Development and implementation of an end-of-shift clinical debriefing method for emergency departments during COVID-19

Abstract Background Multiple guidelines recommend debriefing after clinical events in the emergency department (ED) to improve performance, but their implementation has been limited. We aimed to start a clinical debriefing program to identify opportunities to address teamwork and patient safety during the COVID-19 pandemic. Methods We reviewed existing literature on best-practice guidelines to answer key clinical debriefing program design questions. An end-of-shift huddle format for the debriefs allowed multiple cases of suspected or confirmed COVID-19 illness to be discussed in the same session, promoting situational awareness and team learning. A novel ED-based clinical debriefing tool was implemented and titled Debriefing In Situ COVID-19 to Encourage Reflection and Plus-Delta in Healthcare After Shifts End (DISCOVER-PHASE). A facilitator experienced in simulation debriefings would facilitate a short (10–25 min) discussion of the relevant cases by following a scripted series of stages for debriefing. Data on the number of debriefing opportunities, frequency of utilization of debriefing, debriefing location, and professional background of the facilitator were analyzed. Results During the study period, the ED treated 3386 suspected or confirmed COVID-19 cases, with 11 deaths and 77 ICU admissions. Of the 187 debriefing opportunities in the first 8-week period, 163 (87.2%) were performed. Of the 24 debriefings not performed, 21 (87.5%) of these were during the four first weeks (21/24; 87.5%). Clinical debriefings had a median duration of 10 min (IQR 7–13). They were mostly facilitated by a nurse (85.9%) and mainly performed remotely (89.8%). Conclusion Debriefing with DISCOVER-PHASE during the COVID-19 pandemic were performed often, were relatively brief, and were most often led remotely by a nurse facilitator. Future research should describe the clinical and organizational impact of this DISCOVER-PHASE.

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Determinants of Managed Entry Agreements in the context of Health Technology Assessment: a comparative analysis of oncology therapies in four countries

International Journal of Technology Assessment in Health Care ◽

10.1017/s0266462321000039 ◽

2021 ◽

Vol 37 ◽

Author(s):

Olina Efthymiadou ◽

Panos Kanavos

Keyword(s):

Decision Making ◽

Health Technology Assessment ◽

Technology Assessment ◽

Best Practice ◽

Health Technology ◽

Future Research ◽

Best Practice Guidelines ◽

Chi Squared ◽

Decision Making Factors ◽

Managed Entry Agreements

Abstract Background Managed Entry Agreements (MEAs) are increasingly used to address uncertainties arising in the Health Technology Assessment (HTA) process due to immature evidence of new, high-cost medicines on their real-world performance and cost-effectiveness. The literature remains inconclusive on the HTA decision-making factors that influence the utilization of MEAs. We aimed to assess if the uptake of MEAs differs between countries and if so, to understand which HTA decision-making criteria play a role in determining such differences. Methods All oncology medicines approved since 2009 in Australia, England, Scotland, and Sweden were studied. Four categories of variables were collected from publicly available HTA reports of the above drugs: (i) Social Value Judgments (SVJs), (ii) Clinical/Economic evidence submitted, (iii) Interpretation of this evidence, and (iv) Funding decision. Conditional/restricted decisions were coded as Listed With Conditions (LWC) other than an MEA or LWC including an MEA (LWCMEA). Cohen's κ-scores measured the inter-rater agreement of countries on their LWCMEA outcomes and Pearson's chi-squared tests explored the association between HTA variables and LWCMEA outcomes. Results A total of 74 drug-indication pairs were found resulting in n = 296 observations; 8 percent (n = 23) were LWC and 55 percent (n = 163) were LWCMEA. A poor-to-moderate agreement existed between countries (−.29 < κ < .33) on LWCMEA decisions. Cross-country differences within the LWCMEA sample were partly driven by economic uncertainties and largely driven by SVJs considered across agencies. Conclusions A set of HTA-related variables driving the uptake of MEAs across countries was identified. These findings can be useful in future research aimed at informing country-specific, “best-practice” guidelines for successful MEA implementation.

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LO87: Use of a clinical prediction rule would lead to more effective CTA utilization for urgent brain imaging of suspected TIA/mild stroke in the emergency department

CJEM ◽

10.1017/cem.2017.149 ◽

2017 ◽

Vol 19 (S1) ◽

pp. S58

Author(s):

K. Votova ◽

M. Bibok ◽

R. Balshaw ◽

M. Penn ◽

M.L. Lesperance ◽

...

