Using aviation safety measures to enhance patient outcomes

Recent media reports have put a spotlight on the increasing number of medical errors occurring in US health care institutions. In contrast to health care's increasing error rate, the aviation industry is experiencing a decreasing error rate. Could the safety techniques used in the aviation industry be applied to health care? This article explores that question. The dynamics of the surgical suite are not unlike those of the cockpit of an airplane; therefore, perioperative services was selected to pilot test the aviation model of safety training.     

Differences in Nurse and Surgeon Perceptions of Teamwork: Implications for Use of a Briefing Checklist in the OR

The quality of teamwork among health care professionals is known to affect patient outcomes. In the OR, surgeons report more favorable perceptions of communication during procedures and of teamwork effectiveness than do nurses. We undertook a quality improvement project in the Veterans Health Administration to confirm reported teamwork differences between perioperative nurses and surgeons and to examine the implications of these differences for improving practice patterns in the OR. The Safety Attitudes Questionnaire, which measures safety culture, including the quality of communication and collaboration among health care providers who routinely work together, was administered in 34 hospitals. Perioperative nurses who participated in the survey rated teamwork higher with other nurses than with surgeons, but surgeons rated teamwork high with each other and with nurses. On five of six communication and collaboration items, surgeons had a significantly more favorable perception than did perioperative nurses. To increase the likelihood of success when implementing the use of checklist-based crew resource management tools, such as the World Health Organization's Surgical Safety Checklist, project leaders should anticipate differences in perception between members of the different professions that must be overcome if teamwork is to be improved.     

Communication skills and error in the intensive care unit

PURPOSE OF REVIEW: Poor communication in critical care teams has been frequently shown as a contributing factor to adverse events. There is now a strong emphasis on identifying the communication skills that can contribute to, or protect against, preventable medical errors. This review considers communication research recently conducted in the intensive care unit and other acute domains. RECENT FINDINGS: Error studies in the intensive care unit have shown good communication to be crucial for ensuring patient safety. Interventions to improve communication in the intensive care unit have resulted in reduced reports of adverse events, and simulated emergency scenarios have shown effective communication to be correlated with improved technical performance. In other medical domains where communication is crucial for safety, the relationship between communication skills and error has been examined more closely, with highly detailed teamwork assessment tools being developed. SUMMARY: Critical care teams perform many activities where effective communication is crucial for ensuring patient safety and reducing susceptibility to error. To develop valid team training and assessment tools for improving teamwork in the intensive care unit there is a requirement to better understand and identify the specific communication skills important for safety during the provision of intensive care medicine.     

Value-based formulas for purchasing. Loyalty renaissance: the rebirth of loyalty in health care

As more consumers join managed care organizations, the personal bond between patient and physician or medical group has been transformed into an economic relationship driven chiefly by the price of health care services. Managed care organizations now face the same pressures as the airline and retail industries: To gain and retain client loyalty through product differentiation and consistently high levels of service. How do managed health care plans create and maintain loyalty among their members? What is the value proposition that consumers will respond to in this era of managed care? Discussion will focus on the consumer as the critical variable in the economic model of a health care system and how the consumer will impact the continued evolution of managed care.     

Using simulation pedagogy to enhance teamwork and communication in the care of older adults: the ELDER project

The Expanded Learning and Dedication to Elders in the Region (ELDER) project addressed the needs of under-served older adults by educating health care providers in home health and long-term care facilities. Four agencies in a health professional shortage/medically underserved area participated. Focus groups were held to determine agency-specific educational needs. Curricula from the John A. Hartford Foundation were adapted to design unique curricula for each agency and level of personnel during the first 2 years. The focus of this report is the case-based simulation learning approach used in year 3 to validate application of knowledge and facilitate teamwork and interprofessional communication. Three simulation sessions on varying topics were conducted at each site. Postsimulation surveys and qualitative interviews with hired evaluators showed that participants found simulations helpful to their practice. Tailored on-site education incorporating mid-fidelity simulation was an effective model for translating gerontological knowledge into practice and encouraging communication and teamwork in these settings.     

