scholarly journals Establishing safety huddles on a general adult acute psychiatric ward: staff's views and relation with restrictive practice

BJPsych Open ◽  
2021 ◽  
Vol 7 (S1) ◽  
pp. S178-S179
Author(s):  
Sidra Chaudhry ◽  
Nicoletta Lekka
Keyword(s):  
Patient Care ◽  
Positive Impact ◽  
Team Building ◽  
High Risk Patient ◽  
Psychiatric Ward ◽  
Clinical Activity ◽  
Restrictive Practice ◽  
Feedback Questionnaire ◽  
Multidisciplinary Staff ◽  
The Impact

AimsTo establish Safety Huddles (SH) on an acute general adult psychiatric ward, exploring links to restrictive practice. Additionally, to obtain multidisciplinary staff feedback on SH's impact on their workload/wellbeing and on patient care, and to identify barriers in implementation.Background: A SH is a multidisciplinary daily briefing focused on patients most at risk, held at a fixed time and place, lasting max 5-10 minutes. Effective SH involve agreed actions, are informed by multidisciplinary staff feedback of data and provide the opportunity to appreciate and celebrate success in reducing harm. SH are a valuable team building activity, promoting situational awareness and helping with prioritising daily tasks.MethodSH were introduced on September 2020. Templates were developed to prompt staff how to facilitate. Staff were encouraged to identify key goals and reflect on issues in the last and next 24 hours. Each participant was allocated a role, e.g. record keeping or dissemination of information. In December 2020, records of incidence of restrictive practice (numbers of restraints, seclusions and rapid tranquilisations) were obtained for the periods June-August 2020 and September-November 2020. Additionally, staff feedback was obtained through a short anonymous Survey Monkey questionnaire. It explored whether SH had an effect on patient care and staff's workload/wellbeing, and possible barriers to implementation.ResultComparing the two 3-month periods before and after SH implementation, restraint episodes were reduced from 47 to 21, seclusion episodes from 19 to 2, and rapid tranquilisation episodes from 10 to 3. Nine staff members responded to the feedback questionnaire. All believed SH had a positive impact on patient care, or had the potential to do so. Staff reported SH gave them insight into incidents, made them feel safer and prepared for the day, played a part in reducing restrictive practice, and empowered staff from all professional backgrounds by giving them a voice. Low or late participation, cancellation of SH because of clinical activity, and vague questions in the meeting template were identified as barriers in implementation.ConclusionAcute psychiatric wards regularly face challenges of high clinical activity, low staffing levels, bed pressures, and high-risk patient cohorts. SH contributed to reducing restrictive practice and creating a safer and more positive work environment. It is important to ensure SH are taking place daily, using an appropriate template to guide staff who may be new to facilitating. Accordingly, the impact on restrictive practice, patient care and staff wellbeing can be sustained long-term.

scholarly journals P-BN44 The impact of the COVID-19 pandemic on waiting lists for laparoscopic cholecystectomy and its effect on patient care and outcomes

2021 ◽  
Vol 108 (Supplement_9) ◽  
Author(s):  
Geraint Herbert ◽  
Charlotte Thomas
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Patient Care ◽  
Positive Impact ◽  
Elective Surgery ◽  
Emergency Operation ◽  
Waiting Lists ◽  
Waiting List ◽  
Subtotal Cholecystectomy ◽  
Significant Difference ◽  
The Impact