Keyword(s):

Emergency Department ◽

Brain Imaging ◽

Practice Guidelines ◽

Best Practice ◽

Prediction Rule ◽

Clinical Prediction Rule ◽

Decision Threshold ◽

Clinical Prediction ◽

Focal Neurological Deficit ◽

Best Practice Guidelines

Introduction: Canadian stroke best practice guidelines recommend patients suspected of Acute Cerebrovascular Syndrome (ACVS) receive urgent brain imaging, preferably CTA. Yet, high requisition rates for non-ACVS patients overburdens limited radiological resources. We hypothesize that our clinical prediction rule (CPR) previously developed for diagnosis of ACVS in the emergency department (ED), and which incorporates Canadian guidelines, could improve CTA utilization. Methods: Our data consists of records for 1978 ED-referred patients to our TIA clinic in Victoria, BC from 2015-2016. Clinic referral forms captured all data needed for the CPR. For patients who received CTA, orders were placed in the ED or at the TIA clinic upon arrival. We use McNemar’s test to compare the sensitivity (sens) and specificity (spec) of our CPR vs. the baseline CTA orders for identifying ACVS. Results: Our sample (49.5% male, 60.6% ACVS) has a mean age of 70.9±13.6 yrs. Clinicians ordered 1190 CTAs (baseline) for these patients (60%). Where CTA was ordered, 65% of patients (n=768) were diagnosed as ACVS. To evaluate our CPR, predicted probabilities of ACVS were computed using the ED referral data. Those patients with probabilities greater than the decision threshold and presenting with at least one focal neurological deficit clinically symptomatic of ACVS were flagged as would have received a CTA. Our CPR would have ordered 1208 CTAs (vs. 1190 baseline). Where CTA would have been ordered, 74% of patients (n=893) had an ACVS diagnosis. This is a significantly improved performance over baseline (sens 74.5% vs. 64.1%, p<0.001; spec 59.6% vs. 45.9%, p<0.001). Specifically, the CPR would have ordered an additional 18 CTAs over the 2-yr period, while simultaneously increasing the number of imaged-ACVS patients by 125 with imaging 107 fewer non-ACVS patients. Conclusion: Using ED physician referral data, our CPR demonstrates significantly higher sensitivity and specificity for CTA imaging of ACVS patients than baseline CTA utilization. Moreover, our CPR would assist ED physicians to apply and practice the Canadian stroke best practice guidelines. ED physician use of our CPR would increase the number of ACVS patients receiving CTA imaging before ED discharge (rather than later at TIA clinics), and ultimately reduce the burden of false-positives on radiological departments.

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Assessing the Veracity of Children’s Forensic Interviews

10.1093/oso/9780190612016.003.0006 ◽

2017 ◽

Author(s):

Hayden M. Henderson ◽

Samantha J. Andrews

Keyword(s):

Content Analysis ◽

Practice Guidelines ◽

Best Practice ◽

Field Research ◽

Reality Monitoring ◽

Future Research ◽

Forensic Interviews ◽

Interview Protocol ◽

Investigative Interview ◽

Best Practice Guidelines

This chapter discusses the various ways in which the veracity of children’s forensic interviews can be assessed, and the implications this diversity has for the courtroom. Beforehand, it summarizes the capabilities and vulnerabilities children bring to forensic settings, and then what constitutes veracity, the importance this concept has in legal settings, and how it is typically measured. Reality Monitoring (RM) and Criteria-Based Content Analysis (CBCA) are reviewed alongside experimental and field research designed to elucidate the ways in which interview “quality” can be improved. The usefulness of best practice guidelines, such as the NICHD Investigative Interview Protocol, in assessing quality is considered. Difficulties for translating research into practice are discussed. The implications these factors have for the examination of children in court are then considered, and the experimental and field research is reviewed. The chapter ends by outlining directions for future research.

