Managing the multiply injured patient: the impact of multidisciplinary teams

2019 ◽  
Vol 80 (12) ◽  
pp. 703-706
Author(s):  
Jonathan French ◽  
Lewis M Agius ◽  
Nemandra A Sandiford
Keyword(s):  
Trauma Care ◽  
Care Delivery ◽  
National Level ◽  
Injured Patient ◽  
Improve Patient Care ◽  
Multidisciplinary Teams ◽  
Team Approach ◽  
Trauma Service ◽  
Multiply Injured Patient ◽  
The Impact

Management of trauma has been tackled at a national level to improve patient care and mortality. Decision making through a multidisciplinary team approach has resulted in improved patient outcomes through a complex combination of changes. While the focus of trauma care delivery has been towards establishing an effective multidisciplinary trauma service, there are still improvements which can be made. This article reviews the history of trauma care in the UK, and the impact that multidisciplinary teams have had on the management of the multiply injured patient.

scholarly journals The Impact of a Massachusetts State-Sponsored Educational Program on Antimicrobial Stewardship in Acute Care Hospitals

2013 ◽  
Vol 34 (4) ◽  
pp. 437-439 ◽  
Author(s):  
Adam Weston ◽  
Lauren Epstein ◽  
Lisa E. Davidson ◽  
Alfred DeMaria ◽  
Shira Doron
Keyword(s):  
Acute Care ◽  
Antimicrobial Stewardship ◽  
Educational Program ◽  
Business Models ◽  
National Level ◽  
State Level ◽  
Acute Care Hospitals ◽  
The State ◽  
Team Approach ◽  
The Impact

Antimicrobial stewardship programs (ASPs) are critically important for combating the emergence of antimicrobial resistance. Despite this, there are no regulatory requirements at a national level, which makes initiatives at the state level critical. The objectives of this study were to identify existing antimicrobial stewardship practices, characterize barriers to antimicrobial stewardship implementation in acute care hospitals throughout Massachusetts, and evaluate the impact on these hospitals of a state-sponsored educational conference on antimicrobial stewardship.In September 2011, a state-sponsored educational program entitled “Building Stewardship: A Team Approach Enhancing Antibiotic Stewardship in Acute Care Hospitals” was offered to interested practitioners from throughout the state. The program consisted of 2 audio conferences, reading materials, and a 1-day conference consisting of lectures focusing on the importance of ASPs, strategies for implementation, improvement strategies for existing programs, and panel discussions highlighting successful practices. Smaller breakout sessions focused on operational issues, including understanding of pharmacodynamics, business models, and electronic surveillance.

scholarly journals Simulation as a Multidisciplinary Team Approach in Healthcare Programs in an Urban University Setting

2018 ◽  
Vol 6 (12) ◽  
pp. 61
Author(s):  
Dawn I. Blue ◽  
Geraldine C. Fike ◽  
Guillermo Escalante ◽  
Yeon Kim ◽  
Jose A. Munoz
Keyword(s):  
Video Game ◽  
Health Workers ◽  
Physical Therapists ◽  
Hospital Setting ◽  
Patient Simulation ◽  
Work Force ◽  
Multidisciplinary Teams ◽  
Team Approach ◽  
Public Health Workers ◽  
The Impact

Background: In the hospital setting, patients are usually cared for by a nurse and multidisciplinary teams which may include physical therapists, social workers, and public health workers. However, students in health care programs usually will not experience interdisciplinary scenarios developing needed skills. Combining classes and replacing certain curriculum activities with patient simulation projects that include several departments may improve their educational experience and success. Simulation is technology used to enhance instruction resources for all students. Simulation not only captures the attention of the video-game generation but actively engages students in the learning process. Simulation can be a valuable experience to keep students actively involved in learning by offering the opportunity to apply knowledge learned to the clinical setting, thus making it real. It is compelling to consider the impact of simulation in increasing the competency of students when they are in the work force while decreasing error rate and impacting the quality of care.Methods: A mixed method approach involved simulation experience followed by data collection via survey.Results: Students across all disciplines reported increased ability for collaboration and communication.Conclusions: Demonstrated the value of introducing the students to teamwork and collaboration experiences via simulation.

scholarly journals Impact of consultant obstetric presence on serious incidents

2019 ◽  
Vol 24 (3) ◽  
pp. 187-193
Author(s):  
Sherif Shawer ◽  
Shirley Rowbotham ◽  
Alexander Heazell ◽  
Teresa Kelly ◽  
Sarah Vause
Keyword(s):  
Negative Impact ◽  
Positive Impact ◽  
Care Delivery ◽  
A Priori ◽  
Improve Patient Care ◽  
Positive Influence ◽  
Content Type ◽  
Uk National Health Service ◽  
The Impact ◽  
Improve Patient

