scholarly journals Effect of after action review on safety culture and second victim experience and its implementation in an Irish hospital: A mixed methods study protocol

PLoS ONE ◽  
2021 ◽  
Vol 16 (11) ◽  
pp. e0259887
Author(s):  
Siobhán E. McCarthy ◽  
Theresa Keane ◽  
Aisling Walsh ◽  
Lisa Mellon ◽  
David J. Williams ◽  
...  
Keyword(s):  
Mixed Methods ◽  
Safety Culture ◽  
Hospital Setting ◽  
Theoretical Domains Framework ◽  
The United States ◽  
Mixed Methods Study ◽  
Incident Management ◽  
After Action Review ◽  
Irish Hospital ◽  
Second Victim

Background After Action Review is a form of facilitated team learning and review of events. The methodology originated in the United States Army and forms part of the Incident Management Framework in the Irish Health Services. After Action Review has been hypothesized to improve safety culture and the effect of patient safety events on staff (second victim experience) in health care settings. Yet little direct evidence exists to support this and its implementation has not been studied. Aim To investigate the effect of After Action Review on safety culture and second victim experience and to examine After Action Review implementation in a hospital setting. Methods A mixed methods study will be conducted at an Irish hospital. To assess the effect on safety culture and second victim experience, hospital staff will complete surveys before and twelve months after the introduction of After Action Review to the hospital (Hospital Survey on Safety Culture 2.0 and Second Victim Experience and Support Tool). Approximately one in twelve staff will be trained as After Action Review Facilitators using a simulation based training programme. Six months after the After Action Review training, focus groups will be conducted with a stratified random sample of the trained facilitators. These will explore enablers and barriers to implementation using the Theoretical Domains Framework. At twelve months, information will be collected from the trained facilitators and the hospital to establish the quality and resource implications of implementing After Action Review. Discussion The results of the study will directly inform local hospital decision-making and national and international approaches to incorporating After Action Review in hospitals and other healthcare settings.

scholarly journals Barriers and Facilitators of Following Perioperative Internal Medicine Recommendations by Surgical Teams: A Sequential, Explanatory Mixed-methods Study

2020 ◽  
Author(s):  
Kristin Flemons ◽  
Michael Bosch ◽  
Sarah Coakeley ◽  
Bushra Muzammal ◽  
Rahim Kachra ◽  
...  
Keyword(s):  
Mixed Methods ◽  
Patient Outcomes ◽  
Theoretical Domains Framework ◽  
Medical Consultation ◽  
Mixed Methods Study ◽  
Role Clarity ◽  
Structured Interviews ◽  
Chart Audit ◽  
Anticoagulation Management ◽  
The Impact

Abstract Background: Preoperative medical consultations add expense and burden for patients and the impact of these consults on patient outcomes is conflicting. Previous work suggests that 10-40% of preoperative medical consult recommendations are not followed. This limits measurement of the effect of perioperative medical consultation on patient outcomes and represents a quality gap, given the patient time and healthcare cost associated with consultation. We aimed to measure, characterize, and understand reasons for missed recommendations from preoperative medical consultation.Methods: This explanatory, sequential mixed methods study used chart audits followed by semi-structured interviews. Chart audit of consecutive patients seen in preoperative medical clinic were reviewed to measure the proportion and characterize the type of recommendations that were not completed (‘missed’). This phase informed the interview participants and questions. The interview guide was developed using the Consolidated Framework for Implementation Research and the Theoretical Domains Framework. Template analysis was used to understand drivers and barriers of missed recommendationsResults: Chart audit included 295 patients (n=188, 63.7% female) seen in preadmission clinic between April 1 and April 30th, 2019. 51.8% of patients all recommendations followed (n=142). Postoperative anticoagulation management and postoperative cardiac biomarker surveillance recommendations were least commonly followed (45.2%; n=28, and 64.1%; n=84, respectively). Eighteen surgical team members were interviewed. Missed recommendations were both unintentional and intentional, and the key drivers differed by these categories. Unintentionally missed recommendations occurred due to individual-level factors (drivers: knowledge of the consultation note, lack of routine for reviewing the consultation note, and competing demands on time) and systems-level factors (drivers: lack of role clarity). Intentionally missed recommendations occurred due to user error due (drivers: lack of knowledge of guidelines or evidence) and appropriate modifications (drivers: need to adapt a preoperative plan for a complicated postoperative course).Conclusions: Only 51.8% of consult notes had all recommendations followed, suggesting a quality gap in perioperative medical care. Qualitative data suggests multiple drivers of missed recommendations that should be targeted to improve the efficiency of care for these patients.