Abstract Background It has been widely reported that the COVID-19 pandemic has had a detrimental impact on waiting lists for elective surgery in the NHS. Delays in laparoscopic cholecystectomy (LC) are likely to prolong suffering for symptomatic patients and risk increasing complications for patients which may then require emergency care and intervention. In this study we aim to quantify the impact of the COVID-19 pandemic on elective waiting lists and to assess what implications this might have on patient care and outcomes.  Methods Electronic health records were retrospectively interrogated for patients undergoing LC in both March 2019 (prior to the COVID-19 pandemic) and March 2021. The following data was captured: age, gender, elective vs emergency operation, laparoscopic vs open, total vs subtotal cholecystectomy, use of drains, length of stay/daycase rates, the number of emergency presentations prior to operation and the number of days between being listed for surgery and their operation. The results were analysed using SPSS Statistics (IBM, New York).  Results 111 patients were included in the study (25 male and 86 female). Of these, 60 had their LC in 2019, and 51 in 2021. The age and gender distribution of the patients in both time periods were similar. The median number of days on the waiting list was significantly higher (P < 0.001) for patients in 2021 at 379.5 days, compared with 153 days in 2019. There was a significant increase in the number of emergency presentations prior to LC in 2021 (P = 0.025) with an average of 0.7 presentations per patient compared with 0.45 in 2019. Additionally, there was a significant increase in the number of emergency LC performed in 2021 (P = 0.002), with 15 performed compared with 4 in 2019, representing 29.4% and 6.7% of all LC respectively. There was no significant change in rates of conversion to open, drains or subtotal cholecystectomy. There was no significant difference in daycase rates for elective patients in either period (55% vs 58%). Conclusions Whilst there has been no change in the operative outcomes for patients undergoing LC, there has been a stark increase in the length of time patients are on a waiting list prior to undergoing elective LC. This has resulted in a significant increase in the number of emergency presentations and the number of emergency LC performed. This study demonstrates the wider impact of increasing waiting list times beyond the prolonged suffering of symptomatic patients. A significant reduction in waiting list times would be beneficial to both patients and healthcare providers, with the aim of reducing the number of emergency presentations. A reduction in these would have a positive impact on acute services and on the associated cost implications.  

scholarly journals From Morbidity and Mortality to Quality Improvement

OTO Open ◽  
2017 ◽  
Vol 1 (1) ◽  
pp. 2473974X1769277 ◽  
Author(s):  
Daniel B. Spielman ◽  
Wayne D. Hsueh ◽  
Karen Y. Choi ◽  
John P. Bent
Keyword(s):  
Patient Care ◽  
Positive Impact ◽  
Residency Training Program ◽  
Neck Surgery ◽  
Morbidity And Mortality ◽  
Educational Value ◽  
Morbidity And Mortality Conference ◽  
The Impact ◽  
Future Patient ◽  
Mortality Conference

Objective Measure the effects of a structured morbidity and mortality conference format on the attitudes of resident and faculty participants. Study Design Prospective cohort study. Setting Otorhinolaryngology–head and neck surgery residency training program. Subjects and Methods Two changes were implemented to the structure of our morbidity and mortality conference: (1) we adopted a recently described presentation framework called situation-background-assessment-recommendation and (2) appointed a faculty moderator to lead the conference. Surveys were distributed to residents and faculty before and after these modifications were implemented to measure changes in attitude of conference attendees. Results After implementing the above changes to the morbidity and mortality conference, participant engagement increased from “moderately engaged” to “extremely engaged” ( P < .01). Among both faculty and residents, the perceived educational value of conference also improved from “moderately educational” to “extremely educational” ( P < .01). Finally in the attending cohort, the impact on future patient care increased from “no change” to “greatly enhanced” ( P < .01). Conclusion By implementing the situation-background-assessment-recommendation framework and appointing a faculty moderator to morbidity and mortality conference, participants reported significantly enhanced engagement during the conference, increased educational value of the session, and a positive impact on future patient care.

scholarly journals Cultural diversity drives innovation: modeling in the global pharmaceutical industry

2021 ◽  
Vol 13 (2) ◽  
pp. 133-144
Author(s):  
Graham Jones ◽  
Bernardita Chirino Chace ◽  
Justin Wright
Keyword(s):  
Pharmaceutical Industry ◽  
Cultural Diversity ◽  
Cultural Awareness ◽  
Positive Impact ◽  
Team Building ◽  
Team Dynamics ◽  
Content Type ◽  
Maximum Benefit ◽  
Innovation Teams ◽  
The Impact