Purpose Many organisations, including the Royal College of Obstetricians and Gynaecologists, have recommended increasing the number of hours of consultant obstetric presence in UK National Health Service maternity units to improve patient care. St Mary’s Hospital, Manchester implemented 24-7 consultant presence in September 2014. The paper aims to discuss these issues. Design/methodology/approach To assess the impact of 24-7 consultant presence upon women and babies, a retrospective review of all serious clinical intrapartum incidents occurring between September 2011 and September 2017 was carried out by two independent reviewers; disagreements in classification were reviewed by a senior Obstetrician. The impact of consultant presence was classified in a structure agreed a priori. Findings A total of 72 incidents were reviewed. Consultants were directly involved in the care of 75.6 per cent of cases before 24-7 consultant presence compared to 96.8 per cent afterwards. Negative impact due to a lack of consultant presence fell from 22 per cent of the incidents before 24-7 consultant presence to 9.7 per cent after implementation. In contrast, positive impact of consultant presence increased from 14.6 to 32.3 per cent following the introduction of 24-7 consultant presence. Practical implications Introduction of 24-7 consultant presence reduced the negative impact caused by a lack of, or delay in, consultant presence as identified by serious untoward incident (SUI) reviews. Consultant presence was more likely to have a positive influence on care delivery. Originality/value This is the first assessment of the impact of 24-7 consultant presence on the SUIs in obstetrics.

scholarly journals Clinical Decision Support May Link Multiple Domains to Improve Patient Care: Viewpoint

10.2196/20265 ◽  
2020 ◽  
Vol 8 (10) ◽  
pp. e20265
Author(s):  
David Kao ◽  
Cynthia Larson ◽  
Dana Fletcher ◽  
Kris Stegner
Keyword(s):  
Decision Support ◽  
Clinical Decision Support ◽  
Care Delivery ◽  
Improve Patient Care ◽  
Clinical Decision ◽  
Team Approach ◽  
Electronic Health Record Data ◽  
Target User ◽  
Precision Level ◽  
Improve Patient

Integrating clinical decision support (CDS) across the continuum of population-, encounter-, and precision-level care domains may improve hospital and clinic workflow efficiency. Due to the diversity and volume of electronic health record data, complexity of medical and operational knowledge, and specifics of target user workflows, the development and implementation of comprehensive CDS is challenging. Additionally, many providers have an incomplete understanding of the full capabilities of current CDS to potentially improve the quality and efficiency of care delivery. These varied requirements necessitate a multidisciplinary team approach to CDS development for successful integration. Here, we present a practical overview of current and evolving applications of CDS approaches in a large academic setting and discuss the successes and challenges. We demonstrate that implementing CDS tools in the context of linked population-, encounter-, and precision-level care provides an opportunity to integrate complex algorithms at each level into a unified mechanism to improve patient management.

scholarly journals MP21: Improving the relational aspects of trauma care through translational simulation

CJEM ◽  
2020 ◽  
Vol 22 (S1) ◽  
pp. S49-S50
Author(s):  
E. Purdy ◽  
C. Alexander ◽  
J. Matulich ◽  
V. Brazil
Keyword(s):  
Trauma Care ◽  
Simulation Program ◽  
Shared Knowledge ◽  
Free Text ◽  
Relational Coordination ◽  
Mutual Respect ◽  
Trauma Service ◽  
Shared Goals ◽  
The Impact ◽  
Inductive Analysis

Introduction: Major trauma care is complex, and requires individuals and teams to perform together in time critical, high stakes situations. Scenario based simulation is well established as a strategy for trauma teamwork improvement, but its role in the relational and cultural aspects of trauma care is less well understood. Relational Coordination theory offers a framework though which we aimed to understand the impact of an established trauma simulation program Methods: We studied simulation activities using a narrative survey of trauma providers from anaesthesia, emergency medicine, medical imaging, surgery, trauma service, intensive care and pre-hospital providers at Gold Coast University Hospital, in conjunction with data from an ethnography. Data analysis was performed using a recursive approach - a simultaneous deductive approach using the relational coordination framework and an inductive analysis. Results: 95/480 (19.8%) staff completed free text survey questions on simulation. Deductive analysis of data from this narrative survey results using the RC framework domains identified examples of shared goals, shared knowledge, communication, and mutual respect. Two major themes from the inductive analysis – “Behaviour, process and system change”, and “Culture and relationships” - aligned closely with findings from the RC analysis, with additional themes of “Personal and team learning” and the “Impact of the simulation experience” identified. Conclusion: Our findings suggest that an established trauma simulation program can have a profound impact on the relational aspects of care and the development of a collaborative culture, with perceived tangible impacts on teamwork behaviours and institutional systems and processes. The RC framework – shared knowledge, shared goals and mutual respect in the context of communication that is timely, accurate, frequent and problem-solving based – can provide a common language for simulation educators to design and debrief simulation exercises that aim to have a translational impact.