护理安全管理新思路

病人安全与医疗护理差错日益受到人们关注。从护理角度出发,保障和促进病人安全,需要加强护理安全管理,随着对病人安全的深入研究和探讨,护理管理者对护理安全理念的认识也应更新,重点从接受人皆会犯错的事实、明确差错多来自系统问题、借助安全管理成果和信息技术、创建“安全文化”以及建立自愿报告系统5个方面阐述了护理安全管理的一些新思路。     

The Challenge of Positional Car Seat Testing in Healthy Near-term Neonates

The American Academy of Pediatrics Committee on Injury and Poison Prevention recommends that hospitals develop policies that include a period of observation for any infant less than 37 weeks' gestation in an infant car safety seat before hospital discharge to monitor for apnea, bradycardia, or oxygen desaturation. Development of policy guidelines presents a challenge to health care providers on many levels. What evidence is the basis for this recommendation of the American Academy of Pediatrics? Does this recommendation include healthy near-term infants in level I nurseries? How should such policies be produced and implemented? What training and education will be necessary? How much will this cost? This article reviews the evidence for clinical practice and shares clinical experiences in policy development, education, and cost containment.     

Visually impaired drivers and public protection vs confidentiality

Patients consenting to health care are usually content for information to be disclosed to other team members if it will help to provide effective health care. They rarely state at the commencement of a conversation that information is 'secret', but assume that professionals will use the information solely to assist their care. Nurses working in the field of ophthalmology regularly test patients' visual acuity. Not all patients' eyesight reaches the minimum standard required by the Driver and Vehicle Licensing Agency. What should nurses do if test results reveal a patient who they know is a driver and whose eyesight does not meet the minimum standard for driving? Should the nurse breach confidentiality? There may be a public safety issue. This article discusses the legal, ethical, professional and employment duty of the nurse, giving examples from previous case law and highlighting the standards of confidentiality required of those employed as professionals in the health service.     

Sustainability of Healthcare Environments

If advances in health care during the past century were viewed through the eyes of citizens living in the year 1900, eradication of diseases such as polio and smallpox, and the use of antibiotics and a host of other pharmacologics to cure the seemingly incurable would have seemed miraculous. Now in 1999, we look forward to the beginning of a new millennium and a new century. What will health care providers be pondering and celebrating at the beginning of the 22nd century? What miraculous strides in health care will occur? Will professional nursing as we know it exist?     

Safeguarding patients: complexity science, high reliability organizations, and implications for team training in healthcare

Serious events within healthcare occur daily exposing the failure of the system to safeguard patient and providers. The complex nature of healthcare contributes to myriad ambiguities affecting quality nursing care and patient outcomes. Leaders in healthcare organizations are looking outside the industry for ways to improve care because of the slow rates of improvement in patient safety and insufficient application of evidenced-based research in practice. Military and aviation industry strategies are recognized by clinicians in high-risk care settings such as the operating room, emergency departments, and intensive care units as having great potential to create safe and effective systems of care. Complexity science forms the basis for high reliability teams to recognize even the most minor variances in expected outcomes and take strong action to prevent serious error from occurring. Cultural and system barriers to achieving high reliability performance within healthcare and implications for team training are discussed.     

Patient safety culture in out-of-hours primary care services in the Netherlands: a cross-sectional survey

Objective: To examine patient safety culture in Dutch out-of-hours primary care using the safety attitudes questionnaire (SAQ) which includes five factors: teamwork climate, safety climate, job satisfaction, perceptions of management and communication openness.

Design: Cross-sectional observational study using an anonymous web-survey. Setting Sixteen out-of-hours general practitioner (GP) cooperatives and two call centers in the Netherlands. Subjects Primary healthcare providers in out-of-hours services. Main outcome measures Mean scores on patient safety culture factors; association between patient safety culture and profession, gender, age, and working experience.

Results: Overall response rate was 43%. A total of 784 respondents were included; mainly GPs (N?=?470) and triage nurses (N?=?189). The healthcare providers were most positive about teamwork climate and job satisfaction, and less about communication openness and safety climate. The largest variation between clinics was found on safety climate; the lowest on teamwork climate. Triage nurses scored significantly higher than GPs on each of the five patient safety factors. Older healthcare providers scored significantly higher than younger on safety climate and perceptions of management. More working experience was positively related to higher teamwork climate and communication openness. Gender was not associated with any of the patient safety factors.