Purpose The innovative capacity of an organization is typically realized through unit-level teams. Previous studies correlate innovation performance with cultural diversity of teams, but note that team dynamics need to be optimized to derive maximum benefit. Herein, this study offers an assessment of available team building instruments through the lens of diverse innovation teams. In a demonstration project in the pharmaceutical industry, this study then outlines specific tools and approaches which can be successfully deployed through team coaching and mentoring. Design/methodology/approach A cluster of nine innovation teams with varying degrees of cultural diversity was provided with assessment and management instruments which had been identified and field tested by a mentoring team. Content included cultural awareness tools, innovation team profiling methods and Team Science (SciTS) ideology. Teams were funded, coached and mentored through a six-month performance period and assessed at regular intervals. Findings Team assessments provided correlations between performance (measured by project completion and new intellectual property generated) and diversity together with wealth of information on intra-team culture and dynamics. Concrete recommendations from the study include adoption of appropriate communication standards to promote inclusivity, use of SciTS operational tracking metrics to enhance engagement, use of the FourSight group profiling methodology and cultural quotient scale cultural awareness instruments at team-forming stage to promote effective dynamics and enhance inclusivity. Practical implications Cultural diversity has a positive impact on innovation teams. This said, for maximum benefit cultural awareness of team members should be optimized to avoid unintended conflicts developing. Such issues can be exacerbated when teams are deployed remotely and preventative measures should be established. These issues became of heightened significance as a result of telecommuting imposed by the COVID-19 pandemic and have longer-term implications, as corporations consider global air travel reduction through environmental concerns. A tracking tool is described to monitor team engagement and promote inclusivity. It is expected that the learnings can influence how teams can best form, normalize and operate within corporate innovation programs and form the basis of long-term impact studies. Originality/value This represents the first systematic study on the impact of cultural diversity and team dynamics within innovation programs in the pharmaceutical industry. The tools and methodologies deployed are widely available and can be adopted by innovation teams in many adjacent industries with established innovation ecosystems.

scholarly journals Hospital Libraries Have a Positive Impact on Clinical Decision Making and Patient Care

2007 ◽  
Vol 2 (4) ◽  
pp. 104 ◽  
Author(s):  
Martha I. Preddie
Keyword(s):  
Decision Making ◽  
Rural Communities ◽  
Patient Care ◽  
Sample Size ◽  
Clinical Decision Making ◽  
Positive Impact ◽  
Clinical Care ◽  
Clinical Decision ◽  
Sources Of Information ◽  
The Impact

A review of: Marshall, Joanne Gard. “The Impact of the Hospital Library on Clinical Decision Making: the Rochester Study.” Bulletin of the Medical Library Association 80.2 (1992): 169-78. Objective – To determine the impact of hospital library services on clinical decision making. Design – A descriptive survey. Setting – Fifteen hospitals in the Rochester area of New York, United States of America. Seven hospitals were in the city of Rochester, and eight were in surrounding rural communities. Subjects – Active physicians and residents affiliated with the Rochester hospitals. Methods – This study built upon the methodology used in an earlier study by D. N. King of the contribution of hospital libraries to clinical care in Chicago. Lists were compiled of all the active physicians and residents who were affiliated with the Rochester hospitals. In order to ensure that there was a reasonable number of participants from each hospital, and that librarians in hospitals with larger numbers of staff were not overburdened with requests, predetermined percentages were set for the sample: 10% of active physicians from hospitals with more than 25 medical staff members, 30% from hospitals with less staff, and 30% of residents and rural physicians. This resulted in a desirable sample size of 448. A systematic sample with a random start was then drawn from each hospital’s list, and physicians and residents were recruited until the sample size was achieved. Participants were asked to request information related to a clinical case from their hospital library, and to evaluate its impact on patient care, by responding to a two-page questionnaire. Main results – Based on usable questionnaires, there was an overall response rate of 46.4% (208 of 448). Eighty percent of the respondents stated that they probably (48%) or definitely (32.4%) handled a clinical situation differently due to the information received from the library. In terms of the specific aspects of care for which changes were made, 71.6% reported a change in advice given to the patient, 59.6% cited a change in treatment, 50.5% a change in diagnostic tests, 45.2% a change in drugs, and 38.5% a change in post-hospital care or treatment. Physicians credited the information provided by the library as contributing to their ability to avoid additional tests and procedures (49%), additional outpatient visits (26.4%), surgery (21.2%), patient mortality (19.2%), hospital admission (11.5%), and hospital-acquired infections (8.2%). In response to a question about the importance of several sources of information, the library received the highest rating amidst other sources including lab tests, diagnostic imaging, and discussions with colleagues. Conclusion – This study validates earlier research findings that physicians view the information provided by hospital libraries as having a significant impact on clinical decision making. Library supplied information influences changes to specific aspects of care as well as the avoidance of adverse events for patients. The significance of this influence is underscored by the finding that relative to other sources, information obtained from the hospital library was rated more highly.