scholarly journals Clinical Decision Support May Link Multiple Domains to Improve Patient Care: Viewpoint (Preprint)

2020 ◽  
Author(s):  
David Kao ◽  
Cynthia Larson ◽  
Dana Fletcher ◽  
Kris Stegner
Keyword(s):  
Decision Support ◽  
Clinical Decision Support ◽  
Care Delivery ◽  
Improve Patient Care ◽  
Clinical Decision ◽  
Team Approach ◽  
Electronic Health Record Data ◽  
Target User ◽  
Precision Level ◽  
Improve Patient

UNSTRUCTURED Integrating clinical decision support (CDS) across the continuum of population-, encounter-, and precision-level care domains may improve hospital and clinic workflow efficiency. Due to the diversity and volume of electronic health record data, complexity of medical and operational knowledge, and specifics of target user workflows, the development and implementation of comprehensive CDS is challenging. Additionally, many providers have an incomplete understanding of the full capabilities of current CDS to potentially improve the quality and efficiency of care delivery. These varied requirements necessitate a multidisciplinary team approach to CDS development for successful integration. Here, we present a practical overview of current and evolving applications of CDS approaches in a large academic setting and discuss the successes and challenges. We demonstrate that implementing CDS tools in the context of linked population-, encounter-, and precision-level care provides an opportunity to integrate complex algorithms at each level into a unified mechanism to improve patient management.

scholarly journals Pediatric Orthopedic Trauma Care During the COVID-19 Pandemic: A Survey of the Pediatric Orthopedic Society of North America

2021 ◽  
pp. 155633162110560
Author(s):  
Mitchell A. Johnson ◽  
Theodore J. Ganley ◽  
Lindsay Crawford ◽  
Ishaan Swarup
Keyword(s):  
North America ◽  
Trauma Care ◽  
Care Delivery ◽  
Trauma Surgery ◽  
Trauma Patients ◽  
Orthopedic Trauma ◽  
Fracture Management ◽  
Pediatric Orthopedic ◽  
The Impact

Background: The COVID-19 pandemic has dramatically altered the practice of pediatric orthopedic trauma surgery in both outpatient and inpatient settings. While significant declines in patient volume have been noted, the impact on surgeon decision-making is unclear. Purpose: We sought to investigate changes in pediatric orthopedic trauma care delivery as a result of COVID-19 and determine their implications for future orthopedic practice. Methods: An electronic survey was distributed to all members (N = 1515) of the Pediatric Orthopedic Society of North America (POSNA) in March to April 2021; only members who provided care for pediatric orthopedic trauma patients were asked to complete it. The survey included questions on hospital trauma call, inpatient care, outpatient clinic practice, and 3 unique fracture case scenarios. Results: A total of 147 pediatric orthopedic surgeons completed the survey, for a 9.7% response rate, with 134 (91%) taking trauma call at a hospital as part of their practice. Respondents reported significant differences across institutions regarding COVID-19 testing, hospital rounding, and employee COVID-19 screening. Changes in outpatient fracture management were observed, including a decreased number of follow-up visits for nondisplaced clavicle fractures, distal radius buckle fractures, and toddler’s fractures. Of respondents who changed their fracture follow-up schedules due to COVID-19, over 75% indicated that they would continue these outpatient treatment schedules after the pandemic. Conclusions: This survey found changes in pediatric orthopedic trauma care as a result of the COVID-19 pandemic. The use of telemedicine and abbreviated follow-up practices for common fracture types are likely to persist following the resolution of the COVID-19 pandemic.

Pengaruh Budaya Terhadap Akuntansi, Auditing Dan Praktik Akuntansi Internasional

2016 ◽  
Vol 3 (1) ◽  
pp. 78-95
Author(s):  
Priyastiwi Priyastiwi
Keyword(s):  
Cultural Values ◽  
Leadership Style ◽  
Financial Reporting ◽  
National Level ◽  
Deep Understanding ◽  
Cultural Dimensions ◽  
Financial Disclosure ◽  
Cross Cultural Differences ◽  
The Future ◽  
The Impact

The purpose of this article is to provide the basic model of Hofstede and Grays’ cultural values that relates the Hofstede’s cultural dimensions and Gray‘s accounting value. This article reviews some studies that prove the model and develop the research in the future. There are some evidences that link the Hofstede’s cultural values studies with the auditor’s judgment and decisions by developing a framework that categorizes the auditor’s judgments and decisions are most likely influenced by cross-cultural differences. The categories include risk assessment, risk decisions and ethical judgments. Understanding the impact of cultural factors on the practice of accounting and financial disclosure is important to achieve the harmonization of international accounting. Deep understanding about how the local values may affect the accounting practices and their impacts on the financial disclosure are important to ensure the international comparability of financial reporting. Gray’s framework (1988) expects how the culture may affect accounting practices at the national level. One area of the future studies will examine the impact of cultural dimensions to the values of accounting, auditing and decision making. Key word : Motivation, leadership style, job satisfaction, performance

