Publications
8 results found
Coburn M, Sanders RD, Maze M, et al., 2018, The hip fracture surgery in elderly patients (HIPELD) study to evaluate xenon anaesthesia for the prevention of postoperative delirium: a multicentre, randomized clinical trial, BRITISH JOURNAL OF ANAESTHESIA, Vol: 120, Pages: 127-137, ISSN: 0007-0912
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- Citations: 37
D'Lima, Arnold G, Brett SJ, et al., 2017, Continuous monitoring and feedback of quality of recovery indicators for anaesthetists: A qualitative investigation of reported effects on professional behaviour, British Journal of Anaesthesia, Vol: 119, Pages: 115-124, ISSN: 1471-6771
Background: Research suggests that providing clinicians with feedback on their performance can result in professional behaviour change and improved clinical outcomes. Departments would benefit from understanding which characteristics of feedback support effective quality monitoring, professional behaviour change and service improvement. This study aimed to report the experience of anaesthetists participating in a long-term initiative to provide comprehensive personalized feedback to consultants on patient-reported quality of recovery indicators in a large London teaching hospital.Methods: Semi-structured interviews were conducted with 13 consultant anaesthetists, six surgical nursing leads, the theatre manager and the clinical coordinator for recovery. Transcripts were qualitatively analysed for themes linked to the perceived value of the initiative, its acceptability and its effects upon professional practice.Results: Analysis of qualitative data from participant interviews suggested that effective quality indicators must address areas that are within the control of the anaesthetist. Graphical data presentation, both longitudinal (personal variation over time) and comparative (peer-group distributions), was found to be preferable to summary statistics and provided useful and complementary perspectives for improvement. Developing trust in the reliability and credibility of the data through co-development of data reports with clinical input into areas such as case-mix adjustment was important for engagement. Making feedback specifically relevant to the recipient supported professional learning within a supportive and open collaborative environment.Conclusions: This study investigated the requirements for effective feedback on quality of anaesthetic care for anaesthetists, highlighting the mechanisms by which feedback may translate into improvements in practice at the individual and peer-group level.
Kemp H, Bantel C, Gordon F, et al., 2017, Pain Assessment in INTensive care (PAINT): an observational study of physician-documented pain assessment in 45 intensive care units in the United Kingdom, Anaesthesia, Vol: 72, Pages: 737-748, ISSN: 1365-2044
Pain is a common and distressing symptom experienced by intensive care patients. Assessing pain in this environ-ment is challenging, and published guidelines have been inconsistently implemented. The Pain Assessment in INTen-sive care (PAINT) study aimed to evaluate the frequency and type of physician pain assessments with respect topublished guidelines. This observational service evaluation considered all pain and analgesia-related entries inpatients’records over a 24-h period, in 45 adult intensive care units (ICUs) in London and the South-East ofEngland. Data were collected from 750 patients, reflecting the practice of 362 physicians. Nearly two-thirds ofpatients (n=475, 64.5 95% CI 60.9–67.8%) received no physician-documented pain assessment during the 24-hstudy period. Just under one-third (n=215, 28.6 95% CI 25.5–32.0%) received no nursing-documented pain assess-ment, and over one-fifth (n=159, 21.2 95% CI 19.2–23.4)% received neither a doctor nor a nursing pain assessment.Two of the 45 ICUs used validated behavioural pain assessment tools. The likelihood of receiving a physician painassessment was affected by the following factors: the number of nursing assessments performed; whether the patientwas admitted as a surgical patient; the presence of tracheal tube or tracheostomy; and the length of stay in ICU.Physician-documented pain assessments in the majority of participating ICUs were infrequent and did not utiliserecommended behavioural pain assessment tools. Further research to identify factors influencing physician painassessment behaviour in ICU, such as human factors or cultural attitudes, is urgently needed.
D'Lima DM, Moore J, Bottle A, et al., 2015, Developing effective feedback on quality of anaesthetic care: what are its most valuable characteristics from a clinical perspective?, JOURNAL OF HEALTH SERVICES RESEARCH & POLICY, Vol: 20, Pages: 26-34, ISSN: 1355-8196
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- Citations: 10
Benn J, D'Lima D, Moore J, et al., 2014, ENHANCED FEEDBACK FROM PERIOPERATIVE QUALITY INDICATORS: STUDYING THE IMPACT OF A COMPLEX QUALITY IMPROVEMENT INTERVENTION, BMJ QUALITY & SAFETY, Vol: 23, Pages: 351-U105, ISSN: 2044-5415
D'Lima D, Moore J, Arnold G, et al., 2013, Performance feedback to healthcare professionals: What supports behaviour change?, European Health Psychology Society Annual Conference
Title: Performance feedback to healthcare professionals: What supports behaviour change?Authors: Danielle D’Lima (corresponding author), Centre for Patient Safety and Service Quality (CPSSQ), Imperial College London; Joanna Moore, CPSSQ, Imperial College London; Glenn Arnold, Theatres Department, Imperial College Healthcare NHS Trust; Jonathan Benn, CPSSQ, Imperial College London. Correspondence should be addressed to Danielle D’Lima, Centre for Patient Safety and Service Quality, Medical School, Imperial College London, Praed Street, Paddington, London, W2 1NY. Email: d.dlima@imperial.ac.uk Abstract:Research suggests that feedback on performance to healthcare professionals generally has a small to moderate effect on behaviour. Clinical units would benefit from understanding which characteristics of feedback support optimal use for service improvement. This qualitative study investigated perceptions of end-users on a feedback initiative in the Anaesthetics Department of a UK Academic Health Science Centre. 21 interviews were conducted with Consultant Anaesthetists and Post Anaesthetic Care Unit nurses. Interviews were semi-structured and transcripts analysed using constant-comparative methods in which psychological models were used to inform interpretation. Key findings were associated with the perceived ease of effectively translating ‘data’ into ‘information’ and ‘information’ into ‘behaviour’. Participants also highlighted the need to draw a cognitive distinction between the perceived consequences of using feedback for improvement at the individual level, and for performance management at the departmental level. Theory of Planned Behaviour accounted well for the main categories emerging from the analysis.Category:Oral Presentation/PosterKeywords: Performance feedbackHealthcare professionalsBehaviour changeTheory of Planned BehaviourQualitative analysis
Benn J, Arnold G, Wei I, et al., 2012, Using quality indicators in anaesthesia: feeding back data to improve care, BRITISH JOURNAL OF ANAESTHESIA, Vol: 109, Pages: 80-91, ISSN: 0007-0912
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- Citations: 64
Arnold G, Kluger M, Voss L, et al., 2007, BIS and Entropy in the elderly., Anaesthesia, Vol: 62, Pages: 907-912, ISSN: 0003-2409
The interaction of many poorly defined, physiological, pharmacological, and pathological factors make titration of general anaesthesia in the elderly difficult. There may be a potential clinical benefit using the processed electroencephalogram (EEG) to monitor hypnotic level in this population. We prospectively studied 16 patients aged over 65 years having hip fractures repaired under general anaesthesia by experienced anaesthetists blinded to Bispectral Index (BIS(XP)) and Entropy values. Pre-induction EEG indices did not correlate with age or mini-mental state examination (MMSE). During maintenance of anaesthesia, BIS(XP) and Response Entropy (RE) values were within the recommended range of 40-60, 45% and 32% of the total time, respectively. BIS(XP) and Response Entropy (RE) values were above 60 for 11% and 13% of the total time, respectively, and below 40 for 44% and 55% of the total time, respectively. BIS(XP) correlated well with RE in 12 patients, but in the other four patients there was a difference of more than 20 points between BIS(XP) and RE.
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