. Contingency plans were put in place to ensure that patient care was not compromised at any point. To ensure success, checklists for faculty were devised and adhered to. A medium fidelity manikin with live monitoring was used. The first part of the scenario involved management of a surgical emergency by theatre staff. The second part involved management of a fire in the operating theatre while an emergency procedure was being undertaken. To achieve maximum learning potential, debriefing was provided immediately after each part of the scenario. A fire safety officer was present as a content expert. Latent errors (hidden errors in the workplace, staff knowledge etc) were identified. Malfunctioning of theatre floor windows and staff unawareness about the location of an evacuation site were some of the identified latent errors. Thorough feedback to address these issues was provided to the participants on the day. A detailed report of the training session was given to the relevant departments. This resulted in the equipment faults being rectified. The training session was a very positive experience and helped not only in improving participants’ knowledge, behaviour and confidence but also it made system and environment better equipped.

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