HOME VISITS DURING THE FIRST MONTH OF DELIVERY FOR RECENTLY DELIVERED WOMEN IN UTTAR PRADESH, INDIA

2020 ◽  
Vol 6 (5) ◽  
pp. 1183-1189
Author(s):  
Dr. Tridibesh Tripathy ◽  
Dr. Umakant Prusty ◽  
Dr. Chintamani Nayak ◽  
Dr. Rakesh Dwivedi ◽  
Dr. Mohini Gautam
Keyword(s):  
Large Scale ◽  
National Level ◽  
Uttar Pradesh ◽  
Life Time ◽  
Structured Interview ◽  
The Other ◽  
Registration System ◽  
Action Group ◽  
Current Article ◽  
The Impact

The current article of Uttar Pradesh (UP) is about the ASHAs who are the daughters-in-law of a family that resides in the same community that they serve as the grassroots health worker since 2005 when the NRHM was introduced in the Empowered Action Group (EAG) states. UP is one such Empowered Action Group (EAG) state. The current study explores the actual responses of Recently Delivered Women (RDW) on their visits during the first month of their recent delivery. From the catchment area of each of the 250 ASHAs, two RDWs were selected who had a child in the age group of 3 to 6 months during the survey. The response profiles of the RDWs on the post- delivery first month visits are dwelled upon to evolve a picture representing the entire state of UP. The relevance of the study assumes significance as detailed data on the modalities of postnatal visits are available but not exclusively for the first month period of their recent delivery. The details of the post-delivery first month period related visits are not available even in large scale surveys like National Family Health Survey 4 done in 2015-16. The current study gives an insight in to these visits with a five-point approach i.e. type of personnel doing the visit, frequency of the visits, visits done in a particular week from among those four weeks separately for the three visits separately. The current study is basically regarding the summary of this Penta approach for the post- delivery one-month period.     The first month period after each delivery deals with 70% of the time of the postnatal period & the entire neonatal period. Therefore, it does impact the Maternal Mortality Rate & Ratio (MMR) & the Neonatal Mortality Rates (NMR) in India and especially in UP through the unsafe Maternal & Neonatal practices in the first month period after delivery. The current MM Rate of UP is 20.1 & MM Ratio is 216 whereas the MM ratio is 122 in India (SRS, 2019). The Sample Registration System (SRS) report also mentions that the Life Time Risk (LTR) of a woman in pregnancy is 0.7% which is the highest in the nation (SRS, 2019). This means it is very risky to give birth in UP in comparison to other regions in the country (SRS, 2019). This risk is at the peak in the first month period after each delivery. Similarly, the current NMR in India is 23 per 1000 livebirths (UNIGME,2018). As NMR data is not available separately for states, the national level data also hold good for the states and that’s how for the state of UP as well. These mortalities are the impact indicators and such indicators can be reduced through long drawn processes that includes effective and timely visits to RDWs especially in the first month period after delivery. This would help in making their post-natal & neonatal stage safe. This is the area of post-delivery first month visit profile detailing that the current article helps in popping out in relation to the recent delivery of the respondents.   A total of four districts of Uttar Pradesh were selected purposively for the study and the data collection was conducted in the villages of the respective districts with the help of a pre-tested structured interview schedule with both close-ended and open-ended questions.  The current article deals with five close ended questions with options, two for the type of personnel & frequency while the other three are for each of the three visits in the first month after the recent delivery of respondents. In addition, in-depth interviews were also conducted amongst the RDWs and a total 500 respondents had participated in the study.   Among the districts related to this article, the results showed that ASHA was the type of personnel who did the majority of visits in all the four districts. On the other hand, 25-40% of RDWs in all the 4 districts replied that they did not receive any visit within the first month of their recent delivery. Regarding frequency, most of the RDWs in all the 4 districts received 1-2 times visits by ASHAs.   Regarding the first visit, it was found that the ASHAs of Barabanki and Gonda visited less percentage of RDWs in the first week after delivery. Similarly, the second visit revealed that about 1.2% RDWs in Banda district could not recall about the visit. Further on the second visit, the RDWs responded that most of them in 3 districts except Gonda district did receive the second postnatal visit in 7-15 days after their recent delivery. Less than half of RDWs in Barabanki district & just more than half of RDWs in Gonda district received the third visit in 15-21 days period after delivery. For the same period, the majority of RDWs in the rest two districts responded that they had been entertained through a home visit.

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