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Dehydration and Malnutrition in Residential Care: Recommendations for Strategies for Improving Practice Derived from a Scoping Review of Existing Policies and Guidelines

Geriatrics ◽

10.3390/geriatrics3040077 ◽

2018 ◽

Vol 3 (4) ◽

pp. 77 ◽

Cited By ~ 6

Author(s):

Diane Bunn ◽

Lee Hooper ◽

Ailsa Welch

Keyword(s):

Residential Care ◽

Scoping Review ◽

Best Practice ◽

Care Home ◽

Future Research ◽

Menu Planning ◽

Best Practice Guidelines ◽

Contractual Obligations ◽

Statutory Regulation ◽

Considerable Body

Preventing malnutrition and dehydration in older care home residents is a complex task, with both conditions remaining prevalent, despite numerous guidelines spanning several decades. This policy-mapping scoping review used snowballing search methods to locate publicly-available policies, reports and best practice guidelines relating to hydration and nutrition in UK residential care homes, to describe the existing knowledge base and pinpoint gaps in practice, interpretation and further investigation. The findings were synthesised narratively to identify solutions. Strategies for improvements to nutritional and hydration care include the development of age and population-specific nutrient and fluid intake guidelines, statutory regulation, contractual obligations for commissioners, appropriate menu-planning, the implementation and auditing of care, acknowledgment of residents’ eating and drinking experiences, effective screening, monitoring and treatment and staff training. The considerable body of existing knowledge is failing to influence practice, relating to translational issues of implementing knowledge into care at the point of delivery, and this is where future research and actions should focus.

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Dysphagia Therapy in Adults with a Tracheostomy: A Scoping Review Protocol

10.21203/rs.3.rs-593909/v2 ◽

2021 ◽

Author(s):

Waiza Kadri ◽

Rhiannon Halfpenny ◽

Breege Whiten ◽

Christina Smith ◽

Siofra Mulkerrin

Keyword(s):

Scoping Review ◽

Best Practice ◽

Data Extraction ◽

Grey Literature ◽

Therapeutic Interventions ◽

Current Evidence ◽

Future Research ◽

Limited Information ◽

Best Practice Guidelines ◽

Dysphagia Therapy

Abstract Background Swallowing impairment (dysphagia) and tracheostomy coexist. Research in this area has often provided an overview of dysphagia management as a whole, but there is limited information pertaining to specific dysphagia therapy in the tracheostomy population. The aim of this scoping review is to provide detailed exploration of the literature with regards to dysphagia therapeutic interventions in adults with a tracheostomy. The scoping review will describe current evidence and thus facilitate future discussions to guide clinical practice.Methods A scoping review using the Joanna Briggs Institute and Preferred Reporting Items for Systematic Reviews guideline will be used. Ten electronic databases from inception to July 2021and grey literature will be searched. From identified texts forward and backward citation chasing will be completed. Data extraction will compose of population demographics, aetiology and dysphagia therapy (type, design, dose and intensity). Number of citations and papers included into the scoping review will be presented visually.Discussion The scoping review aims to expand upon the existing literature in this field. A detailed description of the evidence is required to facilitate clinical discussions and develop therapeutic protocols in a tracheostomised population. The results of this scoping review will support future research in dysphagia therapy and provide the basis for development of best practice guidelines.

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Clinical management of acute low back pain in elite and subelite rowers: a Delphi study of experienced and expert clinicians

British Journal of Sports Medicine ◽

10.1136/bjsports-2020-102520 ◽

2021 ◽

pp. bjsports-2020-102520

Author(s):

Kellie Wilkie ◽

Jane S Thornton ◽

Anders Vinther ◽

Larissa Trease ◽

Sarah-Jane McDonnell ◽

...

Keyword(s):

Low Back Pain ◽

Back Pain ◽

Delphi Study ◽

Best Practice ◽

Response Rate ◽

Future Research ◽

Original Research ◽

Low Back ◽

Acute Low Back Pain ◽

Best Practice Guidelines

ObjectivesRowing-related low back pain (LBP) is common but published management research is lacking. This study aims to establish assessment and management behaviours and beliefs of experienced and expert clinicians when elite and subelite rowers present with an acute episode of LBP; second, to investigate how management differs for developing and masters rowers. This original research is intended to be used to develop rowing-related LBP management guidelines.MethodsA three-round Delphi survey was used. Experienced clinicians participated in an internet-based survey (round 1), answering open-ended questions about assessment and management of rowing-related LBP. Statements were generated from the survey for expert clinicians to rate (round 2) and rerate (round 3). Consensus was gained when agreement reached a mean of 7 out of 10 and disagreement was 2 SD or less.ResultsThirty-one experienced clinicians participated in round 1. Thirteen of 20 invited expert clinicians responded to round 2 (response rate 65%) and 12 of the 13 participated in round 3 (response rate 92%).One hundred and fifty-three of 215 statements (71%) relating to the management of LBP in elite and subelite rowers acquired consensus status. Four of six statements (67%) concerning developing rowers and two of four (50%) concerning masters rowers gained consensus.ConclusionIn the absence of established evidence, these consensus-derived statements are imperative to inform the development of guidelines for the assessment and management of rowing-related LBP. Findings broadly reflect adult LBP guidelines with specific differences. Future research is needed to strengthen specific recommendations and develop best practice guidelines in this athletic population.