scholarly journals NHS managers’ use of nursing workforce planning and deployment technologies: a realist synthesis

2018 ◽  
Vol 6 (36) ◽  
pp. 1-176 ◽  
Author(s):  
Christopher R Burton ◽  
Jo Rycroft-Malone ◽  
Lynne Williams ◽  
Siân Davies ◽  
Anne McBride ◽  
...  
Keyword(s):  
Patient Care ◽  
Positive Impact ◽  
Phase 1 ◽  
Workforce Planning ◽  
Realist Synthesis ◽  
Future Research ◽  
Programme Theory ◽  
What Works ◽  
The Impact ◽  
Professional Judgement

BackgroundPolicy and reviews of health-care safety and quality emphasise the role of NHS managers in ensuring safe, good-quality patient care through effective staffing. Guidance requires that NHS managers combine professional judgement with evidence-based workforce planning and deployment tools and technologies (WPTs). Evidence has focused on the effectiveness of WPTs, but little is known about supporting their implementation, or the impact of using WPTs across settings.ObjectivesThe review answered the following question: ‘NHS managers’ use of workforce planning and deployment technologies and their impacts on nursing staffing and patient care: what works, for whom, how and in what circumstances?’.DesignA realist synthesis was conducted. A programme theory was formulated and expressed as hypotheses in the form of context, mechanisms and outcomes; this considered how, through using WPTs, particular conditions produced responses to generate outcomes. There were four phases: (1) development of a theoretical territory to understand nurse workforce planning and deployment complexity, resulting in an initial programme theory; (2) retrieval, review and synthesis of evidence, guided by the programme theory; (3) testing and refinement of the programme theory for practical application; and (4) actionable recommendations to support NHS managers in the implementation of WPTs for safe staffing.ParticipantsNHS managers, patient and public representatives and policy experts informed the programme theory in phase 1, which was validated in interviews with 10 NHS managers. In phase 3, 11 NHS managers were interviewed to refine the programme theory.ResultsWorkforce planning and deployment tools and technologies can be characterised functionally by their ability to summarise and aggregate staffing information, communicate about staffing, allocate staff and facilitate compliance with standards and quality assurance. NHS managers need to combine local knowledge and professional judgement with data from WPTs for effective staffing decisions. WPTs are used in a complex workforce system in which proximal factors (e.g. the workforce satisfaction with staffing) can influence distal factors (e.g. organisational reputation and potential staff recruitment). The system comprises multiple organisational strategies (e.g. professional and financial), which may (or may not) align around effective staffing. The positive impact of WPTs can include ensuring that staff are allocated effectively, promoting the patient safety agenda within an organisation, learning through comparison about ‘what works’ in effective staffing and having greater influence in staffing work. WPTs appear to have a positive impact when they visibly integrate data on needs and resources and when there is technical and leadership support. A collaborative process appears to be best for developing and implementing WPTs, so that they are fit for purpose.LimitationsThe evidence, predominantly from acute care, often lacked detail on how managers applied professional judgement to WPTs for staffing decisions. The evidence lacked specificity about how managers develop skills on communicating staffing decisions to patients and the public.Conclusions and recommendationsThe synthesis produced initial explanations of the use and impact of WPTs for decision-making and what works to support NHS managers to use these effectively. It is suggested that future research should further evaluate the programme theory.Study registrationThis study is registered as PROSPERO CRD42016038132.FundingThe National Institute for Health Research Health Services and Delivery Research programme.