Conclusions: Our study showed that healthcare providers perceive patient safety culture in Dutch GP cooperatives positively, but there are differences related to the respondents’ profession, age and working experience. Recommendations for future studies are to examine reasons for these differences, to examine the effects of interventions to improve safety culture and to make international comparisons of safety culture.

• Key Points

• Creating a positive patient safety culture is assumed to be a prerequisite for quality and safety. We found that:

• ??healthcare providers in Dutch GP cooperatives perceive patient safety culture positively;

• ??triage nurses scored higher than GPs, and older and more experienced healthcare professionals scored higher than younger and less experienced professionals – on several patient safety culture factors; and

• ??within the GP cooperatives, safety climate and openness of communication had the largest potential for improvement.

     

Teamwork and team training in the ICU: Where do the similarities with aviation end?

The aviation industry has made significant progress in identifying the skills and behaviors that result in effective teamwork. Its conceptualization of teamwork, development of training programs, and design of assessment tools are highly relevant to the intensive care unit (ICU). Team skills are important for maintaining safety in both domains, as multidisciplinary teams must work effectively under highly complex, stressful, and uncertain conditions. However, there are substantial differences in the nature of work and structure of teams in the ICU in comparison with those in aviation. While intensive care medicine may wish to use the advances made by the aviation industry for conceptualizing team skills and implementing team training programs, interventions must be tailored to the highly specific demands of the ICU.     

The global emergence of IPE and collaborative care

Abstract

As the United States faces an impending shortage in the primary care workforce, interprofessional teamwork training to improve clinic efficiency and health outcomes is becoming increasingly important. Currently there is limited integration of interprofessional training in educational models for health professionals. The implementation of Patient Aligned Care Teams at the Department of Veterans Affairs (VA) has provided an opportunity for interprofessional collaboration among trainee and faculty providers within the VA system. However, integration of interprofessional education is also necessary to train future providers in order to provide effective team-based care. We describe a transportable educational model for health professional collaboration from our experience as a VA Center of Excellence in Primary Care Education, including a complementary novel one-year post-Master’s adult nurse practitioner interprofessional clinical fellowship. With growing recognition that interprofessional care can improve efficiency and outcomes, there is an increasing need for programs that train future providers in collaboration and team-based care.     

Leadership: Patient safety depends on it!

BackgroundSafety leadership in healthcare is required and should be encouraged from the bedside through to the executive and is essential for the safety of the patients in our care. Major health inquiries have highlighted failure of leadership as a cause of poor patient outcomes.AimTo highlight issues and initiatives raised within discussion forums by postgraduate health care management students asked to reflect upon leadership, quality and safety, and human factors in today's healthcare environmentMethodsA qualitative approach by way of retrospective review of compulsory discussion forum posts from online postgraduate quality and safety and human factors in health care units.FindingsAuthority gradients persist in contemporary healthcare settings, influenced to a certain degree by the multi-generational workforce, and ultimately compromising communication and teamwork. Human factors effects on care provision emphasised fatigue as a significant issue that needs to be addressed by appropriate workforce management.DiscussionThe ability for healthcare professionals to challenge decisions and directives that may compromise safety is hampered by the persistence of both intra- and interprofessional authority gradients. Students reported hesitancy to challenge or seek assistance from those who hold ‘leadership’, or senior positions, due to distrust and fear of ridicule. Students could, however, see the bigger picture and sought to translate their learning into quality improvements in the workplace.ConclusionChallenging perceived authority is necessary and open communication should be encouraged through effective leadership. Effective leadership leads to efficient teamwork and ultimately safe and efficient care for patients.     

Patient safety and teamwork in perinatal care: resources for clinicians

Recent data reveal communication issues and organizational culture to be key factors in adverse perinatal outcomes. Hierarchical communication is common in healthcare and can be a significant impediment to safe care. Principles of teamwork employed by other industries, such as aviation and the military, can be appropriately applied to healthcare. This article provides a brief introduction to Crew Resource Management as well as a listing of print, multimedia, and Web resources for clinicians interested in promoting cultural change and effective teamwork.     