Mixed Methods Study Of Stress, Mental Health, And The Work Environment In EMS Responders In The United States

2017 ◽  
Author(s):  
Jennifer A. Taylor ◽  
Regan Murray ◽  
TJ Risoli ◽  
Andrea L. Davis ◽  
Shannon Widman ◽  
...  
Keyword(s):  
Mental Health ◽  
United States ◽  
Mixed Methods ◽  
Work Environment ◽  
The United States ◽  
Mixed Methods Study

scholarly journals Patients’ information needs and attitudes about post-treatment surveillance for colorectal cancer in the United States: a multi-perspective, mixed methods study

BMJ Open ◽  
2019 ◽  
Vol 9 (8) ◽  
pp. e025888 ◽  
Author(s):  
Lisa M Lowenstein ◽  
Robert J Volk ◽  
Amanda Cuddy ◽  
Andrea P Hempstead ◽  
Y Nancy You ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Mixed Methods ◽  
Safety Net ◽  
The United States ◽  
Post Treatment ◽  
Mixed Methods Study ◽  
Survey Study ◽  
Informational Needs ◽  
Safety Net Hospital ◽  
Patient Advocates

ObjectiveWe sought to determine patients’ informational needs for post-treatment surveillance and elicit clinicians’ and patient advocates’ (ie, stakeholders) opinions regarding what patients should know about post-treatment surveillance in the USA.DesignA mixed-methods study, using semi-structured interviews followed by a survey study.SettingParticipants for the interviews were from two large academic medical centres and a safety-net hospital. The stakeholders were recruited from attendees at the Alliance for Clinical Trials in Oncology Network Spring 2016 meeting.ParticipantsParticipants for the in-depth interviews were purposively sampled. Eligible patients were 6 months to 5 years post curative resection for colorectal cancer and were fluent in English. Participants for the anonymous survey were stakeholders.Main outcome(s) and measure(s)The main outcome was patients’ with colorectal cancer informational needs for post-treatment surveillance, using an interview guide. The second outcome was the importance of the identified informational needs using an anonymous survey.ResultsOf the 67 patients approached, 31 were interviewed (response rate=46%), the majority were between 1 and 3 years post-treatment (81%) and diagnosed at stage III (74%). Despite a desire to monitor for cancer recurrence, patients had little understanding of the concept of post-treatment surveillance, equating surveillance with screening and a belief that if a recurrence was found early there would be a higher likelihood of cure. The survey suggested that clinicians (n=38) and patient advocates (n=11) had some differing opinions regarding what patients should know about surveillance to be active in decisions. For example, compared with clinicians, patient advocates felt that patients should know recurrence treatment options (100% vs 58%) and likelihood for cure following recurrence treatment (100% vs 38%).ConclusionsThe results of this exploratory mixed-methods study suggest that novel educational interventions targeting both patients and clinicians are needed to address the informational needs for post-treatment surveillance of colorectal cancer.

A Sequential Mixed-Methods Study of Pre-Professionals’ Understanding of the Undergraduate Music Therapy Internship

2019 ◽  
Vol 56 (3) ◽  
pp. 209-239
Author(s):  
Amy Clements-Cortes
Keyword(s):  
United States ◽  
Mixed Methods ◽  
Music Therapy ◽  
Online Survey ◽  
Skill Development ◽  
The United States ◽  
Mixed Methods Study ◽  
Role Clarity ◽  
Sequential Mixed Methods ◽  
Personal Skills

Abstract Despite the importance of the clinical music therapy internship, little research has been conducted to understand the perspectives, perceived musical, clinical, and personal skills, concerns, challenges, and anxieties of pre-professionals prior to and upon completion of the internship. This sequential mixed-methods study aimed to assess the perspectives and experiences of undergraduate students in the United States at two stages in the internship in music therapy practice. In total, 177 pre-professionals from the United States participated in this two-part study: (1) an online survey and (2) individual interviews with 25% (n = 44) of the participants. Survey results indicate statistically significant increases in clinical, musical, and personal skill development from pre- to post-internship. Six broad categories emerged from the interviews: confidence, anxiety, role clarity, professional suitability, loneliness, and boundaries/ethics. The results are encouraging, showing that the internship is a valued clinical experience that fosters improvement in the clinical, musical, and personal skills needed to work as a music therapist. This paper concludes with recommendations and suggestions for educators and supervisors on preparing and supporting pre-professionals in their skill development prior to and during internship.

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