E-health system characteristics, medical performance and healthcare quality at UNRWA-Palestine health centers

2020 ◽  
Vol ahead-of-print (ahead-of-print) ◽  
Author(s):  
Khalid Abed Dahleez ◽  
Imad Bader ◽  
Mohammed Aboramadan
Keyword(s):  
Health System ◽  
Patient Care ◽  
Medical Staff ◽  
Positive Impact ◽  
Patient Relationship ◽  
System Quality ◽  
Doctor Patient Relationship ◽  
Content Type ◽  
Staff Performance ◽  
The Impact

PurposeThis study aims to investigate how e-health system characteristics (information quality, system quality, perceived ease of use, perceived usefulness) contribute to the enhancement of medical staff performance, patient care, and doctor–patient relationships at UNRWA-Gaza healthcare centers. It aims at testing an integrative single model comprising Technology Acceptance Model (TAM), D&M model and e-health system utilization.Design/methodology/approachThis study followed the quantitative methodology and the deductive research approach. Data were collected from 241 medical staff who use the system employed in 19 different healthcare centers across the Gaza Strip. Partial least square/structural equation modeling technique was used to analyze the collected data and to test study hypotheses.FindingsStudy concluded that information quality of the adopted Health Information System (HIS) has both direct and indirect positive impact on staff performance, only direct positive impact on patient care and only positive indirect impact on doctor–patient relationship. System quality, on the other hand, was found to have negative direct impact and positive indirect impact on staff performance and has both direct and indirect positive impact on both doctor-patient relationship and patient care.Research limitations/implicationsNoteworthy that HIS has availability, speed and error detection and error prevention issues. It is recommended that these shortfalls be addressed together with improving user perception towards ease of use and usefulness of the system.Practical implicationsManagement should also work to raise confidence in its medical staff to improve the effect of HIS on medical performance and patient care. It is also recommended that UNRWA should implement crowed management techniques such as queuing systems and on-phone booking to minimize patient waiting time.Originality/valueThe importance of the study stems from its context being conducted in a developing region (Gaza Strip-Palestine) which has a fragile economic, political and social environment with many other complexities. It is also conducted at United Nations Relief and Work Agency (UNRWA) healthcare centers, which provide medical services to Palestinian refugees. In addition, this study is among the few studies that address the impact of individual e-health success factors on both doctor-patient relationship and patient care constructs. Most previous studies concentrated on the impact of health system adoption as a whole on these two subject variables and one can hardly ever stop at studies that address effect of individual success factors on them. It also integrated both D&M system success model and TAM model with some additional amendments creating and tested a new model.

Multidisciplinary team decision is rare and decreasing in percutaneous vascular interventions despite positive impact on in-hospital outcomes

VASA ◽  
2019 ◽  
Vol 48 (3) ◽  
pp. 262-269 ◽  
Author(s):  
Christian-Alexander Behrendt ◽  
Tilo Kölbel ◽  
Thea Schwaneberg ◽  
Holger Diener ◽  
Ralf Hohnhold ◽  
...  
Keyword(s):  
Multidisciplinary Team ◽  
Positive Impact ◽  
Cross Sectional Study ◽  
Invasive Treatment ◽  
Cross Sectional ◽  
Hospital Outcomes ◽  
Vascular Intervention ◽  
Medical Specialties ◽  
Team Decision ◽  
The Impact

Abstract. Background: Worldwide prevalence of peripheral artery disease (PAD) is increasing and peripheral vascular intervention (PVI) has become the primary invasive treatment. There is evidence that multidisciplinary team decision-making (MTD) has an impact on in-hospital outcomes. This study aims to depict practice patterns and time changes regarding MTD of different medical specialties. Methods: This is a retrospective cross-sectional study design. 20,748 invasive, percutaneous PVI of PAD conducted in the metropolitan area of Hamburg (Germany) were consecutively collected between January 2004 and December 2014. Results: MTD prior to PVI was associated with lower odds of early unsuccessful termination of the procedures (Odds Ratio 0.662, p < 0.001). The proportion of MTD decreased over the study period (30.9 % until 2009 vs. 16.6 % from 2010, p < 0.001) while rates of critical limb-threatening ischemia (34.5 % vs. 42.1 %), patients´ age (70 vs. 72 years), PVI below-the-knee (BTK) (13.2 % vs. 22.4 %), and rates of severe TASC C/D lesions BTK (43.2 % vs. 54.2 %) increased (all p < 0.001). Utilization of MTD was different between medical specialties with lowest frequency in procedures performed by internists when compared to other medical specialties (7.1 % vs. 25.7 %, p < 0.001). Conclusions: MTD prior to PVI is associated with technical success of the procedure. Nonetheless, rates of MTD prior to PVI are decreasing during the study period. Future studies should address the impact of multidisciplinary vascular teams on long-term outcomes.

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