Health care transition in congenital heart disease: the providers' view point

Unfortunately, despite recommendations for educational training of ACHD health care providers and the goal to create regional ACHD centers, current needs still far outweigh appropriate available services. From a practical standpoint, we will need to work from our current models of health care delivery, which vary because of geographic and institutional issues and the availability of appropriate resources, toward the ideal goal of regional ACHD centers. Successful transition of adolescents and adults with CHD requires collaboration and planning between the pediatric health care team and the ACHD health care team. Good communication and an atmosphere of mutual respect are essential. All members of the ACHD health care team need to be committed to improving the process of transition for the adolescent and adult with CHD. The advanced practice nurse (CNS or ARNP) from both the pediatric program and the adult program are often key players in this process. As ACHD health care providers, we must work toward decreasing barriers to care and become organized advocates for our patients. Ultimately, our goal is not only to provide a smooth transition from one model of care to another, it is to create a health care delivery system that will maximize the lifelong potential and function of adults with congenital heart disease.     

Promoting Patient Safety and Preventing Medical Error in Emergency Departments

An estimated 108,000 people die each year from potentially preventable iatrogenic injury. One in 50 hospitalized patients experiences a preventable adverse event. Up to 3% of these injuries and events take place in emergency departments. With long and detailed training, morbidity and mortality conferences, and an emphasis on practitioner responsibility, medicine has traditionally faced the challenges of medical error and patient safety through an approach focused almost exclusively on individual practitioners. Yet no matter how well trained and how careful health care providers are, individuals will make mistakes because they are human. In general medicine, the study of adverse drug events has led the way to new methods of error detection and error prevention. A combination of chart reviews, incident logs, observation, and peer solicitation has provided a quantitative tool to demonstrate the effectiveness of interventions such as computer order entry and pharmacist order review. In emergency medicine (EM), error detection has focused on subjects of high liability: missed myocardial infarctions, missed appendicitis, and misreading of radiographs. Some system-level efforts in error prevention have focused on teamwork, on strengthening communication between pharmacists and emergency physicians, on automating drug dosing and distribution, and on rationalizing shifts. This article reviews the definitions, detection, and presentation of error in medicine and EM. Based on review of the current literature, recommendations are offered to enhance the likelihood of reduction of error in EM practice.     

Patient safety competence for final-year health professional students: Perceptions of effectiveness of an interprofessional education course

As final-year medical and nursing students will soon play key roles in frontline patient care, their preparedness for safe, reliable care provision is of special importance. We assessed patient safety competencies of final-year health profession students, and the effect of a 1-day patient safety education programme on these competencies. A cross-sectional survey was conducted with 233 students in three colleges of medicine, nursing, and traditional medicine in Seoul. A before-and-after study followed to evaluate the effectiveness of the curriculum. Patient safety competency was measured using the Health-Professional Education for Patients Safety Survey (H-PEPSS) and an objective patient safety knowledge test. The mean scores were 3.4 and 1.7 out of 5.0, respectively. The communication domain was rated the highest and the teamwork domain was rated the lowest. H-PEPSS scores significantly differed between the students from three colleges. The 1-day patient safety education curriculum significantly improved H-PEPSS and knowledge test scores. These results indicated that strengthening patient safety competencies, especially teamwork, of students is required in undergraduate healthcare curricula. A 1-day interprofessional patient safety education programme may be a promising strategy. The findings suggest that interprofessional patient safety education needs to be implemented as a core undergraduate course to improve students’ safety competence.     

Interprofessional team building in the palliative home care setting: Use of a conceptual framework to inform a pilot evaluation

Home-based palliative care is increasingly dependent on interprofessional teams to deliver collaborative care that more adequately meets the needs of clients and families. The purpose of this pilot evaluation was to qualitatively explore the views of an interprofessional group of home care providers (occupational therapists, nurses, personal support work supervisors, community care coordinators, and a team coordinator) regarding a pilot project encouraging teamwork in interprofessional palliative home care services. We used qualitative methods, informed by an interprofessional conceptual framework, to analyse participants’ accounts and provide recommendations regarding strategies for interprofessional team building in palliative home health care. Findings suggest that encouraging practitioners to share past experiences and foster common goals for palliative care are important elements of team building in interprofessional palliative care. Also, establishing a team leader who emphasises sharing power among team members and addressing the need for mutual emotional support may help to maximise interprofessional teamwork in palliative home care. These findings may be used to develop and test more comprehensive efforts to promote stronger interprofessional teamwork in palliative home health care delivery.