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ESHRE PGD consortium best practice guidelines for fluorescence in situ hybridization-based PGD

Human Reproduction ◽

10.1093/humrep/deq230 ◽

2010 ◽

Vol 26 (1) ◽

pp. 25-32 ◽

Cited By ~ 53

Author(s):

G. L. Harton ◽

J. C. Harper ◽

E. Coonen ◽

T. Pehlivan ◽

K. Vesela ◽

...

Keyword(s):

In Situ Hybridization ◽

Fluorescence In Situ Hybridization ◽

Practice Guidelines ◽

Best Practice ◽

Best Practice Guidelines

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The development of a measurement instrument to measure the quality of internet investor relations

South African Journal of Business Management ◽

10.4102/sajbm.v47i4.71 ◽

2016 ◽

Vol 47 (4) ◽

pp. 15-25 ◽

Cited By ~ 4

Author(s):

G. F. Nel ◽

L. M. Brummer

Keyword(s):

Pilot Study ◽

Best Practice ◽

Reliability And Validity ◽

Measurement Instrument ◽

Future Research ◽

Investor Relations ◽

Extensive Literature ◽

Best Practice Guidelines ◽

Measurement Results

The purpose of this study was to develop a measurement instrument to measure the quality of Internet investor relations (IIR). This study will aid future research to examine IIR and provide guidance to companies in the development of an IIRstrategy. The development of the instrument was based on best practice guidelines issued by the Investor Relations Society, an extensive literature review and a pilot study. The result was a measurement instrument that consists of 346 attributes.Quality is assessed by measuring content as widely as possible, by including attributes to measure the accessibility, navigation and timeliness of information, and by allowing for the measurement of attributes as being partially availablebased on breadth, usability and timeliness considerations. The reliability and validity of the measurement instrument was confirmed on the basis of the measurement results of a sample of 85 JSE-listed companies.

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End of life care in the emergency department

Emergency Medicine Journal ◽

10.1136/emermed-2019-208632 ◽

2019 ◽

pp. emermed-2019-208632 ◽

Cited By ~ 1

Author(s):

Mary Dawood

Keyword(s):

Emergency Department ◽

End Of Life ◽

Practice Guidelines ◽

End Of Life Care ◽

Best Practice ◽

Life Care ◽

Best Practice Guidelines

The importance of end of life care (EoLC) for patients and their families is well documented, however, the skills and knowledge of emergency clinicians in delivering EoLC is not widely understood but it is clear from the existing literature that we fall short in delivering consistently good EoLC although there is recognition of the need to improve. This paper will acknowledge the challenges of delivering good EoLC in the emergency department (ED) but more importantly consider practical ways of improving EoLC in the ED in line with best practice guidelines on EoLC.

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Crisis management and human factors

Emergencies in Anaesthesia ◽

10.1093/med/9780198758143.003.0001 ◽

2020 ◽

pp. 1-8

Author(s):

Simon Mercer

Keyword(s):

Decision Making ◽

Human Factors ◽

Mental Models ◽

Crisis Management ◽

Psychological Stress ◽

Practice Guidelines ◽

Best Practice ◽

Situational Awareness ◽

Best Practice Guidelines ◽

National Quality

This first chapter explains how human factors affect the management of crises. The roles human factors play in the management of emergencies and crisis situations are becoming increasingly recognized in healthcare, having gained political momentum following a concordat from the National Quality Board in 2013. A framework is presented for emergency preparation, including standard operating procedures, checklists, allocation of roles, preparing equipment and drugs, sharing mental models, and communicating with support specialists. During the incident the focus is on situational awareness, leadership and teamwork, communication, and decision-making. Post-event debriefing is discussed with the joint goals of addressing psychological stress and learning for the future. Also provided are links to available up-to-date best-practice guidelines and useful resources for further reading.

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